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Marsden Wagner Responds to AWHONN's Statement on CPMs

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Dear Lauren Bates,

I am Marsden Wagner, a perinatologist and epidemiologist and former
Director of Women's and Children's Health in WHO. I attach a brief CV

I am frankly shocked to learn that your organization is against the
legalization of CPMs. I attended the meeting where CIMS was organized and
AWHONN was represented and endorsed CIMS which strongly advocates CPMs as
one of the legitimate birth attendants. Your statement that using CPMs will
put women and babies at risk flies in the face of excellent scientific
data. The excellent study of over 5000 planned home births in the U.S. and
Canada all attended by CPMs and published in the BMJ found no maternal
deaths and a neonatal death rate just as low as found in low risk hospital
births---certified professional midwives and planned home birth is an
absolutely safe choice for low risk pregnant women. You are incorrect in
asserting that CPMs are not adequately trained. They have excellent
standards for training and take a NARM exam which is just as difficult and
thorough as any CNM exam. If there were no CPMs in the U.S., nearly all
women who chose planned home birth would not be able to find competent
assistance at birth.

The nursing profession has become a leader in our country in the
development of competent health care professions including, for example,
nurse practitioners. Your nursing organization will certainly want to
support the further development of midwifery, including both certified nurse

midwives and certified professional midwives. I would be most happy to
discuss this further with you or anyone else in AWHONN. My address is 123
Sherman Ave, Takoma Park Maryland 20912, my telephone is 301 – 920 0241, my

E mail is marsden.patricia@ <mailto:marsden.patricia@ starpower. net>
starpower.net Sincerely, Marsden Wagner M.D.,


Alert: AWHONN article opposes CPM licensure

Dear Friends,

The Association of Women's Health, Obstetric, and Neonatal
Nurses (AWHONN) has published an article in their Fall newsletter asking
members to oppose CPM licensure. You can read the article at the end of
this message.

Citizens for Midwifery would like to encourage nurses
who work in women's health, obstetric, and neonatal nursing (and who are
friendly to CPMs) to contact AWHONN and lodge their opposition to this
statement. If they are members of AWHOON all the better. Please
reach out and ask these members to contact their association.

At this time we do not know the circumstances or intentions
associated with this article. We do not know if this is a position
taken by the organization, or just one person’s contribution to their newsletter. We
do know that AWHONN was a ratifier of the Mother-Friendly Childbirth
Initiative, and that the position expressed in the article contradicts
support of the MFCI.

At this time various efforts are being made to have
communication with AWHONN and address  the content of this article in a
diplomatic way, so we are NOT suggesting at this time that
“everyone†write letters. At the same time we wanted  you to be
aware of this and to encourage nurses and especially AWHONN members to
take action

The following points maybe helpful for AWHONN members when contacting

1. Opposing Licensure of CPMs will make mothers and babies less safe.
Some families will give birth outside the hospital whether they have a
licensed CPM in attendance or not. However, by having CPMs who are licensed,
these midwives can work within a state system of regulation, referral, and

Keeping CPMs from being licensed only serves to further marginalize
CPMs and exacerbate the problems AWHOON identified in its statement. Licensing
can serve to facilitate a CPM's capacity to consult with physicians, facilitate
transporting a patient who needs a different level of care, and gives
parents a public safety net for out-of-hospital providers. AWHONN should support
state legislation for CPMs if they truly want to see moms and babies who
birth in out-of-hospital settings be safer. Studies of clinical outcomes for CPMs
practicing in out of hospital settings strongly supports their safety
for healthy women experiencing normal pregnancies ( for example, see

2. Certified Professional Midwives (CPMs) are not the same as "lay"
midwives. A CPM undergoes educational training and a certification
process that is recognized by the US Department of Education. CPM training and
expertise in out-of-hospital settings make them the most appropriate provider of
out-of-hospital maternity care. If anyone wants to have a better
understanding of CPMs see the North American Registry of Midwives (NARM) at
Education Accreditation Council at

3. AWHONN states it supports CNMs; however, very few CNMs practice in
out-of-hospital settings due to limitations resulting from required
practice agreements and malpractice insurance issues, in addition to the fact
that CNM training does not specifically prepare CNMs to practice in out of
hospital settings. Patients who want to birth at home or in freestanding birth
centers often lack access to CNMs in these settings. In contrast, CPMs are
specifically trained to practice in out-of-hospital settings. Having state licensing
statutes for CPMs makes them both legal and accountable, making them
available to those women who want to give birth with their help.

4. AWHONN has a history of supporting evidence-based care. The research
continues to support the practice of "professional" midwives in
out-of-hospital settings (see Appendix article in
Opposing licensing of CPMs is contrary to AWHONN's mission as a
proponent of evidence-based care.

AWHONN Members can contact AWHONN at :
AWHONN Headquarters
2000 L Street, NW, Suite 740
Washington, DC 20036

Local: 202-261-2400
Toll free US: 800-673-8499
Toll free Canada: 800-245-0231
Fax: 202-728-0575
Email: customerservice@...


>From the Association of Women's Health, Obstetric and

Nurses Fall 2007 newsletter:


Certified Professional (Lay) Midwives Seeking Licensure Status without
Demonstration of Adequate Education, Training, and Physician Links

Certain associations representing midwives have been vigorously
pursuing the
enactment of legislation that would codify for licensure purposes, the
"professional" status of Certified Professional (Lay) Midwives.
AWHONN is aware of such legislative activity in Maine, Delaware,
Illinois and
Alabama and requests that AWHONN sections monitor such activities in
respective states and inform the Public Affairs Department at AWHONN
Headquarters immediately. AWHONN has prepared materials for use in
this unfortunate trend, which would contribute to placing patients at
risk in the face of deliver complications

AWHONN strongly supports the practice of midwifery by a Certified Nurse
(CNM), who is a registered nurse with an advanced degree and broad
range of
training in areas including pharmacology,
and formal collaborates with other health care professionals as an
of their Licensure to provide safe, holistic care.
Certified Professional (Lay) Midwives (CPMs), in contrast, have a far
limited apprenticeship and are not required to have relevant college
pharmacology training, or collaborative practice agreement with an
or hospital in case of complications.
Given the disparities in education, preparedness and professional
AWHONN is concerned that state Licensure of CPMs with have a
negative implications for women and their newborns.
The term "Certified Professional Midwife" is misleading to the public
about the breadth of education and training that the lay midwife may to
and AWHONN fears that licensing these lay practitioners will serve to
this misunderstanding and place consumers and patients at unnecessary
Take Action! This is an urgent situation that requires YOUR action!
Explore whether this issue has arisen in your state and let AWHONN's
Public Affairs Department know promptly. Contact Lauren Bates, AWHONN
Legislative Associate, at LBates@...
To see if your state has pending legislation to provide licensing for
CPMs, visit www.awhonn.org/policy and
click on "State Legislation".
AWHONN headquarters will assist you in developing an appropriate
response your section can then convey to your state legislators.
Your voice matters on this issue. AWHONN is not opposing lay midwives
their livelihood, but rather is against Licensure that could mislead
the public
and cause harm when services are
rendered by those who would be licensed as "professionals," but do
not posses the training or clinical affiliations typically required for
Licensure of trained health professionals.

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