On May 10th before the start of the CPM Symposium, NACPM hosted the first-ever in-person gathering of NACPM chapter members. We were thrilled to have had representation from 13 of our 18 currently formed state chapters at this seminal event plus guests from 4 additional states. This day was designed specifically for chapter leaders and members with the hope of sending them back to their states with information, skills, tools and connections to put to work for their unique state priorities.
NACPM hopes to build on the conversations and connections that began during the Chapter Day through our quarterly chapter collaboration calls, one of which was earlier this week. We had a total of 30 participants over the course of the call and heard from everyone who wished to share about what’s going on in their state and what they are bringing back to their state and local work from our time together at the Chapter Day.
Overview of the Chapter Day
We opened our day together in a circle sharing what question we were bringing. The questions centered around the themes of access and equity, inclusion, unity, and accountability, relationships between NACPM national and Chapters and between Chapters and state associations, and how to bring about broader systemic change:
Access and equity: How do we strategically plan to help POC access midwives? Are we working at our own bigotry and racism?
Inclusion, unity, and accountability: How can we overcome divisions in our midwifery profession? How are we going to ensure communications are in place to learn from our mistakes?
Relationships between NACPM national and Chapters, Chapters and state associations: How can Chapters and state associations work together? How can NACPM support licensed states? Unlicensed states?
Bringing broader systemic change: How does this fit with transformation of our maternity care system overall? How can we support what is coming up?
Chapter Day Presentations
Facilitator Cari Caldwell presented on “Building effective state teams.” Cari shared with us about how to create high performing teams, including asking important questions like why does the team exist? Is there trust within our team? What are our goals? What is our level of commitment? She encouraged us to focus not just on the work we’re doing, but also on how we are building what we’re building. She taught us that it is crucial to get really explicit about the kind of culture we’re creating together and to construct mechanisms for accountability within our organizations.
Saraswathi Vedam from the Birth Place Lab gave a presentation called “Mapping Integration of Midwives Across the United States: Impact on Access, Equity, and Outcomes” in which she described the background and approach of the research behind the work being done at the Birth Place Lab around the importance of integrating midwives into the maternity care system in order to improve perinatal outcomes. She emphasized that understanding the credibility of this research is the basis from which we can bring this information back to our local communities and that the lens for all of their research is ACCESS for families to care, not convenience for midwives.
She reported on the clear correlation between increasing integration of midwives, density of midwives, and access to midwifery care and a decrease in preterm birth and neonatal death. States with a higher population of black babies have poor integration, low density of midwives, and lack of access to care, compounding the unconscionable disparities in outcomes across racial lines with an added layer of risk due to lack of access to the Midwifery Model of Care which we know improves these outcomes. Saras and her team’s research shows how dire the need is to scale up midwifery in the US, where access to midwifery care is significantly lower at around 10% than in other high-resource countries, which typically have 50-75% of births attended by midwives.
This session was packed full of high value, evidence based research and was designed as preparation for the last session of the day in which we applied the State Mapping Tool to our individual state contexts through review of our state report cards, which can be found on the Birth Place Lab website.
Silke Akerson from the Oregon Midwifery Council presented on “Tackling Quality of Care Issues at the State Level / The Oregon Experience” in which she described quality improvement measures taken in Oregon and how these improvements might be applied in other states. Silke defined quality improvement as the “combined and ongoing efforts of a group of people to understand problems and make changes that will lead to better outcomes in a particular system.” She noted that with quality improvement there is a focus on looking at problems and solutions within the system rather than placing specific blame. She taught us about how quality improvement MUST begin with cultural humility and co-creation with the communities they impact.
Some of the specific quality improvement steps that they have taken in Oregon include improving data collection, transport improvement, targeted continuing education, mentorship for new midwives, guidelines for peer review and case review, and midwife participation in public health efforts. Having taken these measures, the perinatal mortality rate of intended community births in Oregon was reduced from 3.9/1,000 in 2012-2013 to 1.005/1,000 in 2015-2016.
In addition to reviewing ACOG’s statements and positions on out-of-hospital birth, Kathryn described for us the membership and governing structure of ACOG, how ACOG sets policy nationally, the leeway state ACOG groups have to set their own agenda, priorities and tactics, and the influence state medical societies have on ACOG on the state level.
She pointed to a few examples where ACOG and CPMs collaborated on legislation, including Maine with its year-long professionally facilitated negotiation among stakeholders, Maryland which underwent a collaborative process before the bridge certificate was available, and Florida’s recent legislation on adverse incident reporting.
Chapter Day Evaluation Results:
We largely received very positive feedback from the Chapter Day evaluation that went out after the event. Participants reported that the content was of high value to them, that they made important connections, and that they would eagerly attend future in-person chapter events. We also received some great suggestions including ideas for affinity groups that could take place before a future Chapter Day, such as an opportunity for people of color or states at similar states/chapters at similar stages of development to meet and strategize. There were requests for focus on how to get state legislation passed, how to hire a lobbyist, what to do and not do as a grassroots movement, and also ways to collaborate with the NACPM national office for states with existing regulation. Many shared that they would have appreciated more time to network and connect with one another, which is a wonderful testament to the richness of our growing community and the need for more of these gatherings.