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Exploring Midwifery Regulation and Prosecution

Exploring Midwifery Regulation and Prosecution: The Case of Ana Pereira in Portugal

 

2023

 

Abstract

This conversation discusses the case of Ana Pereira, a midwife in Portugal who was prosecuted for practicing without a valid license following a perinatal death during a home birth. It explores the details of her prosecution, the reactions from various stakeholders, and the potential implications for midwifery regulation in Portugal. The conversation also delves into the comparison between the International Confederation of Midwives (ICM) and the North American Registry of Midwives (NARM) regarding accreditation standards.

 

Summary

Ana Pereira, a midwife practicing in Portugal without a valid license, was prosecuted after a perinatal death during a home birth. The case was initiated by the parents of the deceased newborn, leading to a fine and suspended jail sentence for Pereira. The prosecution focused on her lack of proper accreditation. Various stakeholders, including professional bodies and public advocates, reacted to the case, emphasizing the need for regulatory compliance and potential reforms in midwifery training and accreditation. The discussion also compared ICM and NARM accreditation standards, highlighting the complexities of midwifery regulation.

 

Detailed Conversation

Question

  • I am an advocate for accreditation of midwives regardless of their path into the profession. Such accreditation validates knowledge, skills, and provides legal protection. Is there a multinational accreditation process similar to NARM? What about prosecutions in Portugal and Mexico for practicing without a license?

Reply

  • The International Confederation of Midwives (ICM) provides global standards for midwifery but does not offer direct accreditation like NARM. ICM works with national associations to align their programs with international standards. In Portugal and Mexico, midwives practicing without licenses face legal repercussions. A notable case in Portugal involved Ana Pereira, who was prosecuted after a perinatal death.

Question

  • What are the details of the case in Portugal?

Reply

  • Ana Pereira was prosecuted for practicing without a license after a perinatal death during a home birth. She was fined €10,000 and given a suspended jail sentence of six months. The case highlighted the strict regulatory environment for midwifery in Portugal and the need for clear accreditation pathways for midwives.

Question

  • Does ICM recognize NARM accreditation? Is there a comparison between ICM and NARM standards?

Reply

  • ICM does not formally recognize NARM accreditation as equivalent for practicing in countries under ICM's guidelines. ICM sets global standards, which national associations adapt. There has been collaboration between ICM and various U.S. midwifery organizations, including NARM, through initiatives like US MERA. In the U.S., the American College of Nurse-Midwives (ACNM) represents midwives to ICM.

Question

  • What title did Ana Pereira use while practicing? How did the prosecutor establish she was practicing without a license?

Reply

  • Ana Pereira used the title 'Midwife' (Parteira), a legally protected title in Portugal. The prosecution established her unlicensed practice through evidence and testimony about her performing duties reserved for licensed midwives. The case was initiated following a perinatal death reported by the parents.

Question

  • Were there any reactions from the Portuguese nurse/midwife representative body, ICM, or public stakeholders? Was there any consideration of reviewing midwifery training in Portugal?

Reply

  • The Ordem dos Enfermeiros emphasized the need for licensed practice to ensure public safety. Public support came from some of Ana Pereira's former clients and home birth advocates who valued her services. Discussions on reviewing midwifery training and accreditation processes in Portugal were triggered, emphasizing more inclusive pathways for experienced practitioners.

Question

  • What happened to Ana Pereira once convicted? Was there further prosecution related to the neonate's death? Do you have details on the cause of death?

Reply

  • Ana Pereira was fined €10,000 and received a suspended jail sentence. There was no further prosecution related to the neonate's death. The death was due to complications during the home birth, but the primary charge was her unlicensed practice.

 

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