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Aviva Romm on the Impact of Midwifery Care on Lifelong Health

Posted by Midwives Alliance on August 18th, 2015

We are incredibly excited to have the honor of hosting Dr. Aviva Romm at this year's MANA conference, Shine, in Albuquerque, New Mexico. We took this opportunity to talk with her about why she thinks midwifery care can improve lifelong health, the impact of interprofessional tensions between maternity health providers, and critical opportunities for midwives to seize now.

MANA: Why have you chosen to present at Midwives Alliance of North America?

AVIVA: When I was asked to speak at MANA this year, aside from just being incredibly honored and grateful, I realized it was such a timely opportunity for me to be able to talk with midwives about something that's very important. As midwives, we are so focused on the importance of prenatal care toward birth outcome that we miss another great opportunity – the impact of pre-conception, prenatal and infancy on the lifelong health for our children.

We know that by the time a baby is born, he or she already has at least 300 environmental chemicals measurable in his or her umbilical cord. We know that early prenatal nutrition can determine a person’s predisposition to everything from eczema and allergies in young children, to believe it or not, diabetes, heart disease, stroke, and cancer, in adults. As midwives, bringing a greater awareness of this to periconception is a powerful way to bridge midwifery with lifelong public health and make a difference.

MANA: What do you believe would be the optimal relationship between families, midwives, and physicians?

AVIVA: I have long believed that the optimal relationship is a seamless one, where there's no separation between midwifery care and the medical model. I’m not saying that midwifery as a model should be subsumed by medicine or that midwifery has to emulate or become part of the way the medical model works. But there has to be a system where families don't perceive a separation in their care. This would optimize the experience of pregnancy and childbirth for women, helping them to make the best choice in where they want to have babies. One of the things I've observed as a midwife for 25 years, and also as a physician, is that women will ultimately birth where they feel the safest. For a lot of women, there's a conflict there. They don't actually feel that a hospital or a birthing center is the safest.

They are concerned, and rightly so, that the medical model dominates there, that they'll be subjected to interventions that they don't want but really can't fend off, whereas they don't necessarily feel entirely safe at home, either. Home isn't their natural first choice. Home birth becomes a reactive choice. For some of those women, the fear factor can determine the physiology of birth. Fear at birth can interfere with the process. I've seen women with this sort of underlying, insidious fear, which may not even be conscious. Sometimes as midwives we pick it up, but don't really know exactly what to do with it, and it sort of drives a transport in some way. Maybe there's a really prolonged labor or difficulty pushing, difficulty opening up and relaxing. It's that fear. I feel like if we took that dichotomy between home or hospital out of the equation and made that seamless, it would make the choice easier for women. Of course this assumes that we're working in a culture where hospital and birthing center births are reliable for women as places where they can go and have the birth that they really want to whenever possible, barring some kind of obvious medical complication.

I also feel that the schism between home and hospital sometimes leads midwives at home to make choices that aren't always in the best interests of the birth outcome. They're afraid to transport to the hospital. Having practiced in an illegal midwifery state for about 15 of my 20+ years as a midwife, I've observed many times where a midwife stayed home a little too long and there were complications that didn't have to happen but did, out of a fear of transport. A seamless system allows for things like ease of transport and emergency services that are specifically designed for midwives practicing at home.

MANA: As more states pass midwifery legislation and more midwives become licensed and provide care at home and in birth centers, how do you see the future of midwifery? We'd especially appreciate hearing your perspective on the integration of midwifery into the mainstream maternal health care system in the US. Do you see any downsides to home birth midwifery becoming integrated into our healthcare system?

AVIVA: I am all for midwives becoming more integrated into the mainstream maternal health system. We've actually seen that already, for the most part, with certified nurse midwives. I do have concerns that the legislated midwifery runs the risk of becoming "med-wifery," so I think the question becomes, how can we preserve the valuable traditional midwifery arts of midwifery while expanding women’s access to midwives and also how can we, as midwives, inform changes in the medical model.

Good examples would be how long a mom can be in labor or how long membranes can be ruptured, or how old or young she can be, or how much weight she has or hasn't gained. All of these kinds of parameters may seem set in stone to the medical model, but in actuality they shift over time and may have some arbitrary aspects to them. Another example would be how far advanced in pregnancy a mom can be before an induction is required rather than just something that happens according to set parameters in the medical model, and is now required for midwives to participate in. I think we're still in the infancy of what this kind of dialogue all looks like.

I've met and talked with many midwives from states that have licensure and feel that they're really in a good situation, that they've got sort of the best of both worlds. I've also met midwives and moms who are frustrated with the limitations placed on them, but sort of accept it as a necessary evil, if you will, to serve the most numbers of moms in the best way knowing that some moms who could be having more natural births, or possibly home births, are getting marginalized by rules. We have to keep our fingers on the pulse of it and try not to lose too much of our art in favor of the benefits that we get. It is a necessary trade-off that I understand that we all make. I'm excited to see where it goes.

MANA: At the 2015 MANA National Conference you are speaking on Shining a Light on Midwives in PeriConception Care, As Upstream as Healthcare Gets. Can you tell us more about the concept of periconception care?

AVIVA: Peri-conception care means the care that women are getting around the time of conception. To my knowledge, most midwives aren't reaching out into their communities or being reached by their communities before pregnancy. We know that in the 3 months or so prior to pregnancy so much can happen that sets the tone for pregnancy health and for what exposures baby might get in that early prenatal period, in that first 6-8 weeks of exposures when so much of the baby's nervous system, immune system, and organ development is happening, in that embryo genesis period.

Ideally, prenatal care would start in the pre-conception period with teaching mom about environmental exposures that she can avoid, possibly even working with moms around detoxification programs if they've had significant exposures. For example, if we know that they have a high mercury level based on testing, or we know that they have elevated homocysteine, which is a serum marker of inflammation that is related to increased risk of miscarriage, preeclampsia, placental abruption, and other problems.

The weight at which a mom becomes pregnant can have an impact on her health. Whether she's obese or whether she's underweight, it can set determinative factors in the baby for how the baby uses sugar and stores fat, not just while the mom is pregnant with that baby, but actually for the baby's entire life. We can have an impact on whether that baby develops heart disease, diabetes, strokes, and Alzheimer's. This is very significant and is a well-worked out science.

MANA: How do you see midwifery care differing from traditional medical care in periconception?

AVIVA: The American College of Obstetrics and Gynecology has recently recognized and emphasized the need for periconception care. But most obstetricians are just not doing it; their knowledge isn't there nor is the time.

As midwives, we can take the lead on this. For example we can make nutrition, and not just calories and protein counting and what micro-nutrients a woman needs, but really true, good food, a part of our midwifery curricula. Right now, the rates of obesity in the United States are reaching about 50%. We have an enormous obesity problem in our kids that also translates to high cholesterol, increased risk for cardiovascular disease and chronic inflammation and all the diseases that are associated with that, such as autoimmune diseases and Alzheimer's.

As midwives, we have an opportunity to do what we do best, which is to do, and teach, what's natural and healthy. That includes foods and awareness of ecological issues. As a whole, our profession tends to be much more green-oriented than the medical model. If we can bring that green orientation in our personal lives into our profession, we'd be way ahead of what the mainstream model has already said is one of the pressing agendas for obstetrics and for pregnant women.

 

Aviva Romm About the author

Aviva Romm, MD, is a Board Certified Family Physician, midwife, herbalist and the creator of Herbal Medicine for Women, a distance course with nearly 1000 students around the world, and Healthiest Kids University, also with nearly 1000 students. Dr. Romm is a leader in the revolution to transform the current medical system into one that respects the intrinsic healing capacities of the body and nature - while helping women take their health into their own hands. Her areas of research include botanical medicine with a focus on the needs of women and children, improving maternity care models, mind-body medicine, and the impact of environment on health. She is a gardener, artist, and visionary physician, as well as the mother of 4 grown children and grandmother of two — all 6 born at home.

15 Questions To Ask Before Choosing a Midwifery Path and Program

Posted by Midwives Alliance on July 21st, 2015

What midwifery credential should I choose? How can I tell if a midwifery school is right for me? As a practicing midwife, I am asked these questions by potential students as they decide between becoming a certified nurse midwife or certified professional midwife and when trying to choose a midwifery program.

I have gathered together the 15 questions I often ask potential students to consider as they make their decisions. Give yourself a few minutes, jot down your answers, and don't think too hard about any one question! You might be surprised at some of your answers. I hope these help you find the path that is right for you.

Choosing a path

Where do you want to practice? Consider both the place of birth - home, hospital or birth center - and the state or states you want to practice in. Research the license/credential requirements for the state and place of birth you'd prefer.

Who do you want to serve? Teen mothers, low income families, a small rural community, a big city busy practice with other midwives - who do you dream of serving?

What are the laws concerning midwifery (and student midwifery) in your community? Is it legal for a CNM to attend home birth? Can CPMs practice legally? Where? Do you need to register with anyone? Do you need to be enrolled in a school program to attend births as a student midwife? Can CNM student midwives have an internship with an out of hospital midwife?

Do you want to be able to move about the country and work in a wide variety of settings? Nurse midwifery may be more flexible when moving a lot, and also has the advantage of being able to work as a nurse as well.

Choosing a program

Are you interested in a Nurse Midwifery program? a Certified Professional Midwife program? Portfolio Evaluation Process? or a MEAC (Midwifery Education Accreditation Council) approved program?

Are you able to relocate to go to midwifery school? Do you have the resources to move and attend a midwifery school in another community? Is there an at-distance or online alternative?

Are you able to organize yourself and learn independently? Would a program that offers few "extras" and where you would need to work independently be a good fit? Would you be more comfortable with a structured program, that includes a clear plan for success? Do you want to work with your local midwifery community to learn in an apprenticeship model? Do the programs you are looking at have "perks" - support groups, libraries, database search engines, writing labs, or other extras?

Do you enjoy group learning activities? Do the programs you are looking at offer an opportunity to build community with other student midwives?

Does the program you are interested in offer clinical internships in your own community? Is your local community large enough for you to find a midwife preceptor who can help you finish your clinical requirements? Do your local hospitals offer Nurse Midwife internships? Does your program help you find a preceptor?

Do you need to complete any portion of your academic program before beginning your clinical training? Some programs, and some mentor midwives require that you complete up to a year of academics before starting clinicals.

How many of the students who start the program or apprenticeship you are considering finish, and go on to pass the credential and/or licensing exams?

Finding your resources

What are your financial, emotional, spiritual resources? What is your community support like? Does your family support your chosen work? Can they manage living "on call" with you? Are they concerned about liability issues?

Do you need a midwifery program that has federal financial aid? Nurse Midwifery and some MEAC approved programs offer Federal Financial Aid. Some MEAC approved programs do not offer aid but are much less expensive than those that do.

Do you have the time necessary to commit to midwifery training? Do you have time in your life for rigorous academic and hands-on demands? Can you be on call? Part time or full time? How much flexibility do you need?

Will you need to work while you are in midwifery training? Is it realistic? What is the expectation of the midwife you are working with or the program you will be attending?

 

I hope these questions have helped you to become clearer about how to choose a midwifery path that is right for you. Becoming a midwife is often a winding path, challenging at times, but rewarding! Good luck to you all!

 

About the author

Treesa McLean, LM, is a homebirth and birth center midwife and has been involved in the birth community as a consumer, an advocate, and a birth professional for more than 30 years. She teaches a workshop "Becoming a California Licensed Midwife" and has been the preceptor for a number of student midwives.

Prison and Birth

Posted by Midwives Alliance on July 21st, 2015

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Desiree Robles, a student midwife at Midwives College of Utah, shares with the MANA community the current state of maternity care for incarcerated women in the United States, along with policy recommendations for improving outcomes for mothers and babies. This post is a part of our student midwife guest post series. Are you a student? Please consider sharing a guest post with us! Contact MANA at publicaffairs@mana.org for more information.

Pregnancy and birth have the remarkable ability to be a common process for all women, regardless of economic status, race, or culture. They can occur at any time in a woman's reproductive life, including when they are sentenced to time in jail or prison. How these instances are handled in the United States is the subject of controversy and varies greatly depending on location but, collectively, is in need of reform. In the United States, incarcerated pregnant women deal with several reproductive issues that need to be addressed, including lack of proper prenatal care and nutrition, use of restraints during transport, labor, and postpartum, and a lack of birth education and support.

Despite the importance of prenatal care and proper nutrition during pregnancy, many inmates are not guaranteed access to them. According to the Committee on Health Care for Underserved Women (CHCUW), thirty-eight states have failed to institute policies requiring that incarcerated pregnant women receive basic prenatal care. In addition, forty-one states do not require prenatal nutrition counseling or do not ensure that these women receive proper nutrition (2011). What is important to note is that, according to a study done by Martin et al. in 1997, prisons are required to provide all pregnant inmates with appropriate prenatal care. However, according to a Women's and Children's Health Policy Center publication, less than half of correctional systems require screening of new female inmates for pregnancy and STD's (2000). Even with more than half of the United States correctional facilities not providing the proper prenatal care and nutrition for these inmates, some of these same women may still be at the same high risk or may actually be better off than if they were pregnant at home. A study done by Clarke et al. points out that pregnancies among incarcerated inmates are usually unplanned, high risk, and have poor outcomes because of, among other things, lack of or failure to access prenatal care and many of these women having poor nutrition (2006). Thankfully, many studies, including one done by Martin et al., have found that incarceration allows these women to have improved maternal and fetal health thanks to access to shelter and regular meals (1997). It is important that we implement screening protocols for incoming inmates at all correctional facilities so that their reproductive health can be addressed if need be, as well as making sure these inmates receive the proper care needed if they are found to be pregnant. 

Using restraints on pregnant inmates during the process of labor is a sensitive issue that has been the subject of scrutiny for years. There have been various studies that have delved into the adverse effects of restraining women in labor both physically and psychologically. While progress has been made in stopping the use of restraints on pregnant inmates, according to the Committee on Health Care for Underserved Women, thirty-six states and the Immigration and Customs Enforcement agency of the Department of Homeland Security have failed to limit the use of restraints on pregnant women during transportation, labor and delivery, and postpartum (2011). Use of "shackling," as it is called, causes discomfort for the pregnant inmate during a time when she is most vulnerable and many times the officers present are male. In an article done by Anderson, there is implication that birth transport often results in numerous medical and mental health complications, thanks to the security precautions used, including shackling. These precautions increase instances of injury and stress while stress in itself can cause complications in labor. Also, the women have limited movement, which adds discomfort and restricts their ability to protect themselves in instances such as falling (2003). An Amnesty International article brings to attention the traumatizing experiences of shackling on the laboring inmates. These included having their legs shackled to their bed post for almost the entirety of their labor which, again, caused restricted movement and hindered their ability to position themselves in more favorable positions during labor (2000). To add to their distress, according to Codd, women in prison many times give birth to their babies who are taken away almost immediately or at discharge from maternity ward, causing the mother much distress and robbing the baby of their mother's important breast milk (2004). Laboring inmates deal with these stressful situations that, while slowly being resolved, would be helped, in part, with childbirth education and support from, at the very least, female officers during labor. 

Birth education and support for pregnant inmates is lacking in many correctional facilities but are excellent resources that would greatly benefit these vulnerable women. According to Hotelling, with the right support and prenatal care, expectant new mothers often discard lifestyle behaviors which would compromise the health of their babies. Some programs have been initiated to provide physical and mental health care to incarcerated women. These programs depend on help from volunteers, grant money, and various organizations coming together in order to thrive (2008). The Bell et al. study noted that what is needed for incarcerated pregnant women is comprehensive programs that include enhanced prenatal care services in the community and greater transitional resources. This would be ideal, given that most women are incarcerated for smaller crimes with shorter sentences than men (2004). A great place to start would be birth education and breastfeeding workshops. In a study by Huang et al., pregnant inmates showed positive views on pregnancy and link it to a new start for them as mothers and in their life in general (2012). Childbirth education and support for pregnant inmates should be available at all correctional facilities as a way to help these women deal with the stress of pregnancy in an already stressful situation for the sake of their health and future as well as their children's.

Pregnancy during incarceration happens whether correctional facilities want it to or not. For this reason, protocols should be made mandatory at all correctional facilities to screen for pregnancy, as well as STD's, to ensure the health of their inmates. While prenatal care is required for all pregnant inmates, screening for pregnancy is not. This very important loop hole should not occur in our correctional facilities, as early prenatal care and nutrition is imperative to the health of both the mother and her infant. For those women who do experience labor during their stay, the use of restraints and shackling should be limited to actual need instead of standard protocol. Women in labor should have the ability to move freely, regardless of their situation. Maternal and fetal health is put at stake when they are put under stressful situations, and shackling only exacerbates the situation. Lastly, childbirth education and support during pregnancy and birth are a great rehabilitation tool which correctional facilities should try to make mandatory. The benefits include healthier inmates both mentally and physically and shorter births which would cut healthcare costs tremendously, considering many incarcerated women are considered high risk. Implementing these policies would help these already vulnerable women and hopefully give them the needed support to change their situations for the better.

Reference List

Amnesty International. (2000). Pregnant and imprisoned in the United States. Birth, 27(4), 266-271.

Anderson, T.L. (2003). Issues in the availability of healthcare for women in prison. In S.F. Sharp & R. Muraskin (Eds.), The incarcerated woman: Rehabilitative programming in women's prisons (pp. 49-60). Upper Saddle River, NJ: Prentice Hall.

Baldwin, K. & Jones, J. (2000) Health issues specific to incarcerated women: Information for state title v programs. Retrieved from http://www.jhsph.edu/research/centers-and-institutes/womens-and-childrens-health-policy-center/publications/prison.pdf

Bell, J. F., Zimmerman, F. J., Cawthon, M. L., Huebner, C. E., Ward, D. H., & Schroeder, C. A. (2004). Jail incarceration and birth outcomes. Journal of Urban Health, 81(4), 630-644.

Clarke, J. G., Herbert, M. R., Rosengard, C., Rose, J. S., DaSilva, K. M., & Stein, M. D. (2006). Reproductive health care and family planning needs among incarcerated women. American Journal of Public Health, 96(5), 834-839.

Codd, H. (2004). Prisoners' families: Issues in law and policy. Amicus Curiae, 55, 2-7.

Committee on Health Care for Underserved Women. (2011). Health care for pregnant and postpartum incarcerated women and adolescent females. Committee Opinion, 511, 1-5.

Hayes, S. L., Mann, M. K., Morgan, F. M., Kelly, M. J., & Weightman, A. L. (2012). Collaboration between local health and local government agencies for health improvement. Cochrane Database of Systemic Reviews, 10, 1-141.

Hotelling, B. A. (2008). Perinatal needs of pregnant, incarcerated women. Journal of Perinatal Education, 17(2), 37-44.

Huang, K., Atlas, R. & Parvez, F. (2012). The significance of breastfeeding to incarcerated pregnant women: An exploratory study. Birth, 39(2), 145-155.

Kitzinger, S. (1997). Sheila kitzinger's letter from Europe: How can we help pregnant women and mothers in prison? Birth, 24(3), 197-198.

Martin, S. L., Rieger, R. H., Kupper, L. L., Meyer, R. E., & Qaqish, B. F. (1997a). The effect of incarceration during pregnancy on birth outcomes. Public Health Reports, 112, 340-346.

Martin, S. L., Kim, H., Kupper, L. L., Meyer, R. E., & Hays, M. (1997b). Is incarceration during pregnancy associated with infant birthweight? American Journal of Public Health, 87(9), 1526-1531.

Minkler, M., Glover Blackwell, A., & Thompson, M., Tamir, H. (2003). Community-based participatory research: Implications for public health funding. American Journal of Public Health, 93(8), 1210-1213.

Walker, J. R., Hilder, L., Levy, M. H., & Sullivan, E. A. (2014). Pregnancy, prison and perinatal outcomes in New South Wales, Australia: a retrospective cohort study using linked health data. BMC Pregnancy and Childbirth, 14(214).

 

About the author

Desiree Robles is a student midwife, attending Midwives College of Utah. She resides in the San Francisco Bay Area and is currently beginning her clinical training with Pearl Yu, LM of Motherborn Midwifery. Desiree also works hard as a volunteer for California Families For Access to Midwives as a member of the social media team.

Albuquerque Has "Poquito de Todo"

Posted by Midwives Alliance on June 23rd, 2015

Albuquerque has "poquito de todo" - a little of everything! We enjoy great mountain views, petroglyphs, hot air balloons, art galleries and many opportunities for cultural learning. There are plenty of things to do in New Mexico no matter where your interests lie.

You might be surprised to learn that New Mexico is a great place to grow lavender, pecans, peanuts, grapes, pinto beans, and more. Of course, we are famous for producing the best chile peppers, a staple in New Mexican dishes.

The MANA Conference will be held at the Hotel Albuquerque at Old Town, right next to colorful Old Town Plaza, a favorite spot to enjoy authentic cuisine and arts. Within walking distance of the hotel are several family oriented museums: Explora, The Museum of Natural History and the Albuquerque Museum.

A short drive from the hotel will take you to the National Hispanic Cultural Center, the Indian Pueblo Cultural Center, and the Albuquerque Bio Park and Zoo.

Albuquerque boasts the world's longest aerial tramway, which runs to the top of the Sandia Mountains. The breathtaking views will give you more reasons to fall in love with New Mexico. If you're brave & into biking, you can also take the chair lift up the mountain and bike down! Beautiful hiking trails are also abundant.

You'll find lots of wineries and craft breweries in the area. There are even bus tours that will do the driving for you! The ABQ trolley will take you on a guided tour where you can see local landmarks, including Breaking Bad filming scenes.

If you're looking for a wonderful day trip, the Jemez Mountains offer gorgeous views, hot springs, canyons, waterfalls, red earth, tall pines and Aspen. Magical Santa Fe, the oldest city in New Mexico and the oldest State Capital in the U.S, is less than an hour away and is home to the Georgia O'Keefe Museum. Just an hour from Santa Fe, in Abiquiu, visit Ghost Ranch.

You can find more info about New Mexico here. For things to do in Albuquerque, visit here.

The New Mexico Midwives are proud to host SHINE MANA#15 in Albuquerque, where we can share with you our history, culture and the amazing support that our community offers midwives.

Please join us for #MANA15 in Albuquerque! Register by clicking the button below.

     SHINE MANA#15

Register for SHINE MANA#15 Now!

About the author

Kelly Camden, LM, CPM, BA, is an Albuquerque-based midwife who is thrilled to serve as the local coordinator of the 2015 MANA Conference. Following her first homebirth 16 years ago, Kelly began attending hospital births as a DONA doula and home births as a midwife's assistant. Later, she became a staff doula at Presbyterian Hospital, where she was recognized for excellent service. Kelly endeavors to empower families through education; she is founder and coordinator of the Albuquerque Birth Network, has taught breastfeeding, prenatal yoga, and childbirth classes and has published articles on pregnancy related topics. Kelly served as Consumer Advisor on the NM Certified Nurse Midwives Advisory Board and Event Coordinator for the ABQ Rally to Improve Birth. Currently, she is a Regional Coordinator for the NM Breastfeeding Task Force. Since 2011, Kelly has practiced as a Licensed and Certified Professional Midwife, offering home and birth center births. She is proud to be a midwife in New Mexico, where a blend of culture, tradition and necessity has led to a continuous history of midwifery care.

Update from the States: Delaware CPM Legislation Passes House and Senate

Posted by Midwives Alliance on June 1st, 2015

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New legislation will make it possible for CPMs to practice in Delaware

House Bill 70 was introduced and passed through both the Delaware House and Senate which will allow for Certified Professional Midwives and Certified Midwives to practice legally in Delaware without a written collaborative agreement beginning June 30, 2016. Since 1984 to present, CPMs needed a physician alliance and written collaborative agreement. This has prevented practice by all but one CPM who currently practices legally and has a written collaborative agreement. That practice currently is limited to serve only the Amish and Mennonite communities per the physician agreement.

Over the past 10 years, there has been continued education and community support for changes to be initiated in the current restrictions toward legal practice of CPMs. Through the many committee meetings with members of the medical community, State Board of Health, and legislators, discussion and education regarding the credentialing process of CPMs has become more clearly understood and accepted. Documents were submitted from numerous states where Certified Professional Midwives are working and valued as a safe option for out-of-hospital birth. Much discussion and work towards safe standards of care has been in process over the past year and now can start to be implemented once the Midwifery Council is designed and in operation. The Midwifery Council will draw up both standards of practice and scope of practice in the state which will then go to the Delaware Board of Medical Practice for approval.

Many thanks to the many members of the medical community, legislators, state board of health and families who were instrumental in helping this goal become realized. Also a special thanks to Shannon Burdeshaw, retired CPM and Karen Webster, CPM for all the time, energy and expertise in assisting the legislative process. Their prior legislative experience in other states served as a great asset to having Delaware join the many other states whose laws recognize and regulate Certified Professional Midwives as primary maternity care providers.

 

About the author

Pat Gallagher, CPM, has been a practicing midwife for 31 years in Delaware. She has been the only CPM legal up to this time due to the need for written collaborative agreement. She has had a physician alliance since 1984 with a practice limited to Amish & Mennonite families per physician back up. 

Pat is a Certified Childbirth Educator (ACHI). She designed and implemented a state wide paramedic refresher class in emergency childbirth and taught a workshop at MANA regional conference on breech & shoulder dystocia. Pat has been active in the legislative process to license CPMs & CMs and on the new legislation.

Meet the MANA Board

Posted by Midwives Alliance on June 1st, 2015

Colleen Donovan-Batson, Director of Health Policy and Advocacy

Colleen Donovan-Batson, Director of Health Policy and Advocacy

Way on way back when, I repaired helicopters for the US Army. It was the 1970s, and next to the hangar I worked in was the Medevac hangar, where the lifesaving Huey helicopters lived. If you're of a certain age, you know what a Huey is, and with them lived the Medevac nurses that made them lifesaving. I'd look at those nurses and think, who would ever want to be a nurse?

Fast forward several years, and I'd just given birth to my first child, in a military hospital. Shortly after Sean's birth, the call to midwifery started in my ear. I didn't even know any midwives, but soon enough I was assisting an experienced Los Angeles midwife, who was the cousin of a dear childhood friend. I'd barely moved into the oil-pouring phase of apprenticeship when a birth convinced me that the path to midwifery for me was via nursing.

It wasn't the birth that was the issue, as the care given was exemplary. It was the response and threats made when we transported a baby with a condition not compatible with life. The reception the family received was so hostile I will never forget it, and afterward I helped the midwife pack her equipment to take to the home of a friend. She expected to be raided by the police. This was the early 80s, well before licensure in CA, and with a husband and a child, I wanted to be legal. That incident led me onto a new path, a path to midwifery school via nursing school.

I completed my BSN at California State University Sacramento, gave birth to Andrew and Caitlin along the way, and went to work in L&D in a large county hospital in CA. There I convinced the county to expand the existing midwifery practice to full scope and precept me in the clinic, as well as fund my training at the first distance midwifery program, Education Program Associates/San Jose State University. I later developed this into a county wide educational track for nurses to follow in my footsteps and train as nurse practitioners/midwives. In recent years, I completed my Masters degree in Midwifery at the Midwifery Institute at Philadelphia University.

Even though I decided to take the nurse path, I've always been involved in unity for midwives. I was an active member of both California Association of Midwives and California Nurse Midwives Association, working as a liaison to the boards of both during the licensed midwife practice act legislation in the 1990s, and lobbied extensively for both CNM and LM legislative efforts.

It's to this end that I feel so strongly about my role as Director of Health Policy and Advocacy, and the place of the Midwives Alliance in global midwifery. MANA began as a place of unity for all midwives and continues to hold that space today. While the MANA leadership is just as diverse now as in the early days, the membership has also grown and changed a great deal. The great majority of us are now certified or licensed in one form or another. This is the direction midwives tell us they want to go; to be recognized in their jurisdiction, able to order tests as needed, obtain and administer life saving medications, and bill for their services. We are working on your behalf in a variety of settings to help you reach your goals.

The Division of Health Policy and Advocacy

Our Division of Health Policy and Advocacy aims to make a difference in the world of maternity healthcare, working with you at the regional, national and international level. If you have a question or comment, or an idea for a collaboration or partnership, please contact me at healthpolicy@mana.org.

Some of our current collaborative work includes:

  • The US MERA collaboration is one of our priorities as we advocate for licensure of direct entry midwives in all fifty states, via a variety of training and education pathways. If you are not familiar with US MERA, read more about the inception and history here, and watch this blog for the report of our latest proceedings, soon to come. MANA is spearheading an EquityTaskForce within the US MERA coalition led by member and Access and Equity Committee advisor Indra Lusero, JD, MA, director of The Elephant Circle.
  • Working with legal organizations protecting a women's human rights; the right to birth at home, have a vaginal birth after a cesarean or avoid court ordered treatments or forced surgeries. These include Birth Rights Bar Association,whose aim is to develop a national network of lawyers who can provide legal resources to both families and midwives experiencing rights violations and National Advocates for Pregnant Women (NAPW), who fight for the personhood rights of pregnant women.
  • We participate in the Coalition for Quality Maternity Care (CQMC), most recently providing input into The Joint Commission's Perinatal Care Certification, as well as signing on in support of a variety of pieces of maternal newborn child health legislation.
  • Our longstanding membership in the International Confederation of Midwives (ICM) is crucial to remaining active in the maternity care world. We hope many of our members will join us at the next Triennial meeting in Toronto in 2017; in fact, we hope you will consider submitting an abstract to speak and represent the US at what is sure to be an exciting meeting. If you haven't been to an ICM Triennial Congress, start planning now. It is so exciting to be in the presence of thousands of other midwives from all around the world! Watch for info here as we get closer to 2017.

Additional plans for the Division of Healthy Policy and Advocacy include being available for testimony, providing policy letters for state organizations, and developing definitive policy statements and position papers.

We need you at the Midwives Alliance. Please become a member and tell us what you need and what you think. Share your ideas about policy and advocacy with me here. I look forward to hearing from you, and seeing you in person at MANA 2015!

Colleen Donovan-BatsonAbout the author

Colleen is a midwife and nurse practitioner living rurally in the mountains of far northeast WA. After years of hospital, community health center, and birth center practice, she now lives and breathes all things MANA, with a small home birth practice on the side. Colleen also tries to find time to travel to visit her children and grandchildren in far away locations.

 

President Marinah Farrell Reports From the Midwives Alliance Spring Board Meeting

Posted by Midwives Alliance on May 19th, 2015

MANA Board Spring 2015

Spring is the perfect time for renewal and budding ideas. The Midwives Alliance Board of Directors took advantage of this fertile time to hold our annual spring board meeting. Together, we narrowed down our 2015-16 initiatives, including:

  • US MERA. The United States Midwifery Education, Regulation and Association meeting was held the weekend before our Spring board meeting. Our delegates who attended came back optimistic and full of good news for the future of US MERA and collaboration between the 7 organizations. The work of coming together and finding common ground is always challenging and rewarding in equal measure, and there is still much work to be done. MANA will continue to communicate with members about our work with US MERA as we move forward.
  • Our recent decision to make the official policy of MANA to require voting members to be credentialed midwives. MANA has received a warm response to this change and a recognition that this is a celebration of the CPM, honoring the many founders of MANA and the midwives who envisioned and created a credential that would validate the apprenticeship model. MANA is deeply committed to advancing midwifery and moving the CPM forward.
  • The challenges of being a board of working midwives who volunteer by putting many unpaid hours into MANA. The joy of the Midwives Alliance is that it is based on community and grassroots work. Our founders did (and still do, many of them!) so many hours of work that we have found ourselves to be quite a force - many good things have come from MANA since we were born in 1982. We work on behalf of midwives who are an invaluable resource for our society and for change in maternity care, and we take great pride in giving of ourselves to the community. We also recognize, unfortunately, the risk of burn out. While we also recognize the privilege involved with being able to give many volunteer hours, the majority of us actually are NOT privileged enough to stop working to do full time volunteer work. And yet we truly want the voice of ALL midwives to be at the MANA table. As the Midwives Alliance faces the competition of corporate interests that may be better funded, we want to continue our work in advocating for quality research and recognition of ALL midwives. In order to do this, we truly need YOUR help.

There is an opening right now on the MANA Board of Directors! The position of Secretary will be filled by appointment as we accept letters of interest, conduct interviews and strive to find a member midwife with appropriate skills and enthusiasm for the future of the Midwives Alliance. Download the MANA Board Job Descriptions here, and contact Sarita if you are interested. 

MANA strategic directions for 2015-2017

We identified the following areas as key initiatives for the Midwives Alliance, and are working to plan the actions needed for implementation, to be initiated at our Fall 2015 board meeting in October.This is exciting work! Among the directions are:

  • The Division of Research. Funding and furthering the ability of the Research committee members in their organizational capacity. 
  • Organizational development for MANA. Reaching out to membership and working on skill-based board positions as the new board structure of MANA.
  • Professional development for our students and midwives. More webinars and conference/networking opportunities. 
  • Policy. MANA continues planning for training and outreach in the arenas of policy, advocacy, and legislation. By partnering with Elephant Circle for training in legislation and equity work and the creation of a specific board position for policy and advocacy, MANA is working on a vision for how we can better represent midwives at state and national levels and in collaborative endeavors with other organizations. 
  • Conference. MANA conferences are a touchstone for midwives. We are growing into the new age of technology and will be implementing better registration, a new director position that uniquely focuses on conference and events, and coordinated effort between all the MANA Board of Directors to make the annual MANA conferences accessible and full of opportunity (we can't wait to see you in Albuquerque in October!). 
  • Communications. MANA has a stellar communications team that wants to reach out to YOU, our members and friends, to ensure that you are always involved in our work, aware of new research or midwives in the news, and to disseminate the information of policy work or other MANA initiatives. The communications team also ensures that our Division of Research has a voice of advocacy in the face of enormous public pressure. MANA communications is doing great work.

Access and Equity - the overarching umbrella

Finally, and as we have done since MANA was envisioned in 1982, we continue discussion around the necessity of working for inclusion and equity for all midwives to feel at home as members of MANA. The MANA board has come to realize that we are finally at a place where our framework has shifted, and an understanding that social justice is not one unique place in the organization, but is the lens through which we do all of our work. It includes thoughtful consideration of how better to help midwives in states that are not legal, students who don't have access to education, midwives who are in the margins or from vulnerable populations who desire more equity in the profession of midwifery, and midwives who aren't able to make fair wages. MANA has worked hard and shifted more than we ever thought we could to make this happen. 

We are justly proud of more than 30 years of work on recognition for all midwives, with inspired midwives who grew the Midwives Alliance to this place where we can say that midwives have created innovative education and associations while protecting and promoting Normal Physiologic Birth and Breastfeeding. We continue to be innovative and progressive and stay attuned to the times. MANA has been diligently rebuilding our structure to be more efficient with our resources, to meet the needs of a younger generation that is wanting more technological access to information, to continue the data collection that is used DAILY by midwives working on legislation, to recognize that the issues of inequities in midwifery (both in access to the profession as well as the families we serve) must be addressed NOW, and also to continue to be the voice at national tables that is thoughtful to the needs of all midwives.

MANA is here to serve you, and we are tenderly reaching out in the spirit of unity and friendship. As the current President of the Midwives Alliance I reaffirm our commitment to you, and ask that you consider joining MANA in our efforts – join as a member, join the board, our committees, volunteer or intern with us. I hope that you will support the initiatives you care about the most in whatever way you can, and in particular recognize that our Division of Research needs your support to continue their dedicated work in data collection and compelling research. As more and more midwives participate in MANA Stats and other organizations wish to collaborate on larger data collectives, I must appeal for your generosity on behalf of MANA's Division of Research to meet the goal of expanding their capacity so that midwives can continue to prove their competence and expertise in natural birth. Please send a donation earmarked for the DOR today.

Thank you for your friendship. With your help we will continue the work of research and advocacy for Every Midwife.

The Midwives Alliance: Unifying Midwives since 1982.

Thank you,

Marinah Farrell

Marinah FarrellAbout the author

Marinah Farrell is a CPM in Phoenix Arizona working in homebirth and birth center practices. She is recognized for her work in public health issues, is a founding member of Phoenix Allies for Community Health, a free clinic in downtown Phoenix, and participates as a human rights activist both in the US and internationally. Marinah is in her first term as MANA President.

Maryland Passes Bill to Increase Access to Home Birth Midwives

Posted by Midwives Alliance on May 18th, 2015

Maryland Midwifery Supporters

(Photo Credit: AIMM)

Becomes 29th state to license and legalize Certified Professional Midwives

Baltimore, MD: On May 12th Maryland's Governor Hogan signed a bill that will license and legalize Certified Professional Midwives, specialists in out-of-hospital birth. The bill is the result of a growing movement of women and families that are calling for greater access to midwifery care at home and in birth centers. Maryland is now the 29th state to license Certified Professional Midwives (CPMs), recognizing the increased need for out-of-hospital care providers in the U.S.

The rate of out-of-hospital birth increased nationwide by almost 60% between 2004 and 2012, according to CDC data. Despite the growing demand, ongoing restrictions on midwifery care options limit the ability of families to decide where, how and with whom to give birth. With the passage of this bill, Maryland joins other states in beginning to open up greater reproductive choice during pregnancy and birth.

Alexa Richardson, President of the Association of Independent Midwives of Maryland (AIMM) which has been working to pass Maryland's bill, says that "Midwifery care at home marks a dramatic departure from the hospital birth experience. In spite of the barriers, more and more women are choosing to birth in settings that offer low rates of intervention and greater autonomy during birth."

The bill, sponsored by Delegate Ariana Kelly and State Senator Mac Middleton, set specific standards for professional education, scope and transfer, and allows for increased collaboration by midwives with physicians, hospitals, and other healthcare providers. Advocates say the new law will now facilitate safer and more transparent care for women and families who choose home birth.

However, Maryland still has work to do to ensure safety and access for all women and families during the birthing process. Out-of-hospital birth is still not covered by most medical insurance plans and remains too costly for many who desire this kind of care. Additionally, women desiring home births who have had previous cesareans are barred from Certified Professional Midwife care under the new law.

The advocacy groups in Maryland will pursue further legislation to ensure access to out-of-hospital birthing care to those with previous cesareans and for families who cannot pay out of pocket for health care.

What Is a Poster Presentation?

Posted by Midwives Alliance on May 18th, 2015

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Please consider sharing your area of expertise or a research project that would be of interest to midwives and others involved in birth with MANA conference attendees by submitting a poster!

The Midwives Alliance welcomes submissions of research posters from students and professional researchers. Here's what we mean when we talk about "poster presentations." A poster is created by someone with information to share—for example, preliminary or final results from a research project, a review of best practices for a maternal-child health issue, a history of an outreach project or initiative, or a summary of the evidence on a particular clinical intervention. Posters are usually big! Standard size is 4 feet wide by 3 feet tall. We provide tips and guidelines for making your poster. Posters often look like this:

From the University of Wisconsin-Madison’s Department of Kinesiology; poster by Sarah Delany

Posters are displayed at the conference for attendees to peruse at their leisure, but the conference schedule will also include a time when poster authors are asked to be by their posters to answer questions and interact with readers. That's the "presentation" part of the conference's poster track, and can be a great time to share your enthusiasm and expertise, gain support for an initiative, or get feedback on your project.

Here's a picture of what a poster-presentation session can look like (at a chemistry conference):

From the University of Virginia's Department of Chemistry

If you have a project or information you would like to share, consider submitting a poster to this year's conference. And as of 2014, the Midwives Alliance gives awards for the best poster presentation in each of two categories: student/apprentice poster and graduate/professional researcher poster. Having a poster accepted for presentation is a form of publication. The presenter can add this honor to their CV. See below for details of how to submit.

In the student/apprentice category, the winner will receive a free year of membership to MANA, and the student's advisor and school or preceptor and program will also be recognized.

In the graduate/professional research category, the winner will receive a 30-minute phone consultation on the winning research project with experienced researcher Melissa Cheyney, PhD, CPM, Chair of the MANA Division of Research Coordinating Council and Assistant Professor, Oregon State University Department of Anthropology.

Many people provide guidance on how to create an effective poster. Here are a few resources besides our tips document:

Designing Conference Posters by Colin Purrington

How to Create a Research Poster by the NYU Libraries

Your poster can be created specifically for the conference or a be poster you have already presented for a different purpose. If you are attending the conference this fall, make sure to check out the posters and see what you can learn. Perhaps you will be inspired to create one of your own to submit next year!

Download the MANA 2015 Poster Application.pdf (PDF)
Download the MANA 2015 Poster Tips & Guidelines.pdf (PDF)
About the author

Ellen Harris-Braun, CPM, is the Director of Database Development for the Midwives Alliance Division of Research, and 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.

What Defines a Midwife: The MANA Perspective

Posted by Midwives Alliance on May 7th, 2015

Together with the world, Midwives Alliance of North America (MANA) celebrates the arrival of a new royal baby girl for the Duke and Duchess of Cambridge. While most news reports shared the names of the medical team, the reality is the baby was born into the hands of a midwife. In fact, Kate, The Duchess of Cambridge, was cared for by a pair of midwives, in a health system where midwifery led practice is the standard of care.

Last week, here in the United States, Midwives Alliance was encouraged by the new policy statement issued by American College of Obstetricians and Gynecologists (ACOG) entitled: ACOG Endorses the International Confederation of Midwives Standards for Midwifery Education, Training, Licensure And Regulation. This document, a companion piece to another 2015 consensus document, entitled Levels of Maternal Care, was prepared by ACOG and the Society for Maternal and Fetal Medicine. With this endorsement, ACOG endorses the ICM education and training standards and strongly advocates the ICM criteria as a baseline for midwife licensure in the United States, through legislation and regulation.

As an International Confederation of Midwives (ICM) membership association since 1984, MANA has been an active participant in the development of all the ICM Global Standards, including the three pillars of Education, Regulation and Member Association, with the intention to "strengthen midwifery worldwide in order to provide high quality, evidence-based health services for women, newborns, and childbearing families." MANA also helped to develop and officially recognizes the ICM International Definition of the Midwife.

Midwives Alliance acknowledges multiple learning styles, and values numerous training pathways, including the experiential education model recognized by the ICM emphasis on competency based education. We are proud to be working in collaboration with other national organizations to develop methods of accrediting direct assessment of student knowledge and learning. We support CPM licensure in all 50 states.

As the US struggles with a rising maternal mortality rate, the highest in the developed world and nearly three times that of the United Kingdom, we might consider that midwives attend 80% of births there, with obstetric care reserved for high-risk specialty cases. Midwife led care is the standard in Britain for all, including members of the royal family. When Prince William presented Royal College of Midwives President Lesley Page with the Commander of the British Empire (CBE) award in 2014, he made it clear to her that he knew about the role and the value of the midwife. Those values were put into practice when his wife Kate, the Duchess of Cambridge, gave birth to both of their children with the care of midwives.

 

About the author

Colleen Donovan-Batson, MS, CNM is the MANA Director of Health Policy & Advocacy.

 

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