Home birth during a pandemic
One of our fearless, long-time leaders of The Big Push for Midwives Campaign, Deborah Fisch of Mama's Got a Plan fame, seeded the idea of a "landing page of landing pages for home birth during this pandemic." Deb shared this with us for the benefit of the whole PushNation, which is pushing to bring Certified Professional Midwives (CPMs) out from underground economies and fully integrate them into the Reproductive, Maternal, Newborn and Child Health (RMNCH) Continuum of Care in all US states and territories:
"There’s a PLAN for home birth and home birth midwifery during COVID-19? Well, not in the sense of a master document that tells all pregnant people in the United States what to do. But there is a lot of information popping up about pregnant people facing crowded hospitals full of sick people, wanting home births, not being able to access midwifery care, and more. As a public service, we track and capture that information on this page. These links will be of use primarily to consumers, if one can call pregnant people consumers – they seem more like producers! In addition, some information will be relevant to home birth midwives, as well as to attorneys who work to safeguard the rights of both the people giving birth and their midwives."
To see the recent News Reports, visit the PushHeadlines page (or just scroll to the bottom of this page). Read this News Release 'Where's My Midwife?' Map Links Midwives to Pregnant People, and see the new crowdmap here.
Speaking of Maps, check out the latest PushMap (and PushChart) that show that in 14 states, as well as in Puerto Rico, Guam, and the US Virgin Islands, CPMs are at risk of criminal prosecution for practicing medicine or nursing without a license, driving the practice of midwifery underground and creating barriers to access for women seeking care.
Here too are several Asks coming forward from the PushStates related to home birth and CPMs.
- Friends of Michigan Midwives, "Letter to Gretchen Whitmer: Requesting an Executive Order to extend Medicaid coverage to midwives licensed in Michigan," March 2020
- Brooke Fortney, "Petition Mario Cuomo: Allow Licensing for Certified Professional Midwives in New York," Change.org, March 2020
- Flor Cruz, "Petition: Homebirths Need to Be Fully Covered by Insurance Companies during COVID-19 and Always!," , March 2020
- Christine Sheets, "Petition J.B. Pritzker: Pass Illinois HB5629 & SB3851, Known as the MIDWIVES PRACTICE ACT," , March 2020
- Meredith Christie, CPM, "North Carolina: requesting a governor’s order to expedite the licensing of CPMs during COVID-19," April 2020
- Mairi Breen Rothman, CNM, DM, "Maryland midwife collective responding to a governor's call to reopen recently closed hospitals to address pandemic-generated needs: working with officials to reopen a community hospital as a place for birth during the pandemic and beyond," April 2020
If you need Legal Resources, please contact these organizations and read their recent analysis.
- Birth Rights Bar Association (BRBA)
- National Advocates for Pregnant Women (NAPW)
- Birth Rights Bar Association | National Advocates for Pregnant Women
Finally, the following are the Landing Pages and many resources from a variety of national and international organizations that are providing helpful information for home birth during this pandemic.
- American Association of Birth Centers (AABC)
American College of Nurse-Midwives (ACNM)
- Birth Place Lab: collating evidence-based resources to support communities with information and community-based resources from global settings and B.C. Includes the relevant WHO social media tools, their just-released Guidelines for Interprofessional Collaboration: Community Midwives and Specialist Providers, and a mobile app for self-assessment
- Black Mamas Matter Alliance (BMMA)
- Black Women Birthing Justice (BWBJ)
- Black Women Do HomeBirth
Black Women's Health Imperative (BWHI)
- BWHI Statement on COVID-19, March 13, 2020
- Centers for Medicaid & Medicare Services (CMS): Coronavirus Waivers and Flexibilities
- Citizens for Midwifery
- Elephant Circle
- Evidence-Based Birth
- Foundation for the Advancement of Midwifery (FAM)
- Hawaiʻi State Commission on the Status of Women Department of Human Services State of Hawaiʻi
- Human Rights in Childbirth
International Confederation of Midwives (ICM)
- ICM Official Statement, "Women's Rights in Childbirth Must be Upheld During the Coronavirus Pandemic," March 2020
Mercy in Action College of Midwifery
- Webinar: Clinical Preceptor Challenges: Best Practice During COVID-19 Pandemic, March 24, 2020
Midwives Alliance of North America (MANA)
- MANA is working to help midwifery supply distributors better understand what supplies are needed to keep midwives safe as they provide care to those in need during the COVID-19 Pandemic. Please help by answering the questions in this short survey.
Colleen Donovan-Batson, MS, CNM, ARNP, Director, Division of Health Policy and Advocacy, "MANA Statement | Implications of COVID-19 in Midwife-led Care of Childbearing Families," March 2020 (PDF)
- Sarita Bennett, "Midwives Alliance of North America COVID-19 Letter," March 26, 2020
- Sarita Bennett, "The Impact of Coronavirus on Community Birth"
- National Association to Advance Black Birth (NAABB)
National Association of Certified Professional Midwives (NACPM)
- Webinar: Grappling with Clinical Challenges During the COVID-19 Pandemic, April 17, 2020
- Webinar: COVID-19: Community Midwives, Public Health, and Emergency Preparedness, April 7, 2020
- Webinar: COVID-19: Telehealth for Community Midwives, April 3, 2020
- Webinar: Coronavirus: Midwives on the Front Line, March 19, 2020
- National Black Midwives Alliance
- Natural Resources, March 31, 2020 Class
- New York State, Secretary to the Governor Melissa DeRosa and New York State Council on Women & Girls Launch COVID-19 Maternity Task Force, April 20, 2020
- North American Registry of Midwives (NARM)
- SisterSong Women of Color Reproductive Justice Collective
- UNLV School of Nursing: IRB-approved survey for wide dissemination: "If you are providing maternity care during the pandemic, the researchers want to hear from you. Please participate and share with your networks! Take survey here. (If you are unsure if you meet the requirements, call or email the study team: Dr. Jennifer Vanderlaan | [email protected] | 702-895-3982 | IRB#1579780-1)
- White Ribbon Alliance
If you want to add your information to this page or otherwise contact us, send us an email.
If you want to LOL during this crazy time, see more from the wicked smaht Deborah Fisch:
Check out the latest PushHeadlines here:
On Mon, Dec 8, 2014 at 5:31 PM, PushGirl #2,135 wrote:
"This study–published in Pediatrics Jan 2015–looked at 2 million kids, and found that children delivered by cesarean delivery had significantly increased risk of asthma, systemic connective tissue disorders, juvenile arthritis, inflammatory bowel disease, immune deficiencies, and leukemia.
"I’d call that some evidence."
On Tue, Dec 9, 2014 at 6:52 PM, PushGirl #4,933 wrote:
"Why isn't this in the news...?"
Birth activists were all pretty happy this week reading about the new U.K. National Health Service NICE guidelines recommending birth at home with a midwife, or in a midwife-unit for first-time mothers. (And again when seeing the ripple headlines here and here and here.)
"The UK gets it right," we posted on The Big Push for Midwives Campaign Facebook page. But, positive as this development may be, it is clear it will take far more than British sanity about birth for US policymakers or the US maternity care system to likewise "get it right" or even to "get it."
As one commenter quickly noted, opponents will quickly hog-tie the new UK policy to British midwifery education, or the integration of home and hospital in that country ... the usual rhetorical smoke-and-mirror tricks used to deflect attention from the fact that US home birth midwives, CPMs, are experts in out-of-hospital care, the gold standard, educated specifically to excel as providers of home and other out-of-hospital maternity care. The casual reader, who does not yet know those facts about CPMs, will then fail to realize that the NICE recommendations hold true also for American women who, like their British sisters, are female mammals (smoke and mirrors be damned).
The good news is that The New York Times journalists saw instantly the real basis for the differences in care between the US and the UK. Read it here. Notice, in the 11th paragraph, right after the obligatory recitation of ACOG's standard rote objection to home birth ("we do not believe" home birth is safe), the article points out:
"If such a recommendation were made in the United States, doctors might worry about losing patients to midwives."
There it is, folks, in a nutshell, laid right out in the open.
The New York Times gets it, it understands that ACOG's opposition to home birth isn't really about safety, or education, or models or care, or liking CNMs better. It is all about competition, losing patients to another type of provider, about money. '
The article continues: "That concern is absent in Britain's taxpayer-funded system. There are no financial incentives in the U.K. for doctors to deliver in a particular setting (that is, hospitals) because there is no personal gain."
Shazam. It is thrilling to read that in (news) print! Yes, the percentage of home births in the US is relatively low, but for heaven's sake, it increased by 29% from 1990 to 2009, and it has continued to rise in an upward trajectory. Consumer choice is a powerful thing.
'ACOG and the hospitals can read these reports too, and they understand the implications for their bottom lines. When MacDorman, Mathews, and Declercq write, in their 2014 Data Brief on 2012 place-of-birth data exactly what those implications are: "If this increase continues, it has the potential to affect facility usage, clinician training, as well as resource allocation," the OBs and hospitals know what is being written on the wall – and we do too.
Add to that the intriguing responses regarding future birth sites provided by the representative sample of women who had given birth in a hospital in 2012-2013 and who responded to Childbirth Connection's 2013 Listening to Mothers III: New Mothers Speak Out Surveys and Reports. Asked how open she might be to a future birth at home, an amazing 11% indicated that they would definitely want to give birth at home, while another 18% said they would consider a home birth. Likewise, 25% of survey participants would definitely want to use a freestanding birth center! Another 39% said they would consider a birth center.
This is huge, friends.
At the present time, the statistics gathered and published by Childbirth Connection reveal that, in 2012, 23% of all hospitalizations were for childbirth and newborn care, and that maternity care is the "single most common" cause for hospitalization in the US.
So, if one owned a hospital, or if one medically managed all of one's patient deliveries at a hospital, how would one feel about handing off 10% or 25% of those families to midwives and birth centers? And not in some distant 20-years-from-now future, but as soon as those Mothers stop speaking out long enough to get pregnant again? Well, if present-day monopolies are any indicator, one would fight tooth and nail to maintain one's market share of the $111 billion one billed for maternity care facility charges alone in 2010.
"First they ignore you, then they laugh at you, then they fight you, then you win."
Many birth activists understand that the out-of-hospital birth movement in the US is in the next-to-last stage of this lifecycle. "They" are fighting against sanity, reality, and consumer choice. Hard. And when their junk science isn't sticking, they are trotting out the bigwigs at ACNM and ACOG shouting that CPMs need more education in more structured institutions, because those bigwigs have a very long history of taking away existing traditional educational paths and intentionally closing off and slowing down production of their competition (King Bigwig himself Abraham Flexner did it exceedingly well in 1914).
Sadly, it gets even worse when "they" sense the ship isn't sailing solely in their $111 billion direction. Bigwigs like those of Delaware ACOG come out from the bowels of the boat with last-ditch, cut-throat tactics to snatch away legislative victory from mothers and families fighting for increased access to CPMs and more out-of-hospital birth options. And when they slink back below deck, Lady Justice rightly asks why do "they" do it? Are "they" truly concerned for patient safety, or only about throwing all the midwife competitors overboard (or nearly as bad, down into the physician-oversight slave galleys)?
As the Listening to Mothers III: New Mothers Speak Out and the latest CDC Data Brief tell the story, The Big Push for Midwives Campaign (and the whole PushNation) is getting the message across. Women are hearing the true facts, and informing and educating themselves. They are beginning to make new choices.
Dearest birth activists, amazing Pushers, and Salty Dogs, we are all seaworthy!
Don't give up the fight now and don't reach uncomfortable compromises.
Do not even be discouraged, all hands on deck!
We are in the fighting stage to turn this battleship around, and the data point toward the absolute bearing of our winning.
Thank you SO much all you amazing Pushers fighting to remove barriers that deny mothers, babies, and families access to high-quality, safe, and cost-effective midwifery care and increased access to Certified Professional Midwives (CPMs), who specialize in out-of-hospital maternity care. http://j.mp/BigPushTY2014
The federal Centers for Medicare and Medicaid Services (CMS) released on April 9 the Medicare billing information for physician providers after decades of litigation by the American Medical Association (AMA) seeking to block the release. [http://www.reuters.com/article/2014/04/09/us-usa-medicare-data-idUSBREA3809H20140409] Some of the dollar figures for federal moneys paid to individual physicians have been shocking, but those of us who have studied the economics of maternity care should not be surprised. It is basic economics that markets in which consumer access to information is blocked, and also where real competition has been suppressed, will be characterized by high prices.
The Big Push for Midwives Campaign supports the release of provider billing information because it benefits women and their families. Consumers should have access to information that could affect decisions about their healthcare, including the choice of provider and the cost of a provider's services. An informed public is better equipped to exercise not only health care choices, but also political speech, especially now that private health plans are required to provide maternity coverage. This kind of data educates both citizens and policymakers about the direct and indirect costs related to healthcare and allows better informed decision making.
Why did the AMA fight to suppress this information for so long? The assumption that consumers are ignorant and need to be protected from information goes back to early American court cases from the 1700s. Back then even physicians did not understand what diseases were and how they spread. Most people could not read and had very limited education. Even if they could read, the information was stuck in books in far-off universities. This remained true even during much of the last century.
Today, most people can read and have access medical and health care information on the internet. They could have had access to this cost-related information if the AMA had not impeded access. Women and their families should have access to whatever information they need that could affect their health care decisions, including relative costs, so they can make intelligent decisions based on the evidence.
The heart of midwifery is educating women and their families so that they make informed decisions instead of keeping them ignorant and dependent on providers. Releasing information like this is a good first step. We need to make this information user-friendly and to educate both citizens and policymakers to compare many factors – costs, outcomes, consumer satisfaction – so they can understand and use the information effectively. Consumers need this information for health care decision, and policy makers should be looking at and comparing what the federal government pays for physician services versus the services of other health professionals, such as midwives.
For those playing along at home, as soon as The Big Push for Midwives announced the "Largest US Study to Date Finds Home Birth to Be a Safe Option for Most Women" based on newly released research (here and here), Big Medicine played a card from its dark deck.
Goliath reached up its sleeve to flip the Ace of Scaremongering at millions of mothers, families, and babies across the US, in its desperate attempt to try to shut/shout down the truth, citing numbers that are neither published nor peer reviewed, and based on birth certificate data.
The good news is that the truth about the safety of out-of-hospital birth as published in the Journal of Midwifery & Women's Health is still available even if Goliath is teetering from the stone that hit his exposed forehead.
While it is beyond pathetic to see the turf war that Big Medicine continues is waging, it is sadly not surprising. Goliath doesn't seem to care that:
- Rural, uninsured, and underinsured women need more maternity care options.
- States need to remove barriers that deny mothers, families, and babies access to high-quality, safe, and cost-effective midwifery care.
- The US needs to get it in gear to significantly reduce rates of prematurity and low-birth weigh that are critical to reducing racial and economic disparities in birth outcomes, and reducing unnecessary costs to our health care system.
- The US has one of the highest rates of both infant and maternal death among industrialized countries, and frankly, the US maternity care system is broken. Maternal and fetal mortality rates are worse than 40 other countries worldwide, and we spend more money than anyone else on maternity care. Where is almost all that care being delivered? The answer Goliath doesn't want you to see through his 30%-c-section-tinted glasses is HOSPITALS.
Big Medicine is NOT doing so great at birth in America, and Big Medicine's problem with out-of-hospital birth is not that it isn't safe. Rather, it's that it is a safe option for most women and thus presents a threat to the Big Medicine status quo and the trade associations and state medical societies who control it. Goliath is deeply dependent on maintaining the status quo … so dependent that Big Medicine will sometimes tell bald-faced lies about out-of-hospital birth research on national television and in other media outlets and hope that no one notices. Here are some other sensible voices on the matter:
- Here's an impressive statement from the American College of Nurse Midwives (ACNM)
- Here's a piece where Missy Cheyney refutes these new scaremongering numbers.
- Here's an item that points out more on the flaws in birth certificate data.
- Here's the response of the Reddit community to a recent diatribe from Big Medicine's biggest shill.
- Here's a commentary by sociologist Barbara Katz Rothman on "Home Birth In a Risk Society."
- Here's a Facebook post by Rebecca Dekker, PhD, RN, APRN of EvidenceBasedBirth.com.
- Here's a Throwback Thursday treat by Wendy Gordon, CPM, LM, MPH, MANA Division of Research, Assistant Professor, Bastyr University Dept of Midwifery in Science & Sensibility.
- Here's another Throwback Thursday treat by Miriam Pérez of radicaldoula.com published in RH Reality Check.
Here at The Big Push for Midwives, we are ALL IN to knocking Goliath down. The powerful and strong are not always what they seem. David had only a stone and a slingshot to bring down the greatest warrior of his time. The Big Push has only the truth, courage, faith, and the amazing grassroots uprising of the PushStates who fight the good fight every day from where they are with what they have. To see more on these dueling studies, visit the PushHeadlines page today.
Submit your question to the Big Push.
QUESTION #4: Home birth legislation seems to be a true non-partisan issue, with Republicans politicians showing support from the right, as well as feminists from the left. Has this been the experience of the Big Push? Is there any instance from state to state that the Big Push knows of where pro-midwife legislation has been split legislators along party lines?
ANSWER: In every state the support for CPM legislation has been roughly 50/50 between Republicans and Democrats—in fact, another comment we frequently hear is how unusual our list of co-sponsors is and how they've never seen certain far right and far left legislators on the same bill together. And that is one of our primary strengths as a movement, that supporting access to out-of-hospital maternity care and midwives who are specially trained to provide it is naturally bipartisan.
In fact, the only people who oppose expanding maternity care options and choices are the special interest groups with a financial stake in maintaining and the legislators who are beholden to them.
What's inspiring about our movement, though, is that we're such a refreshing example of how politics is supposed to work. Many of the legislators we try to recruit have been "bought" by medical industry money, but if enough of their constituents speak up, votes often trump special interest money. And we're able to mobilize a significant number of voters in every state, not only via outreach to legislators and staff, but also through the campaign work we do in support of our friends and, sometimes, against our opponents. Midwifery supporters in a number of states have played a significant role in influencing the outcome of state legislative races—in Wisconsin, we even mobilized the Amish to turn out and vote.
Submit your question to the Big Push.
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.
Submit your question to the Big Push.
QUESTION #1: The American Medical Association (AMA) (along with other doctor trade organizations) has taken a stance diametrically opposed to home birth and Certified Professional Midwives (CPMs). Activist midwives and consumers who are involved in statewide legislative efforts across the US have cited the AMA's stance as a main motivator in their activism: they want to get legislation passed before the anti home birth lobby can. To what degree is the Big Push for Midwives a reaction to the stance of the AMA and other doctor's groups at the state and national levels?
ANSWER: When it comes to Resolutions the AMA passes in opposition to home birth, these are adopted in response to the growing success of the grassroots movement in support of expanding access to Certified Professional Midwives and out-of-hospital maternity care. Since midwifery activists began organizing across states in 2005—an effort that culminated in the launch of the Big Push for Midwives Campaign in 2007—UT, VA, WI, MO, ME, ID, and IN passed laws authorizing legal practice for Certified Professional Midwives, while bills that had been effectively dead for many years in states such as IL, NC, MA, AL, SD, and AL suddenly began to make significant progress.
Once such item, Resolution 205, was brought to the AMA on behalf of the American College of Obstetricians and Gynecologists (ACOG), which had issued alerts to its members about the Big Push’s legislative successes and the need to increase the resources dedicated to fighting CPM legislation (these alerts are titled "ACOG 2007 Midwifery Year In Review" and "ACOG 2008 Midwifery Year In Review").
So clearly they are concerned about the progress we’ve been making and they've made defeating our bills their second most urgent state legislative priority, ahead of issues such as medical liability reform, access to contraception, and reducing perinatal HIV.
Another such item, Resolution 814, sought to limit the scope of practice for allied health care providers, though it predates the Big Push and doesn't specifically mention Certified Professional Midwives (which physician groups love to try to malign by using the oxymoron, "lay midwives"), it was brought to the table by the Texas Association of Anesthesiologists, which had fought quite forcefully, though unsuccessfully, to repeal their state law authorizing CPMs to practice. (If you're interested in learning more about that battle, we can put you in touch with the lobbyist who helped the Texas midwives defeat the TAA, but it’s a safe bet that it was one of the primary catalysts for Resolution 814.)