CFIM Statement on AAP Opposition

HISTORY
In 2015, after the third meeting of the USMERA group, guidelines for national standardized midwifery education were settled upon. A MEAC-accredited education became the standard by which all Certified Professional Midwife training programs should aspire, and the standard which should be acceptable to the remaining states who have yet to legally recognize CPMs. In the past twenty years of trying to get non-nurse midwives one sort of legal recognition or another in Illinois, the issue of adequate education on the part of midwives came up repeatedly with our main opposition, the Illinois State Medical Society. When USMERA came out with their agreed upon standards, based on the International Confederation of Midwives education standards, standards that the American College of Obstetricians and Gynecologists endorses, the Coalition for Illinois Midwifery was fairly confident that putting such standards into a bill would be the final missing piece to getting that bill passed into law.

At first, it looked like we might be right. With Robyn Gabel as our chief sponsor, HB4341 was introduced to the Illinois House. The American College of Nurse-Midwives offered their support of our bill. CFIM was invited to two meetings with medical professionals and lobbyists about the bill. The Illinois Section of the American Congress of Obstetricians and Gynecologists took an interest in the bill and rewrote it to their liking, retaining the MEAC educational requirements, and resubmitting it as HB4364. Their stance on the bill was, and is, neutral.

Surprisingly, this was not good enough for the Illinois State Medical Society and they continued to officially oppose HB4364. Their official opposition letter, published on their website and sent to all lawmakers, was full of misinformation and misleading statements. When pressed by CFIM and lawmakers on the bill, the ISMS claimed it could not drop its opposition to HB4364 because one of its member groups, the Illinois Chapter of the American Academy of Pediatrics, opposed the bill. They promised future meetings on the bill during the summer. Those meetings never happened. Accordingly, CFIM has now published a statement on the opposition of the IL-AAP. We at Illinois Friends of Midwives support this statement from the Coalition of Illinois Midwifery (of which ILFOM is a part). We publish it here for you to read, in advance of our final push on this bill.  (Stayed tuned to ILFOM for what, when, and how to push this bill one last time!)  

Coalition for Illinois Midwifery Statement on AAP Opposition to HB4364

The two entities who are the foremost authorities on birth in Illinois, the Illinois Section of the American Congress of Obstetricians and Gynecologists and the Illinois Chapter of the American College of Nurse-Midwives, support the current bill in the House to license and regulate Certified Professional Midwives. Inexplicably, the Illinois Chapter of the American Academy of Pediatricians does not. The Illinois Chapter of the American Academy of Pediatrics should support legislation that allows for homebirth midwives to openly practice. Illinois families already choose homebirth. Regulation of the practice of midwifery benefits these homebirth babies and mothers. Opposition to licensing of Certified Professional Midwives makes an otherwise safe choice dangerous for Illinois mothers and babies.

HOME BIRTH IS ALREADY HERE
Every year in Illinois nearly 1000 families bring their children into the world at home. These numbers are expected to grow in Illinois the same way they continue to grow across the United States. Nationally, the home birth rate has increased 77.3% since 2009. A certain percentage of families simply want home birth healthcare services. Families who homebirth do so for deeply held religious, philosophical, or cultural reasons.
Many families, especially in rural areas, where there are many counties without a single obstetrician, do not have access to a legal home birth midwife or doctor. Because Illinois has fewer
than 10 legally available home birth practices, many of these families have to use midwives who practice outside the current law in order to receive maternity care. These midwives can practice legally in 30 other states, including those that surround Illinois. They provide services here in Illinois, at legal risk to themselves, out of love and concern for the thousands of families here who need them.

ADVANTAGES OF HOME BIRTH TO BABIES
Although the highly technical, medical model of birth is the most widely well-known and practiced mode of birth in the United States, it is not the only safe and reasonable option. For low risk mothers and babies the midwifery model of care in home birth presents several significant advantages.
Home birth with a qualified health care provider like a certified professional midwife significantly reduces a woman’s chance of cesarean birth. This is an important health goal and personal value for many women, and one of the reasons families choose home birth. Certified professional midwives are exhaustively trained in facilitating normal spontaneous vaginal birth in a low tech, high touch setting. Safe prevention of the primary cesarean is an also important goal of ACOG, because it prevents immediate and future morbidity and mortality of both babies and mothers.
Families who give birth at home have a significantly higher rate of initial, continued, and extended exclusive breastfeeding. Exclusive and extended breastfeeding, as the biological norm, have multiple substantial consequences for immediate and lifelong health for both newborns and their mothers. The lack of unnecessary interventions for low risk mothers during labor and birth certainly contribute to the success home birth mothers experience in breastfeeding. The extensive training Certified Professional Midwives receive in lactation is also a contributing factor to high breastfeeding rates.
Babies under the care of home birth midwives are significantly less likely to be premature or low-birth-weight. This is very important for the viability and overall health of neonates. Children continue to profit their entire life from being born on-time and full weight.
For minorities, all these benefits are intensified. The disparities present in the outcomes for low risk minority women and babies under the care of obstetricians almost completely disappears when pregnant minority women are cared for by midwives. Their babies are markedly healthier in utero, at birth, and beyond.

ACCESS TO SKILLED HEALTH CARE PROVIDERS
Illinois’ home birth families need access to midwives who are not forced to practice outside the law. Studies consistently show that home birth with a well-trained attendant is a safe and reasonable option. The current situation in Illinois, where home birth families are made desperate in their attempt to find someone to attend them, lends itself to encouraging midwives without adequate training to provide services. Legislation which verifies a minimum level of training would give Illinois homebirth families access to a sufficient number of qualified health care providers.
The legislation already put forth by the Coalition for Illinois Midwifery includes the most rigorous education requirement for Certified Professional Midwives in the entire nation. In accordance with ACOG standards, it calls for midwives to be educated and trained through MEAC accredited schools. MEAC accreditation is verified by the same bodies as ACNM schools. A MEAC education is rigorous and thorough, covering preconception to six weeks postpartum for both mother and baby, as outlined by the International Confederation of Midwives educational standards, which are standards ACOG recognizes.
Certified Professional Midwives are specifically qualified to provide the special skills needed for safe home birth. Licensing provides both professional accountability to midwives and a vetting process for home birth families. The law proposed by the Coalition for Illinois Midwifery would license Certified Professional Midwives.

CONCLUSION
Recognizing the rights of parents to determine their own health care, 30 states have enacted legislation that recognizes Certified Professional Midwives as home birth providers. None of these states has rescinded or repealed such recognition, because there is no need to do so. Home birth is a safe, reasonable option for child-bearing families when they have access to licensed and qualified midwives. By opposing the licensing of Certified Professional Midwives, even under conditions that IL-ACOG and IL-ACNM find acceptable, IL-AAP is blocking access to needed health care services for a specific population.

Note: The original statement contained references to studies and articles.  Here is a pdf of that statement: CFIM Statement on AAP Opposition

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