The Disparities are Extreme

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“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”
Martin Luther King, Jr. (1966)

“I have a dream that one day … little black boys and black girls will be able to join hands with little white boys and white girls and walk together as sisters and brothers.”
Martin Luther King, Jr (1963)

“Fifty years ago, on the steps of the Lincoln Memorial, Dr. Martin Luther King Jr. told us about a dream…Fifty years later, all too many little black boys and black girls die even before they learn how to walk with their white sisters and brothers.”
Dr. Michael Lu (2017)

NACPM’s new webinar series on “Equity, Race, and Access to Midwifery” launched on January 5, 2017 with a powerful presentation on “Racial-Ethnic Disparities in Birth Outcomes” by Michael C. Lu, MD, MPH.    Citing data from the National Center for Health Statistics, he described just how extreme the disparities are between black and white babies.  The data never fails to shock when one hears that black babies are:

  • twice as likely to die within the first year of life

  • twice as likely to be born low birth weight

  • nearly three times as likely to be born very low birth weight

  • nearly twice as likely to be born premature

  • and three times as likely to be born very premature.

Although focusing on the health disparities between black and white babies, Dr. Lu also points out that there are great disparities across all racial and ethnic groups in infant mortality.

Examining the underlying causes of infant mortality, Dr. Lu discussed genetics, behaviors, prenatal care, socioeconomic status, and multiple risk factors.  He then described another way of thinking about these not as disconnected issues but as an integrated continuum or life course perspective, “In perinatal health, we focus so much on events occurring in the 9 months of pregnancy we forget that there are a great deal of life course influences on perinatal outcomes, and a great deal of perinatal influences on life course outcomes. For example, in explaining the Black-White gap in infant mortality, for decades we searched for maternal risk factors during pregnancy rather than looking at the mothers’ cumulative life course experiences.”

He then went on to discuss his own research on maternal stress and fetal programming or epigenetics.  It’s fascinating, and sobering, to learn that the same stress reactivity and immune-inflammatory dysregulation that lead to preterm birth will go on in the next 15-20 years to wreak havoc in the mother’s blood vessels, heart, and other vital organs.  In other words, that preterm birth may be an early sign of things to come – it may herald the development of hypertension, heart disease, and other chronic diseases mediated by stress and inflammation.

In sum, he points to the deep, wide and long-term impact of racism in maternal-child health.  The importance of disrupting racism is clear and compels us to examine the topic in more depth as our series continues.   A recording of the first webinar is available on the NACPM website.  “Social & Physiological Impacts of Racism in Maternal Child Health” continues on January 26, 2017, when we will go deeper into the study of epigenetics with Michelle Curtis, MD, MPH, MLL; recent research on racism and birth outcomes with Shandanette Molnar, JD, and Indra Lucero, ESQ; and the implications for health policy with Camille Sealy, MPH. Then on February 23, 2017, we turn our attention to the midwifery profession in “Diversity Matters: What Are Our Challenges.”  Keisha Goode, PhD, will discuss her landmark study “Birthing, Blackness, and the Body: Black Midwives and Experiential Continuities of Institutional Racism” and Nancy Anderson, MD, MPH, will report on her research “Women of Color Entering Midwifery: An Assessment of Unmet Needs.”

Photo: Martin Luther King Jr. addresses marchers during his “I Have a Dream” speech on August 28,1963 – Associated Press file photo

READ MORE ABOUT OUR WEBINAR SERIES, OTHER UPCOMING WEBINARS AND NEWS HERE

Group Beta Streptococcus webinar and new Michigan CPM licensing laws

Please join us this Thursday, January 12 from 2-3:30 pm ET for a free clinical webinar with Vicki Penwell, CPM and Dr. Tolulope Adebanjo on the etiology, diagnosis, prevention and treatment protocols for GBS. MEAC CEUs have been applied for and will be available for $15. More information on upcoming webinars, international midwifery news and the new Michigan CPM licensing laws in our newsletter.

READ THIS WEEK’S NEWSLETTER HERE

Getting Down to Business in 2017

Happy New Year! We have lots of great offerings in the works for this year, including many useful webinars!

We are kicking off the New Year with our new “Racism, Equity and Access to Midwifery” webinar series with the first presentation On the Social and Psychological Impact of Racism this Thursday, January 5 from 2:30 – 3:30 pm ET, and a speaker panel on January 26 from 2-3:30 pm, ET.

For more information on upcoming webinars, registration links and membership benefits, please click through below.

READ THIS WEEK’S NEWSLETTER HERE

Equity, Race and Access to Midwifery

What does the future hold for childbearing families? Who are the CPMs of the future and what contribution will they make to improving the health and well-being of our people? How do we prepare today to bring forward a profession that is fully capable and empowered to meet the needs of the future?

The leadership team of NACPM has been on a quest to deepen our understanding and broaden our thinking about these questions. Challenged by CPMs and other stakeholders who participated in the first national CPM Symposium in 2012, we have been particularly focused on the role that CPMs can play in reducing infant mortality and ending perinatal disparities. We have also been examining the history and current issues of racism in our society and in our profession to more fully commit to increasing access to midwifery care for all childbearing people and increasing access for all aspiring midwives to the CPM profession.

Our quest has led us to many outstanding resources, caused us to commission new research to better understand the landscape, contributed to our thinking about the role of NACPM state chapters, and deepened our resolve to achieve state licensure and federal recognition of CPMs. We have been sharing information and insights as we ourselves pursue this quest on our website, in newsletters, and through our chapter collaboration calls. In January 2017, NACPM will launch a new webinar series on Equity, Race and Access to Midwifery to learn more and identify action steps our profession can take to impact health outcomes and increase diversity within the profession.

NACPM Webinars on Equity, Race and Access to Midwifery

Our new webinar series will include presentations by national experts in health and social justice, disparities in maternal and child health, and the challenges of diversifying health professions. Important research on the experiences of black midwives and students will be presented to inform our thinking about education and practice opportunities. We will learn what new research in epigenetics can tell us about the impact of racism on health outcomes. We’ll explore why the benefits of concordant care – health care provided to a member of a community by a member of the community — and why increasing the number of midwives of color is so important.

Save these dates now, and look out for more information as additional speakers are confirmed!

Thursday, January 5, 2017 from 2:30 to 3:30 pm ET - Dr. Michael C. Lu, Associate Administrator of the Maternal and Child Health Bureau (MCHB) of the Health Resources and Services Administration , will describe his 12-point plan to reduce black-white disparities in birth outcomes using a comprehensive Life-Course approach that has become seminal in maternity care in the U.S. Dr. Keisha Goode will serve as Discussant, highlighting the significance of Dr. Lu’s work to midwifery followed by an opportunity for questions and discussion.

Thursday, January 26, 2017 from 2:00 to 3:30 ET -  A panel of researchers and policy experts will examine will examine how racism has specific health consequences that cross socio-economic lines, describe fascinating new research on the physiological effects of racism, summarize key literature on race and maternity care and discuss the implications for midwives.

Thursday, February 23, 2017 from 2:00 to 3:30 ET - Despite a long history of midwifery in the black community, black women currently represent less than 2% of the nation’s reported 15,000 midwives. At the same time, black women and infants experience the worst birth outcomes of any racial-ethnic cohort in the United States. In a landmark study completed in 2014, Keisha Goode, PhD, interviewed black midwives to better understand how the denigration of black midwives in the early 20th century is still manifesting itself in their experiences and perceptions of predominantly white midwifery education programs and professional organizations. She will report on her research and discuss the policy implications.

Nancy Anderson, MD, MPH, will present the findings of her research regarding the barriers encountered by women of color who wish to enter the midwifery profession. This qualitative study, commissioned by NACPM in 2014, reveals important insights that should inform scholarship and mentorship programs intended to develop a more representative midwifery workforce.

A Brief List of Resources:

NACPM’s Social Justice and Birth webpage  includes a list of initiatives undertaken by midwives of color to eliminate birth outcome disparities

The Anti-Racism and Anti-Oppression Work in Midwifery group of midwives and birth workers, founded at the 2012 CPM Symposium, is working to deepen our shared understanding and take action to dismantle institutional racism and oppression in midwifery.  They welcome those interested in working toward and learning about anti-racism and anti-oppression in midwifery to join their Facebook group to get connected and stay up to date.

Black Mamas Matter: A Toolkit for Advancing the Human Right to Safe and Respectful Maternal Health Care 

Racial Equity Tools  is designed to support individuals and groups working to achieve racial equity. This site offers tools, research, tips, curricula and ideas for people who want to increase their own understanding and to help those working toward justice at every level – in systems, organizations, communities and the culture at large.

 

READ THIS WEEK’S NEWSLETTER HERE

Water Labor and Birth: New Guidance

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For the first time, guidance on hydrotherapy during labor and birth has been created by maternity care experts providing health care professionals and institutions with consensus that had been previously lacking on this topic. A collaboration of the National Association of Certified Professional Midwives (NACPM), American College of Nurse-Midwives (ACNM), the American Association of Birth Centers (AABC), and the Midwives Alliance of North America (MANA) has assembled the guidance template using the most current information and best practices available to outline various roles and responsibilities for caring for women who labor and/or give birth in water. The template is available online now for early review and will be published in the January/February 2017 issue of the Journal of Midwifery & Women’s Health.

This new document has been informed by methodologically-sound, peer-reviewed studies that have been published to date.  The template format allows for adapting and tailoring the guidance according to the maternity care team members providing the care, their institutions and their birth settings.

“Together with our partners, we sought to fill a large void on best practice guidance for caring for families who desire hydrotherapy during labor and birth,” said ACNM President Lisa Kane Low, CNM, PhD, FACNM, FAAN.  “As maternity care providers, we provide evidence-based practices to those we care for.  But unfortunately, the available information and official positions on water birth have varied, which has made access to hydrotherapy difficult for those families who want hydrotherapy to be a part of their maternity care experience.  This document offers guidance for maternity care professionals to aid them in making sound decisions and giving recommendations to those who want to labor, or labor and give birth, in water.”

“Hydrotherapy has been well integrated into interprofessional maternity care in the United Kingdom since the 1980s with written evidence-based guidelines.  Our template offers best practice principles and a standardized approach to providing safe intrapartum immersion for women seeking immersion in the United States,” said Elizabeth Nutter CNM, DNP, co-editor of the guidelines. “Water labor and water birth promote physiologic birth while providing highly effective pain management.  Intrapartum immersion empowers the mother to give birth free from unnecessary intervention.”

Lesley Rathbun, MSN, FNP, CNM, President of AABC, said, “Our research supports the safety of water birth as an effective method of labor pain management when used by skilled, anticipatory providers using appropriate criteria. Many AABC birth centers offer water labor and birth, and we are proud to have participated in this document that will improve access and birth choices for mothers in the US.”

Colleen Donovan-Batson, MS, CNM, ARNP, Director of Health Policy & Advocacy, MANA, said, “The largest ever research on water birth found that, for low-risk mothers whose labors proceed normally, water immersion is generally a safe pain management option.  That’s why Midwives Alliance wanted to make sure this best practice guidance is available to care providers.”

“Immersion in water for labor and birth supports healthy and normal physiologic childbirth, and people giving birth want it as an option,” said Mary Lawlor, CPM, LM, MA and Executive Director of NACPM. “These guidelines provide critical evidence-based information that will support choice for childbearing people and sound clinical practice in all birth settings.”

 

READ THIS WEEK’S NEWSLETTER HERE

NACPM State Legislative Toolkit; ICM Report

State Legislative Toolkit Now Available

Curious how your state licensing law measures up when compared to national and international standards?  Need help planning a campaign to secure licensure for CPMs in your state?  Would information about the benefits of midwifery care be useful in your efforts to promote CPMs?  NACPM has heard your requests for help and is providing a State Legislative Toolkit to address your needs – please click through for more information.

 Midwives’ Voices, Midwives Realities: An International Perspective

The International Confederation of Midwives (ICM), World Health Organization (WHO), White Ribbon Alliance (WRA) and partners are calling for an end to the discrimination, harassment and lack of respect that hinder midwives’ ability to provide quality care to women and newborns. The first global survey of midwifery personnel led by the WHO, the ICM and WRA, Midwives’ Voices, Midwives Realities: Findings from a global consultation on providing quality midwifery care, reports findings from 2400 midwives in 93 countries.

Just as we are all committed to the highest quality care for all women, newborns and their families, so must we be united in our fervor to ensure that the midwifery workforce is supported by quality education, regulation, and safe working conditions.  Midwives must be respected, compensated and valued as equally as other professionals.   Frances Ganges, ICM Chief Executive

It’s time to recognize the pivotal role midwives play in keeping mothers and newborns alive.  Their voices have gone unheard for too long, and too often they have been denied a seat at the decision-making table.   Dr Anthony Costello, Director of Maternal, Children’s and Adolescents’ Health at WHO.

 Related links:

International Confederation of Midwives Facebook Page 

White Ribbon Alliance’s Promotion of Midwifery webpage 

The Lancet, “Midwifery and Quality Care: findings from a new evidence-informed framework for maternal and newborn care“

PLOS ONE, “What Prevents Quality Midwifery Care?”

 READ THIS WEEK’S NEWSLETTER HERE

NACPM Announcement of Cross-Racial Shared Leadership

“Organizations have a calling to contribute something energetically, valuably to the world, and an evolutionary energy to move toward that calling.” *

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The NACPM Board of Directors is taking an extraordinary new direction this year by electing Tanya Khemet and Audrey Levine as Co-Presidents. This decision builds on two important commitments. The first is our commitment to social justice and birth, which includes learning about and addressing racism in maternity care and midwifery. Choosing a cross-racial partnership for our Co-Presidents gives us an opportunity to deepen our practice of challenging racism within our leadership team and bring what we’re learning to our membership and the maternity care system more generally.

The second commitment is to strengthen our model of distributed leadership, which means that we work in self-managed teams and all are encouraged to participate in core leadership decisions.  Over the last 4 years, we have learned to operate more effectively, using a team-based/work-focused approach, thanks to the skillful and dedicated leadership of our immediate past President, Ellie Daniels, and the invaluable support of Cari Caldwell and Shirley McAlpine, our brilliant and inspiring co-facilitators from Birthwise Consulting.

We have made use of the best available web-based project management and collaboration tools, and have become a more “leader-full” organization, committed to creating a culture that fully engages the skills, talents, energy, and expertise of our staff, board, volunteers, and other stakeholders.  We have also challenged ourselves to become a “learning organization,” a community committed to growing together toward a shared vision and purpose.  Through this commitment to interconnected thinking and organized and shared learning, we have experienced more openness, enhanced communication, and greater productivity.  In essence, we have learned that “none of us is as smart as all of us.”

This lesson was brought home powerfully during the 2012 CPM Symposium where we posed the question, “What most requires our shared attention?” and we heard from the midwives of color in attendance that we must address the systemic racism in our culture that shows up in the tragic disparities in birth outcomes and is also present in our midwifery profession.  The Symposium created a space for courageous conversations about how midwifery in the U.S. must shift in order to ensure that all families have access to this kind of comprehensive and compassionate care.  And it generated energy and a commitment to confront racism within the midwifery profession so that we can work together as allies and effect change.

 

Since the CPM Symposium, NACPM has taken the following steps in the pursuit of health equity:

  • We drafted a statement of Strategic Intention

  • NACPM Board members and staff completed an 11-week course: Critical Conversations on Power and Privilege

  • We created two appointed positions on our leadership team for people of color

  • We are continuing to recruit people of color to our organization, recognizing the important impact of having a more representative critical mass

  • We are ready to implement the Racial Equity Tool created by Wendy Gordon and introduced in her article in the November issue of the Journal of Midwifery and Women’s Health. The article highlights the foundational work that NACPM has done to become a more racially just organization. Integrating this racial equity impact tool into our work going forward will allow us to consider and attempt to mitigate the unintended consequences that our initiatives, projects, and organizational policies and practices might have on various communities of color

Additionally, we have clarified what NACPM’s role should be in promoting equity in maternity care access and improving outcomes for all childbearing families and their babies, which is:

  • To amplify the voices and the work of midwives of color, help bring the necessary resources to that work, and use our privilege and access to help scale the innovative models of midwifery care and community-based doula programs that have emerged in communities of color and are having such a transformative impact

  • To advocate for legislative change as well as changes in education that will grow a diverse, representative, and sustainable midwifery workforce to meet the maternity care needs of our increasingly diverse population—with a particular commitment to meeting the urgent needs of the most vulnerable communities

With these pieces in place, embracing a model of cross-racial shared leadership was the logical next step.  We were inspired, in part, by the work of Robin DiAngelo and Darlene Flynn, who have found that “working collaboratively as a cross-racial team challenges racism by interrupting unilateral white leadership.” ** Why is this important for NACPM? Because we will not be able to deliver on our goal of becoming a more socially just organization or fulfill our strategic intention of eliminating inequity in maternity care access and outcomes unless those of us who are white learn how to partner with and take leadership from people of color.  And because this is the only way that addressing systemic racism and the pernicious ways that it affects the health of communities of color will rise to the top of our agenda and become one of our most urgent priorities.

As DiAngelo and Flynn note, this interruption of typical norms for leadership is key not only for the organization being led, but also for the leaders themselves. We see this configuration as a powerful laboratory for cultivating cross-racial skills and an opportunity to practice interrupting socialized patterns of racism.  We don’t anticipate that co-leadership will be easy.  Authentic cross-racial leadership requires sustaining honest and courageous dialogue about how racism manifests, solving problems, coordinating efforts, acknowledging and responding to racial mistakes, and resolving conflicts.  We believe these challenges will make us stronger.

And it is critical that, as a community, too, we build that muscle so that we can take in and really understand the whole picture.  The current research on epigenetics and the life-course perspective make it abundantly clear that the cumulative stress of living in a racist society has profound and lasting impact on the long-term health of people of color, most notably African Americans and Native people.  This is why it’s so important for those of us committed to improving the health of all childbearing families to educate ourselves about systemic racism, examine our own implicit biases, and build our “racial stamina” by staying in conversations that are often painful and difficult so that we can learn from one another and truly make amends.  To quote Maya Angelou: “I did then what I knew how to do. Now that I know better, I do better.”

To those of you who are wondering what took us so long to get here, thank you for urging us forward.  Your impatience has been a virtue.  We will continue to listen and learn.  To those of you who are just entering this conversation about racism and its impact on maternal-child health in the U.S. and want to explore what you can do to promote health equity, we invite you to participate in NACPM’s upcoming webinar series on health equity, join the AROM (Anti-Racism and Oppression in Midwifery) FaceBook group which grew out of the 2012 CPM Symposium, and check out the abundant and continually growing list of resources on the NACPM website’s social justice page.  Our whole profession is on a journey.  Welcome aboard.

 

* Reinventing Organizations: A Guide to Creating Organizations Inspired by the Next Stage of Human Consciousness, Frederic Laloux, 2014

** “Showing What We Tell,” Robin DiAngelo and Darlene Flynn, 2010

READ THE NEWSLETTER HERE

Join us for our Annual Meeting on Thursday!

Calling all CPMs and others interested in the work of NACPM! You are invited to participate in our 2016 Annual Meeting this Thursday, November 7 at 2:00 pm EST. The meeting will be held on-line.

Register Here

This past year, NACPM has undertaken several important initiatives, each designed to strengthen the three pillars of a viable, autonomous profession, as described by the International Confederation of Midwives: Education, Regulation, and Association. We aim to support the development of the CPM profession to better meet the urgent needs of the changing childbearing population in the U.S. and to better position CPMs to participate in the service delivery and payment models that are rapidly coming to define health care in the U.S. The annual meeting is an opportunity for us to share our vision and the values that inform our work. It is also an opportunity for you to ask questions and provide feedback to our national leadership team. Here’s what will be on the agenda:

Leadership: Manifesting Commitments

Meet out new board leadership, including co-presidents Tanya Khemet and Audrey Levine. Learn more about their commitment to cross-racial co-presidency and how it advances NACPM’s commitment to addressing the needs of our childbearing people and diversifying the midwifery workforce. Hear from Keisha Goode, public member of the NACPM Board of Directors, about the important role that public members play in advancing the profession.

NACPM provides leadership and represents CPMs in a number of formal collaborative groups and cultivates relationships with other individuals and organizations to expand our sphere of influence. Find out more about this work and how it might be replicated in your community or state.

Professional Identity, Member Engagement and Support

Continuing education is essential to the development of any profession and NACPM is deeply committed to providing educational resources. Our webinars and newsletters are constructed to address the practice, professional, and policy interests of our members and other stakeholders.  Learn more about the topical threads offered this year: equity, racism and access to midwifery; legislation and public policy; midwifery practice; and midwifery education.

NACPM leadership is deeply committed to addressing the challenges of equity and the impact of racism on perinatal outcomes and to making a real difference as we work to expand and strengthen the midwifery profession.   Learn how this commitment both infuses all aspects of our work and how we maintain a specific focus through workgroups, training, and outreach.

 Are you one of the many CPMs who have been asking for the development of national practice guidelines?  Stay-tuned — NACPM is preparing to launch a Practice Committee that will research the best-evidence available to create guidelines for CPM practice.  Midwives have long been asking for just this kind of support and, after carefully examining the experience and approaches employed by other professional organizations, we are ready to move forward.  Learn how you can inform the priorities for topics to be addressed in practice guidelines.

We can only expand and strengthen the profession when midwifery education is widely accessible and relevant to the needs of our childbearing population.  NACPM is laying the groundwork for an analysis of our current and future midwifery workforce in order to inform our thinking about midwifery education going forward. We are also preparing to draft NACPM Core Competencies, informed by the ICM Essential Competencies.   We aim to convene midwifery educators in the coming months to help us think about best practices in midwifery education, how to build on the strengths of the portfolio evaluation process and the existing formal education programs, and what it will take to grow midwifery exponentially.  We continue to explore the exciting potential for competency-based, direct-assessment education programs as a promising way to expand access to education.

Infrastructure – Foundation for NACPM’s Vision and Purpose

Good financial accountability is key to any viable organization, including NACPM.  We aim to be transparent about our finances, our challenges and our high level of commitment to being a financially sound organization.  Review NACPM’s finances with our Treasurer.

NACPM reaches well beyond individual member dues to support our work.  We have identified individuals and foundations across the country who share our vision and understand the critical nature of our work.  Their contributions make our work possible.  Find out more about our donors, why they support NACPM, and how you can help.

 As the breadth of NACPM initiatives has grown, so has our volunteer base and staff support.  Meet our national staff and learn how they work for you!

 READ THE NEWSLETTER HERE

Our Chapters Are Thriving!

Congratulations to the Illinois Council for Certified Professional Midwives, our newest NACPM State Chapter! We’ve seen the ground breaking work that you’ve accomplished around midwifery legislation in Illinois, and we are excited to work alongside you to bring that work to fruition.

NACPM is working hard to generate high quality webinars for our members and the public.  Chapter Collaboration Calls offer a space for deeper follow up discussion about how these issues relate to our unique state experiences.  We urge you to join our upcoming webinar series on anti-racism and equity in midwifery, planned for December,  and to join our follow up discussion on the December 15th Chapter Collaboration Call.  If you are not already a Chapter member or leader of a Chapter in formation and would like to join these deeper discussions, contact Susan at chapters@nacpm.org to form a Chapter in your state now!

 

North Carolina and South Carolina Host Joint Chapter Event: Carolina Birth Junkies Summer Island Retreat


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One of our goals with the NACPM Chapter Program is to create a nationwide network of CPMs who can learn from and support one another.  Our North Carolina and South Carolina Chapters offer an exciting example of how this mutual support is already building.  This summer, they came together to host a joint retreat, and the results were inspiring.

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Christine Strothers of the North Carolina Association of CPMS and Lori Gibson of the South Carolina Chapter of NACPM came together to create a robust event on Sand Island in the Catawba River.  Lori described this as a vision she and Christine had been cultivating for quite some time, and with the launch of the Carolina State Chapters, they saw an opportunity for joint fundraising in addition to offering “engaging, enticing, and relevant” continuing education: “With both Chapters in infancy and in need of funds, we naturally thought that we would donate any proceeds to the two State Chapters … for expenses related to making CPMs more accessible to families.”  In the end, they raised enough for each Chapter to take home over $1,000 with a very simple marketing strategy using word of mouth, email, and a Facebook page created for the event.

Both Lori and Christine reflected that this retreat went beyond just meeting the needs of local midwives for CEUs and peer review.  Over the course of the weekend they had nearly 40 midwives, midwifery students and doulas flowing in and around the island, some coming from as far as Georgia, Colorado, and New York.  They experienced connection and camaraderie and saw just how much they have in common as midwives, even across state lines.   In addition to the CEUs listed below, they did team building exercises and yoga; they shared meals and shared stories; they got to know one another.

Summer Island Retreat CEU’s:

*Newborn Transitions with Karen Strange, CPM, AAP/NRP

*When Survivors Give Birth, Elizabeth Johnson, MA

* Microbiome, Karen Strange, CPM, AAP/NRP

* Preeclampsia and Nutrition: separating Fact from Fiction, Adrienne Leeds, LM, CPM

* Charting for Midwives, Nancy Koerber, CPM

* Home to Hospital Transfer, Meredith Christie, CPM

* Viewed “The Dark Side of the Full Moon” followed by a round table discussion about post-partum depression

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On Sunday afternoon, State Chapter meetings were held.  The South Carolina Chapter focused their meeting on updates around legislation and regulations in SC, how to grow their membership, and fundraising ideas.  The North Carolina Chapter discussed what NACPM represents and what the goals are on a national level, the new role of State Chapters and goals for NC around legislative efforts, education, professional development, and collaboration with other midwives, consumers, and the medical community including state-level MERA collaborations that they are modeling after USMERA, ideas for handling transport, and opportunities for student involvement.
Plans for next year’s retreat are already underway!

What about your State Chapter?  How are you working to increase your membership and raise funds? How often does your Chapter meet, and where?  Have you connected with another Chapter to offer mutual support?  We’d love to hear what’s working for you and what you’re planning!  Email Susan at chapters@nacpm.org

 

READ THE NEWSLETTER HERE



Payment Reform in Maternity Care

Maternity care in the United States is unnecessarily expensive and does not produce the best results. Midwives know it and now leading experts in health care payment reform agree. But whether CPMs will be seen as part of the solution and whether CPMs are prepared to participate in the new payment reform models are open questions.

A landmark white paper on payment reform was released this summer by the Health Care Payment Learning & Action Network (LAN): Accelerating and Aligning Clinical Episode Payment Models. Interestingly, maternity care is one of three clinical areas explored in-depth in the LAN paper, with recommendations for implementing new payment models.

  • For a brief overview see the LAN Fact Sheet on Clinical Episode Payment Models: Maternity Care

  • You can also read the full White Paper here.

The LAN was created to drive alignment in payment approaches across and within the public and private sectors of the U.S. health care system. More than 100 entities are LAN partners, including major health plans, academic centers, government agencies, consumer groups and private employers.  In keeping with the goals of US Department of Health and Human Services, the LAN aims to have 30% of U.S. health care payments in alternative payment models by 2016 and 50% by 2018.

According to the LAN, one promising area for payment innovation and alignment is in payment for “episodes of care” to improve patient outcomes, enhance health system performance, and control costs. A clinical episode payment is a bundled payment for a set of services that occur over time and across settings. Bundling payments for episodes of care shows promise for reducing costs and improving the quality of care.

An entire chapter of the LAN white paper examines maternity care – cost and quality of current system – with recommendations for designing new payment models that include the definition of clinical episode, population, patient engagement, quality metrics, and so on.  According to the authors of the paper, the goal of episode payment should go beyond lowering costs, and that it should be designed such that it supports a more patient-centered approach to care. Specific goals of maternity episode payment include:

  • Increasing the percentage of vaginal births and decreasing unnecessary cesarean births;

  • Increasing the percentage of births that are full-term and decreasing preterm and early elective births;

  • Decreasing complications and mortality, including readmissions and neonatal intensive-care unit (NICU) use;

  • Providing support for childbearing women and their families in making critical decisions regarding the prenatal, labor and birth, and postpartum phases of maternity care and respecting those choices;

  • Increasing the level of coordination across providers and settings of maternity care; and

  • Consistently providing a woman- and family-centered experience.

Karen Milgate, the Clinical Episode Payment Work Group’s Technical Subject Matter Expert for the Health Care Payment Learning & Action Network, will discuss the white paper and the maternity care recommendations at length on NACPM’s webinar on payment reform on October 27th.  As former Deputy Director of the Center for Strategic Planning within the Centers for Medicare & Medicaid Services (CMS), Karen is a seasoned health care policy executive with a deep knowledge of Medicare and Medicaid policies, programs, operations, and data.

Note: NACPM’s bundled payment proposal is cited in the LAN white paper appendix on maternity care implementation resources.

 

Maternity Neighborhood Blog

Brynne Potter of Maternity Neighborhood has posted a series of excellent pieces on Business Strategies for Payment Reform that also address clinical episode payment and what midwives need to be thinking about.  Maternity Neighborhood is a mission-driven company with a portfolio of digital tools to support woman-centered, relationship-based maternity care. These tools can be configured in a variety of ways to meet the needs of providers, patients, and care navigators.

Other Learning Resources

Catalyst for Payment Reform. Action Brief: Maternity Care Payment.

Center for Health Care Quality and Payment Reform

Pacific Business Group on Health. Transform Maternity Care (TMC) Advancing high-value maternity care.  December 2014.

Whitman, Elizabeth. Bundles of joy?  How new payment models for maternal care could deliver lower costs Modern Health Care, August 13, 2016

PLEASE READ THE FULL NEWSLETTER HERE


CPMs: Playing a Leading Role in the Development of Birth Centers in the U.S.

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Congratulations to Amy Johnson-Grass – First CPM to Serve as President of the American Association of Birth Centers!

The membership of the American Association of Birth Centers (AABC) has elected Amy Johnson-Grass, ND, LM, LN, CPM, President-Elect of the AABC. Johnson-Grass is the first Certified Professional Midwife to serve as President of the Association. As incoming AABC President-Elect, Amy will serve one year with AABC President Lesley Rathbun, MSN, CNM, FNP and officially become President at the AABC 11th Annual Birth Institute in Anchorage, Alaska in 2017.

“I am thrilled to have Amy as our president-elect. She has been a tremendous addition to the Board already and I am looking forward to seeing how she continues the growth of all aspects of the organization,” said President Lesley Rathbun. “She is a strong and creative woman who runs both a successful business and practice. We are lucky to have such a well-rounded leader.”

A visionary committed to the work of building organizations, Amy says, “As an advocate for birth centers, I recognize the impact an organization can make through legislative efforts both on the state and national levels.”  In fact, she has acted on this conviction to support the creation of the Minnesota Chapter of NACPM, currently serving as Chapter Vice-President.

Amy is the founder, owner & director of Health Foundations Family Health & Birth Center (HFBC) in St. Paul, Minnesota. She is adjunct faculty at Bastyr University and Birthwise Midwifery School and HFBC is a preceptor site for midwifery students.  HFBC provides maternity services as well as a wide range of related services, including pediatrics, chiropractic care, naturopathic medicine, prenatal yoga and fitness classes, nutritional counseling, childbirth education, lactation support and more.  Like many CPMs across the country, Amy works collaboratively with other providers to ensure that families have access to care that meets their needs.

One-half of all birth centers in the United States are owned by or employ CPMs.   Mary Lawlor, Executive Director of NACPM and owner of the Monadnock Birth Center in Keene, NH, reports from the 2016 Birth Center Institute in Pittsburgh from September 22-25 that AABC is an important resource for midwives whether they already work in a birth center or are thinking about creating one.   The annual conference provides opportunities for networking and education in both clinical and administrative tracks.  “How to Start a Birth Center” workshops are held regularly around the country.

AABC has a long history of data collection and research evaluating the birth center model and care provided.  In the landmark National Birth Center Study II, 20% of the women were cared for by CPMs, licensed midwives or teams that included CPMs and licensed midwives.

NACPM has worked alongside AABC in the national Coalition for Quality Maternity Care and supports the continuing efforts to ensure Medicaid payment for services provided by CPMs in birth centers.  Tune in for the NACPM webinar on payment reform on October 27, 2016 which will include presentations on improving birth center payment at both the national and state level.

CPMs are also taking leading roles in the Commission for the Accreditation of Birth Centers, serving on the Board of Commissioners and as Site Visitors.

NACPM is also proud to support the National Association for Birth Centers and Clinics of Color, whose mission is to increase the number of maternity clinics and birth centers owned and/or operated by practitioners of color who are committed to serving communities of color.  Founded in 2012 by a group of CPMs, the NABCCC is building on the successes achieved by each of its founders working with women of color – meaning that the women being served experience better health and better care through the deliverance of culturally-competent, evidence-based, comprehensive and cost-efficient midwifery and maternity-care home models.  Watch for NACPM webinars in December 2016 that will feature Midwives Making a Difference!

PLEASE READ THIS WEEK’S FULL NEWSLETTER HERE


CPMs and State Licensure: Finding New Ways Forward in Today’s Environment

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State licensure, combined with national certification, is essential to the future of CPMs. Twenty years after creation of the CPM credential, 24 of the 29 states that license direct-entry midwives recognize the CPM credential as a route to licensure. (see a state-by state chart here.) While there are many obstacles to achieving licensure in every state, CPMs are finding exciting new ways forward with support from NACPM and the work we’ve accomplished with other national midwifery organizations in the US MERA (Midwifery, Education, Regulation, and Association) collaboration.

The significance of this work is reflected in ACOG’s 2015 statement endorsing the ICM Standards and 2016 statement supporting the Bridge Certificate.  NACPM is building a toolkit of resources for advocates that includes new fact sheets, background information on midwifery regulation, national certification, and educational program accreditation; and tools to support advocating for good regulation based on national and international standards.  Watch the NACPM website for resources as they become available!

This year, legislation was passed in Maine to license CPMs.  This was accomplished through a very interesting process of consensus-building among a range of stakeholder groups, including CPMs, nurse-midwives, consumers, physicians, nurses, and state officials.  Using a professional facilitator, these stakeholders met for more than a year to discuss qualifications, scope of practice, accountability, and more.  Agreeing to include legislative language endorsed by the US MERA organizations was pivotal to their progress.   Referencing the US MERA Principles for Model Midwifery Legislation and Regulation, which are based on international standards, also proved helpful to strengthening the proposed legislation.  As always, some creative problem-solving was also required.  Now that the licensing law has passed, new opportunities are emerging for CPMs to impact quality of care issues in the state thanks to the relationships built in their legislative collaboration.  To learn more about this fascinating story, tune into NACPM’s Legislation and Policy Webinar Series on October 6, 2016 or visit the NACPM webinar page after that date for a recorded version.

CPMs and their advocates are actively pursuing legislation in Kentucky and Illinois.  They are also finding that there is new support for their efforts because they’ve chosen to incorporate the international standards for midwifery using the language regarding qualifications adopted by the U.S. MERA collaboration.   The October 6th webinar will also feature representatives from these states describing the opportunities and challenges unfolding this year.

NACPM is fully committed to supporting state licensure for CPMs.  More women will have access to midwifery care when all CPMs are legally authorized to provide services.  Midwifery regulation, which varies state-by-state, will be improved when state laws are based on national certification.  Midwives will be able to move more easily from one jurisdiction to another when state laws are more consistent. More childbearing families, health professionals, public policymakers and third party payers will understand and value the contributions of CPMs when they are recognized in every state.   Be sure to join us as we explore these topics in future webinars and support NACPM by becoming a member today.


Upcoming webinars: Zika Virus and CPM State Licensure

Please join us for webinars on Monday, September 26, 2016 and Thursday, October 6, 2016. The Monday webinar will feature a number of speakers on the Zika virus: how it affects the mother and fetus, how to manage patient care and more.

On October 6 we will hear from CPMs in Maine, Kentucky and Illinois, who are discovering new opportunities for state licensure and building relationships with professional colleagues and policymakers.

LEARN MORE AND REGISTER FOR THE WEBINARS

Join us in Peterborough, NH on September 28

Please join us for a free presentation by NACPM Executive Director Mary Lawlor on September 28, 2016 from 6-7pm at the Peterborough Library on 2 Concord Street in Peterborough, NH. Mary will present “The Future Begins With the Way We Are Born.” Mary will share current trends and practices, a bright future vision, and the work that is being done to achieve that. Discussion will follow.

READ MORE ABOUT THE PRESENTATION HERE

REGISTER NOW for MAMA Campaign Virtual Meeting

All stakeholders are invited to participate in a discussion of the current initiative to secure Medicaid reimbursement for all licensed CPMs. There will be a brief update on the direction and current status of the initiative to be followed by an open discussion of questions and concerns raised by stakeholders. We want to hear from you!!! Please click through for registration information.


READ THE FULL TEXT AND REGISTER HERE