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Politics / Global View of Midwifery

Although rapidly gaining recognition in many states, direct-entry midwifery continues to struggle for acceptance in some areas, and is illegal in a handful of states in the U.S. A recent study published in the British Medical Journal (reference) confirms the safety and benefits of giving birth in the care of a CPM outside the hospital, yet only 1% of all births in the U.S. happen this way. Becoming a CPM today means that you may need to become an activist as well as a skilled caregiver in order to advance the profession of midwifery, and to raise awareness of the midwifery model of care and the option of giving birth outside the hospital.

Direct-entry midwifery in the U.S. is a profession in its infancy, and its future will be determined by the midwives themselves and the new midwives that come behind them. We look to other countries for possible models for maternity care systems as our own U.S. healthcare system struggles to provide quality care, or any care at all, to our citizens. Most Western European nations utilize midwives for the majority of their maternity care to healthy women because women like the care they receive from midwives, their outcomes are excellent and it makes economic sense. Most of these European midwives are direct-entry (not nurses). Within the last 10 years, Canada has integrated direct-entry midwives into their healthcare system, and their midwife attended births and out-of-hospital births are increasing significantly.

Many would like to see direct-entry midwives in the U.S. integrated into and utilized by our healthcare system as they have much to offer healthy pregnant women. Steps have been made in order to facilitate this movement towards mainstreaming midwives: the national certification process was developed by the North American Registry of Midwives (NARM) and there are currently over 1000 CPMs in the U.S., an accreditation process was developed by the Midwifery Education Accreditation Council (MEAC) in 1996 and 10 schools are now accredited, a professional organization of CPMs (NACPM) has been formed and is working on a standards of care document for its members, and midwives in many states have written and introduced midwifery licensure bills in their state legislatures. All this work has been done by volunteers, most of whom are practicing midwives, and there is much more work to be done. As a student entering the field of midwifery, it may be hard to avoid becoming involved in the politics of midwifery on the local, state or national level.

If you are considering becoming a CPM, research the midwifery laws in the state in which you intend to practice, talk with midwives about their practices, and make yourself fully aware of the political status of CPMs in this country as you decide your path. If you are energized and impassioned by the thought of participating in this movement towards a better future for birthing women, despite its current marginalization by the conventional medical system, then perhaps the direct-entry path is the one for you.

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