The changing landscape for CPMs holds great promise. Rather than being diminished by current developments and changes, in fact, the opportunities for CPMs have never been greater: to serve more people, be more relevant to the changing needs and demographics of the childbearing population, be of more service in eliminating racial inequities in care, and infuse the systems of care with CPM knowledge, experience and values.
Birth Centers and Midwifery Care Improve Outcomes
A recent report on the effectiveness of midwifery care in birth outcomes, news on increased birth center reimbursements in WA State, and lots of fall webinars and events are all featured in this week’s newsletter.
Fall Webinar Lineup
Please join us this fall for webinars on Charting for Midwives (Part II), NACPM Vision and the Midwifery Landscape, Gender, Sexuality and Inclusion of all Families in Midwifery Practice, and more.
Our Hearts Are with Those Suffering from Natural Disasters
NACPM reports on efforts by CPMs in communities affected by hurricanes in Puerto Rico, Florida and Texas.
Save the Date! CPM Symposium 2018!
May 11-13, 2018
William F. Bolger Center
Potomac, Maryland
You are invited to join a conversation about the urgent needs of childbearing people in the U.S., how CPMS can better serve families and increase access to midwifery care, and what stepping up to these needs means for the future of workforce composition, practice, education and policy.
Since NACPM’s first CPM Symposium in March of 2012, an exciting new landscape has emerged for CPMs. Health policy has evolved and the health system is in a new state of flux. The demographics of people having babies are shifting significantly, while health inequities and disparities continue to cause unconscionable suffering. The US MERA accords have generated breakthrough progress in state legislation but have also left many anxious and concerned within the profession.
The symposium format is designed to engage participants representing a broad range of stakeholders and demographics in a unique opportunity to plan together for the future of midwifery. It will be an extraordinary opportunity to meet and sit down with consumers, midwifery advocates, leaders of color, public health representatives, midwifery innovators, state leaders, health policy experts, funders, the next generation of midwifery leaders, and more!
We will hear from childbearing families from a broad range of demographics and from public health researchers what most concerns them about quality of care available today. We will examine the disproportionate burden of infant and maternal mortality in communities of color, the challenges we face as obstetric workforce shortages worsen, and more. Charged and informed, we will explore and plan together for how CPMs can step up to these challenges and the role we must play in improving the health and lives of people having babies in the U.S.
NACPM’s co-conveners are the Association of Midwifery Educators and Citizens for Midwifery. We are exploring avenues for input into the program design from a wide array of stakeholders and possible additional partners.
Mark your calendars now and look for more information about the program and registration this fall!
CPM Symposium 2012 – CPMs and Midwifery Educators: Contributing to a New Era in Maternity Care
If you missed CPM Symposium 2012, check out the website to learn more about the important issues that emerged, the speakers and presentation materials, and the reports and actions that followed
NACPM Endorsement of ACNM’s Denouncement of Charlottesville Attacks
Please read the statement put forward by the Board of the American College of Nurse-Midwives addressing the recent events in Charlottesville, as well as an endorsement of this statement by NACPM Board and staff.
Chapters at Work: Leadership Training and Chapter Collaborate
Much of NACPM’s work on the state level this summer has occurred in the chapters, whether it’s working on birth center reimbursement, or equity and anti-racism training. In addition, learn about events for CPMs in Florida and the Carolinas.
ICM 2017 Report
The NACPM Delegation to the Triennial Congress of the International Confederation of Midwives participated in Council discussions, voted on position statements, joined the March for More Midwives and learned about midwifery issues around the world.
Senate Bill Proposes Deep Cuts to Medicaid – Call Your Senators Today!
Deep Concern for the Welfare of Childbearing People
With the Senate’s release on June 22 of the Better Health Reconciliation Act of 2017, NACPM is deeply concerned for the health and well-being of childbearing people, babies and families in the United States. We urge you to acquaint yourself with this bill and call your Senators today to ask them stop this repeal of the Affordable Care Act (ACA).
This legislation, drafted behind closed doors by 13 Republican Senators over the past several weeks, is the Senate’s version of Congress’ effort to repeal the Affordable Care Act. It retains the basic structure of the American Health Care Act (AHCA) passed by the House of Representatives on May 4 of this year, which the Congressional Budget Office projected would cause over 23 million people to lose health care coverage over 10 years.
In March of this year, NACPM released a statement describing the gains for women as a result of the ACA, and the consequences for childbearing people with a repeal of the ACA. Now with the release of the Senate’s bill, this population is more at risk than ever.
Maternity Care Once Again not an Essential Health Benefit
The ACA requires all health plans, with a few exceptions, to cover a set of Essential Health Benefits (EHBs), including maternity care. Just 7 years ago, prior to the ACA, pregnant people frequently could not obtain insurance, maternity and newborn care were not considered essential health benefits and there were multiple barriers to health insurance coverage. The Senate bill would allow states to opt out of covering the Essential Health Benefits, once again leaving pregnant people without access to coverage. Birth impacts everyone at the beginning of life, and 85% of women become pregnant at least once during their lifetimes. The cost of having a baby averages $18,329 and $27,866 for a cesarean section. Almost 1 in 3 births is a cesarean section. Shifting these costs once again back to people having babies, including the poor and most vulnerable, is not sustainable or conscionable.
Drastic Cuts to Medicaid
While the Senate bill contains funds to stabilize the insurance markets and softens some of the provisions in the AHCA, these seeming improvements mask drastic changes to our health care system and deep cuts to Medicaid. Under the provisions of the ACA, 31 states and the District of Columbia took advantage of new federal funding to expand their Medicaid programs, providing new coverage to millions of Americans who had previously not had access to coverage. The Senate bill would phase out this expansion of Medicaid completely by 2024, affecting health care coverage for these millions of people, albeit more slowly than the AHCA, which calls for a phase out by 2020. By changing the mechanisms for determining the federal share of Medicaid spending, it also would impose deep cuts to the Medicaid program in future years, significantly rolling back the federal commitment to Medicaid. States would be left with stark options for reducing services or eliminating many of those newly eligible for coverage, effectively ending Medicaid as we know it now. Currently, Medicaid pays for the health care for 1 in 5 Americans and approximately half of all births in the U.S.
Tax Cuts for the Wealthy Paid for by the Poor
This legislation would reduce the subsidies provided in the ACA that make insurance affordable to people of low and moderate income, and would limit access to coverage for many now eligible by lowering income eligibility levels. It would repeal the taxes put in place by the ACA to pay for expanded coverage for low and moderate-income people, including a payroll tax and a surtax on net investment income. In effect, large tax breaks for the wealthiest Americans – those least in need – will be paid for by taking insurance coverage away from poorer people who are most in need.
A Call to Action
This bill is expected to come to the floor of the Senate this week. Only 20 hours will be allowed for debate. The defection of only 2 Republicans would spell its defeat. NACPM is reaching out to Senators about our deep concerns for the welfare of our citizens. We urge you to call your Senators today!
How to Call Your Senators
Call the Congressional switchboard at 202-224-3121 and ask to be connected to one of your Senators.
Once you are connected, say:
“As your constituent, I urge you to reject the Better Health Reconciliation Act and the repeal of the Affordable Care Act with its critical protections for childbearing people and their babies. I am a midwife (or consumer of maternity care, etc.) and am deeply concerned that maternity care would no longer be required to be covered by insurance. Medicaid pays for ½ of the births in our country and this bill will severely undercut coverage of these services. (Tell a short personal story of why you oppose the Senate bill – this adds much power to your message.)
After you call one of your Senators, call the switchboard again to call your other Senator.
Share any comments or feedback you receive with us by writing to info@nacpm.org.
Florida Legislation Update, Alabama Bill Passes
2017 Florida Legislative Report
by Sharon Hamilton, LM
After many years of very little Legislative activity the midwives of Florida rallied to prevent the opening of their practice act, F.S. 467, during the 2017 Legislative Session. In October, 2016, the midwives were alerted to a District XII ACOG driven plan to open F.S. 467 with the intention of requiring midwives to report Sentinel Events.
Having had many years of lobbying experience as President of the Midwives Association of Florida in the 80s and 90s, I was called into action to perform my old job of Legislative Chairperson. The group had established a Base Camp on the internet that allows us to communicate by Webex, making meetings so much easier than in that time period. The first meeting that I participated in, included a discussion of “Do we need a Lobbyist?” It did not take long to convince people that it was essential to have a lobbyist as this is the person who communicates for and represents us to the legislative and executive branches of the Government. This is the person who is our advocate, guide and defender. There was no telling what type of meddling the doctors may have intended but we had plenty of ideas. We were concerned for instance that they may want to require all mothers to be approved for out-of-hospital birth, although that topic was not part of their final proposal.
Our first discussion included brainstorming names of lobbyists and possible contacts regarding lobbyists. After reviewing 4 or 5 potential candidates, we chose one that was a referral from a home birth client. It turned out to be the perfect choice. The proposal that we received from them was well written and addressed our concerns and objectives. The interview that we had with them, though by phone, indicated their interests and goals. We hired two lobbyists for a fee of $15,000 each, spread out in 3 payments over a 6 month period. It was worth every penny. The two lobbyists between them had over 60 years of experience. They had both done considerable healthcare lobbying including for the Florida Medical Association. We suspected that could give us an advantage in the future and it did. Because they had good, strong relationships with previous associates who still lobbied for the ACOG and FMA, they were able to work congenially with the opposition. Justine Clegg passed along a power point to them on the history of Midwifery in Florida and gave them considerable guidance. They quickly became passionate about our mission.
ACOG’s stated goal, was the reporting of Sentinel Events in the out-of-hospital setting to the Department of Health. There are CNMs and a few doctors who attend out-of-hospital births in Florida, not just L.M.s, so it didn’t seem right that the proposed language should go into F.S. 467, because that would leave out all of the other practitioners attending out-of-hospital births. We did the research and discovered that 20% of out-of-hospital births in Florida are attended by CNMs and doctors. Armed with this new information and at our recommendation, our lobbyists approached their lobbyists to argue that any language should go into F.S. 456, which is an umbrella health care act that covers all health care practitioners. After much negotiation with the Chair of the ACOG Committee and their lobbyist, we were able to negotiate an agreement to leave our practice act alone and instead amend F.S. 456. An amendment was attached to a Health Care Bill in the House which passed. However, when the bill went over to the Senate it failed for unrelated reasons.
Florida Legislative Report
1. Before session began, our Committee prepared a legislative toolkit that included a Position Paper or Fact Sheet on Licensed Midwifery.
2. During Legislative Session our committee met weekly by webinar to discuss our strategy. Our lobbyists attended the first half of the meeting most of the time.
3. We identified every legislator on the health care committees in which we thought our issue would be heard.
4. We identified midwives in many of their districts so that they could be visited by their local midwife and possibly a mom and baby.
5. We kept a tally of each legislator visited and their position on midwifery.
6. Our lobbyists arranged a capitol day for us in the 3rd week of Session that was most effective.
7. We met the evening before in Tallahassee, at a local restaurant, 17 of us including our lobbyists to discuss our strategy and to prepare talking points.
8. Our lobbyists had arranged meetings with 19 legislators in the House and the Senate that were to occur every 15 minutes throughout the day. We divided into 3 groups with 1 experienced person acting as the spokesperson for the group. Our lobbyists accompanied the group that was visiting especially a Chairperson of a Committee or a legislator that was more likely to be particularly helpful.
9. We explained our position that: if the goal was the reporting of all Sentinel Events in the out of hospital setting being reported that the Statute amended needed to be F.S. 456, to address all health care provider rather than singling out Licensed Midwives. Every Legislator that we spoke with understood and supported our argument including the sponsor of the amendment that was initiated by the ACOG.
10. We presented to each Legislator, or their Aide, the benefits of midwifery including reduced costs to the state by Medicaid. Whenever you can argue saving money, it is a winning argument.
Alabama Passes Bill to License CPMs: Congratulations!
NACPM offers our heartfelt congratulations to all families in Alabama, Alabama Midwives Alliance (ALMA), and the Alabama Birth Coalition (ABC) on the long-sought passage of HB 315, the Childbirth Freedom Act, that will at long last allow Certified Professional Midwives to serve families choosing home birth. The bill passed the Senate on May 19 on a 30-0 vote, and was signed into law by Governor Ivey on May 25th. The passage of this legislation is a triumph for families, led by the Alabama Birth Coalition in a resolute grassroots movement that persevered for over 15 years, and who welcomed the new legislation with great joy. The mission of ABC is to unite and empower maternity care consumers in Alabama to advocate for informed choice among high-quality, integrated, evidence-based services in homes, birth centers and hospitals.
HB 315 previously passed the House on April 25 by a vote of 84-11, as a simple decriminalization bill, exempting CPMs from the crime of practicing nurse midwifery without a license, effectively allowing midwives to practice legally in Alabama. The bill was changed in the Senate to provide for licensure and to include a State Board of Midwifery, consisting of four CPMs, one nurse practitioner, one CNM or registered nurse, and one consumer of midwifery services. The bill requires the CPM certification and accredited education for midwives applying to be licensed.
Non-nurse midwives have not been able to practice legally in Alabama since 1976 when the State ended its DEM permitting program. Since then home birth has only been legal if it is not attended by a midwife. Advocates have been introducing bills to decriminalize the practice of Certified Professional Midwifery for over a decade, all in a state with a severe shortage of maternity care providers. Of Alabama’s 67 counties, 33 have no obstetrician in practice, and women often must drive long distances for prenatal care and hospital care for their births. Alabama is among the states with the worst infant mortality, outranked only by Louisiana and Mississippi. In recent decades, the number of doctors delivering babies has declined, several rural hospitals have closed and other hospitals have dropped maternity services. The passage of the new law providing for the legal practice of midwifery will help to alleviate the state’s shortage of maternity care providers and allow for much-needed choice for families.
Certified Professional Midwives are clearly urgently needed by families in Alabama. Where before it was only legal to give birth at home with no help, families now have the right to hire competent, professional help. “The only way this has been possible is because Alabama mothers and fathers have really joined together to let their legislators know how much they want midwives in Alabama,” said Courtney Sirmon, vice-president of the Alabama Birth Coalition.
Congratulations to all in Alabama on this momentous victory!
The ICM Triennial Congress is Coming!
This week’s newsletter features news about the upcoming Congress, NACPM Delegates and a webinar live from the Congress planned for June 19.
Prenatal Genetic Testing, Charting Practices and a Tribute to Dorothea Lang
This weeks’ newsletter provides resources for midwives and clients on prenatal genetic testing, features a summary of last week’s popular webinar on Charting Practices, and pays tribute to midwifery leader Dorothea Lang who recently passed away.
Over-Intervention in Maternity Care is a Global Concern
The Wilson Center, the nation’s key non-partisan policy forum for tackling global issues through independent research and open dialogue to inform actionable ideas for the policy community, recently convened a panel of experts to discuss Too Much Too Soon: Addressing Over-Intervention in Maternity Care. The panel included Saraswathi Vedam, an associate professor and lead investigator at the University of British Columbia’s Birth Place Lab; Suellen Miller, Director, Safe Motherhood Program; and Myriam Vuckovic, Assistant Professor, International Health Department, Georgetown University.
From the Wilson Center website:
For years, the primary approach to improving global maternal health was additive – to increase capacity to address shortfalls in clinics, doctors, supplies, information, and skilled care. Today, however, some women are experiencing issues related to the opposite problem: too much.
So called “over-intervention,” such as the use of Caesarean sections, ultrasounds, and antibiotics when not needed, are costly for health systems and can be dangerous for women and newborns. In addition, it calls attention to whether women are being allowed to make decisions about their own health care under pressure.
“An indicator for poverty and for equity today is quality – the lack of quality,” said Anneka Knutsson, chief of sexual and reproductive health for United Nations Population Fund, at the Wilson Center on April 24. “It comes in the form of underuse, it comes in the form of overuse, but increasingly, the lack of quality is about over-intervention, of losing sight of what is ‘normal’ childbirth and supporting that physiological process.”
In parts of the world, “We have these huge numbers of women going into hospitals with three to a bed and overcrowded hospitals and terrible conditions, and we have not improved the outcomes,” says Dr. Vedam, who is also chair of the Home Birth Summit. “Institutional birth has not been shown to be the answer,” she says. Instead, “it’s about skilled attendants and respectful care.”
You can access a recording of the entire two hour streamed event here.
A twenty minute podcast of Dr. Vedam’s presentation “Reducing Over-Intervention in Maternal Care Through More Autonomy” is available here.
March for Moms and Webinars
Upcoming webinars include “Charting for Midwives” next Thursday, May 25 from 2-3:30 pm EDT and “Genetic Testing” on June 1 from 2-3:30 pm EDT.
Chapter News
Chapter Goals and Priorities for 2017
The NACPM State Chapter Program continues to expand with each state honing in on its unique work and projects. We currently have 12 fully formed chapters in North Carolina, South Carolina, Pennsylvania, Ohio, Minnesota, Illinois, Maine, Wisconsin, Washington, Nevada, Florida, and Oklahoma. Several more states are well on their way, and even more have expressed an interest in forming. The most recent Chapter Collaboration Call was an opportunity for chapters to share their 2017 goals and priorities with one another and with NACPM leadership. Here are a few highlights:
Meredith Christie, president of the North Carolina Chapter of NACPM, reported on their NC MERA collaboration with CPMs and CNMs in the state, which recently met and began plans to organize a NC Community Birth Summit modeled after the Home Birth Summit. They hope to facilitate community conversations with various care providers and stakeholders at the summit. They are also working on transport guidelines and hoping to coordinate a “Smooth Transitions” project modeled after WA state.
Christy Santoro, president of the Pennsylvania Chapter of NACPM, shared about their plans to host a forum around questions of equity, race, and access to care in midwifery. This state level exploration in PA is deeply resonant with NACPM’s commitment to addressing these critical issues nationally. NACPM is excited to see the PA Chapter design this forum, and will seek to empower and equip other chapters to bring this important work forward in their states.
Korina Pubanz, founding board member of the Wisconsin Chapter of NACPM, reflected on the value of the Chapter Collaboration Calls saying, “midwifery practice, legislation, and educational opportunities vary from state to state- it is so interesting to hear how the challenges are being met and great work is getting done. When I have participated in conversations or just listened to the work that is being put forward I can’t help but be motivated and also deeply appreciative for the work that has already been done in our state of WI.”
State Home Visits
Mary Lawlor has made several more “home visits” to state chapters and chapters in formation in MN, WA, and CO. Mary makes these visits both in response to crisis, like in Oklahoma last quarter, and more often simply to learn about the unique experience in each state while also sharing about the important work being done on the national level. These visits are vital to maintaining open lines of communication between NACPM and the midwives we serve. Kate Hogan from the MN Chapter of NACPM reported that “the MN NACPM chapter had a wonderful visit from Mary Lawlor this March. We so enjoyed getting to hear what is happening in the national midwifery community, and our local community was able to learn about and get many questions answered regarding US MERA. Our chapter is excited to be a part of working towards the NACPM strategic priorities.”
NACPM Chapter Team left to right: Kirsten Archibald (Office Manager), Susan Smartt Cook (Chapter Program Manager), Mary Lawlor (Executive Director), Jo Anne Myers-Ciecko (Consultant), Joanna Roche (Program Manager)
Would you like to nominate an extraordinary leader in your state? Let us know! We would love to recognize them in our State Chapter newsletter.
Contact Susan at chapters@nacpm.org.
If you are a chapter member or leader of a chapter in formation, please save the date for our next Chapter Collaboration Call on Tuesday June 6th from 1:30-3:00 ET. We will be discussing NACPM’s new comprehensive set of NACPM briefing papers and recommendations, to be released in early June, which describe NACPM’s vision and the emerging landscape and future directions for CPMs. Watch your email for more information.
READ ABOUT AN UPCOMING WEBINAR IN THIS WEEK’S NEWSLETTER
International Day of the Midwife, Friday, May 5
“Midwives, Mothers and Families: Partners for Life!” is the theme for International Day of the Midwife this Friday, May 5th. The International Confederation of Midwives (ICM) invites and encourages midwives to share your views, photos, stories using the phrase “I believe in partnership” on all ICM information platforms as a celebration of the wonderful work that midwives do around the globe. When you share your stories and photos, make sure you include #IDM2017. Click HERE to watch a video example of Nester T. Moyo, ICM’s Senior Midwifery Advisor, as she shares her views on partnership between midwives, mothers and families.
A message from Sally Pairman, ICM Chief Executive:
“Midwives everywhere understand that by working in partnership with women and their families they can support them to make better decisions about what they need to have a safe and fulfilling birth. It is evident that midwives deliver more than babies, in many instances they provide comprehensive sexual and reproductive health services and play a critical role in promoting health issues in their communities. As members of their communities, midwives are familiar with community issues, cultures and challenges. Working in partnership with women allows midwives and women to get to know each other and build trust and respect. Midwives can then provide individualized care that meets each woman’s needs, is culturally safe, includes the woman’s family and is therefore more likely to have a lasting impact.
Access to a skilled midwife can help reduce and prevent deaths of more than 287,000 women who die while giving birth, those who are left morbidities and 2.7 million newborns who die within the first 28 days of life because they have no mothers. That is why we need to take this partnership between midwives and mothers to a political level. If midwives and women and their families raise their voices together to advocate for changes to midwifery and maternity services they can combine their political power to make more impact and bring about changes so that services meet the needs of women and midwives.
The ICM has prepared a fabulous resource pack with all kind of ideas and tips for celebrating International Day of the Midwife. You’ll find useful advice for planning a special event, tips for issuing a press release, and great examples for posting on social media like Twitter and Facebook. You can also download logos and posters.
We hope you’ll find a way to celebrate and share your stories on International Day of the Midwife. But if you do nothing else this Friday, take a few minutes to breathe deeply and let yourself really feel what it’s like to be part of the global community of midwives numbering in the hundreds of thousands. Hold close to your heart the midwives working in South Sudan where the maternal mortality rate is 2,000 per 100,000 live births.
Imagine the millions who will benefit because Bangladesh, Afghanistan and Kyrgzstan are implementing a Midwifery Services Framework (MSF) that supports the development and strengthening of midwifery services, with a focus on a quality midwifery workforce.
Celebrate the midwives right here in our country, midwives like yourself, who persevere despite the many obstacles and provide community-based care that transforms lives!
Virtual International Day of the Midwife (VIDM) 2017
The Virtual International Day of the Midwife (VIDM) is an annual free 24-hour online international conference celebrating midwifery and birth-related matters on IDM. This is the 9th annual conference and features speakers from around the world, including Scotland, Iran, Ethiopia, Germany, Indonesia and more! Topics range from working with refugees to integrative and complementary health care to post-traumatic stress among midwives. ICM Chief Executive Sally Pairman will be leading the final session. The VIDM conference spans May 4 and 5 depending on your time zone and the program can be accessed HERE.
ICM Triennial Congress to Convene in Toronto in June
More than 4,000 midwives are expected gather in Toronto, Canada from June 18th to 22nd for the 31st ICM Triennial Congress. It’s not too late to register for this incredible opportunity to be part of the learning and action around the theme “Midwives: Making a Difference in the World.” The last congress in North America was held more than 20 years ago in Vancouver, British Columbia. The next Congress will be held in Bali in 2020.
For those lucky enough to be able to attend the Congress, be sure to arrive early for the March for More Midwives on Saturday 17 June when thousands of midwives will take to the streets as part of a spectacular parade through the city. ‘The world needs more midwives now’ is a theme that resonates in many parts of the profession where there are insufficient midwives or inadequate funding for midwife education and more trained midwives. The march will draw attention to the role of midwives in reducing maternal and baby ill health or mortality.
International Council Meeting
ICM is governed by the international Council which meets in full every three years for four days immediately before the Congress. As a member association, NACPM will send two voting delegates to the Council meeting. Delegates debate and discuss policy and update core documents including Position Statements, Guidelines, and Midwifery Standards. They provide strategic direction for ICM. They review financial statements and reports. The Board for the next triennium is appointed. The Council also hears presentations from three shortlisted Midwives Associations (countries) and votes on the Congress country for 6 years hence.
Come Look Through the Window: NACPM Leadership Team Meeting
When you gather passionate people around a shared purpose it becomes a testament to one of the core principles of the model of distributed leadership: together we are all smarter than any one of us alone. Although the full NACPM Leadership Team–Board, staff, and consultants–meet virtually via Zoom every month and our project teams are in contact on an even more regular basis, there’s a particular synergy that happens in our semi-annual in-face meetings. As Frederic Laloux writes in Reinventing Organizations, “When the individual and organizational purpose enter into resonance and reinforce each other, extraordinary things can happen…we often feel overcome with grace. It feels like we have grown wings. Working from our strengths, everything feels effortless and we feel productive like rarely before.”
Here are some of the highlights of our Spring 2017 Leadership Team meeting:
We spent time revising the NACPM Purpose Statement to encompass and reflect our broader, more inclusive goals, and our current working draft is: “NACPM’s purpose is to do our part to ensure a healthy start for all childbearing people and their babies. NACPM supports CPMs in their practice of the art and science of community-based midwifery, influences health policy to widen access to compassionate, physiologic care, and partners with stakeholders to eliminate birth outcome disparities for families in the United States.”
Team leads for each of our projects and focus areas reported on the work their teams have been doing and we celebrated progress on several fronts: a dramatic increase in the number of members; planning for the 2018 CPM Symposium; status of our fundraising efforts; the launch of the NACPM legislative toolkit and response from the states; the gathering of information and input from MEAC-accredited programs necessary to advance our efforts to develop a scholarship and mentorship program for student midwives of color.
We also reviewed the overwhelmingly positive feedback we’ve been receiving about our professional development webinars and noted that participation is robust, with over 600 participants in 13 webinars since September 2016. We are proud that the webinars are providing a valuable resource to our professional community as evidenced by the number of CEUs that have been granted over the past eight months, including a number that qualify for the Midwifery Bridge Certificate. We discussed how to continue to ensure that the recorded webinars remain archived and easily available on the NACPM website.
We celebrated the launch of several new NACPM state chapters. We discussed how best to support these chapters, how to fully engage their members, how to improve connectivity and continue to build communication and collaboration between the chapters through the quarterly calls, and how to continue to expand this dynamic network.
We participated in a lively team activity/discussion, based on the StrengthsFinder assessment tool and facilitated by Dr. Brian Perkins, to identify our core values and our individual and collective strengths. We are committed to developing our leadership skills and anticipate that this StrengthsFinder exercise will add significant value to both our individual work and our work as a team going forward.
Lisa Kane Low, ACNM President, joined us for an hour and 1/2 and we shared information about priorities, current initiatives, and some of the challenges faced by both of our organizations.
We hosted a dinner and conversation with leaders from the D.C. birth community and learned about the inspiring work they’re doing to provide access to high-quality care in historically underserved communities.
We laid the foundation for an exciting new partnership in our work to build a more representative midwifery workforce and promote equity in maternity care outcomes–look for details about this emerging partnership in upcoming newsletters.
Our communication team unveiled a comprehensive set of NACPM briefing papers and recommendations, to be released in May 2017, which describe NACPM’s vision and the emerging landscape and future directions for CPMs. Watch for the release and distribution of these papers over the next few weeks.
We welcomed Camille Sealy, M.Ed, MPH to the NACPM Leadership Team! Camille joined NACPM in the winter of 2017 as our second Public Member of the Board. She currently serves as a Senior Advisor in the Office of Legislation at the Health Resources and Services Administration (HRSA) where she provides strategic direction and leads legislative efforts for the agency around various issues including health workforce, maternal and child health, and primary care. Previously Camille served as a health Legislative Aide to congressional members in both chambers. During her time on Capitol Hill, she drafted provisions within the health reform law pertaining to maternal and child health, prevention and wellness and disparities. Camille presented at the 2012 CPM Symposium with a talk entitled: Maternal Mortality in the U.S.: Taking Action to Eliminate Disparities in Maternal Health Outcomes. In her free time, Camille runs, gardens, and volunteers at the Smithsonian National Museum of African American History & Culture. Prior to our D.C. meeting, Camille made it possible for several members of the NACPM leadership team to visit the museum. We’re so grateful for that opportunity and are thrilled that Camille has joined us!
In our ongoing effort to become a truly multicultural, anti-racist organization, we challenged ourselves to sit in discomfort, to stay in “the confusion room,” knowing that new and important insights and authentic ways of engaging will emerge from the work that happens in that somewhat chaotic and not always comfortable place. With the help of our skilled and compassionate facilitators, Shirley MacAlpine and Cari Caldwell, we explored the difference between comfort and safety, between intent and impact. We confronted the impact of our words and our actions and held ourselves and one another accountable. We also recognized the importance of apology and doing the necessary work of repair.
Throughout our time together, we deepened our understanding and practice of distributed leadership model and honed our skills as members of an emerging Teal organization. To learn more about the core elements of Teal organizations (self-management, wholeness, and evolutionary purpose), check out the book Reinventing Organizations by Frederic Laloux; or go to the website
NACPM strives to continually engage CPMs and stakeholders in envisioning and implementing the role that CPMs can and must play in improving the health, and even saving lives, of childbearing people and their babies in our country. As described above, we do this through our chapters, our professional development webinars, our ‘home visits’ with state midwifery leaders, our outreach to other professional organizations, and we look forward to the opportunity to plan together for the profession with our members and stakeholders at the 2018 CPM Symposium. NACPM strives be a resource for up-do-date information on practice, regulation and health policy impacting midwifery. Watch for information coming soon about the 2018 CPM Symposium and emerging partnerships. Visit the NACPM webpage regularly, sign up for newsletters and other announcements, follow NACPM on Facebook, participate in free webinars, and reach out to NACPM staff for assistance. Join NACPM and your NACPM State Chapter as a CPM, student, or associate member. We look forward to our continued work with you throughout 2017 and beyond.
With all best wishes,
Tanya Khemet, CPM, MPH and Audrey Levine, CPM (Ret)
Co-Presidents, NACPM
Birth Inequities: What Can Midwives Do?
This Thursday Jennie Joseph of Commonsense Childbirth will present a webinar on specific action steps midwives can take to become part of the solution in addressing birth inequities among childbearing people of color and their babies.
Domestic Violence and the Midwife
As midwives we need to be able to identify indicators of domestic violence in all its manifestations. Midwives are uniquely positioned to be able to pick up cues we typically spend more time with clients at each prenatal visit, our focus is on holistic health including the psychosocial aspects of family wellbeing, we provide continuity of care, and conduct home visits. The nature of the midwife-client relationship builds trust and promotes disclosure. It is not unusual for a client to say, “I’ve never told anyone this before…” and share some intimate information that helps us better understand and safeguard the health of the mother, baby and family.
State Legislation Update and Harking Amendment Victory in Oregon
State Legislation Update
Momentum continues to build as more states include the US MERA agreements and principles in bills to license Certified Professional Midwives, helping to overcome opposition to the regulation of CPMs that has stymied efforts, often for years and at times even decades. In addition to legislation to license CPMs, midwives and consumer advocates are stepping up in other states to address threats, and to rise to challenges as well as to emerging opportunities. As we share our experiences with legislation and regulation, state to state, we build our common body of expertise to promote and protect the practice of certified professional midwifery. We are pleased to provide you with these updates and look forward to keeping you abreast of further developments in these and other states in the months to come.
Illinois
The Illinois Council of CPMs – a Chapter of NACPM – and the Illinois Friends of Midwives have introduced the Home Birth Safety Act in both the House of Representatives (HB 677) and the Senate (SB 1754), the same legislation that these groups collaborated on last year with ACOG. With over 1000 babies being born out-of-hospital a year in the state, Illinois ACOG and the midwives believe passage of this bill is a matter of safety for mothers and babies choosing home birth. Aligned with the US MERA agreements, the bill passed out of the Senate Committee of License Activity and Pensions on a 9-2 vote this session, with a promise by the midwives to committee members to further engage with the Illinois State Medical Society who have opposed the bill. A meeting of the parties took place in March, with the Illinois Medical Society agreeing to take the information the midwives provided to them on CPMs and MEAC-accredited education back to their board for discussion. The primary Senate sponsor of SB 1754 has committed to keeping the bill alive and to bringing this legislation to the floor for a vote of that chamber, as soon as next week.
Kentucky
Two identical bills to license CPMs in Kentucky have been introduced, one in the House (HB 148) and one in the Senate (SB 105). HB 148 was heard in the House Committee on Licensing and Occupation, but received no votes this session. Although the bill last year had more hearings and got further in the legislative process, more progress was made in activating the grassroots and building strength for this effort this year than last. CPMs held seven regional meetings around the state this year, effectively engaging people from every corner of the state. The CPMs in Kentucky are rightly proud of this outreach, which took much hard work and organizing, that allowed many more voices to be heard and engaged in the process. Another victory this year was that the midwives were able to effectively stop an oppositional amendment to the bill sponsored by a house member with significant political clout, demonstrating the growing strength of the midwives and the grassroots and the support that is building in the legislature for this effort. Advocates for this US MERA-aligned legislation are busy now preparing for the interim hearing period that begins in June.
Alabama
There are currently three bills in play in Alabama. Advocates have brought forward HB 316 to license CPMs, a bill that aligns with US MERA agreements, and HB 315 that would exempt a midwife holding a current certification from NARM from the crime of practicing midwifery without a license – sometimes referred to as a decriminalization bill, a ‘back-up’ in the case the licensing bill does not pass. A third bill, proposing to regulate the practice of ‘lay midwifery’ brought forward by the Medical Association of the State of Alabama (MASA), would effectively outlaw all direct-entry midwives except Certified Midwives, and does not have the backing of advocates for CPMs. After years of rejection of any bills to license CPMs, HB 315 recently passed through the Judiciary Committee and HB 316 passed through the Committee on Boards, Agencies and Commissions; both bills are headed now to the floor in the House of Representatives. Although there may still be much work ahead to secure passage of these bills, advocates are encouraged by the support they have found in these committees.
Oklahoma
Early this year, Oklahoma CPMs were unexpectedly challenged by the introduction of hostile legislation that would have effectively eliminated their ability to practice in the state. By organizing quickly, engaging midwives and consumers and raising funds to hire an effective lobbying firm, they were able to push back this threat. The newly-formed Oklahoma Chapter of NACPM was chosen by the CPMs in the state to act as the joint legislative arm for the two long-established state midwife associations, with the presidents of each organization serving on the board of the chapter, effectively bridging midwives around the state.
In February, NACPM Executive Director Mary Lawlor, attended the official launch meeting for the Chapter. Midwives came from all over the state to share their concerns and challenges about regulation for midwives, and to learn together about the national picture that is emerging for certified professional midwifery. They discussed the US MERA agreements and Principles for Model U.S. Midwifery Regulation and Legislation, and how alignment with these tools in other states is successfully building momentum. The Chapter board then participated in a work session with Mary, using the NACPM Regulatory Assessment Tool from the NACPM Legislative and Advocacy Took Kit to explore how the US MERA agreements and principles might be applied in Oklahoma to build a strategy for protecting autonomous practice in the state.
Florida
On March 29, the Midwives Association of Florida (MAF), consumers, and the Florida Chapter of NACPM celebrated an impressive turnout for Capitol Day in Tallahassee when many constituents met with their legislators in support of Licensed Midwives. Physicians are seeking to require mandatory reporting of adverse incidents for Florida licensed midwives, to include reporting of maternal and fetal deaths, severe maternal hemorrhage, and transfers of mothers and infants to intensive care units. The midwives agree with these requirements. With the support of their lobbyists they are in dialogue with Florida ACOG about this legislation, which may involve opening up their midwifery practice act, a potential turn of events that is causing the midwives to strengthen their organizations and to rally support from around the state to ensure autonomous practice.
On another note, congratulations are in order! The midwives in Florida are celebrating a long-sought victory: as a result of 20 years of advocacy, new rules now provide for licensed midwives to do their own risk screening for new clients coming into birth center care, reversing a long-standing requirement that birth center clients have their initial exam and risk assessment with an MD or a CNM.
Washington State
With a more than 30-year history of policy and advocacy work, the Midwives Association of Washington State (MAWS), has lobbied this year for two budget provisos: one to maintain the 8-year-old cap on the licensing fee for midwives, and the other to nearly triple the facility fee for birth centers paid by Medicaid. Maintaining the cap on the annual licensing fee, which would otherwise now be triple the current rate of $525, has contributed to a 40% increase in the number of midwives in the state over these last 8 years, now nearly 170. The increased birth center Medicaid reimbursement would not only benefit people having babies in Washington State, but could support efforts to increase the low rates of birth center reimbursement throughout the country, much as the 2007 Department of Health Cost-Benefit Study has helped make the case for Medicaid reimbursement for community birth in other states and to the federal government.
An Oregon Victory for the Harkin Amendment
Just last week NACPM was informed that an insurer, PacificSource in Oregon, has cited the 2015 guidance issued to the states by the U.S. Department of Health and Human Services (HHS) on Section 2706 of the Affordable Care Act (ACA) – commonly known as the Harkin Amendment – as the factor that has led it to finally issue reimbursement for direct entry midwife services provided to an Oregon resident in 2015. Since the ACA passed in March 2010 until now, the implementation of the Harkin Amendment has been a discouraging story.
In agreeing to cover the costs of care for this consumer, the Oregon Insurance Division (OID) stated: “…PacificSource has reviewed the Centers for Medicare and Medicaid Services (CMS) FAQ that provides additional clarification for provider non-discrimination requirements. The insurer has agreed that members who go to in-network Licensed Direct Entry Midwives can receive benefits under their policy. They also have agreed that members who seek out-of-network care by a Licensed Direct Entry Midwife would have their benefits paid at the out-of-network level the member policy permits (in a non-discriminatory manner).”
This victory is celebrated by the Integrative Health Policy Consortium and NACPM. NACPM is an IHPC Partner for Health and has held a board of director’s position for the last decade. This new development in Oregon could portend well for reimbursement of midwife services for people having babies around the country. Dogged persistence on the part of this Oregon consumer who had her baby at home with licensed midwives, along with support from the Oregon Midwifery Council and IHPC, has finally paid off in this unexpected but happy turn of events. Of interest, the OID sent their email on the same day that the American Health Care Act (AHCA) was pulled from the floor of the U.S. House of Representatives, leaving the ACA as the law of the land. Although it is likely that there will be no movement until fall of this year, there is reason to hope that the Oregon Insurance Division now will commit to fully implementing Section 2706 to address the current inconsistencies in coverage for professions in the state, and provide an example to other states on implementation of this important provision of the ACA.
The Integrative Health Policy Consortium was instrumental in working with Senator Harkin and other legislators during the development of the ACA to include Section 2706 to ensure patient access to care. This provision of the law, sometimes known as the non-discrimination clause, requires that insurers include and reimburse licensed healthcare providers in health insurance plans. It states:
(1) A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law.
(2) This section shall not require that a group health plan or health insurance issuer contract with any health care provider willing to abide by the terms and conditions for participation established by the plan or issuer. Nothing in this section shall be construed as preventing a group health plan, a health insurance issuer, or the Secretary from establishing varying reimbursement rates based on quality or performance measures.
Notwithstanding small pockets of progress, implementation of this provision has met roadblock after roadblock since its passage. In 2013, IHPC launched a nation-wide initiative to ensure adequate implementation of Section 2706 called Cover My Care, a national grassroots program of information and patient engagement designed to create public advocacy for access to all healthcare providers who are licensed by states. Cover My Care provides a website, information and FAQs about the law, patient guides,a toolkit for consumers and forums for consumer sharing.
In the coming months, IHPC and NACPM will be closely tracking progress of Section 2706, and providing all possible support for the goal of full implementation of this provision around the country.