I know that CPMs are not real midwives from reading the MANA Statement of Values and Ethics, by which NARM recommends they practice. I have copied portions of it below, with my emphasis.
“I. Woman As a Unique Individual:
A. We value each woman as a strong, creative, unique individual with life-giving powers.
B. We value each woman’s right to a supportive caregiver appropriate to her needs and respectful of her belief system.”
Aside from being incredibly patronizing, this seems to say MANA backs any lay midwife attending a woman’s birth as long as the woman believes she is receiving supportive care, whereas I think that women have a right to a qualified provider who is held to a high standard of competency.
“C. We value a woman’s right to access resources in order to achieve health, happiness and personal growth according to her needs, perceptions and goals.”
It seems as long as a woman perceives treatments, or resources, are helping her, like taking black and blue cohosh to start labor or placenta pills to treat PPD, MANA midwives think that should be encouraged. However, I think it’s the role of a provider to know the difference between sham treatments and evidence-based care and to advise women on the difference.
“D. We value a woman as autonomous and competent to make decisions regarding all aspects of her life.”
Then one could justify encouraging women to make medical decisions in the absence of advice from a real expert, like a doctor or nurse-midwife.
“E. We value the empowerment of a woman during the processes of pregnancy, birth, breastfeeding, mother–infant attachment and parenting.”
It’s interesting that they talk about empowerment in the same section they open the door to all kinds of alternative medicine. It’s not empowering to encourage a woman to go down the path of pseudoscience for her care. Rather it’s taking advantage of her lack of medical knowledge, while fawning over her with compliments of being a strong, creative, unique individual with life-giving powers.
“II. Mother and Baby as Whole:
A. We value the mother and her baby as an inseparable and interdependent whole and acknowledge that each woman and baby have parameters of well-being unique to themselves.”
I believe in the converse, that there are concrete, measurable parameters of well-being common to all women and babies, such as vitals during and after birth, the amount of blood lost, and the APGAR scores of the newborn. Maybe MANA midwives support those parameters as well, but there’s a pattern emerging here: MANA places the most value on the most nebulous aspects of care that one invents for themselves.
The talk of inseparability of the mother and baby seems to be a dig at NICU care a baby might require. It’s a heartbreaking event to be separated from one’s baby in that situation, but after the birth, there are two individual patients with their individual rights and needs, and the medical needs of the newborn cannot ethically be ignored.
“B. We value the physical, psychosocial and spiritual health, well-being and safety of every mother and baby.
C. We value the mother as the direct care provider for her unborn child.
D. We value the process of labor and birth as a rite of passage with mother and baby as equal participants.
E. We value the sentient and sensitive nature of the newborn and affirm every baby’s right to a caring and loving birth without separation from mother and family.
F. We value breastfeeding as the ideal way to nourish and nurture the newborn.”
One has to wonder how much they really value safety. Valuing inseparability of the mother and newborn (over NICU care?), valuing labor and birth as a rite of passage (over cesarean sections?), or valuing breastfeeding as ideal (to the exclusion of formula?) could end up being very UNsafe for the baby.
“III. The Nature of Birth:
A. We value the essential mystery of birth.”
I take this to mean MANA midwives oppose attempts to scientifically investigate or research the less understood aspects of birth. That might wreck the mystery they value, that they think is essential.
“B. We value pregnancy and birth as natural, physiologic and holistic processes that technology will never supplant.
C. We value the integrity of a woman’s body, the inherent rhythm of each woman’s labor and the right of each mother and baby to be supported in their efforts to achieve a natural, spontaneous vaginal birth.”
The dig at technology and the promotion of vaginal birth is simply promoting what midwives can do, while disparaging what hospitals can do. Technology may not supplant natural birth, but it makes pregnancy and birth safe and possible for many women who would either never get to experience the joys of motherhood or die in the process of becoming a mother.
“D. We value birth as a personal, intimate, internal, sexual and social experience to be shared in the environment and with the attendants a woman chooses.”
Regarding birth as sexual, just because a woman’s vagina is involved, is yet another way these midwives are not professionals.
“E. We value the right of a woman and her partner to determine the most healing course of action when difficult situations arise.
F. We value the art of letting go and acknowledge death and loss as possible outcomes of pregnancy and birth.”
I’ve written an entire blog post on the art of letting go. I take this to mean that MANA midwives know babies are dying preventable deaths at homebirths, that they don’t have (and don’t want) the technology to save them, and that they’ve decided death is an acceptable outcome, because otherwise they would have to stop practicing. By contrast, hospital midwives fight for babies to live. And the mention of parents determining the most healing course of action, in the absence of expert medical advice, is a means of shifting blame onto parents. If their baby died at a homebirth, for lack of technology, then they suggest the parents must have wanted it that way, and the midwife is just there to approve somehow, rather than being responsible for that outcome.
“IV. The Art of Midwifery:
A. We value our right to practice the art of midwifery, an ancient vocation of women.
B. We value multiple routes of midwifery education and the essential importance of apprenticeship training.”
This is a clear endorsement of lay midwifery. The practice of midwifery is not a right, but a privilege that is earned through formal education and training. An apprenticeship without formal education under another CPM, as in the NARM PEP route, is not enough.
“C. We value the wisdom of midwifery, an expertise that incorporates theoretical and embodied knowledge, clinical skills, deep listening, intuitive judgment, spiritual awareness and personal experience.”
There is no mention of empirical knowledge, derived from science. MANA midwives don’t seem to be interested in what science can do for women giving birth.
“D. We value the art of nurturing the inherent normalcy of pregnancy and birth as expressions of wellness in a healthy woman.
E. We value continuity of care throughout the childbearing year.
F. We value birth with a midwife in any setting that a woman chooses.
G. We value homebirth with a midwife as a wise and safe choice for healthy families.”
This is an outright lie; homebith hasn’t been safe for a long time. Homebirth is a dangerous choice. Homebirth with a midwife is just a dangerous choice in which a midwife gets paid.
“H. We value caring for a woman to the best of our ability without prejudice with regards to age, race, ethnicity, religion, education, culture, sexual orientation, gender identification, physical abilities or socioeconomic background.
I. We value the art of empowering women, supporting each to birth unhindered and confident in her natural abilities.
J. We value the acquisition and use of skills that identify and guide a complicated pregnancy or birth to move toward greater well-being and be brought to the most healing conclusion possible.
K. We value standing up for what we believe in the face of social pressure and political oppression.”
It’s no surprise that MANA midwives face social pressure, since they promote the belief that homebirth with a midwife is a safe choice, despite the evidence. And it’s only fair that they face political oppression when they declare they have right to and collect a paycheck to attend homebirths. Sham health care providers who specifically target women should be opposed.
“V. Woman as Mother:
A. We value a mother’s intuitive knowledge and innate ability to nurture herself, her unborn baby and her newborn baby.
B. We value the power and beauty of a woman’s body as it grows in pregnancy and a woman’s strength in labor and birth.
C. We value pregnancy and birth as processes that have lifelong impact on a woman’s self-esteem, her health, her ability to nurture and her personal growth.
D. We value the capacity of partners, family and community to support a woman in all aspects of pregnancy, birth and mothering and to provide a safe environment for mother and baby.”
“VI. The Nature of Relationship:
A. We value an egalitarian relationship between a woman and her midwife.”
Health care providers unavoidably have a degree of power over their patients’ decisions, and that should be acknowledged and managed responsibly. Pretending that power imbalance doesn’t exist, by saying the woman and midwife are equals, is a way for the midwife to avoid responsibility for giving out bad medical advice. The woman, as an equal, should have done her research and know when she’s been given bad medical advice. If anything goes wrong because she trusted that bad advice, then it’s her fault. A midwife who gives out medical advice and does not take responsibility for that advice is not a real midwife, but a con artist.
“B. We value the quality, integrity and uniqueness of our interactions, which inform our choices and decisions.
C. We value mutual trust, honesty and respect.
D. We value a woman’s right to privacy, and we honor the confidentiality of all personal interactions and health records.
E. We value direct access to information that is readily understood by all.
F. We value personal responsibility and the right of a woman to make decisions regarding what she deems best for herself, her baby and her family, using both informed consent and informed refusal.
G. We value our relationship to a process that is larger than ourselves, recognizing that birth is something we can seek to learn from and to know, but cannot control.”
What century are these midwives living in, that they think we cannot control birth? The idea that we should admire birth as a process larger than ourselves and declare it cannot be controlled is strikingly anti-science. A science-based approach would be to actively understand as much as we can and to actively try to control medical calamities as much as we can, which is exactly what doctors and midwives do in the hospital.
“H. We value humility and the recognition of our own limitations.
I. We value sharing information and understanding about birth experiences, skills and knowledge.
J. We value a supportive midwifery community as an essential place of learning.
K. We value diversity among midwives that broadens our collective resources and challenges us to work toward greater understanding.
L. We value collaboration between a midwife and other health-care practitioners as essential to providing a family with resources to make responsible and informed choices.
M. We value the right and responsibility of both a midwife and a woman to discontinue care when insurmountable obstacles develop that compromise communication, mutual trust or joint decision making.
N. We value the responsibility of a midwife to consult with other health-care practitioners when appropriate and refer or transfer care when necessary.”
MANA leaves it up to midwives to decide when to consult with other providers and when to transfer care. So there’s no way to know, until an emergency is upon them, if an individual midwife will consult a real doctor or transfer care soon enough to save the baby. And again, if the mother and midwife have an egalitarian relationship, and if the mother doesn’t intuit somehow if and when a transfer is necessary, it is likely she will be blamed for a tragic outcome for which her midwife is responsible.
The portion of the Statement of Ethics that stands out the most to me is,
“We recognize the limitations of traditional codes of ethics that present a list of rules to be followed. Therefore, a midwife must develop a moral compass to guide practice in diverse situations that arise from the uniqueness of pregnancy and birth as well as the relationship between midwives and birthing women. This approach affirms the mystery and potential for transformation present in every experience and fosters truly diverse practice. Midwifery care is woman-led care with informed choice and a clear set of values at its core. Decision making is a shared responsibility with the goals of healthy women and babies and of gentle, empowering births with a focus on individual and family needs and concerns. Ultimately, it is at the heart of midwifery practice to honor and respect the decisions women make about their pregnancies and births based on their knowledge and belief about what is best for themselves and their babies.”
Traditional codes of ethics are too limiting for MANA midwives. Having a list of rules to be followed might impede truly diverse practice. This is not a statement of ethics. It’s excuses for those among their ranks who don’t have any ethics.
They claim in the same paragraph midwifery practice includes shared decision making and respecting the decisions women make based on their own beliefs (even if those beliefs are wrong?). But shared decision making is the opposite of that. It’s a model of care in which women give informed consent to have provider-led care, placing more responsibility on the provider, not less, as would be the case in MANA’s valued egalitarian relationship between woman and midwife. MANA midwives seem to understand that many aspects of their practice conflicts with a traditional code of ethics.
CPMs are not real midwives because they:
- Think formal education is unnecessary
- Lie about the danger of homebirth
- Are anti-science
- Are anti-technology
- Value the art of letting go
- Think midwifery practice is a right, not a privilege
- Have no transfer guidelines
- Lie about shared decision making
- Think ethics don’t apply to them
CPMs are not real midwives, they are quacks.