Friday, July 13, 2012

The pathetically minimal certification requirements for homebirth midwives

Want to know why the certification process for homebirth midwives (certified professional midwives, CPMs) is a joke? Just take a look at the certification requirements.

You can read all about it here.

What kind of background education is required for certification? Anything goes!

.. including programs accredited by the Midwifery Education Accreditation Council (MEAC) ... apprenticeship education, and self-study... If the midwife is preceptor-trained ... s/he must complete the NARM Portfolio Evaluation Process (PEP).
Seriously? Self-study is considered a valid means of acquiring a degree?

Who can be a preceptor and attest to the adequacy of the candidates educational background? Anything goes!
The NARM Portfolio Evaluation Process (PEP) involves documentation of midwifery training under the supervision of a preceptor. This category includes entry-level midwives, internationally educated midwives, and experienced midwives.
Anyone who calls herself "midwife" is automatically accepted as a qualified "preceptor." Moreover, there is no effort to check a preceptor's report of a candidates competency:
The preceptor holds final responsibility for confirming that the applicant provided the required care and demonstrated the appropriate knowledge base for providing the care.
That means that the only real requirement for becoming a CPM is taking the test. It doesn't matter what your educational background is. It doesn't matter how you got your clinical training. They aren't even going to check whether you actually met the minimal clinical requirements. They'll take your preceptors word for that and your preceptor can be anyone else who has passed the test.

Surely, the portfolio process is exercised by only a small number of women who have special circumstances? Wrong.

Consider this unbelievably scary statistic offered by the North American Registry of Midwives (NARM):
Of the more than 5000 births included in the CPM 2000 study published by the British Medical Journal, 99% were attended by midwives who received the CPM credential through the NARM Portfolio Evaluation Process.
In fact:
The majority of CPM candidates continue to become credentialed through NARM’s Portfolio Evaluation Process and all indications are that consumer demand will continue to drive aspiring midwives to seek the apprenticeship, community-based midwifery educational model that PEP validates.
So although there are midwifery schools, most certified professional midwives have never bothered to attend.

Compare that to the educational requirements for European, Canadian and Australian midwives. They must have a 3-4 year university degree, as well as home AND hospital based clinical training supervised by a variety of different instructors. Compare that to the educational requirements for American certified nurse midwives (CNMs). They have a masters' level degree that involves even more education and clinical training.

The certification requirements for an American homebirth midwives (CPMs) are nothing more than a joke. Anyone can become certified so long as she pays the money and takes the test. There are essentially no barriers to certification, so any birth junkie can not only call herself a midwife, she can pay for a nice certificate to fool others into believing that she has completed an actual program of education and training, even if she has not.

How did this strange set of circumstances come about? As Robbie Davis-Floyd explains in Pathways to Becoming a Midwife: Getting an Education, A Midwifery Today book. Eugene, Oregon: Midwifery Today, 1998.
[Homebirth midwives] do not accept the argument that formal, standardized education is necessary to provide safe and competent practitioners.
That's fine; they don't have to "accept," it, but that doesn't mean that the rest of us should follow suit. Whether or not homebirth midwives accept it, formal, standardized education IS necessary to provide safe and competent practitioners.

This piece first appeared on The Skeptical OB in July 2011.

No comments:

Post a Comment