[IL-CNM] CPM licensure

Pohl, Carla cjpohl at ilstu.edu
Mon Sep 28 08:49:36 CDT 2015

Thank you to all who have discussed the pros and cons of CPM legislation.  I was very much against legislation supporting CPM practice thinking (very wrongly) that CPM's wouldn't practice if it were illegal.  The discussion highlights the advantages of supporting legalization of CPM's for all concerned.  I am still concerned about the supervision issue, I do not have a clear picture of how that will work if at all.  Thank you all for a great and intelligent discussion.

Carla Pohl, APRN-CNM, DNP
Assistant Professor
Mennonite College of Nursing

cjpohl at ilstu.edu

From: il-cnm-bounces at luc.edu [mailto:il-cnm-bounces at luc.edu] On Behalf Of Barb Havens
Sent: Friday, September 25, 2015 4:12 PM
To: il-cnm at luc.edu
Subject: Re: [IL-CNM] CPM licensure

Thank you, Amy, for this very well articulated position.  I agree wholeheartedly with your conclusions.
The bottom line is that women will continue to seek home birth and will often go to CPMs.  The CPM needs more accountability and not be working in shadows.  If they were legal, I do believe their whole outlook and practice would change, and they would be safer and not take unwarranted risks.
Yes, folks get confused about two kinds of midwives, but we just have to educate them.  We have two kinds of nurses -- LPN and RN, and folks have seemed to 'get it'.  There are two kinds of midwives also -- our scope of practice is different.

And.......we need to remember that we all have horror stories about individuals, whether CNMs, MDs,  ........or CPMs, hospital birth or home birth.  Birth statistics from states that legalize CPMs would be helpful to look at, in terms of whether to go forward with this legislation.

I believe legitimizing the CPM will make birth safer 'overall'.

Barb Havens

On Sep 25, 2015, at 3:03 PM, Amy Willen <amywillencnm at gmail.com<mailto:amywillencnm at gmail.com>> wrote:

Chiming in from East Africa....
I have been significantly involved in trying to bridge communication between CNMs and CPMs since I was an SNM.  I've been, and still am, a member of MANA (Midwives Alliance of North America) for oh maybe 12 years now.  I've practiced in several settings over the last decade and have too many observations to share here. Although I can try to sum them up....
-Yes, the training, educational level and areas of expertise are different for CNMs and CPMs.  Yet...
-I don't think that caring for a normal pregnancy/birth requires a masters degree.  (such an opinion is akin to saying that an OB/medical degree is superior or preferred to a CNM/masters degree for simply catching a baby). However, discerning when and how to access more intricate resources for certain complications is what a more thorough and theoretical education might provide.

-I have received my education and then practiced in states in which CPMs are legal and more or less integrated into the health care system.  Even though their training is different (you may say less thorough,less than, etc.... again I remind you of the OB vs CNM argument) and their scope of practice is more narrow than ours, I have found these CPMs to be more responsible and less "cowgirl" simply because they are accountable to whatever determines their legal status.  They have nothing to prove.  They're legal. They are integrated into the system and can at least transfer a woman in a timely manner and with appropriate records because they don't fear prosecution. They have some obligatory amount of professionalism and tend to act accordingly.  At least more so than in states like Illinois.
-The cowgirls and magical thinking are only happening because we have created that arena by not licensing CPMs - in the form of blocking their bill, not supporting their bill, or remaining silent because lack of action is basically granting permission.  Know that women will continue to seek them out, they WILL CONTINUE TO PRACTICE, and they will practice however they want.  By remaining illegal and unlicensed, they are not accountable to anyone or anything and therefore can do whatever they want.  The wild west is not going to tame itself, and to expect them to adhere to standards that are nonexistent for them is wishful thinking.  And I'm reminded of Sister Angela Murdaugh, former ACNM president and my mentor who has long supported CPMs and CNMs working together- she always said "You can't wish things away" , i.e., our only choice is to take action do something about it.
And my suggestion for action is to support any process to get them legal and licensed so that there will be some accountability.  A board to report them to. Some basic standards by which to practice.  Because cease and desist orders aren't practical or effective.  ... Illinois wouldn't be the first state to do this.  We are 1 of only 6 states that deems CPM practice illegal, so we are the minority.
Supporting the licensing of CPMs does not mean you have to agree with their practice, it does not mean you love all of them and will refer your patients to them.  It simply means you support a process by which they will be held accountable for what they are doing.  And that patients won't have to go underground, risking further alienation from the health care system, to find them.

-And the CNMs attending home birth in Illinois are burned out and tired.  More and more women are seeking home birth providers, and they're being turned away or waitlisted at 8 wks because the midwife's census is already full.  Which is a bummer for everyone involved.
My 2 cents, 2 dollars, and 2 Ugandan shillings,

On Fri, Sep 25, 2015 at 9:31 PM, <ledbetter72 at mchsi.com<mailto:ledbetter72 at mchsi.com>> wrote:
Deb - I have worked informally a back up practice ( with consent from my original collaborative doc and one subsequent doc ) for years with HB CNM's and CPM's but until we had an influx of " Trust Birth" initiative , things went very well . MANA has a HB data set that ACNM published and I am assumed endorsed ( by virtual that they published the stats ) but many have disputed MANA's conclusion that HB is safe .  MANA itself has acknowledged a higher risk for home VBAC, twins , breech .
We had three stillborns here after attempted HB with influence of the magical thinking of " trust birth " types.  I am pro HB for low risk women with a qualified provider but not with cowboy providers .
The issue is women will do HB.  I want women and baby 's safe. Both CNM's that do HB are 1-2 hrs from here and fill up fast . I do hospital birth but I know some of my ladies really want and qualify for HB .

I can be a med- wife if I need to be and so should some of those "Cowboys" be if they want to see safe birth .

I heartily endorse reading Ghostbelly.  She speaks of our broken HB system and it cost her greatly. Her baby's name was Thor

Something has to change

Thanx. Rita  CNM downstate

Rita.....Also known as " Pixie"

> On Sep 25, 2015, at 10:18, Debbie Boucher APN, CNM <midwife2015 at yourbirth.com<mailto:midwife2015 at yourbirth.com>> wrote:
> The state of Wisconsin has birth records. The birth records do record type of provider, with CNM & LM (licensed midwife, non-CNM) as choices. There are fewer OOH CNMs than CPMs, but the stats would be useful.
> I hope that this is a safe place to share. I would appreciate if people would please keep my comments private & not repeat them outside this list. There are very vocal CPMs who like to criticize CNMs to patients and anyone who will listen, mostly in social media.  And yes they are criticizing the hospital CNMs the most, FYI. You are referred to as 'med-wives'. So don't think that these people are your friends.
> I have worked with legal CPMs, in Wisconsin, and I've been a member of an international listserve with CPMs & CNMs for 10 years. There is a big difference in the knowledge level. I've also noticed that the doctors in Wisconsin prefer to refer to CNMs & CNM/CPM practices, for their own patients who desire OOH birth. Hospital personnel, who see the transfers, treat CNMs differently then CPMs. All these observations have also informed my opinion.
> Are you aware of what's happening in Indiana? A CNM told me that CPMs can be licensed but they require an observation of a number of births by medical doctors. No doctors will do this, so in actuality no CPMs have been able to receive a license.
> The Illinois law will require supervision by an MD or a CNM. Are you prepared to provide that supervision? Will your group practices, liability policies, and hospital bylaws allow it?
> We are fighting our own battle to get rid of our collaborative agreement. Legislators are usually confused about us and the CPMs. I don't even say what kind of APN I am when I go to legislator meetings and I don't give out my card, because I don't want to confuse the issues. But somehow it often comes up. They ask me where I work, what do I do. I try to avoid it but then it's awkward. It's frustrating and I wish they would just give their bill a rest one year so that we could get ours passed.
> Feel free to contact me off list if you want more details. I tried to keep it brief here but I could go on.
> Debbie Boucher APN, CNM
> Sent from my iPhone
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Amy Willen, CNM

"If we hope to create a non-violent world where respect and kindness replace fear and hatred...
We must begin with how we treat each other at the beginning of life.
For that is where our deepest patterns are set.
>From these roots grow fear and alienation... or love and trust"  ~ Suzanne Arms

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