A New Life For Midwifery Care

Amie Newman

The Big Push for Midwives campaign seeks to integrate midwifery care into the health care systems of the United States. Activists are pushing against a strong, well-funded medical lobby that has a professional interest in keeping midwives marginalized.

The Big Push for Midwives campaign, launched last week, has some simple yet ambitious goals:

"Our goals are to fully integrate the Midwives Model of Care into the health care systems of our states, to highlight the importance of family healthcare choices and to defend the ability of CPMs [Ed. Note: CPM stands for Certified Professional Midwifery] to provide legal and safe prenatal, birth and postpartum care to families in every state."

Hmmm. Sounds like reproductive justice to me. Substitute "abortion access" for "Midwives Model of Care" , "abortion providers" for "CPMs" , and "abortion care" for "prenatal, birth and postpartum care" and you can see how the underlying issues are essentially the same whether you're talking about abortion rights or childbirth choices.

That is, whether we're talking about provider choices for childbirth or access to abortion, it is not too much to ask that wherever women live in this nation, the options for reproductive healthcare are not effectively criminalized in some states and legal in others.

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We may not be there quite yet but The Big Push for Midwives has found a great place to start in advocating for legal certified midwifery throughout the nation.

Jennifer Block, author of Pushed: The Painful Truth About Childbirth and Modern Maternity Care, has this to say about the campaign:

"Nevermind that you haven't heard the candidates debating a woman's "right to choose" where, how, and with whom she gives birth. Activists are thrusting the issue onto the political agenda anyway, from all sides of the ideological spectrum. Last week in Chicago, a nonpartisan coalition of consumer advocates launched The Big Push for Midwives campaign to license certified professional midwives in every state. Currently these trained midwives, whose competency in caring for normal birth is supported by rigorous study, cannot obtain a license in several states, which forces them to practice underground, which isn't good for anybody.

These activists are pushing against a strong, well-funded medical lobby that has a professional interest in keeping midwives marginalized – most recently this lobby flexed its muscle in Missouri, the only state where midwifery is a felony. But the research data, as well as other countries that are caring for women and babies better than we are, show that midwives should be supporting normal labor and deliveries (the majority), while MDs should be caring for the complications, emergencies, and women with risk factors. This "division of labor" also happens to be far more cost-effective than our current system, which bleeds more cash for less care than any other in the world. The bottom line from a public health perspective: home-birth midwives should be legitimate care providers, not criminals."

Why the need for such an active "push" across the country? CPMs are being strong-armed by a major mainstream medical group seeking to actively stop them from practicing the care that's been shown to improve maternal and newborn outcomes in the United States.

In 2005, the American Medical Association (AMA) passed a resolution that states:

"RESOLVED, That our AMA, through the Scope of Practice Partnership, immediately embark on a campaign to identify and have elected or appointed to state medical boards physicians (MDs or DOs) who are committed to asserting and exercising their full authority to regulate the practice of medicine by all persons within a state notwithstanding efforts by boards of nursing or other entities that seek to unilaterally redefine their scope of practice into areas that are true medical practice."

The resolution arose from the above-mentioned Scope of Practice Partnership (SOPP) formed by the AMA and other physician trade organizations that targets health care professionals that are not (gasp!) doctors in order, according to The Big Push campaign, "to obstruct expansion and to restrict the licensed scope of practice of other healthcare professionals."

Let it be said that there are certainly physicians this partnership and resolution do not represent. In Washington state, along with a handful of other states, CPMs are licensed and some work in partnership with hospitals and OB/GYNs when necessary. However, to my knowledge, no physicians have objected to the big-brother SOPP and resolution or stand in solidarity with the campaign or midwives attempts not to be shunted to the sidelines of the health care industry.

Common sense says that restricting access to a full-range of health care providers, especially those known to improve health outcomes for maternal and newborn health, is not healthy for women and babies.

The Big Push For Midwives is hoping to change all of that by reaching out to local midwives, policymakers, consumers and advocates in participating states and working with them on the advocacy, communication and fundraising strategies to effect change on a grassroots level.

The good news is that awareness is growing. Pregnancy and childbirth have been integrated into the celebrity-coverage fold. The recent release of the Ricki Lake produced documentary, The Business of Being Born, on the realities of hospital based maternity care and Lake's advocacy on behalf of natural, home-birth is evidence of this growing awareness that this kind of activism is not only sorely needed but bound to happen.

How far to the fringes can we push women's health care options before women strike back? We've seen the barriers to a full range of care for pregnancy and childbirth grow with each passing year. It's the same with abortion care.

Midwives are banding together and saying no more. How powerful we could be if we understood how intertwined all of our reproductive health experiences really are – menstruation, childbirth, miscarriage, abortion, menopause – and how intertwined the care we receive should be. Then, our advocacy on behalf of ensuring that our options to the care we want, the providers we desire, and the access we deserve would be unmatched.

News Politics

Missouri ‘Witch Hunt Hearings’ Modeled on Anti-Choice Congressional Crusade

Christine Grimaldi

Missouri state Rep. Stacey Newman (D) said the Missouri General Assembly's "witch hunt hearings" were "closely modeled" on those in the U.S. Congress. Specifically, she drew parallels between Republicans' special investigative bodies—the U.S. House of Representatives’ Select Investigative Panel on Infant Lives and the Missouri Senate’s Committee on the Sanctity of Life.

Congressional Republicans are responsible for perpetuating widely discredited and often inflammatory allegations about fetal tissue and abortion care practices for a year and counting. Their actions may have charted the course for at least one Republican-controlled state legislature to advance an anti-choice agenda based on a fabricated market in aborted “baby body parts.”

“They say that a lot in Missouri,” state Rep. Stacey Newman (D) told Rewire in an interview at the Democratic National Convention last month.

Newman is a longtime abortion rights advocate who proposed legislation that would subject firearms purchases to the same types of restrictions, including mandatory waiting periods, as abortion care.

Newman said the Missouri General Assembly’s “witch hunt hearings” were “closely modeled” on those in the U.S. Congress. Specifically, she drew parallels between Republicans’ special investigative bodies—the U.S. House of Representatives’ Select Investigative Panel on Infant Lives and the Missouri Senate’s Committee on the Sanctity of Life. Both formed last year in response to videos from the anti-choice front group the Center for Medical Progress (CMP) accusing Planned Parenthood of profiting from fetal tissue donations. Both released reports last month condemning the reproductive health-care provider even though Missouri’s attorney general, among officials in 13 states to date, and three congressional investigations all previously found no evidence of wrongdoing.

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Missouri state Sen. Kurt Schaefer (R), the chair of the committee, and his colleagues alleged that the report potentially contradicted the attorney general’s findings. Schaefer’s district includes the University of Missouri, which ended a 26-year relationship with Planned Parenthood as anti-choice state lawmakers ramped up their inquiries in the legislature. Schaefer’s refusal to confront evidence to the contrary aligned with how Newman described his leadership of the committee.

“It was based on what was going on in Congress, but then Kurt Schaefer took it a step further,” Newman said.

As Schaefer waged an ultimately unsuccessful campaign in the Missouri Republican attorney general primary, the once moderate Republican “felt he needed to jump on the extreme [anti-choice] bandwagon,” she said.

Schaefer in April sought to punish the head of Planned Parenthood’s St. Louis affiliate with fines and jail time for protecting patient documents he had subpoenaed. The state senate suspended contempt proceedings against Mary Kogut, the CEO of Planned Parenthood of St. Louis Region and Southwest Missouri, reaching an agreement before the end of the month, according to news reports.

Newman speculated that Schaefer’s threats thwarted an omnibus abortion bill (HB 1953, SB 644) from proceeding before the end of the 2016 legislative session in May, despite Republican majorities in the Missouri house and senate.

“I think it was part of the compromise that they came up with Planned Parenthood, when they realized their backs [were] against the wall, because she was not, obviously, going to illegally turn over medical records.” Newman said of her Republican colleagues.

Republicans on the select panel in Washington have frequently made similar complaints, and threats, in their pursuit of subpoenas.

Rep. Marsha Blackburn (R-TN), the chair of the select panel, in May pledged “to pursue all means necessary” to obtain documents from the tissue procurement company targeted in the CMP videos. In June, she told a conservative crowd at the faith-based Road to Majority conference that she planned to start contempt of Congress proceedings after little cooperation from “middle men” and their suppliers—“big abortion.” By July, Blackburn seemingly walked back that pledge in front of reporters at a press conference where she unveiled the select panel’s interim report.

The investigations share another common denominator: a lack of transparency about how much money they have cost taxpayers.

“The excuse that’s come back from leadership, both [in the] House and the Senate, is that not everybody has turned in their expense reports,” Newman said. Republicans have used “every stalling tactic” to rebuff inquiries from her and reporters in the state, she said.

Congressional Republicans with varying degrees of oversight over the select panel—Blackburn, House Speaker Paul Ryan (WI), and House Energy and Commerce Committee Chair Fred Upton (MI)—all declined to answer Rewire’s funding questions. Rewire confirmed with a high-ranking GOP aide that Republicans budgeted $1.2 million for the investigation through the end of the year.

Blackburn is expected to resume the panel’s activities after Congress returns from recess in early September. Schaeffer and his fellow Republicans on the committee indicated in their report that an investigation could continue in the 2017 legislative session, which begins in January.

Commentary Contraception

Hillary Clinton Played a Critical Role in Making Emergency Contraception More Accessible

Susan Wood

Today, women are able to access emergency contraception, a safe, second-chance option for preventing unintended pregnancy in a timely manner without a prescription. Clinton helped make this happen, and I can tell the story from having watched it unfold.

In the midst of election-year talk and debates about political controversies, we often forget examples of candidates’ past leadership. But we must not overlook the ways in which Hillary Clinton demonstrated her commitment to women’s health before she became the Democratic presidential nominee. In early 2008, I wrote the following article for Rewirewhich has been lightly edited—from my perspective as a former official at the U.S. Food and Drug Administration (FDA) about the critical role that Clinton, then a senator, had played in making the emergency contraception method Plan B available over the counter. She demanded that reproductive health benefits and the best available science drive decisions at the FDA, not politics. She challenged the Bush administration and pushed the Democratic-controlled Senate to protect the FDA’s decision making from political interference in order to help women get access to EC.

Since that time, Plan B and other emergency contraception pills have become fully over the counter with no age or ID requirements. Despite all the controversy, women at risk of unintended pregnancy finally can get timely access to another method of contraception if they need it—such as in cases of condom failure or sexual assault. By 2010, according to National Center for Health Statistics data, 11 percent of all sexually experienced women ages 15 to 44 had ever used EC, compared with only 4 percent in 2002. Indeed, nearly one-quarter of all women ages 20 to 24 had used emergency contraception by 2010.

As I stated in 2008, “All those who benefited from this decision should know it may not have happened were it not for Hillary Clinton.”

Now, there are new emergency contraceptive pills (Ella) available by prescription, women have access to insurance coverage of contraception without cost-sharing, and there is progress in making some regular contraceptive pills available over the counter, without prescription. Yet extreme calls for defunding Planned Parenthood, the costs and lack of coverage of over-the-counter EC, and refusals by some pharmacies to stock emergency contraception clearly demonstrate that politicization of science and limits to our access to contraception remain a serious problem.

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Today, women are able to access emergency contraception, a safe, second chance option for preventing unintended pregnancy in a timely manner without a prescription. Sen. Hillary Clinton (D-NY) helped make this happen, and I can tell the story from having watched it unfold.

Although stories about reproductive health and politicization of science have made headlines recently, stories of how these problems are solved are less often told. On August 31, 2005 I resigned my position as assistant commissioner for women’s health at the Food and Drug Administration (FDA) because the agency was not allowed to make its decisions based on the science or in the best interests of the public’s health. While my resignation was widely covered by the media, it would have been a hollow gesture were there not leaders in Congress who stepped in and demanded more accountability from the FDA.

I have been working to improve health care for women and families in the United States for nearly 20 years. In 2000, I became the director of women’s health for the FDA. I was rather quietly doing my job when the debate began in 2003 over whether or not emergency contraception should be provided over the counter (OTC). As a scientist, I knew the facts showed that this medication, which can be used after a rape or other emergency situations, prevents an unwanted pregnancy. It does not cause an abortion, but can help prevent the need for one. But it only works if used within 72 hours, and sooner is even better. Since it is completely safe, and many women find it impossible to get a doctor’s appointment within two to three days, making emergency contraception available to women without a prescription was simply the right thing to do. As an FDA employee, I knew it should have been a routine approval within the agency.

Plan B emergency contraception is just like birth control pills—it is not the “abortion pill,” RU-486, and most people in the United States don’t think access to safe and effective contraception is controversial. Sadly, in Congress and in the White House, there are many people who do oppose birth control. And although this may surprise you, this false “controversy” not only has affected emergency contraception, but also caused the recent dramatic increase in the cost of birth control pills on college campuses, and limited family planning services across the country.  The reality is that having more options for contraception helps each of us make our own decisions in planning our families and preventing unwanted pregnancies. This is something we can all agree on.

Meanwhile, inside the walls of the FDA in 2003 and 2004, the Bush administration continued to throw roadblocks at efforts to approve emergency contraception over the counter. When this struggle became public, I was struck by the leadership that Hillary Clinton displayed. She used the tools of a U.S. senator and fought ardently to preserve the FDA’s independent scientific decision-making authority. Many other senators and congressmen agreed, but she was the one who took the lead, saying she simply wanted the FDA to be able to make decisions based on its public health mission and on the medical evidence.

When it became clear that FDA scientists would continue to be overruled for non-scientific reasons, I resigned in protest in late 2005. I was interviewed by news media for months and traveled around the country hoping that many would stand up and demand that FDA do its job properly. But, although it can help, all the media in the world can’t make Congress or a president do the right thing.

Sen. Clinton made the difference. The FDA suddenly announced it would approve emergency contraception for use without a prescription for women ages 18 and older—one day before FDA officials were to face a determined Sen. Clinton and her colleague Sen. Murray (D-WA) at a Senate hearing in 2006. No one was more surprised than I was. All those who benefited from this decision should know it may not have happened were it not for Hillary Clinton.

Sometimes these success stories get lost in the “horse-race stories” about political campaigns and the exposes of taxpayer-funded bridges to nowhere, and who said what to whom. This story of emergency contraception at the FDA is just one story of many. Sen. Clinton saw a problem that affected people’s lives. She then stood up to the challenge and worked to solve it.

The challenges we face in health care, our economy, global climate change, and issues of war and peace, need to be tackled with experience, skills and the commitment to using the best available science and evidence to make the best possible policy.  This will benefit us all.

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