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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.