State Legislation Update and Harking Amendment Victory in Oregon

State Legislation Update

Momentum continues to build as more states include the US  MERA  agreements and principles in bills to license Certified Professional Midwives, helping to overcome opposition to the regulation of CPMs that has stymied efforts, often for years and at times even decades.   In addition to legislation to license CPMs, midwives and consumer advocates are stepping up in other states to address threats, and to rise to challenges as well as to emerging opportunities.  As we share our experiences with legislation and regulation, state to state, we build our common body of expertise to promote and protect the practice of certified professional midwifery.  We are pleased to provide you with these updates and look forward to keeping you abreast of further developments in these and other states in the months to come.

Illinois

The Illinois Council of CPMs – a Chapter of NACPM – and the Illinois Friends of Midwives have introduced the Home Birth Safety Act in both the House of Representatives (HB 677) and the Senate (SB 1754), the same legislation that these groups collaborated on last year with ACOG.  With over 1000 babies being born out-of-hospital a year in the state, Illinois ACOG and the midwives believe passage of this bill is a matter of safety for mothers and babies choosing home birth.  Aligned with the US MERA agreements, the bill passed out of the Senate Committee of License Activity and Pensions on a 9-2 vote this session, with a promise by the midwives to committee members to further engage with the Illinois State Medical Society who have opposed the bill.  A meeting of the parties took place in March, with the Illinois Medical Society agreeing to take the information the midwives provided to them on CPMs and MEAC-accredited education back to their board for discussion.  The primary Senate sponsor of SB 1754 has committed to keeping the bill alive and to bringing this legislation to the floor for a vote of that chamber, as soon as next week.

Kentucky

Two identical bills to license CPMs in Kentucky have been introduced, one in the House (HB 148) and one in the Senate (SB 105).  HB 148 was heard in the House Committee on Licensing and Occupation, but received no votes this session.  Although the bill last year had more hearings and got further in the legislative process, more progress was made in activating the grassroots and building strength for this effort this year than last.  CPMs held seven regional meetings around the state this year, effectively engaging people from every corner of the state.  The CPMs in Kentucky are rightly proud of this outreach, which took much hard work and organizing, that allowed many more voices to be heard and engaged in the process.  Another victory this year was that the midwives were able to effectively stop an oppositional amendment to the bill sponsored by a house member with significant political clout, demonstrating the growing strength of the midwives and the grassroots and the support that is building in the legislature for this effort.  Advocates for this US MERA-aligned legislation are busy now preparing for the interim hearing period that begins in June.

Alabama

There are currently three bills in play in Alabama.  Advocates have brought forward HB 316 to license CPMs, a bill that aligns with US MERA agreements, and HB 315 that would exempt a midwife holding a current certification from NARM from the crime of practicing midwifery without a license – sometimes referred to as a decriminalization bill, a ‘back-up’ in the case the licensing bill does not pass.  A third bill, proposing to regulate the practice of ‘lay midwifery’ brought forward by the Medical Association of the State of Alabama (MASA), would effectively outlaw all direct-entry midwives except Certified Midwives, and does not have the backing of advocates for CPMs.  After years of rejection of any bills to license CPMs, HB 315 recently passed through the Judiciary Committee and HB 316 passed through the Committee on Boards, Agencies and Commissions; both bills are headed now to the floor in the House of Representatives.  Although there may still be much work ahead to secure passage of these bills, advocates are encouraged by the support they have found in these committees.

Oklahoma

Early this year, Oklahoma CPMs were unexpectedly challenged by the introduction of hostile legislation that would have effectively eliminated their ability to practice in the state.  By organizing quickly, engaging midwives and consumers and raising funds to hire an effective lobbying firm, they were able to push back this threat.  The newly-formed Oklahoma Chapter of NACPM was chosen by the CPMs in the state to act as the joint legislative arm for the two long-established state midwife associations, with the presidents of each organization serving on the board of the chapter, effectively bridging midwives around the state.

In February, NACPM Executive Director Mary Lawlor, attended the official launch meeting for the Chapter.  Midwives came from all over the state to share their concerns and challenges about regulation for midwives, and to learn together about the national picture that is emerging for certified professional midwifery.  They discussed the US MERA agreements and Principles for Model U.S. Midwifery Regulation and Legislation, and how alignment with these tools in other states is successfully building momentum.  The Chapter board then participated in a work session with Mary, using the NACPM Regulatory Assessment Tool from the NACPM Legislative and Advocacy Took Kit  to explore how the US MERA agreements and principles might be applied in Oklahoma to build a strategy for protecting autonomous practice in the state.

Florida

On March 29, the Midwives Association of Florida (MAF), consumers, and the Florida Chapter of NACPM celebrated an impressive turnout for Capitol Day in Tallahassee when many constituents met with their legislators in support of Licensed Midwives.  Physicians are seeking to require mandatory reporting of adverse incidents for Florida licensed midwives, to include reporting of maternal and fetal deaths, severe maternal hemorrhage, and transfers of mothers and infants to intensive care units.  The midwives agree with these requirements.  With the support of their lobbyists they are in dialogue with Florida ACOG about this legislation, which may involve opening up their midwifery practice act, a potential turn of events that is causing the midwives to strengthen their organizations and to rally support from around the state to ensure autonomous practice.

On another note, congratulations are in order!  The midwives in Florida are celebrating a long-sought victory:  as a result of 20 years of advocacy, new rules now provide for licensed midwives to do their own risk screening for new clients coming into birth center care, reversing a long-standing requirement that birth center clients have their initial exam and risk assessment with an MD or a CNM.

Washington State

With a more than 30-year history of policy and advocacy work, the Midwives Association of Washington State (MAWS), has lobbied this year for two budget provisos:  one to maintain the 8-year-old cap on the licensing fee for midwives, and the other to nearly triple the facility fee for birth centers paid by Medicaid.  Maintaining the cap on the annual licensing fee, which would otherwise now be triple the current rate of $525, has contributed to a 40% increase in the number of midwives in the state over these last 8 years, now nearly 170.  The increased birth center Medicaid reimbursement would not only benefit people having babies in Washington State, but could support efforts to increase the low rates of birth center reimbursement throughout the country, much as the 2007 Department of Health Cost-Benefit Study has helped make the case for Medicaid reimbursement for community birth in other states and to the federal government.

An Oregon Victory for the Harkin Amendment

Just last week NACPM was informed that an insurer, PacificSource in Oregon, has cited the 2015 guidance issued to the states by the U.S. Department of Health and Human Services (HHS) on Section 2706 of the Affordable Care Act (ACA) – commonly known as the Harkin Amendment – as the factor that has led it to finally issue reimbursement for direct entry midwife services provided to an Oregon resident in 2015.  Since the ACA passed in March 2010 until now, the implementation of the Harkin Amendment has been a discouraging story.

In agreeing to cover the costs of care for this consumer, the Oregon Insurance Division (OID) stated:  “…PacificSource has reviewed the Centers for Medicare and Medicaid Services (CMS) FAQ that provides additional clarification for provider non-discrimination requirements. The insurer has agreed that members who go to in-network Licensed Direct Entry Midwives can receive benefits under their policy. They also have agreed that members who seek out-of-network care by a Licensed Direct Entry Midwife would have their benefits paid at the out-of-network level the member policy permits (in a non-discriminatory manner).”

This victory is celebrated by the Integrative Health Policy Consortium and NACPM.  NACPM is an IHPC Partner for Health  and has held a board of director’s position for the last decade.  This new development in Oregon could portend well for reimbursement of midwife services for people having babies around the country.  Dogged persistence on the part of this Oregon consumer who had her baby at home with licensed midwives, along with support from the Oregon Midwifery Council and IHPC, has finally paid off in this unexpected but happy turn of events.  Of interest, the OID sent their email on the same day that the American Health Care Act (AHCA) was pulled from the floor of the U.S. House of Representatives, leaving the ACA as the law of the land.  Although it is likely that there will be no movement until fall of this year, there is reason to hope that the Oregon Insurance Division now will commit to fully implementing Section 2706 to address the current inconsistencies in coverage for professions in the state, and provide an example to other states on implementation of this important provision of the ACA.

The Integrative Health Policy Consortium was instrumental in working with Senator Harkin and other legislators during the development of the ACA to include Section 2706 to ensure patient access to care.  This provision of the law, sometimes known as the non-discrimination clause, requires that insurers include and reimburse licensed healthcare providers in health insurance plans.  It states:

(1) A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law.

(2) This section shall not require that a group health plan or health insurance issuer contract with any health care provider willing to abide by the terms and conditions for participation established by the plan or issuer. Nothing in this section shall be construed as preventing a group health plan, a health insurance issuer, or the Secretary from establishing varying reimbursement rates based on quality or performance measures.

Notwithstanding small pockets of progress, implementation of this provision has met roadblock after roadblock since its passage.  In 2013, IHPC launched a nation-wide initiative to ensure adequate implementation of Section 2706 called Cover My Care, a national grassroots program of information and patient engagement designed to create public advocacy for access to all healthcare providers who are licensed by states.  Cover My Care provides a website,  information and FAQs about the law, patient guides,a toolkit for consumers and forums for consumer sharing.

In the coming months, IHPC and NACPM will be closely tracking progress of Section 2706, and providing all possible support for the goal of full implementation of this provision around the country.

 READ THIS WEEK’S NEWSLETTER HERE

Diversity Matters: What Are Our Challenges?

The midwifery workforce in the United States is not representative of the racial and ethnic diversity of the childbearing population.

“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. Relatedly, black women and infants experience the worst birth outcomes of any racial-ethnic cohort in the United States.” Keisha Goode, PhD

The first two webinars in our “Equity, Race and Access to Midwifery” series focused our attention on the tragic disparities in maternal and infant outcomes, particularly among black families, the underlying physiologic effects of racism, and steps we can take to reduce disparities. This week Keisha Goode, PhD, and Nancy Anderson, MD, MPH, will discuss the barriers to attaining a representative midwifery profession and the positive impact that a truly representative midwifery workforce could have on health inequities. They report on their landmark research, designed to reveal the experiences of contemporary black midwives and students in midwifery education programs, practice settings, and professional associations. Their important findings and recommendations are a call to action for all midwives.

Keisha’s research is the first study to systematically investigate the experiences and perceptions of contemporary black midwives. Her dissertation, “Birthing, Blackness, and the Body: Black Midwives and Experiential Continuities of Institutional Racism” was completed in 2014 and includes a comprehensive examination of the history of midwifery, particularly among women of color and immigrants, and the long-lasting effects of racism, both as midwifery is generally perceived in the U.S. and within the profession as it has developed in recent decades. Keisha’s qualitative study, included both CPMs and CNMs, and was conducted via in-depth, semi-structured interviews that addressed these questions:

• How do contemporary black midwives interpret the increasing medicalization and credentialism of midwifery and its impact on their work?

• How do contemporary black midwives interpret the relatively high black maternal and infant mortality rate in the United States?

• How do contemporary black midwives interpret the relatively low percentage of black midwives and black women’s underutilization of midwifery services in the United States?

• How do black midwives perceive and experience national midwifery professional organizations?

• How do contemporary black midwives understand their role, its possibilities and challenges, in addressing issues of cost, quality and access in the current health care crisis?

• What are the differences in black midwives’ experiences and perceptions by age cohort, years of experience and type of midwife, i.e. CNM, CM or CPM?

Keisha’s findings have profound implications for midwifery educators and association leaders, for preceptors and midwifery practices, and for those who advocate expansion of the profession.

“To the larger midwifery community, listen to your midwives of color. The future of midwifery and positively impacting birth and birthing options for all women in this country depends on it.” Keisha Goode, PhD

The second speaker in this webinar, Nancy Anderson will share her research project/needs assessment that aimed to understand the barriers that women of color experience with respect to the midwifery profession. Sponsored by NACPM, the objectives of her study were:

• Understand the role of unmet financial need as a barrier to women of color who wish to enter the midwifery profession

• Determine the ideal scholarship structure for financial aid to women of color who enter midwifery education

• Learn more about other barriers to successful midwifery education and practice for women of color.

A few highlights from Nancy’s findings:
The study identified several areas of resiliency and strength that were important to the success of women of color entering midwifery. These included previous work experience and expertise; community support and engagement; and sheer determination. Nancy also found that, while a variety of learning options could meet individual learning styles and personal needs best, the plethora of educational possibilities, each with differing financial implications and a variety of regulatory consequences, also highlights the importance of an organized outreach and information program for potentially interested women of color.

The importance of adequate financial resources for education is difficult to overemphasize, particularly in a population of potential midwives who may be more likely to be lower income at the onset of their midwifery education. One particular complexity is that midwifery education requires tuition, room/board and books, just as other higher education, but midwifery education also requires financial resources for travel to preceptor sites, steady supplies of gasoline and reliable transportation for births, and possible payment for the preceptors. Participants universally described a number of daunting financial challenges both at entry and during the course of their midwifery education.

By definition, someone who is an ethnic minority differs in a culturally prescribed way from most of her classmates. In the best of circumstances, these differences can be daunting. In addition to coping with cultural dissonance, women of color enter any midwifery educational pathway as experienced survivors of racism from childhood, previous education, and/or their employment experiences. Previous educational exposure may have occurred within institutions that were systematically deprived of adequate resources. Students of color carry this reality on their shoulders when they begin their midwifery education. Given the load that they carry, these students need systematic support from educational institutions.

Cultural dissonance, isolation, and racism can reach a zenith during clinical preceptor rotations when students may have to travel, dislocating to isolated locations with few people of color. Given the threats to the academic survival, both in classroom settings and during preceptorships, support in the form of mentorship becomes a key resource. It is the emotional equivalent of a life raft for midwifery students of color in midwifery.

Given the multidimensional needs described, it is recommended that financial and other support needs be integrated into a “package deal” that includes elements of social support, peer support and mentoring.

In her webinar presentation, Nancy will describe her specific recommendations and how they might be acted upon by midwifery education programs, educators, preceptors, and those who could mentor midwives of color.

Two other factors, occasionally forgotten in our concern for inequity, should also be important catalysts for targeted workforce development. First, the US overall is changing in ethnic distribution. As of 2012 there are already almost equal numbers of white and ethnic minority children in kindergarten. It is anticipated that by 2050 white Americans will be an ethnic minority in the United States. A health workforce that does not adequately represent the population it serves will never be able to anticipate or respond to their needs.

“The bottom line is that midwifery will need a more representative (as opposed to diverse) professional workforce to survive. While there’s good evidence that the model of care associated with midwifery can make a difference in the lives of women and babies, midwifery is a client demand-driven profession….no one has to choose a midwife and there’s no reason that they should unless they see themselves reflected in the profession.” Nancy Anderson, MD, MPH

FIND ALL MARCH AND APRIL WEBINAR OFFERINGS IN THIS WEEK’S NEWSLETTER

The NACPM Legislative and Advocacy Toolkit is Growing!

With feedback from our state chapter leaders and others, we are adding a new tool “How to Work Successfully with a Lobbyist” and several reference documents regarding the integration of midwives and midwifery care in the maternity care system.

Most states report that working with a professional lobbyist is one of several critical factors in their legislative success. Unfortunately, we’ve heard too many stories of groups that didn’t engage the best person for their purpose or didn’t really know how to work effectively with their lobbyist — wasting precious time, money, and even political support. NACPM’s new tool describes the criteria for selecting a lobbyist; clarifying goals and exercising appropriate control over the legislative efforts and strategy; clearly defining expectations, including costs; and regularly evaluating the association-lobbyist partnership.

Reference documents now available include the “Best Practice Guidelines: Transfer from Planned Home Birth to Hospital” and other guidelines or projects developed by perinatal collaboratives and various midwifery associations.

Our members have also requested that NACPM provide a statement on scope of practice. Our Legislative and Policy team is reviewing our core documents, as well as descriptions provided by the North American Registry of Midwives and official statements by the International Confederation of Midwives and other professional associations to prepare an updated definition for CPMs. Look for this to be finalized and added to the toolkit next month.

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Passion and Perseverance in South Dakota and Washington State

Congratulations to South Dakota!  Governor Signs Bill to License CPMs 

On March 1st, to the great joy of families across South Dakota, the state House of Representatives passed SB136 to license and regulate Certified Professional Midwives by a vote of 52-16 – exactly 25 years to the day when a baby boy was born at home while his father was recovering from an accident in the hospital.  After the birth, the mother and baby visited the father in the hospital, hospital personnel heard of the home birth, sparking a decades-long quest by the SD Department of Health to shutter the practice of all non-nurse midwives in the state.

On March 10th, Governor Dennis Daugaard signed the bill into law which will go into effect on July 1, making South Dakota the 30th state to establish a path to licensure for CPMs and adding to the growing number of states benefitting from aligning their legislation with the US MERA agreements.  With the $20,000 needed to fund the midwife regulatory board already in hand, thanks to the generosity of SD families, and the development of legislative rules about to begin, it is expected that the first CPMs will be licensed in South Dakota within a year.

The first bill to license direct-entry midwives in South Dakota was introduced in 1994.  In 1995, after giving birth to her 4th child at home, Debbie Pease joined the SD Safe Childbirth Options – which later became South Dakota Birth Matters, a coalition of concerned families advocating for access to midwives.  Over the next 22 years Debbie held various board positions, including Chair and currently Secretary, and has been the lobbyist for the group since 2009.

This legislative success is a story of extraordinary dogged perseverance, with advocates introducing a total of 33 bills over 25 years to expand and protect birth options for South Dakota families – including 9 licensure bills and 22 others to keep women, babies, families and midwives on the legislature’s radar.  “The timing was good this year”, Debbie told NACPM.  A combination of decades of showing up every year to educate lawmakers, having several prime sponsors positioned on key committees of jurisdiction, a sense in the legislature that “these people deserve to make progress” after all their years of hard work, and aligning the bill with US MERA agreements to overcome contention about the education of CPMs, paid off.   “It was a many-year strategy to wear down the opposition”, Debbie said, “and it worked! Every relationship you make takes you one step closer to your goal.”

Congratulations to all families in South Dakota – you inspire us all!

Persistent Perseverence: MAWS Lobby Day Turns 30

Consumers, midwifery students, and midwives are often a presence in state capitols when urging action on a new state licensure bill or fighting attempts to restrict midwifery practice.  But Washington State may hold the record for convening advocates proactively every year for more than 30 years in a row.  The Midwives Association of Washington State (MAWS) hosts an annual Lobby Day to make sure that legislators know just how important midwives are to childbearing families and the value they bring to the maternity care system!

To learn more and see examples of supporting documents, check out the MAWS 2017 Electronic Lobby Day Packet for Legislators  and the Information for Lobby Day Participants.    Also available on the MAWS website is their 45 minute Lobby Day Training Webinar  which prepares advocates with an overview of the legislative process, facts about the benefits of midwifery, coaching to create your own “elevator speech,” and the specifics of this year’s legislative priorities.

Priorities for families and midwives this year included asking legislators to maintain the cap on midwifery licensing fees and triple the Medicaid reimbursement rate for birth centers.  Because of the clear cost savings and health benefits that licensed midwifery confers to the State of Washington as evidenced by the 2007 DOH Cost-Benefit Study, MAWS has successfully lobbied for this cap for the past 8 years.  Last year, MAWS successfully lobbied for a budget proviso directing the Health Care Authority (HCA) to review its methodology for setting the Medicaid reimbursement rate for birth centers.  MAWS leadership then worked diligently with the HCA throughout 2016, compiling data that went into a report sent to the legislature by the HCA in October, recommending that the Medicaid reimbursement rate for birth centers be increased to $1,742.  Midwives believe that, if they are successful in getting this budget proviso passed, not only will birth centers in WA State become more viable, but midwives, birth centers, and consumers in other states will benefit, too.

In addition to the specifics regarding midwifery licensing fees and birth center reimbursement, MAWS also supported several other bills, including:

• a bill requiring that employers make reasonable accommodations for pregnant workers and that hospitals be required to institute baby-friendly practices, such as skin-to-skin contact immediately after birth;

• a bill to strengthen the Family and Medical Leave Act by including a mandate for paid leave;

• a bill to ensure that both midwives and doulas could have access to the state’s jails and prisons to be able to provide education and support to pregnant and postpartum inmates.

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Informed Consent and Shared Decision Making

Join us for this week’s webinar on Informed Consent and Shared Decision Making. Here is an opportunity to refresh and sharpen your understanding of the professional, legal and ethical requirements that underpin your practice. The presentation will also address how midwives and clients can use decision aids and electronic health records to support and document the information sharing and decision ­making processes.

READ ABOUT ALL UPCOMING WEBINARS IN THIS WEEK’S NEWSLETTER

Chapters Effective in State Legislative Efforts

There are now twelve active NACPM State Chapters with more in formation. Read about how Oklahoma midwives used the formation of a state Chapter to address legislative threats to their practice; learn about the next Chapter Collaboration Call, and register for webinars!

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Midwifery Matters Subscription is our Newest CPM Member Benefit

All CPM Members of NACPM will receive an automatic subscription of Midwifery Matters Magazine! Read on for more information about this exciting news, as well as upcoming March webinars and more.

FIND THE FULL NEWSLETTER HERE

Are You Finding the Best Available Research to Inform Your Practice?

It often seems overwhelming these days to keep up with all the research available online to support decision-making for you and your clients. If you’re wondering where to look, what sources to trust, and how to interpret and apply the best research, don’t miss the next NACPM webinar “Evidence-Informed Practice: Research Literacy & Shared Decision-Making.” Dr. Courtney Everson, PhD, will answer these questions and more on Thursday, February 16th from 2:00 to 3:30 pm ET.

The following information about evidence-informed practice or EIP is drawn from Dr. Everson’s excellent presentation at the 2016 MANA Conference with co-presenters Shannon Anton and April Kline.

Evidence-informed practice (EIP) is that sweet spot at the intersection of the best available research evidence, the midwife’s professional/clinical expertise, and the client’s values and individualized needs.

Figure 1 Courtesy of C. Everson

While EIP is fundamental to the model of care provided by CPMs, implementing it consistently can be a challenge for midwives and clients who have trouble accessing or understanding research, or who fear that research ignores individual client needs or supplants clinical expertise. Fortunately, the EIP cycle (Figure 2) can help you integrate research effectively with many new learning resources available to address these challenges. Attend the webinar to learn more about each step of the cycle!

Figure 2 Courtesy of C. Everson

EIP has received increasing attention in recent years from health policy-makers and leading health experts who believe that developing a common knowledge base and language for EIP is key to improving inter-professional collaboration and optimizing health outcomes. Health professional educators are seeking to strengthen professional competency in EIP through enhanced coursework and skills development based on a set of specific EIP competencies. Nationally, six meta-competencies have been outlined for integrated practice that all health professionals are urged to achieve. Meta-competency #5 for integrated practice focused on “Evidence-based healthcare and evidence-informed practice.” Supporting this work is a priority of the Center for Optimal Integration, a strategic initiative of the Academic Collaborative for Integrative Health (ACIH). CPMs are represented on the ACIH Board of Directors nationally by Dr. Everson, Association of Midwifery Educators, and Nichole Reding, Midwifery Education Accreditation Council.

Midwives who want to take a deeper dive into the labyrinth of evidence-informed practice (EIP)—and achieve meta-competency #5 on EIP—can enroll in the Principles of Evidence-Informed Practice, a full 2-credit MEAC-approved online course taught by Dr. Everson at the Midwives College of Utah.

Midwifery educators who want to learn more about incorporating EIP competencies into their programs can visit the EIP Resource Guide for Educators at the Center for Optimal Integration website. Educators may also be interested in attending the annual conference “Process of Integrating Evidence (PIE) for Complementary and Integrative Health Educators” which will be held July 13th-15t, 2017 in Bloomington, Minnesota.

 
FIND THE FULL NEWSLETTER HERE

Looking for Your Feedback

Please help us understand your needs by filling in a quick survey! Also, learn about our newest webinar in the “Race, Equity and Access to Midwifery” Series.

FIND THE SURVEY AND NEWSLETTER HERE

Midwifery Educators: There’s Help Available!

The Association of Midwifery Educators is beginning their second decade of “connection and collaboration” with an amazing line-up of projects and continuing education offerings.  Support for preceptors has been a priority for AME from the beginning and they offer an excellent series of on-line courses focused on the challenges encountered by preceptors.  Now AME is launching an exciting new series that includes:

• Meeting the needs of adult learners

• How to apply theories and principles of adult learning to curriculum, program design, clinical and classroom learning and meet the needs of diverse learners.

• Student assessment: You taught it but did they learn it

• Assessment tools that are fair, objective, accurate, valid, reliable; constructing effective test questions; norm and criterion referencing; learning management systems and test banking.

• Ethics and Social Justice in midwifery education

• Creating a socially conscious educational environment, applying principles of social justice to midwifery care within the context of the US health care system, moving individuals and institutions toward a culture of inclusivity.

There is also a wealth of information on AME’s website, designed to help anyone who is creating a course, looking for clinical teaching aids, thinking about starting a school or preparing a program for accreditation.  The website is well-organized so that preceptors, academic faculty, administrators, and aspiring midwives can easily find content that fits their interests.   AME’s Facebook page is another way to stay in touch with the latest news and resources.

The Clinical Directors Collaborative is another service AME provides to support midwifery educators. Clinical Directors of all the MEAC accredited midwifery schools meet monthly for 1 to 1 ½ hours to discuss topics and issues of mutual interest, to network, troubleshoot problems and share resources.  The monthly calendar is listed on AME’s Clinical Directors Collaborative webpage.

A recording of AME’s 2016 annual meeting held in December is available on their blog.  This one-hour meeting included updates on AME’s various projects which, beyond their web-based resources and continuing education courses, include:

• Expanding Access to Midwifery School Accreditation, a new collaboration with the Midwifery Education Accreditation Council, to create a peer-to-peer institutional mentoring

• Participation in the Academic Collaborative for Integrated Health’s Project to Enhance Research Literacy with the aim of developing a Guide to Evidence Informed Practice for Educators

• Hosting meetings of the Clinical Training Task Force

• Sponsoring student presentations at the MANA conference

• Developing the AME Board of Directors through recruitment and training on power and privilege in midwifery, anti-racism and equity work

NACPM appreciates the tremendously important work being done by AME.  We are also thankful for the support we’ve received from AME over the years – co-sponsoring the 2012 CPM Symposium and partnering with NACPM to present our webinars.  We encourage everyone involved in midwifery education to join AME today!

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Midwives on the March!

This week’s newsletter reports on the Women’s March on Washington, highlights our second webinar on The Social & Psychological Impacts of Racism Part 2, which is set for Thursday, January 26, 2017 from 2:00 to 3:30 pm Eastern time, and more.

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The Disparities are Extreme

“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

Webinars on Group Beta Strep and Evidence-Informed Practice Coming Soon!

On January 12, 2017 from 2:30 pm ET, join Sarah Bay, CNM, and Vicki Penwell, CPM in their presentations on the etiology and treatment protocols for GBS. Then on February 16, 2017 at 2:30 pm, listen to Courtney Everson, PhD present the basics of research literacy, critical appraisal of the literature and applying research to midwifery care.

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.

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Water Labor and Birth: New Guidance

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

New webinars on the Impact of the Election and Equity, Race and Midwifery Access coming soon!

Please join us for a December webinar with Billy Wynne of Thorn Run Partners for an inside look at the election results and what they could mean for CPMs and maternity care in the US. Also, a new webinar series on Equity, Race and Midwifery Access will begin in January with our keynote speaker Dr. Michael Lu.

CLICK THROUGH TO READ MORE AND REGISTER

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.” *

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

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