Earlier this week I wrote about how Navelgazing Midwife has come to accept some basic realities about pregnancy and childbirth that many homebirth midwives reject. It has been a long time coming.
I first wrote about Barb Herrera, Navelgazing Midwife, almost exactly 4 years ago when she transferred a patient to the hospital so someone more experienced could suture a tear. She acknowledged that she really didn’t have enough experience to suture a tear or insert an IV.
A few months later Barb described her experiences with two births, one a face presentation where the baby would have died without a C-section, the other a serious shoulder dystocia that could have led to the death of the baby. Then she offered surprisingly harsh criticism for another homebirth advocate who questioned the judgment of a provider:
In ignorance, for there is no other way to say it but this, [she] says that whenever a doctor or midwife speaks about induction because the baby is getting large, that that is a threat. Only someone who hasn’t struggled with a shoulder dystocia – either in her own vagina OR with one in her hands as a midwife – would say something so amazingly dangerous…
Once again, she acknowledged that experience had taught her many valuable lessons.
… [W]hen women came to me and said, “I don’t want you to do anything but sit in another room,” I used to obsequiously tell them I would. It is the woman’s birth, after all, right?
Then, with more experience, I woke up and figured out I couldn’t help if I didn’t monitor the mom and baby. It’s not like I’ll do vaginal exams that aren’t warranted or intrude in women’s space, but there are minimums that I feel are necessary for competent care and I no longer will compromise on that belief…
In fact, she went so far as to declare that the reason to hire a birth attendant is because of her experience:
When I am hired to be someone’s midwife, I am being hired as a consultant. I am being asked to share my experience and knowledge, to utilize my skills – the ones that can save a life…
Over the intervening years, NGM has gained more experience and has changed her views based on that experience. That is what a good practitioner does. In fact, she has come to believe that the experience required for certification or licensing as a homebirth midwife is so deficient that homebirth midwives are not safe practitioner. She has put her money where her mouth is, suspending her practice as a homebirth midwife until such time as she has greater education and experience. She deserves kudos for that decision and for having the wisdom and humility to publicly acknowledge her evolving views.
Yet there is a deeper issue here, one that I would like to ask Barb about. There are people out there who have the requisite experience that Barb knows she lacks. We call them certified nurse midwives. And there are people out there who come out of their training with even more experience than that. We call them obstetricians. Those CNMs and obstetricians could have (and probably did) point out to Barb that she did not have enough experience to be a safe practitioner and she blithely ignored them.
In other words, Barb demonstrated the Dunning-Kruger effect. She had so little knowledge on the topic that she couldn’t fathom how little knowledge she had. She had a dramatically over inflated view of her own education and experience. Simply put, she didn’t know what she didn’t know.
It is a problem endemic to homebirth midwifery and is probably inherent to homebirth midwifery. Homebirth midwives disparage experience because they have so little of it. To acknowledge the value of experience would mean acknowledging their woeful inadequacy as practitioners. So here’s my question for Barb:
Was there anything that anyone could have said to you at the time you embarked on your career that would have brought home to you the absolute necessity of copious experience in becoming a safe practitioner? Put another way: Is there anything anyone could have told you to convince you that you didn’t know nearly enough?
If I had to guess, the answer would be “no” because the philosophy of homebirth midwifery disparages the value of experience. And that’s why the homebirth midwifery credential (certified professional midwife) must be abolished. It was created for, designed by, and administered under the auspices of a group of women who have so little clinical experience that they don’t understand the value of clinical experience.
The CPM is a pretend credential for women who want to call themselves midwives but can’t be bothered to (or don’t have the academic skills to) obtain a college level degree in midwifery. It is a pretend credential for women who don’t want to spend the time and energy necessary to acquire the experience that is mandated for all other midwives in the industrialized world.
But maybe Navelgazing Midwife would disagree. Barb, is there anything we could say to homebirth midwives to wake them up to the fact that their education and training is deficient? Is there any way we could convince them of the value of experience?
