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.

Take a look if you haven’t already seen this short piece by photojournalist Tess Colwell.  The slideshow of black-and-white photos is accompanied by a voice-over of an Ohio CPM talking about her philosophy of birth, her experiences, and her calling.

Black market for midwives defies bans, reads the Chicago Tribune headline. While Missouri’s new midwifery licensure law awaits a state Supreme Court ruling on its legality, mothers continue to give birth at home, even though their midwives risk felony charges for attending births. (A paid subscription to the paper is not required, but you will need to register your email address to read the article.)

Take a look at this lovely slide show put together by Oregon CPM Pamela Hines-Powell. She has done a great job interspersing quotes and statistics with powerful and beautiful images of unhindered, natural birth.