CPM Symposium Program announced

We are excited to announce the carefully crafted CPM Symposium program! It is focused on the priorities voiced by the CPM community: the needs of childbearing people, state and national policy, challenges and solutions to address equity in education, practice and the composition of the CPM workforce, thorny problems and encouraging innovations in education, along with one of your top priorities – viability and sustainability for the profession and the midwifery movement.

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Meet the CPM Symposium Facilitators

The 2018 CPM Symposium is a two and one-half day facilitated planning event bringing together midwives, childbearing people,students, educators, policy makers, funders, allied professionals and other stakeholders to plan for the future of the CPM profession. With the support of three skilled facilitators, the convening and consulting partners will create a space for innovative collaboration. Meet the facilitators

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February 2018 Chapter Newsletter

Washington State – Midwives’ Lobby Day 2018

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We are excited to share this update from the MAWS lobby day in Washington State. The Washington State Chapter of NACPM was intentionally designed to function in collaboration with the established state association, MAWS, with a vision for ever-deepening partnership and mutual support. Jen Segadelli serves as a liaison between the two organizations, sitting on the board of each. This update comes from Audrey Levine, NACPM co-president and MAWS board member:

You never know what you’ll miss if you don’t show up for Midwives’ Lobby Day…

This year, we had a record turnout: more than 80 licensed midwives, midwifery students, and healthcare consumers braved the rain and showed up in Olympia on January 18th.  Many of you have probably already seen the video that captured the highlight of the day–and, some might say, one of the most memorable moments in MAWS’ history.   Thanks to a good deal of behind-the-scenes finagling by our fabulous lobbyist, Amber Ulvenes, we got to sit in the House gallery and witness the unanimous vote in support of HB 2016, which would give midwives and doulas access to WA State prisons to provide voluntary prenatal and postpartum care.  Several legislators spoke from the floor and sang the praises of the midwives who’d been there for the births of their babies or grandbabies. Then, the Speaker Pro Tempore asked us to stand, and MAWS received a standing ovation from the entire WA State House of Representatives.  It was epic.

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Meanwhile, over in one of the Senate hearing rooms, MAWS President, Neva Gerke, was testifying on SB 6304, a bill that would guarantee continued funding in WA State for the CHIP program, which the federal government had threatened to de-fund. SB 6304 and its companion bill in the House, HB 2660, would not only ensure that all children in Washington would have healthcare coverage; it also would guarantee prenatal care coverage for all childbearing people in the state.  Both SB 6304 and HB 2660 are moving forward in their respective chambers.

In addition to talking about these bills with members and their aides, we asked for support for an amendment to the budget proviso that passed last year, maintaining the cap on the midwifery licensing fee.  Since 2009, when this fee cap went into effect, the licensed midwifery workforce in Washington has grown by 40%. Due to misinformation that we received last year from the Department of Health, the amount we’d requested from the legislature during the 2017 session was insufficient to cover the shortfall in the Midwifery Program budget at the DOH. For the most part, members were very receptive to our request that an additional $50,000 be allocated this year to fulfill on the intention of the proviso. To our surprise, Senator Fortunato (yes, that’s really his name) decided after meeting with several of his constituents, that we shouldn’t have to come back every year and ask for a budget proviso to keep our licensing fee reasonable.  So, he has introduced SB 6559 which would essentially put the midwifery fee cap into statute.  Although it’s unlikely that the bill will go forward this session, it is encouraging that we have some support for a more permanent fix to our licensing fee issue.

We also spent time in our meetings with legislators seeding the concept of title protection for birth centers, sharing the legislative language we have drafted to protect the terms “birth center,” “birthing center,” and “childbirth center” in statute, and conveying the thoughtful process we are engaging in with other stakeholders, including the WA State Hospital Association (WSHA).  The rationale for this effort is two-fold: 1) to protect consumers – we believe that families choosing a birth center for their care should be able to know what kind of care is actually offered in such a facility and what kinds of outcomes are achieved there; and 2) to preserve the integrity of the birth center model of care.  The WSHA representatives we spoke with prior to session indicated that they understand our concerns, but they asked MAWS to wait until 2019 to introduce a bill so that they could have time to educate their members about the rationale for such legislation and give hospitals an opportunity to voluntarily re-brand as necessary.  We agreed to do so—and heard from quite a few legislators how much they appreciated this collaborative approach.

Sen. Fortunato, however, was highly motivated to take action this year and decided to drop SB 6579.  Although it is not at all likely that the bill will get a hearing this session, according to Sen. Fortunato introducing the bill this session conveys to WSHA and their members that MAWS is serious about this effort and that we have legislative support.

READ ON FOR MORE CHAPTER UPDATES HERE

Understanding and Reducing Maternal Stress and Preterm Birth in Puerto Rico, 2018 Webinars

In the November 2017 NACPM webinar, RE:BIRTH: Navigating and Mediating Maternal Stress and Birth Outcomes in Pre- and Post-Hurricane Puerto Rico, Oregon State University researchers Holly Horan and Melissa Cheyney discussed their collaborative research that focuses on the relationship between perceived maternal stress and gestational age at delivery. Existing research hypothesizes an association between perceived maternal stress and preterm birth, and midwifery care has been shown to be the only viable solution to reducing preterm birth rates within communities of color. Horan and Cheyney collaborated with Puerto Rican maternal and infant health providers to develop a project to better understand experiences of maternal stress and pregnancy and how they relate to birth outcomes in Puerto Rico.

Gaps in the Epidemiological Data: Over the last 20 years, epidemiological data on birth outcomes in Puerto Rico indicate that this United States (US) colony has a high rate of preterm birth1 in addition to other poor birth outcomes, including elevated cesarean section (46%)2 and a low birthweight rates#. As of 2016, Puerto Rico had an unusually high rate of preterm birth (11.5%), occurring before 34 weeks completed gestation2. To date, researchers have been unable to explain why Puerto Rico is experiencing such a high rate of preterm birth, as studies specific to Puerto Rico argue that typical epidemiological factors associated with preterm birth rates in the continental US do not explain the high rate of preterm birth on the island1.

Investigating the Gaps: After completing a 2014 pilot study on Puerto Rican providers’ perspectives on maternal and infant health issues on the island, Cheyney and Horan developed a two-phase research project designed to explore how perceptions of maternal stress contribute to gestational age at delivery in Puerto Rico. In the first phase, beginning in August of 2016, 25 pregnant and recently postpartum women in Puerto Rico were interviewed about their experiences of stress during pregnancy to provide a context for stress that was unique to island. In December of 2016, the second phase was initiated to understand the relationship between maternal perceptions of stress, their biological experiences of stress via the hormone cortisol collected from a hair sample, and how these experiences of stress impacted gestational age at delivery. Horan and local, Puerto Rican research assistants traveled to two clinical sites where they invited pregnant people in their first trimester to participate. Pregnant individuals who volunteered and were verbally consented into the study agreed to one prenatal visit per trimester. At the prenatal visits, the participants completed two stress surveys and provided a hair cortisol sample. In addition, there was a postpartum visit where the participant provided patient reported outcomes about the birth, completed a postpartum interview reflecting on their experiences of stress and pregnancy, and provided a final maternal and infant hair sample. Eighty-six participants were recruited for this second phase of the project.

Disaster Strikes: On September 20th, 2017, the project was abruptly halted due to the damages sustained after Hurricane Maria. Horan and Cheyney plan to finish data collection with as many of the remaining participants as can be relocated to complete their postpartum data collection visit. This will enable us to understand how the hurricane influenced their births and early parenting experiences. Preliminary findings indicate that despite the global community’s concerns about the Zika virus, poverty and colonization are significantly greater sources of stress for pregnant and recently postpartum participants in Puerto Rico. In addition, the events of Hurricane Maria have further exposed how the second-class citizen status of Puerto Rican people impacts health and well-being across the island and across social statuses.

References
1) Cordero J. Preterm Births in Puerto Rico 2006-2016. March of Dimes: Sunshine Seminar. 2016. https://progyn.org/wp-content/uploads/2016/08/6.-Dr.-Jose-Cordero-Sunshine-MOD.pdf. Accessed November 6th, 2017.

2) Hamilton B, Martin J, Osterman M, Driscoll A. Births: Provisional Data for 2016. NVSS Vital Statistics Rapid Release. June 2017; 2: 2-21. https://www.cdc.gov/nchs/data/vsrr/report002.pdf. Accessed October 25th, 2017.

3) Landale N, Oropesa S, Davila AL. Puerto Rican Maternal and Infant Health Study (PRMIHS), 1994-1995. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor]. n.d. https://doi.org/10.3886/ICPSR36238.v2. Accessed November 27th, 2017.

FIND NEWS ON UPCOMING WEBINARS IN OUR NEWSLETTER

Reproductive Health and the LBGTQIA Community

The LGBTQIA community is as diverse as the country, and includes members of all races, ethnicities, religions and socioeconomic status, and yet the health needs of this community are frequently overlooked, often with dire consequences. This week’s newsletter presents the issue of LGBTQIA health, resources for health care providers as well as tomorrow’s webinar on Gender, Equity and Inclusion

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Chapter News

Greetings from the NACPM Chapter community!

We have many exciting Chapter updates including our new Google+ community platform for connecting and resource-sharing among chapters, our anti-racism and equity chapter collaboration calls, and updates from several different states about the work they’re doing. Our chapter network is ever-growing, and the map below shows that in addition to our 14 active chapters, midwives from 24 additional states have expressed an interest in chapter formation. Some of those states have begun the formation process, and others are simply exploring the possibility within their local communities. We’d love to connect you with others who are interested in chapter formation in your state! Please reach out to Susan at chapters@nacpm.org for more information. Our goal is to have 20 active chapters by 2018, and we would love for your state to be one of them!

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Chapter Collaboration Call Equity Series

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The October collaboration call “Toward Equity-Grounded State Midwifery Leadership: A Conversation” marked the beginning of the Chapter Collaboration Call Equity Series. Registrants received preparatory materials to read and explore before the call, which helped everyone to enter the conversation with some common ground. NACPM board member, Keisha Goode, Ph.D., punctuated her compelling presentation with opportunities for personal reflection in response to guiding questions. Participants submitted their thoughts, comments, and questions through the chat feature, and these were then used to spark live discussion at the end of the call.

Keisha’s presentation was deeply inspiring, and we had more participant comments than we could bring forward in the allotted time. What a great problem to have! Our hope was for this call to be the start of an ongoing conversation among NACPM Chapter leaders and members about how to create equitable organizations, and we were not disappointed. The December Collaboration Call on Monday, December 11 at 1:30 pm ET, will be a continuation of this conversation using the questions and comments submitted by participants as the framework for our discussion.

We also heard a specific request from call participants for NACPM to create an anti-racism toolkit for chapters to reference as they lay the groundwork for their organizations. We will be working to prepare an initial draft of this toolkit for review and input on the December call. We are learning so much about what it means to prioritize equity and anti-racism systemically, organizationally, and individually, and we have so much more to learn. We would love for you to join us in this learning. The quarterly Chapter Collaboration Calls are unique opportunities for chapter members and leaders to dig deeper into our shared vision and values. Chapter members even enjoyed a sneak peek at the NACPM Vision and the Midwifery Landscape Briefing Papers this summer. Please reach out to Susan at chapters@nacpm.org to be connected to your local chapter or for more information about forming a chapter in your state.

 

Chapter Updates

Each NACPM chapter is unique, and it can take time to create the right moment for chapter formation and to discern the focus for newly formed chapters. Midwives in Idaho and Alaska have officially begun the work of chapter formation, and in Connecticut, after years of discussing chapter formation, the midwives voted unanimously in favor of starting a chapter after Mary Lawlor went for a “Home Visit.” These visits are an opportunity for NACPM leadership to hear from midwives about their hopes and vision for a chapter and to share with them about the national picture for CPMs and the role that state chapters can play in unifying our profession.

Would you like to plan an NACPM Home Visit in your state? We love learning about each state’s unique landscape, answering questions, and sharing about the national perspective and unfolding directions for Certified Professional Midwives. Reach out to Susan at chapters@nacpm.org to schedule your Home Visit.

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Corina Fitch, CPM, secretary of the Florida Chapter of NACPM reports “This has been a ground breaking year for Florida midwives due to legislative threats that we were faced with as well as a need for reorganization.  The founding of our Florida Chapter was in direct response to both of these situations.  FL NACPM focused its efforts this year on educating the midwifery community about the many benefits of joining the chapter, outreach for membership, and fundraising for our lobbyist fund.  We labored collaboratively with the Midwives Association of Florida to put together a state midwifery conference in August.

We look forward to increasing membership in the coming year, along with continued fundraising efforts and providing opportunities for continuing education for midwives.”

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Ellie Daniels, CPM, board member of the Maine Association of CPMs, past board President of NACPM, reports on the Maine Perinatal Quality Collaborative Symposium “Collaboration in Action”:

 

Three years ago in Maine, an unlikely collaboration was formed. Five organizations who had never imagined themselves sitting at the same table all together agreed to come together for the purposes of writing a licensing law for Certified Professional Midwives. These organizations consisted of the Maine Section of ACOG, the Maine Association of CPMs, the Maine Medical Association, the Maine Chapter of ACNM, and the Maine Chapter of AWHHON (perinatal nurses). The first agreements reached were related to how we would do our work, which was facilitated and by consensus. And from there, we went forward, meeting every two weeks, mostly in person, with many of us traveling an hour or more.

Over the course of two years, we got to know a lot about each other, about our respective philosophies of care, our particular skills, our concerns, our strengths and vulnerabilities, and most importantly, what we could agree upon. Those areas of agreement became a bill to license CPMs and CMs in Maine, that successfully passed through the legislature in 2016, overcame a Governor’s veto, and successfully returned to the Legislature in 2017 to gain funding for enactment.

This past Summer, we reflected upon the value and experience of our unique “Home Birth Collaborative”, and made a decision together to move on to another challenge. What would it take to form a Perinatal Collaborative for Maine?

Maine is one of five states in the country with no Perinatal Collaborative. Several states have strong PQCs, with active multi-stakeholder participation and robust funding sources. But very few, if any states, have invited CPMs to be at the table from the beginning. Here is an opportunity for a public health approach that holds moms and babies at the center of its vision, and considers data and quality improvement projects across the entire continuum of choice a family might make regarding place of birth and preference for provider.

Who are the stakeholders? They are the clinicians in all settings and the patients they serve. They are hospital administrators, public health departments, and emergency medical services. They are governmental agencies, and public and private health and liability insurers. PQCs are funded by public and private grants and donations, state budgets, hospital “tax”, federal monies, and support of all kind from state and federal CDC. PQCs rely on the collection of relevant data, and use it to effect meaningful change across provider groups and care settings. We believe that midwives in every care setting have a lot to offer.

As a kick off to our Maine PQC, we held a Symposium on October 21, 2017. We invited attendees from across the stakeholder spectrum, and designed a program to excite people about the possibilities. The day was kicked off with Dr. Alan Picarillo, a neonatologist, who had been involved with the formation of a Neonatal QC in both New England and Virginia. He talked about the necessary steps and stakeholders, and particularly about the value of forming a culture of transparency around data, as a key to stimulating change in practice.

Following Dr. Picarillo was Dr. Larry Leeman talking about a QI project in New Mexico that is lowering the primary C-SEC rate. His talk focused on perinatal collaboration in action, and how a multi-stakeholder focus on the data as an indicator of better and best practice has resulted in lasting change.

Last up for the morning was Dr. Missy Cheyney, talking about data as a quality improvement driver. In particular, she discussed the project in WA state to merge data from the CPM MANA stats with hospital data, and the power of that project for showing evidence that supports a higher rate of physiologic birth overall.

Ethicist Frank Chessa at the Maine Symposium

Ethicist Frank Chessa at the Maine Symposium

The afternoon focused on looking at the Maine state birth data, and discussing the concept and value of forming a PQC for Maine. Going forward, we identified several projects worthy of focus, and people were interested in joining the Steering Committee.

As the Maine Home Birth Collaborative wraps up its legislative work, the Maine Perinatal Quality Collaborative has taken form. It has taken form from the steady work and commitment of a group of previously unlikely partners who now are creating a new and valuable culture of inter-professional collaboration in Maine, for the great benefit of families into the future.

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April Kline, CPM, President of Ohio NACPM reports, “This year, we have focused on the first of our objectives as a professional chapter, offering CEU opportunities on nutrition and other relevant topics. We have also built a trusted circle of midwives for regular peer review which is offered at every quarterly meeting as well as by phone as requested. We are pleased with how our first year has unfolded and look forward to a new year to grow our chapter and continue our good work.”

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Christy Santoro, CPM, President of the Pennsylvania Association of CPMs reports on their chapter’s activities around anti-racism and equity in midwifery:

Childbirth in the Shadow of the American Dream

On Sunday, October 16th, 2017, the Pennsylvania Association of Certified Professional Midwives hosted a Film Screening Fundraiser and discussion of The American Dream, directed by Paolo Patruno. The American Dream is a documentary that only begins to touch the surface of the maternal health crisis. The documentary allowed for the sharing and hearing the stories of Black mothers and their hospital experiences during prenatal, delivery and postpartum that are violent and disempowering.

Read more here (link to webpage)

The American Dream highlighted the work of Certified Professional Midwife Jennie Joseph, and her work to provide an alternative to prenatal care and birth than what the hospitals provide in Florida. The screening was attended by Birth Workers, Certified Nurse Midwives, Certified Professional Midwives, mothers and social justice activists in the Philadelphia area. The discussion after the screening asked the viewers to engage in questions around what “The American Dream” is for black and brown birthing persons in Philly and access to home birth.

Sponsorship for the event was provided by Acupuncture in Motion, Blossoming Bellies Birth, Christine’s Care and Compassion, Luna y Sol Midwifery & Family Wellness, Magnolia Moon Birth, Motherland Midwifery, Rachel Utain-Evans Photography, Sheila Pai: Presence Not Perfection and The Wooden Shoe. The money raised at the event supports the educational expenses of Marqui Taylor, black Student Midwife at Birthwise Midwifery School, and PACPM chapter member who is the founder of Birth Brown (formally The Philly Birth Project).

PACPM continues to be involved as a member organization in the PA Campaign for Women’s Health and the Maternity Care Coalition’s Community Breastfeeding TaskForce in Philadelphia. Several chapter members plan to attend a Racism in Medicine Conference in Philadelphia in November at the University of Pennsylvania and are working to establish a renewed presence at the State Board of Medicine Meetings by 2018.

Our newest chapter member, Ray Rachlin, of Refuge Midwifery, will be offering a workshop about trans-affirming birth practices for out-of-hospital practitioners in January 2018.

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Korina Pubanz, CPM, Board member of the Wisconsin Chapter of NACPM reports, “As a new chapter in WI the beginning of the year was focused on finding a rhythm with meeting times, working on communication platforms for our meetings and figuring out ways to reach out to our midwifery community. One of our chapter goals right now is turning a focus toward providing regular educational opportunities. We are currently working on an educational event coming up in the late winter of 2018! This class will be a focus on anatomy assessment and suturing with MEAC approved credits.”

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North Carolina and South Carolina NACPM CPM Chapters hosted their second annual Carolina Birth Junkies Retreat this summer. Christine Strothers, CPM, board member of the North Carolina Association of CPMS (photo on the right), and Lori Gibson, CPM, President of the South Carolina Chapter of NACPM (photo on the left), served as co-organizers for this event. Lori described the retreat as “another amazing weekend full of eagerness to delve deeper into Midwifery, relationships and self.” In addition to the educational workshops, they added recreational activities this year including kayaking, red tent temple, and a couples session on how to keep a marriage strong while doing birth work.

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They also had a VBAC panel and breech case studies, which both got great reviews. With a total of 27 attendees over the course of the weekend, Christine said, “I think the balance of fun/team building with educational sessions was just right – lots of learning but also lots of time to relax and connect with other birth workers. Spending the whole weekend on an island really brings folks together.”

The retreat brought in $500 profit for each of the two chapters, and the South Carolina state association, PALM, sponsored several student midwives to attend at a reduced rate. Next year, they will have Karen Strange back for NRP plus many other exciting sessions. All are invited, so keep an eye out for next year’s Carolina Birth Junkies Retreat hosted by the North Carolina and South Carolina Chapter of NACPM!

FOR DETAILS ON OUR NEW CHARTING WEBINAR, READ THE NEWSLETTER

Puerto Rico – Webinar and Hurricane Relief

Puerto Rico – New Webinar Scheduled! 

Puerto Rico is home to the highest rate of preterm birth in the entire United States jurisdiction. Learn how the severe and on-going economic crisis in Puerto Rico, the Zika epidemic, and the major natural disaster hurricane Maria have affected pregnant women’s daily lives and their birth outcomes in a new webinar scheduled for Wednesday, November 8, 2017, from 1:30 to 3:00 Eastern time.

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In “RE:BIRTH: Navigating and Mediating Maternal Stress and Birth Outcomes in Pre- and Post-hurricane Puerto Rico,” Oregon State University researchers Holly Horan and Melissa Cheyney, along with Centro MAM founder Vanessa Caldari (see below) will report on their research project, funded by the National Science Foundation. They will provide information about methods for assessing perceived and measurable maternal stress, particularly within the context of a colonized nation that has a complex and insufficient maternal and infant health care system. In addition, Horan and Cheyney will discuss the normal physiologic birth efforts in Puerto Rico as a counter-movement to the existing biomedical system on the island along with the roles Puerto Rican midwives and doulas are playing in the aftermath of hurricane Maria.

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This webinar will provide midwives with information about the effects of maternal stress on gestational outcomes, as well as the impact of midwives and doulas as mediators of that stress. The webinar will conclude with a discussion of opportunities for the support of Puerto Rican midwives who are on the ground providing care for mothers and babies amid post-hurricane devastation.

More information about the situation in Puerto Rico and CENTRO MAM from Vanessa Caldari

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CENTRO MAM has been dedicated to supporting maternal and infant health since 2007. Over those ten years we have served over 1000 families by assisting women and their families in attaining safe, empowering births and postpartum experiences in an integrated and collaborative midwifery and physician clinic. We also educate and certify community members in midwifery, doula, childbirth education and breastfeeding peer support. We are based out of a community center about ten minutes from the San Juan airport. While the space is not a birthing center we have had births there on occasion and it is suitable and ready to be one again when the need arises. Please check out our website to see why we are so proud of the community work we do every day.

As we all know Puerto Rico is facing a major crisis mired in devastation. Pregnant women, infants, and the poor are always the most vulnerable in situations like this. Unfortunately, many obstetricians and doctors have stopped attending clinics and office hours. Instead, mothers are sent to hospitals which are rumored to be filled with the dead and dying due to lack of infrastructure and power. Added to these panic inducing horrors, there are a number of public health diseases creeping in due to unsanitary conditions such as infected waters, lack of plumbing and electricity, excessive heat, mosquitos and flies, and lack of nutritious food. On top of everything, those hospitals that are running (there are many whose doors have not yet opened) have staff who are overworked and stressed which increases the likelihood that women are not receiving the care, attention, support and respect they require for emotional stability and positive outcomes.

MAM will coordinate on the ground to distribute supplies and provide outreach to the community in order to enhance ways of meeting the primary needs of mothers and children. In addition, these efforts will support Midwives and provide a safe space for prenatal and postpartum care at Centro MAM.

Vanessa Caldari, a certified professional midwife who had attended births in Puerto Rico for over 20 years and the founder of CENTRO MAM is currently living in Oakland, California.

Links for CENTRO MAM (organization where midwives in Puerto Rico are providing services)

Website: http://mujeresayudandomadres.com/

Facebook: https://www.facebook.com/mampuertorico/

 

Founder/Point of Contact for MAM:

Vanessa Caldari

(787) 688-6832

mam@mujeresayudandomadres.com

 

Links for donation to CENTRO MAM:

Circle of Health International (With your donation, please indicate the donation is for CENTRO MAM):

http://cohintl.org/take-action/donate-to-our-rainy-day-fund
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