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.

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

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.

TODAY is the day, Massachusetts!!!

1. Miriam Khalsa (Mass Midwives Alliance)
   508-655-7885 ([email protected])
2. Audra Karp (Mass Midwives Alliance)
   617-522-8383 ([email protected])
3. Ann Sweeney (Mass Friends of Midwives)
   617-254-6175/617-901-2777 ([email protected])
4. Krina Patel (The Suffolk Group)
   617-303-4570 ([email protected]) 

• Stephen Kulik 617-722-2380

• Martha M. Walz 617-722-2380

Attention Massachusetts!!!

If you care about mothers and babies, the Commonwealth needs your help TODAY to PASS HB 4253—An Act Relative to Certified Professional Midwives. We have just a few days left to pass this important legislation that will regulate Certified Professional Midwives. Currently, there is no state oversight, which means:

Here at the Big Push for Midwives, we highlight the fundamental importance of state licensing laws. While we all share in the excitement of the news that CPMs and the CPM credential are making headway in the U.S. Congress and in the halls of government in Washington, D.C., the excitement is more than a little tempered by the reality that unless and until CPMs are licensed in a particular state, no federal legislation will take effect in that state.

To wit, as birth centers are learning, state Medicaid plans will NOT cover freestanding birth center services unless the birth center holds a state license, and state Medicaid plans will NOT cover professional services of midwives in birth centers unless the midwives are licensed.

The same will inevitably be true with education loan repayment programs and other federal initiatives. The National Health Service Corps is simply not going to place a CPM in a maternity care shortage area of a state where CPMs are not licensed, and CPMs who are not licensed by their state cannot be eligible for Medicaid reimbursement.

Likewise, in January 2014, when the provider non-discrimination provision of the health care reform law went into effect — it is requiring all health insurance companies and managed care plans to include all categories of state-licensed health professionals in their networks — CPMs will NOT qualify for inclusion with other health professionals unless they are licensed.

Under the U.S. Constitution, only state legislatures—not the federal government—can license health care providers. The Constitution reserves this power strictly to the states. Ultimately, it is state licensure that will ensure that all women have access to CPMs, making them easier to find by legally qualifying them to practice under state agency standards, and making them more affordable by covering their services under private insurance and Medicaid.

So, now is the time for us to re-double our "in-state" efforts. Walking the halls in state legislatures is the most important thing that can be done — right now — to advance midwifery in the United States.

Here at the Big Push for Midwives Campaign nerve center, we are inspired by all of the incredible efforts performed daily by the hard-working, dedicated, unsung, and amazing PushState advocates. What each of you are doing for mothers and babies (and their babies and their babies) every day, against nearly insurmountable odds, in so many states across this great country. But it is important to note: we see you, we honor you for all that you are doing, and we are here from sea to shining sea to support you in any and every way that we can.