Working to build new state licensure for midwives

You see a lot of babies at gatherings that bring out the home birth community, gatherings like the fundraiser for Friends of Michigan Midwives recently held at the Corner Brewery in Ypsilanti.  Resembling a giant play date — a scene full of squirming, crawling, and toddling babies, often nursed and “worn” in snug fitting slings or wraps — this recent fundraiser had another purpose. The event was held to build awareness and raise money for a new initiative that Friends of Michigan Midwives plans on introducing into the state legislature in 2011, a bill to set up the state licensure of certified professional midwives in Michigan.

The legislation would require state licensure of midwives who carry a Certified Professional Midwife (CPM) credential, an international designation awarded by the North American Registry of Midwives after a course of training. CPMs differ from nurse midwives in that they work outside of a hospital setting, and, unlike nurse midwives, they can obtain their training mostly through an apprenticeship with an experienced midwife rather than medical school.  CPMs are trained to deliver only healthy babies from healthy mothers and to recognize signs that a woman or her baby need obstetric attention from a doctor. 

The North American Registry of Midwives “Midwives Model of Care” depicts a holistic approach, including: “Monitoring the physical, psychological, and social well-being of the mother through the childbearing cycle.”  The concept of “minimizing technological interventions” is a key part of a CPMs approach.  Statistics show that home births have a far lower rate of cesarean than the average.  According to the most recent statistic available from the Center for Disease Control, taken from 2007, 32 percent of childbirths in the United States are cesareans.  A study published in 2005 by Betty Anne-Daviss and epidemiologist Ken C Johnson, which also included Canadian home births, found the rate of home births which ended in a transfer to a hospital and a cesarean to be only 3.7 percent.          

doctor debate
Ann Arbor area CPM Amanda Topping sees the legislative effort as a means of increasing access to out-of-hospital-birth, “I would like to see certification open the door for a lot of women who want to have a home birth but can’t afford to pay out of pocket,” she says.  Many of the prospective clients at Amanda’s practice, New Moon Midwifery, end up choosing hospital birth due to financial considerations. “We’ve met with countless women,” Amanda says, “who really want a home birth but opt for a hospital birth because it’s covered by their insurance.  What we’ve seen in states of licensure is that a lot of the time insurance companies are more likely to cover (out-of-hospital birth) because it’s a licensed profession and a regulated profession.” 

The movement for state CPM licensure in Michigan is part of an effort coordinated by the Big Push for Midwives, a national organization that has been involved with similar legislation in many other states.  Katherine Prown, campaign director of the organization, has witnessed staunch opposition to pro-CPM legislation from doctors’ groups in most of those states.  “In virtually every state we generate fierce opposition from professional associations and lobbying groups, such as the American College of Obstetricians and Gynecologists and state medical societies with a vested financial interest in maintaining what amounts to a near monopoly on the provision of maternity care in the U.S. “ she says.

“Early on in the process (in other states), the legislators who support us expect to have an easy road ahead of them and often think we’re exaggerating when we tell them how strong the opposition to our bill is going to be,” Prown explains. “But once they see the unusual procedural roadblocks that typically get thrown our way, the unorthodox committee assignments used to try to kill our bills, and the extreme level of ‘dirty’ politicking that we typically have to overcome, the comment we hear over and over is, ‘Wow—I have never seen that happen before in all my years in the statehouse.’”

Well known doctors groups, such as the American Medical Association and the American College of Obstetricians and Gynecologists, have made strong indictments against out-of-hospital birth, citing obstetric emergencies such as maternal hemorrhage as incidents which could not be dealt with safely outside of a hospital, and calling for “...model legislation in support of the concept that the safest setting for labor, delivery, and the immediate postpartum period is in the hospital...”

Prown counters such attacks by citing statistics which show that hospital birth in America is in need of reform.  “With the U.S. ranking 23rd in birth outcomes and a cesarean section rate of over a third of all births—and as hospitals increasingly struggle with controlling antibiotic-resistant infections and H1N1 outbreaks—women are going to continue choosing alternatives to hospital-based, obstetrician-led care in increasing numbers.” she says.  

a natural selection
Maria Munoz, a client of Amanda Topping’s New Moon Midwifery, sees home births such as hers as actually being safer than a hospital birth:  “As I learned about midwifery in general, and got to know my midwives, I soon realized that midwives are the real experts in normal birth. They regularly witness and attend women in normal birth. They are well-trained and quite capable of detecting and resolving minor complications. They also know when a problem goes beyond their scope of practice and will transport a laboring woman to a hospital if necessary.  When I was in labor it was clear to my husband and me that their main concern was the safety of my baby, and me, yet they remained patient and calm at all times. We were able to develop a trusting relationship with our midwives that I don’t think would have been possible with medical doctors.”

Far from being out of the loop medically, today’s CPMs commonly make use of dopplers to check a baby’s heart rate, and are trained in adult CPR and neonatal resuscitation.  Ann Arbor midwife Amanda Topping feels that the lack of intervention with drugs in a CPM delivered childbirth makes maternal hemorrhage less of an issue.  “We’re not giving women drugs to overtax their uterus, like pitocin, to induce labor, so their uterus isn’t as super-tired typically after a natural birth, as it is (in a hospital birth)...simply not intervening radically reduces the risk of hemorrhage,” Topping explains.        

Although a battle with the medical lobby on a state level over CPM licensure may be inevitable, Amanda Topping has found that out-of-hospital birth is not without its supporters in the Ann Arbor medical community.   “We have doctors in our community who are sympathetic to who we are and what we do, and we have doctors and nurses who have used our services, but they don’t feel like they can do so openly, because it’s so political,” she says.  Like other midwives, however, Amanda finds the AMA’s call for “legislation supporting” hospital birth as the “safest setting” for childbirth unsettling. She says, “I don’t want to see midwives have to practice underground.”
   
To find out more about Michigan’s midwives and their cause visit
www.friendsofmichiganmidwives.org or www.michiganmidwives.org.