Friday, September 16, 2011

Carla Hartley is AGAINST Licensure of Midwives!

Yes, of all the things that are said about me on a regular basis, that one is absolutely 100% correct.  I am against regulation of midwifery of any kind, and that is what licensure is.  Licensure is for the purpose of identification, regulation and elimination.... AND.... for the richification of those who get to decide who does and doesn't get that golden ticket.  They print it and they can decide what it costs.  It is NOT about qualification or education.  In fact, it is not at all about education except to decide which education provider can also get one of them thar golden tickets.

Although most midwives do not think education is as important as I do, it is not my job to say who is or is not qualified to call herself a midwife. Mammas are smart enough to choose from the wide variety of people who want to offer their services as a birth attendant.

My proposition is that we help educate mothers as to what constitutes good midwifery vs. medical midwifery and/or inadequately educated midwifery.  It is not my job to designate who those are, nor to police them.  It is the parents' job to either keep them in business or go elsewhere.  That is called free enterprise.

And remember that it is not so much that I am against licensure, but that I am FOR something else.  That something else is for parents to have the right to choose to birth anywhere and with anyone they want, even if that is no one.  Licensure will ultimately eliminate what I am FOR.

Licensure is a really hot topic and my stance keeps me in hot water, so to speak, but I have yet to be convinced that parents or midwives, for that matter, will benefit from licensure.  NARM, MEAC, MANA will....but that is a different note....the upcoming note on the richification aspect.

I am going to share here some of the questions that come my way frequently.

So what about the dangerous midwives?
I will not deny that there are many dangerous midwives out there.  Most of them have a credential.  Still, I think educating parents about what is dangerous and what is not, is the best way to address this issue.
There are already laws against hurting people. 

Don't parents want licensed midwives?  Licensed midwives tell me that all the time; parents never do. They want something else entirely. Once in a while I will get a letter to the contrary but I can pinpoint it to one particular area where the midwives are writing the proverbial letters and having the mammas sign them. I can quote the letters verbatim.  They are all the same.

Does this mean that you think that midwifery should be illegal and unregulated?  Illegal, no, unregulated, yes.  Midwifery could be, should be, maybe already technically already is legal by virtue of it being legal for parents to exercise their right to life, liberty and the pursuit of happiness in their ownership of the biological function called birth, which is a private family event.  Midwives don't need regulation; they need freedom to practice midwifery (not medicine) and the "regulations" should come from the parents, not the government or any midwifery organization.

Do you think that midwives should be allowed to carry life-saving drugs, which licensure would allow? No, I do not.  I think that drugs = medical training, expertise and risk-taking that midwives have not attained, do not need and they should not take the inherent risks of the administration of chemicals.  Rather than licensing midwives, maybe there could be a license for anyone who wants to carry and administer drugs that involves the appropriate training, education and liability insurance?  Something to think about.  As for "life-saving", education is far more likely to save a life, than the administration of a drug that has the potential to do all kinds of things that a midwife is not prepared to handle in a home situation.  Learn how to prevent and respond to those situations without drugs.  We have the knowledge, but it is often easier to just reach for a syringe, suppository or pill.  Not good science to do that without a very specific education and contengencies.

What about oxygen?  Oxygen is a drug.  Room air is more beneficial and far less dangerous.  I recommend taking every class you can from Karen Strange on the issue of neonatal resuscitation.

But won't licensing bring midwifery into the mainstream and make midwives more likely to be respected?  I have never understood how anyone over the age of 12 could even imagine that licensing midwives could force doctors and hospital personnel to regard someone outside of medicine as equals.  Secondly, can you explain why would we WANT to be mainstream?  What has mainstream done for birth?  I will give you a hint, the numbers are over 34%.  Get back to me on this one.

Won't licensing keep midwives from prosecution and persecution?  Hasn't so far. If someone in the more powerful clan (medicine, government, midwifery organizations) want you, they can get you, no matter what credentials you have.  In medicine, and that is what we are talking about here, let's be honest.... the only initials that really matter are M and D.

Won't licensing which mandates that insurance companies pay midwives mean that more women can have home births with midwives?  Mandating MEDICAL insurance coverage for a NON medical event is not a good idea for a number of reasons.  Birth is medical or not.  Choose.  If birth becomes medical, medical insurance should pay, but as long as it is normal....why?  I am not convinced that money is the real obstacle for women who are wanting homebirths.  I would have sold all my furniture to have a home birth with a midwife after my first birth in the hospital. For what we knew at the time, my husband and I worked a second job each to pay for so we could get the "best" aka most expensive for our baby. The insurance and medicaid aspect is tricky in many ways.  For one, it can and will have a cap and midwives will NOT want those clients once the cap is in place and then, the "poor" women are back where they were.   And the other issue that no one seems to address is how many women will choose home birth, if their insurance pays,  just for that reason....not because they trust it...but because their insurance will cover it or their friends are doing it.  I would rather work with parents who are willing to work to pay for a home birth midwife because it is THAT important to them.  As for the ridiculous "equal access" blarney, women have a lot more equal access in a free enterprise system than in any government run program, which is what home birth midwifery will be.

I live in an alegal state and all the midwives here are pushing for licensure.  Shouldn't I be a part of that effort to make midwifery legal?  If your friends all jumped off a bridge, would you? Just because others are doing it, it doesn't mean you have to.  I am going to let you in on a little secret here.  The emperor has no clothes.  I do not care who they are or how famous they are, if they are working for licensure of midwives they are NOT working for parents' rights.  Parents' rights are always in danger when midwives are pushing for theirs.

Why are so many pushing for licensure if it is such a bad idea?  I cannot tell you that. I just know it is a bad idea.  I can tell you why some are pushing for it and it has to do with the concept of monopolization. If the only people who can legally drive are those who drive Volvos, the Volvo folks are going to make out like bandits.  I will let you do the math....and watch for the upcoming note on how licensure is motivated by a desire for monopoly and money.

But why should midwifery be exempt from regulation when even people who give pedicures have to be licensed?  Licensing is never about protecting the public. Interior designers are being licensed now as are florists, and there is talk of licensing dance teachers.  Think about the need for those professions to be licensed for a minute.  Licensing is a golden ticket printed by someone else, that allows you to do what you do. It always takes money out of the individual pocket and puts it into an organization or government entity's pocket.  Two wrongs, or in this example, multiple wrongs, don't make a right. I am not persuaded that midwives need to be licensed on the faulty premise that we have to because everyone else is.  Look at why everyone else is. And you don't want to get me started on the travesty of constraint of trade and the right to earn a living. I will put that in the richification note.....Otherwise, we would be here all day.

All the midwives in my state say you are crazy.  They are correct, but that does not tarnish the brilliance of the principle for which I work night and day. Mothers own their births.
Here are a few of my previously published notes on the topic of licensure and The Big Push.  Feel free to look through my notes for more.
 And visit

Background note:  I am completely FOR education and competition....I think if midwives are preparing to serve parents who have a lot of different midwives to choose from the will pay more attention to their education.  I think midwives should put years and years of concentrated effort into  becoming a midwife. I created the most comprehensive midwifery course on the planet.  My stance is that midwives need to know EVERYTHING, so that they are comfortable doing as little as possible.  DOING is what adds risk to the inherently safe biological function of birth.  I think midwives need a great deal more education than it takes to become credentialed o  licensed in this country, but I will have no part in any effort to determine who may or may not call herself a midwife and will not support any group that does.  That takes the power from the mother to choose her own midwife.

1 comment:

Magdalena Alvarez said...

I couldn't agree more. Keep saying it--loudly.