For Midwives, Getting Into Health Reform May Not Be the Answer

I write this blog entry as homebirth midwives from all over the United States are heading to California to the annual conference of the Midwives Alliance of North America (MANA). I have many friends that will be at the MANA conference, and I wish I could join them, since it is always a fun time. I believe that this blog entry becomes a talking point at the conference. First, a little background: In the United States there are two types of midwives; nurse midwives, and non-nurse midwives generally referred to as direct entry. (I am aware that there are a few other classifications, but I'm trying to keep this as simple as possible). Nurse midwives generally deliver in hospitals and are called Certified Nurse Midwives and direct-entry midwives generally deliver out-of-hospital. and are rapidly embracing a designation known as "Certified Professional Midwife." Many CPM's (Certified Professional Midwives) attend the MANA conference. While nurse-midwives are legal in all states and are a mandated service under Medicare and Medicaid, the CPM’s do not enjoy the same status. The CPM's are working very hard to be included in the federal health care reform legislation working its way through Congress. The importance the CPM's are placing on getting into health care reform cannot be underestimated, for if they fail, they could conceivably find it impossible to attract new patients (clients). Many believe that being excluded from healthcare reform will doom the profession. I hope I can word. my next point, very carefully so as not to be misunderstood by my friends at the conference. Assuming the CPM is successful in getting into health care reform, what will they do differently so as not to allow legislative success to become their albatross?? I'm sure many of you are scratching your head, asking, “What is Alan talking about??” Let me give you a little Florida midwifery history. First of all, in Florida, direct entry midwives are called “Licensed Midwives” and are automatically qualified as CPMs (although they are NOT required to become CPM's). In 1992, Florida Gov. Lawton Chiles signed a law giving Florida the best direct entry midwifery legislation in the United States. The governor may have been America's most powerful midwife advocate, after his daughter was aided by a midwife during her birth. Basically, the Florida law coupled with the Governor’s and his daughter’s ongoing support gave Florida Licensed Midwives everything could have asked for. They got licensure, midwifery schools, a requirement for insurance companies to pay Licensed Midwives, they could be autonomous (work without supervision of a physician), they can receive Medicaid reimbursement and if there were any regulatory hoops, the Governor's daughter held a seat on the Florida Council of License Midwifery, which meant that every Dept. of Health employee worked for her father. This combination was considered the Royal-Flush of midwifery legislation! In fact, when the governor signed the 1992 law, he said that in 10 years, the Licensed Midwives will handle 50% of the births in the State of Florida. So what were the results? The number of licensed midwives increased from 30 to 300 between 1975 and 1990, the number of licensed birth centers from none to 20, and the percentage of births attended by midwives (10 percent) was one of the highest rates in the nation. Remember, this is before the governor signed the best direct entry midwifery legislation in the country. In the year 2007, 98.9% of the resident births occurred in hospitals; .6%, in freestanding birth centers; .4% were home births; and .1% happened either en route to a delivery facility or in some other location. Medical doctors attended 83% of the births; osteopathic physicians delivered 5% of the babies; 10.8% were delivered by certified nurse midwives; 0.6%, by licensed midwives; and 0.6%, by some other person As of August 2008, there were more than 540 certified nurse midwives (CNM) with active Florida Advanced Registered Nurse Practitioner licenses. Approximately 293 locations in Florida have certified nurse-midwives providing comprehensive maternity care and/or well-woman care services. In 2007, CNMs attended 25,861 births, or 11% of Florida births for that year (Florida CHARTS). Since 1988, CNMs are able to write prescriptions under a joint practice protocol signed by the certified nurse midwife and the physician. During the most recent reporting period, there were 34 licensed non-nurse midwives practicing - 18 working in individual practice and 16 in a 12 multi-practice setting. Of the 1,126 clients who gave birth under the care of a licensed, non-nurse midwife, 328 gave birth at home and 798 gave birth in a birth center. Medicaid was the payer for 471 of these women. (Click Here Tao Read the Florida Dept of Health Report citing the above stats) Recapping: in 2008 there were 34 licensed non-nurse (CPM type) midwives practicing, delivering less than 1% of the babies in the State of Florida So, I again repeat the question, if the CPM's get everything they want nationally, what will they do differently so as not to repeat any mistakes that were made post-Florida legislation? I wish the MANA midwives, a fun, wonderful and productive conference. Alan