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Your Birth Photos Featured On the MANA Website!

Posted by Midwives Alliance on September 7th, 2016


MANA's getting a new look, and we'd love your pictures to be a part of it. Read on to learn how to share your images with the MANA website.

The MANA website is getting a makeover, and we would love to feature your birth images! The MANA website receives thousands of views each month, and we hope your images will be a part of it. Sharing your photos is one way that you can support midwifery.

We are seeking photos that show the many sides of birth, including different settings (home, birth center, and hospital) and a variety of families (we are especially seeking images that depict families of color and LGBTQIA pictures). Photos can be taken during any stage of care, from prenatal care to labor and birth to postpartum visits. We are hoping to include midwives themselves in as many pictures as possible, but we'll consider your amazing birth picture where the midwife is not in the shot!


  • Keep the Photo Simple: Focus on the subject while limiting background items and distractions.
  • High Resolution and Size: Photos must meet the MINIMUM specifications of being a jpeg file, 300DPI; and at least 8″ wide. Please do not send photos of lesser size and resolution. They cannot be used for print publication. Photos which do not meet these specifications can not be considered.
  • Keep Cropping in Mind: All of the images on our website are horizontal (landscape). Please either submit your photos in this manner or be aware of how this cropping could impact your photo.
  • Photo Consent: If a recognizable person is in the photo (e.g., the face of a parent/baby/midwife), you must be able to provide a photo consent form. If your photo is selected, we will provide you with a specific release form for use.
  • No Watermarking. Photo credit and, if requested, a link to the photographer's website will be provided on the MANA website. However, we are unable to use watermarked images.

Please submit your photos to Marie. If your photo is under consideration, MANA will contact you to request a photo release form and discuss other next steps. Please consider sharing with photographers and families you know who would like to share their pictures and support midwifery care!

New CPM Legislation: Good For Maine? Guest Opinion by Jill Breen, CPM, CLC

Posted by Midwives Alliance on May 4th, 2016

Editor's note: While many are celebrating the recent passage of CPM legislation in Maine, others have shared with MANA leadership their concerns about the specifics of the legislation and the particular legislative process. While MANA fully supports licensure in all 50 states, we also believe that, as more states engage in the process, we need to hear from all voices in the debate. We asked Jill Breen, CPM, CLC of Maine to take off her official MANA communications chair hat and share with us her personal perspective on the changes in her state. What follows is Jill's personal response. Like all guest posts at MANA, this post represents her experiences in Maine and should not be construed as MANA's position.

While some midwives in Maine are celebrating the fruits of their labors, others are grieving for their beautiful state. It is a sad time for Maine families who will not in the future be able to use the midwife of their choice. A bill to license certified midwives cleared its final hurdle on April 29, 2016 when the legislature, after intense lobbying from medical influences, voted to override the Governor's veto and pass it into enactment, in spite of hundreds of calls urging them to sustain the veto. As of Jan 1, 2020 only licensed midwives will be legal to practice, only MEAC accredited CPMs may be licensed, unless the current PEP CPMs have completed a "Bridge" to accreditation by that date. After that date no new PEP CPMs will be able to "bridge" to licensure, as per US MERA language. The statute itself states that no licensed midwives may attend breeches, twins or VBACs in an out-of-hospital setting. Although that restriction has an expiration date in a few years the decisions about scope of practice rules and regs, including lifting the ban on VBACs will be made by The Complementary Medicine Board composed of several naturopaths and accupuncturists, a consumer, and now 2 certified midwives and 2 physicians. The Board of Medicine also has joint rulemaking rights until 2021. With the appalling C-section rates, the lack of access to hospital VBAC, the lack of training for physicians in vaginal birth for breeches and twins, and the hospital liability insurance restrictions, the birthing population of Maine will be under the gun, or should I say knife, for the foreseeable future.

For 230 years, since the time of Martha Moore Ballard and the settling of Maine, midwives have been free to practice and families have been free to choose how, where and with whom to birth their babies.This is the founding principle of both MANA and Midwives of Maine, the 2 organizations I have been devoted to and who, for over 33 years, have worked to ensure competency and accountability while protecting these rights to care and be cared for. Unfortunately this new Maine law does not meet that standard. Crafted in collaboration with the Maine Medical Association and other medical practitioners including CNMs, OB nurses, ACOG and several others, along with 6 CPMs, compromises were made in an effort to reach an understanding and gain support for the bill. The position of the Governor and the Commissioner of the Department of Professional Regulation have consistently asserted to the legislature and the public that there is no need to regulate midwives who already have a national credential, have a good track record and pose no threat to public safety. The Governor is absolutely correct when he says in his veto letter that licensure leads to "economic protectionism" - allowing some midwives to practice and not others, and "over-regulation" - allowing midwives to serve some people but not others. He said he was contacted by "many midwives" and dozens of Maine people urging him to veto this bill. The autonomous practice of midwifery includes risk assessment, informed consent and refusal, peer review, and ethical behavior. These are the tools of self-regulation and protection, in my opinion not needing legislation to achieve.

There has never been an illegal midwife in Maine. Now, thanks to this law, there will be. It is a shame that this happened in a state where midwives are already legal, are recognized by the state in statute, and have good relations with state agencies. I believe some midwives will "go underground", some will retire, and many others will go through the mechanism and expense of licensure. More layers, more cost, more restrictions. I sincerely hope that Maine families benefit more from the advantages of licensure than suffer from the disadvantages. People should always be able to choose their midwife and their midwife be able to choose them. With a heavy heart, I raise my glass of cider to Maine, the way life used to be.

About the Author

Jill BreeenJill Breen CPM, CLC has been serving women, babies and families for 37 years as a homebirth midwife and natural family health consultant, and for 20 years as a CPM. A MANA member since 1984, Jill has served on the Board of Directors in several positions including President, as well as on several working committees, and currently is Communications Chair. She is a founding member of Midwives of Maine, a statewide, inclusive association of midwives since 1981. Jill is a Home Birth Summit delegate active on the Collaboration Task Force. She was an appointee to the Maine Governor’s Advisory Committee on Rulemaking regarding certified midwives and was a member of the Maine CDC Inter-professional Work Group addressing flow of care across birth settings. Jill writes, speaks, and mentors including as a guest lecturer at University of Maine. She is the mother of 6 children, all born at home, and has 9 grandchildren, all born into the hands of midwives, including her own.

Women Are Choosing Home Birth: The Infant-Maternal Health Care System in the U.S. Owes Them A Safe Option

Posted by Midwives Alliance on May 3rd, 2016

Women Are Choosing Home Birth

In the face of increasing home birth rates and declining maternal health outcomes in hospitals, society owes it to families to ensure safe birth options, regardless of the setting.

A small but growing number of families are opting out of a maternal health care system that is falling short. According to the Lancet, the U.S. is only one of eight countries in the world where the maternal death rate is increasing. In some states, such as California, rates of maternal and newborn mortality in hospitals have risen substantially – notably and alarmingly for women of color. 

Families choose home birth for many reasons. Some opt to avoid the often unnecessary interventions associated with hospital birth (including inductions, high cesarean section rates, and NICU stays). Others do not want to leave their communities or their families and have a tradition of birthing at home for personal, religious or cultural reasons. Some families cannot afford to pay the cost of a hospital or, for those who can afford to be more discriminating in their healthcare choices, feel as if their beliefs and preferences will not be honored. An integrated health care system for families that choose home birth and the midwives who serve them is the safest option.

The debate around U.S. home birth statistics as it is currently framed is only serving to confuse stakeholders in this debate. Critics of home birth cite flawed birth certificate studies and highlight relative instead of absolute risk. The State of Oregon has recently made an important leap forward by creating a birth certificate that captures the intended place of birth as well as provider type. Early data is being collected and research completed, which provides consumers and providers with the kind of data that can be used to inform practice and decision making.

The U.S maternal health care system has an obligation to support the conditions that increase safety for home births, including access to consultation, smooth transfers of care and transport to hospital when necessary. The Home Birth Summit, which brings together obstetricians, midwives, consumers, hospital administrators and others in maternal-health care, has published Guidelines for smooth transports crafted by a multidisciplinary Collaboration Task Force, as well as Transport Forms and Scripts to ease communications.

As the professional association for home birth midwives, MANA firmly supports the rights of families to birth outside of a hospital setting, with the providers who are trained in home birth specifically and within a system that supports midwives in all settings.   

The CPM, issued by the North American Registry of Midwives (NARM), is accredited by the National Commission for Certifying Agencies (NCCA), the accrediting body of the Institute for Credentialing Excellence (ICE, formerly NOCA). The mission of ICE is to promote excellence in credentialing for practitioners in all occupations and professions. The NCCA accredits many healthcare credentials, including nurse-midwives, nurse anesthetists, nurse practitioners, and critical care nurses. The CPM credential requires extensive training and the passage of exams that assure competency and focuses exclusively on the safe provision of out of hospital birth. 

Midwifery organizations and coalitions around the country are working to secure licensure for home birth midwives in all 50 states. Licensure gives families the reassurance that their provider is competent and does not have to work under the radar. Currently, misinformation, fractured interprofessional relationships (learn more here and here) and medical monopolies prevent this safe choice for mothers and babies.

Families deserve the support of a provider that meets international standards. The International Confederation of Midwives, with input from over 100 countries’ midwifery associations including those from the United States, have created standards that are increasing safety for families globally. The International Confederation of Midwives supports the “recognition that midwifery is a profession that is autonomous, separate and distinct from nursing and medicine.” and does not expect, nor recommend, that midwives be nurses first. MANA, among other midwifery organizations, is working on continuing to meet and even exceed the recommendations of the ICM. 

Families deserve the right to make choices with high quality evidence informing their decisions. A growing body of literature (including in the United States, Canada, and ) suggests that home birth is safe for women and babies when the birthing parent is healthy, the midwife is trained and medical-back-up is available should a complication arise. One of the hallmarks of home birth midwives’ care is their commitment to providing evidence based information so that clients can make truly informed decisions regarding their care during pregnancy and birth. In a system that supports the autonomy of the family, decisions can be made based on evidence, not fear.

When the maternal health system of the U.S. can have a balanced discussion on how to fully incorporate non-nurse midwives into our system, regardless of place of birth, our families will have better access to the care providers of their choice, fewer interventions including surgical birth, and better outcomes. 


About the Author

Marinah FarrellMarinah Valenzuela Farrell, LM, CPM Politics and traditional medicine are what led Marinah to midwifery, and she has a firm commitment to both political activism and birth work. Marinah has worked in waterbirth centers and medical facilities for international NGOs, in free­standing birth centers in the U.S., and is the owner of a long standing homebirth practice in Phoenix, Arizona. In addition, Marinah is known for her grassroots activism at the community level. Marinah is currently a founding board member and the Director of Maternal Health for Phoenix Allies for Community Health (PACH) a community, not federally, funded free clinic in downtown Phoenix, and the President of the Midwives Alliance of North America (MANA). Marinah is focused on the issue of lack of access to midwives and the profession of midwifery in communities where health disparities are overwhelming, trainings in cultural safety and is active in numerous grassroots political collaboratives. Marinah continues to work with traditional midwives outside of the U.S and bridges professional midwifery with community traditions.

Validating MANA Stats 4.0: The Largest Available Dataset on Physiologic Birth in the US

Posted by Midwives Alliance on May 2nd, 2016


Validating MANA Stats 4.0

More than 50,000 cases of midwifery-led care will now be available to researchers thanks to the validation of the MANA stats 4.0 dataset. This key achievement makes MANA Stats by far the largest available dataset on physiologic birth and midwife-led care in the United States. Of particular interest to researchers is that MANA stats is based on medical records, which are considered to be the "gold standard" of health care research.

"Validity" is a statistical term that means, essentially, that the data are accurate. In this case, it means that the MANA Division of Research (DOR) selected a random sample of 10% of the records in 4.0, and checked them against the original medical records. We now know which variables in the 4.0 dataset are extremely accurate (cesarean, for instance, is almost always entered correctly), and which variables are slightly less accurate (labor duration has a little more "wiggle room" in it).DOR members are currently analyzing the validation findings, and plan to submit a validation paper for publication in the near future. These steps are time-consuming, but critical, because they ensure that the data can be used by academic researchers in studies for publication.

The 4.0 validation process began in 2012 and was made possible thanks to the efforts of:

  • Midwives whose practices were sampled for the 4.0 validation study for their extensive cooperation with this process
  • Research assistants - Gina Gerboth, Susanna Snyder, and Sudy Storm, who were responsible for checking the existing MANA Stats data against the medical records for sampled births
  • Project Manager - Holly Horan, who generally organized and kept the project on track
  • Funders - the Foundation for the Advancement of Midwifery, who provided much needed funding to support the validation
  • MANA DOR members - Melissa Cheyney, Bruce Ackerman, Marit Bovbjerg, Jennifer Brown, Courtney Everson, Ellen Harris-Braun, and Saraswathi Vedam

MANA Stats datasets include some of the only U.S. data that exists regarding physiologic, low-intervention labor and birth -- data that are becoming more and more rare due to the ubiquitous use of "routine" interventions in the hospital setting. The MANA Stats datasets are a source of information on outcomes of midwifery care, normal lengths of pregnancy and labor, non-pharmacological approaches to pain management, mother-led birth positions, hydrotherapy in labor, and more.

The MANA Stats datasets have been provided to every researcher who has applied to date. These investigators engage research projects designed to explore midwifery care and normal, physiologic birth processes. Learn more about published studies using MANA Stats data and approved projects here.

Next up for validation: the MANA stats 3.0 dataset. The 3.0 data form had the largest number of variables available, which led to a uniquely rich - but more challenging to process - dataset. This effort is being led by Saraswathi Vedam and Kathrin Stoll at the University of British Columbia.

About the authors

Missy Cheney

Melissa Cheyney PhD, CPM, LDM is Associate Professor of Clinical Medical Anthropology at Oregon State University (OSU) with additional appointments in Public Health and Women’s Studies. She is also a Certified Professional Midwife in active practice, and the Chair of the Division of Research for the Midwives Alliance of North America where she directs the MANA Statistics Project. She is the author of an ethnography entitled Born at Home (2010, Wadsworth Press) along with several, peer-reviewed articles that examine the cultural beliefs and clinical outcomes associated with midwife-led birth at home. Dr. Cheyney is an award-winning teacher and was recently given Oregon State University’s prestigious Scholarship Impact Award for her work in the International Reproductive Health Laboratory and with the MANA Statistics Project. She is the mother of a daughter born at home on International Day of the Midwife in 2009.

Marit Bovbjerg

Marit Bovbjerg PhD, MS is a reproductive and health services epidemiologist at Oregon State University. Dr. Bovbjerg's research focuses on maternity care in the US, with a sideline into physical activity during pregnancy/postpartum. In her non-work time, she likes to knit, grow vegetables, cook, and play outside (hiking, running, biking, etc.) She does not like to sit still and in fact avoids doing so whenever possible. Marit and her husband are attempting to turn three exuberant children into responsible adults, a task at which they might, on a good day, be slowly succeeding (though likely through no fault of their own). They live in an untidy but cheerfully-painted house in rural Oregon, and enjoy vacationing in places with abundant outdoor activities but few people.

Courtney Everson

Courtney L. Everson PhD is a Medical Anthropologist and the Dean of Graduate Studies at the Midwives College of Utah, Salt Lake City, UT. Dr. Everson is also the Director of Research Education for the Midwives Alliance of North America (MANA) Division of Research (DOR); Co-founder and Vice President of the Oregon Doula Association (ODA); a Research Working Group (RWG) member of the Academic Collaborative for Integrative Health (ACIH); an Accreditation Review Committee (ARC) member for the Midwifery Education Accreditation Council (MEAC); and serves on the Boards of Directors for the Australasian Professional Doula Regulatory Association (APDRA), the Oregon Doula Connection, the Association of Midwifery Educators (AME), and the Academic Collaborative for Integrative Health (ACIH). Dr. Everson's research and teaching specializations include: maternal-child health; human childbirth; adolescent pregnancy and parenting; psychosocial stress; social support; doula care; midwifery care; research and clinical ethics; evidence-informed practice; collaborative care models; mixed methodologies; health inequities; cultural competency/humility; social justice; and underserved populations. She actively publishes in academic forums, and is an invited, avid speaker at local, national and international venues.


Meet the Midwives Alliance Division of Research (DOR)

Posted by Midwives Alliance on March 8th, 2016


Meet the Midwives Alliance Division of Research

The Midwives Alliance Division of Research (DOR) is a volunteer group comprised of clinicians, academics, research and policy experts, and database developers. Together they work to increase knowledge about midwifery care and help midwives become more fluent in conducting research, critically appraising the available data, and incorporating the best available research findings into their practice. 

The DOR is guided by an Advisory Panel and Coordinating Council. The DOR is currently working on a series of projects designed to increase the capacity for, and dissemination of, rigorous research and innovation in maternal-infant health and midwifery care. These projects include the Maternity Care Data Alliance (MCDA), annual benchmarking, expansion of dissemination capacity, public information about the MANA Stats datasets, and educating midwives about research. 

Meet the Coordinating Council

Chair of the Midwives Alliance Division of Research

Melissa CheneyMelissa Cheyney PhD CPM LDM HBM is Associate Professor of Clinical Medical Anthropology at Oregon State University (OSU) with additional appointments in Public Health and Women Gender and Sexuality Studies. She is also a Certified Professional Midwife in active practice, and the Chair of the Division of Research for the Midwives Alliance of North America. She is the author of an ethnography entitled Born at Home (2010, Wadsworth Press) along with several peer-reviewed articles that examine the cultural beliefs and clinical outcomes associated with midwife-led birth at home. Dr. Cheyney is an award-winning teacher and in 2014 was given Oregon State University’s prestigious Scholarship Impact Award for her work in the International Reproductive Health Laboratory and with the MANA Statistics Project. She is the mother of a daughter born at home on International Day of the Midwife in 2009.

Dr. Cheyney is responsible for overseeing DOR projects including the MANA Stats Projects. Her major responsibilities fall into three categories: 1) Facilitation of projects and management of DOR and Coordinating Council activities; 2) Provision of research expertise and recommendations for DOR activities and projects; and 3) Liaison between the DOR Coordinating Council and other midwifery research entities and experts (for example, the ACNM benchmarking project, the Home Birth Summit Research Committee, the MCDA), as well as liaison between the DOR Coordinating Council and the MANA membership at-large via MANA conference presentations and other communications. 

Director of Data Collection

Bruce AckermanBruce Ackerman HBD works on design and improvement of the web data collection system, supports users of this system, and participates in DOR coordination. His interest in birth comes through his marriage to a midwife and long-time involvement with the Midwives Alliance, and the births of his two children at home, and also through a lifelong interest in the ways that our future and our relationship with technology are envisioned. He has worked in laboratory instrumentation, on medical devices, and on renewable energy planning and research.

Bruce’s role on the DOR is to coordinate among multiple disciplines, including researchers, software developers, funders, the MANA Board, and the midwives who contribute data, for the long-term planning and detailed maintenance of the MANA Stats system.

Director of Data Quality

Marit BovbjergMarit Bovbjerg PhD MS HBM is a reproductive and health services epidemiologist in the College of Public Health and Human Sciences at Oregon State University. Her research focuses on maternity care in the U.S., with a particular focus on midwifery care, homebirth, and other potential interventions that might improve outcomes for low-risk women by de-medicalizing childbearing. Marit also studies physical activity during pregnancy/postpartum, breastfeeding, the economics of various healthcare choices, and has recently become interested in methods for quantifying and analyzing variability in longitudinal data. She has 3 children--two intelligent, engaging, beautiful daughters (who came with her husband), and a son, born at home while his sisters slept, who is entirely too smart and energetic for his own good.

Dr. Bovbjerg is the DOR’s Director of Data Quality. Her roles include: serving as the main liaison with external researchers wishing to use MANA Stats data, developing and maintaining the research datasets and accompanying documentation, consulting with the Data Collection team as necessary (e.g., when we are contemplating a slight alteration to question wording or determining what to do with an unusual case), and  since math with greek letters makes her really happy — she is the primary person responsible for data analysis for internal DOR projects. 

Director of Research Education

Courtney EversonCourtney L. Everson PhD is a Medical Anthropologist and the Dean of Graduate Studies at the Midwives College of Utah, Salt Lake City, UT. Dr. Everson is also co-founder and Vice President of the Oregon Doula Association (ODA); an Accreditation Review Committee (ARC) member for the Midwifery Education Accreditation Council (MEAC); and serves on the Boards of Directors for the Australasian Professional Doula Regulatory Association (APDRA), the Oregon Doula Connection, the Association of Midwifery Educators (AME), and the Academic Collaborative for Integrative Health (ACIH). Dr. Everson's research and teaching foci include: psychosocial stress, social support, midwifery care, doula care, physiologic birth, and health inequities. She actively publishes in academic forums, is an avid guest speaker, and has won multiple awards for her teaching, research, and service.

Dr. Everson’s role on the DOR is Director of Research Education. Dr. Everson leads efforts to increase research education among aspiring and currently practicing midwives. She also contributes to many DOR and Coordinating Council (CC) initiatives and research projects. In her role of advancing research education, Dr. Everson works with midwifery schools and midwifery education professional organizations to integrate research literacy skills into educational routes (both initial training and ongoing continuing education). She also collaborates with external stakeholders to ensure that best practices and resources in research fluency for practitioners can be incorporated into both midwifery education/training and client care, with the goal of advancing evidence-informed practice frameworks. Dr. Everson also serves on the Research Review Committee (RRC) of the DOR CC and coordinates the Connect Me! Mentorship program.

Director of Database Development

Ellen Harris-BraunEllen Harris-Braun CPM HBM is half of Harris-Braun Enterprises, an experienced Web-development team that wrote the software for the MANA Statistics web site. Ellen is also a midwife, certified doula, and childbirth teacher involved with birth since 1999 and with MANA since 2002.

Ellen Harris-Braun’s role on the DOR is focused primarily on the creation and maintenance of the software that operates the beautiful MANA Stats web site.

Senior Advisor for the MANA Division of Research

Saraswathi VedamSaraswathi Vedam RM FACNM MSN Sci D (h.c.) HBM is Associate Professor at the Division of Midwifery in the Faculty of Medicine, University of British Columbia, and founder of the UBC Midwifery Faculty Practice, Birth & Beyond. Over the last 30 years, she has cared for families in the USA, the Netherlands, India, and Canada in a variety of private and public health care settings. She serves on the Interim Executive Board, Canadian Association of Midwifery Educators, and is the Founding Chair of the historic multi-disciplinary Home Birth Consensus Summits. Professor Vedam has also enjoyed teaching midwifery, medical, and nursing students in universities across North America.

Saraswathi Vedam is the senior advisor to the project.