License midwives for safety

By Bethany Gates


At present, Certified Professional Midwives, midwives who attend the majority of out-of-hospital births, are not licensed in Iowa; 28 states offer a license to CPMs. Three of those 28 states border Iowa and the other three states that border Iowa have introduced legislation that would offer a license for CPMs. No state that has licensed CPMs ever has rescinded that license and all have found licensing midwives to produce reduced health care costs.

The lack of licensure in Iowa means that CPMs can be (and have been) charged with the felony of practicing medicine without a license. The irony is that midwives who are being charged with such a crime are not being charged because of bad outcomes but rather because anonymous reports from those who disagree with the idea of home birth.

One of the concerns that comes up when legalizing CPMs is talked about is safety — of the practitioner and of home birth. Study after study consistently has shown that home birth with a CPM is just as safe as hospital birth and, in some cases, safer. The most recent study, released this year, surveyed almost 17,000 planned out-of-hospital births. Of all the women in this study, just 5.2 percent wound up with a Cesarean section procedure, compared with a national average of 32.8 percent. That is just one example of the many ways that CPMs working in home birth settings reduces interventions and health care costs.

Another concern is that of the education CPMs receive. To receive the credential, one must have 1,350 clinical hours of training and attend at least 55 births before even applying to take the eight-hour written and four-hour skills exam. Compare this to the birth training of Certified Nurse Midwives (licensed in Iowa) who can attend as few as 20 births with 700 to 900 clinical hours and receive their license. CPMs are required to recertify every three years while CNMs are required to recertify every five years. CPMs are trained exclusively in out-of-hospital births while only 3 percent of births attended by CNMs happen outside of the hospital.

There are three bills in the Iowa House and Senate proposing CPM licensure. A Senate bill has been assigned to a subcommittee. If senators choose not to put this bill through by the first funnel deadline, which is Friday, this bill is dead this session. A companion bill in the Houseand a third billalso await action.

Legislators need to hear from their constituents today, letting them know that access to safe midwifery care in Iowa is a priority. They need to be reminded that a Scope of Practice Review, ordered by their own legislative body in 1999, came back in 2000 with the following recommendation: “The Review Committee agrees that licensure for Certified Professional Midwives should be done through the legislative body.”

Certified Professional Midwives are the only midwives exclusively trained to work in out-of-hospital settings.Bethany Gates of Vinton has worked in the birth field for three years, first as a doula and now as a midwife-in-training. She is working toward the Certified Professional Midwife Credential offered by the North American Registry of Midwives. Comments:

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