We asked and you responded! Find out what the CPM Symposium survey revealed in this week’s newsletter.
Happy New Year! More about webinars!
We have added another speaker to our 1/17 webinar on the Bridge Certificate. Also, please find a detailed description of the NACPM and MANA sponsored 2/21 webinar on neonatal mortality below:
Understanding and Reducing Maternal Stress and Preterm Birth in Puerto Rico, 2018 Webinars
In the November 2017 NACPM webinar, RE:BIRTH: Navigating and Mediating Maternal Stress and Birth Outcomes in Pre- and Post-Hurricane Puerto Rico, Oregon State University researchers Holly Horan and Melissa Cheyney discussed their collaborative research that focuses on the relationship between perceived maternal stress and gestational age at delivery. Existing research hypothesizes an association between perceived maternal stress and preterm birth, and midwifery care has been shown to be the only viable solution to reducing preterm birth rates within communities of color. Horan and Cheyney collaborated with Puerto Rican maternal and infant health providers to develop a project to better understand experiences of maternal stress and pregnancy and how they relate to birth outcomes in Puerto Rico.
Gaps in the Epidemiological Data: Over the last 20 years, epidemiological data on birth outcomes in Puerto Rico indicate that this United States (US) colony has a high rate of preterm birth1 in addition to other poor birth outcomes, including elevated cesarean section (46%)2 and a low birthweight rates#. As of 2016, Puerto Rico had an unusually high rate of preterm birth (11.5%), occurring before 34 weeks completed gestation2. To date, researchers have been unable to explain why Puerto Rico is experiencing such a high rate of preterm birth, as studies specific to Puerto Rico argue that typical epidemiological factors associated with preterm birth rates in the continental US do not explain the high rate of preterm birth on the island1.
Investigating the Gaps: After completing a 2014 pilot study on Puerto Rican providers’ perspectives on maternal and infant health issues on the island, Cheyney and Horan developed a two-phase research project designed to explore how perceptions of maternal stress contribute to gestational age at delivery in Puerto Rico. In the first phase, beginning in August of 2016, 25 pregnant and recently postpartum women in Puerto Rico were interviewed about their experiences of stress during pregnancy to provide a context for stress that was unique to island. In December of 2016, the second phase was initiated to understand the relationship between maternal perceptions of stress, their biological experiences of stress via the hormone cortisol collected from a hair sample, and how these experiences of stress impacted gestational age at delivery. Horan and local, Puerto Rican research assistants traveled to two clinical sites where they invited pregnant people in their first trimester to participate. Pregnant individuals who volunteered and were verbally consented into the study agreed to one prenatal visit per trimester. At the prenatal visits, the participants completed two stress surveys and provided a hair cortisol sample. In addition, there was a postpartum visit where the participant provided patient reported outcomes about the birth, completed a postpartum interview reflecting on their experiences of stress and pregnancy, and provided a final maternal and infant hair sample. Eighty-six participants were recruited for this second phase of the project.
Disaster Strikes: On September 20th, 2017, the project was abruptly halted due to the damages sustained after Hurricane Maria. Horan and Cheyney plan to finish data collection with as many of the remaining participants as can be relocated to complete their postpartum data collection visit. This will enable us to understand how the hurricane influenced their births and early parenting experiences. Preliminary findings indicate that despite the global community’s concerns about the Zika virus, poverty and colonization are significantly greater sources of stress for pregnant and recently postpartum participants in Puerto Rico. In addition, the events of Hurricane Maria have further exposed how the second-class citizen status of Puerto Rican people impacts health and well-being across the island and across social statuses.
References
1) Cordero J. Preterm Births in Puerto Rico 2006-2016. March of Dimes: Sunshine Seminar. 2016. https://progyn.org/wp-content/uploads/2016/08/6.-Dr.-Jose-Cordero-Sunshine-MOD.pdf. Accessed November 6th, 2017.
2) Hamilton B, Martin J, Osterman M, Driscoll A. Births: Provisional Data for 2016. NVSS Vital Statistics Rapid Release. June 2017; 2: 2-21. https://www.cdc.gov/nchs/data/vsrr/report002.pdf. Accessed October 25th, 2017.
3) Landale N, Oropesa S, Davila AL. Puerto Rican Maternal and Infant Health Study (PRMIHS), 1994-1995. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor]. n.d. https://doi.org/10.3886/ICPSR36238.v2. Accessed November 27th, 2017.
CPM Symposium E-News
Our inaugural 2018 CPM Symposium enews went out recently. The planning team is seeking your input through a survey
Reproductive Health and the LBGTQIA Community
The LGBTQIA community is as diverse as the country, and includes members of all races, ethnicities, religions and socioeconomic status, and yet the health needs of this community are frequently overlooked, often with dire consequences. This week’s newsletter presents the issue of LGBTQIA health, resources for health care providers as well as tomorrow’s webinar on Gender, Equity and Inclusion
Join Us for the 4th Virtual Annual Meeting!!!
Please join NACPM’s Board of Directors, staff and consultants for the 4th NACPM Virtual Annual Meeting on Friday, December 15th from 1:30-3:30 pm ET. The annual meeting is brought to you virtually to make participation available broadly to CPM members, students
and stakeholders.
Spotlight on Midwifery Education and Accreditation
Read all about The Midwifery Accreditation Support Track (MAST) program, a collaboration between The Midwifery
Education Accreditation Council (MEAC) and the Association of Midwifery Educators (AME).
READ MORE ABOUT MAST AS WELL AS WEBINAR OFFERINGS IN THIS WEEK’S NEWSLETTER
Chapter News
Greetings from the NACPM Chapter community!
We have many exciting Chapter updates including our new Google+ community platform for connecting and resource-sharing among chapters, our anti-racism and equity chapter collaboration calls, and updates from several different states about the work they’re doing. Our chapter network is ever-growing, and the map below shows that in addition to our 14 active chapters, midwives from 24 additional states have expressed an interest in chapter formation. Some of those states have begun the formation process, and others are simply exploring the possibility within their local communities. We’d love to connect you with others who are interested in chapter formation in your state! Please reach out to Susan at chapters@nacpm.org for more information. Our goal is to have 20 active chapters by 2018, and we would love for your state to be one of them!
Chapter Collaboration Call Equity Series
The October collaboration call “Toward Equity-Grounded State Midwifery Leadership: A Conversation” marked the beginning of the Chapter Collaboration Call Equity Series. Registrants received preparatory materials to read and explore before the call, which helped everyone to enter the conversation with some common ground. NACPM board member, Keisha Goode, Ph.D., punctuated her compelling presentation with opportunities for personal reflection in response to guiding questions. Participants submitted their thoughts, comments, and questions through the chat feature, and these were then used to spark live discussion at the end of the call.
Keisha’s presentation was deeply inspiring, and we had more participant comments than we could bring forward in the allotted time. What a great problem to have! Our hope was for this call to be the start of an ongoing conversation among NACPM Chapter leaders and members about how to create equitable organizations, and we were not disappointed. The December Collaboration Call on Monday, December 11 at 1:30 pm ET, will be a continuation of this conversation using the questions and comments submitted by participants as the framework for our discussion.
We also heard a specific request from call participants for NACPM to create an anti-racism toolkit for chapters to reference as they lay the groundwork for their organizations. We will be working to prepare an initial draft of this toolkit for review and input on the December call. We are learning so much about what it means to prioritize equity and anti-racism systemically, organizationally, and individually, and we have so much more to learn. We would love for you to join us in this learning. The quarterly Chapter Collaboration Calls are unique opportunities for chapter members and leaders to dig deeper into our shared vision and values. Chapter members even enjoyed a sneak peek at the NACPM Vision and the Midwifery Landscape Briefing Papers this summer. Please reach out to Susan at chapters@nacpm.org to be connected to your local chapter or for more information about forming a chapter in your state.
Chapter Updates
Each NACPM chapter is unique, and it can take time to create the right moment for chapter formation and to discern the focus for newly formed chapters. Midwives in Idaho and Alaska have officially begun the work of chapter formation, and in Connecticut, after years of discussing chapter formation, the midwives voted unanimously in favor of starting a chapter after Mary Lawlor went for a “Home Visit.” These visits are an opportunity for NACPM leadership to hear from midwives about their hopes and vision for a chapter and to share with them about the national picture for CPMs and the role that state chapters can play in unifying our profession.
Would you like to plan an NACPM Home Visit in your state? We love learning about each state’s unique landscape, answering questions, and sharing about the national perspective and unfolding directions for Certified Professional Midwives. Reach out to Susan at chapters@nacpm.org to schedule your Home Visit.
Corina Fitch, CPM, secretary of the Florida Chapter of NACPM reports “This has been a ground breaking year for Florida midwives due to legislative threats that we were faced with as well as a need for reorganization. The founding of our Florida Chapter was in direct response to both of these situations. FL NACPM focused its efforts this year on educating the midwifery community about the many benefits of joining the chapter, outreach for membership, and fundraising for our lobbyist fund. We labored collaboratively with the Midwives Association of Florida to put together a state midwifery conference in August.
We look forward to increasing membership in the coming year, along with continued fundraising efforts and providing opportunities for continuing education for midwives.”
Ellie Daniels, CPM, board member of the Maine Association of CPMs, past board President of NACPM, reports on the Maine Perinatal Quality Collaborative Symposium “Collaboration in Action”:
Three years ago in Maine, an unlikely collaboration was formed. Five organizations who had never imagined themselves sitting at the same table all together agreed to come together for the purposes of writing a licensing law for Certified Professional Midwives. These organizations consisted of the Maine Section of ACOG, the Maine Association of CPMs, the Maine Medical Association, the Maine Chapter of ACNM, and the Maine Chapter of AWHHON (perinatal nurses). The first agreements reached were related to how we would do our work, which was facilitated and by consensus. And from there, we went forward, meeting every two weeks, mostly in person, with many of us traveling an hour or more.
Over the course of two years, we got to know a lot about each other, about our respective philosophies of care, our particular skills, our concerns, our strengths and vulnerabilities, and most importantly, what we could agree upon. Those areas of agreement became a bill to license CPMs and CMs in Maine, that successfully passed through the legislature in 2016, overcame a Governor’s veto, and successfully returned to the Legislature in 2017 to gain funding for enactment.
This past Summer, we reflected upon the value and experience of our unique “Home Birth Collaborative”, and made a decision together to move on to another challenge. What would it take to form a Perinatal Collaborative for Maine?
Maine is one of five states in the country with no Perinatal Collaborative. Several states have strong PQCs, with active multi-stakeholder participation and robust funding sources. But very few, if any states, have invited CPMs to be at the table from the beginning. Here is an opportunity for a public health approach that holds moms and babies at the center of its vision, and considers data and quality improvement projects across the entire continuum of choice a family might make regarding place of birth and preference for provider.
Who are the stakeholders? They are the clinicians in all settings and the patients they serve. They are hospital administrators, public health departments, and emergency medical services. They are governmental agencies, and public and private health and liability insurers. PQCs are funded by public and private grants and donations, state budgets, hospital “tax”, federal monies, and support of all kind from state and federal CDC. PQCs rely on the collection of relevant data, and use it to effect meaningful change across provider groups and care settings. We believe that midwives in every care setting have a lot to offer.
As a kick off to our Maine PQC, we held a Symposium on October 21, 2017. We invited attendees from across the stakeholder spectrum, and designed a program to excite people about the possibilities. The day was kicked off with Dr. Alan Picarillo, a neonatologist, who had been involved with the formation of a Neonatal QC in both New England and Virginia. He talked about the necessary steps and stakeholders, and particularly about the value of forming a culture of transparency around data, as a key to stimulating change in practice.
Following Dr. Picarillo was Dr. Larry Leeman talking about a QI project in New Mexico that is lowering the primary C-SEC rate. His talk focused on perinatal collaboration in action, and how a multi-stakeholder focus on the data as an indicator of better and best practice has resulted in lasting change.
Last up for the morning was Dr. Missy Cheyney, talking about data as a quality improvement driver. In particular, she discussed the project in WA state to merge data from the CPM MANA stats with hospital data, and the power of that project for showing evidence that supports a higher rate of physiologic birth overall.
Ethicist Frank Chessa at the Maine Symposium
The afternoon focused on looking at the Maine state birth data, and discussing the concept and value of forming a PQC for Maine. Going forward, we identified several projects worthy of focus, and people were interested in joining the Steering Committee.
As the Maine Home Birth Collaborative wraps up its legislative work, the Maine Perinatal Quality Collaborative has taken form. It has taken form from the steady work and commitment of a group of previously unlikely partners who now are creating a new and valuable culture of inter-professional collaboration in Maine, for the great benefit of families into the future.
April Kline, CPM, President of Ohio NACPM reports, “This year, we have focused on the first of our objectives as a professional chapter, offering CEU opportunities on nutrition and other relevant topics. We have also built a trusted circle of midwives for regular peer review which is offered at every quarterly meeting as well as by phone as requested. We are pleased with how our first year has unfolded and look forward to a new year to grow our chapter and continue our good work.”
Christy Santoro, CPM, President of the Pennsylvania Association of CPMs reports on their chapter’s activities around anti-racism and equity in midwifery:
Childbirth in the Shadow of the American Dream
On Sunday, October 16th, 2017, the Pennsylvania Association of Certified Professional Midwives hosted a Film Screening Fundraiser and discussion of The American Dream, directed by Paolo Patruno. The American Dream is a documentary that only begins to touch the surface of the maternal health crisis. The documentary allowed for the sharing and hearing the stories of Black mothers and their hospital experiences during prenatal, delivery and postpartum that are violent and disempowering.
Read more here (link to webpage)
The American Dream highlighted the work of Certified Professional Midwife Jennie Joseph, and her work to provide an alternative to prenatal care and birth than what the hospitals provide in Florida. The screening was attended by Birth Workers, Certified Nurse Midwives, Certified Professional Midwives, mothers and social justice activists in the Philadelphia area. The discussion after the screening asked the viewers to engage in questions around what “The American Dream” is for black and brown birthing persons in Philly and access to home birth.
Sponsorship for the event was provided by Acupuncture in Motion, Blossoming Bellies Birth, Christine’s Care and Compassion, Luna y Sol Midwifery & Family Wellness, Magnolia Moon Birth, Motherland Midwifery, Rachel Utain-Evans Photography, Sheila Pai: Presence Not Perfection and The Wooden Shoe. The money raised at the event supports the educational expenses of Marqui Taylor, black Student Midwife at Birthwise Midwifery School, and PACPM chapter member who is the founder of Birth Brown (formally The Philly Birth Project).
PACPM continues to be involved as a member organization in the PA Campaign for Women’s Health and the Maternity Care Coalition’s Community Breastfeeding TaskForce in Philadelphia. Several chapter members plan to attend a Racism in Medicine Conference in Philadelphia in November at the University of Pennsylvania and are working to establish a renewed presence at the State Board of Medicine Meetings by 2018.
Our newest chapter member, Ray Rachlin, of Refuge Midwifery, will be offering a workshop about trans-affirming birth practices for out-of-hospital practitioners in January 2018.
Korina Pubanz, CPM, Board member of the Wisconsin Chapter of NACPM reports, “As a new chapter in WI the beginning of the year was focused on finding a rhythm with meeting times, working on communication platforms for our meetings and figuring out ways to reach out to our midwifery community. One of our chapter goals right now is turning a focus toward providing regular educational opportunities. We are currently working on an educational event coming up in the late winter of 2018! This class will be a focus on anatomy assessment and suturing with MEAC approved credits.”
North Carolina and South Carolina NACPM CPM Chapters hosted their second annual Carolina Birth Junkies Retreat this summer. Christine Strothers, CPM, board member of the North Carolina Association of CPMS (photo on the right), and Lori Gibson, CPM, President of the South Carolina Chapter of NACPM (photo on the left), served as co-organizers for this event. Lori described the retreat as “another amazing weekend full of eagerness to delve deeper into Midwifery, relationships and self.” In addition to the educational workshops, they added recreational activities this year including kayaking, red tent temple, and a couples session on how to keep a marriage strong while doing birth work.
They also had a VBAC panel and breech case studies, which both got great reviews. With a total of 27 attendees over the course of the weekend, Christine said, “I think the balance of fun/team building with educational sessions was just right – lots of learning but also lots of time to relax and connect with other birth workers. Spending the whole weekend on an island really brings folks together.”
The retreat brought in $500 profit for each of the two chapters, and the South Carolina state association, PALM, sponsored several student midwives to attend at a reduced rate. Next year, they will have Karen Strange back for NRP plus many other exciting sessions. All are invited, so keep an eye out for next year’s Carolina Birth Junkies Retreat hosted by the North Carolina and South Carolina Chapter of NACPM!
FOR DETAILS ON OUR NEW CHARTING WEBINAR, READ THE NEWSLETTER
New Webinar Speakers Added!
Vanessa Caldari, BSN, CPM and Founder of Centro MAM will be joining the November 8 webinar on Maternal Stress and Birth Outcomes in Puerto Rico; Jamarah Amani, LM, will be speaking at the November 22 webinar on Gender, Sexuality and Inclusion.
Puerto Rico – Webinar and Hurricane Relief
Puerto Rico – New Webinar Scheduled!
Puerto Rico is home to the highest rate of preterm birth in the entire United States jurisdiction. Learn how the severe and on-going economic crisis in Puerto Rico, the Zika epidemic, and the major natural disaster hurricane Maria have affected pregnant women’s daily lives and their birth outcomes in a new webinar scheduled for Wednesday, November 8, 2017, from 1:30 to 3:00 Eastern time.
In “RE:BIRTH: Navigating and Mediating Maternal Stress and Birth Outcomes in Pre- and Post-hurricane Puerto Rico,” Oregon State University researchers Holly Horan and Melissa Cheyney, along with Centro MAM founder Vanessa Caldari (see below) will report on their research project, funded by the National Science Foundation. They will provide information about methods for assessing perceived and measurable maternal stress, particularly within the context of a colonized nation that has a complex and insufficient maternal and infant health care system. In addition, Horan and Cheyney will discuss the normal physiologic birth efforts in Puerto Rico as a counter-movement to the existing biomedical system on the island along with the roles Puerto Rican midwives and doulas are playing in the aftermath of hurricane Maria.
This webinar will provide midwives with information about the effects of maternal stress on gestational outcomes, as well as the impact of midwives and doulas as mediators of that stress. The webinar will conclude with a discussion of opportunities for the support of Puerto Rican midwives who are on the ground providing care for mothers and babies amid post-hurricane devastation.
More information about the situation in Puerto Rico and CENTRO MAM from Vanessa Caldari
CENTRO MAM has been dedicated to supporting maternal and infant health since 2007. Over those ten years we have served over 1000 families by assisting women and their families in attaining safe, empowering births and postpartum experiences in an integrated and collaborative midwifery and physician clinic. We also educate and certify community members in midwifery, doula, childbirth education and breastfeeding peer support. We are based out of a community center about ten minutes from the San Juan airport. While the space is not a birthing center we have had births there on occasion and it is suitable and ready to be one again when the need arises. Please check out our website to see why we are so proud of the community work we do every day.
As we all know Puerto Rico is facing a major crisis mired in devastation. Pregnant women, infants, and the poor are always the most vulnerable in situations like this. Unfortunately, many obstetricians and doctors have stopped attending clinics and office hours. Instead, mothers are sent to hospitals which are rumored to be filled with the dead and dying due to lack of infrastructure and power. Added to these panic inducing horrors, there are a number of public health diseases creeping in due to unsanitary conditions such as infected waters, lack of plumbing and electricity, excessive heat, mosquitos and flies, and lack of nutritious food. On top of everything, those hospitals that are running (there are many whose doors have not yet opened) have staff who are overworked and stressed which increases the likelihood that women are not receiving the care, attention, support and respect they require for emotional stability and positive outcomes.
MAM will coordinate on the ground to distribute supplies and provide outreach to the community in order to enhance ways of meeting the primary needs of mothers and children. In addition, these efforts will support Midwives and provide a safe space for prenatal and postpartum care at Centro MAM.
Vanessa Caldari, a certified professional midwife who had attended births in Puerto Rico for over 20 years and the founder of CENTRO MAM is currently living in Oakland, California.
Links for CENTRO MAM (organization where midwives in Puerto Rico are providing services)
Website: http://mujeresayudandomadres.com/
Facebook: https://www.facebook.com/mampuertorico/
Founder/Point of Contact for MAM:
Vanessa Caldari
(787) 688-6832
mam@mujeresayudandomadres.com
Links for donation to CENTRO MAM:
Circle of Health International (With your donation, please indicate the donation is for CENTRO MAM):
http://cohintl.org/take-action/donate-to-our-rainy-day-fund
READ MORE IN THIS WEEK’S NEWSLETTER
CPMs – A New Future is Emerging
The changing landscape for CPMs holds great promise. Rather than being diminished by current developments and changes, in fact, the opportunities for CPMs have never been greater: to serve more people, be more relevant to the changing needs and demographics of the childbearing population, be of more service in eliminating racial inequities in care, and infuse the systems of care with CPM knowledge, experience and values.
Birth Centers and Midwifery Care Improve Outcomes
A recent report on the effectiveness of midwifery care in birth outcomes, news on increased birth center reimbursements in WA State, and lots of fall webinars and events are all featured in this week’s newsletter.
Fall Webinar Lineup
Please join us this fall for webinars on Charting for Midwives (Part II), NACPM Vision and the Midwifery Landscape, Gender, Sexuality and Inclusion of all Families in Midwifery Practice, and more.
Our Hearts Are with Those Suffering from Natural Disasters
NACPM reports on efforts by CPMs in communities affected by hurricanes in Puerto Rico, Florida and Texas.
Save the Date! CPM Symposium 2018!
May 11-13, 2018
William F. Bolger Center
Potomac, Maryland
You are invited to join a conversation about the urgent needs of childbearing people in the U.S., how CPMS can better serve families and increase access to midwifery care, and what stepping up to these needs means for the future of workforce composition, practice, education and policy.
Since NACPM’s first CPM Symposium in March of 2012, an exciting new landscape has emerged for CPMs. Health policy has evolved and the health system is in a new state of flux. The demographics of people having babies are shifting significantly, while health inequities and disparities continue to cause unconscionable suffering. The US MERA accords have generated breakthrough progress in state legislation but have also left many anxious and concerned within the profession.
The symposium format is designed to engage participants representing a broad range of stakeholders and demographics in a unique opportunity to plan together for the future of midwifery. It will be an extraordinary opportunity to meet and sit down with consumers, midwifery advocates, leaders of color, public health representatives, midwifery innovators, state leaders, health policy experts, funders, the next generation of midwifery leaders, and more!
We will hear from childbearing families from a broad range of demographics and from public health researchers what most concerns them about quality of care available today. We will examine the disproportionate burden of infant and maternal mortality in communities of color, the challenges we face as obstetric workforce shortages worsen, and more. Charged and informed, we will explore and plan together for how CPMs can step up to these challenges and the role we must play in improving the health and lives of people having babies in the U.S.
NACPM’s co-conveners are the Association of Midwifery Educators and Citizens for Midwifery. We are exploring avenues for input into the program design from a wide array of stakeholders and possible additional partners.
Mark your calendars now and look for more information about the program and registration this fall!
CPM Symposium 2012 – CPMs and Midwifery Educators: Contributing to a New Era in Maternity Care
If you missed CPM Symposium 2012, check out the website to learn more about the important issues that emerged, the speakers and presentation materials, and the reports and actions that followed
NACPM Endorsement of ACNM’s Denouncement of Charlottesville Attacks
Please read the statement put forward by the Board of the American College of Nurse-Midwives addressing the recent events in Charlottesville, as well as an endorsement of this statement by NACPM Board and staff.
Chapters at Work: Leadership Training and Chapter Collaborate
Much of NACPM’s work on the state level this summer has occurred in the chapters, whether it’s working on birth center reimbursement, or equity and anti-racism training. In addition, learn about events for CPMs in Florida and the Carolinas.
ICM 2017 Report
The NACPM Delegation to the Triennial Congress of the International Confederation of Midwives participated in Council discussions, voted on position statements, joined the March for More Midwives and learned about midwifery issues around the world.
Senate Bill Proposes Deep Cuts to Medicaid – Call Your Senators Today!
Deep Concern for the Welfare of Childbearing People
With the Senate’s release on June 22 of the Better Health Reconciliation Act of 2017, NACPM is deeply concerned for the health and well-being of childbearing people, babies and families in the United States. We urge you to acquaint yourself with this bill and call your Senators today to ask them stop this repeal of the Affordable Care Act (ACA).
This legislation, drafted behind closed doors by 13 Republican Senators over the past several weeks, is the Senate’s version of Congress’ effort to repeal the Affordable Care Act. It retains the basic structure of the American Health Care Act (AHCA) passed by the House of Representatives on May 4 of this year, which the Congressional Budget Office projected would cause over 23 million people to lose health care coverage over 10 years.
In March of this year, NACPM released a statement describing the gains for women as a result of the ACA, and the consequences for childbearing people with a repeal of the ACA. Now with the release of the Senate’s bill, this population is more at risk than ever.
Maternity Care Once Again not an Essential Health Benefit
The ACA requires all health plans, with a few exceptions, to cover a set of Essential Health Benefits (EHBs), including maternity care. Just 7 years ago, prior to the ACA, pregnant people frequently could not obtain insurance, maternity and newborn care were not considered essential health benefits and there were multiple barriers to health insurance coverage. The Senate bill would allow states to opt out of covering the Essential Health Benefits, once again leaving pregnant people without access to coverage. Birth impacts everyone at the beginning of life, and 85% of women become pregnant at least once during their lifetimes. The cost of having a baby averages $18,329 and $27,866 for a cesarean section. Almost 1 in 3 births is a cesarean section. Shifting these costs once again back to people having babies, including the poor and most vulnerable, is not sustainable or conscionable.
Drastic Cuts to Medicaid
While the Senate bill contains funds to stabilize the insurance markets and softens some of the provisions in the AHCA, these seeming improvements mask drastic changes to our health care system and deep cuts to Medicaid. Under the provisions of the ACA, 31 states and the District of Columbia took advantage of new federal funding to expand their Medicaid programs, providing new coverage to millions of Americans who had previously not had access to coverage. The Senate bill would phase out this expansion of Medicaid completely by 2024, affecting health care coverage for these millions of people, albeit more slowly than the AHCA, which calls for a phase out by 2020. By changing the mechanisms for determining the federal share of Medicaid spending, it also would impose deep cuts to the Medicaid program in future years, significantly rolling back the federal commitment to Medicaid. States would be left with stark options for reducing services or eliminating many of those newly eligible for coverage, effectively ending Medicaid as we know it now. Currently, Medicaid pays for the health care for 1 in 5 Americans and approximately half of all births in the U.S.
Tax Cuts for the Wealthy Paid for by the Poor
This legislation would reduce the subsidies provided in the ACA that make insurance affordable to people of low and moderate income, and would limit access to coverage for many now eligible by lowering income eligibility levels. It would repeal the taxes put in place by the ACA to pay for expanded coverage for low and moderate-income people, including a payroll tax and a surtax on net investment income. In effect, large tax breaks for the wealthiest Americans – those least in need – will be paid for by taking insurance coverage away from poorer people who are most in need.
A Call to Action
This bill is expected to come to the floor of the Senate this week. Only 20 hours will be allowed for debate. The defection of only 2 Republicans would spell its defeat. NACPM is reaching out to Senators about our deep concerns for the welfare of our citizens. We urge you to call your Senators today!
How to Call Your Senators
Call the Congressional switchboard at 202-224-3121 and ask to be connected to one of your Senators.
Once you are connected, say:
“As your constituent, I urge you to reject the Better Health Reconciliation Act and the repeal of the Affordable Care Act with its critical protections for childbearing people and their babies. I am a midwife (or consumer of maternity care, etc.) and am deeply concerned that maternity care would no longer be required to be covered by insurance. Medicaid pays for ½ of the births in our country and this bill will severely undercut coverage of these services. (Tell a short personal story of why you oppose the Senate bill – this adds much power to your message.)
After you call one of your Senators, call the switchboard again to call your other Senator.
Share any comments or feedback you receive with us by writing to info@nacpm.org.
Florida Legislation Update, Alabama Bill Passes
2017 Florida Legislative Report
by Sharon Hamilton, LM
After many years of very little Legislative activity the midwives of Florida rallied to prevent the opening of their practice act, F.S. 467, during the 2017 Legislative Session. In October, 2016, the midwives were alerted to a District XII ACOG driven plan to open F.S. 467 with the intention of requiring midwives to report Sentinel Events.
Having had many years of lobbying experience as President of the Midwives Association of Florida in the 80s and 90s, I was called into action to perform my old job of Legislative Chairperson. The group had established a Base Camp on the internet that allows us to communicate by Webex, making meetings so much easier than in that time period. The first meeting that I participated in, included a discussion of “Do we need a Lobbyist?” It did not take long to convince people that it was essential to have a lobbyist as this is the person who communicates for and represents us to the legislative and executive branches of the Government. This is the person who is our advocate, guide and defender. There was no telling what type of meddling the doctors may have intended but we had plenty of ideas. We were concerned for instance that they may want to require all mothers to be approved for out-of-hospital birth, although that topic was not part of their final proposal.
Our first discussion included brainstorming names of lobbyists and possible contacts regarding lobbyists. After reviewing 4 or 5 potential candidates, we chose one that was a referral from a home birth client. It turned out to be the perfect choice. The proposal that we received from them was well written and addressed our concerns and objectives. The interview that we had with them, though by phone, indicated their interests and goals. We hired two lobbyists for a fee of $15,000 each, spread out in 3 payments over a 6 month period. It was worth every penny. The two lobbyists between them had over 60 years of experience. They had both done considerable healthcare lobbying including for the Florida Medical Association. We suspected that could give us an advantage in the future and it did. Because they had good, strong relationships with previous associates who still lobbied for the ACOG and FMA, they were able to work congenially with the opposition. Justine Clegg passed along a power point to them on the history of Midwifery in Florida and gave them considerable guidance. They quickly became passionate about our mission.
ACOG’s stated goal, was the reporting of Sentinel Events in the out-of-hospital setting to the Department of Health. There are CNMs and a few doctors who attend out-of-hospital births in Florida, not just L.M.s, so it didn’t seem right that the proposed language should go into F.S. 467, because that would leave out all of the other practitioners attending out-of-hospital births. We did the research and discovered that 20% of out-of-hospital births in Florida are attended by CNMs and doctors. Armed with this new information and at our recommendation, our lobbyists approached their lobbyists to argue that any language should go into F.S. 456, which is an umbrella health care act that covers all health care practitioners. After much negotiation with the Chair of the ACOG Committee and their lobbyist, we were able to negotiate an agreement to leave our practice act alone and instead amend F.S. 456. An amendment was attached to a Health Care Bill in the House which passed. However, when the bill went over to the Senate it failed for unrelated reasons.
Florida Legislative Report
1. Before session began, our Committee prepared a legislative toolkit that included a Position Paper or Fact Sheet on Licensed Midwifery.
2. During Legislative Session our committee met weekly by webinar to discuss our strategy. Our lobbyists attended the first half of the meeting most of the time.
3. We identified every legislator on the health care committees in which we thought our issue would be heard.
4. We identified midwives in many of their districts so that they could be visited by their local midwife and possibly a mom and baby.
5. We kept a tally of each legislator visited and their position on midwifery.
6. Our lobbyists arranged a capitol day for us in the 3rd week of Session that was most effective.
7. We met the evening before in Tallahassee, at a local restaurant, 17 of us including our lobbyists to discuss our strategy and to prepare talking points.
8. Our lobbyists had arranged meetings with 19 legislators in the House and the Senate that were to occur every 15 minutes throughout the day. We divided into 3 groups with 1 experienced person acting as the spokesperson for the group. Our lobbyists accompanied the group that was visiting especially a Chairperson of a Committee or a legislator that was more likely to be particularly helpful.
9. We explained our position that: if the goal was the reporting of all Sentinel Events in the out of hospital setting being reported that the Statute amended needed to be F.S. 456, to address all health care provider rather than singling out Licensed Midwives. Every Legislator that we spoke with understood and supported our argument including the sponsor of the amendment that was initiated by the ACOG.
10. We presented to each Legislator, or their Aide, the benefits of midwifery including reduced costs to the state by Medicaid. Whenever you can argue saving money, it is a winning argument.
Alabama Passes Bill to License CPMs: Congratulations!
NACPM offers our heartfelt congratulations to all families in Alabama, Alabama Midwives Alliance (ALMA), and the Alabama Birth Coalition (ABC) on the long-sought passage of HB 315, the Childbirth Freedom Act, that will at long last allow Certified Professional Midwives to serve families choosing home birth. The bill passed the Senate on May 19 on a 30-0 vote, and was signed into law by Governor Ivey on May 25th. The passage of this legislation is a triumph for families, led by the Alabama Birth Coalition in a resolute grassroots movement that persevered for over 15 years, and who welcomed the new legislation with great joy. The mission of ABC is to unite and empower maternity care consumers in Alabama to advocate for informed choice among high-quality, integrated, evidence-based services in homes, birth centers and hospitals.
HB 315 previously passed the House on April 25 by a vote of 84-11, as a simple decriminalization bill, exempting CPMs from the crime of practicing nurse midwifery without a license, effectively allowing midwives to practice legally in Alabama. The bill was changed in the Senate to provide for licensure and to include a State Board of Midwifery, consisting of four CPMs, one nurse practitioner, one CNM or registered nurse, and one consumer of midwifery services. The bill requires the CPM certification and accredited education for midwives applying to be licensed.
Non-nurse midwives have not been able to practice legally in Alabama since 1976 when the State ended its DEM permitting program. Since then home birth has only been legal if it is not attended by a midwife. Advocates have been introducing bills to decriminalize the practice of Certified Professional Midwifery for over a decade, all in a state with a severe shortage of maternity care providers. Of Alabama’s 67 counties, 33 have no obstetrician in practice, and women often must drive long distances for prenatal care and hospital care for their births. Alabama is among the states with the worst infant mortality, outranked only by Louisiana and Mississippi. In recent decades, the number of doctors delivering babies has declined, several rural hospitals have closed and other hospitals have dropped maternity services. The passage of the new law providing for the legal practice of midwifery will help to alleviate the state’s shortage of maternity care providers and allow for much-needed choice for families.
Certified Professional Midwives are clearly urgently needed by families in Alabama. Where before it was only legal to give birth at home with no help, families now have the right to hire competent, professional help. “The only way this has been possible is because Alabama mothers and fathers have really joined together to let their legislators know how much they want midwives in Alabama,” said Courtney Sirmon, vice-president of the Alabama Birth Coalition.
Congratulations to all in Alabama on this momentous victory!