Licensure sends a loud message to women: YOU DON’T KNOW WHAT YOU ARE DOING!

January 25, 2012 at 10:23am

Where is the evidence that those who are demanding midwifery icensure are speaking for birthing women? Their actions say something else. Have you read Erin Levier’s story?


I think the pushers are speaking for monopoly, control, money….while they are telling women that they don’t own their own births.


.I think those who are working for licensure are telling mothers:

“…You are too stupid to make your own choices of who attends your OWN birth. “Trust us to make that decision for you.  We are more qualified than you are to make these decisions….” 

“… birth is medical and needs medical assistance, so don’t bother trusting your body…Trust us instead!”  (Sound familiar?)

“…only CERTAIN midwives–in fact just one brand– can be trusted” and “IN GENERAL, midwives cannot be trusted and must be regulated” (mixed message)

“…birth is not a normal function of biology and that birth is not a private family matter, it is a public health concern. ”  (actual quote in response to my promotion of birth as a normal function of biology)


The truth is that in licensed states, the state and/or state midwifery organization have more rights to a woman’s birth than she does.  Who has the right to tell any mother that she must trust THEM to make a number of decisions for her. Their power doesn’t stop at WHO can be there, but licensing boards also determine what the license holder may or may not do, regarless of the mother’s wishes. In some states a woman must put up with all kinds of invasion so the licensed midwife can comply with her regulations. In some states perhaps licensed midwives can still attend vbacs, breeches, etc. but that is not true in every licensure state.  Once licensing is complete, it will be only a short amount of time until no mamma with a birth scar or a baby with its own idea of how to come out will have the option of a home birth with a midwife.


The bottom line here is that in a state where the mother is not free to choose her own attendant,  the midwife/client relationship is fundamentally flawed.  Anytime a woman is told she may NOT choose her own birth attendant,  that someone else will make that choice for her, the relationsip starts out without integrity.  Deep in every woman’s heart she knows that SHE owns her birth. …but she is being coerced into giving away her choices and her power by people she wants to trust….but obviously they do not trust her?  I will not be complicit with any system that tells a woman that her birth is beyond her physical or mental or emotional capability.   How is it that ANY piece of paper trumps the mother’s ownership of her birth?


If you are opposed to licensure, please have the courage to say that.  Somebody has to speak up for the mammas and babies, and if not you, then …..who? 


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Carla Hartley is FOR the OPPOSITE of Licensure

Carla Hartley is FOR the OPPOSITE of Licensure

July 23, 2011 at 2:16pm

This was originally Carla Hartley is AGAiNST Licensure of Midwives….Yes, of all the things that are said about me on a regular basis, that one is absolutely 100% correct.  I am against regulation of midwifery of any kind, and that is what licensure is.  Licensure is for the purpose of identification, regulation and elimination…. AND…. for the richification of those who get to decide who does and doesn’t get that golden ticket.  They print it and they can decide what it costs.  It is NOT about qualification or education.  In fact, it is not at all about education except to decide which education provider can also get one of them thar golden tickets.  


Although most midwives do not think education is as important as I do, it is not my job to say who is or is not qualified to call herself a midwife. Mammas are smart enough to choose from the wide variety of people who want to offer their services as a birth attendant.


My proposition is that we help educate mothers as to what constitutes good midwifery vs. medical midwifery and/or inadequately educated midwifery.  It is not my job to designate who those are, nor to police them.  It is the parents’ job to either keep them in business or go elsewhere.  That is called free enterprise.


And remember that it is not so much that I am against licensure, but that I am FOR something else.  That something else is for parents to have the right to choose to birth anywhere and with anyone they want, even if that is no one.  Licensure will ultimately eliminate what I am FOR.


Licensure is a really hot topic and my stance keeps me in hot water, so to speak, but I have yet to be convinced that parents or midwives, for that matter, will benefit from licensure.  NARM, MEAC, MANA will….but that is a different note….the upcoming note on the richification aspect.


I am going to share here some of the questions that come my way frequently.


So what about the dangerous midwives?

I will not deny that there are many dangerous midwives out there.  Most of them have a credential.  Still, I think educating parents about what is dangerous and what is not, is the best way to address this issue.

There are already laws against hurting people.  


Don’t parents want licensed midwives?  Licensed midwives tell me that all the time; parents never do. They want something else entirely. Once in a while I will get a letter to the contrary but I can pinpoint it to one particular area where the midwives are writing the proverbial letters and having the mammas sign them. I can quote the letters verbatim.  They are all the same. 


Does this mean that you think that midwifery should be illegal and unregulated?  Illegal, no, unregulated, yes.  Midwifery could be, should be, maybe already technically already is legal by virtue of it being legal for parents to exercise their right to life, liberty and the pursuit of happiness in their ownership of the biological function called birth, which is a private family event.  Midwives don’t need regulation; they need freedom to practice midwifery (not medicine) and the “regulations” should come from the parents, not the government or any midwifery organization.


Do you think that midwives should be allowed to carry life-saving drugs, which licensure would allow? No, I do not.  I think that drugs = medical training, expertise and risk-taking that midwives have not attained, do not need and they should not take the inherent risks of the administration of chemicals.  Rather than licensing midwives, maybe there could be a license for anyone who wants to carry and administer drugs that involves the appropriate training, education and liability insurance?  Something to think about.  As for “life-saving”, education is far more likely to save a life, than the administration of a drug that has the potential to do all kinds of things that a midwife is not prepared to handle in a home situation.  Learn how to prevent and respond to those situations without drugs.  We have the knowledge, but it is often easier to just reach for a syringe, suppository or pill.  Not good science to do that without a very specific education and contengencies.


What about oxygen?  Oxygen is a drug.  Room air is more beneficial and far less dangerous.  I recommend taking every class you can from Karen Strange on the issue of neonatal resuscitation.


But won’t licensing bring midwifery into the mainstream and make midwives more likely to be respected?  I have never understood how anyone over the age of 12 could even imagine that licensing midwives could force doctors and hospital personnel to regard someone outside of medicine as equals.  Secondly, can you explain why would we WANT to be mainstream?  What has mainstream done for birth?  I will give you a hint, the numbers are over 34%.  Get back to me on this one.


Won’t licensing keep midwives from prosecution and persecution?  Hasn’t so far. If someone in the more powerful clan (medicine, government, midwifery organizations) want you, they can get you, no matter what credentials you have.  In medicine, and that is what we are talking about here, let’s be honest…. the only initials that really matter are M and D. 


Won’t licensing which mandates that insurance companies pay midwives mean that more women can have home births with midwives?  Mandating MEDICAL insurance coverage for a NON medical event is not a good idea for a number of reasons.  Birth is medical or not.  Choose.  If birth becomes medical, medical insurance should pay, but as long as it is normal….why?  I am not convinced that money is the real obstacle for women who are wanting homebirths.  I would have sold all my furniture to have a home birth with a midwife after my first birth in the hospital. For what we knew at the time, my husband and I worked a second job each to pay for so we could get the “best” aka most expensive for our baby. The insurance and medicaid aspect is tricky in many ways.  For one, it can and will have a cap and midwives will NOT want those clients once the cap is in place and then, the “poor” women are back where they were.   And the other issue that no one seems to address is how many women will choose home birth, if their insurance pays,  just for that reason….not because they trust it…but because their insurance will cover it or their friends are doing it.  I would rather work with parents who are willing to work to pay for a home birth midwife because it is THAT important to them.  As for the ridiculous “equal access” blarney, women have a lot more equal access in a free enterprise system than in any government run program, which is what home birth midwifery will be.


I live in an alegal state and all the midwives here are pushing for licensure.  Shouldn’t I be a part of that effort to make midwifery legal?  If your friends all jumped off a bridge, would you? Just because others are doing it, it doesn’t mean you have to.  I am going to let you in on a little secret here.  The emperor has no clothes.  I do not care who they are or how famous they are, if they are working for licensure of midwives they are NOT working for parents’ rights.  Parents’ rights are always in danger when midwives are pushing for theirs.


Why are so many pushing for licensure if it is such a bad idea?  I cannot tell you that. I just know it is a bad idea.  I can tell you why some are pushing for it and it has to do with the concept of monopolization. If the only people who can legally drive are those who drive Volvos, the Volvo folks are going to make out like bandits.  I will let you do the math….and watch for the upcoming note on how licensure is motivated by a desire for monopoly and money.


But why should midwifery be exempt from regulation when even people who give pedicures have to be licensed?  Licensing is never about protecting the public. Interior designers are being licensed now as are florists, and there is talk of licensing dance teachers.  Think about the need for those professions to be licensed for a minute.  Licensing is a golden ticket printed by someone else, that allows you to do what you do. It always takes money out of the individual pocket and puts it into an organization or government entity’s pocket.  Two wrongs, or in this example, multiple wrongs, don’t make a right. I am not persuaded that midwives need to be licensed on the faulty premise that we have to because everyone else is.  Look at why everyone else is. And you don’t want to get me started on the travesty of constraint of trade and the right to earn a living. I will put that in the richification note…..Otherwise, we would be here all day.


All the midwives in my state say you are crazy.  They are correct, but that does not tarnish the brilliance of the principle for which I work night and day. Mothers own their births.

Here are a few of my previously published notes on the topic of licensure and The Big Push.  Feel free to look through my notes for more.

 And visit



Background note:  I am completely FOR education and competition….I think if midwives are preparing to serve parents who have a lot of different midwives to choose from the will pay more attention to their education.  I think midwives should put years and years of concentrated effort into  becoming a midwife. I created the most comprehensive midwifery course on the planet.  My stance is that midwives need to know EVERYTHING, so that they are comfortable doing as little as possible.  DOING is what adds risk to the inherently safe biological function of birth.  I think midwives need a great deal more education than it takes to become credentialed o  licensed in this country, but I will have no part in any effort to determine who may or may not call herself a midwife and will not support any group that does.  That takes the power from the mother to choose her own midwife.   I AM FOR MOTHERS OWNING THEIR OWN BIRTHS AND EXERCISING HER OWN POWER TO CHOSE TO BIRTH WHERE AND WITH WHOM TO GIVE BIRTH


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Dear Up and Coming Midwife

I hope this letter reaches you in time. There is so much that you may not know about the world you are entering… I have some very important questions to ask you…

You may think that you are there to monitor mother’s in pregnancy. You may think that you are there to schedule this mama’s ultrasound appointments, and listen to the fetal heart with your Doppler. You may think you are there to fill out all the little boxes in your ACOG chart. You may think that you are there to test this mother for gestational diabetes, and test her urine and blood. You may think that you are there to teach her about the benefits and risks of each intervention that will be recommended for her birth. You may think that you are there to asses her risk level for vaginal birth and home birth. You may think that you are there assess fetal well being at the end of her pregnancy. You may think that you are there to decide if she is safe to go past 40 weeks, 41 weeks and as far as 42 weeks before induction is needed. You may think you are there to catch babies. You may think you there to suction, resucitate, clamp and cut the cord, inject this mama with pit and “guide” the placenta out with “gentle cord traction.” You may think you are there to ensure this birth is safe, to tell the mother when she needs to transfer, to latch her baby to  mother’s breast. You may think you are there to swaddle the baby and put a hat on it, and weigh the baby. You may think that you are going to do all of these things, or some of these things…

But have you considered what it would be like to do none of these things?


not a single one?


not even a little?



Have you ever held space for a mother throughout her pregnancy, while she described her pregnancy to you, and you took it all in, without an ultrasound and blood work to check her words against?Have you ever not done a single urine dip for an entire gestation? Have you ever listened to her dreams of her baby when she is 44 weeks, with no biophysical profile to compare notes with, and no fundal height on record? Have you ever left the home after the birth without having done a newborn exam, your chart empty? Have you ever just witnessed a pregnancy, even just one, without testing it, measuring it, doubting it, fearing it? Have you ever just trusted that dilation, effacement and decent was going as it needed to, without taking a single heart tone in labor?

Have you ever considered the importance of experiencing undisturbed pregnancy as a midwife? Watching the mama and baby dance in their journey towards what is full term to them? Only giving what is asked for and leaving the rest for them to decide on their own?

If you don’t know what undisturbed, uninterupted pregnancy and birth looks like, how are you going to know what isn’t normal?


If you don’t know what is normal, how are you going to know when help is needed?


If all your training is about the risks, the dangers, the what if’s, and the fear, how will you train yourself to trust this mama and her baby?


If you can’t answer these questions, and if your school or your preceptor can’t answer these questions….


Then no license in the world, no paper in the world, no letters behind your name will convince me that you are safe to be at this mamas birth…

Trust Birth. Trust Mamas.





~Ninja Midwife, 2013

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Unsuitable for Children

Unsuitable for Children.

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Who said, “You can’t have your cake and eat it, too”……….?

If you want to be paid by the state to attend a woman’s birth, do not be all shocked when the state says: “on our terms.” That is the way it works, people.
When you ask for licensure and third party reimbursement you are asking for regulation and stipulations and control……
And please do not tell me that the only way for women to be able to access midwifery assistance is third party reimbursement…..that is simply not true. Midwives CAN lower their fees, take payments, barter, take credit cards…paypal….and make all kinds of concessions. What midwife would turn away a truly needy mom who was willing to clean the midwife’s house for a year in exchange for help at her birth? You do not need to demand that the state or an insurance company pay you to help women…..What I respect is the midwives I see who are looking for a way to help women rather than looking for a way to get paid for helping women….I am not saying you should not get paid…..just that you should get paid by the women you serve. That is good for you AND good for her……


~Carla Hartley

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No frogs were boiled in the writing of this note…but the metaphorical reference is intentional…


So all this uproar about licensure doesn’t affect you….right? WRONG….if you are a mother or a midwife, it definitely has the potential to change your life in a major way. If you are a mother, you will find that licensed midwives are NOT allowed in some instances to serve you because of history or your size or age…..or you won’t be able to choose a veteran 35 year midwife with stellar stats because she chooses not to align politically with the ONLY licensing group…..or you may find that the cost of hiring a midwife has much for that inceased access theory if you don’t qualify for medicaid and have no insurance coverage..and what happens when the insurance companies start limiting coverage, which is their right? It will cost a midwife a LOT more to get the credentials since MEAC and NARM will be the ONLY grantors and they can and will charge whatever they want…and keeping a license will prove to be costly…again just because the exclusivity makes that possible….

If you are a papered up midwife, with a CPM and a license, you may not have thought of this…but the reality is that you will be forced to practice medicine without a license under the guise of practicing midwifery. The administration of drugs and oxygen are indeed medical…(which, if you really knew your stuff, you would know that these are REALLY dangerous ideas.) And year after next you might have to start on your master’s degree in order to maintain your status….Often, you will find yourself practicing CYA style rather than just serving the way you want to. You will be pushed into many corners where you have to choose between serving women and serving those who gave you the paper….remember that they can take them away for any reason they choose with no real recourse on your end.

Here are some facts….licensure does not mean you are a better midwife, the CPM doesn’t mean you are a better midwife than one who chooses not to attain that title….In fact the most incredible midwives I know have put their investment into education rather than credentials. An in-depth education that is sought voluntarily has far more integrity than a short easy one to prepare for a test. And that is all that many CPMs and licensed midwives have to offer. Very few have gone beyond the “entry level” education and testing required for the CPM. At the onset of the CPM credential, I asked NARM to reconsider the long term ramifications of creating a credential, and specifically of creating one that is so easily obtained. At that time, two thirds of my enrollment was experienced midwives, many with 300 or more births and some with 1000 or more. As I predicted, once the credential became the goal, the really thorough education we offer would not be so highly sought after. I was right. Almost no experienced midwives enroll in AAMI’s Advanced Midwifery Studies anymore. We have many dedicated and brilliant students, but most of them are inexperienced and only starting their journey.

AND papering up says a lot of things about you that you may not want said next year or the next….Do you really not mind if mothers’ rights to choose anyone they want are taken away? Do you really want to sign a paper that affirms that you will rat out other people who attend a birth? Will you really agree to carry drugs and oxygen, induce, use a doppler or routine vaginal exams after you have done the research like we do at AAMI about the dangers of those? Will you agree to be liable for NOT practicing the way that NARM, MEAC, MANA and your state entities want you to practice…..practices that are based on medical myth and NOT on science or respect for mothers’ ownership of their own births? It is important for you to stop thinking this is about OTHER people. If you are a birthing woman, or someone who serves birthing women, everything is at stake here. Everything.

A last word about qualifications and education. I honor the fact that mothers own their births. Each mother has the right to choose where and with whom to birth, even if that is no one. However, I think that any woman who calls herself a midwife should know a lot more than what it takes to pass the NARM exam. My conviction, as a midwifery educator of more than three decades is that it takes a lot more education to not interfere with birth. Midwives need to know everything in order to be competent and confident doing as little as possible. That is what KEEPS birth safe. It starts at safe….it is usually what WE do that adds risk. And that is the difference in the principles I stand for and those who are pushing for licensure. I do not believe birth is a medical event except for a small percentage of women some of the time. I believe that birth belongs to mothers and not to medicine or midwives. I do not think midwives should be trying to be part of the medical system that has proven it has little regard for mothers and babies and no faith in the process. I think midwives should be putting their desires for “recognition” or third party reimbursement aside, in light of the far more pressing issues of protecting a mothers right to choose her, or anyone, or no one. Once parents’ rights are gone, midwifery rights will be a moot point……and it will be too late to jump.

~Carla Hartley

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Birth Truth on Labor Day!


BIRTHTRUTH on Labor Day is an annual Labor Day weekend effort to raise awareness of birth issues and encourage women to find the facts and exercise their rights to make the decisions about their own births….
No one can give your birth back to you….you have to take birth back. We are here to help you do just that!

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