What makes a profession?

I’ve read before that calling non nurse midwives ‘lay’ midwives is offensive somehow, because of their ‘extensive’ training and standards. They would prefer to be called a Certified Professional Midwive, or CPM. The middle initial prompted me to ask- What exactly makes something a profession? I’ve identified a few characteristics which can be said to apply to virtually any recognized profession.

 

The first is a standard of practice- this applies to everyone from a HVAC repairmen to an automechanic to a registered nurse. Real professions require a clear and defined set of practices or protocols to deal with specific problems. Do CPMs follow this standard?

 

No, they don’t. NARM (which certifies midwives, which in itself is entirely optional depending on the state in which a midwife practices has this to say):

NARM recognizes that each midwife is an individual with specific practice protocols that reflect her own style and philosophy, level of experience, and legal status, and that practice guidelines may vary with each midwife. NARM does not set protocols for all CPMs to follow, but requires that they develop their own practice guidelines in written form.

 

Can you imagine if people who worked at pharmaceutical companies, or toy companies, or car manufacturers, or a blood bank could just *decide* what made for a safe product? Whenever this has been allowed to happen the results were deadly. In the past hemophiliacs who needed blood products to live normally did become victims of a lack of legislation and oversight in the blood products industry.  They were infected with hepatitis and HIV and given little compensation for it. There is a heartbreaking documentary on netflix about it called Bad Blood. The results of decisions made during childbirth are no less consequential than decisions made about consumer products and drugs.  One could argue that the variability in street drug content and potency is another good example of what happens when an industry effectively has no real standard of practice.

 

You may be wondering, how do midwives recommend that parents find a competent practitioner in light of the lack of regulation? They typically believe it is up to parents to ‘research’ their midwives credentials, all while they refuse to have any kind of central governing body to make it possible for parents to adequately check the credentials of any midwife. Which brings me to my next standard….

 

Central, authoritative leadership is the second quality I’ve identified in a professional line of work. Real professions have leadership in the state (and possibly national) level, leadership which can revoke them from working in their chosen profession. Any deviance from a standard of professional practice is seen to diminish the profession as a whole.  Real professionals don’t want people working under their official title without having obeyed the strict standards of practice and ethics.

Local midwives organizations are not able to revoke practice in most cases, and when a local occupational or medical board CAN prevent a midwife from practicing its only at the state level. She can simply move to a state with fewer regulations.

National groups include NARM, whose accountability department is a real joke. They dodge the complaints of mothers who lost their children in home birth deaths. Here is a story of the run around given to mothers who had to bury their own children because their midwife screwed up. If you don’t believe me, email them yourself with a subject line about a negligent or dangerous midwife, and watch them avoid giving a meaningful response. I waited months for mine, and it had a disclaimer about how every midwife decides her own practice standards.

MANA is another national midwives group, but they mostly lobby for the profession. They refuse to set practice guidelines like defining what constitutes a “low risk” patient, despite referencing the phrase repeatedly to prove the safety of home birth. There is no way to discipline a midwife via MANA.

Out of the main two qualities that make an actual profession, CPMs or lay midwifes do not seem to obey either of them. Why is anyone obligated to call them a professional?

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