The Big Push for Midwives needs YOU…

Help alert Congress to the Capitol Hill Issue Briefing This Thursday, May 21, focused on how out-of-hospital maternity care reduces costs and improves outcomes.

We need your help today! Please visit our PushAlert page right now to find out everything you need to know about reaching out to your elected officials about this important event!

http://www.thebigpushformidwives.org/index.cfm?fuseaction=enews.signup

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The deadline to include out-of-hospital maternity care in federal health care reform is just weeks away, so it’s urgent that we get our message to federal lawmakers ASAP!

Go to the links provided below and call or email your Senators and members of Congress today!

Help tell Congress about how access to out-of-hospital maternity care and Certified Professional Midwives (CPMs), who are specially trained to provide it, are a top priority in national health care reform!

Invite your elected officials and their staff to sponsor and attend the briefing at the Sewall-Belmont House at 144 Constitution Avenue, NE, between 8 and 9 a.m. on Thursday, May 21.

This is our first chance to show Congress and the media how much grassroots support there is out here in the states for including out-of-hospital maternity care and the services of CPMs in health care reform.

Download the issue briefing flyer for reference. Then call your congressional representative (look up you rep ) and your senators (find them here) and ask that they or a member of their staff attend this important issue briefing THIS THURSDAY. (If you have access to a fax machine, you can also fax the flyer to their office.)

Advocates Call on State and Federal Policy Makers to Prioritize Maternal and Infant Safety

WASHINGTON, D.C. (April 28, 2009)-Maternal and infant health advocates are calling on policy makers to take action to ensure that there are enough Certified Professional Midwives (CPMs), who are trained as experts in out-of-hospital delivery, to meet the needs of pregnant women in the event that a flu pandemic makes hospitals unsafe settings for the provision of maternity care.

“Hospitals filled to capacity with flu patients are unsafe and inaccessible places for healthy women to deliver their babies,” said Colette Bernhard, Vice President of Illinois Families for Midwifery. “Fewer than 3 percent of nurse-midwives have undergone the additional training needed to establish out-of-hospital practices, while legal and reimbursement barriers at the state and federal level prevent far too many Certified Professional Midwives, who already have the necessary training and equipment, to utilize their services to the fullest. Given the very real possibility of a flu pandemic, the need to fully incorporate CPMs into our health care system could not be more urgent.”

Certified Nurse-Midwives (CNMs), who are trained to practice in hospital settings, are legally authorized by all 50 states and are federally mandated Medicaid providers. CPMs are the only professional midwives in the United States whose educational and credentialing process requires them to develop the specialized skills necessary to safely deliver babies in private homes and in freestanding birth centers. However, CPMs are legally authorized to practice in just over half the states and are eligible for Medicaid reimbursement in fewer than a dozen states.

Recognizing the need for more midwives with expertise in out-of-hospital maternity care and risk assessment, as well as the ability to safely triage laboring women during a disaster, advocates called on state and federal policy makers to take immediate steps to safeguard maternal and infant health in preparation for a possible flu pandemic.

“First, all states need to get on board and license CPMs to practice legally,” said Russ Fawcett of The National Birth Policy Coalition. “But it is every bit as critical that our federal policy makers require Homeland Security to include CPMs-who function as mobile primary care facilities for pregnant women-in disaster planning at local, regional, and national levels and as eligible providers for the National Health Service Corps.”

In the wake of Hurricane Katrina, members of the White Ribbon Alliance for Safe Motherhood formed the National Working Group for Women and Infant Needs in Emergencies in the United States, and the group’s April 2007 report includes CPMs among those who can educate and train home-based delivery skills to institution-based birth providers.

The Big Push for Midwives is the first initiative of the National Birth Policy Coalition (NBPC), whose mission is to promote the autonomous practice of Certified Professional Midwives and Certified Nurse-Midwives and to ensure the availability of safe, evidence-based care during pregnancy, labor, birth, and postpartum. The Big Push is a nationally coordinated campaign to advocate for regulation and licensure of Certified Professional Midwives (CPMs) in all 50 states, the District of Columbia and Puerto Rico, and to push back against the attempts of the American Medical Association Scope of Practice Partnership
to deny American families access to legal midwifery care.

Through its work with state-level advocates, the Big Push is helping to build a new model of U.S. maternity care built on expanding access to out-of-hospital maternity care and CPMs, who provide affordable, quality, community-based care that is proven to reduce costly and preventable interventions as well as the rate of low-birth weight and premature births.

Media inquiries: Steff Hedenkamp (816) 506-4630, steff@thebigpushformidwives.org.

The Concord Monitor just published a lengthy article centered around Jeanne Browne, who offers home and birth center births to New Hampshire moms.

This paragraph was of particular interest:

Through a series of legislative measures, New Hampshire has welcomed and regulated certified midwifery. Midwives like Browne do not have medical or nursing degrees, but they are required to complete coursework and to spend time as apprentices to practicing midwives. They are governed by a state board of midwifery and are required to apply for recertification every two years. Insurance companies are required to reimburse midwives who assist with births outside of the hospital. “New Hampshire is a leader in this area and has been for a long time,” said Ida Darragh, the chairwoman of the North American Registry of Midwives, the group that certifies midwives nationally.

Even when legal, licensed home birth providers are available, many women’s ability to access them is limited by financial considerations. Health insurance providers may use ACOG’s policy on home birth as grounds for systematically denying coverage for home birth, even though the cost of a home birth is substantially less than for a normal hospital delivery. Private insurance providers which do not have an official policy in place on coverage for out-of-hospital maternity services may or may not cover home birth with an unlicensed provider, and usually, the family must pay their midwife out-of-pocket without knowing whether or not their insurance will provide reimbursement until weeks or months after the birth.

However, even Aetna, whose official policy is to refuse coverage for home birth, has to pay up in New Hampshire.

The American College of Nurse-Midwives’ response to the recently adopted American Medical Association’s resolutions regarding home birth and midwifery may be found here, and it is a delightful read. In particular, the thoroughly documented addenda to the letter is not to be missed.

In the past, medical lobbyists have frequently counted CNMs as allies in opposing state licensure of direct-entry midwives, and the AMA and ACOG have made much of their position that only certification from the ACNM should be considered adequate for midwifery practice. In light of this, the following paragraph from the addenda was of special significance (emphasis in the original):

“It should be noted that Resolution 205 erroneously states that ACNM has defined Certified Professional Midwives (CPMs) as “traditional, independent (of the health care system), non-formally trained and community-based providers of care during pregnancy, childbirth and the post-natal period.” ACNM does not define CPMs in this or any other manner, and will not do so. CPMs have their own professional organizations to represent them and standards which address their education, certification and scope of practice. ACNM is in dialogue with these organizations with the goal of working toward the highest quality midwifery care for women and families in all settings.”

Thank you, ACNM!

The CPM Licensure Initiative is a statement that clarifies the mission and sums up the goals of Ohio Families for Safe Birth in advocating for a new state law licensing Certified Professional Midwives. This is the statement that groups or individuals are signing on to when they join the coalition.

Ohio Families for Safe Birth CPM Licensure Initiative:

Increasing Access to Out-of-Hospital Maternity Care Services through state regulation of Certified Professional Midwives

MISSION

 Ohio Families for Safe Birth (OFSB) is a consumer-driven effort to create a statewide coalition of families and professionals promoting legislation and policies grounded in the Midwives Model of Care which support families’ access to safe, appropriate, evidence-based care during pregnancy, labor, delivery and postpartum. Our purposes are:

• Supporting legislation that licenses Certified Professional Midwives (CPMs) in Ohio;

• Raising awareness and support for families choosing an out-of-hospital birth as a safe, appropriate option;

• Supporting safe family and baby initiatives in all birth settings.

PREAMBLE

WHEREAS in 2005, Ohio Department of Public Health Vital Statistics documented 969 home births in Ohio;*

WHEREAS childbirth is a normal, healthy event for the majority of women, and includes important emotional and social components not usually addressed by hospital-based maternity care;

WHEREAS healthy women giving birth in hospitals are increasingly subjected to routine interventions, which may not be evidence-based or beneficial for their specific circumstances;

WHEREAS each woman and family is unique and deserves the maternity care provider and setting that best addresses individual needs and preferences;

WHEREAS the American Public Health Association supports efforts to increase access to out-of-hospital maternity care services and increase the range of quality maternity care choices available to consumers, through recognition that legally-regulated and nationally certified direct-entry midwives can serve clients desiring safe, planned, out-of-hospital maternity care services;¹

WHEREAS studies have demonstrated dramatically lower cesarean rates in out-of-hospital birth settings, an issue of great significance at a time when 29.3% of Ohio mothers are giving birth by major abdominal surgery with all of its attendant risks and the rising rate of cesarean sections nationwide is increasingly recognized as a serious public health problem;

WHEREAS Certified Professional Midwives are nationally certified providers of out-of-hospital maternity care services;

WHEREAS Certified Professional Midwives are licensed in 24 states;*

THEREFORE, we the undersigned members of Ohio Families for Safe Birth support and acknowledge the following:

The interest of the State of Ohio in the health care of its citizens;

The right of the State of Ohio to regulate licensed professionals;

The right of parents to receive qualified care from a well-trained professional;

The right of families to choose safe alternatives to hospital birth including free-standing birth centers and home birth;

The proven safety of direct-entry midwife-attended birth;

The right of parents to choose a direct-entry midwife to provide care during pregnancy, birth, and postpartum;

The right of direct-entry midwives to practice without unwarranted governmental harassment;

The Certified Professional Midwife (CPM) credential as a mechanism to ensure entry-level competence of direct-entry midwives;

The implementation of legislation providing for direct-entry midwife licensure, using the CPM credential as a basis for licensure requirements in Ohio.

* Statistics updated periodically

[1] American Public Health Association Position Paper 2001-3: Guidelines for Licensing and Regulating Birth Centers. APHA Public Policy Statements, 1948 to present, cumulative. Washington, D.C.

For those interested in learning more about the Certified Professional Midwife credential, a great starting point is this new Issue Brief (pdf file) jointly issued by the North American Registry of Midwives, the Midwifery Education Council, the National Association of Certified Professional Midwives, and the Midwives Alliance of North America.

Certified Professional Midwives are now free to practice in Missouri. Check out the Friends of Missouri Midwives’ press release with details about their Missouri State Supreme Court victory reinstating the law which physicians organizations challenged last summer. The Court ruled today that the Missouri State Medical Association and its co-plaintiffs “have no standing to challenge the constitutional validity of section 376.1753, and for that reason, the judgment is reversed.”

Pennsylvania Certified Professional Midwife (CPM_ Diane Goslin, who was fined $11,000 by the State Medical board last year for unlicensed practice, has won her appeal. The court has reversed the Medical Board’s decision and ruled that midwifery is not the practice of medicine and that the medical board’s jurisdiction is only over certified nurse midwives (PA does not currently recognize the CPM credential). Hundreds of Amish families rallied in support of Goslin’s at her trial last year. See this site for more details as they become available.

This is a guest post from a “Post Modern Midwife.” 

21st century midwives who provide out of hospital maternity services are trained, educated primary care providers who often have relationships with physicians and other care providers to offer full scope care. A post modern midwife accesses technology as appropriate and consults in an independent fashion as necessary to provide evidence based care with great outcomes.

As the Big Push garners more and more visibility on a national mainstream level, and OFSB becomes more visible on a state level, there will be more citizens who see our publicity and legislative efforts and have visions of what I call “Little House on the Prairie birthin’”. We need to make clear that midwifery is not tribal woo woo, nor the practice of medicine, but its own independent field grounded in evidence-based practice.

Women with major health problems such as heart disease and type I diabetes which can cause serious complications in pregnancy and labor are not good candidates for out-of-hospital birth and will either self screen out or a midwife would screen them as too high risk for an out-of-hospital birth.

As well, every prenatal visit with a midwife is in fact a screening visit, looking for potential problems that could risk a women out of home birth. Because of this very intense screening process and preventative model of care, families with major problems or risk factors are not tossing the dice on a birth outside of a hospital.

Midwives monitor mother and baby via intermittent fetal monitoring and other assessment means, just as a hospital does. Problems do not fall out of the sky, they develop with plenty of time for response. The Obstetrical Standard of Care is “Thirty minutes from Decision to Incision”. Out-of-hospital birth with a qualified attendant in relationship with her community health services provides the ability to adhere to this standard.

It is important for the general citizenry to understand that the way to protect families is to provide regulation and mandate minimum standards of training and experience for midwives to ensure public safety. No one is trying to convince anyone who doesn’t want to have a home birth, we are just trying to show policy makers that the best way to protect families who choose out-of-hospital birth is to ensure that their providers are in a regulatory framework.

The president of the Missouri Midwives Association has an editorial in the Kansas City Star on the need for CPMs to be part of each state’s emergency response / distaster management plan.