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Why Is American Home Birth So Dangerous?

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Many studies of American home birth show that planned home birth with a midwife has a perinatal death rate at least triple that of a comparable hospital birth. (The perinatal death rate refers to the death rate of babies in their last weeks in the womb and first week outside it.)

The problem is that there are two types of midwives in the United States. The first, certified nurse midwives, called C.N.M.s, are perhaps the best-educated, best-trained midwives in the world, exceeding standards set by the International Confederation of Midwives. Their qualifications, similar to those of midwives in Canada, include a university degree in midwifery and extensive training in a hospital diagnosing and managing complications.

The other, certified professional midwives, or C.P.M.s, fall far short of international standards. One 2010 study of midwives published in The Journal of Perinatology found that home births attended by nurse midwives had double the neonatal mortality rate of hospital births attended by nurse midwives, while home births attended by C.P.M.s and other midwives had nearly four times that rate.

This second class of poorly trained midwives attend the majority of American home births. And yet they are legal in only 28 states; in the rest of the country, many practice outside the law.

They used to be called “lay midwives” or “direct entry midwives,” in recognition of their lack of formal medical schooling. That didn’t sound very impressive. In a brilliant marketing ploy, they created a credential — the C.P.M. — and awarded it to themselves. Many receive their education through correspondence courses and their training through apprenticeships with another C.P.M., observing several dozen births and presiding at fewer. How woefully inadequate is this education? In 2012 the requirements were updated to require proof of a high school diploma.

They seem to believe they don’t need more training because they are “experts in normal birth.” As I often say, that makes as much sense as a meteorologist being an expert in sunny weather. Anyone from a taxi driver to a 12-year-old sibling can handle (and has handled) an uncomplicated birth. The only reason to have a trained attendant is to prevent, diagnose and manage complications, the very things that C.P.M.s never have to learn to do.

Amy Tuteur, a former clinical instructor in obstetrics- gynecology at Harvard Medical School, blogs about childbirth at The Skeptical OB and is the author of the book “Push Back: Guilt in the Age of Natural Parenting.”

So... Dangerous because there are two types of midwives?

It's the Certified Nurse Midwife (CNM) that has the extensive, diverse and formal medical education, hence safe (and expensive). The Certified Professional Midwife (CPM) leans to a more bureaucratic form of when frontier farm wives were just there for each other, yet this is the group doing the most deliveries.

Ah, ok, look for the nurse!

Just curious about stuff, so I checked. 

Certified Nurse Midwife:



Nurse midwives (CNMs) provide care to women, including gynecological exams, family planning services, and prenatal care. They deliver babies; manage emergency situations during labor, such as hemorrhaging; repair lacerations; and may provide surgical assistance to physicians during cesarean births. They may act as primary care providers for women and newborns. Nurse midwives also provide wellness care, educating their patients on how to lead healthy lives by discussing topics such as nutrition and disease prevention. Nurse midwives also provide care to their patients’ partners for sexual or reproductive health issues.

Certified Professional Midwife (not listed in Bureau of Labor Statistics)


Education and all other requirements were on Websites that looked almost like from the back of magazines. I could almost hear the mid-afternoon sales pitch if on TV.

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