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.

Admin note — This is NOT an April Fool’s joke — CPMs really are now legally authorized to practice in over half of the States!

Physician and Midwife Groups Forge Unprecedented Alliance as Idaho Becomes the 26th State to Pass Legislation to Legalizing Certified Professional Midwives

BOISE, ID (April 1, 2009)—Governor C.L. “Butch” Otter signed into law today a bill to license and regulate Certified Professional Midwives, making Idaho the 26th state to legally authorize them to provide out-of-hospital maternity care. In a notable reversal of longstanding anti-midwife policies, medical groups worked together with legislators, midwives, and advocates to reach consensus on a law that provides for independent practice, mutual collaboration, and the rights of parents to choose where and how their babies are born.

“This is a great day for midwives and home birth advocates all across the country,” said Kyndal May of Idahoans for Midwives ( www.idahoansformidwives.org ). “We truly have reached the tipping point, breaking through the medical lobby’s longstanding opposition and developing a legislative consensus model that other states are looking to follow.”

Certified Nurse-Midwives (CNMs), who practice primarily in hospital settings, are legally authorized in all 50 states, while Certified Professional Midwives (CPMs), who specialize in out-of-hospital birth, until today were legally authorized to practice in just half the states. Representatives from The Big Push for Midwives Campaign noted that Idaho typifies recent legislative trends across the country, as a growing number of states come closer to passing CPM legislation.

“We’re seeing unprecedented advances this legislative season,” said Katie Prown, Campaign Manager of The Big Push for Midwives. “For the first time, physician groups are coming to the table and negotiating in good faith, and bills that had long been stalled in previously antagonistic committees are suddenly starting to move.” States that have recently seen significant legislative advances include South Dakota, Indiana, Illinois, Iowa, North Carolina, and Alabama. Idaho joins Missouri and Maine as among the most recent states to legally authorize CPMs to provide maternity care.

“It’s clear that organized medicine has finally realized that, between current economic trends and the drive for healthcare reform, the demand for access to CPMs and out-of-hospital maternity care is only going to grow,” said Susan M. Jenkins, Legal Counsel for the Big Push. “It simply makes good sense to pass laws that provide for regulatory oversight, transparency, and accountability, all of which are necessary to ensure safe practice.”

Thousands of people from across the nation watched the Senate floor vote on live video from the Idaho statehouse last week, cheering on their fellow midwife advocates on Facebook, Twitter, and email groups. “It’s very exciting to be part of a growing national movement,” said Michelle Bartlett, CPM, Legislative Liaison for the Idaho Midwifery Council. “I’m humbled to hear from so many advocates in other states who are looking to us as a model for how to work with every stakeholder to craft CPM legislation that addresses the needs and concerns of all of us who care about the health and safety of mothers and babies.”

Idaho is a priority of The Big Push for Midwives Campaign, 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 forge 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.

This AP article is being picked up by papers all over the country. Look for it in your local paper!

By DAVID CRARY

NEW YORK (AP) — With health care costs high on the national agenda, advocates of home births are challenging the medical and political establishments to give midwives a larger role in maternity care and to ease the state laws that limit their out-of-hospital practice.

Pending bills to further this goal have significant backing in several states, which home-birth supporters want to add to the 25 states that already have taken such steps.

Nationally, a group called the Big Push for Midwives marked President Barack Obama’s inauguration with an e-mail campaign urging him to ensure that midwives who specialize in home births are included in deliberations on federal health care reform.

“We’re at a tipping point now,” said Katherine Prown, the Big Push campaign manager. “Home births are still only a small part of the total, but it’s poised for growth.”

The campaign seeks to emphasize that in this time of economic crisis, home births can be a safe, satisfying and moneysaving option for many women. But it runs into adamant opposition from the American Medical Association and the American College of Obstetricians and Gynecologists.

“Childbirth decisions should not be dictated or influenced by what’s fashionable, trendy, or the latest cause celebre,” the obstetricians’ policy statement says. “Despite the rosy picture painted by home birth advocates, a seemingly normal labor and delivery can quickly become life-threatening for both the mother and baby.”

According to the latest federal data, there were only about 25,000 home births nationally in 2006 — most of them assisted by midwives — out of nearly 4.3 million total births.

Midwife-attended home births increased by 27 percent between 1996 and 2006. Home-birth advocates believe the numbers will rise as more states amend their laws to accommodate the practice, which they contend is at least as safe as hospital births for healthy women with low-risk pregnancies.

One of the strengths of the state-by-state campaign is its diversity, Prown said.

“We’re one of the few movements that’s succeeded in bringing together pro-life and pro-choice activists, liberal feminists and Christian conservatives,” she said. “In every state we manage to recruit Republican and Democratic co-sponsors who normally would never be on the same bill together.”

The states are now evenly split on legal recognition of certified professional midwives (CPMs) — those who lack nursing degrees and who account for most midwife-assisted home births.

Half the states have procedures allowing CPMs to practice legally — including five which have taken such steps since 2005. The other 25 states lack such procedures and CPMs are subject to prosecution for practicing medicine without a license.

Depending on legislative decisions, the balance could shift this year. Among the battlegrounds:

_In North Carolina, a House study committee recommended in December that the legislature develop licensing standards for CPMs. The committee said the current system doesn’t meet the needs of women who chose non-hospital births because of the “extremely limited supply” of obstetricians and nurse-midwives offering to handle such births.

_In Idaho, advocates who failed previously to get a voluntary licensing bill through the legislature are back with a mandatory licensing bill. State Rep. Janice McGeachin, R-Idaho Falls, says the changes helped persuade the state boards of nursing and pharmacy to drop their opposition. The Idaho Medical Association, which fought the earlier version, has expressed respect for the changes in the bill and is deliberating on whether further changes might produce a version it could accept.

_In Illinois, advocates also are back with a new version of a licensing bill that failed in 2007. Rep. Julie Hamos, D-Evanston, says it toughens qualification standards for CPMs — changes that prompted the Illinois Nurses Association to drop its opposition. The Illinois State Medical Society remains opposed.

“There are many in the legislature who feel a need to have this option — they need to be educated,” said Dr. Shastri Swaminathan, the society’s president. “We’re in strong opposition to licensing midwives who don’t have the medical training to provide safe home births.”

Cost is a major element in the debate. A routine hospital birth often can cost $8,000 to $10,000, with higher bills for cesarean section deliveries that now account for 31 percent of U.S. births.

Midwives’ fees for home births are often less than a third of the hospital cost, in part because the mothers generally don’t receive epidural anesthesia or various other medical interventions at home.

For pregnant women, insurance coverage can be a decisive factor in their choice. Many insurers cover care by nurse-midwives in hospitals; coverage is less common for midwives who aren’t nurses or who assist with home births.

Many obstetricians acknowledge that the spiraling cost of maternity care and high rate of C-sections are problems.

“But the answer is not to have births at home,” said Dr. Erin Tracy, an obstetrician at Massachusetts General Hospital in Boston. “We obviously support women’s empowerment, but the No. 1 guiding principle has to be the health and safety of the mother and baby.”

The national physicians’ groups do support births assisted in hospitals and birthing centers by midwives who’ve completed nursing school or an equivalent postgraduate program.

The American College of Nurse-Midwives, which represents these midwives, says it differs from the AMA in considering home births a legitimate option for pregnant women. But the college says only nurse-midwives or others with comparable training should be allowed to assist.

“We don’t believe it’s safe without being integrated into the full health care system,” said Melissa Avery, the college’s president.

The education standards endorsed by the college would exclude many of the estimated 1,400 certified professional midwives, who often acquire training through apprenticeships.

Jane Peterson of Iola, Wis., is an example. She began a midwife apprenticeship in 1980 and has attended more than 1,330 births since then, many of them before she and her counterparts were legally authorized to practice under a 2005 state law.

Peterson, 56, said she strives to develop collaborative relations with local doctors so that transfers to hospitals go smoothly if risk factors develop. She believes such cooperation should be encouraged nationwide, so more women can feel comfortable about choosing home births.

“People will tell you that you changed their lives,” said Peterson, reflecting on the rewards of her job.

“It’s hard work — getting up on a cold winter night, going out one more time through the snow. What keeps you going is the recognition women feel — as though they are a different kind of mother when they’ve been able to give birth their way.”

Newsweek.com has a brand new article about Birth Choices which references The Big Push for Midwives. The article does a good job of briefly analyzing the choices available to pregnant women in the United States and the pros and cons of each provider: obstetrician, certified nurse midwife, or certified professional midwife.

The article closed with this quote:“As a woman and a mom and an obstetrician, I feel strongly that patients should have choices,” says Dr. Anne Foster-Rosales, former chair of ACOG’s international committee. “But I think making it as safe as possible is very important.” Foster-Rosales has worked with mothers around the world, including in countries where most women give birth at home with untrained attendants. Because of what she has seen, she feels that it is important that home-birth providers not feel ostracized so that they can come to the hospital if necessary. Emergencies may be rare, but the course of an individual pregnancy is unpredictable no matter where you choose to give birth. Protect yourself and your baby by learning as much as you can.

Ohio Families for Safe Birth strongly agrees with Dr. Foster-Rosales’ sentiments. A good first step in helping home-birth providers not feel “ostracized” in Ohio would be to license them instead of prosecuting them.

This press release from the Big Push for Midwives is in response to a news story which appeared in the Cleveland Plain Dealer last week.

Ohio Case Shows Need for Legal Reform on Liability Issues

In states where out-of-hospital midwives are unregulated, physicians put at risk to assume undue liability

(January 28, 2007) — An Ohio physician is being sued for damages on behalf of a baby born at home, and the tragic case highlights the need for legal protections for health care providers who collaborate with out-of-hospital midwives. In states where Certified Professional Midwives, who specialize in providing out-of-hospital maternity care, are licensed and regulated, laws can stipulate that physicians will not be held liable for accepting a transfer of care or for consulting with a licensed midwife.

“This case is just plain tragic on so many levels, and we sympathize with the family’s plight,” said Big Push for Midwives national campaign manager Katie Prown. “But this lawsuit fails to address the real issue here, which is that in states where out-of-hospital midwifery practice remains unregulated, physicians who provide ‘continuity of care’ in the event of a transport to the hospital are put at risk of assuming undue liability burdens.”

Prown, who co-lead the legislative campaign to license CPMs in Wisconsin – the most recent state to pass legislation to license and regulate Certified Professional Midwives (CPMs) – said that the law there clearly states that midwives are responsible for their own actions and that the physicians who work with them cannot be held liable for their acts or omissions. Physicians in Ohio lack such legal protections.

“Physicians who collaborate with CPMs in states where they remain unlicensed put the needs of mothers and babies first, and they deserve legal protection for doing so,” said Big Push campaign attorney for legal strategy, Susan M. Jenkins. A leading expert on vicarious liability, Jenkins said laws providing for the licensure and regulation of CPMs further ensure that collaborating physicians will not face disciplinary sanctions for aiding and abetting the unlicensed practice of health care.

“While I am not aware of a case where a physician has been found vicariously liable for a midwife’s actions, the risk of being sued nonetheless is still there, as the Ohio case demonstrates,” added Jenkins. “That’s why providing liability protection for the physicians who collaborate with CPMs is one of the primary goals of The Big Push for Midwives Campaign to license and regulate CPMs in every state.”

States that license and regulate CPMs offer additional liability protection for physicians by ensuring that they cannot be forced into mandatory written contracts with collaborating midwives. “Licensing CPMs works for everyone,” said Prown. “When physicians and midwives are free to collaborate together without binding contracts and under laws that provide for liability protection, mothers and babies receive better care.”

Currently, Certified Nurse-Midwives, who work predominantly in hospital settings, are licensed and regulated in all 50 states, while Certified Professional Midwives, who work in out-of-hospital settings, are licensed and regulated in just 24 states. CPMs are specifically trained to provide out-of-hospital maternity care for healthy women experiencing normal pregnancies, with a particular emphasis on risk assessment and preventative care.

Here’s a great report on the Idaho Big Push rally. Don’t miss the video portion of this local coverage.

The Big Push for Midwives Campaign will be launched today in Chicago to advocate for regulation and licensure of Certified Professional Midwives (CPMs) in all 50 states and the District of Columbia. The Big Push Campaign is also pushing back against the attempts by the American Medical Association to deny American families access to legal midwifery care.

Chicago events include a “PushDay” news conference about the national campaign launch, a book signing by author and journalist Jennifer Block for her book “Pushed,” a film screening of the Ricki Lake and Abby Epstein documentary, “The Business of Being Born,” and a viewing of The Safe Motherhood Quilt Project created by midwife pioneer Ina May Gaskin. In addition, multiple states will have PushRallies and PushParties to kickoff the Big Push Campaign. There are events planned in Alabama, Idaho, Indiana, North Carolina, Pennsylvania and South Dakota.

Currently, Certified Nurse-Midwives (CNMs), who work predominantly in hospital settings, are licensed and legal in all 50 states. Certified Professional Midwives (CPMs), who specialize in out-of-hospital delivery, are licensed and legal in fewer than half of our states.

CPMs:

• Are specifically trained to provide out-of-hospital maternity care for healthy women experiencing normal pregnancies.
• Offer a family-centered model of care, which is associated with reducing the incidence of c-section, birth injury and trauma, as well as significantly reducing the cost of maternity care.
• Play a vital role in reducing the two most preventable risk factors for infant mortality: low-birth weight and premature birth: babies born too small or too soon.
• Serve a disproportionate percentage of underserved populations, including low-income, rural, inner-city, immigrant, and uninsured families, as well as those Americans who choose out-of-hospital birth for deeply held cultural and philosophical reasons.

The Big Push for Midwives Campaign is the first initiative of the National Birth Policy Coalition (NBPC), which was established in 2007 and is focused on increasing access to the Midwives Model of Care in all settings, as well as supporting legislative initiatives that promote the autonomous practice of Certified Professional Midwives and Certified Nurse-Midwives. So far, the NBPC has been endorsed by nearly 40 organizations, including national and state midwifery organizations, as well as state consumer organizations.

Ricki Lake’s statement of support for the Big Push campaign states: ““When I decided to give birth to my second child at home under the care of a professional midwife, I faced a lot of criticism and skepticism from family and friends. Most of the people around me had a perception of childbirth as a risky medical procedure and thought that I was taking a chance by giving birth in my home, instead of at the local hospital. But after extensive research and a previous hospital birth with my first child, I knew that homebirth with a trained midwife was not only safe, but potentially safer than giving birth in a hospital. I knew that I was giving my child a gift by allowing him to come into the world gently, in our bathtub, with his mother in control of the birth. I knew that I was receiving the best prenatal care available and that it was costing me a few thousand dollars, instead of the thousands and thousand of dollars involved in most hospital births. This was not just a privilege that I could enjoy as a celebrity — this was excellent, cost- efficient healthcare that all women should have access to. …

“…The Big Push for Midwives Campaign comes at a time when we realize we much increase access to U.S. maternity care, decrease maternity care costs, and improve our nation’s birth outcomes. The campaign will facilitate this by achieving licensure for ALL midwives in ALL states, D.C. and Puerto Rico. The campaign will highlight the importance of family healthcare choices, and will defend the ability of CPMs to provide legal and safe prenatal, birth and postpartum care to families in every state…

“… I sincerely hope that U.S. state lawmakers do not deny parents a basic human right by restricting how their children can come into the world. I also hope that policy makers recognize midwifery as a serious, social-service profession that deserves licensing, public support and admiration.”

Ohio Families for Safe Birth is proud to be a supporting member of the Big Push and member of the National Birth Policy Coalition.