Why the “L” in “LM” Matters

Opinion by Rosanna Davis, LM, CPM
President, California Association of Licensed Midwives

I am not a lay midwife.

I am a California licensed midwife. And I am going to insist that health care providers and policy makers understand why this matters.

My initial training included 3 years of didactic education and clinical experience as required by California law. I was trained and supervised under the direct supervision of licensed midwives, graduated from a Medical Board of California approved program of study and passed a board exam. My application for licensure included having my fingerprints taken and submitted to the licensing board, as is required of all other regulated health care professionals. I am required to take continuing education to advance my skills in order to maintain my license. I follow a midwifery standard of care in the provision of care to my patients. I have individual practice guidelines that I keep up to date as evidence and research informs the specifics of safe care.

As a licensed midwife my scope of practice includes caring for the mother/baby dyad during the complete pregnancy, childbearing, newborn and postpartum cycle. I facilitate standard screening and testing, and make health assessments regularly throughout the pregnancy. I prepare the family for the rigors of labor, for a safe delivery and newborn care. I give guidance for self-care and preventative measures, plus instruct parents about potential health problems that require follow up with myself and/or medical care with a doctor. I am present during the labor and birth, making necessary assessments and decisions in collaboration with the mother throughout to guard the normalcy of the labor and birth.

Fortunately, for healthy pregnancies and labors that progress normally, time critical urgencies and/or emergencies are rare. However, I am trained and experienced in managing situations like postpartum bleeding, shoulder dystocia, newborn resuscitation, most of which are managed quickly with no harm sustained and/or need for transfer or medical attention. For on-going and/or unresolved issues such as high blood pressure, prolonged labor, or need for pain management in labor I transfer my patients to a nearby hospital where they can receive more advanced care for their more complicated situations.

During a transfer I am legally and ethically responsible for professional communication with the receiving providers. During an emergency I will continue hands on emergency measures until a qualified other care provider can take over safely.

The first definition of a layperson is “a non-ordained member of a church.” Therefore, if one views modern medicine as a religion, then only doctors are ordained and therefore nurses and nurse midwives are handmaids of doctors.

The second definition is “a person without professional or specialized knowledge in a particular subject.” Therefore, obstetricians are lay midwives, not having received any training or experience in normal childbirth and/or the care of newborns, but still managing the care of 90% of cases of childbirth in the US, the overwhelming majority of which are normal. Obstetricians are trained in medicine and as surgeons, learning to manage all manner of illness and complication. No wonder a growing number of births in the US and in the west are done by surgery.

Medical associations, doctors and nurse midwives often refer to non-nurse midwives as “lay” midwives. However, the definition of a lay midwife is one without formal training and/or who is not licensed or regulated. In a health care system that holds credentialing and certification in high esteem, the use of “lay” when referring to someone who is highly skilled and also credentialed is clearly intended to be condescending and derogatory. It is a paternalistic practice in which other credentialed care providers participate to raise their own standing in a hierarchical health care system and to disparage the provider they are labeling as “lay.” It is disrespectful, misogynist and undermines collaborative relationships across disciplines and, therefore, undermines collegial communication and safe care.

I am a California licensed midwife—an expert in physiological supervision and management of pregnancy and childbirth. I am an emergency first responder for complications of childbirth. I am skilled, well-educated and behave as a professional with my clients and other allied health care professionals. I insist that I, my midwife colleagues, and our childbearing clients be treated with respect.