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

April 2014 Legislative Update from CFIM

2014 April CPM Legislation Update April 14, 2014

Greetings from the Coalition for Illinois Midwifery! It’s time for an update on our CPM licensure efforts. We are currently in the second year of the Illinois legislative cycle. In general, not many bills advance during the second year because it is an election year. We have been trying to get one of our three bills moving, but as of the end of March, we have passed the deadline for passing a bill through a House committee. So for now, our bills are considered dead. Having revived a bill once before, we have learned that such bills are not truly expired until the end of the legislative cycle in January when the new General Assembly is sworn in. However we also know it takes very unusual circumstances to revive them between the committee deadlines and the following January.
CFIM will certainly notify the community if any circumstances arise that might get any of our bills moving again during this current cycle, but in the meantime, we will be turning our focus to a number of effective actions the home birth community can take to help insure that if we submit a bill next year, the issue will still be very much alive in the minds of our legislators.

Here are those actions in order of importance:

1) Get involved in the campaign of any current legislator or new candidate. He or she does not have to be someone in your own district. They just need to be someone you feel you can support. Contact their campaign office and offer to make calls from a script or put stamps on envelopes or walk neighborhoods with the candidate. Do anything you feel you can do, and while doing it, let anyone you talk to know your issue is home birth and midwifery. Wear a Got Midwife Button or put a Born at Home T-shirt on your baby if they come with you. This summer and into autumn is the time to do this.

2) Please respond enthusiastically and quickly to any action alert we send out. And please consider supporting even if you are not fully satisfied with the exact language of any bill we might be promoting at the moment. CFIM’s board consists of a balance of leadership members from both Illinois Friends of Midwives (ILFOM) and the Illinois Council of Certified Professional Midwives (ICCPM). As a board we discuss, in depth, the consequences of any concessions we might make In any bill. We calculate carefully based on input from the ILFOM and ICCPM groups as well as from the national CPM Licensure “think tank,” The Big Push for Midwives. We also factor in advice from an experienced Springfield lobbyist and from our bill’s sponsors. We also factor in more than three decades worth of experience in submitting licensure bills in Illinois. We’ve learned that in Illinois, when a bill passes, no one ever gets exactly what they wanted. Compromise and baby steps are the name of the game here. Any bill we ask you to support has been carefully weighed with all of this in mind.

3) Visit your legislator in their home office during the summer. Bring others from the district with you as well. If you feel unsure about how to conduct such a meeting, let us know by posting on ILFOM. ILFOM will get the request back to us and we will do our best to send someone from the CFIM board with you. During your visit, let your legislator know how important it is to you that home birth midwives be allowed to practice legally in Illinois. Point out that the 7 nurse-midwife practices who attend home births in Illinois are not nearly enough to cover the state, especially because only two of those practices are south of I88. Let them know community midwives fill the gaps as best they can, but they cannot legally have the things that make home birth safer – oxygen, anti-hemorrhage medications and physician backup. To make home birth safe, we need community midwives to be legal. The CPM credential would ensure these midwives have met a national standard that 28 other states recognize.

If your legislator is experienced and seems particularly enthusiastic about our issue or shows an interest in really learning about it in depth, ask if they would consider becoming a sponsor next time we file a bill. Our current chief sponsor, Toni Berrios, lost her primary. So she will not be back. Our other past chief, Robyn Gabel is expected to return, but we can always use additional chief and co-sponsors. Once you’ve met, please inform ILFOM or ICCPM leadership of the outcomes of any meetings .

4) Please help create fundraisers to help CFIM pay for lobbying expenses when our bills are in play. If you cannot create a fundraiser, please attend any you hear about. ILFOM and ICCPM both sponsor these events and give a considerable portion toward lobbying.

With your help on all four of these fronts, it is our hope that in January 2015, when the 99th Illinois General Assembly is sworn in, we will have a strong groundwork already in place to support any home birth bills that we submit. None of this can happen however, without YOU. Please make home birth activism a priority for the rest of this year, so we can finally legalize the majority of home birth midwives in Illinois!

Best Wishes from your CFIM Board:
Rachel Dolan Wickersham, CPM – President CFIM and ICCPM
Vicki Johnson, CPM – Sec/Treasurer CFIM and ICCPM
Tonesha Cross, SCPM – Vice President CFIM , ICCPM board
Hillary Shirven
Audrey Stillerman, MD
Ashley Price – President ILFOM
Carrie Vickery – ILFOM board
Trish Sherman Pfeiffer – ILFOM board

MANA publishes largest ever study on planned homebirth!

http://www.mana.org/blog/home-birth-safety-outcomes

by Geradine Simkins, CNM, MSN, Executive Director, Midwives Alliance of North America

In today’s peer-reviewed Journal of Midwifery & Women’s Health (JMWH), a landmark study** confirms that among low-risk women, planned home births result in low rates of interventions without an increase in adverse outcomes for mothers and babies.

This study, which examines nearly 17,000 courses of midwife-led care, is the largest analysis of planned home birth in the U.S. ever published.

The results of this study, and those of its companion article about the development of the MANA Stats registry, confirm the safety and overwhelmingly positive health benefits for low-risk mothers and babies who choose to birth at home with a midwife. At every step of the way, midwives are providing excellent care. This study enables families, providers and policymakers to have a transparent look at the risks and benefits of planned home birth as well as the health benefits of normal physiologic birth.

Of particular note is a cesarean rate of 5.2%, a remarkably low rate when compared to the U.S. national average of 31% for full-term pregnancies. When we consider the well-known health consequences of a cesarean — not to mention the exponentially higher costs — this study brings a fresh reminder of the benefits of midwife-led care outside of our overburdened hospital system.

Home birth mothers had much lower rates of interventions in labor. While some interventions are necessary for the safety and health of the mother or baby, many are overused, are lacking scientific evidence of benefit, and even carry their own risks. Cautious and judicious use of intervention results in healthier outcomes and easier recovery, and this is an area in which midwives excel. Women who planned a home birth had fewer episiotomies, pitocin for labor augmentation, and epidurals.

Most importantly, their babies were born healthy and safe. Ninety-seven percent of babies were carried to full-term, they weighed an average of eight pounds at birth, and nearly 98% were being breastfed at the six-week postpartum visit with their midwife. Only 1% of babies required transfer to the hospital after birth, most for non-urgent conditions. Babies born to low-risk mothers had no higher risk of death in labor or the first few weeks of life than those in comparable studies of similarly low-risk pregnancies.

Importantly, this study also sheds light on factors that may increase risk. These findings are consistent with other research on pregnancy complications, but the numbers of these pregnancies were low in the MANA Stats dataset, making it impossible to make clear recommendations. This article from Citizens for Midwifery contains important information to share with families who are contemplating their birth options and weighing their individual risks and benefits.

This study is critically important at a time when many deeply-flawed and misleading studies about home birth have been receiving media attention. Previous studies have relied on birth certificate data, which only capture the final place of birth (regardless of where a woman intended to give birth). The MANA Stats dataset is based on the gold standard — the medical record. As a result, this study provides a much-needed look at the outcomes of women who intended to give birth at home (regardless of whether they ultimately transferred to hospital care). The MANA Stats data reflects not only the outcomes of mothers and babies who birthed at home, but also includes those who transferred to the hospital during a planned home birth, resolving a common concern about home birth data.

This study adds to the large and growing body of research that has found that planned home birth with a midwife is not only safe for babies and mothers with low-risk pregnancies, but results in health and cost benefits that reach far beyond one pregnancy. We invite you to share this news in your communities, and join the conversation on our Facebook page, Twitter, and Pinterest.

We are grateful to the ongoing support of the Foundation for the Advancement of Midwifery, which has been a major funder of the MANA Statistics Project.

** note – the Journal of Midwifery & Womens Health has made both articles free online for all of 2014. Go to www.jmwh.org, Find Articles, and then click on Early View. The articles will be live sometime on Thursday, January 30. If you are not yet able to get access, please check back or watch this website for updates.

CFIM on WCIA3 Springfield

Midwives seek licensing in Illinois

Illinois doctors block bids to expand medical authority of nurses, dentists, others

This June, 4 2013 article in Crain’s frankly discusses our biggest obstacle to licensed midwives; territorial physicians.

http://www.chicagobusiness.com/article/20130604/NEWS03/130609934/illinois-doctors-block-bids-to-expand-medical-authority-of-nurses?utm_source=NEWS03&utm_medium=rss&utm_campaign=chicagobusiness

 

Improving Birth Rally in Carbondale

Here’s a great article on yesterday’s Improving Birth Rally in Carbondale which interviews a CPM. Activists Rally in Support of Improved Maternity Care

Good news out of Connecticut!

A state Appellate Court ruling is being hailed as a victory for midwives and the right of Connecticut families to choose home births.