Skip to main content

Update from the States: Massachusetts

Posted by Midwives Alliance on April 9th, 2015

Topics  

Guest Author: Sarah Whedon, Ph.D

Here in Massachusetts, midwifery supporters have been working for many years to pass a bill that would license Certified Professional Midwives (CPMs). We believe we now have a real shot at passing the bill into law in the current legislative session.

This January we re-filed the bill, An Act Relative To Certified Professional Midwives (SB 1825/HB 2941), sponsored by Representative Kay Khan and Senator Anne Gobi. If passed into law, the legislation would:

  • require all midwives practicing out-of-hospital to be CPMs;
  • create state licensing requirements for CPMs;
  • establish a Committee on Midwifery to issue CPM licenses and regulate CPM practice.

Currently, Massachusetts regulates only Certified Nurse Midwives (CNMs), who do not attend homebirths here. There is no state oversight of CPMs, who provide out-of-hospital care to approximately 500 women and their families across the state each year, a number that is growing annually.

Representative Khan, the House sponsor of the bill has said, "It is critical for the future of maternal health care that we establish oversight for the homebirth midwives practicing in the Commonwealth. Not only will it ensure accountability and offer families secure options for choosing to deliver their child at home, but it will reduce medical costs, promote collaboration among healthcare professionals, and improve public safety for consumers."

Although the bill was originally drafted in 1998 by supporters of Massachusetts CPMs, they quickly formed a coalition with CNMs to advocate for the midwifery legislation. That coalition operated for more than a decade until, for both administrative and policy reasons, the formal coalition was dissolved in 2010 and the bill was cleaved into two, one that would regulate the practice of CPMs and the other which expanded the scope of practice for CNMs. The CNM bill passed in 2012, freeing CNMs from a requirement to work under a supervising physician and allowing them to both write prescriptions and order tests.

The CPM bill has been reintroduced into the Massachusetts legislature multiple times, working its way through various committees. During this time, it has the gained the support of powerful consumer organizations like the Massachusetts ACLU, Amnesty International, Massachusetts NOW, Mass Friends of Midwives, Massachusetts League of Women Voters, Our Bodies Ourselves, and the Massachusetts' Women's Bar Association. However, due to pressure from powerful medical organizations, the bill has been stalled each time.

Judy Norsigian, who for many years was executive director of Our Bodies, Ourselves, wrote to debunk myths about the midwifery bill perpetrated by medical dissenters. She asserted that, "failure to license CPMs will make the several hundred home births that occur in Massachusetts every year less safe by failing to create an integrated maternal health care system with enhanced collaboration among all care providers. This bill would affirm that all Massachusetts maternal health care providers are committed to practicing with state oversight and public accountability."

Massachusetts Midwives Alliance and Massachusetts Friends of Midwives continue to collaborate on advocating for the bill. We recently received the good news that Rep. Jeffrey Sanchez will now be the House Chair of the Health Care Financing Committee and Rep. Kate Hogan will be the new House Chair of the Public Health Committee. Both have been supporters of the midwifery bill during prior sessions and have indicated an ongoing commitment to advance this legislation. We congratulate Reps. Sanchez and Hogan in their new leadership roles and look forward to working with them on An Act Relative To Certified Professional Midwifery.

We are hopeful that this session will be the one in which Massachusetts formally recognizes the vital role of Certified Professional Midwives in providing broader birth options for low-risk birthing families.

For more information and to get involved please contact:

Audra Karp, Mass. Midwives Alliance, 617-522-8383

Ann Sweeney, Mass. Friends of Midwives, 617-254-6175/617-901-2777

Follow along with the bill's progress on Facebook and Twitter.

The history of this bill is drawn from an unpublished paper by Molly J. Lawney, "Massachusetts: 'An Act Relative To Certified Professional Midwives'" March 18, 2013.

 

About the author

Sarah Whedon, Ph.D, is a homebirth mom who serves as co-director of the Boston Doula Project and managing editor of Pagan Families.

Update from the States: California

Posted by Midwives Alliance on March 24th, 2015

Topics  

California midwives are going to the legislature with three midwifery bills this session. California Association of Midwives (CAM) and California Nurse Midwives Association (CNMA) have each sponsored legislation that will increase access to midwifery care for the families of California.

New California Legislation: Expanding Access To Midwifery Care Through Medi-Cal

California Senate Bill 407 will, if passed, authorize California Department of Health Care Services to recognize licensed midwives as providers in the Comprehensive Perinatal Services Program (CPSP). This is a critical step towards Medi-Cal coverage for licensed midwives in California. SB 407, sponsored by CAM, will add licensed midwives to the list of qualified Comprehensive Perinatal Service Program providers under Medi-Cal, further expanding access to community-based midwifery care in all settings for all women and families in California. The Comprehensive Perinatal Services Program (CPSP) provides educational, nutritional, and psychosocial support to pregnant women, as well as childbirth and breastfeeding education, services already provided within the scope of LM practice and fully in line with the midwifery model of care.

The Comprehensive Perinatal Services Program became a Medi-Cal benefit in 1987. Licensed midwives are not currently, but should be, recognized as eligible providers of these benefits, which fall squarely within their scope of practice. The passage of this bill would allow licensed midwives who work in clinics providing CPSP services to bill Medi- Cal.

This bill is a part of a larger legislative strategy spearheaded by the California Association of Midwives (CAM). "All women in California deserve to be able to choose midwifery care," said Sarah Davis, LM "Our goal is to expand the option of midwifery care to all women in California by making care with licensed midwives Medi-Cal eligible."

If passed SB 408 will expand midwifery care – particularly in rural and other underserved areas – by allowing 'midwife assistants' to legally assist licensed midwives at out-of-hospital births. Typically, two providers attend each birth, but licensed midwives are scarce in some areas of the state. This bill would allow a specially trained 'midwife assistant' to legally assist a licensed midwife, expanding the reach of existing providers.

California Assembly Bill 1306 removes physician supervision from the law governing CNM practice. It also authorizes a certified nurse-midwife to manage a full range of primary health care services for women from adolescence beyond menopause in all settings, including, but not limited to, a home, without direct supervision of a physician. The bill, sponsored by CNMA, would provide for consultation, collaboration, or referral as indicated by the health status of the client and the resources of the medical personnel available in the setting of care, and would provide that the practice of nurse-midwifery emphasizes informed consent, preventive care and early detection and referral of complications to a physician and surgeon. This bill would authorize a certified nurse-midwife to provide peripartum care in an out-of-hospital setting to low-risk women with uncomplicated singleton-term pregnancies who are expected to have uncomplicated birth. It would also allow nurse- midwives to furnish medications and devices within the scope of her practice, and to make repairs of the perineum for 1st and 2 degree lacerations.

Regulatory Process Still Underway

Physician supervision is no longer required for licensed midwives, thanks to the passage of California bill AB1308 in 2013. That bill also called for a number of changes to be determined through regulation (as opposed to legislation). CAM, alongside the consumer group California Families for Access to Midwifery (CFAM) have been participating in the regulatory process.

The new regulations dictate a physician referral for preexisting maternal diseases or conditions likely to affect a pregnancy and significant diseases arising from pregnancy. At issue is the complete list of those conditions. The regulation has been the source of some confusion (it calls for exams, not a required transfer of care to a physician). It has also sparked concern, particularly from consumers concerned that a physician may be unwilling to address their desire for a home birth with a licensed midwife.

"Consumers of California want the option of using a midwife, either at home for birth or in clinics, birth centers and hospitals. California Families for Access to Midwifery is very excited to support the three midwifery bills introduced to our legislators! We were a part of the process from the passage of AB1308 (the removal of physician supervison for LMs), to the regulatory process, and now we are supporting SB 407 and 408 and again supporting the removal of physician supervision from the nurse midwives of California AB 1306. " -Tanya Smith-Johnson President CFAM

To keep up-to-date with changes in California, visit CAM's website here and CFAM's website here.

About the author

Sarah Davis, LM, IBCLC, is the Policy Chair of California Association of Midwives and a midwifery advocate in San Diego, California. She has practiced in home, birth center, and clinic settings and is the mother of an amazing 2 1/2 year old.

Our Treasurer Midwifes MANA

Posted by Midwives Alliance on March 23rd, 2015

MANA Treasurer Vicki Hedley shares her background and her passion for The Midwives Alliance, our mission, health and growth

I live in Montvale, NJ and have a busy homebirth practice. I have five children ranging in age from 32 down to 13. I also have two grandchildren, whom I had the privilege to receive into my hands in October of 2012 and October of 2014. I have been attending births since 1996, first as a doula, doula trainer, and childbirth educator, and since 2008 as a CPM when I graduated from the National College of Midwifery. In 2010 I also became a CM. My learning occurred through the apprenticeship model in many different settings with beautiful and wise midwives who taught the art of midwifery through their example. I continue the tradition of mentoring others through study groups and apprenticeship. Midwifery is the most difficult and the most rewarding work I have ever done, and I am honored to have the title "midwife".

Before becoming a midwife I had a private accounting practice for sixteen years. I feel as if I midwifed my clients through the stresses of finances and taxes. I have been a member of MANA since 1999, many years before becoming a midwife. MANA has been the home for all midwives for over 30 years, the mother of the CPM and NARM, and an organization with integrity that I have great respect for. I have served on the Board of Directors as treasurer for nearly two years. I have a feeling there aren't too many midwife/accountants out there, so it seems that I am a good fit for the job. It is a challenge working with a small budget, but we spend our money wisely, always thinking of our membership and how you would benefit most from the available dollars.

I see my role as treasurer as more than just a number cruncher. There is certainly importance in the day-to-day bookkeeping that is required to run our operation; but the treasurer is involved in virtually every aspect of the organization. I oversee conference finances, create budgets, work closely with the Division of Research helping them with their finances, assist in writing grants, and work very hard to strategize ways of increasing our income. Our membership is our most valuable asset. It is you, the members of MANA who keep the operation going. Grants are not used for operations, so we count on your membership dollars to pay for all things operations such as upkeep on our websites, our wonderful conference coordinator, our amazing membership support staff, communications, and more. Without you we could not do the important work that we do.

With your help we can achieve our goals:

  • To engage midwives in dialog and to encourage solidarity across North America
  • To recognize the diversity among midwives and to foster inclusive community building
  • To build an identity as a cohesive organization representing the profession as well as the tradition of midwifery at regional, national and international levels
  • To position midwives as acknowledged authorities, working to improve perinatal health in collaboration with other professionals
  • To collect and disseminate high quality research about midwifery care
  • To promote excellence in midwifery practice
  • To sponsor continuing education opportunities for midwives
  • To increase access to midwives in all settings
  • To endorse the Midwives Model of Care™ as the gold standard for childbirth
  • To affirm the rights of pregnant women to give birth where and with whom they choose

The Midwives Alliance promotes professional development and continuing education of midwives so all women and babies will have access to practitioners who can provide excellent prenatal care, safe and empowering births, comprehensive postpartum care, and privacy during the critically important bonding period of mother-infant attachment.

Thank you for the privilege of serving on your Board of Directors. I look forward to seeing you in Albuquerque in October for our annual conference. Contact me at treasurer@mana.org.

About the author

Vicki Hedley, CPM, CM, is a mother, grandmother and midwife in Montvale, NJ.

Update from the States: Wisconsin

Posted by Midwives Alliance on March 10th, 2015

As a part of our new "Update from the States" series, we asked Marijke van Roojen, president of the Wisconsin Guild of Midwives, to catch us up on the current activities of the midwifery community in this progressive midwestern state. Read on to learn about their current initiatives:

Wisconsin Guild of Midwives Current Initiatives (WGOM)

WGOM has once again had a busy year. Our vibrant membership of midwives and student midwives meet 5 times a year and in addition to sustaining private midwifery practices across the state, we are engaged in various public health efforts in collaboration with community, state and university partners.

The Wisconsin Guild of Midwives Doula Project

In November 2014, with support from the March of Dimes and many community partners, WGOM hosted the ICTC Full Circle Doula training in Milwaukee, offering full and partial scholarships to 18 women of color from our state. These women are now in the process of forming 2 regional doula collectives to serve Milwaukee and Dane Counties. The project is designed to build mother mentorship networks and to increase access to culturally concordant and relevant birth services in order to reduce adverse birth outcomes in the African American communities in our state. This training and the empowerment of women exposed to this model of care introduces families to alternatives in childbirth and parenting, teaches self and community advocacy to reduce unnecessary interventions in birth, promotes earlier entry into services including midwifery care, builds provider-client trust, and profoundly impacts the life course of these women and their children. WGOM also intends to use this training to establish a culturally-accessible, low-cost route of entry to a midwifery model of birth work, laying the groundwork for women of color to consider midwifery as a profession and to be fully supported in that choice.

MEAC Accreditation

The direct-entry midwifery program at South West Technical College in Fennimore WI, under the able leadership of Ms. Sherry DeVries, CPM, LM, CNM, MSN, became MEAC accredited in September 2014. There are two tracks - one for the student midwife and the other for the CPM seeking a degree in Direct Entry Midwifery. The CPM bridge program is an abbreviated program and the candidate receives advanced standing for work accomplished because of the previously earned CPM credential. Congratulations to Ms. DeVries, program coordinator and instructor, and SWTC!!

Newborn Screening Program

Gretchen Spicer, LM, CPM has been hired by the State of Wisconsin to provide Newborn Screening education and services to the OOH population in our state. She writes:

"Thanks to a wonderful collaboration built by many people over the last 12 years, Wisconsin has one of the highest rates of newborn screening in out of hospital deliveries in the nation. Nearly all the babies delivered by Licensed Midwives in Wisconsin get blood and heart screening in the first 24 to 48 hours of life and hearing screening within the first month of life. Wisconsin Sound Beginnings (WSB) provided grant funding for the purchase of 11 OAE hearing screeners that are shared by midwives in each geographic area. The Wisconsin SHINE (Screening Hearts in Newborns) project included Licensed Midwives in their pilot project for screening newborns for Critical Congenital Heart Disease (CCHD). The SHINE project has placed 80 pulse oximeters in OOH practice settings and has provided extensive training and support for midwives as they began pulse oximeter screening."

About the author

Marijke van Roojen, LM, CPM, MPH, President, Wisconsin Guild of Midwives, has dedicated her professional life to two disciplines: maternal child health with an emphasis on the social determinants of health, and community-based mediation, restorative justice and the field of Alternative Dispute Resolution. She currently resides near Green Bay, Wisconsin with her family, is an AAP/AHA Neonatal Resuscitation Instructor and is semi-retired as a midwife in private practice with BirthWise Health and Birth Center. As an MPH in Maternal Child Health and a License Midwife with 28 years of experience in private midwifery practice, Ms. van Roojen has served on numerous oversight committees, advocacy organizations and boards, representing direct-entry midwifery at the local, state, national and international levels.

Connect With MANA: Vice President's Address

Posted by Midwives Alliance on February 18th, 2015

Topics  

MANA Vice President Sarita Bennett, DO, CPM, shares with us her role on the board of the Midwives Alliance, her priorities for 2015, and ways to deepen your involvement at MANA.

As the vice president, my job is often very fluid and calls for being willing to do whatever needs done. I strive to keep an eye on the general board work and have at least some understanding of the many projects that are in process. At the same time I look for opportunities to hear what members and midwives are saying "on the ground." Through the last 3+ years on the board, my phone contact list has filled with what looks like a huge family – all with the last name MANA!

Have a question about MANA? Contact me!

I receive all of the emails to info@mana.org including communications from midwives, students, potential students and consumers. My goal: respond within 24-48 hours. Consumers are usually looking for midwifery services and I refer them immediately to the "Find a Midwife" feature on our consumer site, www.mothersnaturally.org. MANA members: be sure to opt in to this excellent benefit by making sure your membership is current and your information is accurate.

Mother's Naturally: What Would You Like Changed?

In 2015, I will be working with a team to update this website so that midwives can feel confident recommending it to their clients. It has the potential to be a great resource and just needs a little TLC. Please take a moment to look at the current website and give us feedback for what you would like to see. I'm the one who receives the info@mothersnaturally.org emails, too!

Tap into the resources the MANA website has to offer!

Have you looked at the MANA website (www.mana.org) lately? I am amazed at the vast amount of information and resources contained there. I encourage each of you to take some time to look through it and get a sense of the family of volunteers and staff that keep this organization on track and of the tremendous amount of work that has been done through the years to define and support the midwifery profession. As you explore, think about what could be updated or added to make the website an even stronger benefit to members. Some ideas we are looking at include a members only "classified ads" page where not only books and equipment can be advertised but also opportunities for apprenticeships and employment. Again, let me know what would serve you and ways you might be willing to get involved.

Deepen your connection to MANA

Did I say "willing to get involved"? One of the MANA Board's most important responsibilities in 2015 is looking for innovative – and fun! - ways to raise funds to support the Division of Research. The work of the DOR benefits us all as the MANA Statistics Project produces the evidence needed to support the wisdom of physiologic birth and midwifery care. These benefits range from the ability to provide improved care to the ability to affect policy. This dedicated team of professionals has worked for many years on a shoestring budget and now are standing on the edge of the potential for huge growth. But the DOR can't grow without funds. If you are willing to help, please contact me asap at vp@mana.org. We need you!

Free Membership For New Midwives

If you are a newly credentialed midwife or soon-to-be-credentialed midwife, don't forget to sign up for MANA's free one year membership honoring you and the hard work you have put in to achieve your goals. You are the future of the profession and we want you to know that you matter to MANA.

Thanks to Face of Birth

I want to take this opportunity to thank the producers of the amazing new video "The Face of Birth" for their generosity in supporting MANA. If you haven't had a chance to watch it, please do. Please visit and Like their Facebook page, too. To get a deeper feel for the passion behind the film, you can check out the blog on the MANA website that features an interview I did with one of the producers, Gavin Banks. The film was screened on the first night of our conference in St. Louis last fall, and shown again later in the weekend in response to many requests.

Join Us In Albuquerque!

Even though October seems far away during this long winter, the MANA 2015 conference is already taking shape. Abstracts are coming in and ideas are brewing. Make sure you find a way to join us in New Mexico!

Thank you for your midwifery passion and your dedication to families. And, thank you for your support of MANA - where all midwives matter. Feel free to contact me - in person at the conference, or by email vp@mana.org - with your ideas and visions for MANA.

 

About the author

Sarita Bennett, DO, CPM, grew up in a rural mountain culture that valued self-reliance and in which home birth was the norm. In the early 1980’s, she joined with other young midwives in her state to support one another and find sisterhood as they developed standards of care, risk factor guidelines and a well-honed peer review process. In 1994, Sarita found herself answering another calling and began her Osteopathic education at the West Virginia School of Osteopathic Medicine. In 2001, she returned to her rural home town, providing home birth and general family practice until 2013, when she relocated to begin a new adventure. Along with her passion for midwifery, she discovered her gift for mentoring and is actively involved in educating future midwives through The Academy of Experiential Midwifery Education. Sarita served as secretary for the MANA Board of Directors from October 2011 until being elected as vice president in 2014.