It does depend on the state. All licensed home birth midwives in my state are considered LDEM's (Licensed Direct Entry Midwives), but in order to become an LDEM here you basically have to qualify for your CPM first. It gets more and more interesting the more I learn, and the more I learn the more I realize how much we need standardized education and licensing requirements.
I personally would love to see it standardized for women's sake. I feel like then women don't have to go out there and work even harder to know if their midwife is educated enough. I do think, though, that someone can gain an education and be wonderful midwifes. In Utah, I know some midwifes who would fight back against standardizing it all because they feel like that is too much government intervention. I can see that in some ways, but like I said, I think it makes it easier for the mom to know that their midwife is educated up to a certain standard.
I totally see both sides as well. Especially now, as I'm starting my midwifery apprenticeship, I'm really grateful that there are options for me in how to become a midwife. The apprenticeship option fits my needs the best right now, and I'm so glad I can do it. People learn differently and are motivated differently. I truly believe that a midwife can get a quality education through either school or apprenticeship, but it can be difficult to measure her qualifications. If the licensing tests and certification requirements are standardized across the nation, then I think the method of education shouldn't matter.
If a Midwife is registered as a CPM by NARM then their education/training is pretty much standard. They have either attended a MEAC approved school and passed an exam (lets call this the direct method) or have gone through a NARM "deficiency" plan for MW that recieved training in an apprentice method. In that case, they have to have a portfolio, prove that they have recieved the same amount of clinical hands on training as would be required of them in a school program, show their emergency management and transport plan, and pass the same exam that school trained MW do.
I am a teacher so i'll make a comparision to that profession. If you already have a BS in any subject/course of study, you can take specific education related courses, some related to pedagogy and child development and others to the subject you wish to teach. Subject specific courses can be exempted through credit by exam (lets say you have a BS in business/accounting and want to become a Math teacher, chances are you have a strong Math background and don't need courses in that subject, you could test out of those classes and focus on the classes specific to pedogogy and child development). After completing your course of study you would have a Masters of Arts in Teaching and would be eligible to take the state liscensing exam for teachers. This is the equivalent of a deficiency plan for teachers. Or if you are an incoming student with no degree and you want to be a teacher you do a course of study that is specific to teachers then you take the state exam (like the direct method of becoming a MW). Either way you have demonstrated that you have the cometencies, know the material, and can pass the test. The expectations and knowledge requirements are the same--standardized--even if the route of education, or the way you gained the knowledge, may be very different.
I was thinking about the fact that regulation by MW is done on a state by state basis and in Canada on a providence by providence basis. And is not standardized on a national level. What I realized is that this is no different than any other profession. Doctors, lawyers, teachers, vets, even cosmetologists, electricians and plumbers are all liscensed/certified by the state they work in and not all requirements state to state are the same from any of these professions.
For example, the AMA sets the standards of care and practice for doctors and the medical profession but they do not have the authority to liscense doctors--that rests with the state medical boards. Much like NARM does for MW and then each state is responsible for regulating and liscensing them.
I am a liscensed teacher in TX. That does not mean I would automatically get a liscense in another state. I may have to take classes they require that TX did not and be able to pass their state liscense exam. For example, in TX you have to have TX history to become a teacher, so a liscensed teacher from Utah wouldn't have taken that class and would not meet that requirements to be a teacher in TX, until they took that class and passed the state exam. The US Dept of Eduation sets the standards of practice for what teachers are expected to know and be able to do--they define what a "highly qualified teacher" is, but it is up to each state to set the specific requirements, accredit the schools of teacher preparation, regulate, and liscense teachers. And the courses of study, classes, and requirements for graduation vary greatly between schools. For example, I had to have 133 hours of "credits", just over 100 hours of practicum and 15 weeks of student teaching to meet the university requirements for a BS degree and be recommended to take the state board. Another school that offers BS in eduation in my area only requires 120 hours of credit, 60 hours of practicum, and 10 weeks of student teaching. But both offer the same degree and graduates from both schools have to take the same test and get the same liscense.
Expecting national liscensing/certification requirements for MW is not necessarily the only way, or even a very realistic way, to ensure that knowledge/education is standardized. In my opinion, if a woman wnats to be sure that her MW is highly educated and meets the standards of the profession, she should either have a CNM or a CPM that is registered with NARM (either through the direct entry method or the deficiency plan). This would eliminate the confusion over how well trained and the level of eduation recieved. I say this only because there is such a vast descrepency of requirements/standards for liscensing/certification from state to state and some states do not liscense or regulate the practice of midwifery.
Your probably right. But I know here in Utah, anyone can deliver a baby. Which I'm ok with as long as the mom understands that that person may not be as educated. My main concern is that moms may not know that they have to look for someone who is NARM certified. I don't think most people know that there is a difference between someone who calls themself a midwife and someone who has passed the NARM standards.
Then of course there is the problem of those states where it is not legal at all. In my opinion, this is even more dangerous. You create a system where there is great incentive for the midwife not to transfer her patients.
I am uncear about the legal status in states that don't certify and/or liscense midwives. Does that mean that it is illegal to practice midwifery at all in any capacity (except CNM who are legally recognized & able to practice in all 50 states) or does it mean that anyone can say they are a midwife,training or not, since there is no legal certification/regulation? Are there actually states where it is illegal to be a practicing midwife?
I would have to do more research on state laws, but it is my understanding that in all 50 states cnms can do home births, but in some it is illegal for cpms in some of them. I think Alabama is one of those. Here in Utah, it used to be illegal also until recently. Now in Ut. anyone can deliver a baby, regardless of training. They can still call themselves midwifes, even without training. We now have the designation of an LDEM, which is a licensed DEM (meaning they are licensed by the state). In order to do this, they have to fulfill other requirements beyond the NARM ones and they can't deliver twins or breech babies(unless it is unexpected).
So what we have here is a couple classifications of midwifes. Those who have been licensed by the state, those who are licensed, but have passed the NARM exam, and then anyone else who may have received any sort of training. Most people don't realize that there are different educational levels and certifications.
That is scary. That leaves a lot of pressure on women to investigate and research the laws and regulation of midwives in their state. No wonder there is such controversy surronding the safety & training of midwives and homebirths. I guess that getting every state to regulate the profession of midwifery is a very important step in advocating for changes in maternity care and mainstream views on their profession and out of hospital births.
Thank you for posting this topic. I had no idea that the laws were so different and that in some states there is no regulation at all and in others its illegal to practice midwifery w/out CNM liscense.
I live in Utah like Rachel. While it's confusing, I actually appreciate that we have so many options here. It's a hard thing to balance, and it would be very helpful if all 50 states had the same laws, but I don't see how that would actually happen without federal regulation.
My own midwife is unlicensed and prefers to stay that way so that she can catch breech or twin babies if she feels comfortable with it, and not be bound to transfer care if she doesn't feel it's necessary. This is obviously controversial, but I understand and support her choice to do this. She caught my breech baby, and I don't plan to change midwives at all. I also know that she received her education from MCU (attending over 80 births during her education - more than the 50 required) and has been practicing midwifery for 15 years, as well as worked as a doula longer than that in attending hospital births. She continues to attend hospital births as a doula and attend home births as a midwife, and I think that helps her stay up with the current medical approach.
I do believe that the burden falls upon the expectant mothers to do their research and know who they are interviewing and hiring. I assumed my midwife was certified when I asked her to be my midwife, and when I asked her directly at the first prenatal visit about her certification she was completely honest with me and explained her reasons for choosing to remain uncertified. By that time I already knew I wanted her at my baby's birth and I didn't feel any reason to change my midwife. It's such an individual decision, and I don't think there is a one-size-fits-all option.
We had a meeting of midwives and apprentices last week and we talked about the certification laws. There is a local CPM who has full certification, and she encourages all apprentices and midwives to have their NARM paperwork filled out and ready in a binder whether or not they plan to certify. She says that the laws could change at any time and the state could require certification and give current midwives a short window of time to complete their registration with the state. The concept is that we could simply pull the binder off our shelf and turn it in to certify as soon as it is required. I imagine an uncertified midwife could also use that binder to show perspective clients what she's done to become qualified to attend births. For me the certification wasn't an issue because I knew my midwife's qualifications and the piece of paper wasn't necessary in my mind.
We also talked about the scary idea of an apprentice deciding she didn't want to do all the work to be fully trained, and calling herself a midwife and attending births uncertified. That's the risk with our current laws, but I suppose that's the risk we take so we can have more options. My midwife commented that she didn't understand why anyone would want to do that, because midwifery is such hard work for not a lot of money, and it would be idiotic to try to do it with no training.