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Citizens for Midwifery



Last Updated: 6/25/2008

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[19 Jun 2010 | Saturday] 
Citizens for Midwifery has outlined our most basic core values relating to both maternity care and to the role of Citizens for Midwifery in efforts to improve maternity care.

Core Values About Maternity Care

  • Pregnancy and childbirth are normal, healthy processes.
  • Access to midwives and the Midwives Model of Care is vital to normal childbirth.
  • The Midwives Model of Care outlines a type of care and is not limited to the education or any specific category of provider.
  • Respect is at the core of the Midwives Model of Care. Every woman should be treated with respect in every phase of her care from pregnancythrough postpartum. Respect includes, but is not limited to completeinformation about tests, treatments, and procedures, fully informed consent,preservation of privacy, and polite respectful communications by all involvedwith her care.
  • Pregnancy and childbirth effect the physical, mental, and psycho-social well-being of mothers, babies, and families, therefore maternity care should not only avoid harm, but also provide benefits to them.
  • Maternity care should be grounded in evidence, and care providers should be accountable to the mother and family for the mental and physical outcomes resulting from their actions or inactions.
  • Clinical decisions in maternity care should be focused on promoting the overall health and well-being of the mother-baby dyad; these decisions should never be influenced or determined by economic considerations or legal fears.
  • The use of practices, medications, and medical procedures should be based on the needs of each individual woman, her baby, and the circumstances of her pregnancy, labor, birth, and postpartum experiences withher full understanding and consent and based on the best evidence available.Routine protocols not based on research evidence should be avoided.
  • Maternity care is an important aspect of health care in theUnited States and must be included in all discussions of health care policy.
  • The quality and cost of maternity care and its outcomes directly or indirectly affect every US citizen.

Core Values of Citizens for Midwifery

  • Citizens have a right to be involved in maternity care policy, and CfM is a powerful voice for consumers.
  • CfM works to improve access to the Midwives Model of Care in all settings for women of all ages, ethnic backgrounds, races, religions,sexual orientations, abilities, and socioeconomic circumstances.
  • Coalition-building, communications, and networking with other organizations are essential for achieving our vision.
  • The education, credentialing, regulation, and licensing of midwives are of critical concern to consumers, because they determine whether or not childbearing women will be able to get the kind of midwifery care they want and need.
Visit http://www.cfmidwifery.org for more info.
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[19 Jun 2010 | Saturday] 

What is a midwife?

A midwife is a trained professional with special expertise in supporting women to maintain a healthy pregnancy birth, offering expert individualized care, education, counseling and support to a woman and her newborn throughout the childbearing cycle.

A midwife works with each woman and her family to identify their unique physical, social and emotional needs. When the care required is outside the midwife's scope of practice or expertise, the woman is referred to other health care providers for additional consultation or care.

The Midwives Alliance of North America, the North American Registry of Midwives, the Midwifery Education Accreditation Council and Citizens for Midwifery agreed on a short definition of what "midwifery care" means. However, just because a person is a midwife does not guarantee that they provide this kind of care; consumers looking for a midwife should ask questions to determine if a prospective caregiver will be able to provide the kind of care they seek.

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The Midwives Model of Care

The Midwives Model of Care is based on the fact that pregnancy and birth are normal life processes.

The Midwives Model of Care includes:

  • Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle
  • Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
  • Minimizing technological interventions
  • Identifying and referring women who require obstetrical attention

The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section.

Copyright © 1996-2004, Midwifery Task Force
All Rights Reserved

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Midwives in the U.S.

There are two main categories of midwives in the U.S., nurse-midwives, who are trained in both nursing and midwifery, and direct entry midwives, who trained as midwives without being nurses first. Within the category of direct entry midwives are several subcategories reflecting the varying legal status of these midwives in different states and the fact that until recently there was no nationally recognized credential available for direct entry midwives. Direct entry midwives include highly trained and very competent midwives; however, anyone may call herself a midwife at this time, and if you are looking for a midwife, it is up to you to find out if the midwife is qualified and experienced to your satisfaction. If a midwife is a Certified Professional Midwife (CPM), you are at least assured that she has met specific requirements for certification (and re-certification every three years).

Here is a brief overview:

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Direct-Entry Midwives (including Licensed Midwives)

  • Not required to be nurses.
  • Multiple routes of education (apprenticeship, workshops, formal classes or programs, etc., usually a combination).
  • May or may not have a college degree.
  • May or may not be certified by a state or national organization.
  • Legal status varies according to state.
  • Licensed or regulated in 21 states.
  • In most states licensed midwives are not required to have any practice agreement with a doctor.
  • Educational background requirements and licensing requirements vary by state.
  • By and large maintain autonomous practices outside of institutions.
  • Train and practice most often in home or out-of-hospital birth center settings.

For more information contact your state's midwifery organization or CfM.

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The Certified Professional Midwife (CPM) credential and
the North American Registry of Midwives

  • Not required to be nurses.
  • Multiple routes of education recognized; direct entry midwives and certified nurse midwives can qualify for this credential.
  • Education programs accredited by the Midwifery Education Accreditation Council prepare students to meet the requirements for the CPM.
  • Out-of-hospital birth experience is required.
  • Have met rigorous requirements and passed written exam and hands-on skills evaluation.
  • Administered by the North American Registry of Midwives.
  • Legal status varies according to state.
  • Practice most often in homes and birth centers.

For more information e-mail info@narm.org or call 1-888-84-BIRTH (eastern time).

The North American Registry of Midwives (NARM)

In 1987 educators, program directors and experienced midwives in the field of direct entry midwifery decided it was time to begin developing a national credential, the Certified Professional Midwife (CPM) credential, which is administered through the North American Registry of Midwives and has rigorous standards for knowledge, skills and experience.

As of January 2004, there are over 850 CPMs in the United States, Mexico, and Canada. The nineteen states that license direct-entry midwives to attend births out of the hospital use the NARM exam or the CPM process as the basis for licensure. States that are seeking licensure for direct-entry midwives are planning legislation which requires the CPM credential for licensure.

The North American Registry of Midwives has a free brochure "How to Become a Certified Professional Midwife (CPM)." You can request a copy or ask for more information about the CPM by contacting the North American Registry of Midwives at 1-888-84-BIRTH (eastern time), or by e-mail North American Registry of Midwives.

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Certified Nurse Midwives (CNMs) and
the ACNM's CM credential

Certified Nurse Midwives (CNMs)

  • Educated in both nursing and midwifery, primarily in the hospital setting; are "advanced practice nurses."
  • Must have at least a Bachelors Degree when training is complete.
  • Have successfully completed a university-affiliated nurse-midwifery program accredited by the American College of Nurse-Midwives, and passed the exam.
  • Out-of-hospital clinical experience is not required.
  • Are legal and can be licensed in all states.
  • Most practice in hospitals and birth centers.
  • In most states must have some kind of agreement with a doctor for consultation and referral; practicing without such an agreement can lead to loss of license.

Certified Midwife (CM)

The Certified Midwife (CM) is a new credential from the ACNM that does not require a nursing degree but is otherwise similar to the CNM credential. As of 1998 the CM is legally recognized in only one state (NY) and does not meet existing direct entry midwife licensing requirements in any other states.

For more information contact the American College of Nurse-Midwives at 202-728-9860, or write to 818 Connecticut Ave. NW, Suite 900, Washington, DC 20006.

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Legal Status of Direct Entry Midwives

As of 2003, 21 states recognize and regulate direct entry midwives (although for two of the states, New York and Rhode Island, only the CM credential is acceptable). Regulation varies from state to state, including licensure, certification, registration and documentation. Only 9 states and the District of Columbia actually prohibit the practice of direct entry midwives, but in 5 more states licensure is required but unavailable. In the remaining states direct entry midwives practice without any kind of state regulation, and in a few the legal status in not entirely clear. So, direct entry midwives are practicing essentially legally in about 34 states, but are considered unlawful or illegal in 14 states. However, these figures are subject to change as new legislation is enacted or new legal opinions are established that can change status in the a-legal states where direct entry midwives are neither specifically regulated nor specifically prohibited.

Refer to the Legal Status Chart for the most current status of midwifery across the country.

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Points to consider if you want to become a midwife

Which kind of midwife should you become?

You need to consider how much education you want, what setting(s) you want to practice in, what state(s) you might want to live and practice in, and what income level is important to you, because these factors differ pretty much along the lines of the two categories of midwives. We recommend that you interview several different kinds of midwives with different practices before making a decision.

Setting: Are you interested in practicing in the hospital setting or primarily out-of-hospital?

CNMs practice mainly in medical settings and in almost every state are required to have some kind of agreement with a physician in order to practice (which means your work situation is dependent on the physician letting you practice, even though you may both be competing for the same clients/patients). However, since CNMs are trained as advanced practice nurses, and are under "doctor supervision" they can "do" more in terms of using drugs for pain relief, some kinds of well-woman care, even in some instances assisting at cesarean births, depending on the state and the physician they work with/for. Fewer than 2% of CNMs attend home births; in some states quite a few CNMs work in birth centers.

Direct entry midwives also usually are able to spend much more time with women during prenatal care visits and usually stay with the birthing woman throughout labor and delivery. While some CNMs are able to practice like direct entry midwives, most are limited by hospital and doctor policies, and busy practices, sometimes mandated by HMOs, may mean the CNM just comes in to catch the baby and is not able to provide the continuous hands-on care we associate with the Midwives Model of Care.

In contrast, almost all direct entry midwives attend births in homes or in free-standing birth centers, although a very few licensed midwives are now getting hospital privileges or hospital employment. What direct entry midwives are legally able to do in terms of drugs and minor interventions depends on each individual state law. On the other hand, direct entry midwives are generally much freer to use alternative methods including homeopathic, herbs, massage and imagery for pain relief and encouragement of labor

Education and accredited programs

In terms of education, while in the past a baccalaureate degree was not required to become a CNM, the trend is toward requiring this degree, and moving toward requiring a Masters Degree. For example, even now to practice as a CNM in Oregon, you must have a Bachelors Degree, even if you already got your CNM credential without that degree. The American College of Nurse Midwives has made it quite clear that they are moving toward all their midwife programs eventually requiring a Masters; they are already phasing out programs that did not require a Bachelors.

The ACNM's Department of Accreditation accredits nurse-midwifery programs. For more information about direct entry midwifery education programs, especially those accredited by MEAC, email MEAC or call 928-214-0997.

The Certified Professional Midwife credential, by contrast, is not degree-oriented or program-based. A college degree is not required, and the emphasis is on what you know rather than how you learned it. The rigorous credentialing process validates that you have all the knowledge, skills and experience necessary to practice as an entry level midwife, as determined by a comprehensive task analysis involving hundreds of midwives encompassing the full range of midwifery from CNMs to apprentice-trained rural midwives. The CPM credential is available to any kind of midwife, including CNMs, who meet the requirements.

Direct entry midwifery programs increasingly are being accredited by the Midwifery Education Accreditation Council (MEAC) a federally recognized accrediting agency, which as of January 2004 has accredited or pre-accredited nine programs located in 11 states (Arkansas, Florida, Maine, New Mexico, Oregon, Texas, Utah, Vermont and Washington). All include a structured curriculum, mostly in formal classroom settings, as well as apprenticeship elements ("one on one learning by experience with a mentor having a significant relationship with a student"). Pre-accredited programs have met all requirements for accreditation except that they do not yet have the required number of graduates who are certified or licensed. For more information about direct entry midwifery education programs, especially those accredited by MEAC, email MEAC or call 928-214-0997.

At this time you can become a midwife and qualify for CPM certification without completing a MEAC-accredited program. Ask actively practicing direct entry midwives for their suggestions on how to go about becoming a midwife. For example, many start out being childbirth educators or doulas first, and there is also a lot of "book learning" you can do even before you are in a position to actually apprentice or go to a program.

Some midwives end up with combined training - they either started out as direct entry midwives, but at some point went back to school to become a CNM in order to practice legally, or for income or job security, or to be able to serve more and higher risk women, or for some other reason. So they are CNMs but retain their direct entry midwife orientation. Alternatively, other women become CNMs, but wanting to acquire a less medicalized fear-based approach to birth, subsequently work with direct entry midwives in an apprenticeship-type arrangement.

Income

Income for a CNM ranges from around $30,000 to $80,000, depending on where she practices and what she does. The higher income brackets include CNMs with management positions in urban hospitals, and CNMs in teaching positions in nurse-midwifery programs. For DEMs the income range generally is lower, and depends on factors like the location (urban or rural), which state (legal or not, insurance coverage or not), and how many births a DEM does in a given period of time.

Another consideration is whether you want to work for someone else or have your own practice (ie, your own business). Almost all direct entry midwives have their own businesses; the majority of nurse-midwives are employees of hospitals or doctors or birth centers and even those in private practice must of necessity be closely aligned with one or more doctor practices - relatively few are entrepreneurs in the way that most direct entry midwives are. Being an employee often means regular hours, vacations and employee benefits. Being self-employed can mean longer and more unpredictable hours, but also more flexibility. Either way is likely to affect the kind of care you are able to offer to your clients.

Legal Status

On the MANA website is a Legal Status Chart showing the legal status of direct entry midwives in every state. Direct entry midwives practice in all states, but are vulnerable to investigation and arrest in those states with no functional regulatory law.

While CNMs are legal in all states, the need for doctor collaboration or practice agreements means most CNMs are vulnerable to the ability of doctors to terminate or refuse to participate in practice agreements with midwives, and their ability to influence hospitals to refuse privileges to midwives (who in many cases are competing for the same clients as the doctors are).

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A little about Citizens for Midwifery!

CfM is a national, grassroots organization of midwifery advocates dedicated to promoting the Midwives Model of Care so that it becomes universally available and recognized as the optimal kind of care for childbirth.

For more information about CfM click here.

For membership information and form click here.

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Permission to reprint granted with attribution and contact information.

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[27 Aug 2008 | Wednesday] 

Facts about Maternity Care and Midwifery
Prepared by Susan Hodges, President, Citizens for Midwifery, for NAPW Summit January 2007

Pregnancy and childbirth are normal, healthy processes for the majority of women and babies.

"Having a highly trained obstetrical surgeon attend a normal birth is analogous to having a pediatric surgeon
baby-sit a healthy 2-year-old."   -- Marsden Wagner

Birth facts for the US
•    Over four million births in the US each year (26.4 births per 1000 women aged 15-44 years in 2004).[1]
•    Second most common reason for hospitalization of women.[2]
•    Care for mothers and babies combined rank 4th for hospital expenses. [2]
•    Hospital costs for deliveries mounted to more than $30 billion in 2004. [2]
•    Of all births, 99% take place in hospitals, 90% are attended by obstetricians.[1]
•    Over 6 million obstetric procedures are performed – the most common category of surgical procedures.[2]
•    More than 30% of births by cesarean section in 2005, ranking seventh highest total on the "national bill" for procedures (over $17 billion per year).[3, 4]

Outcomes of births in the U.S. are getting worse
•    Infant mortality is increasing: Twenty-seven countries have better outcomes than the US, where the infant mortality rate is 6.8 per 1000 live births in 2005.[5] Cuba, Slovenia and the Czech Republic have lower infant mortality rates than the United States.[6] According to the CDC the US ranked 11th internationally in 2002, but 28th as of 2005[7].
•    Maternal mortality is increasing.  Probably underreported by 1/3 to 1/2 [8, 9], maternal mortality was reported by the CDC as 13.1 per 100,000 live births in 2004 for the US, up from 12.1 in 2003.[10] Fifteen other countries have lower rates of maternal mortality than the US. [11]    
•    More babies are being born prematurely.  Pre-term birth rate was 12.5% of all births in 2004, up 18% since 1990, all with heightened risks for morbidity and mortality.[1]
•    Low birthweight is increasing.  The rate was 8.1% in 2004, the highest since 1969.[1] Low birth weight is also associated with heightened risks for morbidity and mortality.

Place of birth and providers: Ninety-nine percent of babies are born in hospitals. More than 90% of babies are "delivered" by physicians in hospitals. Certified nurse midwives attend about 8% of births, and about 11% of vaginal births, most in hospitals. On average bout 1% of births occur in settings outside the hospital (OOH) in homes and birth centers. Most of these are attended by midwives who are not certified nurse midwives (see definitions below).[1] The rate of OOH births varies depending on the presence of providers and the degree of professional autonomy for midwives provided in state laws.

Who Pays? The percentage of births paid for by Medicaid varies from state to state but can be as high as 50% or more in some states.  Coverage by all insurers (Federal government, Medicaid, private, HMOs, etc.) varies; many will not reimburse for OOH births, and when midwives are covered, the reimbursement rate is only a percentage of the rate for physicians.  We all pay for births, including unnecessary interventions and preventable complications and injuries, through our taxes, health insurance withholding, and individual policies.

Medical Interventions: In the US medical interventions are increasingly used, usually unnecessarily, even on women who are healthy and having normal pregnancies and labors. One example is cesarean section (surgical removal of the baby through an incision in the mother's abdomen); in 2005 nearly one in every three women was sectioned, a rate of 30.2 % of all births, the highest rate ever reported for the U.S [3], and these mothers are 3.9 times[12]  more likely to die in childbirth than with vaginal birth; while cesarean section can be lifesaving when truly needed, the surgery has many risks for both the mother and the baby. Even planned repeat cesareans, which have a lower risk than in-labor cesareans, have a 2-3 times greater risk of death than vaginal birth. [13-15]  While obstetricians are claiming that the increase in cesarean sections is due to women "demanding" them, a recent national survey found this was not true.[16] Typically there is a "cascade of interventions," with changes or complications from one leading to the use of the next, often ultimately ending in a cesarean section, or obstetricians suggest or persuade that a cesarean section is "best". Women are seldom fully informed about the risks and complications associated with the many common practices and interventions, a few of which are epidural anesthesia (drugs for pain relief), the use of drugs to start labor or speed up labor, electronic fetal monitoring, and restrictions on food and movement,[16] "… there were virtually no "natural childbirths" among the mothers we surveyed. … Less than 1% of mothers gave birth without at least one of these interventions…" (Listening to Mothers Survey)

For additional facts and statistics about interventions, see Resources: Fact Sheets on www.cfmidwifery.org and materials on www.childbirthconnection.org and other links listed below.

Medical Model vs. Midwifery Model
Childbirth in the U.S. has become increasingly medicalized, with most deliveries managed by obstetricians, who are actually surgical specialists in the pathology of childbirth.  The medical model is characterized by the notion that childbirth is an intrinsically dangerous physical event that requires authoritative medical management along with drugs and technology to control the process and save the mother and baby. Physicians and hospital staff working from the medical model impart fear in the mother, undermine her confidence and objectify both the mother and the process; the fetus is to be protected from the mother.

In contrast, the midwifery model is characterized by respect for the mother, baby, family who are experiencing one of life's most significant events.  Pregnancy and birth are considered to be intrinsically normal healthy processes with physiological, emotional and social aspects that can happen safely when the mother feels safe and private and is supported emotionally; medical interventions (drugs, technology, surgery) are rarely needed.  The midwife is a specialist in normal birth and acts as a guide who provides individualized care and emotional support appropriate to the mother's needs and preferences, including referral to medical care when needed and practical breastfeeding encouragement. The midwifery model has been defined in The Midwives Model of Care definition and brochure found at http://cfmidwifery.org/mmoc/.

Maternity Care-Providers
Obstetrician(OB): A physician who is a surgical specialist in the pathology of childbirth. Often also a gynecologist (OB/GYN) and therefore qualified to treat diseases of the female reproductive organs.  There are 42,059 OB/GYNs in the US.[17]
Midwife: A specialist in normal childbirth. May provide additional well-woman care depending on training and credential.  Provides thorough and individualized prenatal care and supports physiological (normal) childbirth.  See the Midwives Model of Care.
Midwifery credentials: There are two widely recognized national credentials (CNM and CPM) as well as the less known CM credential.
Certified nurse-midwife (CNM): "Certified nurse-midwives are registered nurses who have graduated from a nurse-midwifery education program accredited by the American College of Nurse-Midwives (ACNM) Division of Accreditation (DOA) and have passed a national certification examination to receive the professional designation of certified nurse-midwife." [18] CNMs are legal and licensed in all 50 states, primarily attending births in hospitals, although some practice in out-of-hospital settings.  There are about 6200 CNMs.[19]
Certified Midwife (CM): A recently developed direct entry credential recognized by the ACNM. CMs "are individuals who have or receive a background in a health related field other than nursing and graduate from a midwifery education program accredited by the ACNM DOA. Graduates of an ACNM accredited midwifery education program take the same national certification examination as CNMs but receive the professional designation of certified midwife." [18] CMs currently are legally recognized in only three states.  There are 57 CMs. [19]
Certified Professional Midwife (CPM):  A midwifery credential that does not require nursing and emphasizes OOH practice. "A Certified Professional Midwife (CPM) is an independent practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the Midwives Model of Care. The NARM certification process recognizes multiple routes of entry into midwifery and includes verification of knowledge and skills and the successful completion of both a Written Examination and Skills Assessment. The CPM credential requires training in out-of-hospital settings."[20] There are 1244 CPMs.[21]
"Direct Entry" midwife (DEM) is not a certification, but refers to midwives who have entered the profession of midwifery directly, without becoming a nurse first. The CM and CPM credentials are "direct entry", but the term is used most often to denote midwives who do not have one of the above credentials.
Regulation:  Direct Entry Midwives, primarily CPMs, are regulated (licensed) in 24 states[22]; in many of the remaining states grassroots efforts are under way to achieve licensing legislation for direct entry midwives. CNMs are regulated in every state, most through State Nursing Boards.

In the US there are about 7 obstetricians for every midwife (42,000 OBs to about 6,000 midwives). In contrast, in Great Britain for each OB/GYN there are about 35 midwives (1,000 OBs and 35,000 midwives).[23]  

Doula: Not a midwife, a doula is "a woman experienced in childbirth who provides continuous physical, emotional, and informational support to the mother before, during and just after childbirth." [24] Having a doula has been shown to reduce pain, complications and cesarean section.


Definitions of Birth-Related Terms
Augmentation: The use of drugs, most frequently pitocin, to make labor contractions happen more frequently and/or more intensely and usually more painfully.
Breech presentation/delivery: When the baby's bottom or feet are the presenting part in the birth canal. This means the baby's feet and body are born first and the head is born last. A higher risk delivery than a head first birth. In contrast to midwives, OBs are no longer trained in techniques of vaginal breech delivery and almost always perform a cesarean section.
Cesarean section (c-section): a surgical procedure to remove the baby from the mother's uterus that involves cutting through the abdomen, moving the bladder, and cutting through the uterine wall, and repairing the incisions. There are many risks of complications, including serious problems in future pregnancies. For more information read "What Every Pregnant Woman Needs To Know About Cesarean Section" (2006) at http://www.childbirthconnection.net/article.asp?ck=10164 .
Epidural: The administration of drugs for pain relief into the dura of the spinal column, to numb the body from roughly the waist down. May slow labor, cause fever (leading to septic work-up for the newborn, including spinal tap and IV antibiotics) and/or maternal blood pressure irregularities, and result in breastfeeding problems for the baby.
Episiotomy: Surgical incision through the perineum to enlarge the vaginal opening, associated with significantly more severe injury than occurs if the tissue tears by itself. Thoroughly discredited for routine practice, but still performed in more than 20% of births. A western form of genital mutilation.
Induction: The use of drugs and/or physical manipulations (strip the membranes or artificial rupture of the amniotic sac) to attempt to get labor started.  Not always successful, and may often result in cesarean section. May be used in attempts to schedule births.
Informed consent: The process by which a health care provider seeks permission from a patient to conduct a diagnostic test, surgical procedure, or medical treatment. This process should involve a discussion of risks, benefits, and alternatives of the proposed treatment, including risks and benefits of not doing the treatment. A person, including a pregnant or laboring woman, has the right to accept or refuse any treatment.
Informed refusal: A patient's right to refuse any medical treatment including tests, surgery or drug treatment after being fully informed or risks and benefits (see informed consent).
 "The Midwives Model of Care is based on the fact that pregnancy and birth are normal life processes. The Midwives Model of Care includes:
•    Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle
•    Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
•    Minimizing technological interventions
•    Identifying and referring women who require obstetrical attention.
The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section."
Copyright (c) 1996-2005, Midwifery Task Force, Inc., All Rights Reserved.
More information at http://cfmidwifery.org/mmoc    
OOH (Out-of-hospital) birth: Out-of-hospital birth sites are anywhere except in a hospital, usually in a free-standing birth center (a birth center that is not physically part of a hospital) or at home. Free-standing birth centers are usually staffed by certified nurse-midwives but in some states may also be staffed by licensed direct entry midwives. Almost all OOH births are attended by midwives.    

VBAC means "vaginal birth after cesarean section." The evidence demonstrates that this is a safe option for most women with a scarred uterus, but many hospitals are "not allowing VBACs" for economic and legal reasons, forcing many women to undergo a repeat cesarean section. For more information see www.vbac.com .
 
Midwives Organizations
American College of Nurse-Midwives (ACNM)  www.acnm.org The professional organization for nurse-midwifery. Consumer info website:   www.mymidwife.org  Information on midwifery, maternity, women's health, and family centered care.
International Center for Traditional Childbearing, Inc. (ICTC) www.blackmidwives.org  A non-profit African centered organization, was created to promote the health of women and their families and to train Black women aspiring to become midwives.
Midwifery Education Accreditation Council (MEAC) www.meacschools.org  Sets the standards for direct entry midwifery education programs and accredits programs and institutions based on these standards; resources for midwifery educators and those seeking programs.
Midwives Alliance of North America (MANA)  www.mana.org Professional organization for all midwives.
National Association of Certified Professional Midwives (NACPM) www.nacpm.net  Professional organization for CPMs.
North American Registry of Midwives (NARM) www.narm.org Complete information about the Certified Professional Midwife (CPM) credential and its administration.


Some Additional Useful Website Resources
Association for Improvements in the Maternity Services (AIMS) http://www.aims.org.uk  Internet site with a wealth of information for midwifery and midwifery-related issues; much of the information is not country-specific.
American Association of Birth Centers (AABC) www.birthcenters.org  A membership organization for anyone interested in promoting birth centers; website includes related information and resources.
BirthNetwork  www.birthnetwork.org  A non-profit, national consumer-advocacy group promoting awareness of the benefits and availability of healthy, normal pregnancy and childbirth through information and support, with chapters in various states.
Childbirth Connection: www.childbirthconnection.org Information, evidence about interventions, Listening to Mothers Surveys, Rights of Childbearing Women and other resources.
Citizens for Midwifery: www.cfmidwifery.org Grassroots membership organization promoting the Midwives Model of Care. Fact sheets, advocacy tools, links and more.
Coalition for Improving Maternity Services www.motherfriendly.org Promoting a wellness model of maternity care that will improve birth outcomes and substantially reduce costs. Created the Mother-Friendly Childbirth Initiative--: evidence-based principles and ten steps for implementing and recognizing "mother-friendly" birth sites and practices.
Henci Goer's website www.hencigoer.com Find articles and many resources from this independent scholar, acknowledged expert on evidence-based maternity care and award-winning medical writer; author of The Thinking Woman's Guide to a Better Birth.
International Cesarean Awareness Network (ICAN)  www.icanonline.org  A nonprofit organization working to lower the rate of unnecessary cesareans, support vaginal birth after cesarean (VBAC), and encourage positive birthing through education and advocacy.
Lamaze Institute for Normal Birth  www.lamaze.org/Default.aspx?tabid=171 Supports initiatives that provide credible, relevant and useful information about normal birth to new and expectant parents and childbirth professionals.
Midwifery Today www.midwiferytoday.com A periodical for midwives and anyone interested in maternity care, the website includes extensive searchable archives of past articles as well as other resources.
VBAC.com  www.vbac.com  A woman-centered, evidence based, resource for research-based information, resources, continuing education and support for VBAC* (vaginal birth after cesarean).
White Ribbon Alliance www.whiteribbonalliance.org  An international coalition of individuals and organizations dedicated to the memory of all women who have died in pregnancy and childbirth and working to make pregnancy and childbirth safe for all women.



Citations

1.    Martin, J.A., MPH, et al., Births: Final Data for 2004. National Vital Statistics Reports, 2005. 55(1).
2.    Agency for Healthcare Research and Quality. H-CUPnet.  2007  [cited 2007 1/16/07]; Available from: http://hcupnet.ahrq.gov/.
3.    Hamilton, B.E., PhD, J.A. Martin, MPH, and S.J. Ventura, MA. Births: Preliminary Data for 2005.  2006  [cited 2007 1/16/07]; Available from: http://www.cdc.gov/nchs/products/pubs/pubd/hestats/prelimbirths05/prelimbirths05.htm.
4.    Agency for Healthcare Research and Quality. H-CUPnet: Custom Queried Birth Tables.  2007  [cited 2007 1/16/07]; Available from: (http://hcupnet.ahrq.gov/HCUPnet.jsp?Id=662B13081A131E1F&Form=SelDXPR&JS=Y&Action=%3E%3ENext%3E%3E&_DXPR=PreRunDRG).
5.    National Center for Health Statistics, Births, Marriages, Divorces, and Deaths: Provisional Data for 2005. National Vital Statistics Reports, 2006. 54(20).
6.    Central Intelligence Agency. The World Factbook: Rank Order for Infant Mortality.  2007  [cited 2007 1/16/07].
7.    National Center for Health Statistics, Health, United States, 2006, in 2005 Electronic Chartbook Edition, Table 25. 2006, U.S. Department of Health and Human Services, CDC.
8.    Gaskin, I.M., Ina May's Guide to Childbirth. 2003, New York, NY: Bantam Books. 348.
9.    Horon, I., Underreporting of Maternal Deaths on Death Certificates and The Magnitude of the Problem of Maternal Mortality. American Journal of Public Health, 2005. 95(3): p. 478-482.
10.    National Center for Health Statistics. Deaths: Final Data for 2004, Table 1.  2004  [cited 2007 1/16/07]; Available from: http://www.cdc.gov/nchs/products/pubs/pubd/hestats/finaldeaths04/finaldeaths04.htm.
11.    Wagner, M., M.D., Revealing the Real Risks: Obstetrical Interventions and Maternal Mortality, in Mothering. 2003. p. 49-53.
12.    Harper, M.A., et al., Pregnancy-Related Death and Health Care Services. Obstetrics & Gynecology, 2003. 102(2): p. 273-278.
13.    Petitti, D.B., MD, Maternal Mortality and Morbidity in Cesarean Section. Clinical Obstetrics and Gynecology, 1985. 28(4): p. 763-769.
14.    Hall, M.H. and S. Bewley, Maternal Mortality and Mode of Delivery. The Lancet, 1999. 354(August): p. 776.
15.    Petitti, D.B., MD, et al., In-Hospital Maternal Mortality in the United States: Time Trends and Relation to Methods of Delivery. Obstetrics and Gynecology, 1982. 59(1): p. 6-12.
16.    Declercq, E.R., et al., Listening to Mothers: Report of the First National U.S. Survey of Women's Childbearing Experiences. 2002, Maternity Center Association: New York.
17.    American College of Obstetricians and Gynecologists, Personal Communication. 2007.
18.    American College of Nurse-Midwives. The Credential CNM and CM.  2007  [cited 2007 1/16/07]; Available from: http://www.acnm.org/careers.cfm?id=94.
19.    American College of Nurse-Midwives, Personal Communication. 2007.
20.    North American Registry of Midwives. www.narm.org.  2007  [cited; Available from: www.narm.org/map.htm.
21.    North American Registry of Midwives, personal communication. 2007.
22.    Midwives Alliance of North America. Direct-Entry Midwifery State-By-State Legal Status. [website] 2006  [cited 2006 4/10/2006]; Available from: www.mana.org/statechart.html.
23.    Wagner, M., Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First. 2006, Berkley, CA: University of California Press.
24.    Marshall Klaus, M., J.H. Kennell, and P.H. Klaus, Mothering the Mother. 1993: Addision Wesley Publishing Company.


 
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[08 Jul 2008 | Tuesday] 

Grassroots Network Message 806035
Attorneys looking for VBAC ban victims

Dear Friends,

As you are likely aware, many women are denied access to VBAC (Vaginal birth after cesarean) because of hospital policies and outright bans.  Attorneys with the Northwest Women's Law Center in Seattle are looking at this issue. One of them asked us to post the following:

I'm a lawyer with the Northwest Women's Law Center in Seattle. I'm investigating possible legal responses to bans on vaginal birth after cesarean at hospitals in the northwest states  Alaska, Idaho, Montana, Washington and Oregon. If you are currently pregnant and want to have a VBAC, but are facing a hospital policy that would require you to have a c-section regardless of whether you want it and regardless of whether it is actually medically necessary, and you are willing to consider working with a lawyer on this, we'd like to talk with you. Please respond to vbacbanhelp@ican-online.org .

Even if you are not in one of the states listed, you can still help by emailing this out to any email lists you are on and asking everyone who receives it to email it to all the lists THEY are on as well so that it is distributed far and wide. Thanks.

Sincerely,
Susan Hodges, "gatekeeper"
20:44 
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[20 Jun 2008 | Friday] 

Grassroots Network Message 806032
AMA Resolution to outlaw home birth


Dear Friends,

At their annual meeting over the weekend, the American Medical Association voted on two Resolutions that both denigrate CPMs and appear to be an effort to solidify medical monopoly of birth by seeking to prevent home births and to increase MD control over midwives.

You can find AMA's many Resolutions by going to http://www.ama-assn.org/ama/pub/category /18587.html and scrolling down.  Two especially egregious resolutions are:
Resolution 205 Home Deliveries (32KB)
Resolution 239 Midwifery Scope of Practice and Licensure (38KB)

Resolution 205 includes a resolve to "develop model legislation in support of the concept that the safest setting for labor, delivery, and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex, that meets standards jointly outlined by the AAP and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers." 

As usual, the AMA has provided no scientific evidence to support the statements or intent of the resolutions.

Clearly, the medical profession is getting desperate!

The Big Push for Midwives has issued a press release.  For a version on Big Push letterhead (that you could download and print) go to: http://thebigpushformidwives.org/pdf-bin/news.061608.pdf . I have also included the text of the press release below.

Sincerely,
Susan Hodges  "gatekeeper"



PushNews from The Big Push for Midwives Campaign

CONTACT: Steff Hedenkamp, (816) 506-4630, RedQuill@kc.rr.com
FOR IMMEDIATE RELEASE: Monday, June 16, 2008

Father Knows Best Meets Big Brother Is Watching
Physician Group Seeks to Outlaw Home BirthIs Jail for Moms Next?

WASHINGTON, D.C. (June 16, 2008)Just in time for Father's Day, at its annual meeting last weekend, the American Medical Association (AMA) adopted a resolution to introduce legislation outlawing home birth, and potentially making criminals of the mothers who choose home birth with the help of Certified Professional Midwives (CPMs) for their families.

"It's unclear what penalties the AMA will seek to impose on women who choose to give birth at home, either for religious, cultural or financial reasonsor just because they didn't make it to the hospital in time," said Susan Jenkins, Legal Counsel for The Big Push for Midwives 2008 campaign. "What we do know, however, is that any state that enacts such a law will immediately find itself in court, since a law dictating where a woman must give birth would be a clear violation of fundamental rights to privacy and other freedoms currently protected by the U.S. Constitution."

Until the AMA proposed 'Resolution 205 on Home Deliveries,' no state had considered legislation forcing women to deliver their babies in the hospital or limiting the choice of birth setting. Instead, states have regulated the types of midwives that may legally provide care. Currently, 22 states already license and regulate CPMs, who specialize in out-of-hospital maternity care and have received extensive training to qualify as experts in the types of risk assessment and preventive care necessary for safe and highquality care for women who choose give birth at home. Certified Nurse Midwives (CNMs), who are trained primarily as hospital-based providers, are licensed in all 50 states and the District of Columbia.

The resolution did not offer any science-based information for the AMA's anti-midwife or anti-home birth position.

"Maternity care is a multi-billion dollar industry in the United States," said Steff Hedenkamp, Communications Coordinator for The Big Push for Midwives. "So it's no surprise to see the AMA join the American College of Obstetricians and Gynecologists in its ongoing fight to corner the market and ensure that the only midwives able to practice legally are hospital-based midwives forced to practice under physician control. I will say, though, that I'm shocked to learn that the AMA is taking this turf battle to the next level by setting the stage for outlawing home birth itselfa direct attack on those families who choose home birth, who could be subject to criminal prosecution if the AMA has its way."

The Big Push for Midwives (http://www.TheBigPushforMidwives.org) is a nationally coordinated campaign organized to advocate for regulation and licensure of Certified Professional Midwives (CPMs) in all 50 states, the District of Columbia and Puerto Rico, and to push back against the attempts of the American Medical Association to deny American families access to safe and legal midwifery care.

Media inquiries should be directed to Steff Hedenkamp (816) 506-4630, RedQuill@kc.rr.com.


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SEND US NEWS!
If you find news, resources or other valuable information that you think should be posted on the Grassroots Network, please send it to info@cfmidwifery.org with "for the grassroots network" in the subject line. We will definitely consider using them!

CONSIDER JOINING Citizens for Midwifery!
Find out more about CfM at www.cfmidwifery.org
Easy to join on-line with a credit card  go to http://cfmidwifery.org/join 

HOW TO JOIN THE GRASSROOTS NETWORK LIST
Visit the Citizens for Midwifery website at www.cfmidwifery.org .
Scroll to the bottom of the page and enter your e-mail address.  It's that simple!

GET INVOLVED!
Are you interested in volunteering with some dynamic women in a supportive environment?
Help CfM promote the Midwives Model of Care!
We have many ways to get more involved ~ committees, state and regional representatives,
And smaller tasks that will help CfM grow stronger and become more effective.
Get in touch with us!

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00:53 
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[20 Jun 2008 | Friday] 
Dear Friends,

Grassroots Network Message 806028 noted the MA ACOG letter to members regarding their talking points for opposing the MA midwifery bill.

The MA ACOG letter contains a number of completely inaccurate statements, especially regarding the CPM credential. The North American Registry of Midwives has addressed these points specifically, as follows:

The MA ACOG letter states:
"The academic standards for certified professional midwifery (CPM) are
remarkably lower than the academic standards for training and
certification of physicians, as well as for nurse-midwives certified
by the ACNM. Moreover, CPM training requirements fall short of
internationally established standards for midwives and traditional
birth attendants."
NARM states:
Certified Professional Midwives are neither physicians nor nurse-midwives. Their education is specific to risk assessment and management for normal births in out-of-hospital settings. They recognize and refer, but do not diagnose nor treat, pathologies best suited for physician management. The education of the CPM is sufficient for this task as evidenced by the outcomes of the CPM2000 study published in the British Medical Journal, and as evidenced by the acceptance of the CPM by many states that license direct-entry midwives. Twenty-two states license midwives with requirements similar to or equivalent to the CPM; many have been in existence for over 20 years, and all have found the training to be sufficient for the task.

The MA ACOG letter states:
"An individual without a high school degree could be
licensed as a CPM if he or she passed the certifying exam, observed
20 deliveries, and participated as the primary attendant in 10."
NARM states:
Because the CPM is a midwifery credential, it does not set pre-requisites for non-midwifery education. The curriculum and training have been determined by the NARM Job Analysis according to procedures established by the National Commission for Certifying Agencies. The numbers in the above paragraph are false. In addition to the didactic education of over 750 competencies, the CPM candidate must complete 20 births as an assistant (not observer) and 20 births as the primary attendant, all under the supervision of a qualified preceptor. Additional verification of skills and knowledge is verified by a hands-on practical exam and an 8-hour written exam.

The MA ACOG letter states:
"CPMs have not adopted a set of criteria based on generally
accepted medical evidence or public safety for patients who may be
appropriate candidates for home birth, relying instead on the
decision of the individual midwife and patient."
NARM states:
Certification, by definition, defines the knowledge and skills necessary for attainment of the credential - indicating that the midwife has demonstrated the ability to make appropriate decisions for the practice of midwifery. The North American Registry of Midwives (NARM), which issues the credential, does have a mechanism for addressing complaints about the practice of a CPM. NARM does not, however, regulate the practice of midwifery. Regulation is a function of state licensure, and varies from state to state.

The MA ACOG letter states:
"The curriculum, clinical skills training, and experiences
of CPMs have not been approved by any authority recognized in
certifying knowledge and skills associated with the practice of
obstetrics, including the American Board of Obstetrics and
Gynecology, the American Midwifery Certification Board (AMCB), and
the American Board of Family Medicine."
NARM states:
Neither the American Board of Obstetrics and Gynecology nor the American Midwifery Certification Board approves the curriculum or sets clinical requirements for their own certificants, much less for the applicants for any other certification program. Each certification program sets its own prerequisites and conditions for application without approval from a completing or complementary certification board.

The MA ACOG letter states:
" The North American Registry of Midwives’ Portfolio
Evaluation Process (PEP) requires midwives to be the primary care
provider on 50 homebirths and have three years of experience. The
average intern in obstetrics and gynecology gets this much experience
in 1 month."
NARM states:
The Certified Professional Midwife does not function as an obstetrician/ gynecologist. The clinical training for the CPM is similar in number to that of most certified nurse-midwives and is more extensive in vaginal births than the number required for family practice physicians.


MA  ACOG could have easily checked their information before posting, but chose instead to post opinion and innuendo as if it were fact…

It is also interesting to note that the letter mentions no health evidence to support the ACOG position, and does not address the needs or preferences of mothers…

NARM's "Planning for Legislation Handbook" includes lots of info, including factual information (p. 30) similar to the information above addressing the MA ACOG letter, and can be found at: http://www.narm.org/pdffiles/legislativebooklet1-06.pdf .

Sincerely,
Susan Hodges, "gatekeeper"



============ ========= ========= ========= ========= ========= ========

SHARE WITH OTHERS IN YOUR AREA!
Feel free to forward the Grassroots Network messages to others who might be interested!

SEND US NEWS!
If you find news, resources or other valuable information that you think should be posted on the Grassroots Network, please send it to info@cfmidwifery.org with "for the grassroots network" in the subject line. We will definitely consider using them!

CONSIDER JOINING Citizens for Midwifery!
Find out more about CfM at www.cfmidwifery.org
Easy to join on-line with a credit card  go to http://cfmidwifery.org/join 

HOW TO JOIN THE GRASSROOTS NETWORK LIST
Visit the Citizens for Midwifery website at www.cfmidwifery.org .
Scroll to the bottom of the page and enter your e-mail address.  It's that simple!

GET INVOLVED!
Are you interested in volunteering with some dynamic women in a supportive environment?
Help CfM promote the Midwives Model of Care!
We have many ways to get more involved ~ committees, state and regional representatives,
And smaller tasks that will help CfM grow stronger and become more effective.
Get in touch with us!

============ ========= ========= ========= ========= ========= ========
00:52 
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[20 Jun 2008 | Friday] 
Grassroots Network Message 806029
Action Needed: NQF proposed measures for perinatal care

Dear Friends,

Please forgive a long message, but this is important to know about, and you are very much encouraged to comment!

The National Quality Forum (NQF) has drafted a set of performance measures of perinatal care (last trimester through hospital discharge of mother and newborn). This is the first time the NQF has specifically addressed perinatal care. The proposed "measurement set" is now public; YOU can comment, and the deadline for public comment is June 11.

There are quite a number of measures included.  The NQF has a specific framework, and many people have put a lot of time and effort into drafting these measures, which are specifically to measure quality of maternity, including care when there are problems.  You may not agree with, or even understand, all of the measures, but this is a situation where we need to look at the glass have full rather than the glass half empty.

It is hoped that many individuals and organization will provide comments.

For excellent background information, read Childbirth Connection's analysis and comments at: http://www.childbirthconnection.org/article.asp?ck=10565.  Also, I have included two letters (see below), one from Maureen Corry of Childbirth Connection, who also was co-chair of the Steering Committee, and one from Judith Norsigian that also provide useful context and information.

Next, go to:  http://www.qualityforum.org/projects/ongoing/perinatal/Comments/index.asp. At the end of the brief article on that page, find a link to a pdf of "National Voluntary Consensus Standards for Perinatal Care".  This is the actual document, and includes information about the framework the NQF was working from, and some discussion and rationale for each measure considered, including those not included in the final draft.

While this may seem like a somewhat daunting task (the NQF document is 36 pages, double spaced), it did not take me long to look through it especially after reading the information on Childbirth Connection's page.

Finally, you can comment on the report as a whole, and/or on individual measures, (see links in the left hand menu on the NQF site) and you can read the comments already submitted, including the excellent comments submitted by Childbirth Connection. Comments are quite limited in length, but there is nothing to say you can't refer to a comment already submitted, or submit more than one comment on a particular measure. 

Also, you can comment on just one or two items  you don't have to comment on everything.  For example, the NQF had reasons why they did not include either proposed measure regarding VBACs, which is disturbing, and something you might want to comment on (see the last comment category "19. Measures not recommended") . Furthermore, the recommended measures focus on "outcomes", and do not at all address the role of any birth practices on these outcomes.  I am sure you will easily find one or more measures you feel are important to comment on! 

Keep in mind that these proposed measures represent a lot of work, and are the FIRST TIME measures to assess the quality of perinatal care in the US, which is a good thing!  In general, few projects like this are "perfect" on the first go, and it is good to remember that people who have worked on a project respond best to a combination of appreciation and constructive suggestions!

Sincerely,
Susan Hodges "gatekeeper"


------------ --
Letter from Maureen Corry of Childbirth Connection:

May 29, 2008

Dear Colleague:

We are writing to alert you to a very exciting development for those of us deeply committed to improving the quality of maternal and newborn health care in this country.  This winter the National Quality Forum (NQF) embarked upon a project to consider endorsement of a set of performance measures of perinatal care received during the last trimester of pregnancy through hospital discharge of both mother and newborn. 

Although several measures already endorsed by the NQF touch on maternity or newborn care, this is the first time the NQF has considered a comprehensive set of perinatal measures.  The NQF has now released the proposed measurement set for public review and comment.

The set contains 18 perinatal measures, and 10 recommendations for further research and measure development to address gaps in measures. The full list of measures, together with supporting information, is available at NQF's Perinatal Care Project web page.   While all the proposed measures have been recommended for endorsement by the Perinatal Steering Committee, we believe five of these measures will be of special interest to you and your organization.  They are:  1) the percentage of C-sections among low-risk women giving birth for the first time; (2) the percentage of elective deliveries prior to 39 completed weeks' gestation; (3) hospital support of breastfeeding; (4) rate of episiotomy; and (5) the percentage of infants screened for jaundice prior to hospital discharge.  Available here is a brief background document we have prepared about each of these five measures and about important measures that were not recommended and recommendations for research and measure development.

The NQF public comment period runs through close of business June 11, 2008.  All are invited to comment, whether or not you are an NQF member.  The comments will be made available to the NQF members for their consideration in the voting that will follow, and can result in revisions to the proposed measure set if warranted.   At the conclusion of the comment and voting periods, the final proposed set of measures will be submitted to the NQF Consensus Standards Approval Committee and ultimately to the NQF Board of Directors for endorsement.

We believe it is important that the NQF and its membership realize how significant this first maternal and newborn set of measures is to individuals and organizations that care about improving the quality of care for childbearing women and newborns. We therefore urge you to submit comments to the NQF on the measures and research recommendations, even if only a few sentences.

For more information, please don't hesitate to contact Maureen at Corry@childbirthcon nection.org or Lee Partridge, at Lpartridge@national partnership. org.

Thank you.

Maureen Corry     
Maureen Corry
Executive Director
Childbirth Connection
Debra Ness
Debra L. Ness     
President
National Partnership for Women & Families

------------ ---------

Letter from Judith Norsigian of Our Bodies Our Selves

Dear friends:
I write to urge you to comment on the National Quality Forum (NQF) Perinatal Care performance measure project, which is described more fully at: http://www.childbirthconnection. org/article.asp?ck=10565.

The National Quality Forum (NQF) has invited review and comment on its draft report, National Voluntary Consensus Standards for Perinatal Care, by June 18, 2008 (NQF members) or June 11, 2008 (general public). A multi-stakeholder Perinatal Care Steering Committee reviewed 33 performance measures, and recommended that 18 receive the "NQF-endorsed" designation. To address gaps in measures, the Steering Committee also developed 10 recommendations for further research and measure development. The full draft report, related documents and forms for providing comments are at NQF's Perinatal Care Project web page. Following the comment period, NQF members will vote on the measures and research and development recommendations, and NQF leadership will approve the final set.

As you well know, poor quality maternity care, during pregnancy, childbirth, and the postpartum period, can lead to unnecessary interventions and complications, longer hospital stays, and infants needing intensive care services. These problems, in turn, lead to increased costs and increased short and long term health problems for mothers and babies. With more than four million expectant mothers admitted to hospitals each year, maternity care quality affects a large number of women, newborns and families.

Up to now, there has been very little focus on quality measurement and reporting for maternity care. No nationally recognized set of maternity care performance measures exist, and relatively few providers utilize the measures that do exist. Only sporadic public reporting on maternity care quality has occurred. Similarly, public access to information about maternity care quality has varied widely.

A nationally recognized set of maternity care performance measures will help improve maternity care quality by:
• providing information about the performance of caregivers and facilities, thereby increasing transparency and accountability
• assisting women in choosing high-quality maternity services • helping caregivers and facilities improve their services, and providing incentives for improvement
• helping policy-makers identify and address problems such as disparities
• giving focus to local quality improvement efforts

The general public is invited to comment until next Wednesday, June 11, on the draft report, which includes:
- measures being recommended for NQF endorsement
- measures that were submitted but are not being recommended for endorsement
- priority areas for development of needed measures

The comments that the Childbirth Connection in NYC has submitted on the NQF website in response to the request for feedback are excellent (see att), and we at OBOS will be submitting something similar. WE ARE DEEPLY CONCERNED that the current draft does NOT include one or both of the VBAC (vaginal birth after cesarean) measures that were under consideration: a risk-adjusted VBAC rate and a measure for VBAC access (latter defined as VBAC rate of 5% or more). The final two entries in the attached document from the Childbirth Connection lay out many of the most salient issues in support of including these measures.

Please respond to the NQF before 6pm on June 11 to comment on the importance of including one or both of these VBAC measures in the current measure set. Thanks so much, and I can be reached via cell (617 233 0062), if you would like to talk. Thanks so much!

The link for providing comments is at http://qualityforum.org/projects/ongoing/perinata l/Comments/index.asp

Best-Judy

PS If you have read our new book on pregnancy and birth and haven't yet considered doing a review or making a comment, do let me know. I know now from my recent book tour (26 cities in 3 months) that the book is being well received by both caregivers and women seeking basic information about pregnancy and birth. The combination of a well-written text, evidence-based information, and the stories of women from varying backgrounds makes for an excellent resource. Although we have had practically no national media attention, letters like the one attached from Dr. Tim Johnson in Ann Arbor are starting to circulate and reach educators and community women alike.
Judy Norsigian
Executive Director, Our Bodies Ourselves
co-author of "Our Bodies, Ourselves"
34 Plympton St
Boston, MA 02118
Ph: 617 451 3666 x11
Fax: 617 451 3664
Email: judy@bwhbc.org
Website: www.ourbodiesourselves.org


============ ========= ========= ========= ========= ========= ========

SHARE WITH OTHERS IN YOUR AREA!
Feel free to forward the Grassroots Network messages to others who might be interested!

SEND US NEWS!
If you find news, resources or other valuable information that you think should be posted on the Grassroots Network, please send it to info@cfmidwifery.org with "for the grassroots network" in the subject line. We will definitely consider using them!

CONSIDER JOINING Citizens for Midwifery!
Find out more about CfM at www.cfmidwifery.org
Easy to join on-line with a credit card  go to http://cfmidwifery.org/join 

HOW TO JOIN THE GRASSROOTS NETWORK LIST
Visit the Citizens for Midwifery website at www.cfmidwifery.org .
Scroll to the bottom of the page and enter your e-mail address.  It's that simple!

GET INVOLVED!
Are you interested in volunteering with some dynamic women in a supportive environment?
Help CfM promote the Midwives Model of Care!
We have many ways to get more involved ~ committees, state and regional representatives,
And smaller tasks that will help CfM grow stronger and become more effective.
Get in touch with us!

============ ========= ========= ========= ========= ========= ========
00:50 
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[20 Jun 2008 | Friday] 
Grassroots Network Message 806028
ACOG and the Massachusetts Bill for a Board of Midwifery

Dear Friends,

Many of you already know of the bill wending its way through the MA legislative process:  a bill developed by CNMs, CPMs, CMs and consumers, working together. The gist of the bill is that it would create a single midwifery board that would license CNMs, CMs and CPMs, with slightly different licenses that reflect differences in training, and includes prescriptive privileges for CNMs/CMs and administration of emergency and state mandated meds for CPMs.

Of course, ACOG (American College of Obstetricians and Gynecologists) is opposed, as they are opposed to any bill that would license CPMs and allow for legal midwife-attended home births. 

Now you can read exactly what ACOG is saying about the bill, and how they are urging their members to actively work to stop passage of this bill. You can read their latest statement at: http://www.acog.org/acog_sections/dist_notice. cfm?recno=27&bulletin=2154

I am sure you will recognize the many errors and misinformation, starting with the novel idea that CPMs are what used to be called "lay midwives"  absolutely not true!

Whether you are involved with state legislation for CPMs or not, in MA or elsewhere, it is worthwhile to be aware of what ACOG is telling its members. You never know when you will have a chance to enlighten a physician or other person who has been misled by ACOG's statements!

Sincerely,
Susan Hodges, "gatekeeper"



============ ========= ========= ========= ========= ========= ========

SHARE WITH OTHERS IN YOUR AREA!
Feel free to forward the Grassroots Network messages to others who might be interested!

SEND US NEWS!
If you find news, resources or other valuable information that you think should be posted on the Grassroots Network, please send it to info@cfmidwifery.org with "for the grassroots network" in the subject line. We will definitely consider using them!

CONSIDER JOINING Citizens for Midwifery!
Find out more about CfM at www.cfmidwifery.org
Easy to join on-line with a credit card  go to http://cfmidwifery.org/join 

HOW TO JOIN THE GRASSROOTS NETWORK LIST
Visit the Citizens for Midwifery website at www.cfmidwifery.org .
Scroll to the bottom of the page and enter your e-mail address.  It's that simple!

GET INVOLVED!
Are you interested in volunteering with some dynamic women in a supportive environment?
Help CfM promote the Midwives Model of Care!
We have many ways to get more involved ~ committees, state and regional representatives,
And smaller tasks that will help CfM grow stronger and become more effective.
Get in touch with us!

============ ========= ========= ========= ========= ========= ========
00:49 
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[20 Jun 2008 | Friday] 

Grassroots Network Message 806027
New study shows benefits of doulas

Dear Friends,

A new randomized controlled trial of continuous labor support for middle-class couples looks at the effect on cesarean delivery rates and found significant benefits.  From the abstract:

CONCLUSIONS: For middle-class women laboring with the support of their male partner, the continuous presence of a doula during labor significantly decreased the likelihood of cesarean delivery and reduced the need for epidural analgesia. Women and their male partners were unequivocal in their positive opinions about laboring with the support of a doula.

In fact, the study found that "the doula group had a significantly lower cesarean delivery rate than the control group (13.4% vs 25.0%)".

You can read the abstract at:
http://highwire.stanford.edu/cgi/medline/ pmid;18507579

Here is the citation:
A randomized controlled trial of continuous labor support for middle-class couples: effect on cesarean delivery rates.
SK McGrath and JH Kennell
Birth, June 1, 2008; 35(2): 92-7.

Sincerely,
Susan Hodges "gatekeeper"




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If you find news, resources or other valuable information that you think should be posted on the Grassroots Network, please send it to info@cfmidwifery.org with "for the grassroots network" in the subject line. We will definitely consider using them!

CONSIDER JOINING Citizens for Midwifery!
Find out more about CfM at www.cfmidwifery.org
Easy to join on-line with a credit card  go to http://cfmidwifery.org/join 

HOW TO JOIN THE GRASSROOTS NETWORK LIST
Visit the Citizens for Midwifery website at www.cfmidwifery.org .
Scroll to the bottom of the page and enter your e-mail address.  It's that simple!

GET INVOLVED!
Are you interested in volunteering with some dynamic women in a supportive environment?
Help CfM promote the Midwives Model of Care!
We have many ways to get more involved ~ committees, state and regional representatives,
And smaller tasks that will help CfM grow stronger and become more effective.
Get in touch with us!

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00:48 
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[20 Jun 2008 | Friday] 
Grassroots Network Message 806026
Cesarean section excuse to increase insurance premiums

Dear Friends,

The Sunday New York Times includes an article documenting that women who have individual health insurance coverage (not group insurance through an employer), are being penalized by some insurance companies with higher premiums, just because they had a cesarean section for any reason.

As the friend who sent me this link wrote:
"Talk about being between a rock and a hard place -- women who have had cesarean surgery are now, on top of everything else, ping-pong balls in a game between the health insurance companies and the malpractice insurance companies."

You can read the article at the link below.  When obstetricians have openly admitted to performing cesarean sections merely to decrease their vulnerability to a lawsuit (and other equally outrageous non-medical reasons), the fact that women are first operated on for non-medical reasons, and then are required to pay extra for health insurance, is just plain unacceptable.

Sincerely,
Susan Hodges, "gatekeeper"



http://www.nytimes.com/2008/06/01/health/01insure.html?hp
HEALTH | June 1, 2008
After Caesareans, Some Women See Higher Insurance Cost
By DENISE GRADY
With individual insurance, prices differ based on a person's medical history; a past Caesarean can mean higher premiums.
….



============ ========= ========= ========= ========= ========= ========

SHARE WITH OTHERS IN YOUR AREA!
Feel free to forward the Grassroots Network messages to others who might be interested!

SEND US NEWS!
If you find news, resources or other valuable information that you think should be posted on the Grassroots Network, please send it to info@cfmidwifery.org with "for the grassroots network" in the subject line. We will definitely consider using them!

CONSIDER JOINING Citizens for Midwifery!
Find out more about CfM at www.cfmidwifery.org
Easy to join on-line with a credit card  go to http://cfmidwifery.org/join 
HOW TO JOIN THE GRASSROOTS NETWORK LIST
Visit the Citizens for Midwifery website at www.cfmidwifery.org .
Scroll to the bottom of the page and enter your e-mail address.  It's that simple!

GET INVOLVED!
Are you interested in volunteering with some dynamic women in a supportive environment?
Help CfM promote the Midwives Model of Care!
We have many ways to get more involved ~ committees, state and regional representatives,
And smaller tasks that will help CfM grow stronger and become more effective.
Get in touch with us!

============ ========= ========= ========= ========= ========= ========
00:46 
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