Substance and Structure of Midwifery Practice
Identity Crisis
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Just Kill Me
“ Why would anyone want to go to a midwife?” These were the first words from a physician in-law on the first day we met. I was accustomed to a different question: “Why did you want to be a midwife?” After wishing that I could vanish into thin air, I stuttered something to the effect of: “less intervention and better outcomes”, “more natural”, “better relationships and communication”. I promised myself I would be prepared for this question, the next time.
John Tyson
Although the midwife question unnerved me, it was valid and one I’ve considered on occasion. It is present in the eyes of strangers and friends when discussing midwifery. After decades of practice, I can answer with confidence, fortified over time by my CNM colleagues, supportive physicians and nurses, and those I’ve been delighted to support in childbirth. Following countless deliveries, and a long career, the more appropriate question has become, “Why wouldn’t anyone want to go to a midwife?
Where Did the ACNM Standards Go?
Despite the intense gratification and personal rewards associated with my career choices, professional midwifery and law practice have, over time, revealed one disturbing reality. A segment of practicing CNMs are failing to incorporate ACNM standards into individual practice. This realization developed from observing the testimonies of nurse-midwives on trial for malpractice and, also, testimony from midwifery expert witnesses.
CNM Testimony At Trial
It has been difficult to review the testimony of nurse-midwifery defendants, and expert witnesses, who justify, under oath, their departure from ACNM practice standards, core competencies, and ethics. These documents establish the professional basis for the care that Certified Nurse-Midwives and Certified Midwives provide.
Adherence to ACNM Standards and Documents
I have come to the conclusion that a number of certified nurse-midwives have chosen to conform the basis and quality of their practice to the institutional and medical models of their chosen workplace. While this may be understandable, to a certain extent, it is the apparent departure from the ACNM practice documents that is unexpected. I am able to consider why this might happen in the pressure-cooker context of litigation, but I still find it an alarming departure from ACNM standards of practice.
I acknowledge the legal practice of intense witness preparation and persuasion to support a specific claim or defense, and this might be partially to blame. But for CNMs to deny and misrepresent, in courtroom appearances, the very first principles they were taught in their educational programs is particularly disturbing, especially since they are representing a profession that is already musunderstood.
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Medical-Legal Review in CNM Litigation?
At the very least, I would advocate for the CNM/CM certification and re-certification materials to include additional journal articles and questions related to ACNM practice standards, ethics, and competencies, including litigation vulnerabilities in practice. In addition, it might be helpful for collegiate and certificate midwifery programs to incorporate pertinent medical-legal articles and recommendations into their educational materials and clinical teaching.
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