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.
Birth Center Study Shows Excellent Outcomes for CPMs and CNMs, Points to Need for More Access for Low-Income Women
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!"
Maryland's Action Alert
Dear Loyal Supporters,
The year 2012 has been full of excitement! It was exciting when we decided to submit a bill to license Certified Professional Midwives. It was thrilling to find a dedicated sponsor. It was truly wonderful and encouraging to get serious consideration by the HGO Committee. It is no surprise that the reason these things happened and continue to happen is because of the support that MFSB supporters give to this campaign!
The HGO Committee received hundreds of hand written letters last year asking them to consider our CPM licensure bill. It is your letters that pushed the committee to consider our bill and to assign a DHMH workgroup to review the possibilities and issues.
It is time to work your magic again!
Please grab pen and paper, solicit the help of your children, and start writing letters to your representatives. Your letters should be be personal. Perhaps recount why you choose to birth at home, how you decided that home was the safest place for you and your baby, and how challenging it was to find a midwife to support you.
A few buzz words/phrases that would be helpful to include:
Have your children decorate the letters or envelopes. Include a family picture. Remind your representatives that they are in their positions to represent you! Tell them that you want CPMs to be licensed and regulated in the state of Maryland so that you have access to their services.
- Having a baby at home is your legal right. Having a midwife helps ensure safety.
- 26 US states already license CPMs to attend homebirth.
- CPMs establish personal relationships with the families that they serve. CPMs engage in an informed/shared consent practice that enables families to make educated choices about the practices that affect their families.
- Access to midwives in Maryland is seriously limited. Homebirth is on the rise. Families need access to midwives at home in order to ensure safety.
- It is a basic human right to choose the place of birth and the attendants. Let Maryland women have this right.
Don't know who your representatives are? Find your elected officials by address by going to the Maryland State Archives, WHO ARE YOUR ELECTED OFFICIALS page: http://mdelect.net/
Please also continue to ask your family, neighbors, and co-workers to sign the License Midwives Petition. It is vital that we continue our momentum and collect more signatures. The link to the petition can be accessed at www.MFSB.me. Are you unsure if you signed the new petition? No worries, it will not submit your signature more than once. Go ahead, sign it. Make sure that your voice is heard.
Your MFSB Leadership Team
Jeremy Galvan, Robin O’Brien, Kathy Talbott, and Andrea Goldstein
Maryland Families for Safe Birth is a nonprofit, 501(c)(4), consumer-driven, social welfare organization. Our mission is to ensure the health and well being of Maryland families by expanding access to the evidence-based maternity care provided by Certified Professional Midwives.In order to meet our mission the organization will:
We appreciate your support. Click here to volunteer your time and talents. Click here to donate via PayPal.
- Introduce legislation to license Certified Professional Midwives (CPMs) and regulate the practice of midwifery
- Monitor and deter legislation that would be detrimental to families and care providers who choose out-of-hospital birth
- Support organizations who offer, through education and other means, information, support, and advocacy regarding the midwifery model of care
Action Items! Letter Writing Campaign
Access your Maryland State Representative Contact Information Here. Hand written letters, telephone calls, and in person visits carry the most weight. If your schedule only permits time to email, please know that emails are important as well. Best Yet -- Do All 4!
Petition Drive! We need signatures on the petition. Every Maryland signature that is collected generates an email that is sent directly to the House and Senate representatives. This is big, especially right now. We want them to see the community support for midwives. Please commit to collecting 10 or more signatures each week.Petition link is available at the MFSB website. www.MFSB.me
Hearing Day Rally! Remember last year's big rally? We will be doing it again! Details to be announced as soon as the dates are set. Please plan to attend.
Freedom for Birth Movie Fundraiser/Potluck and Outreach Event Click Here January 12, 2013, 5 pm Takoma Park, MD Please contact Ryan for details.
Birthing Circle of Frederick January 28, 7-9 pm, Frederick, MD Contact Bridget or Lindsey for more information
Potential Spring Events
Coordinators and Volunteers Needed!
Request information here.
March 11: 11am-4pm, Columbia, MD, Baby Expo
April: 12pm-5pm, Baltimore, MD, Greenworks EcoFest
May: 10am-5pm, Boonsboro, MD, Green Festival
Please share information on local events and happenings where MFSB might be welcomed as a vendor or speaker. Invite us to your book club, birth circle meeting, ICAN event, knitting circle, PTA meeting, to share our common goal of increasing access to midwives in Maryland.
Click here to let us know of events in your area (in Maryland).
TODAY is the day, Massachusetts!!!
The midwifery bill URGENTLY needs you!
Please call your own legislator NOW, letting him/her know that having good birth options is important to you. Please ask them to call Chairman Dempsey and ask him to release our bill—HB 4253—An Act Relative to Certified Professional Midwives—today.
We only have HOURS left to get the bill out of committee.
Every call makes a big difference.
If you have more time, please call the following Ways and Means committee members (list with numbers follows at the end of this message), asking them to release the bill ASAP so it can go to the House floor for a vote. We can still get the bill out but need your help now, more than ever.
With your help, we can do this. Thank you!
Find your own rep’s contact info here:
Ways and Means Committee members:
Please call and ask them to release the bill for a vote!
- Stephen Kulik 617-722-2380
- Martha M. Walz 617-722-2380
- Angelo M. Scaccia 617-722-2060
- Gloria L. Fox 617-722-2060
- Thomas M. Petrolati 617-722-2255
- Robert M. Koczera 617-722-2582
- Christine E. Canavan 617-722-2575
- Timothy J. Toomey Jr 617-722-2380
- Benjamin Swan 617-722-2680
- Colleen M. Garry 617-722-2380
- Geraldine Creedon 617-722-2305
- Kevin J. Murphy 617-722-2877
- David B. Sullivan 617-722-2070
- Ruth B. Balser 617-722-2396
- John P. Fresolo 617-722-2017
- Walter F. Timilty 617-722-2230
- Thomas M. Stanley 617-722-2230
- William Smitty Pignatelli 617-722-2582
- Joyce A. Spiliotis 617-722-2430
- Carl M. Sciortino, Jr 617-722-2013
- Angelo J. Puppolo, Jr. 617-722-2090
- Michael D. Brady 617-722-2230
- James J. Dwyer 617-722-2220
- Ann-Margaret Ferrante 617-722-2210
- Timothy R. Madden 617-722-2810
- Viriato Manuel deMacedo 617-722-2100
- Daniel K. Webster 617-722-2487
- Geoffrey G. Diehl 617-722-2810
- Angelo D'Emilia 617-722-2810
- Shaunna O'Connell 617-722-2305
- Donald H. Wong 617-722-2488
617-254-6175 617-901-2777 - c
Contact for information and questions:
- Miriam Khalsa (Mass Midwives Alliance)
508-655-7885 (akmid[email protected])
- Audra Karp (Mass Midwives Alliance)
617-522-8383 ([email protected])
- Ann Sweeney (Mass Friends of Midwives)
617-254-6175/617-901-2777 ([email protected])
- Krina Patel (The Suffolk Group)
617-303-4570 ([email protected])
Stephen Kulik 617-722-2380
Martha M. Walz 617-722-2380
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:
- ANYONE—even an 18 year old car mechanic—can hang out a shingle and practice as a midwife and
- Hairdressers must be licensed to practice in Massachusetts but midwives do not. Should a “cut and color” be regulated and have professional practice requirements while MA midwives currently have none?
How to help?
CALL your own STATE REPRESENTATIVEYou can find contact information for your representative at the following link: http://wheredoivotema.com/bal/myelectioninfo.php
- GIVE them an update on the bill, HB 4253—An Act Relative to Certified Professional Midwives—and let them know the bill is now with the House Ways and Means committee
- ASK them to contact Chairman Dempsey's office (617-722-2990) (representing Haverill and Chair, House Ways & Means Committee) to REQUEST that HB 4253 BE RELEASED TO THE HOUSE FLOOR FOR A VOTE ASAP
- ASK them to then support the bill when it reaches the House Floor
- URGE them to tell their colleagues to support the bill on the House Floor
Want to do more?
PLEASE reach out to Massachusetts HOUSE LEADERSHIP(see listing at the end of this message), letting them know:
- This bill is important to you
- That this bill is being supported by House leaders
Also, we will be at the State House on Wednesday and Thursday afternoons this week (7/25 and 7/26). Please join us! Drop a quick email to Ann Sweeney at [email protected], and we’ll let you know where to rendezvous with us.
Text of the bill can be found on the State House website: http://www.malegislature.gov/Bills/187/House/H04253 Please help us in spreading the word and passing this legislation into law! Keep the calls coming!!! We need EVERYONE to call to get this done! Make a difference! Make it count.
Here is how you do more:
CALL more Massachusetts HOUSE LEADERSHIP
- Rep. Haddad—very supportive—617-722-2600
- Speaker DeLeo—he is aware of the bill—seems to understand need for it—617-722-2500
- Rep. Reinstein—very supportive and a co sponsor—617-722-2180
- Rep. Moran (Boston and Brookline)—supportive and a co-sponsor— 617-722-2006
- Rep. Story (Amherst)—very supportive—617-722-2012
- Rep. Donato—seems supportive—617-722-2040
- Rep. Mariano—has always supported licensure bills—617-722-2300
- Rep. Jones—aide seems supportive—617-722-2100
- Rep. Rushing—617-722-2783
- Rep. Bradley—617-722-2520
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.