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QUESTION #3: What type of opposition have you encountered during your work for the Big Push? Can you note a prominent incident or situation?

ANSWER: In virtually every state we generate fierce opposition from professional associations, such as ACOG 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. Opponent groups, of course, deny that their objections to legislation authorizing Certified Professional Midwives to practice has anything to do with money or turf because out-of-hospital birth represents such a small corner of the maternity care market.

But what they aren’t saying is that out-of-hospital maternity care is a market that is poised for growth and has, in fact, been growing at a noticeable pace since the economic downturn began. As more families are losing their health insurance and as more women are finding the high-cost of maternity care riders and deductibles to be beyond their means, more women are seeking out alternatives to hospital-based maternity care. And this is another reason why our media outreach efforts have been so successful—more women are learning that about those alternatives.

Certified Professional Midwives all over the country are reporting unprecedented demand for their services, and a North Carolina study recently found a 50 percent increase in the demand over the course of one year alone. No single incident stands out, but we have noticed an interesting pattern in many states. Early on in the process, 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, since they consider our issue to be a pretty small one, a no-brainer that will sail right through both houses in no time.

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." We can’t tell you how many times we’ve heard comments to that effect from legislators who are shocked by how opponent groups will stop at nothing to kill CPM legislation, often employing desperate and heavy-handed tactics.

Submit your question to the Big Push.

QUESTION #2: The Big Push for Midwives seems to be the center of a very successful campaign for midwives; with pro midwife legislation having been passed in Idaho, as well as Missouri, where the law was tested in the State Supreme Court and won, despite the direct advocacy of the AMA in the form of a friend of the court brief. Recently legislation passed in Indiana, there is also legislation pending in states such as Alabama, and there is an effort to get legislation written in many others. How much of this effort has been grassroots on the part of midwives in these states and how much of this can be attributed to the Big Push? What is the most notable accomplishment of the Big Push to date?

ANSWER: The Big Push for Midwives is a consumer-driven campaign, made up of every day people who have either had their babies at home or in freestanding birth centers under the care of CPMs or who strongly believe that this should be an option for pregnant women and their families to choose. Legislators most definitely take notice and respond when they hear from a significant number of constituents who are being denied access to health care providers and options. Because midwives are at a disadvantage in the legislative arena, having to compete with much more powerful and well-financed physician groups for legislators’ attention, our strategy from the beginning has been develop a consumer-led campaign, with a grassroots base made up of a diverse coalition of constituencies, including Democrats and Republicans, feminists and Christian conservatives, Amish and Mennonite, and pro-life and pro-choice activists all working together to defend our right to choose how and where our babies are born.

One of the Big Push’s most notable accomplishments has been our success in transforming media coverage of Certified Professional Midwives and out-of-hospital birth from almost universally negative to consistently positive. Prior to our media outreach campaign, which we launched in 2007, the media’s focus was almost exclusively on a handful of high-profile criminal prosecutions in states where there were no laws or regulations governing the practice of direct-entry midwifery. As a result, the impression that came through loud and clear in the media was that midwives who deliver babies at home are illegal, untrained, and unscrupulous women who routinely endanger the lives of mothers and babies. Since we began our campaign to raise awareness about the CPM credential, the safety, benefits, and cost effectiveness of the care they provide, as well as the need for legislation in all states to license and regulate direct-entry midwives using the CPM credential, the shift in the tone and the content of our media coverage has been remarkable.

When journalists receive objective information about Certified Professional Midwives and out-of-hospital care, they are no longer interested in pursuing sensationalized and simplistic storylines that perpetuate age-old stereotypes and misinformation, which in turn helps us as advocates to direct legislators and policy-makers to more in-depth and thoughtful media coverage about CPMs and out-of-hospital birth and the grassroots movement to advocate on behalf of increasing access to both.