MANA Position Statements

Access to Midwifery Care

Approved May 1994

Access to affordable, community-based midwifery care is the right of every pregnant woman

The Midwives’ Alliance of North America holds the position that appropriate, accessible maternity care contributes to the health of mothers and babies and facilitates the birth process. MANA recognizes that each birthing woman has individual needs, and further recognizes her right to select the care provider and setting for birth that best fits those needs.

In keeping with this position, MANA:

  • Addresses barriers to midwifery care such as: legality of practitioners, insurance reimbursement policies, geographic distribution of care givers, and scarcity of educational routes into midwifery
  • Supports the establishment of a primary maternity care systems which offers a variety of options in prenatal care and birth settings and in choice of care givers

Midwifery Certification

Approved May 1994

The Midwives’ Alliance of North America acknowledges all midwives who, with or without formal credentials, offer midwifery services to childbearing women.

In keeping with this belief, MANA:

  • Acknowledges that formal validation processes which test midwifery knowledge and skills can be useful measures of one’s accomplishments in educational endeavors 
  • Supports activities such as the development of examinations and ongoing certification processes relevant to midwifery practice
  • Recognizes that no exam or certification can assure quality of practice or accurately measure a midwife’s experience and intuitive understanding of the art of midwifery; and therefore
  • Encourages the use of informed consent, which allows each woman, within her community, to choose the practitioner who best meets her individual needs

National health Policy

Approved May 1994

The Midwives’ Alliance of North America holds the position that midwifery must be the central component in a primary maternity care system. National Health Policy should promote midwifery as a profession independent from both nursing and obstetrics by supporting the training, legalization, and reimbursement of all midwives. Such policy should encourage collaborative relationships between physicians, midwives, and social service agencies as part of a comprehensive program of care during the childbearing year.

MANA asserts that a national health policy fully incorporating midwifery will:

  • Allow for the use of the appropriate level of care provider for services needed, thus freeing specialists for use in high-risk settings  
  • Promote the allocation of resources towards measures which support the basic needs of women and their babies, while reducing the over-use of expensive obstetric technology; and guarantee access to midwifery care for all women

The Decriminalization of Midwifery

Approved May 1994

The Midwives’ Alliance of North America holds the position that the practice of midwifery is not a criminal offense and that midwifery practice is not the practice of medicine.

In keeping with this position, MANA:

  • Supports the passage of legislation which insures that the rights of women and midwives are preserved
  • Supports the right of midwives from diverse educational backgrounds to practice in the setting of their choice
  • Supports the right of all women to choose their care givers and where they will receive care

Any effort to separate the midwife who wishes to serve from the women who seek her care is detrimental to the community. The Midwives’ Alliance of North America calls for the immediate decriminalization of all midwifery practice.

Intervention in Childbirth

Approved May 1994

The Midwives’ Alliance of North America’s position if that childbirth is a normal physiological process as well as a social event in the life of a woman and her family.

Intervention in the process and the application of technology are potentially harmful and are therefore only justified when their use can be shown to enhance well being and improve outcome for a particular mother and her baby.

In keeping with this position, the midwife will:

  • Promote childbirth practices which enhance the normal physiological process
  • Promote the allocation of resources towards measures which support the basic needs of women and their babies as a priority, such as improved nutrition and social support during pregnancy
  • Continuously evaluate intervention and the use of technology in midwifery practice and take measures to avoid unnecessary interference; and provide information to women and their families which enhances the understanding of birth as a normal life process and enables them to make informed decisions


The Midwifery Relationship With Women

Approved May 1994

The Midwives’ Alliance of North America recognizes that midwives work in partnership with childbearing women. In this relationship, women retain the responsibility for decision- making with regard to themselves and their babies.

MANA therefore holds the position that:

  • Midwifery practice should be responsive to the needs of women in society
  • The collaborative relationship between midwives and the women they serve should be reflected in midwifery legislation
  • Childbearing women should be involved in the development and maintenance of midwifery policies
  • MANA will continue to encourage childbearing women to participate in the activities of the organization as well as in local midwifery associations


Policy Making and Resource Allocation

Approved May 1994

The Midwives’ Alliance of North America asserts that midwives; through their close association with women and their families, are in a unique position to respond to women’s health care needs and to define the resources required to provide appropriate services. MANA further believes that all women have the right of access to midwifery care.

In keeping with this conviction, midwives should:

  • Liaise with governments, non-governmental organizations and other agencies to support the provision of effective maternal/child health care services and the equitable distribution of human and material resources 
  • Participate in the formulation of policy decisions which affect midwifery practice or education
  • Participate in the evaluation of available maternal/child health care services and make recommendations as necessary to improve maternal and/or neonatal outcomes

Third-Party Reimbursement

Approved May 1994

Midwifery care is the most appropriate and cost-effective care for the majority of pregnant women.

In light of this, the Midwives’ Alliance of North America recommends that:

  • All insurance companies, including all state, provincial and federal assistance programs and all health reform legislation, recognize direct-entry midwives for third-party reimbursement
  • Insurance coverage include prenatal care and births in all settings (hospital, birth center and home)
  • Third-party reimbursement should be reflective of the time invested by midwives in individualized care

Midwifery Education

Approved May 1997

Access to midwifery education ultimately determines the midwives of the future. In order to best serve the needs of all childbearing women, the midwifery profession should reflect the racial, ethnic and cultural diversity of North America. MANA believes that multiple educational routes that result in competent midwifery practice are the best way to assure this diversity.

The Midwives’ Alliance of North America has a vision of midwifery education that:

  • Supports educational processes that culminate in midwifery competency and promote the Midwifery Model of Care
  • Supports the use of the “MANA Core Competencies for Midwifery Practice” as the foundation for midwifery education curricula
  • Embraces multiple educational routes of entry into the profession of midwifery including institutionally-based programs, university-based programs, at-a-distance learning, and apprenticeship
  • Encourages the development of accessible routes of entry to midwifery education
  • Affirms that experienced midwives should be the primary educators of midwives
  • Supports midwifery education that includes extensive and varied clinical experiences as an integral part of the learning process
  • Supports credentialing mechanisms which validate the knowledge, skills, and experience essential for competent midwifery practice

Downloadable File: 

PDF iconMANAPositionStatementsExceptHB.pdf

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