I am so deeply saddened by the American College of Nurse Midwives’
decision to fight the inclusion of Certified Professional Midwives in
health-care reform. 

I have a lot of respect for the work of
Certified Nurse-Midwives (CNMs), who are trained as RNs and go on to
pursue graduate-level education in midwifery, similar to a
Nurse-Practitioner or ARNP.  Most practice in hospitals under the
supervision of an obstetrician, and they are recognized in all 50
states.  Because of their status as medical professionals, CNMs are
able to both serve women who may never have heard or considered
out-of-hospital birth and receive reimbursement from insurance and
government-funded Medicaid programs.  They provide humanized birthing
care within the hospital, often reducing intervention and improving
outcomes in poor or under-served communities.  They are able to do
this, again, because they are legal recognized throughout the country
and by the federal government as health-care providers.

Certified Professional Midwives are not nurses.  They are, I would argue, health care providers but not medical professionals. 
For most healthy women, birth doesn’t need to be a medical event, and
what they need is primarily someone to safe-guard and support the
healthy choices they will make when given good information.  CPMs
practice exclusively in out-of-hospital settings, including homes and
free-standing (i.e. not hospital affeliated) birth centers.  They
recieve  the CPM credential after demonstrating that they have an
agreed-upon set of skills which are necessary to facilitate normal
birth and manage the rare emergency.  Their training takes place primarily outside the hospital, allowing them to approach birth from the perspective of normalcy rather than from the perspective of medical emergency.  Unfortuanately, in many states,
CPMs are not recognized health care providers.  Their clients must pay
out-of-pocket for services, their access to medical referral is
limited, and their practice is sometimes tolerated by Attorneys General
who choose not to prosecute them for practiing medicine without a
license.  Thus, though many healthy women could be good candidates for
out of hospital birth, they have never heard of CPMs or are too poor to
pay for their care.  

Health care reform could change all that. 
If the CPM was recognized as a health care provider by the federal
Medicaid program, out of hospital birth care could spread to women who
now could only be served by doctors and nurse-midwives, and the stage
would be set for incorporation of CPMs into the health care system
nationwide. 

I wish the ACNM would rejoice and support this possibility instead of lobbying congress against the expansion of midwifery in the US. 
Their claim that graduate-level education is required to support a
normal physiologic process falls flat in the face of the broad evidence that CPMs provide safe and competent care to healthy women and babies, and reports of dangerous abuse of intervention by birth attendants who receive the most post-graduate education.