NACPM-OK has been made aware of a series of emails and social media posts calling into question the qualifications and competency of Certified Professional Midwives (CPMs) and Certified Midwives (CMs), which are the two types of midwives now able to serve as Licensed Midwives (LMs) in Oklahoma. We are saddened to see patently false information being put forward by respected members of professional communities and are confused about why members of the Advisory Committee on Midwifery (ACM) are crowdsourcing these answers rather than reaching out to their CPM peers on the ACM for clarification.
To correct this situation, NACPM-OK provides the following clarification regarding the false and discriminatory statements that are being circulated.
Regarding references to:
“The whole point of the law” – The expressed legislative intent, per the authors of the law, is to provide an oversight and accountability process for CMs and CPMs without removing any options previously available to Oklahoma families, and without limiting consumer autonomy. The rules intentionally allow statistics to be collected so that any necessary course corrections can be made based on confirmed data.
“Lay midwives” – A Lay midwife is a midwife who has received no formal training, and usually serves her immediate community in a traditional way. Neither CPMs nor CMs are “lay midwives” and it is intentionally pejorative to refer to them as such. Both CPMs and CMs are meticulously trained in all the skills and competencies required to provide expert midwifery care.
“High risk” – High risk is a valueless term that was intentionally left out of the law because it has no clear definition. There is no accepted threshold for what makes something “high risk” so it can be applied to any situation where there is increased risk. This is unhelpful in determining appropriateness for midwifery care. “Normal” is the term intentionally used in the law, and it is defined as “circumstances under which a Licensed Midwife has determined that a Client does not have a condition that requires medical intervention.” There are well established professional standards that guide these determinations, and we can rely on midwives, as we rely on other practitioners, to make these judgements.
“ACOG guidelines” – Midwives are not admitted to, certified by, nor governed by, the American College of Obstetrics and Gynecology, and have their own guidelines set forth by MANA, MEAC and NARM. Guidelines made without all stakeholders at the table are not universally applicable. While ACOG guidelines are important resources to consider they are based on the medical practice of obstetrics. CPMs practice midwifery and therefore guidelines and rules of practice take into consideration the unique practice setting and the Midwifery Model of Care.
“VBAC, Multiples, and Breech” – Section 3040.10 of Title 59 clearly protects the practice of delivery by a CPM of VBAC births, multiple gestations, and breech presentations. As such any efforts within the rules to prohibit these practices run afoul of the statutory protections which the Legislature clearly intended to include.
“Prescriptive Authority” – Title 59 Section 3040.4 directs the commissioner to develop a formulary of medications that licensed midwives may obtain, transport, and administer when providing midwifery services. The formulary does not grant prescriptive authority. This statement is patently false, and it has been addressed in committee meetings multiple times.
“No evidence of training” – This may be the most troubling accusation as it speaks directly to biases that seek to discredit both the profession of midwifery and the families who prefer midwifery care. The evidence of training, as with all other professions, are the credentials themselves, both of which are accredited by the National Commission for Certifying Agencies (NCCA), the accrediting body of the Institute for Credentialing Excellence (ICE), which accredits many healthcare credentials, including the Certified Nurse-Midwife. Furthermore, the educational guidelines of CPMs and CMs are easily accessible through a cursory internet search and clearly outline that both credentials required explicit academic knowledge and clinical mastery both of the “uses, limitations, contraindications, dosing, and repeat dosing recommendations” of medicines commonly used by midwives in the field and included in the formulary, and of all scenarios that “would necessitate transfer to a hospital.” Additionally, all Oklahoma applicants are required to provide proof of continuing education and additional pharmacology training every renewal period.
Sadly, NACPM-OK has already received reports from our members that this intentional undermining of Oklahoma’s CPMs is actively harming Oklahoma families by fostering mistrust within the medical community and reducing access to consultation and collaboration. We ask that clinicians please note that Title 59 Section 3040.12 specifically waives liability for physicians and CNMs who issue orders or direction to a midwife.
In closing, we hope that you will help to counter this attempt to undermine community midwifery in Oklahoma, and will take a moment to make a public comment in support of robust midwifery practice and consumer autonomy. CPMs have been serving Oklahoma families, autonomously, for 30 years and remain the appropriate caregivers for families who choose community birthing locations.
Respectfully,
Sarah Foster, LM, CPM
MA Maternal-Child Health Systems
President, National Association of Certified Professional Midwives, Oklahoma Chapter
Director of Organizational Development, Midwives Alliance of North America