No more felonies! Midwives push for state recognition

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A group of women and families plans a march on the Statehouse Wednesday morning to push for the recognition and licensure of midwifery.

With the way the law is currently written, advocates of home births say the practice is essentially outlawed in Indiana.

Midwives plan to gather at the Statehouse at 9 a.m. to make their case to change public policy

While some midwives first go to nursing school, others go straight into their midwife training and earn a CPM, or Certified Professional Midwife.  The 3- to 5-year CPM process involves study and in-field training and culminates with taking a nationally accredited exam, according to Mary Ann Griffin of the Indiana Midwifery Task Force.

Griffin said 27 states recognize CPM with licensure.  Indiana does not, nor does it offer an alternative licensure for those midwives without the traditional nursing school education, she said.

Still, Griffin estimated CPMs help with approximately 1,000 home births in Indiana each year, which technically means they’re breaking the state’s practicing midwifery without a license law, a felony.

“We work professionally, and yet we’re still considered to be illegal or somewhat underground,” Griffin said.

The push for licensure has been a long process, with Mary Helen Ayres, president of the Indiana Midwives Association, advocating for change for nearly 20 years.

“I think everybody should care about women’s rights to have their babies where they want to have their babies. It’s a very intrinsic human right,” Ayres said.  “States that license CPMs have lower [perinatal] mortality rates.  It’s very important to us as midwives that the standards of midwifery care in our state are high, remain high and we’d like to see the state support that.”

“I, among others, want the recognition for my midwife so she doesn’t have to worry about a knock on her door or somebody politically saying, ‘You can’t do this,’ when she has the education and has the knowledge,” midwife Lynda Barton-Kirch added.

Advocates maintain home births with properly trained midwives are just as safe as, if not safer than, hospital deliveries.

60 comments

  • Stella

    Get this archaic law changed. Stop punishing women who want the very best beginning to life for their children.

  • Indiana Resident

    27 Other states recognize CPM's. Come On Indiana, don't be the last state -get with it already! CPM's are a safe option for Indiana families.

  • Chelsea

    With CPM recognition comes better tracking, better research, and a symbiotic relationship between all healthcare workers. Relieve obstetricians of overload resulting in poor birth outcomes by licensing CPMs!

      • LostinSuburbia

        How many happen because of the hostile environment that frightens families from seeking the care they need in a timely fashion? See what can happen with licensed midwives and a change in hospital attitude: http://portlandmonthlymag.com/health-and-fitness/
        From the OB who saw the need for change: 'More important, Neilson says, are what the hospital no longer sees: “We used to have these horrible [home-birth] disasters show up at the ER. And we do not see those disasters now. They have just about gone away.”'

      • Jolie

        You should probably research your stats before making comments such as these, it’s very obvious you haven’t. Mortality rates are lower in the case of a Midwife than in cases of hospitals. I birthed my child a midwife & would do it the same again & again. Just because you choose not to have any faith in your body, God, or choose not to do any research, doesn’t mean everyone should be subjected to the same narrow,close minded, outlooks such as yours.

      • Sanveann

        Mortality is lower in the case of CNMs — not CPMs. CPMs, in every state where they have to report outcomes, have appalling perinatal mortality rates.

  • Rosie

    In the propsed lincensure laws is there tracking of births? Do midwives need to report monthly, quarterly, or annually the births they are attending and the outcomes of those births. What is in the regulations that will hold midwives as accountable as physicians and give parents recourse to file complaints?
    If someone had a link to the proposed licensure law it would be very helpful. Without knowing the baseline for how many births the midwives are currently attending it is hard to say if the perinatal mortality or morbidity rates will improve.

  • Guest

    CPMs in Indiana have no formal education. Homebirth in Indiana is LEGAL with a Certified Nurse Midwife. CNMs are nurses first with additional education to be primary care providers for women as well as attend births. CNMs have the skills to manage an emergency which CPMS do not. How many CPMs have the equipment to start an IV and could even do it if they needed to. How about insert a foley catheter so that a woman is prepped and ready for an emergency C-section when it is necessary. Birth is generally safe, but you should hire a trained midwife in case of an emergency. Without a well trained, nurse midwife you might as well do it alone.

    • Nell

      In Indiana you cannot easily hire or find a CNM for a home birth. Trust me, I looked and the hospitals pretty much own all rights to the CNMs.

    • Guest7

      How do you know what skills (emergency or otherwise) CPM's have or DO NOT have? That is rather presumptuous of you isn't it?

    • Anna

      A Certified Professional Midwife (CPM) is a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the Midwives Model of Care. The CPM is the only midwifery credential that requires knowledge about and experience in out-of-hospital settings.
      They undergo a training program lasting 3-5 years.

      • guest

        Not always. I know of one in particular who attended 5 births before sitting for the CPM exam and then opened her own practice. And she is practicing in Indiana right now.
        Anna, what is so wrong with being a CNM?

      • Ashley

        I can't speak for Indiana but Illinois' homebirth situation is similar. A CNM can legally attend homebirth with written collaborative agreement with a physician, however there are few physicians willing to oversee homebirth CNMs. This has resulted in no legal homebirth provider south of I-80 in Illinois (so, most of the state).

      • Guest7

        Really? How is that when the NARM CPM PEP process requires AT LEAST 40 supervised births to be able to submit your application and sit for the exam. 40. I think you need to check your facts.

  • Jessica

    CPM's want the state to recognise their licensure to maintain a high standard of care. CPM's do have formal training. My midwife is very profesional, she has 20 years of experience, she has never lost a mother, she has never lost a baby. I have had 2 home births attended by a CPM and I belive every woman should have that option.

  • Penny Lane MSN, CNM

    I think the article is somewhat misleading but understandably. This is a very complex argument. To be clear, midwifery is licensed and regulated in the state of Indiana. One must become a Certified Nurse Midwife and any practice of midwifery otherwise is a felony. This bill is not about homebirth. In fact, more than twenty Nurse Midwives practice in the homebirth environment in our state currently, completely within the law. This bill is about determining whether the non-nurse-midwife has sufficient training to provide primary care to a mother and her newborn. As the nursing profession moves towards requiring a doctorate for entry level into clinical practice, our legislative body would be hard pressed, I believe, to approve a bill that would essentially support a high school graduate with experience at a limited number of births to be a qualified attendant.

    • Eva Peron

      Nursing is moving towards requiring a doctorate for clinical practice? What, do you work for a nursing school trying to swindle students out of more money? Why would anyone other than a potential nursing professor want to spend that much time in school when they can go to medical school in the same amount of time with a much higher pay incentive. That said, I do believe midwives should be licensed nurses. So many women in history died in childbirth and now everyone wants to go back to homebirths. I think if we could lower the cost of having a child in a hospital would curb this trend altogether,

      • Guest

        It is not about the cost for a lot of people. And "curbing" this trend is not something most choosing a home birth want. It was not about the cost of a hospital birth for us. It was about the asinine approach to birth that a hospital takes and the lack of respect they have in allowing the mother to do what she is fully capable of doing.

      • guest

        actually there are two in the indy area. one in southern indiana and the rest are up north (lots of amish in the northern part of the state)

  • Guest

    Guest that is actually not true, CNMs are in Indiana are not independent practitioners and DO require WRITTEN collaborative agreements and very few doctors are willing to do that.

    Penny, just curious, which doctor is your written collaboration with?

    Also there are not enough CNMs in the state that practice home birth as the majority of home births in Indiana are attended by CPMs.

    Also, you can not attend just 5 births and become a CPM. Additionally, NARM just increased the requirements to become a CPM and your apprenticeship has to cover 2 years and the same number of births that is required to become a CNM.

    Also, the way the current bill is written, it requires that new CPMs graduated from a Midwifery Education Accreditation Council (MEAC) school. These are typically 3-4 year programs with extensive didactic training along with 1500-1800 clinical hours.

  • Penny Lane MSN, CNM

    CNMs are independent practitioners, and licensed as such in the state of Indiana. Here is a copy and paste from our Nurse Practice Act: "A nurse-midwife shall perform as an independent and interdependent member of the health care team as defined in 848 IAC 2-1-3." Just because many hospitals choose to restrict the practice of Nurse Midwifery in their bylaws, doesn't mean Indiana statute mandates this. Unfortunately this leads to misconception among the medical community, even among Nurse Midwives, but doesn't make it accurate. Our only restriction currently is specific to prescription privileges.

    Guest above – our practice has relationships with a large number of practitioners in Central Indiana, but our high risk clients are primarily seen by the MFM team at St. Vincent Hospital where I have privileges.

    As for doctoral level for entry to practice, I have blogged about this here: http://believemidwiferyservices.com/doctorate-in-… and if you nose around on the blog, you'll find a few other posts that go further into the issue. The graduate degree for the advance practice nurse is dissolving, and those seeking these degrees in the near future will hold doctorate degrees. This is the entry level for the vast majority of clinical professions, such as the chiropractor, dentist, physical therapist, medicine, podiatrist, audiologist, psychology and soon, the advance practice nurse.

    Frontier Nursing University, where a large number of Indiana nurse-midwives were trained, is incorporating the DNP into their program in 2014, so those holding a bachelor's degree in nursing will complete the program with a DNP and a certification in either Nurse Midwifery or Family Nursing. The doctorate in clinical practice is not specific to teaching, which I think you've confused with the PhD.

  • Guest

    Penny are you saying that CNMs doing home birth do not need a written collaborative agreement? The attorney general's offices has said the CNMs doing home birth need a written collaborative agreement and that is not just regarding prescriptive authority but regarding full collaboration over the practice.

  • Haddie

    I am a native Hoosier who has acted as a consumer and a provider in women's health care and birth networking. In order to obtain my CPM license, I have had to relocate to another state where CPMs practice openly, legally, have working laws, and educators available. It is not just to refrain from providing health care options to women, particularly those that are studied and shown to improve outcomes for mothers and babies, lower health care cost, and improve patient satisfaction. I hope to one day return to my home state to practice. Until then, I am fully supporting the women and workers who provide evidence-based care for home birth.

  • Sanvean

    CPMs have appallingly poor outcomes in states where their results are tracked — Colorado, for instance. I hope Indiana doesn't bow to the homebirth Nazis and allow these undereducated practitioners to practice with the state's blessing. The results we've had with CPMs and DEMs in Michigan are nothing short of horrific.

    • Jane

      Oh, that must be why every state where CPMs have been licensed have decided to revoke the licensure, seeing as they made a huge mistake. Oh wait… none of them have revoked it.

      • Sanveann

        Gladly! http://1.usa.gov/XbtHwN — right from the Colorado midwives.

        If you parse the data (which they make it very difficult to do), you'll see that in 2011, there were 905 homebirths (including 186 transfers) and 14 deaths. That gives us a mind-boggling perinatal mortality rate of 15.5/1000 in a population of supposedly low-risk women. Gosh, where can I sign up?!

        What do you want to bet they wouldn't be releasing this data if they weren't compelled to by state law? (They tried to get away without publishing it in 2010.)

      • LostInSuburbia

        I only see people quote Colorado statistics, and yet New Mexico has had licensed non- cnm midwives for more than 30 years. How about stats from one of the other 20+ states that license CPMs? And where are the stats for Michigan?

      • Sanvea

        No one has stats for other states, because almost no other state mandates reporting for CPMs, and MANA won't release its data (which, from what I hear about CPMs' record-keeping, is probably worthless anyway).

      • LostInSuburbia

        So your statement that the "results we've had with CPMs and DEMs in Michigan are nothing short of horrific" is based on… Anecdote? Since the state doesn't provide that data you have little upon which to make a statement that encompasses all CPMs and DEMs in Michigan. I mean, I could quote you some horrific hospital birth stories, but that doesn't mean all doctors are poorly trained or bad practitioners My doc was great, and the nurses were nigh upon angelic. Doesn't mean it's that way for everyone. Your Anectdata is insufficient evidence that all CPMs or DEMs are such poor practitioners that they should be illegal.

      • G uEsT

        When babies die in hospitals it is due to 'complications', and therefore it doesn't go into their database of infant mortality. The fact is that Midwifery is probably one of the oldest
        professions there is, and it is very hands on training. I would put my money on a CPM with 15 years experience than with a doctor that is 2 yrs out of med school.

      • LostInSuburbia

        And. Nice dig at CPMs. It would have been nice if my hospital records were accurate, but alas, they're not. Even great practitioners with a whole system to back them up can have bad record keeping. Again with the anecdata…

      • LostInSuburbia

        Also, looking through the 2010 sunset review for DEMs in Colorado, they note the following regarding perinatal deaths: " In 2010, the Director determined that the definition of perinatal death, for reporting requirements, would start at 20 weeks of pregnancy and end 28 days after delivery. The validity of perinatal deaths reported in Table 8, therefore, is problematic because previously the definition was not clear."
        http://www.colorado.gov/cs/Satellite/DORA-OPRRR/C

        So, those 14 perinatal deaths you gleaned from the report may not represent an insane jump from one year to the next, as much as a change in which deaths are to be reported. By the 20 weeks gestation definition, babies who aren't even viable outside the womb are being used as ammunition in the war against homebirth midwives. Those pesky difference in definition sure muddling things and provide fodder for people to make outrageous claims about perinatal death rates.

  • Penny Lane MSN, CNM

    Correct. All CNMs require collaboration to practice, but the written collaboration is specific ONLY to prescription privileges. I have worked with the AGs office and they have this understanding as well, but there are a number of representatives in this office, so confusion certainly may have been an issue for one or more in the past. Representatives on our nursing board have even been confused, and certainly it is common for nurse-midwives to believe otherwise, but this is frequently because rather than read the actual statutes, we tend to believe whatever is disseminated in midwifery circles. Our community has safe homebirth options with nurse-midwives who not only have graduate level training, but have clinical skill and collaborative relationships to appropriately handle emergencies.

    • Jane

      Interesting, though, that so many homebirth CNMs and even many hospital CNMs support this bill. Ones with more years of experience and certainly more birth experience than you have.

  • Guest

    Wow Penny, because nobody asked you about your education, your degrees, nor your opinion on CPM's. Thanks so much for chiming in. Nothing like tooting ones own horn.

  • guest

    Penny Lane talks about all the experience CNMs have, but fails to mention that ACNM does not require any more births to graduate then NARM does for CPMs. Most CNMs graduate from school without ever attending a homebirth, while the majority of training a CPM has is at homebirths. This makes an incredible difference, because when you train in the hospital, you have multiple hands and resources available to you, as opposed to training in out-of-hospital births where you have to learn very quick because the extra people and resources aren't available to rescue you.

  • Leanne

    CPMs/DEMs should be 100% illegal. They have no real education or training. Not even to the standard of the lowest level nurse. Yes, hospitals should give more choice/freedom of birthing methods, but they are still the safest place to be for mom and baby. Prove me wrong. Show me MANA’s data proving that homebirth is as safe as birth in a hospital. You can’t, can you?

  • Jennifer

    CPMs have extensive training. DEMs their training varies. My last child was delivered by a DEM who had trained for 5 years. That is part of the reasoning behind the law to create a required training foThey are safer in states that allow midwives to practice above board. If you want stats look up the Farm Study. Did you know the Farm midwives have a C-Section rate of 1.7% and the hospital down the road from me had over a 50% c-section rate. I can not fathom that 1/2 the women that go there to deliver need major surgery. Women are not broken the system is.

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