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A midwife examining a pregnant woman during a home visit. (Andrew Shurtleff/AP)

Once again, a bill that would license and regulate Certified Professional Midwives, or CPMs, has been introduced in the Massachusetts legislature. And it’s time for the Commonwealth to join the 28 other states in this country that already have adopted such regulation.

CPMs are educated to develop hands-on expertise in the home or birth center setting. Maternity care professionals with many decades of experience as well as prominent consumer organizations are supporting this bill because they believe it will increase the safety of home birth for families choosing this option.

Among these professionals writing to the legislature are pediatricians, obstetricians, midwives and academic researchers. See excerpts from their letters below:

Martha Richardson, MD, practicing obstetrician in the Boston area for 33 years: “Home birth is an option in some states and in many countries including some where the overall birth outcomes are better than in the U.S. Bringing home birth under public surveillance in Massachusetts is unlikely to worsen outcomes and could help us address our lack of reliable information.”

Robyn Churchill, former director of midwifery at Mt. Auburn Hospital: “I am a Certified Nurse Midwife with over 20 years of clinical and research experience in maternal health care. I…am now at the Harvard School of Public Health, working on a large trial of the WHO Safe Childbirth Checklist in India…My experience and research has shown that safe childbirth can occur in many settings, within a well-coordinated system, with regulation and oversight of providers.”

Lisa Paine, a Certified Nurse-Midwife and DrPH long involved at the national level with policy development to improve health education and regulation: “For nearly 30 years I have been involved in a variety of clinical, academic and administrative roles related to maternity care, midwifery and public health… My policy and advocacy experiences are numerous and have led to several publications and testimonies, including undertakings directly relevant to my support of this legislation….these fully support House Bill 2008/Senate Bill 1081.”

In its testimony opposing this legislation, the Mass Medical Society (MMS) makes several incorrect statements.

For example, they assert that “CPMs have not adopted a set of criteria based on generally accepted medical evidence or public safety for patients who may be appropriate candidates for home birth, relying instead on the decision of the individual midwife and patient.”

This is not true. Although CPMs respect a women’s right to informed consent in childbirth (as all health professionals should do), the CPM profession (through the National Association of Certified Professional Midwives) has clearly defined professional guidelines and standards. Also, many state midwifery organizations have developed extensive practice guidelines because licensure laws were passed in their states.

One good example is New Mexico, where CPMs are regulated and licensed by the Department of Health. Extensive clinical guidelines have been developed by the state midwifery association and are enforced by the NM state licensing and disciplinary authority. House Bill 2008/Senate Bill 1081 would allow Massachusetts to place similar guidelines on CPM practice here.

This bill, would affirm that all Massachusetts maternal health care providers are committed to practicing with state oversight and public accountability.

No state adopting the regulation and oversight of CPMs has reversed its policy. Some states — Texas, Colorado, and California, for example — have more recently re-affirmed these earlier legislative decisions.

CPMs are specifically educated to develop hands-on expertise in the home or birth center setting.  The CPM credential is overseen and certified by the same national organization that validates the CNM credential for nurse-midwives.

The Mass Medical Society also states: “The curriculum, clinical skills training, and experiences of CPMs have not been approved by any authority recognized in certifying knowledge and skills associated with the practice of obstetrics, including the American Board of Obstetrics and Gynecology, the American Midwifery Certification Board (AMCB), and the American Board of Family Medicine.” These three entities do not engage in the approval of curricula for other professionals in their fields, so this comment is not actually relevant.

The Committee on Public Health should report this bill out favorably, so it can advance to the next step in the legislative process, and eventually be released to the floor for a vote and enable the state to oversee this growing health profession.

Failure to license CPMs will make the several hundred home births that occur in Massachusetts every year less safe  TWEET by failing to create an integrated maternal health care system with enhanced collaboration among all care providers. This bill, would affirm that all Massachusetts maternal health care providers are committed to practicing with state oversight and public accountability.

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Tags: Women's Health

The views and opinions expressed in this piece are solely those of the writer and do not in any way reflect the views of WBUR management or its employees.

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  • Amy Tuteur, MD

    The single most important thing that Massachusetts legislators and residents need to know about homebirth midwives (CPMs) is this:

    The Midwives Alliance of North America (MANA), the organization that represents homebirth midwives REFUSES to release their own deaths rates!

    They’ve amassed a database of 27,000+ births attended by their members. They’ve publicly boasted about the C-section rate, intervention rate, transfer rate, just about every parameter you can think of the most important one: how many of those 27,000+ babies died?

    We know how many of those babies died in the state of Oregon. In 2012, Oregon engaged Judith Rooks, CNM MPH to analyze the outcomes of homebirth with licensed homebirth midwives. Rooks found that the death rate of PLANNED homebirths attended by licensed midwives was 800% higher than comparable risk hospital birth.

    Homebirth midwives are not real midwives. They lack the education and training of real midwives (certified nurse midwives) and their credential is not accepted by ANY other industrialized country. All other first world countries require a minimum of a university degree in midwifery. In contrast, the CPM requirements were “strengthened” in September 2012 to mandate a high school diploma.

    The effort to license homebirth midwives has nothing to do with safety; they are not safe practitioners. They are pushing for licensing so they can bill insurance companies. This is not about safety, babies, or mothers. This is about a group of women who can’t be bothered to get a real midwifery education, but want to charge insurance companies for their “services.”

  • Lisa Murakami

    Most compelling to me is that all of the studies are about mortality. The fact that something didn’t kill you doesn’t make it safe (even if the studies showed home birth was safe, which they don’t). My father as a pediatrician has cared for babies born not even at home but at a local freestanding birthing center who lost valuable minutes in transfer time. Minor cognitive damage isn’t apparent until much later, and isn’t in the studies. The entire argument in favor of home birth boils down to the premise that it’s just as safe to be away from the hospital as it is to be already admitted and cared for in the hospital when things unexpectedly tank. Common sense precludes that premise. http://www.youtube.com/watch?v=Nhitx-DwLCs

  • Emily A

    I have had two amazing, gentle births at home. For low-risk women, it can be the safest place to birth. I feel so fortunate that my midwives supported my physiologic births, allowing me freedom of movement and giving me the confidence to let my body birth my baby as it knows how. I am in the minority amongst my friends and family most of whom feel their births were unnecessarily interfered with by their well-meaning doctors.

    I was confident because my births were attended by well-equipped and experienced Certified Professional Midwives. Many educated, informed, and scientific families (like mine) make a thoughtful and informed choice when they choose to birth at home.

  • NathanG

    You say: “the CPM profession (through the National Association of Certified Professional Midwives) has clearly defined professional guidelines and standards.” but that is not really true, is it? Or can you sahe it with us because nobody can find these “clearly defined professional guidelines”. Where are they

  • Emily A

    Fortunately, it’s very easy to find out more about Certified Professional Midwives and their standards of care.

    http://www.nacpm.org/Resources/nacpm-standards.pdf
    http://narm.org/

  • M Lawney, MPH Candidate at BU

    Thank you for addressing some of the false statements that have been made in opposition to this bill! I had a home birth with two highly educated CPMs and I had full confidence in their abilities to oversee my labor, delivery, and postpartum health. It was so wonderful to receive personalized and continuous care, and to be allowed to labor and birth in the comfort of my own home with women who I knew and trusted.

    CPMs are trained to know when birth is not progressing as it should and to act quickly if a transfer for intervention is necessary. This bill would help make home births even safer by setting up standard procedures for transfers to all hospitals in MA. In New Mothers Speak Out (Listening to Mothers III Survey: http://transform.childbirthconnection.org/wp-content/uploads/2013/06/LTM-III_NMSO.pdf), over a quarter of new mothers said they would consider giving birth at home. Thus, women desire options other than hospitals and birth centers for labor and birth.

    In addition, due to overuse of interventions such as cesarean sections in hospitals, neonatal and maternal outcomes in this country are terrible compared with other industrialized countries, many of which have higher rates of home birth (see http://www.birthbythenumbers.org/). Regulation of the practices of home midwifery in MA would make home birth a more visible option, drawing more women to the practice and improving birth outcomes in this state.

  • Kate M

    As an undergraduate student with both an academic and personal interest in
    women’s health, I have read the scientific literature regarding the safety
    of homebirth and listened to the stories of women who have chosen to give
    birth at home. I believe that this bill is a crucial step for improving
    birth outcomes for those families choosing to birth at home in
    Massachusetts. Science and the experience of mothers have shown us that
    hospital births often involve unnecessary medical interventions, birthing
    practices that go against the process of natural physiologic birth, and
    oftentimes a disregard for a woman’s preferences and instincts around birthing. Planned homebirth for low-risk women has been shown to be a
    reasonably safe choice, and by legislating greater regulation for Certified
    Professional Midwives, Massachusetts will be making that choice even safer.
    It is clear that the home and the hospital each offer different advantages
    and disadvantages – even with respect to safety – and our goal should be to
    make each setting as safe as possible. As I enter my childbearing years, I
    want to live in a state that recognizes and supports a variety of options
    for my birthing experience.
    Kate M., Middlebury College Junior

  • Gabriella H

    As an undergraduate student at Oberlin College in Ohio who is looking ahead into my reproductive years, I support the Massachusetts CPM Bill. Although my preference right now would be to give birth in a hospital setting with the aid of both a doctor and a midwife, I see the importance of having CPMs for several reasons.
    Currently, there is no regulation for Certified Professional Midwives in Massachusetts, and I believe that such regulation would improve home birth safety by requiring a minimum of training and experience for those attending home births.

    I noticed that in some of the comments, folks posted about the death rates for home births. Much of the data that we have on the home birth mortality rate is skewed because of the failure to distinguish between planned and unplanned home births. Planned home births for low-risk mothers – with the aid of trained midwives – are shown to have good outcomes for both the mother and the baby.

  • Christine Morton

    Women in Canada and the UK as well as other countries are considered autonomous decision makers and have the option of deciding to have a home birth. In these countries, this option exists within an integrated healthcare system that supports hospital transfer when appropriate. Women in Massachusetts should be able to make decisions about the location of their births, and feel confident that they are attended by trained professionals with necessary medical back up, just as women are able to do so in the states where home birth is a legal option.

    These two articles report on data from the MANA Stats dataset, about home birth attended by midwives in the US. They were just published in the Journal of Midwifery & Women’s Health. The data demonstrate excellent outcomes.

    http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12172/pdf

    http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12165/pdf

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