Posted By n/a on 06/29/2008 12:39 PM
Henci - you acknowledge that mid-wives have different training in each country. Are you familiar with the different requirements? Can you please detail what the differences are between American DEMs, CNMs and those certified/licensed in other industrialized nations? Also, I did note that you accused Dr. Amy of misinterpreting the WHO statement but clearly she included the "home-like setting" in her post and was transparent in including this in her post. Can you please explain to me how/why you believe she was misinterpreting the statement? The terms they use (as was included in her post) "home-like setting" clearly includes home births and birthing centers with a home-like setting as opposed to a hospital, correct? Do you believe that home-birth data as opposed to "home-like setting" would fare better if they were not lumped together? Do you have any statistics or data to support this?

 

In the U.S., CNMs or Certified Nurse-Midwives, get an RN first then go through a training program that certifies them through the American College of Nurse Midwives. The ACNM also started a few years ago--and I presume still has--a certification program for direct-entry midwives, meaning midwives who train to be midwives without the prerequisite of an RN. If I recall correctly, direct-entry midwives in their program receive a CM (Certified Midwife). The biggest and best known of the U.S. certification programs is through NARM, the North American Registry of Midwives, the organization to which I provided the link. NARM gives the certification "CPM" or Certified Professional Midwife. I'm on shakier ground here (perhaps someone more knowledgeable than I would like to chime in) but there is also an "LM" or Licensed Midwife, and I think these are midwives who have been certified by state programs. I do not have the details of training of midwives in developed countries. I wrote what I wrote in my response from my general knowledge gained from speaking with international activists for normal birth and from speaking abroad.

 

I didn't accuse Amy of anything. She, although at the time I didn't know it was her, made the false statement that the WHO supports her claim that home birth increases the risk of perinatal death: "Homebirth increases the risk of neonatal death. This is accepted and acknowledged by the WHO, the CDC, NICE (The National Insitute for Health and Clinical Excellence), a healthcare watchdog in the UK, among other major health organizations." However, as I wrote in my response, when I tracked down her source quote, the WHO said nothing about home birth, but expressed a concern about in-hospital birth centers based on a systematic review. It is, to put it mildly, disingenuous, to say that the WHO indicts home birth, using the word "homelike" when, in fact the WHO does nothing of the kind. Home birth studies and studies of in-hospital birthing centers do not overlap, something I am sure Amy knows. They are not, in fact, ever "lumped together." As for data and statistics, there is a substantial body of well-done research into home birth concluding that a home birth with a qualified home birth attendant achieves equally good or better outcomes than hospital birth for low-risk women. The primary reason why is that healthy women at home and their babies are much less likely to be subjected to policies, practices, drugs, procedures, and restrictions that are ineffective and harmful than healthy women undergoing conventional obstetric management. If you would like to see the evidence for the safety and efficacy of home birth, Lamaze's Journal of Perinatal Education published the review project "Evidence Basis for the Ten Steps of Mother-Friendly Care" and the articles are downloadable for free. One of them is on out-of-hospital birth.

 

I should also add that the systematic review of in-hospital birth centers has some weaknesses having to do with problems with the component studies on which it is based. I don't want to spend the time going into, but do not take it as gospel that in-hospital birth centers pose undue risk, or, at the very least, that all in-hospital birth centers increase risk.

 

-- Henci