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.

Plug In to Community for a Healthy Pregnancy

by Melissa Garvey, ACNM Writer and Editor

An interesting study from the University of Michigan rolled into the ACNM news alerts this week. It involved 297 African American and European American women through 32 weeks of pregnancy. Compared to women of higher status based on race or education and income, African American women and women of lower socioeconomic status had higher levels of stress and higher blood pressure during pregnancy. However, women who felt a strong sense of community (higher communalism) did not experience these disparities.
Results of the study suggest that a woman’s sense of community is more important for her mental health during pregnancy than ethnicity or socioeconomic status. It also suggests that community can counteract the effect of ethnic minority and lower socioeconomic status on pregnant women’s blood pressure.
There is a catch. Researchers also found that higher socioeconomic status is associated with a higher sense of community—regardless of ethnic background. Let’s face it. Resources—including community—are easier to come by when you have more money.

Look for the study this month in the American Psychological Association's Journal of Cultural Diversity & Ethnic Minority Psychology. To learn more about the effects of communalism on health during pregnancy, you may also want to read a 2007 study in Obstetrics & Gynecology, which found group prenatal care—based on the CenteringPregnancy model created by Sharon Schindler Rising, CNM—is associated with a 33% reduction in risk of preterm birth.
Looking for a way to increase your sense of community? Try connecting online. Here are a couple suggestions. Feel free to add your favorite online community in the comments section of this post.

GivingBirthWithConfidence.org

• Who It’s For: Written by and for real women, this Lamaze International-hosted online community is the go-to place for information and support related to pregnancy, birth, parenting, and breastfeeding.
• Features: Follow several bloggers, including one woman posting regular updates about her pregnancy. The site also features discussion groups and allows members to create their own groups.
  

KeepEmCookin.com

• Who It’s For: Women with high-risk pregnancies or on bed rest.
• Features: KeepEmCookin features online forums, a place to share your story, and links to news and resources related to preterm birth.

California’s Whooping Cough Epidemic: An Opportunity to Reexamine Vaccination Decisions?

by Melissa Garvey, ACNM Writer and Editor

According to state public health officials, California residents are experiencing epidemic levels of whooping cough. With five infant deaths already and nearly 1500 reported cases so far in 2010, California is on track to experience the highest levels of whooping cough in 50 years.

The Fall and Rise of Whooping Cough in America

Whooping cough, also known as pertussis, is a highly contagious, life-threatening infection. In the early 1900s, it was a leading cause of childhood death in the United States. By the 1970s, following the introduction of a vaccine, infection levels waned.

Since the mid-1970s, cases of whooping cough have been increasing—especially in infants too young to have completed their vaccination schedule and in teens and adults whose immunity has expired.

Could Vaccines be Linked?

Some experts are wondering if California’s low rate of vaccination against whooping cough could be a factor in the state’s epidemic. While the state’s rate of adolescent vaccination is above the national average, it falls short of many states who require adolescents to receive the pertussis vaccine (commonly known as Tdap) by law. California legislation currently does not require Tdap.

Given this information, does this change your mind about vaccination decisions for you, your family, or your patients? Does it reinforce your beliefs or encourage you to reconsider your opinions?

ACNM Responds to Lancet Home Birth Editorial

by Holly Powell Kennedy, CNM, PhD, FACNM, FAAN,
President, American College of Nurse-Midwives

On the heels of a disturbing AJOG study on home birth, an editorial released today in The Lancet is fanning the flames of the home birth controversy that has been playing out in the media this summer. This morning I talked with an NPR reporter about ACNM’s take on the editorial. View her blog here, and read on for a more in-depth view of ACNM’s perspective.

Does ACNM disagree with the perspective articulated by The Lancet editorial regarding the AJOG study?

It's surprising that this study is getting traction, when virtually every other organization that has looked at it has pointed to flaws in the methodology of the study.

What flaws?

There are several concerns.

They included studies that did not distinguish between planned and unplanned home births. For example, if you had planned a hospital birth, but your labor progressed so quickly that you gave birth before you even made it to the hospital, then you wouldn’t have had a skilled attendant or necessary resources present.

In contrast, a planned home birth means that the woman and her health care provider have determined she is healthy, at low risk for complications, and has the necessary resources in place for a safe birth. By combining the two types of home births, the findings are limited.

Second, a meta-analysis is a way of combining the results of many studies. But in this case, there seems to be no clear reason as to which studies they included versus those they excluded. In fact, they actually did not include the best and by far largest study that's been done—which did not find a higher neonatal mortality rate.

What's good about home birth?

Keep in mind that only slightly more than one half of 1% of women in the US will have their babies at home, but the voice of the home birth movement is very strong. That's because they are the voice of women who want their maternity care provider to follow evidence-based practices to minimize intervention in childbirth. They do not believe they will receive this kind of care in a hospital and see home birth as their only way of avoiding a cesarean section.

Should we care about this home birth argument?

Yes! Healthy mothers and babies are the most important goal. However, we’ve lost sight that how a woman gives birth matters for both short- and long-term physiologic and emotional health. Research has demonstrated that how we are born is important. Mothers and babies are both better off if we support and facilitate labor and childbirth using interventions as they are needed, but avoiding them when they are not.

Labor and childbirth is an arena in which more technology is not always better. Consumer advocates and health experts have called cesarean sections one of the most over-used surgical procedures in America. One in three women in the United States will have a cesarean section – this is twice the number recommended by the World Health Organization.

What's underlying this debate?

Many women fear childbirth—thanks to images they've seen in movies, stories, and even childbirth education books that emphasize what can go wrong, rather than focusing on women’s strength and capacity to birth. A study conducted by Childbirth Connection found that almost half felt overwhelmed by their labor and birth.

The malpractice debate is also driving practice – many obstetricians will tell you that they will not be sued if they do a cesarean section, but will if they delay, even though it might not yet be indicated. Working in maternity care today is very complex and difficult.

But, what many women do not know is that labor has beneficial effects for the mother and baby. Many childbearing practices that support women’s ability to forestall a cesarean, such as avoiding elective induction of labor and continuous fetal monitoring and the ability to stay mobile and upright during labor and support are common midwifery practices, yet the majority of women in the US do not have access to midwifery care.

Why do they not have access to midwives?

Approximately 10% of women are attended by midwives during birth – 97% of those births will be in the hospital. The rest will be in birth centers or at home. They are experts in providing individualized care using evidenced-based practices to facilitate a woman’s ability to give birth. They work with the woman to help her cope with labor and pain, using a broad array of resources from hydrotherapy to epidurals – based on the woman’s desires and needs. Working with a midwife means you have the best of both worlds: the opportunity to work with a professional who is highly skilled in supporting women in labor and childbirth, but also has access to an obstetrician who can assist if complications arise.

In fact, a large study recently conducted by the Cochrane Collaboration – a highly respected organization that gathers best evidence in health care – found that midwifery-led care is associated with fewer episiotomies and more spontaneous vaginal birth, feeling in control, and initiation of breastfeeding. Women were more likely to know the midwife caring for them. These researchers concluded that most women should be offered midwife-led models of care.

Many countries have far better birth outcomes than the US. In these countries women are allowed to choose home birth, and they have skilled midwives attending them in all birth settings. This is not the case in the US. Most women do not have the option to work with a midwife, in part because the US health care system places multiple barriers to their practice. Few women are offered collaborative models that include both physicians and midwives, including seamless transition from home to hospital if needed.

What’s the Bottom Line?

As we reform US health care, all maternity care providers must partner to demand robust systems which deliver the necessary resources for high quality maternity care in all birth settings, including home, birth center, and hospital—and care by midwives.

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.

Midwife Reflects on Government Affairs Committee (GAC) Experience and Lobby Day 2010

My ACNM legislative tenure ended on a great high. The Midwifery Care Access and Reimbursement Equity Act of 2009 passed last March; as of January 1, 2011, the CNM reimbursement rate will increase from 65% to 100% of the Medicare Part B fee schedule. My other role as chair was to help organize midwives from across the country for Lobby Day.

ACNM hosts its Annual Meeting in DC once every four years so midwives can meet with their legislators in person on Capitol Hill and discuss issues vital to the sustainability and growth of midwifery. This is one of the most important personal contributions we can make to our profession. I am so proud and thankful that more than 450 midwives (from forty nine states) met with more than 300 offices that afternoon. It was quite a sight to walk up and down the streets of the Capitol and see midwives on every corner. As a Washington state midwife, I was quite proud of our strong contingency. More than 25 of us met with Senators Murray and Cantwell’s offices, and then split into individual groups and met with each US representative (or their staff) from our state.

The focus of our visit was a new bill that ACNM is championing called the MOMs 21 Act, which stands for Maximizing Optimal Maternity Services for the 21st Century. This bill will improve maternity care outcomes for mothers and babies and bend the cost curve of our maternity care expenditures in the US. It has many components, and the section we are most interested in will establish reimbursement for midwives who supervise residents, medical students, and student midwives in academic health centers.

After we met with our legislators, nearly 450 of us gathered at a nearby restaurant for a Capitol Hill reception, where we rehashed our day, celebrated equitable reimbursement under Medicare, and watched 10 legislators (or their staff) receive ACNM awards for their contributions to midwifery and women’s health. The highlight was when Senator Menendez (D-NJ) ended his speech by saying, “I love midwives!” I had tears in my eyes and felt so proud that midwives have such vital voices on Capitol Hill. I hope you can join us the next time we are in DC. Putting a face on midwifery for our legislators is essential to effect change in the laws that regulate our practice.

Heather Bradford served on ACNM’s Government Affairs Committee (GAC) since 2001, including three years as chair. She received an ACNM Public Policy Award at the Capitol Hill Reception.