10 Midwifery-friendly Ways to Spend Black Friday

by Melissa Garvey, ACNM Writer and Editor

Make Black Friday 2010 count by doing more than bargain hunting at o’-dark-thirty. Use these tips to spend your time and money updating your professional skills and making a difference for midwives.

1. Connect with other midwives and midwifery supporters via Facebook (both the ACNM page and the ACNM Student Midwives group) and on Twitter (@acnmmidwives and @acnmmeeting).

2. Watch advocates promote midwifery and student midwives show why they are becoming midwives on the ACNM You Tube Channel.

3. View FREE Annual Meeting sessions in the ACNM Live Learning Center, and earn free CEUs while you’re at it! Look for a green square that indicates the 2 free sessions.

4. Jump over to the Online Education tab in the ACNM Live Learning Center to register for Billing and Coding Modules 1 & 2 so you’re prepared for live modules 3 & 4 on December 7 and December 14, 7pm – 8pm EST.

5. Buy ACNM midwifery postage stamps to support the A.C.N.M. Foundation and promote midwifery with every holiday card, bill, and letter you send this season.

6. Submit a poster presentation for the ACNM 56th Annual Meeting & Exposition. General non-research submissions are due December 31. Research submissions to the Division of Global Health and the Division of Research are due February 15.

7. Start on your paper describing your successful collaborative practice model. It’s due to ACNM and the American College of Obstetricians and Gynecologists on February 1!

8. Flip through the November/December issue of the Journal of Midwifery & Women’s Health. If you don’t have a subscription, check out the new Share With Women Handouts (Weight Gain During Pregnancy and Omega-3 Fatty Acids During Pregnancy).

9. Apply for the A.C.N.M. Foundation Midwives of Color-Watson Basic Midwifery Student Scholarship.

10. Learn about the ACNM Department of Global Outreach and the ACNM Division of Global Health. Get involved by joining the division or registering for the Life Saving Skills workshop to be held in Tuscon, AZ, April 11 – 15, 2011.

How to Present Evidence-based Midwifery Care Like a Pro

by Melissa Garvey, ACNM Writer and Editor

This week we launched an exciting project that has been in development for more than a year. Evidence-Based Practice: Pearls of Midwifery is a professionally developed presentation featuring nearly 100 fully referenced slides to assist midwives and their advocates (expectant moms, active dads, other health care providers, everyone!) in explaining the science and art of the midwifery maternity care model. Designed to showcase the evidence-based foundation of midwifery practice, Pearls of Midwifery emphasizes the proven benefits of physiologic labor and childbirth for mothers and their newborns.

Pearls of Midwifery is a long-overdue resource. In the words of ACNM President Holly Powell Kennedy, CNM, PhD, FACNM, FAAN, “Despite the recent plethora of information on evidence-based maternity care practices, there continues to be an underuse of many beneficial interventions while some harmful practices persist. We must continue sharing the evidence with our clients and other health care providers to ensure that all women receive the safest and most effective maternity care.”

Evidence-Based Practice: Pearls of Midwifery includes suggested speaking notes for each slide and a checklist that can be printed and shared.

Pearls of Midwifery is free to ACNM members and available for nonmembers to purchase in the ACNM Live Learning Center for just $69. Where do you plan to use this new resource?

Trail-Blazing for Midwives: An Unexpected Encounter

by Michelle Grandy, CNM, MN, President, Washington ACNM State Affiliate

Pictured in center: Michelle Grandy, CNM, and Congressman Jay Inslee

You never know where opportunities will arise to support midwifery. My most recent unexpected opportunity happened as I was backpacking with my daughter in the great outdoors of Washington State.

We heard a few men down the trail talking about taking a group photo. One voice was particularly boisterous in the otherwise quiet wilderness. As we rounded the corner, the group said, "Great! Here is someone who may be willing to take our photo."

I replied, "For you, I could do that."

After snapping their photo with a magnificent mountain range in the background, one of the men made a comment about "My chief of staff…"

"What do you do?"

"Well, I'm a congressman,” he answered.

"What is your name?"

"I'm Jay Inslee."

I jumped into gear and began talking about our recent ACNM Annual Meeting in Washington, DC, and how we'd missed talking with him personally but met Megan, his health legislative assistant. I asked if he'd heard of the MOMS 21 bill. He stated that he had not. I kicked it up a notch and began discussing the bill, using personal references to my practice at the University of Washington. I mentioned that one component of the bill would support certified nurse-midwives (CNMs) billing while supervising residents in medical schools.

A week later, I sent a follow-up e-mail that included a photo and a copy of the MOMS 21 bill to Congressman Inslee and Megan. Shortly after, I was notified that he signed as a cosponsor for the bill!

Interested in learning more about MOMS 21? Visit the ACNM website or contact Kathryn Kravetz Carr at kkccnm@gmail.com.

Supporters Join Forces to Save Terre Haute Midwives

by Melissa Garvey, ACNM Writer and Editor

A group of midwives at Union Hospital in Terre Haute, Indiana, have been notified that their employment contracts will not be renewed this year. It’s a familiar situation—one that we saw play out in Wilmington, North Carolina, about this time last year.

The midwives’ last scheduled day at the hospital is October 29, but a dedicated group of supporters is refusing to stand by as the date approaches. Prompted by outrage, their love of midwifery, and a little help from Where’s My Midwife?, Friends of Wabash Valley Midwifery have organized to fight for their community’s midwives. They are on their second letter to the hospital and their third action meeting. Meanwhile, their Facebook group has grown to 113 members who are prepared to picket if the group so decides.

Want to show your support for Terre Haute midwives? Here’s how to help:

• Join the Friends of Wabash Valley Midwifery group on Facebook and stay tuned to updates and calls for action.
• Organize or participate in a Where’s My Midwife? Walk for Moms and Midwives on Saturday, October 9, during National Midwifery Week.
• Sign the Save Our Midwives! petition.
• Help spread the word by sharing this post, the Friends of Wabash Valley Midwifery group, and the Walk for Moms and Midwives with coworkers, friends, and family.
  

Access to Midwifery Care Improves Maternity Outcomes

by Tina Johnson, CNM, MS, ACNM Director of Professional Practice & Health Policy

The Patient Protection and Affordable Care Act will bring millions of newly insured citizens into the health care system. In order to meet the country’s needs, leaders are calling for high value, evidence-based solutions. Let’s start with the health condition that affects 100% of all Americans...childbirth! How can we provide high quality, high value maternity care for all women and families? The answers are in the evidence: midwifery care improves maternal and newborn outcomes and patient satisfaction, reduces health disparities, and saves money and resources.

The U.S. grossly outspends every other nation per capita on health care, yet our maternal and newborn outcomes lag far behind those of other developed nations. Childbirth is the number one reason for hospitalization, and its related hospital charges surpass those of any other health condition. Resource-intensive interventions like labor induction, epidural analgesia and cesarean section are overused, often without indication or consideration of alternatives, resulting in increased risk of maternal and newborn harm.

Cesarean section is the single most common operating room procedure in the U.S., and the rate is steadily climbing. Incredibly, in 2007, nearly one-third of American women delivered their babies by cesarean section. Maternal mortality has risen dramatically, and glaring racial disparities in maternal and neonatal outcomes persist.

How can we reverse these disturbing trends? Ensure that all women have access to maternity care providers and practices that support the normal processes of birth. Labor support, freedom of movement, intermittent monitoring, alternative birth settings, vaginal birth after cesarean...all have been identified as evidence-based practices that are underused.

Midwives truly are the experts in supporting healthy vaginal birth in all settings. Midwives caring for low-risk women improve infant mortality rates in both hospitals and birth centers when compared with physicians caring for equally low-risk women. Midwife-led models of group prenatal care reduce preterm and low birthweight rates and improve patient satisfaction. Birth centers provide improved outcomes for even the most at-risk women, reducing preterm birth, low birthweight and cesarean section rates, and reducing costs to our health care system. Skilled midwifery care is the gold standard among nations with the best maternal and neonatal outcomes, and has been identified as essential to reducing maternal mortality worldwide.

It’s time to bring that message back home. The time is now to promote and support midwifery in America—and to follow the evidence.

This post was originally published on the the Center to Champion Nursing in America (CCNA) blog. Visit CCNA to join more conversation about this post.

August is Midwifery Advocacy Month: Ten easy and energizing steps to make a difference!

Kathryn Kravetz Carr, CNM, Chair, ACNM GAC

1. Get educated about MOMS 21. Learn how Maximizing Optimal Maternity Services for the 21st Century (MOMS21, HR 5807) will improve maternity outcomes, increase access to care, and curb rising health care costs. Also be sure to visit the new ACNM MOMS 21 Web page.
   
   
2. Check if your representative is a cosponsor (search here to find out). We ALREADY have the support of 30 US Representatives! If yours is a cosponsor, thank them for their support.
   
   
3. Call your US Representative and Senators in their DC office. Find out who your legislators are here, and ask them to cosponsor MOMs 21. Use these talking points as a guide.
   
   
4. Email or fax a letter (view samples here) to your Representative’s and Senators’ Health Legislative Aide in the DC office. Attach the Dear Colleague Letter and the bill info sheet.
   
   
5. Spice it up. Consider including some of these supporting documents: Essential Facts about Midwives, Nurse-Midwifery in 2008, Primary Care Providers, and Evidence-based Maternity Care.
   
   
6. Meet your legislators in their local offices or invite them to your practice. Congress will recess August 9 through September 12. To find their local offices click “contact” at this link. Request a visit using this Senate letter or this Representative letter.
   
   
7. Capture your visit with a photograph. Have your fellow midwives sign the photo, and return it as a thank you gift. Submit the lobby day evaluation form to let us know how it went.
   
   
8. Don’t sweat the details. When you talk with your legislators, their health care staff, and the media, discuss the women you serve and obstacles to better care. Should they have questions regarding the legislation, they can contact ACNM Federal Lobbyist Patrick Cooney at 202-347-0034 or patrick@federalgrp.com.
   
   
9. Involve the Media. Send the MOMS 21 Press Release out, and call your local media. ACNM members, don’t forget to let the Ambassador Toolkit help you out. Let midwives in your community know you reached out, and see if others have personal contacts in the media.
   
   
10. Keep the relationship going! Once you have established a connection with the Health Legislative Aide, maintain it throughout the year with continued communication. Successful advocacy is all about the relationship!
    

For the Love of Midwives: Wilmington Women Launch a Revolution

The following post was written by Where’s My Midwife? in honor of National Midwifery Advocacy Month, which is commemorated each August. The American College of Nurse-Midwives (ACNM) and its Government Affairs Committee encourage all ACNM members and supporters to participate in National Midwifery Advocacy Month. Learn more about advocacy activities here.

One year ago, on August 1, 2 certified nurse-midwives (CNMs) were fired from a Wilmington, NC, private practice, and 80 pregnant women were suddenly left without the care provider of their choice. They had chosen a midwife for very personal reasons, and had grown to know and trust their providers. The physicians at the practice assumed the women would simply start seeing the obstetricians, but they did not understand the type of care midwives provide. Our midwives spend 20 – 30 minutes with their clients at each prenatal appointment; they ask about a woman's personal and emotional well-being because they understand that these factors will have an impact on her labor; midwives stay with a patient throughout her labor and delivery.

The women in Wilmington have little or no choice when it comes to maternity care. There is only one hospital in three counties where women can give birth. After two midwives were fired, there was only one midwife serving our community. This was simply not acceptable. So, we took matters into our own hands. We stood up to the hospital and the physicians and said, “We want to be treated a certain way, and we will not allow you to take away or block our access to the type of care we want.” We successfully got the physicians to change a policy that required a physician to be in-house while a midwife labored with her patient. It was a policy put in place by the physicians who then complained when they had to stay at the hospital! It was absurd—and these types of policies are in place all over the country.

When we first started investigating whether or not this had happened anywhere else, Sylvia did a Google search on “CNMs fired” and after searching for ONE NIGHT came up with the following locations:

This kind of bullying has got to stop. Midwives are in a very difficult position – if they ask their ladies to speak out in support of them, the physicians who collaborate with them may take it as an insult, leading to a strained work environment. The next time you are at a visit with your midwife, ask her how she is doing. Ask her how she feels about her practice. Ask her what you can do for her. It may help prevent another situation like the one we experienced here. It is time to give back to the midwives who give us so much.

In order for the culture of fear surrounding birth in this country to change, women must stand with their midwives and say, “ENOUGH!” Our midwives give us support through one of the most challenging, vulnerable experiences in our lives. We believe we owe it to them and ourselves to stand up to those who would restrict their ability to practice. We believe mothers who have lost their midwife mid-pregnancy need to share their stories so that the people who make these decisions based on financial gain can see the consequences of their actions. We believe that women need to reclaim the power of their body's ability to give birth.

If you have experienced the loss of a midwife, or if you are a midwife who has been restricted in your practice, please contact us. Your story is important. Your voice must be heard to effect change.



The c-section rate in this country has just gone up for the 12th straight year.

Amnesty International has declared maternity care in the US a human rights issue.

The United States ranks 41st in the world in maternal mortality—it is safer to have your baby in 40 other countries.

It is time for change.
It is time for a revolution.

At Last, Life after Medicare: MOMS for the 21st Century

by Kathryn Kravetz Carr, CNM, Chair ACNM Government Affairs Committee

At last Medicare reimbursement equity for nurse-midwives will begin in January. As I start my first year as chair of ACNM’s Government Affairs Committee, we are riding high on the glory that comes from decades of hard work. Now we are blessed with the opportunity to work on something new, at last, something new!

Maximizing Optimal Maternity Services (MOMS) for the 21st Century, known as MOMS21, stole the show this year in DC. This magnificent piece of legislation will support improved maternity outcomes, help decrease maternity care costs, and place midwives at the center of the solution. It should come as no surprise that we have one of our very own, certified nurse-midwife Deb Jessup and Legislative Assistant to Representative Lucille Roybal-Allard to thank for drafting this tour de force. MOMS21 has been introduced in the House of Representatives (H.R. 5807) and a Senate companion bill is expected to follow.

Despite higher childbirth costs in the United States than other industrialized countries, we rank far behind on perinatal outcomes, with striking disparities in communities of color. Procedure-rich hospital stays during a woman’s pregnancy and delivery in the United States render hospital maternity care as Medicaid’s most costly expense.

MOMS21 will allow us, and those who value our work, to pressure Congress to support best maternity practices and the education of a more diverse maternity care workforce. Bill provisions include the promotion of optimal maternity care, a national media campaign, expansion and dissemination of best maternity care data, and core maternity care curricula, more loan repayment and funding for minority recruitment and retention as well as establishing reimbursement for midwives who supervise medical residents, medical students, and student midwives.

Government Affairs Committee (GAC) members will be calling on all midwives and our supporters to contact their legislators and ask them to cosponsor MOMS21. As midwives, we are well positioned and well prepared to be at the forefront of maternity care solutions.

Need more details on MOMS for the 21st Century Act of 2010? Read the ACNM press release and the bill summary.

How to Achieve Woman-friendly Policy One Legislator at a Time

by the ACNM Government Affairs Committee

Minnesota midwives with Senator Al Franken (D-MN)

Last month, more than 450 midwives and midwifery students traveled to the US Capitol to educate members of Congress on issues vital to the sustainability and growth of midwifery practice and to discuss our legislative agenda. Here is a peak into how midwives promoted woman-friendly policy one legislator at a time:

I ended up meeting with my representative by myself. I expected to meet with an aide, but ended up meeting with Representative McGovern (D-MA) himself! After recovering from my initial shock, I spoke with him about midwifery in Massachusetts and encouraged him to support the MOMS for the 21st Century Act. Not only was he nice to me, but he agreed to cosponsor the bill! As a student nurse-midwife, this was the perfect introduction to lobbying, and I am so glad that I participated!
~Christian M. Ornburn, SNM, ACNM Student Representative, Massachusetts

I had difficulty getting an appointment with Congressman Ruben Hinojosa (D-TX), but was able to obtain a meeting with his aide. I met with his aide in the office for 30 minutes to discuss midwifery issues and care of women in the Rio Grande Valley. As I was leaving, I ran into my representative. I introduced myself, thanked him for his vote for health care reform, and told him how pleased we were that Medicaid payment for birth centers was included in the bill that passed. He asked me to continue our discussion and join him in the congressional elevator. I mentioned that it said congressmen only, and he smiled and said, “You are with me.” We boarded a guarded train and continued to discuss women and children's health care issues. Next he took me to a waiting area and asked me to write my name and telephone numbers while he went to cast a vote. He returned in a few minutes, took me to the exit where I could catch a taxi or bus to the Lobby Day reception, and handed me his card.
~Nivia Nieves Fisch, CNM, Texas

My visit with Congressman Robert Andrews (D-NJ) could not have gone better! Though he was in the middle of voting, his health legislative aide whisked me off to the Capitol building because Mr. Andrews wanted to meet with me himself. The congressman and I spent a very pleasant 30 minutes discussing midwifery, health care reform, and the future of maternity care in the US. Before I could ask him, he volunteered to cosponsor Rep. Roybal-Allard's MOMS for the 21st Century bill.
~Robyn Carlisle, CNM, Mt. Royal, New Jersey

I first became aware of the importance of educating our legislators during graduate school. I quickly learned that unless the senator or representative had previously had some formal health care education, they couldn’t possibly be aware of the issues we providers face almost daily. What does it take for the issues to become important to them? The answer, at least in part, was demonstrated by the scores of midwives calling on our legislators during Lobby Day. I thoroughly enjoyed experiencing the momentum that our Washington midwife contingency exhibited during meetings with our senators’ assistants. I felt our voice was heard, and that felt great!
~Susan Collins, CNM, Washington

Midwives of Washington State

MN Passes Bill to License Birth Centers, Save Midwives from Reduced Payments

by Brielle Stoyke, CNM

The efforts of midwives across the US who lobbied their federal
legislators for fair reimbursement of midwifery services has paid off big in Minnesota.

This year, a group of midwives worked on birth center licensure legislation – we wanted a basic bill to license birth centers in our state. Two birth centers opened in February, and at least two more are in the works. The Senate author for the bill was inspired by the birth center model of care AND the cost savings for the state’s bottom financial line. Our intention was just licensure, but because it included fiscal savings, the bill became a bit more complicated. The bill went through dozens of hearings, and was held onto (or held up) until the final moments of the legislative session, so that it could serve as a potential vehicle to carry all the other health care bills. In the end, it was not used as a vehicle, but because it was held until the last minute, it had the chance of either passing or NOT. Scary.

To thicken the plot, there was a cost-cutting proposal in MN to “rebase” all provider fees to match Medicare. We did not find out about this until seven days before the end of the session. Certified nurse-midwives (CNMs) in MN are currently paid at 100% of what physicians receive for their services under Medicaid, and we would have been brought down to the 65% Medicare rate. But, because of the new federal health care reform law that will raise Medicare reimbursement for CNMs to 100% beginning in January 2011, we were able to persuasively argue that imposing a 35% reimbursement cut would be unfair and contrary to the intent of federal policy. In the process of working with legislators and lobbyists, we were able to whip up an amendment to exempt CNMs from the Medicare rebasing! On the last day of the session, both our amendment and the birth center bill were passed by both houses, and the bill now awaits consideration by the Governor. We have our fingers crossed that the bill will soon become law. For the hard work it took to get this far, special thanks go to the American Association of Birth Centers (AABC), MN midwives, as well as midwives and their supporters across the US.

Bonus Video: Scroll to 2:35:00 to watch the MN House pass the birth center bill.

A Win for the Little People

by Heather Bradford, CNM, ARNP
Chair, ACNM Government Affairs Committee

Tuesday, March 23, was a big day for many Americans when the President signed major health care reform legislation into law. But Tuesday was an even BIGGER day for midwives. Under this new law, after 19 years of hard work, certified nurse-midwives (CNMs) will be equitably reimbursed for their services under Medicare beginning January 1, 2011.

It would seem like receiving our current rate—65% of what physicians receive from Medicare—wouldn’t be that much of a hardship on a day-to-day basis for most midwives, as we don’t care for many women covered by Medicare. But receiving 100% is a very important change because Medicare often serves as the gold standard of reimbursement rates. For example, I just learned last week that Aetna is reducing its reimbursement rate in Washington State (and many other states) for nurse practitioners, physician assistants, and certified nurse-midwives to 85% of what physicians receive starting June 1. It’s not a coincidence that they did not apply these new rates to certified nurse anesthetists, as they currently receive 100% under Medicare. Other insurers who have a discrepancy in rates include Blue Cross Blue Shield and Regence, and I am sure there are many others. There are also 22 states where Medicaid currently reimburses CNMs less than 100% for their services. What’s their reasoning? That’s the interesting part—they don’t have to give one.

When we midwifery advocates lobbied on this bill, we explained to legislators that a pap smear is a pap smear is a pap smear. Meaning—it doesn’t matter what the letters are after your name; as long as you are qualified and licensed to perform it, you should be equitably reimbursed. But for CNMs, this took a lot of education, phone calls, e-mails, letters, trips to DC, and downright begging to convince legislators to understand. I have been lobbying on this bill since 2001, and there were many midwives that came before me who are celebrating just as loudly as me. So, here’s a toast to us little people who have finally won one in the battle against the giants. Watch out, private insurers and Medicaid states. The new gold standard rate for CNMs is 100%.

Editor’s note: If you have been involved in gaining support for equitable reimbursement for CNMs at any point in time—by contacting your members of Congress, visiting Capitol Hill, or working to mobilize support—help ACNM thank and celebrate you by sending your name, picture, and a sentence or two about your involvement to pr@acnm.org. And, while you’re at it, leave a comment on this post!












From left to right: ACNM Executive Director Lorrie Kline Kaplan; Midwives-PAC President Katy Dawley, CNM, PhD, FACNM; Representative Jim McDermott (D-WA); ACNM Government Affairs Committee Chair Heather Bradford, CNM, ARNP; ACNM President Melissa Avery, CNM, PhD, FACNM, FAAN.














Senator Al Franken and Brielle Stoyke, CNM

Top 10 Reasons to Attend Lobby Day

by Heather Bradford, CNM, ARNP, Chair, ACNM Government Affairs Committee

Once about every four years, ACNM hosts its Annual Meeting in DC. Why DC? We need your voice. On Tuesday, June 15, we hope hundreds of midwives will storm Capitol Hill to meet with their legislators (two senators and one US representative) and discuss issues vital to the sustainability and growth of midwifery. This is one of the most important personal contributions you can make to your profession. Not convinced? Here are my top 10 reasons why you should lobby on Capitol Hill in pumps and pearls or shirt and tie instead of spending the afternoon touring the White House in shorts and a T-shirt.

1. Only you can tell the story of midwifery. Our lobbyist can talk about our issues until he is blue in the face, but only you can share the stories of your clients and the barriers you face in caring for them.

2. You don’t have to worry about what to say or do because we have all the answers. Set your mind at ease by attending the one-hour Lobby Day Prep session the morning of Lobby Day and then hop on the ACNM-provided buses to the Capitol. We’ll also provide maps to get you home.

3. There is power in numbers. Every constituent that attends sends a stronger message to our members of Congress.

4. You will feel empowered after this experience. This is the third time I have helped organize Lobby Day, and it’s probably my most favorite part of the job.

5. Meet with your legislators and their staff in a more casual setting at the Capitol Hill Reception immediately following Lobby Day. Tickets sell fast, so buy one when you register for the Annual Meeting.

6. Show your children and practice partners the importance of political action. What better civics lesson can you teach your child?

7. Meet other midwives from your home state. All midwives from each state go together to meet with their two senators. Midwives from different congressional districts then divide into small groups and meet with their House representatives.

8. Have a picture taken of you and your member of Congress to hang in your office or home. All legislators are happy to do this.

9. Earn two contact hours. Simply lobby and complete a lobbying evaluation form afterward.

10. Every woman deserves a midwife. Even if you’re not a fan of your elected official, there are some things we can all agree on, including access to midwifery care.

June 15 seems like a long way off, but the time to plan is now:

• Find out if visits have already been scheduled for your district or state.
• Make an appointment for your district or state.
• Learn more about Lobby Day.
• Not a midwife? You can still advocate for midwifery!
  

Midwifery Advocates Protest Seemingly Illogical Hospital Decision

by Candace Curlee, CNM, MS, ACNM Region VI Representative

A curious thing happened last month in Ventura County, CA. St. John’s Pleasant Valley Hospital in Camarillo decided that midwives can no longer practice at their facility. Midwives have been practicing at St. John’s for the past 30 years. Evidently, the pediatrics and obstetrics committees along with the board of directors made the decision for “safety reasons.” Midwives were not included in the discussion.

One would assume this was related to bad outcomes; however, no peer review on the midwives’ quality of care occurred prior to the decision. In fact, the letter notifying staff midwives, three days prior to their effective dismissal, said that the loss of hospital privileges was not a reflection upon the care provided. The letter also stated that there was no allowance for a hearing or review.

The odd part of this whole situation is the board and committees’ reasoning. They say that because the hospital does not have a neonatal intensive care unit (NICU), it is unsafe for midwives to attend birth on the premises. However, physicians continue to deliver babies at St. John’s Pleasant Valley, including cesarean births, which statistically have more risk for a newborn to be admitted to NICU. Officials at the hospital have been mute, except to insist that this new policy is all about patient safety without further explanation. They declined to respond when asked to release statistics of babies admitted to NICU whose birth was attended by midwives as opposed to those attended by physicians.

In general, midwives care for women who are at low risk for complications. Numerous studies, including a recent Cochrane Review, testify to the high quality and safety of midwifery care. In fact, research indicates that midwifery care may reduce the risk of neonatal morbidity and mortality and therefore the need for NICU admission. Birth Action Coalition, is spearheading a campaign to force the hospital to rescind this unjust and unsubstantiated policy. If you live in the area, please join them at their next rally Friday, March 19, 11am to 1pm.

Will Washington State Lead the Way for Improved Access to Midwifery Care?

by Heather Bradford, CNM, ARNP, Chair, ACNM Government Affairs Committee

In Washington State, we are working on legislation related to an access to care issue. The legislation would authorize pharmacists to fill prescriptions written by advanced registered nurse practitioners (ARNPs) in other states or in certain provinces of Canada. What does this have to do with midwifery? In Washington, certified nurse-midwives (CNMs) are licensed as ARNPs. The legislation would help CNMs in border states too, as the language considers those midwives to be ARNPs.

Current law authorizes pharmacists to accept prescriptions from physicians, osteopaths, dentists, podiatrists, and veterinarians licensed in any state or in a province of Canada that shares a common border with the state of Washington; however, ARNPs are not included. This can be problematic for women choosing an ARNP or CNM as her primary care provider. Most people need prescriptions filled locally so they have easy access to refills and consultation with their pharmacists. In our argument to legislators, we have shared that CNMs and ARNPs in our bordering states, Idaho and Oregon, have the same independent scope of practice and full authority to write prescriptions. The good news is the bill has passed unanimously in our state Senate and is moving forward through the House of Representatives.

Unfortunately, the language of the bill does not extend to prescriptions written by ARNPs across the country. Currently, only two other states (Kentucky and Texas) have limits on accepting prescriptions from ARNPs licensed in other states. In these states, pharmacists will not accept schedule II prescriptions for which their state’s ARNPs are not authorized to write. It is less clear which states have limits on accepting prescriptions written by CNMs licensed in other states. I received varying responses in an informal poll on the ACNM eMidwife clinical practice discussion group. There are some limitations with pharmacy laws in Texas and Kansas, both requiring a physician name on all prescriptions. However, with the use of a DEA or NPI number (which are essentially national license numbers), many states accept out-of-state prescriptions written by a CNM. Of the 15 or so responses I received, these states include Massachusetts, New Hampshire, New York, New Jersey, Virginia, Georgia, Mississippi, Arkansas, Missouri, and Alabama. Obviously, this is not a conclusive list, but it seems that the law needs to change in Washington State with hopes of others following suit.

Is anyone else advocating for or working on midwifery legislation in their state similar to this?

My Top Ten Legislative Wish List for 2010

by Heather Bradford, CNM, ARNP,
Chair, ACNM Government Affairs Committee

Because every woman deserves a midwife, here’s what I’ll be advocating for in the coming year:

1. Reimburse Midwives Fairly Under Medicare. I’m eagerly watching the health care reform package, which includes provisions from HR. 1101/S. 662 – the Midwifery Care Access and Reimbursement Equity Act of 2009. That’s right! After more than 20 years of work, our bill is part of both the House and Senate reform packages. This bill would allow for equitable reimbursement of certified nurse-midwife (CNM) services under the Medicare Part B fee schedule. Compared to physicians, we currently are reimbursed at just 65% for our services. Passage of health care reform will provide CNMs reimbursement equal to physicians under Medicare.
2. License Certified Midwives (CMs). Even though the CM credential is considered equivalent to the CNM credential, CMs are licensed to practice in only three states—New York, New Jersey, and Rhode Island. I want to see legislation introduced in at least 10 states that would provide full practice equity and licensure of CMs.
3. Reimburse Birth Centers Under Medicaid. HR. 2358/S. 1423 (The Medicaid Birth Center Reimbursement Act) would provide improved access to birth centers for pregnant women covered by Medicaid. It has already passed in both the House and the Senate as part of the health care reform package, and is awaiting final passage.
4. Reimburse Midwives Fairly Under Medicaid. I want to see legislation introduced in at least 10 states that would allow midwives to receive equitable reimbursement under Medicaid. Currently, only 28 states provide equitable reimbursement.
5. Recognize Midwives as Primary Care Providers. Midwives do more than care for pregnant women and babies. We specialize in women’s health throughout the reproductive life cycle. Therefore, midwives should be recognized in all state and federal legislation as primary care providers wherever the term is used.
6. Support Midwives Who Teach Students. More and more midwives are supervising students at academic health centers. However, there is no incentive for health centers to hire more, because midwives are not able to bill under Medicare for their supervisory role. Legislation needs to be introduced to address this.
7. Prevent Discrimination Against Midwives. We need a change to the Centers for Medicare and Medicaid Services (CMS) regulations to prohibit discrimination against midwives in hospital privileging.
8. Add Midwives to the VA. Midwives should provide care to female veterans covered by the Veterans Health Administration. All other advanced practice nursing groups are eligible providers, but midwives are not. The growing population of wounded women of childbearing age deserves a midwife, too.
9. Fund Nursing and Midwifery Education. I want additional funding for nursing and midwifery education within the Public Health Service Act (Title VIII) and the National Health Service Corps.
10. Protect Breastfeeding and Provide Tax Incentives for Businesses to Encourage it. As a breastfeeding mother of twins, I am ready for more legislation to be passed in this arena.
    

What would you like to see happen in 2010?

Help Reopen the Bellevue Hospital Birth Center

by Melissa Garvey, ACNM Writer and Editor

Those of you who follow ACNM on Facebook know that the Bellevue Hospital Birth Center in New York City officially closed "until further notice" on Sept 1. Bellevue was the only birth center available to Medicaid-eligible women and their families in Manhattan.

Since then, there has been a collective effort to reopen the birth center’s doors. In December, a public petition and a letter signed by ACNM and other supporting organizations was presented to Bellevue Hospital’s Community Advisory Board (CAB)—the body charged with representing the voice of the public to the hospital administration. The hope is that the CAB will officially support the letter and become a significant ally in the effort to reopen.

On Wednesday, January 27, the CAB will vote on becoming a joint signatory of the letter. At that public meeting, Dr. Keefe, the new head of obstetrics and gynecology, will address the board in support of the birth center reopening. After the meeting, supporters will present the public petition and organizational letter to Linda Curtis, executive director of Bellevue Hospital. Anyone interested in supporting the cause is encouraged to participate in the public meeting on Wednesday, January 27, 6 p.m., at Bellevue Hospital, C/D Building, 8th Floor Medical Library.

Persistence Pays for Minnesota Midwife

by Brielle Stoyke, CNM, Minnesota Chapter Legislative Contact

Senator Al Franken and Brielle Stoyke, CNM

In December 2007, I was invited to a fundraiser for Al Franken. Franken was running for a Minnesota Senate seat. I went that night thinking maybe there would be an opportunity to talk to him directly about S. 662, the Midwifery Care Access and Reimbursement Equity Act, just in case he was elected. I didn’t get to talk to him long enough to mention midwifery, but I got my photo taken with him, which I tucked away for later.

He ended up winning the Senate seat, and I attended his celebration party in St. Paul. He had only been in office a few days and did not have a full staff yet. I didn’t even get near him that night, but was able to get the name of his new legislative health aide. So, I went home and e-mailed her about being a midwife, and specifically about S.662, and was sure to attach the photo of Franken and me from the 2007 party. Next, I e-mailed many of the CNMs in MN urging them to ask the senator to cosponsor S. 662.

Just a few weeks later, I was in my hometown of Duluth, MN, where I was offered an extra ticket to an event that Senator Franken was attending. I went with some friends, and we arrived an hour early. The venue staff were not seating yet, so we went across the street for a drink. When we arrived, we were pleased to find a private party in honor of the senator. I instantly recognized the staffer from the celebratory party in St. Paul and was talking with her, when I noticed a lull at the senator’s circle. So, I approached him and told him that I was a nurse-midwife from St. Paul and that I wanted him to cosponsor S. 662. He asked about the bill, and I told him it would increase reimbursement rates to midwives under Medicare. He looked puzzled. So, instead of explaining the details, I told him that I had been in contact with his legislative health aide, that S. 662 would provide equal pay for equal work, that his Senate partner Amy Klobuchar had signed the bill already, and that the bill had no opposition. He then asked me about my training, and I was proud to tell him I had a master’s degree in nursing, with a focus on midwifery. Right then one of my friends approached us with a camera and captured ‘my moment’ with the Senator on camera again! I followed up with his legislative health aide later that week and sure enough, he signed onto S. 662 just six short days later!

What did I learn from this experience? Success comes after persistence and teamwork. Never let an opportunity pass to talk to your legislator about what you do and why midwives deserve equitable reimbursement. Thanks to my fellow MN midwives for following up as well, and thanks to Senator Franken for supporting our bill!

Nurses Stand with Obama; Are Midwives Next?

by Dawn Durain, CNM, ACNM Vice President

I was trying to find some news coverage on the Sonia Sotomayor hearings on Wednesday afternoon, when suddenly there was President Obama on the White House steps surrounded by women! This being an atypical sight, I quickly unmuted. As it turned out, the people accompanying the president were mostly nurses and members of the Congressional Nursing Caucus—nurses in the Rose Garden! Nurses were being praised by the president for their dedication, ability to convey complex information to patients, and skills in caring for women in labor and their nervous husbands—all of this from the personal experiences of President Obama no less.

The occasion of the speech was, of course, to mark a significant step by Congress toward health care reform. I encourage you to read the Senate and House legislation and the president’s speech for yourself. I find the recognition of the work of nurses refreshing—more refreshing than the recent spate of TV shows featuring nurses for sure! I found myself hoping for the impossible though. Would the president mention nurse-midwives when he spoke of his experiences when his daughters were born? He didn’t. Would he mention the importance of nurse practitioners, certified nurse-midwives (CNMs), and certified midwives (CMs) as primary care providers when he spoke of the need for coordinated health care? He didn’t do that either. But, the legislation he referenced does, thanks to the hard work of our ACNM staff and midwives around the country who are talking and talking and talking to their representatives in Congress. Wednesday felt like a giant step forward. And maybe next time the White House will invite a midwife to the Rose Garden!

On a personal note, I’d like to give a shout-out to Keisha Walker, one of the nurses President Obama introduced who was there with him. She is a graduate of the University of Pennsylvania Graduate School of Nursing and worked on two projects in my Public Policy class at UPenn. She was passionate about nurses being involved in the political process and about the ability of nurses to have an impact on reproductive health care policy. She is currently at Johns Hopkins as a nurse researcher in their MPH program and clearly still involved in health care policy. Way to go, Keisha! Who is next in line to talk to the president about midwifery?

An Inside Look at the PAC Reception

by Heather Bradford, CNM, ARNP
Chair, ACNM Government Affairs Committee

While at the Annual Meeting, I had the distinct honor of introducing US Representative Jim McDermott (D-WA) as the keynote speaker at the Midwives-PAC Reception on Sunday night at the Seattle Convention Center. He was welcomed by a roaring crowd of over 60 midwives and 100 nurse-midwifery students who, with standing room only, were chomping at the bit to discuss health care reform and how midwives are part of the solution. Rep. McDermott is a senior member of the U.S. House of Representatives and a psychiatrist known for advocating for affordable access to health care coverage. Since 1993, he has introduced universal health care legislation in every Congress, and is again leading the way in drafting comprehensive health care reform legislation with recommendations for a robust public option provision.

There were several highlights to his speech. When he used the phrase, equal pay for equal services, we all cheered and clapped, as we are once again advocating for equitable reimbursement with respect to Medicare Part B services with our Midwifery Care Access and Reimbursement Equity Act of 2009 (HR. 1101/S. 662), and trying to encourage Rep. McDermott to cosponsor our bill. It was refreshing to hear him talk about the value of having varying types of providers provide health care so patients have choices, and his history of supporting midwifery in WA when he served as a state legislator.

The other highlight of the night was his encouragement for us to teach our legislators about midwives. There was a real “aha” moment, especially among the students, when he essentially said that if you don’t contact your legislators and let them know about your profession, they won’t know about you and will never be able to stand up for you. But if you do your part and advocate for yourself, you can really make a difference. As Chair of the Government Affairs Committee, this was music to my ears. Often I find many midwives only want to deliver babies and leave the grassroots lobbying to a select few. But unfortunately we can’t do it alone! Thank you, Rep. McDermott, for inspiring a room of over 160 to get in touch with our legislators and speak out.

So at the end of the night I was able to walk the Congressman and his staff out. We discussed how HR 1101/S. 662, our equitable reimbursement bill, is a reimbursement bill (which follows his agreement that equal services deserve equal pay), that ACOG was supportive of midwives receiving 100% under Medicare, and that the bill had been scored by the Congressional Budget Office at zero (meaning it wouldn’t cost the government a dime). And with those words I proceeded to the bar to order a glass of wine to toast with my colleagues a successful event. Because that is what the Midwives-PAC is all about – access to legislators. By soliciting dollars from ACNM members, the Midwives-PAC facilitates the direct exchange of information between members of Congress and midwives and gives us the opportunity to speak out about our profession and our health care policy agenda.

Donate Your Data to Help Mainstream Midwives

One of the most tiring things about being a midwife is having to justify and explain your profession. It’s not common knowledge that most midwives can provide primary care, write prescriptions, and even handle complications in childbirth. It’s frustrating as a midwife supporter, too. We need to keep up our efforts to get the word out!

Part of ACNM’s role is to update midwifery fact sheets that educate consumers, media professionals, policymakers, and others about the profession. While the Childbirth Connection’s Evidence-Based Maternity Care report and a recent Cochrane Review gives us a nice new pool of information to draw from, we still need more data to advocate for the profession and for improved maternity care.

Whether you’re a midwife or a midwife supporter, please help mainstream midwives by donating your data. Imagine what we could do in health care reform, media outreach, and public education if we had proof that midwifery care leads to X% less cesarean sections, X% lower health care bills, and X% higher patient satisfaction.

If you’re an ACNM member, you have until Wednesday, April 15, to complete the Benchmarking Survey, which tracks interventions, maternal health, infant health, and practice information. And you have the remainder of 2009 to take the Core Data Survey, which keeps track of current trends in CNM/CM practice.

If you’re a woman who has given birth, donate your data to the Transparency in Maternity Care Project by taking The Birth Survey—a comprehensive survey designed to give the public access to accurate information about maternity care providers and institutions.