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.

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