If I want to wash your hair in the state of Oregon, I’m required to complete
1450 hours of training, 150 hours of safety and infection control training, and 100 hours of career development training. I must also pass both a practical and written examination. If I want to deliver your baby, I just have to tell you that I’m a midwife.
And it’s not just Oregon. All across the country, there are lax standards for homebirth midwives. Like Oregon, Utah offers voluntary licensure, and fifteen other states offer no regulation at all. There are some states where lay midwifery is illegal, but in almost all cases
, midwives flout the law and are rarely prosecuted. Even in states where it’s amazingly easy to become a legal midwife. In fact, there’s even a book
that brazenly describes how to do it and get away with it. Unfortunately, there can be tragic consequences
when a woman chooses a poorly trained “midwife,” but under the law, there is little that can be done.
- Since licenses are not required, they can’t be charged for practicing without a license.
- Because licenses are not required, there are no standards of practice they are bound to follow; they can take on high-risk patients with impunity, among other questionable practices. There are no penalties for violating reasonable standards of practice, as there are for OB-GYNs or CNMs, because there aren’t any standards!
- There are no standards for the use of the term “midwife”, so they can’t be charged for falsely representing their skills.
- There are no educational standards — When it comes to homebirth and the eyes of Oregon law, midwives with doctorates in Nursing are equal with those who’ve taken a weekend seminar in midwifery.
- There is no insurance required, so these midwives are judgment proof, even if by some miracle gross negligence was proven. No attorney is willing to take on a malpractice case when there is no insurance involved. Just in case, though, there are online resources for midwives explaining how to brainwash your clients to keep them from suing you or reporting you to the police.
So what about those voluntarily licensed midwives? The requirements are hardly stringent. In order to get licensed
, you have to attend 25 births as a midwife — only 10 of which need to have been in the past two years — take a written exam, write a plan for how you’re going to transport a mother who needs it, and obtain a CPR certification. In contrast, a CNM or OB/GYN will attend hundreds of births before receiving their licensure. LDMs in Oregon could be anywhere from completely incompetent to excellent caregivers.
So just do your homework, right? Like Mothering
and Birth Without Fear
are always telling us, just make sure your midwife is one of the competent ones and nothing bad will happen to you! But how can you tell? Unfortunately, the Oregon Health Licensing Agency
, the entity that regulates direct entry midwives (DEMs) in Oregon, has done a terrible job of protecting consumers. Thirty percent of licensed Oregon midwives have complaints against them pending before the Board. Which ones are they? You won’t be able to tell from the OHLA website, since even midwives currently on probation have no special notation regarding their status on the Board’s searchable database. There is no malpractice database, as there is for OB/GYNs and CNMs, so you can’t easily find if a midwife in whom you’re interested has been sued. Why not? Because licensed midwives aren’t required to carry malpractice insurance, either, so even in the most egregious cases there has not only been no compensation for the victims, but there is no warning for future victims either.
But the state or SOMEONE has a searchable database of outcomes, right? Maybe you could look at the stats from an area and ascertain if the midwives working there have good outcomes? Wrong again! The state legislature charged the OHLA to keep records of outcomes of home births, but they’ve failed to do so. Because of this, we have no official database on direct entry midwifery in Oregon. Melissa Cheyney, Ph.D
., at Oregon State University does have a registry of Oregon homebirth outcomes, but has absolutely refused to release it to anyone outside the Midwives Alliance of North America
(MANA), of which she just happens to be the research director. If fact, in order to gain access to the data, you must pledge to use it to the benefit of midwifery. Oddly enough, no one has been able to get their hands on it.
So what do you do if you want to find a competent midwife in Oregon? Ask her? Of COURSE any midwife will be completely honest about her record and give you references from parents who have been harmed by her lack of skill. Just ask Bambi Chapman
Not only this, but licensed midwives in Oregon actively fight any attempt to regulate their practice or report poor outcomes. In the last couple of years, Oregon has seen several deaths during attempted home breech deliveries. Because of this, the legislature considered making it illegal for licensed midwives to attend breech births at home. However, as with any birth-related legislation discussion in this state, they raised such a stink
(and shouted down their opposition), that nothing was done. When a hospital in Portland attempted to report poor outcomes dumped on their doorstep, they and the OHLA were sued
, and it was framed as “Look at this big bad hospital harassing these poor midwives.”If I were queen of Oregon, how would I handle this? My goal would not be to take away the right of women to have a homebirth
(I bold this because I know I will be accused of just that); I just want it to be SAFE. [In every case where there is regulation of midwives, there are no restrictions on PARENTS. If you find a unicorn to attend your birth in a cave, that is, and should absolutely remain, your right. However, if that unicorn claims that it will help you birth safely and then gores your baby? It should face repercussions for that.
] There are several things I would do…
- Require that those advertising themselves as homebirth midwives meet truly stringent educational and clinical standards, comparable to those of CNMs
- Mandate the reporting of outcomes for every birth and keep a publicly accessible database of this data
- Require malpractice insurance for anyone advertising themselves as a midwife
- Provide both criminal and civil punishments for those who practice without meeting the standards, even without poor outcomes
I don’t understand why so many midwives are willing to put up with negligence and incompetence in their midst. Any other profession would be chomping at the bit to throw the bums out, not circling the wagons! Is it because they care more about advancing the cause of midwifery than they do about the women for whom they are providing care? This shouldn’t be the case!
How can Oregon turn it around and stop these tragedies from taking place? How would you fix this?