Update on North Carolina’s Certified Nurse Midwives

It’s been nearly two weeks since Dr. Henry Dorn informed the certified nurse midwives for whom he was providing physician back-up that he could no longer do so. When I wrote about this issue before, I said I didn’t know all the factors — and I still don’t.

I’ve heard that this was “in the works” for months between Dr. Dorn and the North Carolina board of medicine — and yet all of the affected certified nurse midwives were SHOCKED by his announcement email. I speculate that he knew something was happening and didn’t share information with his CNMs until it was official. However, nothing “official” exists yet: according to the North Carolina board of medicine, Dr. Dorn has no sanctions from them; he’s never even had a patient complain on record.

However, they cannot comment on pending complaints or investigations.

Just after Dr. Dorn’s announcement, I saw an email from the North Carolina board of medicine, sent to physicians, asking them to contact the NCBOM with evidence of adverse outcomes from homebirths — but only if it’s public record; no HIPAA violations, kthnxbai! (Note: I saw a picture of the email on Facebook, through a friend-of-a-friend, and I’ve searched in vain for it, but can’t find it right now.)

I haven’t heard of any particular incident that preceded Dr. Dorn’s decision and subsequent notice to the certified nurse midwives he was supervising. He has not made any public statement.

Today I read an article which noted that the Certified Nurse Midwives were given a 75-day “grace period” to continue practicing. Under the proposed law — which isn’t law yet, but is being followed as if a law — certified nurse midwives have 45 days to continue practicing after suddenly losing a supervising physician, while they search “diligently” for a new physician, and then can file for a 30-day extension.

So, this is a small victory for the certified nurse midwives — and more importantly, THEIR CLIENTS — but the problem is that the certified nurse midwife interviewed for the article said that she’d appealed to four obstetricians and had been turned down by all due to malpractice concerns. And I don’t think she’s in the minority; I think most of the certified nurse midwives will have a difficult time finding physician backup because of concerns about litigation.

Thus I bang my head on my parents’ lovely granite kitchen table (I’m on vacation. I’m typing this from my mom’s MacBook Pro. I have no idea how to cut/copy/paste, nor insert photos. Sorry!) Usually, North Carolina is busy insisting that certified professional midwives aren’t competent enough to legally attend homebirths (unlike in South Carolina, Tennessee and Virginia, to name just a few of our fellow southern states where certified professional midwives are legally recognized and allowed to attend homebirths). Nobody debates that a certified nurse midwife is a skilled attendant for homebirths. And yet, because of something that may or may not have happened, within legislation that is decidedly NOT transparent — the law is not very easy to read nor interpret regarding physicians supervising nurse-midwives — a lot of  pregnant women are without a provider come September.

These women may make up a small percentage of all the women who will have babies this year. But they matter. Their rights matter. They are not going to acquiesce on their home birth plans just because they are being strong-armed into a hospital birth — or being somewhat forced have a potentially-dangerous unassisted homebirth — just because their provider’s rights (and thus, their rights) are stripped. There must be a better way.

I hope to update again in the near future with more information.

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7 Responses

  1. As one of the Mommy-to-be’s who lost my planned home birth with a CNM over mess, it’s good to see a continued focus on this issue, even after the initial dust has settled. A few comments/additions of my own:

    The letter you reference was actually sent by the NC Ob/Gyn Society (not that it’s any consolation that it wasn’t the medical board). Here’s a link to the letter: http://wheresmymidwife.org/2012/06/06/a-sad-day-in-nc/

    As a result, the group ‘Where’s my Midwife’ has requested a meeting with the NC Ob/Gyn society. Not sure if it will happen, but you can keep up with the latest on their facebook page.

    As for the 45/75 day extentoin, while I indeed think it’s a step in the right direction, it doesn’t help me personally and I would suspect many other mothers, too. I’m due in October, which would exceed the potential 75 days. While I could go back to a home-birth CNM at the moment (although the practice I was formerly with closed altogether), I shudder to think what would happen to me (again) if they continue to not be able to find backup care after the 75 day period. Unfortunately, I have a feeling the CNMs will continue to have great difficulty finding a new supervising physician. It’s a risk I cannot take that close to my due date, and I simply cannot emotionally handle what I went through two weeks ago again. Thus, I will not be returning to a CNM with this pregnancy.

    While I am certain that many other women in my position will continue with their home birth plans in an alternate fashion, I personally am not comfortable with a CPM for home birth. Luckily, the birth center in Chapel Hill squeezed me into their schedule, as they’re pretty much always booked full. I’ve heard they’ve done the same for some other women who were left high and dry. Otherwise, I would have indeed been strong-armed into a hospital birth. I hate to think that I would play into the hands of the medical society (and already have, to a certain extent), but I also have to think of the safety for me and my child. It’s pretty much a lose-lose situation, unless we can get these crazy, outdated laws changed for good. Perhaps in time for my next child, somewhere down the line. Makes me so terribly sad (and outraged) that my first child won’t have that right…….

    • I’m so sorry that you have to go through this while you’re pregnant. You do not need this stress! I hope you’re able to process the situation and can come to terms with it before the birth. (Aside: I highly recommend hypnobabies for dealing with unexpected issues in birth. I used it while pregnant with #5 and it helped me process my disappointment with #4’s birth.) I’m interested in the birth center at Chapel Hill — from what I hear, they are ALWAYS full. How does that help women? I would like to see them hire more midwives to serve more women. The Carolina Community Maternity Center (in Fort Mill, SC, just outside Charlotte) takes clients all throughout pregnancy — even in labor if they have paperwork from their former provider.

  2. Thanks for your comments. 🙂 I’m at peace with being at the birth center now that I’m confirmed there. In those few days that I didn’t know what I was going to do, I was NOT ok, though. I’ve heard about the hypnobabies and need to look into it more. Thanks for the recommendation. I think the birth center actually does some of those classes. Honestly, I think they try to stay small-ish on purpose – so that they can provide more personal care for their clients (which I certainly want). According to them, they’re already the second busiest birth center in the US. Maybe the solution would be to just have MORE birth centers, or fix this darn midwife issue so that those of us who would prefer to do it at home aren’t clogging up their system!

  3. Please read this post that I found from Jan 9 2012 by one of the midwives involved. Why were they “SHOCKED” about this news in May? It seems that they were aware of the issue from the beginning.

    http://marksloanmd.wordpress.com/2012/01/06/home-birth-tragedy-in-north-carolina/#comment-302

    • Interesting link, Lisa! I don’t know where the “shocked” comes from, but I read it over and over from the NC CNMs I follow on Facebook. I assume that they were just burying their heads in the sand that Dr. Dorn’s testimony wouldn’t change the status quo. As I’ve written, I have not read the restrictions on CNMs but they sound extremely… restrictive. North Carolina is not a great place to live if you are a minority or a marginalized population.

  4. I think the midwives were SHOCKED that 6 months after they had been warned that they might lose their supervision and therefore their licenses, that they were going to have to tell their patients who were expecting a homebirth, that they would need to seek care elsewhere. Perhaps if they had communicated to these expectant moms this possibility earlier, then this ‘crisis’ would have been somewhat averted, as patients could have prepared alternatives.
    The fundamental issue at hand is the dependence of midwives on MDs, who are essentially competitors in the current system, for their survival – a perfect formula for such outcomes. It is a wonder that Dr. Dorn agreed to supervise the midwives in the first place, given the potential medicolegal risks and lack of financial benefit.
    The law regulating CNMs needs to be changed, and this battle must be fought in the legislature, not the Medical Board.

    • Well said, Lisa. It’s a wonder that competitors are supervising — and probably not in the best interests of the mothers and babies. The doctor has no incentive, financial or otherwise, to support the CNM. You raise some really interesting thoughts.

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