I agree that national regulation and standards may reduce the ability of midwives to practice the midwife model of care. And I in no way believe that liscence/certification shold be limited to CNM.
The AMA sets the standards of practice for drs but each state regulates and liscenses them. Teachers are the same way. US Dept of Ed sets standards for the profession of teachers but each state regulates and liscenses them. NARM is the body that sets the standards for the practice of Midwifery but each state is responsible for regulating, educating, and liscensing them.
I understand that, the way things are now, in some cases the practices of Midwives would be unduly restricted by setting national and/or state standards. However, I think that is more of an issue with medical philosophy and practices than with the issue of regulating the practice of midwifery. Ideally, if NARM trains and supports the practice of Midwives delivering breech babies and twins then states would honor that and not restrict their ability to do so. In a perfect world...this would eliminate the reasons why so many Midwives prefer to be unliscensed/certified.
In my state, Texas, CPM are legally able to do both in out of hospital births. They are also allowed to do HBAC. All of which are deemed illegal by some states. So, I understand the pressure that Midwives are under to circumvent unwarranted laws/regulations by remaining unliscensed/certified. Hopefully, at some point in the future, this will no longer be necessary and the regulations/laws of states regarding Midwives will be based on scientific data and the standards of practice set in place by NARM, which would remove the restrictions that encourage midwives to be uncertified.
I agree with this also. It is a hard line to take and there are a lot of ways that I think you can become knowledgeable. My bet, though, is that there are more deaths for those who are not certified(not because you can't become a good midwife, but because it isn't necessarily required of you). I personally would do extensive interviews with any midwife should I choose to do a home birth.
"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"
This is where I think we run into trouble. Because this does happen. And this is where medical personal assume all midwifes who deliver at home are in their training. I absolutely admire those who do receive training, though and are excellent midwifes.
I think women need to understand, though, that they need to know what training their midwifes have had.
One thing I learned at the apprentice meeting is just how little I know. I thought I was pretty well educated as a mother and a doula, but heading into the realm of midwifery is a whole new thing. I think the right education and training is essential.
"In 24 states, as well as the District of Columbia and Puerto Rico, Certified Professional Midwives (CPMs) are subject to criminal prosecution for practicing medicine or nursing without a license."
In a few states it is legal, but not regulated.
" Maine—Legal, yet unregulated as licensure is unavailable. New 2008
without fear of prosecution, as well as carry and administer medications.
Missouri—Legal, yet unregulated as licensure is unavailable."
Just wanted to put out there that the new issue of the Journal of Midwifery and Women's Health has a couple of articles regarding education/credentialing/reimbursement for all types of midwives. It's very relevant to the discussions in this group!