Nursing Birth

One Labor & Delivery Nurse’s View From the Inside

The Big Push For Midwives Campaign 2009 June 25, 2009

I believe that pregnancy and birth are normal, healthy processes and should not be treated as illness or disease and that women and babies have the inherent wisdom necessary for birth.

 

I believe that midwives can obtain quality education and experience in a variety of ways and programs, including certified nurse midwifery and direct-entry midwifery.

 

 I believe that women need access to professional midwives whose educational and credentialing process provides them with expertise in out-of-hospital birth as well as hospital-based and clinical care that extends beyond the childbearing cycle.

 

 I believe that empowering and safe births can and do take place in a variety of settings including birth centers, hospitals, and homes.

 

 I believe that every woman should have the opportunity to give birth as she wishes in an environment in which she feels nurtured and secure and her emotional well-being, privacy, and personal preferences are respected, whether that be in a hospital, birthing center, or at home and I believe that women in every part of the United States DESERVE THAT CHOICE!

 

  (Excerpts from my post My Philosophy: Birth, Breastfeeding, and Advocacy)

 

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Because of all of these things I support The Big Push For Midwives Campaign 2009 and I want to share with all of you a bit more about it!!

  

According to BigPushTube:

 

“The Big Push for Midwives Campaign builds state-level advocacy campaigns to license Certified Professional Midwives (CPMs) in all 50 states, D.C., and Puerto Rico, and educates national policymakers about out-of-hospital maternity care.

 

 [The Big Push for Midwives Campaign] works tirelessly to:

 

1) Educate state and national policymakers about the reduced costs and improved outcomes associated with out-of-hospital maternity care. $9.1 BILLION IN SAVINGS PER YEAR.

  

2) Support advocacy groups working for state licensure in the 24 states where out-of-hospital practice by CPMs is under threat of criminal prosecution.

 

3) Encourage mothers to tell their stories because only grassroots activists will be able to topple the money/power vested in keeping the status quo.

  

4) Advocate for CPM guaranteed reimbursement in National Health Reform, the Federal Employees Health Benefit Plan, Tricare, and Medicaid/Medicare.

  

5) Support freestanding birth centers seeking guaranteed Medicaid reimbursement, and midwives advocating for equitable Medicaid reimbursement rates.

 

The Big Push for Midwives Campaign empowers midwife advocates and moms groups as they promote increased access to out-of-hospital maternity care and the Certified Professional Midwives (CPMs) who are specially trained to provide it.

  

Our dedicated campaigners, or “Pushers” as they are affectionately known, help to educate the people in power (at the insurance companies, in the hospital associations, in the Statehouses, and on Capitol Hill) about the reduced costs and improved outcomes associated with using out-of-hospital maternity care and CPMs, who are specially trained to provide it, and works to widely share the stories of U.S. citizens who choose CPMs as their maternity care providers.” 

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I found this video on YouTube and I got all verklempt watching it!!  (Perhaps it was partly related to the beautiful song that was playing throughout the movie!  I’m such a sap!)  It’s only about 4 minutes long so if you have a chance please take a look!

 

 

 

 Our mothers and babies in this country DESERVE better care than what they are receiving!!  They DESERVE a midwifery model of care (whether that is provided by a certified nurse midwife, a certified professional midwife, a family practice physician, or an obstetrician).  They DESERVE to have CHOICES in childbirth that are proven to promote the best outcomes for both mothers and babies.  And they deserve these choices to be LEGAL!

 

Have you ever heard the term “lay midwife”?  Are you under the impression that a “lay midwife” doesn’t have any education and that all midwives who attend out of hospital births are “lay midwives?”  Do you want to know what the term “lay midwife” is really referring to?  Are you interested in learning what the real differences are between the different types of midwives?  Are you interested in learning more about how midwives train and what type of education they obtain?  If so please check out:  FAQ about Midwives and Midwifery by Citizens for Midwifery (CfM) and Midwifery Definitions by the Midwives Alliance of North America (MANA).

 

 Have any of you ever received care from a certified professional midwife?  I’d love to hear about it!

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17 Responses to “The Big Push For Midwives Campaign 2009”

  1. Emily Jones Says:

    I have a hard time supporting the Big Push campaign, and here’s why: while I am all for legalizing midwives, I have found that licensing itself is a way the various state medical associations have found to restrict midwives’ practice as to make them de facto unable to practice.

    It has happened in my own state of Utah, and I see it happening increasingly in other states where midwives are licensed. The problem is, who does the licensing? Who gets to outline the scope of practice? The medical associations, which are populated by whom? OBs.

    Once the OBs get the midwives under their thumb, so to speak, they can dictate when and how, if ever, midwives can practice at home. For instance in this state, midwives were licensed 4 years ago. Then last year, the UMA finally brought its true intentions to the table, and was able to pass a bill that restricted the scope of practice of home birth midwives. Now they are no longer allowed to attend postdate, breech, twins, or VBA+2C births, among others. And because midwives are licensed by the state medical board, they have no choice but to accept these restrictions if they want to keep their licenses.

    The medical associations are not stupid. They are already figuring out that if midwives are licensed, then they can be restricted, and that is exactly what they want. I am afraid that licensing will just become a euphemism for legislating midwives out of existence.

    Now, it could be that I am just paranoid, but it does make me nervous.

  2. Laura Says:

    My reply is similar to Emily’s. I had a homebirth in Dec 2007 with a CPM in UT. My midwife chooses not to be licensed, mainly to avoid the restrictions put on licensed midwives. So she still does the births mentioned by Emily. The one disadvantage is that she’s not allowed to carry medications, but she partners with a licensed midwife to have access to those if needed. My husband and I have been talking about the idea of medical licensing (by the government) in general lately. A disadvantage of government licensing is that alternative medicine gets suppressed, because the government influences what will be taught in schools. Also, licensing allows people to be lax about choosing a provider, because of the “guarantee” that a license means that a provider is trustworthy. (Your post about the doctor with 74% c/s rate shows that a license doesn’t even mean that.) That leads away from mother-oriented care that we are looking for in childbirth. In conclusion, I totally trusted my CPM even though she was not licensed. And that’s because I did take the responsibility to interview her before choosing her.

  3. My first expereince with a midwife took place in a military treatment facility. Fort Hood utilized almost nothing but midwives for all “healthy” women. They had a bunch of CNMs. However, their practice was greatly structured by the shear volume of cases they saw. The birthing census was the highest in the entire army (probably the greatest census in the whole U.S. military). And it was a horrible experience, that involved a membrane stripping (at 39 weeks) and a whole lot of pitocin at 40 weeks. Horrendous birth experience!

    My first CPM experience was in Texas almost two years later. This CPM was my only care provider through the entire pregnancy, and the birth was respected, peaceful, and serene. The difference was night and day. The CPM was not restricted by the hospital OBGYN protocols as the CNM had been. My CPM was not the Medwive the CNM was required to be. CNM are often, in my expirience, OB’s in sheep’s clothing.

    On an academic level I would like to love the CNM more (since I’m a BSN myself), but as a client I’d much rather hire a CPM because she’s often more free to allow me to birth as I need to.

    Another side note: I had an semi-unusual, but mild case of hereditary anemia (hereditary spherocytosis). My CPM was the first one to really look at the labs and wonder what was going on. For years I’d been on iron without any further work up or investigation into my family history (which was littered with H.S. signs and symptoms). Because of my CPM I was given access to my RBC differentials and blood smear results and I was able to start to peice it together myself. No doctor or CNM I’d seen before ever bothered to ask what was really my problem. Even the Internal Med doc I saw afterward didn’t know what the problem was. They just wanted me to take more iron. I will forever be endebted to that CPM. And now, I know that iron is not what I need. I need as much folate and B vits as I can stand, and I needed someone to pay attention to my spleen too.

  4. carey Says:

    some additional thoughts about this are found on Jan Tritten’s Midwifery Today blog…

  5. Sarah Says:

    My midwife (a licenced midwife) has decided not to jump through the hoop of becoming “certified,” to add a few extra letters after her name. Though she is already qualified and could easily become certified (she’s been doing this for over 30 years and has amazing stats and credentials) she has told me that to her, it is a piece of paper; she doesn’t need that to assure her clients of her qualifications. If I’m not mistaken, all it would give her is the ability to dispense some meds, and as she aptly pointed out, she and her colleagues are home birth midwives for the very reason *to steer clear of thinking in a medical mindset.* Her thought is: Do we really want to be able to dispense meds even if it means that the cost is more interference and medical oversight in an event (birth) we have worked so hard to see as normal, *not* medical? They see that for them, certification would be a step in the wrong direction.

    However, she is not against CPMs themselves, and neither am I. My point in bringing this up is that some seemingly less-credentialed midwives may be so by choice, and it may have nothing to do with their ability to provide safe and effective care for women. In fact, I would rrecommend my midwife in a heartbeat because of her qualifications (experience in different parts of the world that include vaginal breech and twin home births).

    I agree with your opening statements, and yes, we do need to support all kinds of providers who help women give birth in a safe and relaxing environment.

    Love your posts!

  6. lpnmon Says:

    It’s sad that, as a society, we often discount and discredit any knowledge that is not “officially” learned. Like it doesn’t count if it hasn’t been gained at a sanctioned facility. Midwives who have been in practice for years upon years but no “formal” training will almost always have more knowledge than a new CNM and will definitely have more experience than one. And yet so many look down on them as lay midwives who have never been to school. What wonderful experience are we losing out on when these wonderful ladies retire or are forced out of business?
    -lpnmon

  7. Aisha Says:

    I am delivering my first baby in a hospital setting with a CNM (I’m 35 weeks!) and I want to go as natural as possible with having options provided by a hospital.
    I definitely recommend a midwife rather than an OB/GYN on an uncomplicated birth or pregnancy. However, I don’t think its so much to do with the Midwifery model of care, to me its more about delivering in a hospital or a provider that follows “evidence based maternity care” which so far my hospital seems to favor with some exceptions. At least the L&D nurses that I have met are sooooo prepared and confident about the woman’s ability to deliver without any interventions, it makes me feel much more comfortable. The OB’s and Midwives don’t come in until you are in active labor so the L&D nurses are given the space to work with the mother more intensively without medical interventions.
    As a first time pregnant woman soon to be delivering, it makes the world of a difference being informed about labor and labor options than not knowing anything and going to the hospital ready to deliver. I highly recommend all women getting informed, taking prepared childbirth classes, reading, doing your research 🙂

  8. briome Says:

    I had a CNM with my first hospital birth (cascade of interventions then c-section) and my second at home with a CPM. I prefered my second birth for many reasons including my care and the setting. CPM’s are a-legal in MD but I certainly like that she was not answering to anybody but me and her own judgement, which I trust. No midwives are allowed to practice in the hospital 5 blocks from my house…. the other nearest hospitals (an hour or more away) allow CNM’s but the midwife way of care is limited by “standard of care” and supervising docotor’s ideas and many other things not the woman’s and babies best intrest. Even if midwives become better ultilized for more of the population I will be happy, but still prefer my unregulated by my state wise midwife.

    • Anon Says:

      Actually, it is a felony in Maryland and your midwife could go to jail for serving you. There is no such thing as a-legal- your state just regulates midwives as criminals. Though licensing might restrict practice somewhat, your midwife could remain unlicensed, and at the very least jail would be off the table.

  9. Molly Says:

    I loved the video link!

    I am planning a home birth for December with 3 “lay” midwives. I asked them why they were not CPMs, as the certainly had enough experience. One reason was that they were afraid they if they were licensed they would have to one day follow a strict set of rules… ie you must transfer after X hours of the water breaking. When in reality, it really is a case by case situation. Also they mentioned how much paper work was involved, and money it costs to get the license. And, at this point it would not change a thing about how they practice, so they all decided not to get certified.

    That being said, I would NOT be having a homebirth if it wasn’t for the Big Push for Midwives! I had came across their booth at a LLL conference, and got on their e-mail list. They had Birth Circle meetings in my state, where people talk to interested mothers about homebirth. That is where I met my Midwife, and really learned about homebirth, and the rest is history! So, I really appreciate all the they do!

  10. Elizabeth Allemann, MD Says:

    As a family physician I understand the limits of being licensed and regulated. I fully support and endorse the independent practice of midwifery in all settings by all midwives. That said, I also fully support the Big Push because I don’t want any more midwives in prison. In about half of the states in the US, midwives are not licensed and so they run the risk of being charged with practicing medicine without a license. When something hard happens (a mother or baby dies), the presumption on the part of the uninformed majority of the public is that the bad outcome is the result of home birth or midwifery care, even if it is obvious the outcome would have likely been the same with hospital care. If there is no licensure, a midwife who gets in trouble faces the prospect of prison time, she is often arrested, held in jail, and must deal with criminal prosecutors who have no understanding of the practice of midwifery or home birth. In a state with licensure, a midwife who gets in trouble faces the prospect of losing her license, is not arrested, and deals with her licensing body, which should understand midwifery. Of course, if the midwives are licensed by the medical board, that is a really bad situation.

    In addition to changing the consequences of getting in trouble, licensure allows midwives to bill insurance and be reimbursed by medicaid. There is no reason that poor women should be denied this option. And there is no reason that CPM’s should not work alongside CNM’s in birth centers as equals.

    For the record, the Big Push SUPPORTS local efforts. Of course the midwives and midwifery advocates in each state must evaluate the situation on the ground and decide what, if any, legislative changes they want to make. The Big Push is a group of people who have been trying to change laws in several states, some of us successfully. We are available and increasingly organized to provide the wisdom of our experience from midwifery, consumer, legal, medical, nursing, and lobbying experience. It’s like we are midwives for the actual citizen activists on the ground. They do the work, we cheer, guide, give feedback.

    What’s not to support in that?

    Elizabeth Allemann, MD
    Columbia, MO

  11. Uli Pele Says:

    Look — all these pie in the sky ideals mean nothing when the state decides to shut down all those unlicensed midwifery practices. My home state has shut down a few dozen practices and without getting licensure where I am, there are some scary practices going on here … if your lucky enough to find anyone.

    No one is claiming the licensure is ideal, just necessary. I know there are some midwives who will never “submit” to taking a certification exam to be licensed, but that doesn’t mean that we can all pretend, la-dee-da, that practicing illegally is the right answer for everyone. Plus, just b/c you everyone thinks a midwife has good stats doesn’t necessarily mean it’s true.

    I worry when someone tells me they don’t need any real accountability.

    Take your heads out of the sand!

  12. QoB Says:

    I think something like what Emily mentioned is happening in Australia at the moment. Lisa Barrett has been blogging about proposals for insurance requirements and what it would mean for her homebirth midwifery practice at http://www.homebirth.net.au/

  13. sarah Says:

    I haven’t seen a CPM, I saw CNM’s for my last pregnancy. The first birthing center I was going to was okay, better than an OB but I heard that some of the midwives were more medwives. I ended up having to switch at the end (to a different birth center) b/c they closed and the ones I ended up with (also all CNM’s) were absolutely wonderful. Everything you want from a midwife. My labor and delivery were IMO perfect (I could have lived w/o it being 42 hours, but still :-))
    This time around I am seeing CNM at a birth centeragain because my insurance will not cover CPM’s who are the only ones who do homebirths in my state because of the way physician agreements are required to be structured by law. At my appointments my CNM seems wonderful, but I have heard bad things about how they treat L&D so I am quite worried.

    I would see a homebirth CPM but I can’t pay out of pocket, which is why I like the licensing of CPM’s b/c it usually requires them to be covered by insurance. I also see the downside though because my SIL (in another state) wants to have a homebirth or birth center birth with midwives, but due to over-regulation midwives are not legally allowed to see her for a VBAC, even though she had a vaginal birth before and after her c/s. She (amazingly) found an OB who does OOH waterbirths (in his office) who will take her as a patient.

    When I was calling midwives to see what my options were I called CPM’s and DEM’s. I was bothered by the fact that the DEM charged the same rate as the CPM’s since she didn’t have any formal midwifery schooling. Not that I wouldn’t have used her because she didn’t have formal schooling, but I didn’t feel it was fair for her to be charging the same price as CPM’s who had done 3+ years of schooling.

  14. Megan Says:

    I went to a birth center and saw a CPM for the second half of my pregnancy, after switching from a high-volume OB/GYN office that delivers in 2 city hospitals. My experience with my CPMs were wonderful; they were so very knowledgeable, kind, considerate, gentle, and very well-informed. They took no risks with me. The time I had blurry vision and a headache they sent me straight to the hospital (I was discharged in a few hrs and NOT preeclamptic, thank goodness). The time I had a blood clot in my leg postpartum they also sent me straight for an ultrasound and did not write it off, thank goodness again! I had a wonderful birth experience at the center and am so grateful I was given that opportunity. Unfortunately, I’ll probably be considered “high-risk” for any future pregnancies due to the blood clot and the SGA baby I delivered, but I hope to find a hospital environment with midwives available (and my doula, of course!) so I can somewhat recreate what I had for my first birth-it was beautiful!

    • nursingbirth Says:

      Megan, that sounds wonderful!! THank you for sharing your experience!! Most people think that when a CPM encounters a “problem” they just do some voodoo magic and hope it goes away! Haha! But they are skilled practitioners who know when to send you for a consult with another health care provider if they need too!

  15. Susan Jenkins Says:

    Hi, nursingbirth! Good blog. Thanks for your positive evaluation of the Big Push for Midwives. I’m a member of the steering committee of the Big Push and I just wanted to invite anyone who had questions to come check out our website or on our facebook page or follow Steff, our communications director onTwitter.
    Also, wanted to share with you that the Big Push took our campaign to Washington DC this spring and summer to work for the inclusion of CPMs alongside CNMs in Medicaid and health care reform legislation so that women who want to choose a CPM for her birth won’t be prevented from doing so because her health plan doesn’t cover midwives or home birth. We understand the pros and cons of licensure but, as Elizabeth and some of the other commenters suggest — we at the Big Push would rather see midwives out in the open practicing legally and accessible by more and more women than practicing underground and getting arrested. The way the Big Push got started was when several state midwife groups and consumer groups got together to figure out how to deal with a rash of arrests and prosecutions that began popping up during a two-week period in the fall of 2007. Regulation seemed a better option than prosecution.
    Please, everyone, write or call your Congressperson or your federal Senator and let them know that, if we are going to reform health care, we have to start with birth!
    Thanks to all,
    Susan
    Legal Counsel, The Big Push for Midwives


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