Midwifery infighting

I was really upset to see the news that the American College of Nurse Midwives (ACNM) had come out against the Certified Professional Midwives (CPMs) attempts at getting recognized in the health care reform process. You can read the ACNM letter to their members here.

It all just makes me sad, reading this letter, wishing I understood exactly why those dialogues between the CPM groups and the CNM groups broke down. If your read this letter in response to ACNM’s actions, Geradine Simkins, CNM, MSN, MANA Board President explains that it was actually just one phone call where ACNM refused to concede anything.

It is disingenuous of ACNM to state in its Special Alert to ACNM Members on July 15, 2009, “ACNM’s decision to oppose this initiative followed unsuccessful attempts by ACNM and MAMA Campaign leaders to reach a compromise that both organizations could support…” There was no formal process or interaction, no negotiations, and no attempt at collaboration between ACNM leaders and MAMA Campaign leaders. There was one phone conversation in which the ACNM representative stated there was only one concession they would accept: federal recognition only for gradates of MEAC-accredited programs; this is not a compromise. The MAMA Campaign, of course, is promoting all CPMs to receive federal recognition as Medicaid providers, not just some CPMs.

I’m a big fan of CPMs, and while I think CNMs have done a lot to bring the midwifery model of care to the hospital setting, women need more options. I like that there is a midwifery model out there that doesn’t start with nursing school, or rotations in the labor and delivery wards of hospitals. I like that some midwives are just trained to do home births, or birth center births. We need that, just like we need OBs to do c-sections (when necessary) and CNMs to do births in hospital.

ACNMs main issue with CPMs seems to be the fact that apprenticeship model’s of education are recognized alongside traditional brick and mortar education. I don’t want to throw apprenticeship out the window. I want it to be a valid way of learning. This is how midwifery started! These are our roots. We can’t abandon them completely. They’ve served us.

Why can’t we all just get along?

Well, because everyone has their own professional interests in mind.

I can’t pretend I understand what is behind ACNM’s opposition to CPMs.

Maybe ACNM is afraid of their reputation. Maybe they are afraid if these other midwives get acknowledged as providers by the federal government, it will tarnish the name of midwives. Maybe they are afraid of losing business to a new group of midwives. I don’t really know, but it’s just typical for those on the margins to end up fighting each other over little scraps when the big players (doctors) end up with all the power and gains.

I know not all CNMs are supportive of this decision by ACNM. Read this letter from a group of CNMs, even in leadership of other organizations, for a great breakdown of why this was a terrible move on the part of ACNM, why it’s wrong, bad for midwifery and ignores the evidence (does this sound familiar?).


You can sign this petition in response to ACNMs campaign.


4 thoughts on “Midwifery infighting

  1. Abby July 24, 2009 / 4:37 pm

    I agree, this is upsetting. I’m a registered nurse. When I started nursing school, I did so to become a midwife. As I went through my OB rotation, I changed my mind. I did a 14 day rotation. I saw one vaginal birth. I knew then that I was not necessarily willing to go through the training to become a CNM because it would mean having to support a system I’m not willing to support at this time in my nursing career. I’ve thought of becoming a CPM. I’ve received a fair share of judgment from the nursing community when I even mention it.

    I feel as though there is a little bit of “my way is the best way” syndrome. I’ve noticed that Bachelor’s degree RN’s feel this way about Associate’s degree RN’s. I think CNM’s do the same with CPM’s. They believe their path is the best and most appropriate.

    We must all be aware of the ultimate goal. Healthy mom’s and healthy babies. That means the availability of different choices. It’s unfortunate that the ACNM has taken this stance.

    Thank you for writing and bringing awareness to this topic.

  2. I love moms August 2, 2009 / 7:26 am

    I know this may not be well received but, in a spirit of hope, I will offer it anyway. If you read the ACNm statement carefully, the salient point is not that ACNM opposes ALL CPMs. What matters is supporting those who have taken up a comprehensive curriculum and have obtained their CPM certification in those states that recognize the credential. While I have no problem with the apprentice model of education into midwifery, its obvious limitation is the expertise and education of the mentor; that is the precise locus that is unmeasurable and unverifiable.
    As a CNM who has called herself ‘midwife’ for most of my 30 year-long career, and who has lots of experience with home birth, I can tell you that I very much want us to 1) resolve our differences and direct our energies to very much-needed maternity care reform (particularly around birth at home), and/or 2) getting our differences behind closed doors so as to present a united front to the dominant medical model. History shows that medicine has effectively used the divide-and-conquer strategy to eliminate the midwife. Let’s take away their guns.

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