Midwives lack medical training

Here in Missouri, a bill passed the legislature with an amendment that will allow certified professional midwives (CPMs) to practice. The governor has stated that he intends to sign it. This issue is all over the news. The medical associations voice their objections, warning that midwives are not medically trained.

CPMs are not medically trained. Is this a lack of training, or an asset? These midwives are extensively trained in normal birth. Birth is not inherently a medical event. The first priority of the midwife's training is to know when the mother and baby could benefit from medical intervention. That's when she calls in the doctors and nurses. That's when medical training comes in handy. In the other 90% of births, the midwife does not lack any training. The absence of a medical background helps her support the mother through the birth process. Her extensive training helps her to prevent the birth from becoming a medical event, even as it reveals whether medical intervention will be beneficial.

Some people want to compare our birth results with countries who only have midwives as an option, no hospitals or doctors available. See how much better doctors are, they say! No one denies how fantastic the doctors and hospitals are when they're needed. They're essential for good outcomes in at least 1:20 births. But countries who have both options available, who use midwives for normal pregnancies and birth and call in obstetricians when they're needed, have the best birth outcomes of all!

I want to live in one of those countries. And I don't intend to move.

http://www.youtube.com/watch?v=SIRS-hez-qg

Birth outcomes

Yesterday I flipped through The Economist's "Pocket World in Figures 2007." It lists the highest and lowest infant mortality rates by country. The list lowest mortality rates lists the top 25 countries. The US doesn't make the list.

We spend more on maternity care than any other country in the world, by far. Why aren't we in the top 25 of infant survival rates? We are doing something wrong.