Members of the Big Push for Midwives Campaign applaud the publication of the American Association of Birth Centers' landmark National Birth Center Study II in the Journal of Midwifery & Women’s Health.

The national prospective study pointed to excellent outcomes in midwife-led birth centers run by both Certified Professional Midwives and Certified Nurse-Midwives. Seventy-nine birth centers participated in the study, recording data for more than 15,000 prenatal courses and births. For more information and insights, check out the blog posts and alerts from Childbirth Connection, Citizens for Midwifery, Lamaze International's Science and Sensibility and many others about the study.

While it wasn’t intended as a direct comparison of CPM and CNM outcomes in birth centers, the study nevertheless provides solid evidence that the excellent outcomes achieved in these birth centers occurred regardless of whether a CNM, a CPM, or a joint team of both provided the midwifery care. At the same time the study, which was published in a scientific peer-reviewed journal, shows that outcomes are not dependent upon any one particular midwifery certification program or any particular educational pathway to certification.

The Big Push calls on policy makers to focus on the demographics of the more than 15,000 women who participated in the study. The majority of birth center consumers were middle-class white women, confirming the unfortunate reality that women of color and low-income women are much less likely to take advantage of the out-of-hospital birth options that produce such excellent outcomes.

Increasing access to birth centers through section 2301 of the Affordable Care Act, which added birth centers and midwifery care in birth centers as mandatory Medicaid services, as well as access to home birth through federal legislation that would guarantee CPMs as providers of a mandated Medicaid service, are necessary steps to making the midwives model care in both settings accessible to all women.

The first step needs to be continued pushing for licensing for CPMs, the specialists in out-of-hospital maternity care, to legally practice in all fifty states. Unless they are licensed by their state, CPMs cannot be included in Medicaid, Tricare, and other government programs – including the new health insurance exchanges under the Affordable Care Act – that will make midwifery care accessible to all women. This new study should go far to convince state legislators to license midwives and federal policymakers to include CPMs in these payment systems and other federal health care programs.

We are keeping the focus on what really matters, after all – delivering the kind of excellent woman-centered care highlighted in this study to the women to want and need it.

PushGirl Friday gets down to where rubber meets road, sharing her hard-won expertise from the campaign trail to increase pro-midwife and pro-birth options in the U.S. The work continues, and together, we are pushing forward for birth options! Sign-up for PushAlerts!

"Good news out of Maryland—and what an excellent action alert! (Please see Maryland's Alert below.) Jeremy and other folks working in MD and other states, my only caution would be that when you ask folks to personalize their communications to legislators (which is so critical), do NOT encourage them to write about why they decided to have a home birth.

"What we’ve found to be much more effective is to ask them instead to pick one or two of your suggested talking points and put them into their own words (and you all have a great list for a state with a Democratic majority—it’s so critical to tailor your talking points to the majority party in each chamber).

"When people include the reasons why they decided to have a home birth they veer way off message, go on way too long, and get into all sorts of thorny issues that tend to be very off-putting to people outside the home birth community, who often feel put on the defensive about their own birth choices and who often see home birth parents as misinformed, irresponsible, and smug people who put the birth “experience” above the safety of their own babies. Then you leave the door wide open for keeping the discussion framed around bad mothers and dead babies instead of on the one point opponent groups can’t refute—it doesn’t matter why people are having their babies at home, the fact is they are, and the numbers are steadily increasing each year. So here’s what we need to do to make it safe—license home birth midwives as Certified Professional Midwives (CPMs).

"We’ve consistently found that the only reasons for talking about why people have home births that gain us any traction are religious, cultural, or financial reasons. It’s hard to argue with those, and most people won’t, even if they still think home birth is a bad idea. But just a reminder to everyone gearing up for the new legislative season is that it’s always most effective for us to keep the focus on the reasons why home birth is a reality for a whole range of reasons other than personal choice.

"One of the realities we often neglect to mention but that is very effective to point out has to do with issues around birth certificate security. A good reason to have a licensed provider attend every birth is, for Democratic legislators, to make sure that no baby born in the U.S., regardless of the immigration status of their parents, can have their citizenship challenged or revoked because their birth certificate was signed by an unlicensed midwife (which has been a big problem in Texas, for example). And for Republican legislators, so that birth certificates handled by unlicensed, illegal providers who may or may not be on the up-and-up don’t fall into the wrong hands—terrorists, illegal immigrants, or black-market adoption peddlers. Actually, this point works well with Democratic legislators, too, but the threat posed to the citizenship of the children of undocumented immigrants is pretty much unique to them for obvious reasons having to do with the partisan fault-lines around the immigration debate.

"I know these points seem preposterous to us, but it’s amazing how effective they are with legislators who are already biased to consider midwifery and home birth to be somewhat shady practices, so why not turn that negative bias into one we can use to bolster our argument about why the safest route for multiple reasons is to license and regulate home birth midwives as CPMs. So I do like to remind folks every once in a while about the birth certificate issue since it’s one we tend to overlook. "Happy New Year everyone!"

~PushGirl Friday