Jill Duggar is Now a Lay Midwife

[Jezebel Duggar]

I don't really understand when (if) Jill transitions from a "Lay Midwife Apprentice" to an actual Lay Midwife. Maybe the laws in Arkansas are different, but in the states I have lived in, a CPM is a certified direct-entry midwife and a Lay Midwife is just someone with training, but no certification or legal recognition. Is Jill on track to become a CPM?

No, she is not. They have CNMs (Certified Nurse Midwifes) who are actual college educated nurses, and then they have Lay Midwifes who were originally only allowed in poverty-stricken counties!

It was determined by the General Assembly that adequate maternal care is not readily available in some parts of the state resulting in undue hardships to poor expectant mothers. Act 838 of 1983 provided for the lawful practice of Lay Midwifery in counties having 32.5% or more of this population below the poverty level. Act 481 of 1987 supercedes Act 838 of 1983, and expands the Lay Midwife licensure statewide.

http://www.healthy.arkansas.gov/program ... ifery.aspx

[gustava]

As Jezebel noted, Jill is not a nurse or on track to become one. Here are some of the requirements to move from Apprentice to Lay Midwife:

4. Practical Experience

The applicant must submit a notarized statement that the following minimal practical experience requirements have been performed under the supervision of a Physician, Certified Nurse Midwife, or Licensed Lay Midwife. The applicant must also provide the name and a current postal address of the supervisor to allow verification by the Division.

Applicants for licensure must demonstrate competency in performing clinical skills during the antepartum, intrapartum, postpartum, and the immediate newborn period. Each applicant must successfully complete an evaluation of clinical skills. The “ Clinical Evaluation of Apprentices†form must be completed by the preceptor and presented with the application for licensure.

5.

This form should be submitted only after the applicant has a "pass" on each item except for certain emergencies that may not occur during a preceptorship.

When practical experience has been obtained outside of Arkansas, the Lay Midwife Advisory Board will review the preceptorship and make a recommendation to the Division concerning its adequacy.

a. The applicant must attend a minimum of 20 births as an active participant. b. Functioning in the role of primary Lay Midwife under direct on site

supervision, the applicant must attend a minimum of an additional 20 births, of these:

a. A minimum of 10 must occur in an out-of-hospital setting and b. A minimum of 3 must include at least 4 prenatal exams, birth

attendance, the newborn exam, and 1 postpartum exam, each

conducted personally by the applicant with direct supervision. c. 75 prenatal exams, including 20 initial exams

d. 20 newborn exams

e. 40 postpartum exams

Licensing Examination

After provisions 1-4, listed in Section 301.01, are satisfactorily completed, the applicant is eligible to sit for the licensing exam.

1. Pass the North American Registry of Midwives (NARM) written examination. The exam may be administered by the Arkansas Department of Health and Human Services, Division of Health, or at a regularly scheduled test site arranged through NARM.

2. Pass the Arkansas Midwife Regulations exam with a score of 75% or higher. This exam is administered by the Division.

3. If necessary to obtain a passing score, the examinations may be taken up to three times. If the Midwife fails either the NARM exam or the Arkansas Midwife Regulations exam three times, she must repeat an apprenticeship before being allowed to re-test.

[3 is enough]

First, kudos to Jill for pursuing her dream. She's doing the best she can with the limited opportunities given to her, and the state does recognize lay midwives. Hopefully at some time in the future she can continue with her education and get a CNM, but if not, she will still have a career.

I noticed that one of the Query sisters is also on the list as a licensed lay midwife apprentice. With Jill and Miss Teresa that's 3 in Washington County, not counting any who have passed their certification. The county only has 200,000 people. Is there that much of a demand for lay midwives? Personally, I would choose a doctor or CNM to deliver my babies. Maybe it's an economic thing? The lay midwives probably have lower fees, and possibly there is a large segment of the population who aren't insured or can't afford to see OB-GYNs or CNMs. Or are there really that many fundies in their neck of the woods?

Nevermind. As I was typing this, Jezebel Duggar found the info to answer my question. I guess it is an economic thing.

[sassycupcake]

Thanks, Jezebel Duggar and gustava, for clearing that up!

It sounds like a licensed lay midwife in Arkansas is very similar to a Certified Professional Midwife (CPM) in other states. CPMs are direct-entry, which means they have no nursing education or experience, but must complete hours of guided experience and pass exams to become licensed. I was confused because a lay midwife typically means someone who is not licensed, at least in areas where licensed direct-entry midwives are called CPMs.

I knew she wasn't going to be a CNM, that would require a post-SOTDRT education beyond CollegeMinus!

[browngrl]

My guess is that they something underneath the scrub skirts. Knowing how Mullet is she would probably demand that her snowflake Jill wear something underneath a scrub skirt.

Some of the nurses and one doctor that I worked with liked the scrub dresses better than the pants (I've never seen just a scrub skirt but don't go to the OR often now). The people who liked the dresses would usually wear tights underneath - it is cold in the OR. I don't think it would matter that much if you wore a dress or scrubs - you could easily put on one of the gowns that are made to be put on over scrubs for extra protection from bodily fluids.

[Kitchen Princess]

Because the surrounding counties around Washington county are rural, there is a demand for midwives and other birth services much larger than just Washington County. When someone I know had her two VBAC home births in north central Arkansas, her midwife had to come from a county and a half away.

[chaotic life]

The US is unique in that we have a path to midwifery that tracks through nursing. It is not that abnormal to go directly to midwifery and not track through nursing. The US is the only nation that requires it and did so back early 1900s when OBs campaigned to wipe miwifery out of existance for the express purpose of channeling obstetrical work through doctors instead of the midwives women preferred to use for their care. The AMA forced midwives to track through nursing in a claim that it would make them somehow more legitimate and altered the scene of midwifery in the US. DEMs never entirely disappeared, and the movement to reinstate them to their position is growing across the US.

I know in Australia that to get into a midwifery program in University requires higher entrance exams than nursing. I also know there are still a few collegiate programs geared specifically towards midwifery and not this new fangled CNM concept.

The problem is that in attempting to eradicate midwifery, the US developed an ad hoc system whereby DEMs do not meet the same requirements and training. Certification through NARM is attempting to restore standards in the profession and obtain recognition in all states for CPMs. In states where midwifery is legalized, this effort is working relatively well, as the states can identify those who are genuinely CPMs versus unlicensed DEMs. In states that continue to criminalize all midwifery except that which tracks through nursing, the situation is far more dangerous and inconsistent. I'm aware that in some states without legalized CPMs, some anabaptist midwived declare themselves DEMs with as few as five birth attendents, and not always as the primary midwife on the case.

You do not have to track through nursing to be a qualified midwife. Most of the world considers that a crazy concept in the first place. You do have to be more careful of midwives not tracked through nursing in the US because of the inconsistencies in DEM in the US now. Arkansas has legal requirements to recognize and license midwives. Their requirements conform to CPM requirements whether they call their status CPM or not.

It's good that Jill is pursuing this now while she is unmarried. It becomes more complicated to become a midwife after married with young children. If she follows the same path as her family, she will likely eventually have to choose between giving up midwifery or giving up quiverful. I know very few CPMs able to balance large family and midwifery and far more who give one idea or the other up as less important to them. I hope if she walks away from midwifery it is because *she* deems a large family more important for her and NOT because she has been groomed and brainwashed into believing she must accept a large family as inevitable and she has no alternative choices.

As for choosing CPM versus CNM, I know plenty of non-religious, intelligent women who choose that path because they philosophically believe that midwifery does not belong in the nursing track. I even know crunchy CPMs who had backgrounds in nursing and opted for CPM instead of CNM because they felt so strongly that they don't go together. Fundamentalist Christianity is only a small portion of the crunchy, alternative birthing community in this nation. Most are far more liberal and alternative (often not Christian at all) than the Duggars. Jill Duggar could have examined her options and gone down the path of CPM versus CNM without her religion dictating that this was her *only* option.

On the bright side, she may be the one to escape. Finding a Fundie brand husband willing to support a wife who is already in training or perhaps already attains CPM before meeting him will automatically lead to more liberaly suitors, longer waiting before considering marriage, and more liberal and freedom exposure than her family and religion holds by it's very nature.

[Visionoyahweh]

I can't be happy for her like everyone else is. She's still stifled. As soon as she gets married, it will be the end of everything. The only reason she's even allowed to do this is for publicity so the Duggars can claim one "success" from the SOTDRT. And we all know that Jill will use her position to proselytize, if she's even willing in the first place to work with non-fundies.

Thank you. I want Jill involved in something hat isn't childcare, childbirth, or submissive marriage.

[Coconut Flan]

I'm glad to see Jill doing anything that is remotely independent and that she could use to support herself if she needs to or wants to be on her own. It seems big step up from Sarah Maxwell and similar SAHDs. Granted there is so much more she could do, but it's also so much more than many of the young women in the movement have attempted to do or have been allowed to do.

[mockingbird]

I am cautiously happy for her because in the pictures she has a genuine smile. I haven't seen any of the Duggar girls look so happy for awhile.

However I agree that it could be likely that she will stay forever an apprentice or be forced to give up her career. I don't have much hope she'll be able to break out of the fundy world.

[Guest LilaFowler]

I know this is probably a dumb question, but do lay midwives get paid?

[purpleeee]

I know this is probably a dumb question, but do lay midwives get paid?

Googling around gives very different estimates of Jill's possible income. Some people say they've paid their lay midwife $2,000-3,000; this site http://www.motherearthnews.com/Modern-H ... eback.aspx suggests $12,000 per year is high, on average. I can't imagine she'd have only 4 to 6 clients a year. But perhaps most lay midwives are part time.

While it's true she's not straying far from the beaten kids-kids-quiver-birth-kids-mothercult track, what I like is that she'll have a skill and possibly some (even if low level) certification. It gives her an out that truly sheltered unskilled SAHDs don't have.

P.S. Here are the rules for Arkansas: http://www.healthy.arkansas.gov/program ... ifery.aspx

[Guest LilaFowler]

Thank you!

[terranova]

Thank you. I want Jill involved in something hat isn't childcare, childbirth, or submissive marriage.

If I had to choose between a submissive marriage and midwiffery, I know what I'd choose. I hope Jill is happy and feeling fufilled in her life.

[moreorlessnu]

Thank you. I want Jill involved in something hat isn't childcare, childbirth, or submissive marriage.

I'm thrilled that she is able to go off and do something without any other family member in attendance. I'm also thrilled that she'll be exposed to all types of people (hospital personnel if not the actual patients and their family members).

[chaotic life]

Most CPMs generally take 4-6 patients per month, not per year. They average $50-$70,000 annual income according to stastitics I could find. From the looking I did on income, it appears midwives in Arkansas are on the upper, not the lower end of that income average.

What I don't see is whether the salary is net or gross. Most CPMs are self-employed and have to pay for their office/equipment, their continuing education and pay their assistants out of what they earn, not an additional fee to the clients.

That said, in states where they are legal, midwives do better because they can bill both private insurance and often state insurance programs, which allows more people to get them paid for and their demand goes up.

[ScaryMagdalene]

This girl is not ready for what's to come. She's probably attended 5-6 happy normal births.

When birth goes south, it goes fast. Shoulder dystocia, hemorrhage, retained placenta, abruption, just to name few. You have to be quick on your feet and you need to know what the next step is automatically. No time to stop and ask Jesus.

Example:

Extreme post-partum hemorrhage, sometimes when the uterus can't clamp down properly, you have to do it for her. This entails inserting your fist into the birth canal and applying pressure integrally and externally. Meanwhile, blood is pumping down your inserted arm. This is called Bi-manual compression.

Can you really see this sheltered girl pulling this off? Or even able to watch , so she can learn? Midwifery is not all cute babies and happy families. Sometimes it's downright brutal, scary and depressing. Just my .02 as a former midwife. Now, back to lurking.

[Handmaiden of Dog]

Most CPMs generally take 4-6 patients per month, not per year. They average $50-$70,000 annual income according to stastitics I could find. From the looking I did on income, it appears midwives in Arkansas are on the upper, not the lower end of that income average.

What I don't see is whether the salary is net or gross. Most CPMs are self-employed and have to pay for their office/equipment, their continuing education and pay their assistants out of what they earn, not an additional fee to the clients.

That said, in states where they are legal, midwives do better because they can bill both private insurance and often state insurance programs, which allows more people to get them paid for and their demand goes up.

What about malpractice insurance? I know that OBs in America have very high malpractice insurance premiums because so much can go wrong and a family left with a handicapped child are often pressured into suing so that the child can be cared for.

I lost my first child but chose not to sue (although my OB was investigated by the board and lost his hospital privileges) because I didn't want any blood money, but I know that I am odd in this stance.

[moreorlessnu]

This girl is not ready for what's to come. She's probably attended 5-6 happy normal births.

When birth goes south, it goes fast. Shoulder dystocia, hemorrhage, retained placenta, abruption, just to name few. You have to be quick on your feet and you need to know what the next step is automatically. No time to stop and ask Jesus.

Example:

Extreme post-partum hemorrhage, sometimes when the uterus can't clamp down properly, you have to do it for her. This entails inserting your fist into the birth canal and applying pressure integrally and externally. Meanwhile, blood is pumping down your inserted arm. This is called Bi-manual compression.

Can you really see this sheltered girl pulling this off? Or even able to watch , so she can learn? Midwifery is not all cute babies and happy families. Sometimes it's downright brutal, scary and depressing. Just my .02 as a former midwife. Now, back to lurking.

Do you think Jill's supervisor has allowed her to attend any potentially problematic births? Or, only those that the supervisor assumes will go swimmingly?

[PennySycamore]

Malpractice insurance for midwives (CNMs, CPMs or DEMs) is, I think, still rather low compared to that OB/GYNs For CNMs at least it's risen somewhat, but it's still way lower than it is for OBs

[ScaryMagdalene]

You can never assume anything with birth. Ever. Things go bad with a quickness that can be terrifying. Everything normal one second, the next thing you know you're doing cpr on a newborn. You can never predict what's going to happen next. If her supervisor is at all competent, she wont hide her from the realities of birth.

I doubt competency though, I think her supervisor see's a high profile apprentice could equal more clients. I'm not a huge fan of CPM's. They're dangerous.

[moreorlessnu]

I think her supervisor see's a high profile apprentice could equal more clients.

This. I also wonder if this is why some of the moms are letting Jill be involved in the delivery.

[terranova]

You can never assume anything with birth. Ever. Things go bad with a quickness that can be terrifying. Everything normal one second, the next thing you know you're doing cpr on a newborn. You can never predict what's going to happen next. If her supervisor is at all competent, she wont hide her from the realities of birth.

I doubt competency though, I think her supervisor see's a high profile apprentice could equal more clients. I'm not a huge fan of CPM's. They're dangerous.

Almost our entire maternity system is midwife based. We are only referred to a specialist if there is an issue during pregnancy.

Sure there are incidents, but there are incidents with obstetricians delivering and caring for the baby too. Plus, the obgyn doesn't provide inhome, after birth care that the midwives do. I would go with a midwive over a obstetrician during a normal pregnancy anyday.

[purpleeee]

Is Jill's supervisor also a lay midwife or a certified one? If lay, she won't attend any high risk birth, though as mentioned any birth can go scary without warning.

From the Arkansas rules, once she is licensed, Jill will have to give clients a disclosure form listing the risks and benefits of both home birthing and hospital delivery (though the rules don't specify what she actually will have to tell them). She'll also have to make an emergency plan for every client that includes

provisions for transport to the nearest hospital with an obstetrical service, or to the

hospital where the Physician or CNM has obstetrical privileges. This hospital must be

located within 50 miles of the planned delivery site.

And she'll have to ensure all her clients also see a CNM at least, or a doctor, to determine if home birth is ok. She won't be allowed to attend a VBAC, twin pregnancy, or premature labour.

An under-the-table midwife, God knows. I'm glad Jill's going for a license.

50 miles?!? That's an hour's drive. Yikes.

[ScaryMagdalene]

I never said midwives were dangerous. I said CPM's were dangerous. Statistics don't lie.