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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.


New report recommendations point to midwifery care as optimal maternity care

Posted by Midwives Alliance on January 14th, 2015

Midwives have long been the guardians of normal physiologic birth, recognizing that labor often does not progress as efficiently and safely when interrupted by routine procedures or unnecessary interventions. Recent maternity care discussions within the professions and in the media have revolved around the benefits for mother and baby of allowing normal labor to progress on its own as safest and most conducive to satisfaction, bonding, breastfeeding and neurological development of the newborn. A new report from Childbirth Connections goes in depth to identify the hormonal processes that are critical not only to reproductive success but to long-term health of mother and baby. Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care provides compelling evidence that unnecessary medical interventions disturb these hormonal processes, reducing the benefits of physiologic pathways and creating new health challenges for mothers and newborns. Author Sarah Buckley describes the science of these innate hormonal systems that promote fetal readiness for birth, encourage safe and effective labor, reduce stress and pain, facilitate newborn and maternal transitions and adaptations, and optimize bonding and breastfeeding, among many effects. She discusses how routine procedures and medical interventions can interrupt and disrupt healthy labor and birth.

The report emphasizes the impact of how maternity care is delivered and makes concrete recommendations for improving care while still maintaining safety. Examining the recommendations closely reveals how appropriately midwives provide care and how support of physiologic birth is inherent to their practice. These recommendations, all components of midwifery care, include:

1. Provide education during pregnancy that builds women's confidence in their ability to labor and give birth without medical intervention that can pose additional risks.

2. Foster physiologic birth and safely limit maternity care interventions

3. Inform women about physiologic birth and involve them in their own care.

4. Limit routine practices and interventions to those that have proven benefits.

5. Provide prenatal care that reduces stress and anxiety

6. Foster privacy and reduce stress and anxiety during labor.

7. Employ non-pharmacological comfort measures for pain relief.

8. Provide continuous support during labor.

9. Facilitate spontaneous vaginal birth and immediate skin-to-skin contact between mother and newborn.

Clearly, all of us can use the revelations in this report to better understand the impacts of our care and as midwives reassess our practices accordingly. Midwives have the knowledge, training and experience to support physiologic birth and have developed care models and practices around providing information, reducing stress, building confidence, allowing nature to take its time, and promoting healthy biologic processes and innate hormonal systems that this report shows are essential elements in the health and well-being of mothers and babies and families. What we now know from Unnatural Causes: "When the Bough Breaks" is that the stress hormones in pregnant women of color caused by the stress of daily engagements with racism may contribute to more complicated pregnancies and births, including prematurity and increased mortality and morbidity. The Buckley report's new information on the hormonal physiology of birth makes an even clearer case for the importance of access to culturally competent midwifery care for women of color as a way to address the disturbing and unacceptable disparity in outcomes for mothers and babies of color. Every woman deserves a midwife.

Take a look at the MANA Homebirth Position Paper that outlines the values that guide the practice of homebirth midwifery.


About the author

Jill Breen, CPM, CLC, has been serving women, babies and families for 36 years as a homebirth midwife and natural family health consultant in central Maine. She has 6 children and 8 grandchildren, all born into the hands of midwives including her own. She has served MANA in several capacities, most recently as President , and is currently Communications Chair. She is a member of the Home Birth Summit Collaboration Taskforce.



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