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Thank You Midwives! join Lamaze in Celebrating National Midwifery Week!

October 7th, 2014 by avatar

midwifery week poster 2014Please join Lamaze International and Science & Sensibility as we celebrate National Midwifery Week.  Midwives can and should play an integral part of healthy and safe birth practices here in the United States and around the world. Maternal infant health organizations and consumers alike are now aware that we have reached a tipping point.  Our cesarean rate is too high, the availability of VBAC supportive providers is dismal, the rate of inductions, particularly before 39 weeks is cause for concern, labor augmentations are commonplace and infant mortality – particularly amongst babies of color, in our country puts the United States ranking at an embarrassing 56 amongst all the other countries.

The midwifery model of care offers women and babies care by qualified, skilled health care providers who are experts at normal physiologic birth and meeting the needs of healthy, low risk, pregnant women.  The midwifery model of care respects the shared decision making process between the mother and her health care provider, the importance of the mother’s emotional health as well as her physical health and recognizes pregnancy and birth as part of a woman’s normal lifecycle, rather than an illness or pathological condition.  There is respect for the normal physiological process of birth, and the recognition that when things deviate from normal, collaboration and referral to obstetricians and other specialists is appropriate.  When midwives have the opportunity to care for more healthy low risk women, the United States might start to see some of the dismal statistics reverse, and women and babies will benefit from the new trend.

The American College of Nurse Midwives has created a consumer website, Our Moment of Truth, where women can learn more about midwifery, increase awareness and understanding of the different care options available, make informed choices about the type of care they would like to receive and even find a midwife in their area.  There is also a brochure available – “Normal Healthy Childbirth for Women and Families: What You Need to Know” to download in English and Spanish and share with your students and clients. This document and the ACNM program “Our Moment of Truth” was supported and endorsed by Lamaze International along with many other maternal infant health organizations.

The ACNM has a very nice “Essential Facts about Midwives” info sheet that contains some great statistics and information about Certified Nurse Midwives and Certified Midwives.  Midwives can catch babies in hospitals, birth centers and at home and Medicaid reimbursement is mandated for CNMS/CMs in all 50 states.  In 2012, CNMs/CMs attended over 300,000 births in the U.S.  When you add in Certified Professional Midwives/Licensed Midwives who also attend births at birth centers and homes, the number of midwife attended births goes up even further.

ACNM has created a fun video highlighting midwives and the care they provide.  I have also collected of a few of my favorite videos about midwives that you might enjoy viewing and sharing.

Mother of Many from emma lazenby on Vimeo.

What are you doing to celebrate and honor midwives this week?  Do you talk about the midwifery model of care in your childbirth classes and with your doula clients?  What resources do you like using to help your students understand the scope of practice and benefits of working with midwives?  Share with others in our comments below.

Babies, Childbirth Education, Healthy Birth Practices, Home Birth, Midwifery, Newborns , , , , , , ,

A Celebration of Midwifery – Supporting Safe, Healthy Birth!

July 1st, 2014 by avatar

In June, midwives were making news all around the world in person and in print.   Maternity care researcher Judith Lothian presented at the International Congress of Midwives conference in Prague, an enormous international gathering of thousands of midwives from all the corners of the globe that occurs every three years. Dr. Lothian shares her impressions of the Congress gathering today.  Additionally, the journal, The Lancet released its Series on Midwifery, long awaited and recognizing that if normal, safe birth is to be supported, midwifery care is the key to achieving that goal.  Dr Lothian summarizes this important series and shares what it means for women and their babies. – Sharon Muza, Community Manager, Science & Sensibility

@ Barbara Harper

@ Barbara Harper

In the US, where midwives attend around 10% of births and around 1% of women have planned out of hospital births, most women and many health care providers know little, if anything, about midwifery. Several decades ago, I began to write about midwifery and out of hospital birth as a way of promoting, protecting and supporting normal birth.  More recently, I’ve done research on women’s and midwives’ experiences of home birth. I’ve also spent a great deal of time with midwives, with my daughters during the births of my grandchildren, at two historic Home Birth Summits, at Normal Birth conferences and, in the last 2 years working with the American College of Nurse Midwives on their Normal Birth Initiative. I count many midwives among my most respected and cherished friends.

I’ve wanted to spread the good news about midwifery and women and babies for a very long time, but the last month has me wanting to ring bells, light candles, and shout from the rooftops to celebrate the tremendous accomplishments of midwives and midwifery, the courage of midwives, and the commitment of midwifery to women and children here in the United States and across the globe.

In early June I attended the International Congress of Midwives in Prague. Thirty eight hundred midwives (and a smaller group of nurses, sociologists, epidemiologists, birth advocates and researchers) came together as they do every three years to share what they know, learn what they don’t know, and recommit themselves to women and babies around the world.  Midwives from 85 countries, most often in the traditional dress of their country, paraded into the opening ceremony. The video and pictures from this event can’t begin to capture what it was like to be there, but it does give you a taste of the excitement and the pride.  It was truly amazing.

ICM.Frances_open

@ Barbara Harper

The number of sessions was mind boggling. In each time slot there were multiple sessions on normal birth. It was difficult to choose and impossible to get to even a small percentage of what was offered. I am sharing some of the standouts for me.

Lisa Kane Low, from the University of Michigan, and a champion of midwifery and evidence based maternity care, was a plenary speaker. Her talk on access to care highlighted the importance of meeting women where they are and putting their needs, not ours, first. Toyin Saraki is the newly appointed ICM Global Goodwill Ambassador. The former First Lady of Nigeria, she is the founder and director of the Wellbeing Foundation Africa. The work of the foundation has reduced maternal mortality in Nigeria by 20%.

Ms. Saraki shared a Nigerian saying with us: If you want to go fast, go alone. If you want to go far, go together.  I can’t stop thinking about that, and its implications for our work.  Cecily Begley, the Chair of Nursing and Midwifery at Trinity College Dublin, participated in a plenary panel, Education: The Bridge to Midwifery and Women’s Autonomy. Professor Begley talked about “communities of change” and she described education and research as necessary in crossing the bridge to change. Ray DeVries and Saras Vedam participated in a symposium on ethics related to birth place. Both Ray and Saras contributed to the Journal of Clinical Ethics Fall 2013 special issue on place of birth. The audience participation was lively.

© Barbara Harper

© Barbara Harper

The ethical issues related to pushing women to unassisted births when there is no real choice related to planned, assisted out of hospital birth and the ethical issues of hospitals and providers stonewalling efforts to make transfer seamless, safe, and without recrimination were discussed. Dr. Marianne Nieuwenhuijze from the Netherlands, presented her excellent work on shared decision making. Tanya Tanner from ACNMEllie Daniels from National Association of Certified Professional Midwives, and I presented the collaborative work of ACNM, MANA and NACPM developing a consensus statement on normal, physiologic birth, and more specifically, our work developing a consumer statement based on the consensus statement, Normal, Healthy Childbirth for Women and Families: What You Need to Know.

It was wonderful meeting midwives from Australia, Canada, Ghana, the UK, and Ireland. The challenges are not exactly the same as ours in the US, but we are all fighting uphill battles in support of normal birth.

On the heels of the ICM, The Lancet launched its eagerly awaited Lancet Series on Midwifery.  In Ireland for the summer, I was glued to my computer savoring every moment of the launch online on June 23.    The lead author of each of the four major papers provided a summary and there were comments from a wide array of noted scholars, researchers, practitioners and policy makers from around the world. There were many familiar faces from the International Congress of Midwives. Toyin Saraki gave a stirring speech applauding midwifery, noting that midwifery is not a job, but a passion, a vocation.  Holly Kennedy, who co-authored a paper, and is working on a follow up paper, brought congratulations from the ACNM.

Why did the Lancet do a series on midwifery? Richard Horton, who was involved in the project from the beginning , has this to say in his commentary, The Power of Midwifery:

“Midwifery is commonly misunderstood. The Series of four papers and five Comments we publish today sets out to correct that misunderstanding. One important conclusion is that application of the evidence presented in this Series could avert more than 80% of maternal and newborn deaths including stillbirths. Midwifery therefore has a pivotal, yet widely neglected, part to play in accelerating progress to end preventable mortality of women and children”.  Horton and Astudillo  go on to note that the work is based on a set of values and philosophy that are distinctive. “These values include respect, communication, community knowledge and understanding, and care tailored to a woman’s circumstances and needs. The philosophy is equally important—to optimise the normal biological, psychological, social, and cultural processes of childbirth, reducing the use of interventions to a minimum. “

The four papers include

  • Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care by Mary J Renfrew, Alison McFadden, Maria Helena Bastos, James Campbell, Andrew Amos Channon, Ngai Fen Cheung, Deborah Rachel Audebert Delage Silva, Soo Downe, Holly Powell Kennedy, Address Malata, Felicia McCormick, Laura Wick, Eugene Declercq
  • The projected effect of scaling up midwifery by Caroline S E Homer, Ingrid K Friberg, Marcos Augusto Bastos Dias, Petra ten Hoope-Bender, Jane Sandall, Anna Maria Speciale, Linda A Bartlett
  • Country experience with strengthening of health systems and deployment of midwives in countries with high maternal mortality by Wim Van Lerberghe, Zoe Matthews, Endang Achadi, Chiara Ancona, James Campbell, Amos Channon, Luc de Bernis, Vincent De Brouwere, Vincent Fauveau, Helga Fogstad, Marge Koblinsky, Jerker Liljestrand, Abdelhay Mechbal, Susan F Murray, Tung Rathavay, Helen Rehr, Fabienne Richard, Petra ten Hoope-Bender, Sabera Turkmani
  • Improvement of maternal and newborn health through midwifery by Petra ten Hoope-Bender, Luc de Bernis, James Campbell, Soo Downe, Vincent Fauveau, Helga Fogstad, Caroline S E Homer, Holly Powell Kennedy, Zoe Matthews, Alison McFadden, Mary J Renfrew, Wim Van Lerberghe

The Lancet Series on Midwifery makes a major contribution to the literature bringing together the evidence basis for midwifery, its outcomes, and how to affect policy. We need to translate that evidence into action, into the education of the women we teach, and into our advocacy efforts on behalf of safe, healthy birth.

The Lancet Series on  Midwifery can be accessed at through this link. The series includes an executive summary, commentaries, and the four major papers. You need to register on the Lancet site but everything can be accessed for free.

The time has come to recognize and celebrate the incredible work that midwives do. In the US, it is time for women to know about midwifery, and to see the connection of midwifery and normal, physiologic birth.  It is time for childbirth educators to encourage women to choose midwifery care, and time to collaborate with midwives both in our communities and on organizational and governmental levels.  If we want to promote safe, healthy, normal physiologic birth, we need to promote and support midwifery. Healthy low risk women need to know that if they want the safest, healthiest birth for themselves and their babies that they need to find a midwife.

About Judith Lothian

@ Judith Lothian

@ Judith Lothian

Judith Lothian, PhD, RN, LCCE, FACCE is a nurse and childbirth educator. She is an Associate Professor at the College of Nursing, Seton Hall University and the current Chairperson of the Lamaze Certification Council Governing Body. Judith is also the Associate Editor of the Journal of Perinatal Education and writes a regular column for the journal. Judith is the co-author of The Official Lamaze Guide: Giving Birth with Confidence. Her research focus is planned home birth and her most recent publication is Being Safe: Making the Decision to Have a Planned Home Birth in the US published in the Journal of Clinical Ethics (Fall 2013).

Evidence Based Medicine, Guest Posts, Home Birth, Maternal Quality Improvement, Maternity Care, Midwifery , , , , , , ,

Midwifery As A Birth Option? – Tools for Educators to Share with Families

May 29th, 2014 by avatar

By Nasima Pfaffl, President, Citizens for Midwifery

midwife care

© Richard Kimbrough

Childbirth education students are typically attending classes in the last trimester of their pregnancy. Most likely, they have established care with a health care provider months ago. Families may receive care from obstetricians, family practice doctors or midwives and find themselves sitting next to each other in class. Conversations may come up in class about the type of care they are receiving. Some families, for a variety of reasons, may be considering changing providers. The educator may be asked what is the difference between the different types of providers who might help them with their birth. Today, guest contributor Nasima Pfaffl shares information about the midwifery model of care, for those families that are interested in pursuing care with a midwife. In future posts, a family practice doctor and an obstetrician will explain more about the type of care they provide. – Sharon Muza, Community Manager, Science & Sensibility.

At Citizens for Midwifery, we get frequent requests for information about birth with a midwife. Is it safe? What training does a midwife have? How is midwifery care different than other care?

We’ve pulled together some of our favorite resources for you to use as you educate families about their birth options. We hope you’ll share with us your favorites that we’ve missed, in the comments section below.

Are there different kinds of midwives?

Yes. There are two main categories of midwives in the U.S., nurse-midwives, who are trained in both nursing and midwifery, and direct entry midwives, who trained as midwives without being nurses first. The majority of direct entry midwives are Certified Professional Midwives (CPMs); but this category also includes Certified Midwives and Licensed/Registered Midwives. The legal status of direct entry midwives varies in different states. The Midwives Alliance of North America (MANA) has good information on the kind of care direct entry midwives provide.

Direct entry midwives include highly trained and very competent midwives; however, anyone may call him/herself a midwife at this time, and if you are looking for a midwife, it is up to you to find out if the midwife is qualified and experienced to your satisfaction. If a midwife is a Certified Professional Midwife (CPM), you are assured that s/he has met specific requirements for certification (and recertification every three years).

Consumers can learn more about the CPM credential and why state licensing of midwives is important from the North American Registry of Midwives (NARM). Many states are also working on bills to license CPMs (check your state here at the Big Push site). The National Association of Certified Professional Midwives has resources about how CPMs practice and how midwifery organizations are working to integrate CPMs into the health care system.

Is midwifery care safe?

Midwifery care is generally provided for people who are at low-risk for complications during pregnancy and birth in one of three settings: hospital, home, or birth centers.

Many of the questions around safety center around home and hospital births. A recent study of birth center births found that people experienced very low cesarean rates, and stillborn and newborn death rates comparable to rates seen in other low-risk populations.

A growing body of research shows that, for low-risk  people, home birth results in fewer interventions for the birthing parent and is safe for the baby. Citizens for Midwifery summarized the recent study published in the Journal of Midwifery and Women’s Health.  Judith Lothian also wrote a good summary in a previous post on Science & Sensibility. A helpful bibliography that outlines the research – and the quality of that research – around home birth can provide additional information.

What does midwifery care look like?

Midwifery care in the United States varies widely by provider and setting. The Midwives Alliance of North America is launching a series of videos called “I am a Midwife” to educate consumers on common questions about midwife led care, including safety, training, how midwives collaborate with other health professionals, and how midwives and families work together to make decisions about care. You can watch the video and sign up for updates here.

 

Brochures describing the Midwives Model of Care are also available from Citizens for Midwifery. These brochures can be very helpful in describing the kind of care midwives provide.

Is midwifery care available in my community?

This depends on what kind of care you are looking for. Midwives are available in many, but not all, hospital settings. You may need to search a few different resources to get a complete picture of what is available in your community.

The Find A Midwife Tool from the American College of Nurse Midwives can help you locate certified nurse midwives and certified midwives.

Mothers Naturally’s Find A Midwife Tool can help you identify midwives who are members of the Midwives Alliance of North America. They have members of all credentials.

The Birth Center locator will find the 10 birth centers closest to you (which could be quite far, depending on the legal status of your state).

If you have families in your classes exploring pregnancy and birth care with a midwife, these resources that you can share may answer questions and help them to decide what type of provider is the right one for them.  What resources do you like sharing in your classes on the different types of care available?  Let us know in the comments section. – SM

About Nasima Pfaffl

Nasima Pfaffl HeadshotNasima Pfaffl, MA is a medical sociologist with a focus on social movements and women’s health. She is a second generation home birth mom. She is the current president of Citizens for Midwifery and has served on the board since 2006. She worked for the Midwifery Education Accreditation Council as their Accreditation Coordinator. She served on the MAMA Campaign steering committee, on the Birth Network National Board, the Coalition for Improving Maternity Services Leadership Team (Board), and as the Grassroots Advocates Committee Co-Chair and Survey Team Lead for The Birth Survey. Nasima focuses on coalition building and utilizing capacity building technologies and tools to make midwifery advocacy organizations stronger, more effective and able to create the change needed in our broken maternity care system. She lives in Florida with her son, daughter and husband. Nasima can be reached by email - nasima@cfmidwifery.org

 

Childbirth Education, Guest Posts, Maternity Care, Midwifery , , , , , , , , ,

Birth as the Ultimate Collaboration

August 22nd, 2013 by avatar

By Richard N. Waldman, MD

The Lamaze International Annual Conference is being held October 11-13, 2013 in New Orleans, LA.  ”Let the Good Times Roll for Safe and Healthy Birth” is the theme and there is a fabulous line up of speakers and events planned.   Birth professionals who serve women and babies in all capacities will find many sessions of great interest to them.  Dr. Richard Waldman, former President of ACOG, is one of the two keynote speakers preparing to speak to those in attendance.  Today, on Science & Sensibility, Dr. Waldman shares his thoughts in a blog post on communication and collaboration amongst caregivers and other professionals to achieve a healthy outcome for mother and baby.  Learn more about Dr. Waldman in my interview with him published a few days ago.

_____________________________ 

Three years ago I had the honor of being inducted as the President of the American Congress of Obstetricians and Gynecologists. I titled my talk on that day “Together We Can Do Something Wonderful” and I discussed many issues surrounding childbirth that impact mothers and families. My title was partially borrowed from Mother Teresa who stated it so well when she said: “What I do you cannot do; but what you do, I cannot do. The needs are great and none of us, including me, ever do great things. But we can all do small things, with great love, and together we can do something wonderful.” This is so true today.

(A section from Dr. Waldman’s Induction as President of ACOG, June 2010.  Additional segments available here.)

It is appropriate for me to address families concerned with childbirth and childbirth educators because you are so important to the future of birthing.

We have been changing the culture of birth without Nature’s permission in so many ways that are really troubling. For instance, the distribution of births to a lower gestational age has been developing in the last two decades. There has been a sharp decline in deliveries occurring after 39 weeks with a concomitant sharp increase in births occurring particularly between 36-38 weeks gestation. There are many reasons for this and sometimes delivering a baby early can be life saving.

In the early part of my career it was not unusual for pregnancies to go beyond 43 weeks. Although I was a naturalist at heart and did not easily embrace inductions just past 42 weeks, I was impressed by the decrease in morbidity that I encountered. For instance, I do not miss seeing babies who suffered with meconium aspiration syndrome, I still see a family whose baby boy died shortly after birth from meconium aspiration syndrome. Every time I see her I think of their family’s tragic birth experience. You never forget those losses.

There is no question that the wonderful care in the neonatal nursery has made some maternity care providers complacent. However, we often overreact. If delivering at 42 weeks is a good idea why not deliver at 41 weeks? If we are delivering our prior cesarean patients at 39 weeks, why not deliver them at 38 weeks? The babies will do well will they not? I once gave a talk for ICEA entitled “Deliver Us from Technology?”  My point was that some technology, used as a fine instrument only when it is clearly indicated, can be lifesaving but technology used too frequently and without clear indications can be a real problem. Good practitioners walk a tightrope with nature on one side and technology on the other.

On other hand, physicians are sometimes under great pressure to deliver their patients before their due dates. Women have been led to believe that delivering early is not going to harm the baby and they put tremendous pressure on their care providers to “end their misery”  or deliver the week before their due date because “that is the only week that mom can fly in from California.” The March Of Dimes has a wonderful program called “Healthy Babies are Worth the Wait” but they cannot do it alone.

Induction of labor is a similar and related problem. If you are planning to deliver early then you have to do so by inducing labor or by doing a cesarean section. Over 20% of pregnancies resulted in an induction of labor in 2007, representing a 140% increase since 1990. In one hospital report 44% of their patients were induced.   Pregnant women who are induced are 37% more likely to require cesarean compared to those with spontaneous labor. If a ripening agent is used they are nearly three times more likely to undergo a cesarean. Nulliparous women undergoing elective induction of labor with an unripe cervix (low Bishop Score) face almost a 50% risk of cesarean delivery.

Now those are the facts, but how do we educate the women in this country so that they can ask the right questions and make the best birthing decisions?  We all need to work together to convince families that delivering early is not good for mother or baby unless there are clear medical indications and that inductions of labor may lead to unnecessary cesarean sections but knowledge in itself is not enough. Perhaps we should regard birth as the ultimate collaboration. In order to have successful collaboration, the participants need to communicate as equals.  I know that our maternity suite at our hospital is so much happier place to work since we instituted a non hierarchal formal communication system.

While I was President of ACOG I made “collaborative intelligence” a  top priority of our college. We worked very hard at our communication styles with other organizations (specifically the ACNM) to overcome trust issues and we had amazing results. It seems to me that facts are facts but how educators and doulas, families and caregivers communicate with each other is equally important and can have a tremendous impact on a birth outcome. Collaboration and formal communication are not easy to learn and are recursive processes that require time and effort. But resolving conflicts in labor and delivery are worth it, because in the end, what we all really want is what is best for both mother and baby.

About Richard Waldman, MD

Dr. Richard N. Waldman is a diplomat of the American Board of Obstetrics and Gynecology, and is the past president of the American College of Obstetricians and Gynecologists (ACOG), a premier private, not-for-profit organization dedicated to the advancement of women’s health care through continuing medical education, practice and research. Dr. Waldman is the president-elect of the Medical Staff at St. Joseph’s Hospital Health Center in Syracuse, NY, and a member of the Board of Trustees. Dr. Waldman is a Senior Medical Consultant at OB Consult. Among other things, he established the first hospital-based midwifery practice in central New York. He served as the president of ACOG from 2010-2011. He has lectured extensively on pregnancy and childbirth across the United States and has also lectured internationally. He has published several articles in peer review journals and recently co-edited an issue of Obstetrics and Gynecology Clinics of North America dedicated to collaborative practice.

ACOG, Cesarean Birth, Childbirth Education, Continuing Education, Guest Posts, Lamaze International, Lamaze International 2013 Annual Conference , , , , , , , ,

MANA Response to Recent AAP Home Birth Statement: High-quality out-of-hospital newborn and postpartum care is standard for midwives

May 2nd, 2013 by avatar

By Geradine Simkins, CNM, MSN, Executive Director of Midwives Alliance of North America

This week, the American Academy of Pediatrics released a policy statement on home birth. While the statement affirmed “the right of women to make a medically informed decision about delivery”, many advocates expressed concerns. The statement failed to recognize Certified Professional Midwives, the providers most likely to attend a home birth in the United States. In this response, the Midwives Alliance of North America helps families, providers, and policy makers understand the critical role CPMs play in safe, healthy birth options. – Sharon Muza, Community Manager, Science & Sensibility

High-quality out-of-hospital newborn and postpartum care is standard for midwives

 

© http://flic.kr/p/8d52Qc

The Midwives Alliance of North America welcomes the primary concept communicated in the American Academy of Pediatrics’ April 24, 2013, policy statement entitled “Planned Home Birth.” As should be expected, AAP reminds its practitioners that newborn infants—regardless of the setting in which they are born—deserve an equal and unbiased, high-quality standard of care. The Midwives Alliance joins with AAP in affirming the need for a collaborative and integrated maternity care system that addresses the needs of all mothers and infants, regardless of the provider type or birth setting a woman chooses.

We are disappointed, however, in AAP’s decision to align with the American Congress of Obstetrics and Gynecologists’ policy on home birth. Serving the needs of the growing number of families choosing to birth at home, Certified Professional Midwives attend the majority of intended home births in the U.S., when a skilled attendant is present, making them the primary care providers for newborns in the home setting.

Certified Professional Midwives are skilled maternity care providers

AAP’s itemized recommendations for infant and newborn care, contained in their policy statement, are standard practice for credentialed midwives. In that respect, we find much with which we agree. These standard newborn exams, screens, and preventative care practices are wholly part of a credentialed midwife’s scope of practice, and further endorsed by individual state health departments. We also note that as AAP Neonatal Resuscitation Program certificate holders (required for certification and recertification), credentialed midwives follow guidelines laid out in AAP’s recommendations, and typically surpass those standard recommendations by having at least two NRP- and CPR-trained attendants at out-of-hospital births.

In fact, the AAP’s guidelines for the care of infants intentionally born at home parallel those standards practiced by trained midwives in all birth settings. The practices listed—such as working medical equipment, emergency plans of transfer, thorough newborn exams, and so forth—are professional standards exhibited and documented by credentialed midwives, regardless of the place of birth.

The AAP policy statement, however, did not recognize or acknowledge Certified Professional Midwives (CPM), indicating that AAP may not have a thorough understanding of the training, skills, knowledge, and abilities of this country’s primary maternity care provider for infants born out of the hospital. The Certified Professional Midwife is the only national midwifery credential that requires practitioners to be trained specifically to provide prenatal, intrapartum, and postnatal care in out-of-hospital settings. CPMs are knowledgeable, expert and independent midwifery practitioners who have met the standards for certification set by the North American Registry of Midwives (NARM). NARM is accredited by the National Commission for Certifying Agencies (NCCA) to issue the professional credential of Certified Professional Midwife, which is the same agency that accredits the American Midwifery Certification Board to issue the professional credentials of Certified-Nurse Midwife, and Certified Midwife.  

Midwives are the providers of choice for out-of-hospital births, whether they occur at home or in freestanding birth centers. Offered since 1994, the CPM is currently the basis for licensure in 27 states while 11 additional states are actively seeking CPM licensure. In fact, one in nine newly certified midwives in the U.S. are Certified Professional Midwives.  

The AAP policy statement endorses birth center maternity care, which is another area in which we are in agreement. Recent numbers from the American Association of Birth Centers (AABC) indicate that a significant proportion of accredited birth centers are owned and operated by Certified Professional Midwives. A January 2013 study, The National Birth Center Study II , conducted by AABC and published in the Journal of Midwifery & Women’s Health, the official journal of the American College of Nurse-Midwives (ACNM), highlights the benefits for women who seek care at midwife-led birth centers. Findings also reinforce longstanding evidence that providers at midwife-led birth centers provide safe and effective health care for women during pregnancy, labor, birth, and the postpartum period.  

Midwives provide high-quality care that meets both national and international guidelines 

In highlighting the ethic of high-quality care for all infants across the spectrum—regardless of the site of birth—it should be noted that Certified Professional Midwives provide care intentionally similar to that of nurse-midwives and physicians. Yet we also know that CPMs are able to offer additional and valued care in terms of frequency of home visits and intense monitoring of newborns in their homes in the first weeks of life—a benefit not normally conferred to women and babies who have experienced hospital births.

This high-quality midwifery care includes routine newborn APGAR assessments, comprehensive head-to-toe physical examinations, measurements of length, head, abdomen and birth weight, monitoring vital signs including thermoregulation, assessment of respiratory sounds and patterns, assessments of cardiac sounds and peripheral pulses, assessment of gestational age and physical maturity, neuromuscular assessments, and assistance with initiation and ongoing assessment of breastfeeding. All findings are recorded in patient records and shared with mothers, per professional standards.

In addition, CPMs provide newborns with Vitamin K treatment, antibiotic eye ointment, umbilical cord care, metabolic newborn screening, glucose and bilirubin testing as indicated, and either perform Otoacoustic Emissions (OAE) hearing screens or refer to area audiologists. Midwives in a number of states are moving toward, or already offering, pulse-oximetry screening for Critical Congenital Heart Defects (CCHD) per AAP guidelines, in advance of many hospital systems. In the rare cases when newborns require consultation or referral, infants are transferred to the tertiary care system, and pediatricians where available, for active management.

Not only do Certified Professional Midwives and Certified Nurse-Midwives who attend home births provide the level of care outlined by the AAP, they provide it in a personalized, woman-centered, family-centered, culturally competent, and individualized manner that is qualitatively different from the customary assembly-line postpartum care commonly experienced in U.S. hospitals.

For example, in a home birth setting, the midwife typically conducts the initial newborn exam in the presence of the mother and family, which does not disrupt the crucial process of mother-infant bonding and breastfeeding, and is focused on being instructive to the family. Midwives provide holistic care to the mother-baby dyad in concordance with World Health Organization’s Baby-Friendly best practices.

As a way of illustrating important differences in care practices, we can point to the recent Breastfeeding Report Card issued by the CDC (2012) that indicates only six percent of U.S. hospitals are offering care that aligns with the international best practices outlined by Healthy People 2020.   By contrast in a 2005 study, 95% of babies born at home under the care of Certified Professional Midwives were exclusively breastfeeding at six weeks of age (Johnson & Daviss, 2005). This is just one area where midwives are well-trained, skilled, and uniquely positioned to help families succeed.

An opportunity for collaboration and integrated care 

Physician conversations about home birth and midwife-led birth will be better informed and more useful to maternity care consumers if AAP is able to become more cognizant of important changes in the landscape of U.S. midwifery. 

The release of the AAP policy statement on care of newborns born at home is an opportunity to reinforce the need for professional and seamless collaboration with members of community health care teams. We view this statement’s release as an opportunity to align best practices for all parties who care for and support families choosing home birth.

The Midwives Alliance stands ready to work with other pediatric and maternity care providers to establish best practices in the postpartum period to not merely provide the basic level of care in the first hours, days and weeks of life for the newborn as outlined in the latest AAP statement, but to elevate that standard to include support for breastfeeding and the personal attention that can prevent infant death and improve maternal and child health.  Babies born in all settings deserve this kind of care.

About Geradine Simkins

Geradine Simkins, CNM, MSN is an activist, midwife and author. She began as a direct-entry home birth midwife in 1976 and became a nurse-midwife twenty years later. For over thirty years she has provided health care for women, infants and families in a variety of settings, including attendance at births in the home, a freestanding birth center, and hospitals. Geradine’s work with migrant farmworkers and American Indian tribes focuses on addressing health care disparities and engendering a more equitable maternity care system for all women and infants.  Geradine is currently the Executive Director of Midwives Alliance of North America, a professional organization that promotes excellence in midwifery and is dedicated to unifying and strengthening the profession, thereby increasing access to quality health care and improving outcomes for women, babies and their families. She is the editor of the recently published book entitled Into These Hands: Wisdom from Midwives, an anthology of the life stories of 25 remarkable women who have dedicated their lives and careers to the path of midwifery and social change.  More info about Geraldine Simkins can be found here.

ACOG, American Academy of Pediatrics, Babies, Delayed Cord Clamping, Home Birth, informed Consent, Maternity Care, Midwifery, Transforming Maternity Care , , , , , , , , , ,