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.

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.

The Big Push for Midwives collaborated with the California Families for Access to Midwives (CFAM) to get out this latest news release in California. CFAM is a social justice organization dedicated to removing barriers that deny California citizens access to licensed midwife care.

It looks like the "Free Our Midwives!" rally on July 1 at the Capitol in Sacramento, CA, was a great success, with 375 parents, babies, and midwife supporters converging on the Capitol in support of efforts to remove from California law a repressive and outdated provision that is threatening the future of legal midwifery in California, and perpetuating racial and economic disparities in birth outcomes.

Assemblywoman Susan A. Bonilla told the crowd at the rally that "You have made an impact here today." In addition, Assemblywoman Bonilla did two important things to help remove physician supervision:

1. She removed language from the bill (AB1308) that restated and outlined a plan for implementing California’s famously ill-conceived and unobtainable requirement of physician supervision of licensed midwives.
2. She also verbally committed to amending the existing law to take physician supervision completely off the books. PLEASE THANK HER (using old fashioned pen and paper! No calls for now!) for her support.

Resulting PushHeadlines:

• The Modesto Bee  |  July 8, 2013
• The Sacramento Bee (photo gallery)  |  July 8, 2013
• Point Reyes Light  | July 3, 2013
• LAFamily.com  |  June 2013

Congratulations from the Big Push for Midwives Campaign to the Friends of Missouri Midwives (FOMM) and the Missouri Midwives Association (MMA) on the fifth anniversary of the Missouri Supreme Court decision!

The Big Push for Midwives steering committee particularly LOVES this latest FOMM news release as our own Susan Jenkins was one of the attorneys who wrote the birth activists' amicus brief back then and consulted with MMA leadership on the text of the bill.

Please enjoy the news release here, which is well-written, upbeat, and positive. Again, congratulations to Missouri!!

Resulting PushHeadlines:

• Missourinet  |  July 9, 2013

Fire up the PushMediaMachine, we are back in business! We live to Push again! Many thanks and lots of hugs and kisses to all of you incredibly wonderful Pushers and other folks who chipped in on this latest fundraising effort.

Because you reached down and gave what you could, the Big Push for Midwives campaign's "50+ Shades of Green for CPMs" fundraiser was a pretty solid success.

Although we did not quite reach our goal of $5,000 (and anyone who wants to tip us over the top is still happily encouraged to do so), we got SOOOO close that our media relaunch is a definite GO.

We are thrilled to report that we will now be able to sign up again with our media software vendor, pay our loyal social-media-maven intern his back wages, and be back to our old PushNewsRelease and PushAlert tricks again real soon.

Don't forget to visit the Newsroom and get signed up for PushAlerts!

If you have any favorite reporters, bloggers, media outlets who you want to make sure are on our lists, please pass their contact info on to [email protected].

The Big Push for Midwives campaign belongs to you.

• It isn't the website alone (although we do have a lovely website).
• It isn't the Facebook page alone (though we're delighted to have so many fans!)
• And it certainly isn't just the steering committee.

We are here to help you in the PushStates out and to keep the Big Push for Midwives campaign going, but we are not a top-down organization, rather, we are the essence of grassroots. The Big Push campaign has always been the work of a coalition of the PushState groups, and our focus has always been to create a mutual-help project for all the consumers and midwives pushing in the statehouses and sharing ideas, strategies, successes, and setbacks to create efficiencies and interconnectivity.

For this coalition to be be sustainable, we realize that it will be necessary for periodic fundraisers. Please think of these as chipping in to keep your coalition going. A natural question is what other sources of funding might be available to us?

Our applications for grants have not been successful for the most part. Grant-makers don't seem to get it that, without licensing CPMs, nothing else really matters much—Medicaid, education, federal "recognition," schmoozing with midwives from the rest of the world, really none of it.

So long as nearly half of the women in the US lack access to Certified Professional Midwives (CPMs) just because they live in the wrong state, License First has to be the policy priority. We won't stop sharing this message.

So, again, THANKS SO MUCH to all of you and to everyone else who helped us turn 50+ shades of green into some much-needed green dollars.

Dear Childbirth Professionals, Moms, Dads, and Birth Options Activists:

On behalf of The Big Push for Midwives, a most sincere THANK YOU for all you do to increase pro-midwife and pro-birth options in the U.S. You inspire us.

Before 2012 gets away, please take a breath to think of all you've done this year to push for victories in the ongoing movement to protect our birth rights. Stay encouraged. Note all you have invested in our shared cause! The work continues: together, we're pushing for birth options!

The Big Push for Midwives Campaign is fiscally sponsored by Sustainable Markets Foundation, a 501(c)3 nonprofit organization. Support the work of the amazing folks in the PushStates. 

Please donate.