Background: There are three general categories of midwives: Certified Nurse Midwives, who train in a medical program as nurses and then obtain a master’s degree in midwifery; certified professional midwives, who train and apprentice according to national standards set by the North American Registry of Midwives; and “direct-entry” midwives, who train by lengthy apprenticeships and hands-on, peer-based, self-education.
1983 – Midwives seek legal accountability from state
Legislation is passed allowing Certified Nurse Midwives to attend home birth in North Carolina, with their permitting contingent on obtaining the signature of a physician who agrees to “supervise” them.
Although a state study finds home birth to be a safe option that should be legal, no physicians will agree to supply the signature required for a CNM to attend births at home. Thus, there is still no legal provider option for families who choose out-of-hospital birth.
The direct-entry midwives hire a lobbyist and work hard to establish a permitting/licensure system that will make them legal and accountable to the state. Their efforts are largely stymied by a single state senator who is also a doctor. (Senator Purcell retired in 2013.)
1991 to 1995 – development of the CPM credential
2007 – Consumers step in
Consumer group North Carolina Friends of Midwives (NCFOM) takes over legislative efforts from the organization that represents Certified Professional Midwives in the state, the North Carolina Midwives Alliance (NCMA).
Throughout 2007 and 2008, the General Assembly forms a study committee to investigate whether or not the state will license Certified Professional Midwives. After testimony from both sides, the committee finds in favor of licensing and, in 2009, charges the Midwifery Joint Committee (MJC)—the board that issues permits to CNMs—with figuring out a pathway to licensure for Certified Professional Midwives. Midwives are, unfortunately, disproportionately represented on a committee that is made up of two Certified Nurse Midwives and another eight folks from the Board of Medicine and Board of Nursing.
[Side Note/Tangent: Also in August of 2009, two Certified Nurse Midwives were fired from a private practice here in Wilmington leaving 80 pregnant women without their care provider of choice. The local families asked NCFOM to write a letter to the hospital asking for a meeting. The hospital was unresponsive, so we protested outside the hospital (every day, M thru F from noon to one) for a month until they agreed to meet with us. That was when I became aware of the climate in our state for Nurse Midwives, and when we first asked the midwives to work together on licensure.]
After a series of monthly meetings at the MJC, the medical folks on the committee point to the language of the state study, which says the MJC “may” find a methodology to license Certified Professional Midwives. Because of the word “may,” the MJC chooses not to interpret the state’s study as a directive, and decides that they also “may not” find a methodology to license Certified Professional Midwives. A vote from the board on whether to continue the discussion yields “No” votes from everyone but the two midwives.
A Certified Professional Midwife is arrested and charged with practicing midwifery without a license, and with providing prenatal care in a second case.
The largest rally regarding midwifery issues that has ever taken place in the United States is at the North Carolina General Assembly, when 650 people come to demonstrate their support of licensing Certified Professional Midwives. At that time, NCFOM has two bills in limbo—both of which end up languishing in Health Committee in both chambers.
A direct-entry midwife and her doula are arrested and charged with practicing midwifery without a license. Charges are eventually dropped.
A series of bad outcomes comes to the attention of the Midwifery Joint Committee (involving direct-entry midwife Rowan Bailey in July, and a Certified Professional Midwife and two Certified Nurse Midwives around the same time). A cease and desist order is filed against both Rowan and the Certified Professional Midwife.
During testimony by one of the Certified Nurse Midwives, she mentions that the obstetrician who signed her permit to practice is also providing supervision for approximately eleven other Certified Nurse Midwives serving families across the state. This obstetrician is called into a closed-door session before the Board of Medicine, immediately after which he notifies each of the eleven midwives that he will no longer serve as their supervising physician.
This leaves hundreds of families planning legal, professionally assisted home births with no care and very few options. There are not enough practicing Certified Professional Midwives, whose numbers have been thinned by fear of arrest, to attend all of these births.
The MJC issues a temporary 75-day license to the Certified Nurse Midwives to cover the gap in physician supervision, but most are unable to find a doctor willing to buck the establishment and allow them legal status. Today, only four Certified Nurse Midwife home birth practices are left in the state.
Around the same time, the NCFOM tries to get their bills moving out of the Health Committee. This is when they are shown a copy of a letter from the Medical Society to its members looking for “tragic transport stories” (that is, home births that ended with deaths in a hospital of either mother or baby) to share with legislators. WMM? publishes the letter on its website, leading, ultimately, to a meeting with the Medical Society.
In that meeting, WMM? is told in response to the question, “What are these families supposed to do without their midwives?” that they should “Go to the hospital.” The doctors also express surprise that women are seeking alternatives to birth in the hospital as a direct result of their experiences in the hospital—pressure or coercion into unwanted interventions and high incidences of c-sections that may have been preventable. One doctor comments, “Women feel pressured in the hospital? I thought women chose home birth because they wanted to be in control; they had control issues.”
A Certified Nurse Midwife in Wilmington is assisting a woman at home and makes a prudent and appropriate call to 911 for assistance transporting the woman to a hospital for an emergency procedure. Police arrive before the ambulance. This leads us to believe that the North Carolina district attorneys have been instructed to send police to any call to EMS regarding birth at home.
Today: The War on Mothers
It’s our feeling that the strategic decision was made not to arrest any more Certified Professional Midwives after the huge public outcry following the arrest of the CPM in February 2011. Instead, a year-long campaign was launched to pick off home birth midwives one by one by issuing a series of cease and desist orders.
If Rowan had not been charged with murder, surely, the next midwife arrested would have been charged with something equally as damning. The arrest and criminalization of “a” Rowan has been a long time coming.
But we’re not going to take this assault on families lying down.
It’s the basic right of a woman to decide where she wants to give birth, and with whom. That includes birth outside of the medical monopoly. It’s time we addressed the fact that the corporations making money off the business of birth in North Carolina are the ones dictating our policy and law, and doing their best to eliminate the competition.
Meanwhile, our hospitals—where 94% of women give birth—are delivering us care that has placed our state 47th in the nation for mothers dying in childbirth. We believe it is time we addressed the REAL problem in birth in North Carolina: the system that prompts almost daily reports of unsafe and outdated medical care and violations of women’s dignity and legal rights.
Please continue sending your hospital stories to us. We are planning to print them and place them in a notebook to be delivered to the Medical establishment sometime in the next couple of weeks, as a part of a public awareness campaign. We will be asking them to sit down, again, and discuss how we can all work together to improve the climate for birthing families in our state.
Stay tuned for more information about our upcoming events. . .