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When Tim Armstrong, CEO of AOL, cited the cost of “distressed babies” as the reason for cutting 401K benefits to AOL employees, he created a media storm by blaming sick babies for poor corporate governance.  Armstrong cited the million dollar costs of caring for two premature babies as the reason for needing to change employee benefits, essentially outing the private health information of a few of its workers (possibly against HIPPA regulations). He put the mother of one of those babies in a position of defending her daughter’s life and honor, and their family’s sizeable use of the benefits package they pay for through AOL’s employee insurance program.

It is much easier to blame babies and the women who bear them than it is to shine a light on selfish corporate leadership and our bloated, inefficient, for-profit medical system that often works on the rationale of doing procedures “because it can” instead of establishing criteria for action “because it should or should not.”  Extreme incidences such as this mask the underlying problems inherent in our “can do” medical system’s approach to caring for those who are ill, and hold a special lens for viewing maternity care.

I have not yet in the media coverage of this story seen a reference to the question of whether or not a “micro-preemie,” born barely at the age of viability, should undergo extensive lifesaving measures.  Some would call the procedures necessary to keep a five-month fetus alive outside of the womb “heroic measures,” but others could call those procedures “torture.”  Numerous needle sticks in veins that are so small they are barely visible to the eye, tubes in the nostrils and down the throat for months on end, electrodes and monitors attached all over the body, kept in a plastic box to maintain body temperature because the baby is unable to do that on its own, attached to a ventilator because it cannot breathe on its own, fed through a tube threaded through its nostril and down into its belly into an underdeveloped gastric system which is at high risk for painful and deadly infection, being so fragile that it cannot be held or touched for months are just some of the “heroic” measures that micro-preemies endure.

In addition to the efforts made to save the fetus, the mother often undergoes a cesarean section; a major abdominal surgery that puts her at risk for complications and infections and can jeopardize her health in future pregnancies.

Furthermore, the micro-preemies that survive into early childhood often suffer from ongoing health problems, learning disabilities, and behavioral problems.  Sometimes these problems are relatively minor and children grow to become healthy, productive adults.  Sometimes though, these children do not fare as well and demand constant, high-level care throughout their lives.  There is no crystal ball to tell the future and know which outcome will occur.

It is truly a miracle of modern science that a baby can be born so early and survive, but the doctors who make the decisions in the Neonatal Intensive Care Unit are not the same doctors who continue to treat the life-long illnesses and deficits from which micro-preemies often suffer, and they are not the doctors guiding the mothers through future pregnancies where they are denied Vaginal Births After Cesareans (VBACs) or suffer complications from the previous cesarean.  Previous cesarean has been linked to infertility, and by using surgical means to attempt to save a fetus with a 1 in 3 chance of survival, doctors put in jeopardy the very thing the parents may desperately want if their premature baby dies – a chance for another baby.  Pushing the envelope of viability is really a grand experiment on human subjects that sometimes seems to focus more on whether or not the doctors and medical teams can create miracles of life in the moment, but doesn’t take a long view of what those lives might look like in the days, months, or years ahead.

A surgeon’s tool is surgery, so it is the prescribed course of action for many who are confronted with illness and seek help through our current medical system.  There are numerous unnecessary and unhelpful surgeries performed every year to provide “healing” from heart disease and back problems, as well as other maladies.  Based on our doctors’ advice, we are optimistic to a fault, believing we can prolong life and cheat death without truly understanding the odds in each healthcare situation, believing we will be the one with the winning lottery ticket and consoling ourselves when failure occurs that “at least we did everything possible to save a life.”  What this system denies is the possibility of a more compassionate acceptance of fate, and tragic though it may be, there can be such a thing as a good death.

Maternity care is particularly vulnerable to over-action and heroic measures because birth, by its very nature, is the entryway into life.  Our modern system of obstetrics in the United States uses numerous interventions and takes every precaution to ensure a healthy baby which, ironically, leads to the highest death rates of mothers and babies of any country in the industrialized world.  Countries that treat birth as a normal, healthy process intervene less and get better outcomes.  Often, the families that are receiving this over-medicalized care are not even given enough information to make care decisions based on informed consent, nor are they given true choice in the medical setting.  Blaming the women, and without question, blaming the babies for costly care is the epitome of shit rolling downhill.

All this care, optimism, and desire to cheat death – this attitude of “life at any cost” does cost us dearly.  Our inability to grapple with these issues ends up being very expensive, and truly does lead to “million dollar babies.”  I don’t have the answers for many of the questions these dilemmas raise.  What I might choose in a life or death situation would be very different from what you would choose, I am sure. There are no simple solutions.  It seems to me though, if doctors want to advance medical science through human experimentation the subjects should be fully informed and not have to pay for it, and if we truly believe as a society in “life at any cost,” that should extend to everyone and we shouldn’t gripe about it when it comes time to actually pay.

If AOL had planned for the rising costs associated with the rollout of the Affordable Care Act, which strives to provide everyone in our country with access to healthcare so they too might have a chance to cheat death, it would not have made the news.  If AOL leadership had respect for and appreciation of its employees to the point of reducing management’s salaries in favor of buffering these unusual and short-term costs of healthcare and retirement for its workers, it probably would not have made the news.  If it made an effort to improve the healthcare system in our country to one that is evidence-based, efficient and affordable, that probably would not have made the news either.  That bad behavior gets highlighted instead of examples of how to move equitable, affordable, high-quality healthcare forward for our country; that makes me “distressed.”

 

Michal Klau-Stevens is The Birth Lady.  She is a Lamaze Certified Childbirth Educator and expert on citizen childbirth issues.  Her website is TheBIrthLady.INFO.

Do you remember the uproar that created the dolphin-safe tuna movement?  People discovered that fishermen, with nets trawling the ocean searching for tuna, captured and killed whole pods of dolphins.  Nets, as big as two kilometers long and two hundred feet deep, were used to encircle schools of tuna.  Once the tuna were surrounded in the net, the bottom was pulled tight, and the catch was hauled onto the boat.  The practice is still continued today, with about 60% of tuna being caught by this method.  It turns out many different species of marine life are caught in those giant nets.  It is called “bycatch.”  It is the unintended consequence of the business of industrial tuna fishing, and it kills hundreds of thousands of non-targeted sea animals, including endangered sea turtles, sharks, barracuda, and a number of other species.

Every time I read about the anti-abortion legislation being passed in states around our country I think about the dolphins and other majestic creatures that die in those giant nets as bycatch.  I think about them because to me they represent the collateral damage of a sweeping, indiscriminate practice that is wasteful and damaging, and that is how I see this legislation.

If the reproductive rights movement was viewed on a spectrum, one end would be those fighting for access to birth control and abortion, and at the other end would be those of us who are demanding access to optimal maternity care for women so they can have their babies in a safe and healthy way.  As an advocate for healthy birth, I am at the forefront of a movement that involves reproductive rights, and I fight for women who have made the decision to follow through with their pregnancies.

I have experienced the unintended consequences of anti-abortion legislation, including limited access to healthcare and polarized community.  The birth-related organization I work for decided to remove the tagline, “It’s your birth.  Know your options,”   that we used for marketing because I and several other chapter leaders reported being confronted at events on several occasions by angry people who thought the word “options” referred to abortion.  How many women did not approach our booths to get information about healthy birth and breastfeeding because they mistook our mission?  A woman I know who desperately wanted another child had to wait to miscarry a pregnancy that was not viable (no heartbeat was detected) because she was in a place that did not allow “abortions” and they would not do a D&C.

The whole idea of “personhood” seems to put the needs of fetus before the needs of the already living, breathing mother.  Both anti-abortion and personhood legislation seem to make it acceptable to view the mother as simply a vessel for growing life; an incubator that has no need for healthcare, human rights, personal autonomy, or bodily integrity.  Every woman who is denied a VBAC (vaginal birth after cesarean) because the risks to the baby may be slightly greater than a repeat cesarean, regardless of the fact that cesarean surgery exposes the mother to serious risk, is affected by this attitude.  Women who live in places where women are denied homebirth with a qualified birth attendant are victims of the same philosophy.  A friend of mine who moved to North Carolina had to go through the “underground railroad,” sending carefully coded emails and having furtive phone conversations to find a homebirth midwife who would attend her.  She felt a homebirth was a safer choice for her than a hospital birth because of all the unnecessary interventions to which she would be subjected in the name of ensuring a “healthy baby,” even at the sacrifice of her own health.  And heaven help the women who attempt a home birth but need to transfer to a hospital and are seen as criminals and undergo investigations by child protective services or are arrested for child endangerment.

Women have been carried out of their homes in shackles while in labor and forced to undergo cesarean surgeries.  This video by the National Advocates for Pregnant Women describes incidents where pregnant women, some of whom are anti-abortion, were denied their rights in order to protect the rights of the fetuses they were carrying.  While this video focuses on personhood legislation, what we are seeing with much of the current anti-abortion legislation which is closing down clinics is that women will have less access to all kinds of healthcare, including well woman exams, cancer screenings, and STD and HIV screening.

The other type of anti-abortion legislation that has unintended consequences for women who want to be pregnant involves mandatory ultrasound.  I have already heard stories of women who have found out that their babies suffered from genetic defects that are incompatible with life or who died in utero who had to endure mandatory vaginal ultrasounds before undergoing medically necessary abortions.  How much more pain and grief must these women suffer?

These laws being enacted are just like those giant fishing nets, catching their target but also capturing women who are pregnant and have very different needs than those of the women the laws seek to thwart.  Yet, women’s reproductive health runs along the full spectrum, and all women need individualized care.  Each woman has a different story, different needs, different circumstances, and different health concerns.  Women need to make these healthcare decisions with their doctors and have access to the full package of reproductive healthcare in order to remain healthy.  Legislation is too broad and general to adequately answer women’s healthcare needs when it comes to pregnancy.  It is wasteful and damaging, and produces too much bycatch in the form of personal pain and suffering for individual women and societal damage because so many women are unintentionally caught up in the sweeping net.

One step that pregnant women can take towards making sure their care provider is familiar with the latest evidence-based maternity practices is to give their doctor or midwife a copy of the book “Optimal Care in Childbirth,” by Henci Goer and Amy Romano.  Every maternity care provider should read this book, and keep it handy as a reference.  Women might want to keep a copy for themselves too.  Giving this book to your doctor or midwife sends a strong message that you value and expect to receive evidence-based maternity care and that you are savvy enough and motivated enough to seek out the evidence basis of their practice.

This book is not an easy read, nor is it intended as a reference for expectant women.  Instead of “what to expect…” this book is full of detailed scientific evidence about the care birthing women should be given and uses the physiologic, or the normal natural physical process of birth as the basis of care.  Authored by a medical writer and acknowledged expert in evidence-based maternity care and a research expert/midwife, “Optimal Care in Childbirth” gives thorough analyses of current medical maternity practices and the evidence that supports or refutes their use.  It also provides strategies for optimal care and mini-reviews of the evidence, and leaves no stone unturned with respect to the scientific basis for cesarean surgery, induction of labor, augmentation of labor, positioning for labor and birth, care after birth, newborn practices, and more.

I have heard doctors and midwives complain that it is hard to keep up with the research because they are so busy delivering babies.  I have also seen that “silos” exist, where doctors only read journals in their specialty, and miss out on the research that is conducted in related fields, such as midwifery, nursing, and childbirth education.  This book captures research from many sources and packages it in a manner that is portable and easy to share with others.  The mini-reviews provide quick reference points for decision-making in non-emergency situations.

The book costs $50, and by giving it as a gift to your doctor or midwife the message it sends is priceless:  receiving evidence-based maternity care matters to you and you are willing to invest your time and your money in order to get it.

Do they already have a copy?  Suggest they re-gift it to another doctor or midwife in the practice, or to the nurse’s station on the labor and delivery floor of the hospital, or to a nurse, or a hospital administrator, or…

 

Goer, H. and Romano, A. (2012). Opimal Care In Childbirth:  The Case For a Physiologic Approach. Seattle, WA: Classic Day Publishing.

Available on Amazon.com

This is an unsolicited review and I receive no compensation for posting it.

Cut, Stapled, & Mended:  When One Woman Reclaimed Her Body and Gave Birth On Her Own Terms After Cesarean by Roanna Rosewood

©2013 by Roanna Rosewood.

Cut, Stapled, & Mended tells the story of Roanna Rosewood’s journey to motherhood and how the births of her three children changed her life.  Fiercely independent, emotionally detached from her painful childhood, and with rebelliousness against modern medical treatment instilled in her by her holistically minded divorced parents, she faces the birth of her first child with the self-assuredness of a proud warrior as yet untested in battle.  When her planned home birth goes awry because her water breaks but labor does not start, she finds herself in the midst of a hospital birth overseen by an unknown doctor who is not supportive of Roanna’s efforts for a natural birth and on the hospital’s timeclock to force her slow labor to speed up.  Exhausted and overwhelmed, Roanna consents to a cesarean delivery.  Roanna is tied down to a surgical table, and when her son is born and screaming at his entrance into the world, she is unable to go to him, to comfort him, or even caress him.  She begins her journey to motherhood feeling like a failure.  Her body feels broken and scarred, and visions of the surgery replay in her mind while she believes that the first experience her son has had in life is one of abandonment.

When Roanna is pregnant a second time, she pursues every alternative therapy she can find that might heal her body to help her have a vaginal birth.  When this pregnancy ends in a cesarean birth as well, the doctor informs her that she had dense scar tissue, called adhesions, growing throughout her abdomen and her uterus actually tore during the birth.  She refuses her midwife’s attempts to process through the birth experience, instead choosing numbness and a grim acceptance of her belief that she is not strong enough to bring life into the world.

During her third pregnancy, Roanna takes the opportunity to go on the trip of a lifetime to Hawaii.  While away from daily life, she is able to reimagine herself as different person and mentally process through many of her life experiences and her beliefs about herself, her relationships, and her needs.  She is able to connect with some core truths, and strip away some of the armor that has shielded her emotionally since she was a child.  Finally, she is able to have an unmedicated vaginal birth.  But, even that experience, which she has dreamed about and fought for tirelessly for years, leaves her with feelings that are completely unexpected.

Birth stories teach a number of important lessons to everyone who is involved in birth.  Women who will give birth need to hear them in order to learn more about what to expect.  Men who will be fathers need to hear them to better understand how birth transforms their partners into mothers.  Doctors, midwives, nurses, other caregivers, and hospital administrators need to hear the stories of the women they work with to hear firsthand the effects of the care they give on the women they care for.  While each birth story is as unique as the woman who is telling her story, there are themes and similarities that one can identify after hearing many of them.  Ms. Rosewood’s birth stories share similarities to many other birth stories which can act as guides to help improve birth in our country.

Ms. Rosewood eloquently speaks about the physical and emotional effects of cesarean surgery on women as they enter into motherhood.  She writes about the desire for a VBAC (vaginal birth after cesarean) which many women wish for but few achieve in this country.  She writes with refreshing honesty about the surprising nature of birth and how even a seemingly “perfect” birth demands to be processed emotionally and integrated into a women’s life.  In my opinion, the value and the beauty of this book are the depth of description and the honesty about the emotional components of Ms. Rosewood’s journeys through birth because few women give voice with such clarity to this side of the experience.  The emotional truths she describes are her own, and they are similar to the truths of thousands of other women.

Birth in this country is treated as a medical condition to be managed, not as the rite of passage which contains physical, psychological, and emotional components that all must be addressed.  The mind plays a vital role before, during, and after birth.  Cut, Stapled, & Mended thoughtfully explores the side of birth that is often ignored.  In doing so it highlights both the damage and the growth that can occur during any kind of birth, and that is something all people involved in birth should be paying attention to.

It would be simple to say that the problems in maternity care in this country, including high intervention rates, poor outcomes and high cost, are “women’s problems,” but it would be untrue.  Men are deeply affected by the crisis in maternity care now too.  On a personal level, as fathers, they carry the heavy burden of caring for their partners throughout pregnancy, birth, and the postpartum period.  Expectations of parental involvement in pregnancy are high now, and many men must juggle the daily demands of their jobs with medical appointments, prenatal testing, ultrasounds, which require time off during working hours and pull them away from their workplace.  Finances and job security are high on their list of concerns at the same time that they are called away to support their partner and participate in the pregnancy.  Managing childbirth classes and dealing with major life changes such as finding space in the house for the new baby, or having to purchase a bigger car or baby furnishings weigh heavy in men’s minds.  Stress is increased if their partner or newborn needs extra care, which can further affect their attendance and performance at work.  Their income is affected in the form of insurance premiums, co-pays, and deductibles when paying for care that is more expensive than it needs to be, and fosters poor outcomes that demand even more care. 

 

The psychological effects of managing the conflicts and dealing with the additional stresses of parenthood as a working father can take a toll in terms of productivity on the job.  This can create a vicious cycle of stress reducing productivity, which further increases the stress.  This level of high anxiety can affect a man’s health, his ability to do his job, his connection to his partner, and his connection to his baby.  Extended periods like this can ultimately even effect his partner and child if it leads to illness or abuse.

 

Businesses that provide family friendly work environments create programs that reduce these types of conflicts and stresses.  Flex-time, telecommuting, in-house support resources including financial planning and childcare can go a long way towards making a work/family life balance achievable for working fathers.  Men who are given the tools they need to manage the demands of both work and family are happier and more productive on the job.  Businesses that strive to go the extra mile to help their employees reach that balance will find that the costs associated with these programs are offset by lower healthcare costs, less absenteeism, and a more loyal workforce.

 

The ultimate program that businesses can work to implement though, is a reworking of our healthcare system so that the system is more efficient, less costly, and produces better outcomes.  That would reduce everyone’s stress levels.

 

This is a post that I wrote that was published on Childbirth Today from Birthsource.com

http://www.childbirthtoday.blogspot.com/

Welcome to Day #5 of the Blog Carnival honoring 
the International Week for Respecting Childbirth.  
We are focusing this Blog Carnival on the importance of childbirth education!

Lights!  Camera!  Childbirth Education!

By Michal Klau-Stevens

Contrary to popular belief, watching reality birth TV shows like “A Baby Story” does not constitute childbirth education.  Women should understand that while you feel like you are watching a birth from inside the delivery room, what you are really watching is a highly edited soap opera.  The woman giving birth has often had her labor artificially started, sped up by drugs, optimized for filming schedules, and managed to conform to hospital schedules and regulations (and carefully overseen to avoid lawsuits because everything happening is captured on video).  The boring parts end up on the cutting room floor, and the exciting, scary, or emotional parts have been hyped up with tension-inducing music and quick-cut editing.  A process that has really taken up to 24 hours to transpire has been whittled down to a half-hour snippet of tantalizing mom-to-be “birth porn” meant to excite women who have no other way of viewing birth from a more realistic perspective.

Quality childbirth education is the next-best thing to actually observing another woman giving birth.  You learn how your body naturally works to birth a baby, techniques to prepare you for the physical and mental work of labor, and common interventions that might become necessary and why you might or might not need or benefit from them.  You gain an understanding of the issues surrounding giving birth in an environment that is more accustomed to processing you through a system than providing you with individualized care, and you learn methods to give you the best chance of getting quality care suited to your specific needs.

You also build your community by sharing a common experience with other pregnant couples.  That social support is priceless during pregnancy; a time that can be challenging, nerve wracking, and exciting.  As important as it is for you, it can be even more important for your man, who may not have anyone else to connect with about his concerns and needs for the birth of his child.

Seeing more realistic images and videos of real births, having a teacher who can answer your questions, making friends, and learning good information and skills are hallmarks of a good childbirth education experience.  The real thing is NOT like what you usually see on TV!  Birth is a situation where the less drama you have, the better.  Childbirth education helps you be a NO DRAMA MAMA!

Michal Klau-Stevens is the President of BirthNetwork National, an expert on consumer maternity care issues, a Lamaze Certified Childbirth Educator, and mother of three active boys.

I was recently speaking with a Certified Nurse Midwife (CNM) about what needs to change for midwifery to become the standard of care for maternity care in the United States.  We hit on the subject of friction between CNMs, who mostly work in hospitals, and Certified Professional Midwives (CPMs), who work mainly in birth centers and at home births.  While the national organizations that govern these two types of midwives are striving to work together on common ground, too often there is continuing conflict at the state level and between individuals.   I stated that the enmity between CNMs and Certified Professional Midwives (CPMs) needs to be addressed, since too often CNMs will try to eliminate the practice of CPMs through legislation in order to secure the position of CNMs.

Both of us recognized that CNMs are between a rock and a hard place.  They are lower in the hospital hierarchy than the doctors, to whom they are usually dependent for work agreements in order to practice.  Or, as employees of the hospital, they cannot condone any competition, which is what CPMs and homebirth represent.  The reasons this midwife stated for her personal discomfort with CPMs were that she did not trust that the apprentice model of training and the certification process were vigorous enough.  Also, she wants to ensure that the title “Midwife” is protected and regarded with respect commensurate with the level of education she has acquired.  I know she is not alone in these concerns.

The more I thought about these responses, the more dissatisfied I became about them.  Here are the reasons why:

In the birth movement we tend to be unhappy about how doctors want to control midwives.  We believe midwives should operate autonomously, but collaboratively, with doctors.  We often argue that midwives should have their own regulatory bodies because the training and practice of midwifery is separate and different from the training and practice of medicine; so why should doctors and not midwives have control of their own practices?  The same could be said for CPMs.  Their training and practice as out-of-hospital birth specialists is very different from CNMs, who mainly train and work in hospitals.  CPM training and certification is rigorous and is accredited by NCCA, the same independent regulatory group that accredits CNMs. For CNMs to disparage the certification of CPMs is to inflict the same type of judgmental paternalism on CPMs that CNMs often experience from doctors.

As far as protecting the title “Midwife,” I understand that each of us takes pride in the work that we do and we want to be respected for it, especially if we have spent years of our lives and thousands of dollars to get the education necessary to earn that title.  But, many types of workers can fall under the same title.  Take “Doctor” as an example.  There are general practitioners, surgeons, cardiologists, neurologists, psychologists, dentists, and veterinarians.  They are all doctors, but do very different types of work.  Then, there are academics that have PhDs but don’t practice medicine at all, yet they are also called doctors.  Their schooling is different.  The title can have many different meanings.  This is another reason why it is important that CNMs and CPMs are autonomous from each other and have equal representation on midwifery boards.  Leaders of each type of midwifery should have oversight of their practices to ensure that individuals are maintaining rigorous standards of care appropriate to their scope of practice.  And, as a colleague once told me, 50% of all doctors graduated at the bottom half of their class.  Every profession allows people of varying abilities to practice as long as they have passed the certifying exam, proving a certain level of competence.

Also, women are savvy enough to learn the differences between the different types of midwives available to them.  I have never heard of a person going to a cardiologist for their annual gynecological exam because they both are called “Doctor.”  A little education and a few questions can clarify the differences.  To infer that the options are too confusing or that we are incapable of figuring it out is a bit insulting, actually.

Ultimately, it is citizens, and not CNMs or doctors, who should be making decisions about whether people have access to CPMs.  Women have the right to choose their care provider and their place of birth.  There are women who want CPMs as their care providers, and there are women who want to give birth in birth centers or at home.  CPMs have been shown to have comparable outcomes and provide huge cost savings for maternity care in relation to hospital birth.  For CNMs to deny women these rights by denying access to CPMs is in direct conflict with their beliefs in “the basic human rights of all persons,” and “equitable, ethical, accessible quality health care that promotes healing and health.”

So I say, “Live and let live.”  There is too much work to be done to repair our broken maternity care system for this kind of arguing to continue.  Midwives and out-of-hospital birth are accepted around the world, and are an integral answer to our healthcare needs.  Focus on building a system that puts the woman at the center of care, and let the woman choose the provider who best serves her needs.  CNMs, it is not your decision to make.

How easily can the women you cover with your benefits packages access low-cost, low intervention maternity care?  There is a lot of discussion around the internet these days about how the use of midwives and birth centers could save the government billions of dollars because it pays for almost half the births in this country through Medicaid.  Who pays for the other half of the births in the country?  American businesses, through their employee benefits packages.  The style of care that midwives in birth centers and out-of-hospital provide is low-intervention and lower cost, is beneficial for the majority of women giving birth, most of whom are considered at low risk for problems with their pregnancies, and leads to better outcomes with less morbidity.  That’s great, but if women can’t access it, then it doesn’t lead to cost savings.  Women can’t access midwifery care if state legislation does not support it.

In order to see the cost and performance benefits of midwifery care, out-of-hospital midwifery and birth center regulations, along with payment structures, must be aligned with the goal of providing widespread access.  These state-level regulations are set through legislation.  Every state has a different set of rules dictating what type of licensure midwives must have, how birth centers must function – if they are allowed at all, and whether or not payment is required through Medicaid or Medicare and private insurance.

The ideal legislation would:

  • Set clear guidelines for who may legally practice as a midwife out-of-hospital, and include all the pathways for licensure, including Certified Nurse Midwives, Certified Professional Midwives, Certified Midwives, and Licensed Midwives
  • Allow midwives who practice out-of-hospital to be regulated by midwifery boards, not medical boards and have no requirement for written collaborative practice agreements with obstetricians
  • Allow independent birth centers to operate unencumbered by onerous rules
  • Require that all types of licensed midwives be reimbursed by Medicaid, and also private insurance
  • Provide adequate funding and appropriate regulation of the educational system in order to train more midwives

26 states currently have legislation that regulates out-of-hospital midwifery.   10 states outlaw direct-entry midwifery, and 14 states have ambiguous regulations or licensure is unavailable.   82% of states have regulations regarding birth centers, and it is important to know if those regulations in your state favor them or not.  There are also regular pushes by medical trade groups, hospital organizations, and medical boards to alter legislation to favor hospital birth in order to maintain market share.  There is a lot of money at stake when it comes to maternity care, and hospitals and doctors are reluctant to allow the competition that midwifery creates in the marketplace.

If legislation doesn’t align to provide your employees with access to midwifery and birth center maternity care, your business will continue to pay top dollar.