Comparing a Certified Professional Midwife to a "Birth Keeper"

There is a buzz in my area surrounding Birth Keepers. Who are they? From what I can figure out through my own research, Birth Keepers go through a weekend training of some sort, then calling themselves "Birth Keepers" and encourage mothers to have basically unassisted births at home without a trained midwife. I have heard that they will claim that Certified Professional Midwives (CPMs- midwives who undergo training and receive a national certification to work specifically in out of hospital settings) are "too medical" and they-the Birth Keepers-will give you the natural care you are actually looking for.
But I have some questions for Birth Keepers:
What qualifications do you have for making medical recommendations? A weekend course for giving comfort care to a mother in labor is great for doulas! But the training should include instruction on scope of practice. Medical advice is outside the scope of practice for a doula. Doulas can suggest questions for mothers to ask their provider and they can suggest that any medical interventions suggested be discussed with potential benefits and risks considered. But to give outright medical advice is outside of their scope of care.
I have heard of a situation where the Birth Keeper was giving medical advice to a mother-who was very much in need of hospital care- to not do any of the things this woman's caregiver suggested to her so she could have a safe and healthy birth. Sadly, the baby passed away because the mother had declined many interventions and even in-depth monitoring at the advice of her Birth Keeper.
What training have you had to take care of medical emergencies that are rare but can happen in a Homebirth setting?
Birth Keepers might suggest to their clients that they don't need to have trained midwives at their births. That they can just allow nature to take over and that their bodies will naturally do whatever is necessary to birth their babies. Birth is a natural process, but so is death! Are they willing to take responsibility if the worst outcome happens, if that outcome could have been prevented by simply having a qualified caregiver at their birth who would have been trained to handle the most common emergencies? CPMs often bring emergency equipment, medications and sometimes even IV fluids to births and are specifically trained to provide resuscitation measures to help babies who are slow to breathe on their own at the birth. They can normally stop excessive bleeding using medications and other methods to make sure moms stabilize after the birth. If hospital care is needed, they should be trained and prepared to recognize such situations and arrange transport. Birth Keepers do not have such skills and are not prepared to handle emergencies. Sadly, that could be the difference between life and death for the mother and baby! Mothers need to really know who they are hiring for their Homebirth and whether or not that person is adequately trained and knowledgable to handle emergencies. Not even all CPMs are the same! Some have not had enough training, because the minimum requirements to become a CPM are really not enough. The midwife you hire should have much more training than the minimum requirements.
Are you being upfront and honest with the mothers hiring you?
If you are not a trained midwife, be honest about that. Mothers hiring Birth Keepers or doulas need to know what services they receive from you and what your scope of care is. When mothers interview their doula, "Birth Keeper", or midwife they need to ask good questions that allow them to ascertain the person’s education, training, qualifications, back-up plan, certifications, number of births they have attended, etc. Ask really good questions. For the Doula or Birth Keeper you may want to ask:
*How many out-of-hospital/home births have you attended?
*Will you give me medical advice?
*Will you support me hiring a midwife to provide medical care for me?
*Tell me about your training and qualifications?
*What comfort measures do you offer?
*How will you support my husband/partner during pregnancy, labor and birth and involve them in my birth process?

For the Midwife you may want to ask:
*What are your qualifications/ how did you gain experience?
*Are you a Certified Professional Midwife/Licensed Midwife?
*Tell me about your training
*What does your prenatal care look like?
*When do you come to your clients in labor?
*What care do you provide in labor and birth?
*What postpartum care do you provide?
*What happens if I do not want the interventions you are suggesting? (Will there be any alternatives offered? Will I be able to say "no" to your suggestions? Will you explain why you make the suggestions you are making?)
What kind of testing do you offer?
How do you handle the more common emergencies that might come up at home such as baby not breathing right away/mom bleeding excessively after birth?
Will you provide comfort measures in labor or are you only there to provide medical care?

Most CPMs will offer wholistic care. They are not commonly "overly medical". Often, they will want to do minimal. important testing and thorough prenatal care. and will give you space and quiet while you labor. At the same time, a good qualified midwife is going to watch over you and your baby carefully to make sure no unexpected complications arise. But those unexpected complications, though rare, are the reason you hire a midwife (often a CPM) to provide you with prenatal, labor and birth and postpartum care! They are ready to step in if needed to handle emergencies. You want your chosen caregiver to be someone who is not only respectful but knowledgable and steady under pressure.
I am concerned that Birth Keepers are going to give Homebirth midwives a bad name and make Homebirth less safe. It is already difficult enough to find a good midwife in places like North Carolina, since pretty much all the Homebirth midwives are forced to practice underground. You can go over the boarder and have a "legal" midwife attend you in South Carolina or Virginia, but that will come with a big huge rule book, and some who feel they would be safe staying home will not be allowed to be attended by a legal midwife because of the tiny box in which they want home birthing moms to fit.

I just want to address one more thing before I close. It is very common for people to balk at the cost of Homebirth. They don't want to spend "that much money". But the Homebirth midwife goes above and beyond to give mothers the best care. Often much better than what they receive with a busy hospital practice, simply because hospital staff and doctors are overworked and have a huge amount of patients. A Homebirth typically doesn't cost even as much as most hospital co-pays for most people. And if you recognize the value of what you get in a good Homebirth midwife, you will realize you are getting a phenomenal deal. How many doctors or hospital midwives sit with their patients throughout active labor? Hardly any. Most are coming in at the last minute to catch the baby once the nurse sees baby is crowning. How many hospital nurses hang out in your room the entire time you are in labor? Hardly any! Most are going to hook you up to a monitor they will watch from the desk while doing a mountain of charting on their many patients. How long are your OB/CNM prenatal visits? 5 minutes long? 10 minutes? After you've waited an hour in the waiting room? How many questions do you manage to ask them before they shuffle you off down the hall to schedule your next appointment? With a good Homebirth midwife, you get at least a 30 min visit if not an hour long visit every time. You get someone lovingly feeling the position your baby is in and being excited about your pregnancy. You get someone who wants to answer all your questions and to help you stay low risk. There is so much more you gain, it is well worth the investment!

What about you? Do you have any experience with a CPM or out of hospital caregiver? Have you worked with a Birth Keeper? Do you have advice for others? Please leave your comments below. You can help others as they are making decisions concerning their births. Thank you.