Jan 282013

“Midwives don’t receive any medical training to become certified”  - Health care practitioner to pregnant woman after inquiring who was providing her prenatal care.

Share Button
 January 28, 2013  Midwife  Add comments

  49 Responses to ““Midwives Don’t Receive Any Medical Training…””

  1. Yeah, the state issues midwifery certification to any woman who wears Birkenstocks and eats organic produce. Pretty cool, huh?

    • Didn’t you know? The little paper tag that you’ve got to peel of your Birkenstock sole doesn’t only display the price, it’s also your coupon code for downloading the free midwife certificate. What did YOU think it was?? Duh. ;-)

  2. That very much depends on which type of midwife you are talking about and how you define medical. CNM’s have a BSRN and a Maters in midwifery. Direct entry have a less “medical” based training, but do have training to meet the standards of whichever group they are members of. I’m sure there exist direct entry midwives whose training consisted of catching a few babies but those wouldn’t be considered “certified.” But in states with resonable requirements where nobody need go underground, the training can be top notch and frankly better than an MD or DO for a natural birth. If your defination is “medical training” equals “went to medical school” then yes of course you are right, but since the typical hospital leaves the L&D nurses in charge for 80-90% of labor and they could be LPN’s then what exactly is your point?
    Shows how little you know!
    See it is the darn pesky details tripping you up again Mr./Ms./Dr. Stupid but Arrogant! If you want to be arrogant then you HAVE to know what the heck you are talking about! It is a rule.

  3. Midwives don’t go to medical school – correct. Midwives get no medical training – boy, are you wrong. Medical training is so much larger than “just” med school. (But yes, if the midwife went through med school until the end, she’d likely be an OB/Gyn and not a midwife anymore.)

    • For that matter, paramedics don’t go to medical school either, and yet we entrust the most fragile people to their care. I can’t imagine this health care professional scoffing at a paramedic.

      • Correct me if I’m wrong, but nurses don’t typically go to medical school, either — and they manage about 75-90% of birth in the hospital.

      • Neither paramedics nor nurses go to medical school…but that’s not what’s being discussed. To earn those licenses and practice paramedics and nurses absolutely do have to complete specific medical training and courses and have some kind of certification/transcripts to verify they have done so. My brother-in-law is a paramedic and he spent and spends a ton of time in “class”. CPMs do not have to complete specific training like that – though they may have to take some kind of test they can often be “book taught”. And I know at least in my state there are no CE requirements for CPMs.

        • I have no idea what state you’re in or what it additionally requires of CPMs, but NARM (the national certifying body) requires CPMs to recertify every three years, which includes 25 hours of continuing education *plus* regular retraining in CPR and neonatal resuscitation.

          As for taking “some test,” the qualifying exam is difficult and requires a thorough background in clinical midwifery. And educational requirements are either attendance at a MEAC-accredited school, or midwifery classes plus a long arduous apprenticeship process involving reams of documentation. (Having been through a year of midwifery school, I’ve considered following the latter path, but I simply don’t have the time and energy to invest around what my kids need from me right now.) They don’t just hand out CPMs to any Jo Schmo who walks off the street!

          • Not to mention the MINIMUM of 55 supervised births attended at some capacity or another, along with 100 prenatal exams, 40 newborn exams and 50 postpartum exams required by NARM. And that assumes that every birth the trainee attended fully qualifies to be documented in her CPM certification process. So, yes, there is more to the CPM certification than “book” knowledge.

  4. This isn’t mine, but it very well have could been. Just yesterday I had a hospital midwife tell me pretty much the same thing about the midwives at my birth center. Except that she was wrong. I had a couple comments submitted from my hour and a half there yesterday that will hopefully come up at some point.

  5. Well, let’s assume for a second this is true for all midwives ( it’s true for some types, but most are very well trained professionals ). OBs don’t get any training in natural physiological birth either, what’s your point?

    • This was my thought. CPMs have to attend 50 births to be certified. OBs can make it through their whole career without seeing a natural birth.

      • OB’s spend 4 years in residency catching thousands of babies by the time they are done. Of course they see the spectrum from a non-medicated uncomplicated vaginal delivery to c-sections.

        • Actually, it isn’t a requirement. One can see the last 15 minutes of thousands of pit and epidural births and nobody is going to go WAIT you can’t move on to the next phase without a fully natural birth that you actually attented from start (or let’s say 5 cm) to birth. There is no requirement of that nature at all. Don’t kid yourself. None of us are buying it, and you just look like a fool.

          • Really? You think that when you catch that many kids, not one mother is going to have a spontaneous unmedicated vaginal delivery, seeing as about 95%+ of the population delivers with OB’s you seem to have a very low opinion of other women.

          • I’ve had three unmedicated vaginal deliveries in hospitals with an MD as my primary care giver. He didn’t see one of those labors for more than a few minutes at the end… and each time most of the nurses in attendance told me they had never seen one before either.

            The only reason I know my doc has seen several natural births in his career for more than just the big finish is that he did part of his residency in a hospital where he was encouraged to shadow births where the primary care giver was a midwife.

            I’m certain *many* doctors have never seen a spontaneous unmedicated vaginal delivery… and that *most* have not seen one that did not include the sort of intrutions that Jane mentioned (frequent cervical checks, continuous fetal monitering, etc).

            Women are not encouraged to birth that way in a hospital setting… and that fact has nothing to do with my opinion of other women.

          • Goldilocks, as I replied to Sarah, there’s more to it than spontaneous and unmedicated. A non-medicalized delivery would involve, among other things, no cervical checks unless the mother requested them or something was wrong, no continuous fetal monitoring, no augmentation, no AROM, no episiotomy, physiologic pushing (no counting) in whatever position the mother desired, and delivery of the placenta without traction or pitocin.

            I believe interventions are actually higher in teaching hospitals than in other hospitals, so yes, I do believe it’s possible for a doctor to emerge from residency without seeing a woman deliver on hands and knees (eg, I was forced onto my back even though the hospital’s own birth classes said not to deliver on your back) and most doctors routinely administer pitocin to deliver the placenta or routinely order cervical checks every couple of hours just because that’s what the hospital birthing envirnoment requires.

          • It is the difference between flipping through a photo album of 200 pictures and sitting down to watch 50 movies. The training is different. As I understand it you are still in med school and not in residency, but when was the last time you walked into the labor room and sat down? If you sit down and absorb the labor phase you will be a better OB. I’m sure some places encourage this, but clearly most don’t. There is no way we would have a 30+% C-section rate if doctors understood labor.

          • that was supposed to be 2000 photos. Since you said thousands of births. Seriously if you are attending 10 births a week plus whatever else you have to learn about female cancers and fertility then how much do you really learn about that which could be handled by a midwife. Until doctors and midwives start working as a team rather than adversaries things just won’t improve!

          • It’s kind of interesting that if you read the standard pregnancy literature, you’ll hear that women dilate at 1cm/hour if they’re multips and 1.5cm/hour if they’re primips. But when I started hanging out on a midwifery forum, I heard midwives discussing other “typical” patterns of labor, such as prodromal labor, or women who stop dilating but whose babies descend during that time, or women whose contractions will stop for about half an hour after 10cm and then resume with the urge to push.

            Doctors who are just looking at charts and getting this info over the phone don’t get a chance to experience the wide variety of labor patterns that are within the range of normal, and often will try to override the woman’s natural labor pattern by administering pitocin if she’s not sticking to the curve. Why? Because it’s not “normal.”

            Same with complete dilation: the woman’s at 10, so the doctor will arrive at this point and tell her to start pushing even if her body is resting, overriding the woman’s own labor pattern in order to conform it to what the doctor has been told is normal.

      • You know, the thing I want when I develop PPH, or my baby has persistent bradycardia is someone that’s seen 50 births and is only trained “natural physiological birth”.

        • Midwives are trained in managing postpartum hemorrhage and also know how to transfer a patient to the hospital. In fact, one of the chief things a midwife does is screen out for problems that require a doctor. Ideally this would ensure the hospital’s resources are expended on patients who benefit from them, and women who don’t need the resources of a hospital are not taking them away from patients who do.

        • No, what I want (and what midwives are qualified to do) is someone who can recognize the complication and treat it immediately or transfer care to a specialist. What I don’t want is a scalpel happy OB who doesn’t know how to recognize when things are normal and intervenes whether it’s needed or not, putting both me and my baby at unnecessary risk.

    • Of course OBs get training in “normal physiological birth”. You can’t learn abnormal until you learn normal. But seeing as normal doesn’t KILL mothers or babies, they are trained to save mothers and babies through prevention, detection and treatment of abnormal.

      • I disbelieve that in a teaching hospital these beginning OBs will occasionally attend a birth in which in the absence of problems there are no cervical checks, no continuous fetal monitoring, no episiotomy, the woman pushing according to her own sensation in a position other than on her back, and then a physiologic third stage where the placenta delivers without pitocin and without traction.

        The doctors in a teaching hospital are there to learn the procedures, so they’re going to be doing them at every chance they have.

        ANd I totally agree: you can’t learn abnormal until you learn normal. The difficulty is that we’ve set up a situation in which the hospital adds so many procedures and interruptions to the natural process that most doctors have normalized the abnormal labor patterns of a woman laboring in the hospital environment.

        The same happens with the menstrual cycle, by the way. Many doctors have no clue how to read a fertility chart and don’t know how to recognize a short luteal phase or estrogen dominance or anovulatory cycles. For these doctors, if you’re bleeding about every 28 days, you’re probably fertile, and if you’re having abnormal bleeding patterns, you can take the Pill to override your own hormones. These doctors don’t know “normal” and therefore cannot identify abnormal, let alone treat it.

  6. This one is mine.

    I am not sure / can’t remember what kind of health care professional this lady was… but she wasn’t a doctor.

    I was at a meditation center for a weekly evening meditation night they do and during the break I got up to use the washroom and a women approached me, excited that I was visibly pregnant (5 months). She casually mentioned that her job involved working with pregnant mothers/ babies and asked me how my pregnancy was going thus far. I said it was going really well and I was feeling great. She then asked me who was providing me with care and I named a midwifery clinic in town. her demeanor changed slightly form one of cheeriness to one of slight concern for me.

    She then asked how that was going to which I said really well, that I’ve been really impressed with the level of attention I’ve received through them as opposed to going to my doctor. She then said, “so you’ve had no prenatal care then?” This caught me off guard since I had just finished explaining to her I was seeing midwives.

    I reiterated that yes I was receiving prenatal care, that the midwives had been giving me excellent medical attention throughout my pregnancy to which she responded with the above quote. I insisted she was wrong and the conversation quickly went from friendliness to awkwardness and I was clearly annoyed. She awkwardly walked away from me after that.

    And just a note… I am from BC Canada where it is actually illegal for someone to call themselves a midwife without being certified through the college of midwives… therefore everyone claiming to be a midwife MUST meet the standards, that of course includes comprehensive and rigorous medical training in pregnancy, childbirth and post natal care.

    • Wow, she said this about midwives in BC? Really?!?? Just unbelievable that someone in the health care field could be so ignorant about a respected, highly regulated health care profession. I’m in Ontario and here midwives have to go through an intense 4 year university program, have to write a board exam to get licenced and keep up to date through mandatory CE courses. I assume it is the same in BC.

      • Yes it is the same in BC… 4 year program that has been described to me as an intensive boot camp by those who took it. They would have to be extremely proficient at being medical care providers in order for our government to cover them under provincial health insurance!

        • Not to mention that last time I checked the government doesn’t just let someone off the street with no medical training prescribe drugs, order blood tests and ultrasounds and hold hospital priviledges.

    • It must have been hard to hear what she was saying to you! You know, because you describe being in a public place and I assume she was wearing pants…so her voice must have been awfully muffled, considering she was talking out of her ass.

      I love when perfect strangers give you unsolicited advice. Bonus points if what they say could not be more wrong!

  7. Could she have gotten midwives mixed up with doulas? (From reading the OP, I doubt it, but that’s the first thought that went through my mind.)

    • After she said they received no medical training I did ask her if she was referring to doulas, not midwives but she insisted it was midwives… our conversation quickly dwindled after that.

  8. Someone better tell the three midwives who work as CNMs at the hospital in which I delivered my oldest son! I saw two of them for prenatal care over the course of my pregnancy, and the third delivered him.

  9. I heard this from a pediatric nurse. She sort of knew my midwife (small town) and felt the need to point out that “she majored in *sociology*.” Yeah…and then she attended two hundred births and got special training. Same lady told me that home birth should be considered child abuse. My two home-grown kiddos haven’t complained.

    • But only if you plan for a homebirth and have what you need and a plan for an emergency transfer. If you get stranded at home and the ambulance is dealing with a multicar pile up and you and your partner aren’t prepared, well that’s safe right? (yes, this was all sarcasm)

  10. Well, if you’re talking about CPMs that’s pretty darn accurate. In my state the requirements are: a high school degree or GED, 1 college level human anatomy class (or test out of it – they don’t even have to actually take the class), passing some test and 25 births. That’s it. No requirements for a specific course of study or instruction – which is what is meant by “medical training”. And that’s in a very homebirth friendly state…and pretty par for the course for most states. Being certified by the state means nothing if the bar is 6 inches off the ground.

  11. This is preposterous. I wanted to be a CNM at one point, but I quit when I discovered there was too much schooling and medical training for me to want to continue. (The expense)

  12. I had something similar happen to me. Since I gave birth at a freestanding birth center with a midwife, I had to take my baby to the hospital to do the hearing test (a pediatrician came out to the waiting room of the L&D unit and did it right there).

    When I went to the front desk to…sign in?…the receptionist asked me who my baby’s doctor was, so I said “Dr. Kim Bauer, my midwife.” The receptionist gave me a look and said, “So she’s not really a doctor.”

    My midwife is a Naturopathic Family Physician AND a Licensed Midwife. So yeah, she’s really a doctor.

    I guess I can’t blame her for not knowing that, but she was so condescending! And both this lady and my midwife have been around for a while. I would think this receptionist would have heard the names of the local midwives at some point, since the out-of-hospital birth rate in our small city is around 11%!

  13. Don’t you love unsolicited bs?

  14. Midwives don’t receive medical training? Of course not! The unicorn tells them where to hold their hands to catch the baby.

    • Damn! I knew I shouldn’t have told the unicorn to leave. And of course my midwife was so compassionate, she just let him go. It was after all, my birth, and the unicorn was interfering with the ambiance of the dancing and twinkle lights.

  15. My midwife was certified and had her diplomas proudly displayed on the wall. So, where’d you get your info from?

Leave a Reply