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Vote Yes for Midwives!

Tomorrow February 9, 2005, the Regulation and Registration Committee of the Illinois House of Representatives is scheduled to hear testimony on HB645, the Certified Professional Midwife Licensure Act.
Tomorrow February 9, 2005, the Regulation and Registration Committee of the Illinois House of Representatives is scheduled to hear testimony on HB645, the Certified Professional Midwife Licensure Act.

Consumer supporters of the Midwives Model of Care have been pushing similar legislation for decades. Supporters are hoping that 2005 will be the year to make real progress on assuring access to this evidence-based model of maternity care. With fewer and fewer options for homebirth providers, the public response to this bill has been overwhelming this legislative session. Some Springfield secretaries of legislators assigned to the Regulation and Registration Committee have been flooded with phone calls. So many calls are being received that the secretaries have stopped taking names and addresses.

Certified Professional Midwives are professionals specialized in out-of-hospital birth. Certified Professional Midwives practice the Midwives Model of Care (midwivesmodelofcare.org) which recognizes childbirth as a physiological process rarely requiring medical intervention. The Midwives Model of Care is not anti-medicine. It includes identifying and referring women who require obstetrical attention. The process of becoming a Certified Professional Midwife is rigorous, nationally recognized and has been scrutinized by esteemed scientists in the field of jobs analysis. Most importantly, the Midwives Model of Care is safe (www.cfmidwifery.org/citizens/pdf/safety.pdf).

Because a degree in nursing is not required to become a Certified Professional Midwife, these midwives are often referred to as “direct-entry” midwives, i.e. they enter the profession of midwifery directly without previous training in nursing. One of the biggest practical differences between certified nurse-midwives and Certified Professional Midwives is that the nurse-midwives receive hospital-based training and primarily practice in hospitals.

The need for enabling legislation for Certified Professional Midwives has never been greater than it is in 2005. A recent judicial decision has rendered direct-entry midwifery illegal in Illinois. In many other states, like Minnesota, California, Florida and Vermont, Certified Professional Midwives are licensed professionals, providing evidence-based maternity care in a collaborative environment. Though all families deserve equal access to this kind of care, in Illinois, access is close to zero.

In the Chicago metropolitan area, there are a handful of physicians and nurse-midwives providing homebirth services but they certainly do not meet the demands of the state. Outside of the Chicago metropolitan area, homebirth services are scarce and in the southern part of our state (south of I88) homebirth services are virtually non-existent. Enabling legislation for Certified Professional Midwives will help serve this need. Even without legal access to Certified Professional Midwives, families are still seeking their services. Because nurse-midwives are hospital-trained, many consumers, invested in having a midwifery-managed homebirth, seek the services of non-nurse midwives. Without licensing, consumers have no protection, no recourse, and no access to collaborative care. This is the status quo in Illinois, and it is a public health nightmare.

Families employing the services of direct-entry midwives have the burden of distinguishing between well-trained midwives and poorly trained midwives. Many families do not have the personal resources to recognize the difference. Furthermore, in the event when medical collaboration is necessary, pregnant women in need of consultation are left in a lurch. The solution is simple. The solution is licensing.

The popularity of out-of-hospital birth and direct-entry midwifery care is growing. Women are learning about this evidence-based maternity care option from word of mouth, from birthing literature and from the media. The growing list of celebrities who have chosen home birth includes: Cindy Crawford, Demi Moore, Lucy Lawless, Carol King, Meryl Streep, Lisa Bonet, Pamela Anderson, Enrykah Badu, Julianne Moore, Jade Jagger, Thandie Newton, Kelly Preston and Rikki Lake. Additionally, cable birthing shows are bringing the Midwives Model of Care into our living rooms with frequent broadcasts of births attended by Certified Professional Midwives. More and more states are recognizing the benefits of the Midwives Model of Care by passing enabling legislation licensing Certified Professional Midwives. With the recently passed legislation in Vermont and Minnesota, the number of states licensing Certified Profession Midwives is 19. In about nine other states, consumer groups are actively pursuing licensing legislation. (There are a number of other states that permit the practice without requiring licensure. This is substandard and subject to the policies of changing administrations).

Support for the Midwives Model of Care and Certified Professional Midwives can be found in many national organizations, including the Pew Center for Health Professions, the Maternity Center Association, the American Public Health Association, Ohio State University, the National Commission for Certifying Agencies, the US Department of Education, the American Public Health Association, the National Organization of Women (NOW), and even the Veteran's Administration (VA) which reimburses the cost of the CPM written exam. Below is more detailed information about some of the above-mentioned groups.

US Department of Education -- HB645 requires that a licensed midwife must attend an approved program of education. These programs are approved by the Midwifery Education and Accreditation Council (MEAC). MEAC is a nationally recognized accrediting agency recognized by the US Department of Education (DOE). The DOE makes a distinction between midwifery education and nurse-midwifery education. MEAC is the agency listed under midwifery education (www.ed.gov/admins/finaid/accred/accreditation_pg5.html).
National Commission for Certifying Agencies -- The National Commission for Certifying Agencies (NCCA) is the accreditation body of National Organization for Competency Assurance. Certification programs have to apply for accreditation. A certifying program can be accredited by NCCA if it demonstrates compliance with applicable accreditation standards (www.noca.org/faqs.htm). The North American Registry of Midwives, the organization that administers the Certified Professional Midwife credential, has successfully completed the process of NCAA accreditation (www.noca.org/ncca/accredorg.htm). Other organizations which have received this distinction include: the American College of Nurse Midwives Certification Council, the American Academy of Nurse Practitioners, the American Board for Certification in Orthotics and Prosthetics, Inc., American Board for Occupational Health Nurses, as well as many other health accrediting agencies.
The American Public Health Association – in its resolution, titled “Increasing Access To Out-Of-Hospital Maternity Care Services Through State-Regulated and Nationally-Certified Direct-Entry Midwives.” “encourages the development and implementation of guidelines for the licensing, certification and practice for direct-entry midwifery practitioners” The full text of this resolution is available on the Citizens for Midwifery website at www.cfmidwifery.org/pdf/apha.pdf.

The Illinois State Medical Society is the primary opposition to the Certified Professional Midwife Licensure Act. The voice of this organization is strong and very influential, yet its opinion about Certified Professional Midwives is not supported by medical evidence. Ironically, this organization does not need to scientific evidence in order to be influential The belief that birth is a medical issue is ingrained in our society. Most of us have been raised with the belief that birth is best left up to doctors. While, unsupported by evidence (www.cfmidwifery.org/citizens/pdf/safety.pdf), this belief-system serves physicians quite nicely. Childbirth is very big business. Birth is the most frequent reason for hospitalization for individuals under the age of 65 ("National Hospital Discharge Survey: 2002 Annual Summary with Detailed Diagnosis and Procedure Data. Vital Health Statistics Series 13 #158, NCHS.)

Since the ISMS has not provided evidence-based documentation for its opposition to licensing Certified Professional Midwives, one can only conclude that the ISMS is protecting the financial interests of its members. This opposition is quite similar to the organized, physician opposition certified nurse-midwives faced in recent history. The American Academy of Family Physicians opposed nurse-midwifery and issued formal statements to that effect in 1980, 1990 and 1993.

Please do not hesitate to contact me for additional information, such as scientific references.


The Coalition for Illinois Midwifery Steering Committee
Michelle Breen, MHS, Public Health Consultant
Rachel Dolan Wickersham, CD, LCCE, Chicago Community Midwives
Jacque Shannon-McNulty, President, Chicago Community Midwives
Gail B. Karlovsky, CD, BCCE, Chicago Community Midwives
Pat Cole, President, Illinois Families for Midwifery
Colette M. Bernhard, Illinois Families for Midwifery
 
 

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