CPM’s and OBs: Why can’t we all just get along?

“Women can’t easily turn to data to make an informed decision. Groups representing doctors and midwives are pushing statistics that advance their polar-opposite ideologies and confirm their own opinions.” (Zadrozny, 2014)

For those who do not know it, in May I began a four year degree, Bachelor or Science, Midwifery. The studies are taking up vast amounts of my time, which is just fine, because this is something I believe in and want to do. I have chosen to pursue the credential of Certified Professional Midwife, a credential conferred by the North American Registry of Midwives, and recognized by the federal government of the United States. A CPM is often called a direct entry midwife, as she is not a doctor or a nurse first, but educated and trained to be an expert in the fields of well woman care, pregnancy, labor and delivery, and postnatal care of mother and child. CPMs view the mother as a whole, the child as a whole, and the both of them as part of a family, as a whole. In this way, CPMs are holistic caregivers. Pregnant women are more than the sum of their reproductive organs and CPMs take an interest in more than the S&S that affect those reproductive organs. A prenatal check is more than a blood pressure, weight, pee in a cup, measure your fundus, check your vagina, and have a nice day. No, its more: How do you feel? OK, how to you really feel? What are you experiencing? How are things in your relationship with your partner? How are you eating? How does your family feel about the new comer? Do you need to ask any questions? Can I answer anything for you? Do you have everything you need? You have my cell number, right? You know you can call anytime? A CPM is a technical expert whose training and education is solely centered on the woman and her unborn or new born child. But she is also a source of information and support, an encourager and an assurer. Sometimes a CPM is a referrer—telling a mom-to-be that homebirth is not a safe option for her this time and sending her to see an OB who can complete her care. Sometimes a CPM is a transferrer, going with her client to the hospital during labor when things just aren’t going right, or the pain is too intense, and then the CPM usually stays on and helps the woman to complete her labor in the role of a friend or a doula, if the hospital staff don’t throw her out. A CPM is a lot of things.

One thing a CPM is not, is an untrained “lay midwife” as many doctors, and doctor’s associations would have the public believe. The phrase “lay midwife” is really degrading, like calling one a shade-tree mechanic, a Mickey Mouse plumber or a “weekend cowboy”. Images of Larry the Cable Guy declaring “Git-r-done!” come to mind. Images of the old hag with ridiculously long fingernails who smears squirrel pooh on a woman’s forehead, burns dried herbs and chants during labor creep into one’s mind as well. Or of hippies wearing puka beads and singing Kumbaya with guitar and tambourine giving birth in the back of a VW microbus. Unfortunately, in most states in the U.S., this is how midwives are viewed by the established medical community as a whole. There are exceptions to this rule, but not as many as one would hope.

In European countries, in most of Asia, and in Africa, midwifery is a long established and well respected profession. Midwives are seen as separate, equally contributing members of the established medical community, and their input, knowledge and experience are sought after by others in that community. Obstetricians, who are after all primarily surgeons, only see the 10-15% of women who actually need the care of a specialist in a hospital setting to give birth and have a healthy baby medically. When I started out in midwifery study, I was surprised to learn that this relationship did not exist between American doctors and midwives.

As an example of over medicalized birth in the U.S.: I was shocked when I discovered that in the U.S., our cesarean rate is 31.8%. (CDC, 2013) In most countries that number is closer to 12-15%. (WHO, 2011) One might say, well, obviously, we’re taking better care of mothers and their babies, because we’re saving their lives by doing more cesareans. Sadly, this is not true. The U.S. is 41st in the world for mother/infant mortality in the time period just before, during and just after birth. (Wagner, 2008) One of the main reasons that our cesarean rate is so high? This should embarrass us, but the answer is “convenience.” Doctors do promote cesarean section as a perfectly safe alternative to the “horrors” of labor and delivery, which will, after all, have negative affects on a woman’s life long vaginal resiliency. Not to mention, you can pick your baby’s due date, and schedule time off from work, and arrange for your family to be here, and for child care, etc….

Contrary to the suggestions of many midwives and the illustration I’ve just shared, most OB’s are NOT bloodthirsty fiends just looking for a chance to carve women up, with dollar signs in their eyes and their next vacation on their mind. I do not believe that there is a doctor in this world who would willfully tell their patient that thus and such a surgical option is perfectly safe and a reasonable option, unless they really believed it to be true. I do not believe they do this just for the money, (a cesarean birth costs 33-50% more than a natural birth in the hospital) for the convenience, or because they are just plain misogynistic, as has been suggested by some. I believe, that they believe what their textbooks, journals and professional associations promote: that cesareans and all of the other interventions that technology has provided to us, are safe, reasonable means in delivery of a baby, any baby or every baby. This is simply what medicalized birth is.

So, here in my little Pollyanna world, there are no wicked-crone or voodoo midwives trying to use pregnant and laboring women for rituals involving guitars, rodent poop or smokey herbs, and no doctors gleefully planning to perpetrate their next bloody, rascally, hospital-pocket-book inflating unnecessary procedure on poor unsuspecting women for their own gruesome entertainment. My conclusion? Simply this: Both the CPM and the OB want what’s best for the pregnant woman and her unborn child. They just happen to disagree on what “best” is. As it happens, in the Netherlands for example, where midwifery care is an accepted norm, midwives and doctors consult together as lateral equals, recognizing that they both have different roles to play in maternity care.

My solution is this: Let women and their families decide. It is past time for doctors and midwives to stop demonizing one another, and to encourage honest, open research that can result in good, evidence based practices that are suited to the majority of the people both groups want to serve. There are more than enough pregnant gals to go ’round! Quit being jealous and territorial. Consider what is good for others, rather than what is good oneself. Let people make their own, thoroughly informed choice. Of course, this requires people to make the effort to educate themselves, and that is a challenge. But I think that it is one that we as a society could rise to, just as soon as the experts in the field can quit fighting over maternity care like children on a playground.

I should note that the reason I took to my seldom used blog to write about this, is that I am currently trying to write a research paper, and the opening quote of this post sums up the way I am feeling as I am trying to shuffle through the currently available research.

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