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March 28th, 2013, 08:28 PM
Join Date: Feb 2013
Liz, I'm so sorry to hear about your loss, and I thank you for sharing your story with us. Out of respect for your pain, if you want me to drop this entire conversation, I will, just say the word.
Babybear4, I am going to respond to the points you made in great detail, and in the next post I will respond to the bottom half of Brie's post.
Most of the points you are trying to make, though, are based on your own speculations. None of it has been based on fact.
I was very careful to make a clear distinction between what was fact and what was speculation. Perhaps I overdid it and made it sound like everything was speculation. Here are some facts that the data shows:
1) The death rate (deaths per thousand births) for births attended by non-CNM midwifes out side the hospital (1.43) was 2.5 times the death rate fore for births attended by MDs in the hospital (0.57), and 4 times the death rate for births attended by CNMs in the hospital (0.36).
2) The death rate for births attended by CNMs outside of the hospital (0.68) was
1.9 times the death rate for births attended by CNMs inside the hospital.
You did intentionally make a misleading statement about what CPM's need, education wise. You stated that all that was required was a HS diploma, when that was untrue and it was disputed in other posts based on the website that you linked.
These are the statements that I made:
"I've heard that some women with only a highschool education are passing themselves off as midwives, when they don't have any ability to deal with complications. "
"However, there is a certification out there for mid-wives that have only a high-school education, and I was alarmed when I learned about that."
I did NOT state that "all that was required was a HS diploma", and I further clarified in later posts that a) when I say "only a high school education", I mean that someone has no college degrees, no formal education, above and beyond a high school diploma and b) when I say "only a high school education", I don't mean that the person's knowledge is limited to what they learned in high school. I gave the example of a carpenter who has only a high school education, but knows a lot about how to build houses (or cabinets or chairs or whatever).
So, lets have a careful look at the requirements for a CPM, as posted on the NARM website:
. I'm cutting out parts that say things irrelvant to the discussion like "documents must be submitted in such and such a way" and replacing them with dots (....).
"New requirements for PEP-Entry Level applications effective September 1, 2012:
ĽAll applicants will be required to submit evidence of a high school diploma or equivalent.
ĽAll applicants must submit proof of completion of an approved module on cultural competency for health professionals. The online module offered by Georgetown University may be found at:
NEW requirements for PEP-Entry Level applications effective January 1, 2013
The clinical requirements will be documented in four phases.
Phase 1: Births as an Observer
Document attendance at ten births in any setting, in any capacity
Phase 2: Clinicals as Assistant under Supervision
Document at least 20 births, 25 prenatals (including 3 initial prenatal exams), 20 newborn exams, 10 postpartum visits as an assistant under the supervision of a qualified preceptor.
Phase 3: Clinicals as Primary under Supervision
Document 20 births, 75 prenatals (including 20 initial prenatal exams), 20 newborn exams, and 40 postpartum exams as a primary midwife under supervision.
Phase 4: Five Additional Births as Primary under Supervision
So, in other words, as long as I have a high school diploma, fill out an online questionaire (took me 10 min; there were no right or wrong answers), attend 55 births in various capacities along with a bunch of other prenatal and postnatal visits, and complete the NARM test (not described above, it is described in their candidate information booklet
as a 350 question multiple choice test), then I'm good to go. No need for college level science courses, no need for any formal medical training. If that doesn't fit the definition of "only a high school education", then I don't know what does. I'm not saying that no CPMs have additional training beyond that, I'm just saying that this is their minimum standard.
You also totally ignored the entire bottom half of Brie's post which is pretty convenient, considering it almost completely disputed any of the points you had made thus far.
Very well, I'll go ahead and address it in detail after this post.
Now, you are grasping at straws trying to convince all of us that these statistics that you gathered from the CDC prove your point when the reality is, is that you are spinning it based on your own assumptions of how or why these situations occurred ....
I find a neonatal death rate with lay midwifes outside hospitals that is 4 times the death rate of CNMs in hospitals to be very disturbing. I don't have to know how or why each individual situation occured to realize some babies died because they were born outside a hospital with a lay midwife who would have survived if they had been born in a hospital with a CNM or an MD.
...and, as you already stated, the website doesn't have information on stillbirths or babies born with hypoxic brain injuries. I could speculate that many of the deaths that occurred with other midwives was due to stillbirth or babies born with hypoxic brain injuries and then that blows your entire theory out of the water, since my speculation is just as justified as your own.
No, you can't speculate that, because the definition of neonatal death excludes those. By definition, a still born baby is not a neonatal death because the baby was never born alive. Even if it was alive and healthy when labor started, and died during labor because there was inadequate fetal monitoring and noone realized it's cord was compressed, it is still not considered a neonatal death. By definition, a baby born with a hypoxic brain injury that survives past 27 days is not a neonatal death. That baby might have severe brain damage, and might need lifelong expensive medical care, but it is not a neonatal death. By definition, a baby born with a hypoxic brain injury that does
survive past 27 days
a neonatal death. I am sure you will want proof of these definitions, and I will provide that proof, but it is getting late and I'm not going to do it right now.
Not to mention that you, yourself, stated that you don't even KNOW what other midwife actually means.
I do know that someone who is an "other midwife" is not a medical doctor or a certified nurse midwife, because people in those categories are already accounted for. I do know that they are not taxi drivers or people that just happend to be standing nearby, because then they would have been in the category of "Other" rather than "Other Midwife" (this category had an even higher death rate, but I left it out because it seemed irrelevant to the discussion- that may have been a mistake), so I do know that the people in this category identified themselves as midwives. What I don't know is if people in the "other midwife" category are CPMs or simply people who call themselves midwives but have not met the minimum criteria to be a CPM. I don't care if they call themselves CPMs or lay midwives or direct entry midwives or whatever...the point is that they do not have the medical training that an MD or a CNM has, and they are calling themselves midwives, and the death rate for these people attending births outside of the hospital is several times higher than the death rate for MDs or CNMs in the hospital.
ETA: Keep in mind that I am saying this from an unbiased perspective. The only personal research I have done thus far is find out what midwives practice in my area, so this is an outside perspective from somebody just reading along. I can see why people are getting frustrated "debating" with you because you are either a.) ignoring their data or b.) spinning things to fit your own opinion, rather than posting unbiased sources that prove your point.
Thankyou, Babybear4, for your comments. I do have limited time, and I have been not responding to things that are a) statements of opinion, or b) statements of facts that are clearly well supported by data, or c) statements that are not supported by data, and that I don't have time to research and dispute right now. Obviously there is no way for anyone to know which category their statement falls in, and I can see how that would be frustrating. As for the need to post information from unbiased sources that prove my point, well, that is what I was trying to do with the CDC data.
Brie, I have run out of time to respond to the second half of your post. I have also run out of time to respond to anyone elses posts.
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