Ł Ł midwives registry of midwives north american news · (207)647-5968 Š Š ŁŁ what™s on the...

of North AmericaVolume 1X, Issue 1, Summer 2006Providing certification standards for

Certified Professional Midwives

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� �Inside This IssueWay to go, Wisconsin! . . . . . . . . . . 1Interview with Sharon Evans, retiringNARM Board member . . . . . . . . . 2

Outreach to Educators Project . . . . . 3

Committee Reports:Applications Department 2005 Year-end Report . . . . . . . . . . . . . . . . . . 4

NARM Accountability CommitteeYear-end Report 2005 . . . . . . . . . . 4

Treasurer�s Report 2005 . . . . . . . . . 5Test Dept, Year-end Report 2005 . . 5

NARM PolicyNARM policy on preceptors withrevoked CPMs . . . . . . . . . . . . . . . . 7

CPM Recertification . . . . . . . . . . . . 7

Midwives Under AttackJennifer Williams, CPM, IN . . . . . . 8Shaheeda Pierce, CPM, WA . . . . . . 8State Updates . . . . . . . . . . . . . . . . . 9

Midwives Alliance (MANA) NewsMarketing Midwives...What�s in aname? From the PR Committee . . 10

Report from the Midwives AllianceDivision of Research . . . . . . . . . . 11

MEAC News . . . . . . . . . . . . . . . . 12Sixth North American Conference onShaken Baby Syndrome . . . . . . . . 12

NARM Board of DirectorsNARM Board Members . . . . . . . . 13NARM Workshops . . . . . . . . . . . . 13Upcoming Conferences . . . . . . . . . 15Can You Help? . . . . . . . . . . . . . . . 15

CPM2000:Research Update . . . . . . . . . . . . . . 16

NACPM NewsNews from NACPM . . . . . . . . . . . 19

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Registry of MidwivesMidwivesNorth American

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�� Way to go, Wisconsin!

February 23, 2006

We have had a remarkable journey here in Wisconsin, with a successful vote onour CPM licensing bill in both houses of our legislature on the same day (whichis the first time in anyone�s memory that�s happened). We�re now awaiting theGovernor�s signature and are very hopeful that it will come soon. **

There were several things that were key to our success. We�ve been organizingfor years, developing collaborative relationships with other providers and work-ing with our state public health department to become partners in carrying outthe public health agenda to home birth families. We�ve also been instrumental inproviding the appropriate range of newborn metabolic screening to our largeAmish and Mennonite populations and in educating them about the need forthese tests. We�ve also benefited enormously from the work done on a nationallevel to earn the APHA resolution to increase access to CPMs.

The remarkable work of Betty Anne Daviss and Dr. Ken Johnson and the BMJstudy was infinitely helpful. This study was examined by dozens of physicians;we sent it to many medical professionals and public health officials. Most ofthese nurses and doctors know and understand the care we give and, while we arefortunate here to have many supportive relationships, the BMJ study was theproof they needed to write letters and get behind our bill. It was without a doubtthe single most valuable document in our success.

We certainly had numerous barriers (the medical lobby came out the week be-fore our vote with a huge push against our legislation) and our journey is notover until the bill is signed; we are still vacillating between breathing deep andholding our breath! We�re grateful to all of the nationwide advisors who helpedus, to our remarkable legislative chair Katherine Prown, and to all of the citizenswho traveled far and wrote letter after letter tomake their voices heard. Recentlya physician and well respectedmember of the legislature said,�That midwife bill was the great-est victory of the people Ihave seen in a long time.�That was enough for me!

Jane Crawford Peterson CPMPresident, Wisconsin Guild ofMidwives

** Update:The Governor of Wisconsin signed the

bill on April 10, 2006. It is now officiallylaw.

Wisconsinlegal!

2 NORTH AMERICAN REGISTRY OF MIDWIVES, SUMMER 2006��

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CPM News is a newsletter of theNorth American Registry of Mid-wives (NARM) published twice ayear, Winter and Summer. We wel-come submissions of questions, an-swers, news tips, tidbits, birth art,photographs, letters to the editor, etc.

Deadlines for submissions are De-cember 1 and June 1. Send all news-letter material to: Luna Armstrong,P.O. Box 1606, Mendocino, CA95460 or [email protected]

The views and opinions expressedby individual writers do not necessar-ily represent the views and opinionsof NARM.

� �Contact Information

NARM General Information(or to order How to Become a CPM)888-842-4784Fax: 404-521-4052

Applications & Recertification:NARM Applications Department:P.O. Box 420Summertown, TN 38483

NARM BoardDebbie Pulley, CPM5257 Rosestone DriveLilburn, GA [email protected]

Test Department information:Ida Darragh, CPMPO Box 7703Little Rock, AR [email protected]

CPM News Editor:Abby J. Kinne, CPM58 South Center StreetWest Jefferson, OH [email protected]

CPM News� � �Interview with Sharon Evans, retired NARMBoard Member

gave you the idea to do that,what criteria you used, what wasyour process and motivation increating it?

One wintry day in 1991, my midwifefriend, Pam Weaver, and I came upwith a plan to help midwives and theirstudents. We were inspired to write thePractical Skills Guide for Midwifery. Weenvisioned a book of midwifery skillsthat would hopefully help the studentand the teacher alike, a book that couldtest midwifery skills. We started outjust wanting a skills book for Alaska�sstudent midwives, but our dream cameto include seeing the book translatedinto Spanish, to serve the neighboringThird World countries like Mexico andSouth America. With input from manymidwives, and particularly Abby J.Kinne, the book was finally publishedin 1994. Today, we are seeking to im-prove and update the third edition.Pam and I became aware, through theMidwives Alliance of North America(MANA) that the North American Reg-istry of Midwives (NARM) had formedafter we started writing the PracticalSkills Guide for Midwifery in 1993. Wefound out that NARM�s task was tocreate a legally defensible written ex-amination for midwives. This organi-zation would become an internationalcredentialing body, certifying midwives

by Robbie Davis-Floyd

Why did you become a midwifeand how many years have youpracticed?

I became a midwife because I wasdissatisfied with mainstreammedicine�s approach to childbirth. Ibecame a midwife 5 years after thebirth of my 7th baby. I studiedHerbology while I was nursing my ba-bies, so came to my midwifery teacherwith some knowledge. I was also a cer-tified massage therapist and had takenmany courses in the natural healingarts and was also a teacher of some ofthe natural healing arts such as Cre-ative Healing, Reflexology, Kinesiology,Accupressure, Swedish Massage, Co-lonic Hydrotherapy, and other massagetechniques when I became a midwife.

What is the most important as-pect of being a midwife to you�in other words, why have youstuck with it?

I came close to quitting midwiferyback in the late 80s because I was sodiscouraged with the treatment womenwould get when we transported to thehospital, and I was tired of the treat-ment midwives received in an alegalstate. My husband said to me, �Howdare you take away women�s ability tochoose out-of-hospital births by notbeing available to them?� So I contin-ued. Instead of quitting, I became in-volved in our state midwifery politicsand NARM. I have always consideredmyself the �apprentice�s advocate,� be-cause I want to see midwives practicingfar into the future, to help my grand-children and their children. Helpingwith the preservation of midwifery be-came my primary focus.

You and Pam Weaver developedthe PSGM�please describe what Sharon Evans

Sharon Evans

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SUMMER 2006, NORTH AMERICAN REGISTRY OF MIDWIVES 3� �

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from various educational routes, creat-ing the Certified Professional Midwife(CPM) credential. We felt the PracticalSkills Guide could be helpful in the pro-cess of credentialing midwives.

How long did you serve on theNARM Board? What were yourprimary responsibilities? Whydid you devote so much timeand energy to NARM and theCPM?

I devoted much time to NARM be-cause it was, and is, a worthy causewith the preservation of midwifery atits roots. From 1995 to 1997 I workedfor NARM as a committee chair. From1997 to the to 2003 I worked forNARM as Director of Applications.In 1999 I was invited to be onNARM�s Board of Directors. Mydaughter, Anna, and I reviewed appli-cations of those desirous of receivingthe Certified Professional Midwife(CPM) credential, and issued re-certifi-cation to CPMs until 2003.

As an experienced midwife andlong-term NARM Board Mem-ber, what advice do you have foraspiring midwives? Why shouldthey become CPMs? What kindsof education should they pur-sue? What do you know thatmight most benefit them?

We midwives need to remember whata powerful role we play in the empow-erment of birthing women and peoplein general. Yes, we see horrific infantand maternal mortality rates in theworld. We also see the difference inOUR infant and maternal mortalityrates compared to hospital rates. Itcannot be ignored forever. Our workin educating the public and providingexcellent prenatal, birthing, and post-partum care is making a difference byreplacing fear with knowledge, impart-ing empowerment as a result.

� �Outreach to EducatorsProject

The charter issue of Giving Birth toMidwives: A Forum for Midwifery Educa-tors premiered at the MANA 2005 con-ference. The response from the mid-wifery community has been very posi-tive and encouraging.

The newsletter includes profiles ofexisting schools, book reviews, teachingtips, and other issues of interest to any-one involved in the education of thenext generation of midwives. It is dis-tributed to all midwifery schools andcoordinated by the Outreach to Educa-tors Project. This newsletter is one ofmany projects planned for this grantfunded initiative to get midwifery edu-cators communicating and learningfrom each other.

The mission of the Outreach to Edu-cators Project (OTEP) is to strengthenthe organizational capacities of direct-entry midwifery schools, encourage ac-creditation, and advance direct-entrymidwifery education.

If you would like to receive thisnewsletter, just contact OTEP. All mid-wifery educators are invited to contrib-ute to this newsletter. Deadlines forsubmission are April 1, August 1, andDecember 1. Send articles, letters, cal-endar items, or other submissions toOTEP at [email protected] or 24 S.High St. Bridgton, Maine, 04009.

Heidi Fillmore-Patrick, CPM, NHCMExecutive DirectorBirthwise Midwifery School24 S. High St.Bridgton, ME 04009(207)647-5968

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� �What�s on the Website:

Site Sections

� Contact NARM

� About NARM

� How to Become a CPM

� Candidate InformationBulletin

� CPM Recertification

� CPM Inactive Status

� Policy and Procedures

� Professional Accountability

� Peer Review

� CPM State Information

� OSU Testimony

� 1995 Job Analysis

� Application Deadlines

� CPM Stat Forms

� CPM Newsletters Online

www.narm.org


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� �NARM Applications Department Report2005 Year-End Report

Committee Report s

Carol Nelson, LM, CPM-TN, Director ofApplications, Summertown, TN

Greetings from the NARM Applica-tions Department. We hope you are allhaving a wonderful new year. The Ap-plications Department continues to getbusier every month.

In the year 2005 NARM Applica-tions Department received a total of124 applications.

There were 267 application packetssent out to people requesting applica-tion packets.

103 New CPM certificates were is-sued in 2005.

TABLE OF COMPARISONTotal number of CPM�s

2005 11072004 9962003 8932002 8042001 7242000 624

RecertificationThe Applications Department has a

Recertification Table to keep track ofincoming and outgoing recertifica-tions. We will be sending out Recerti-fication reminders a few months beforeyour recertification is due. Debbie Pul-ley, Public Education and AdvocacyDepartment, can look in the recertifi-cation Table, should a CPM want toknow their status.

We had 214 CPMs recertify in 2005.

Table of Comparison2005 2142004 1682003 1262002 1432001 1482000 72

Inactive StatusTwenty three people chose to take

inactive status in 2005. InactiveCPMs will continue to receive the

CPM News and may recertify within asix year period. Inactive status must beestablished within 90 days of the CPMexpiration, and is maintained annuallyfor up to six years. Inactive status isrenewed each year by filing an intentto be inactive form (available atwww.narm.org) and a fee of $35.00.During this period, inactive CPMs willreceive the CPM News and all NARMmailings, but may not use the CPMdesignation or refer to themselves pub-licly as a CPM or as certified byNARM. During the six year period, aninactive midwife may renew the certifi-cation by submitting the recertificationform and fees ($150.00, 25 continuingeducation hours, five hours of peer re-view, plus the recertification formdocumentation.).

Expired CPMsCPMs whose certification has been

expired for more than 90 days, or whohave not declared inactive status, willbe given expired status and will be re-quired to follow the new policy on re-activation in order to be recertified.All of NARM policies regarding recer-tification, certification status, or reacti-vation are available on the web atwww.narm.org.

AuditsThe Applications Department gener-

ates random audits from all applicantsand CPMs recertifying. One (1) out ofevery five (5) applicants will be audited.Items required are Practice Guidelines,an Informed Consent document,forms, and handouts relating to mid-wifery practice and an Emergency CarePlan. For recertification, you will needto send your CEU verifications alongwith the other items.

Just a reminder our address is:NARM ApplicationsP.O. Box 420Summertown, TN 38483

Please include your Social Securitynumber and CPM number in any cor-respondence.

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� �NARM AccountabilityCommitteeYear-endReport 2005Shannon Anton, LM, CPMDirector of Accountability

NARM Accountability Committeefollows Peer Review and GrievanceMechanism policies and addressescomplaints against CPMs. Legal adviceis sought when appropriate. NARMBoard receives regular updates regard-ing the activities of AccountabilityCommittee.

NARM Accountability processeswork to address concerns regardingcompetent midwifery practice. TheNARM Board reserves the right toevaluate, in its sole discretion, the ap-propriate application of NARM�s PeerReview and the Grievance Mechanism.Complaints received by the NARMBoard that do not involve issues relat-ing to competent midwifery practicewill not be addressed through the PeerReview and the Grievance Mechanismthat NARM has established.

There were no active complaints dur-ing 2005. Since the beginning of theCPM credential in 1995, this commit-tee has received eighteen formal (writ-ten) complaints appropriate for NARMaccountability processes. Three CPMcredentials have been revoked; each ofthe midwives faced at least three sepa-rate complaints. Two complaints re-main on file and must be cleared be-fore those midwives may apply for re-certification.

The outcome of two complaintsheard in Peer Review found no faultwith the CPM; in one of these in-stances the consumer was dissatisfiedwith that outcome and filed a secondcomplaint to initiate the GrievanceMechanism. The outcome of the Griev-ance Mechanism proceedings reachedthe same conclusion. Four midwiveshave had complaints that proceeded to

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the Grievance Mechanism. Of those,three had their CPM credentials re-voked. NARM has revoked three CPMcredentials, one in 2000, one in 2003and one in 2004.

Participation in peer review or peerreview education is mandatory forCPM recertification. The CPM creden-tial is renewed every three years.

In February 2005 and 2006, Shan-non Anton, CPM and Heidi Biegle,CNM spoke to the nurse midwiferyclass at Yale University. NARM Ac-countability and models of peer reviewwere among the many topics of discus-sion. Community peer review was pre-sented as an excellent opportunity tomeet and establish working relation-ships between all of the midwives pro-viding out of hospital birth services.

� �Treasurer�s Report 2005Carol Nelson CPM, LM

The year 2005 was a good year forNARM from a fiscal standpoint. Weended the year with money in the bankand all expenses paid. The certifica-tion process has taken a lot of finan-cial resources and continues to takemore as we grow in numbers. By thetime this newsletter comes out we willbe over 1100 CPMs! Our total incomefor the year ending 2005 was$187,142.00.

NARM�s main sources of income arefrom Test Sales and Applications. Ap-plications include requests for applica-tions, certifications, and recertifica-tions. Our income from the Applica-tions Department last year was$153,117.00. Test Sales are from thestates that use the NARM exam in theirLicensures/Certification process. In-come from the Test Department in2005 was $32,930.00. Occasionallywe will get a grant for a specific projectsuch as the 1995 and 2001 Job Analy-sis. A Job Analysis every five years orso is necessary to remain state of theart in testing. We also have incomefrom brochure sales, and frames thatcame to $1,095.00.

As the Treasurer for NARM, I believea balanced budget is the only fiscallyresponsible way to run our organiza-tion. We need to not only be balancedbut we must think ahead to projects ofthe future and be saving money forthose projects. Another Job Analysisin five years is one such project. Toremain state of the art in testing, this isa must. Other projects include contin-ued work on our test such as Item Writ-ing and cut score workshops, recertifi-cation work with the Qualified Evalua-tors and the Skills Assessment for a fewexamples.

Our expenses closely run the same asour income. A few of our main ex-penses are: Consultants that run ourApplications Office and the TestingCompany we work with, Printing, Post-age, Telephone, Conference Fees (goingto conferences to promote the CPMand the Midwives Model of Care),Dues/Membership in organizationssuch as the National Organization forCertifying Agencies (NOCA), Insur-ance, Legal Fees to be sure we stay Le-gally Defensible, Office Expenses andSupplies.

We are looking forward to NARM�scontinued growth and a balanced bud-get in 2006.

With the growth of our certificationprocess and more Certified Profes-sional Midwives each year, we feel hon-ored to be doing our part to move mid-wifery forward and to promote theMidwives Model of Care as a viableoption for women and familiesthrough out North America.

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� �Test Department 2005Year End ReportIda Darragh, Director of Testing

Major Tasks of the Test Departmentin 2005 included:

1. Maintaining yearly renewal ofNARM accreditation by the NationalCommission of Credentialing Agencies(NCCA), the accrediting arm of theNational Organization for Compe-tency Assurance (NOCA).

2. Presenting the new LegislativeWorkshop at the MANA conference inBoulder and the Item Writing Work-shop in New Hampshire at the NE Re-gional MANA conference.

3. Working with the CPMs in statesconsidering licensure. NARM BoardMembers regularly participate in e-mailand telephone discussion with mid-wives in states seeking licensure andsometimes visit midwives, regulatoryagencies, and legislators in those states.Carol Nelson spoke to the MedicalBoard of Louisiana in January on thescope of practice for CPMs, and onlegislative issues in Alabama in March.Ida Darragh wrote letters in support ofmidwifery legislation to the legislatorsand/or Governors in Nebraska, Wis-consin, and Virginia, and spoke on thescope of practice of CPMs for a hear-ing in Washington State.

4. Training and recertifying NARMQualified Evaluators, who administerthe NARM Skills Assessment to thePEP candidates. Our total number ofactive QEs is now 69.

5. Administering the NARM SkillsAssessment to 46 PEP candidates, andthe NARM Written Examination to137 candidates.

6. Attending the annual NOCA andCLEAR conferences, and participatingon the NOCA Program Committeeand the CLEAR Program Committeeand Credentialing and Exam ResourcesCommittee.

NARM TestingThe NARM Skills Assessment was

administered to 46 PEP candidates in


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2005. The assessment was taken bycandidates from 21 states.

The NARM Written Examinationwas given to 137 candidates from 32states, 3 Canadian provinces, and onefrom Costa Rica who traveled to theUnited States to get her certification.Ninety-three candidates were taking theexam to complete the CPM certifica-tion process and forty-four candidateswere taking the exam for state licen-sure, though many who receive theCPM apply for licensure and manywho receive licensure then apply for theCPM. Eleven states currently adminis-ter the NARM Written Exam as a statelicensure exam. These states are Alaska,Arkansas, Arizona, California, Colo-rado, Louisiana, Montana, NewMexico, South Carolina, Texas, andWashington. An additional elevenstates require the CPM or the Examportion of the CPM for licensure:Delaware, Florida, Minnesota, NewHampshire, New Jersey, Oregon, Ten-nessee, Utah, Vermont, Virginia, andWisconsin. NARM currently offersthe Written Examination at the elevenstate agencies and at eleven UniversityTesting Centers in California, Florida,Idaho, Iowa, Massachusetts, Maryland,Ohio, Oregon, Tennessee, Utah, Ver-mont, and Virginia.

Test DevelopmentTest questions are written by teams

during the Item Writing Workshopsand many writers continue to submitquestions throughout the year. Allquestions are reviewed again by twoteams of item writers. Final reviews aredone by the NARM Board. Form H ofthe NARM Exam was translated intoSpanish for administration in 2005.

NARM Participation in NOCAand CLEAR

The NARM Test Department andBoard of Directors participates in thenational conferences of both the Na-tional Organization for Competency

Committee Report sAssurance and the Council for Licen-sure, Enforcement, and Regulation. In2005, Director of Testing Ida Darraghattended the NOCA conference inCalifornia in November and theCLEAR conference in Phoenix in Sep-tember and business meeting inCharleston in January. In addition,Ida served on the NOCA programcommittee, and on CLEAR Exam Re-sources and Advisory Committee andCredentialing and Examination IssuesCommittee. In October, Ida waselected to serve on the National Com-mission for Certifying Agencies(NCCA), the accrediting arm ofNOCA. Ida also attended the Coali-tion for Improving Maternity Services(CIMS) in Washington in February, theJacob Institute Conference in Washing-ton in May, the MANA Division ofResearch meeting with the CDC in At-lanta in June, and the American PublicHealth Association conference inPhiladelphia in December.

Goals for 2006Test Department goals for 2006 in-

clude:

� Training and working with moreItem Writers to create a largerdatabank of test questions. Form Jof the NARM Exam will be adminis-tered for the first time in August.

� Continue working with NOCA andCLEAR, maintaining our certifica-tion with NOCA, and serving on theNCCA commission.

�Revision of the Qualified Evaluatorstraining manual and the Item Writertraining manual. Presentation ofItem Writer workshops and Quali-fied Evaluator workshops.

� Participation on the weekly NARMBoard phone calls and annual meet-ings.

� Scheduling of NARM Skills Assess-ments as needed, and of the NARMWritten Examination on the thirdWednesdays of February and Augustat regional sites and again at the an-nual MANA Conference.

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� �Public Education &AdvocacyDebbie Pulley, CPMDirector of Public Education & Advocacy

This department�s main responsibili-ties are to answer phone calls, emails,and send out information. In 2005, wereceived over 2000 calls on the toll freeline. The calls included requests forinformation on how to become aCPM, NARM brochures, Agency/PRPackets, and the Candidate Informa-tion Bulletin. Most of NARM�s materi-als are now available on the webpage.Over 3500 NARM Brochures weremailed out in 2005. The remainder ofthe calls were general questions aboutthe NARM process or requests for mid-wife referrals.

This department also routes callsand emails to the appropriate depart-ments, manages the Board e-mail list,keeps minutes for Board calls andmeetings, assists with the CPM News,acts as PR liaison to the press, arrangeslodging/meeting space for Board meet-ings, oversees updating of the NARMwebpage, and assists in formatting andarranging printing for NARM docu-ments.

In 2005, we exhibited at eight confer-ences, including the InternationalConfederation of Midwives (ICM) inBrisbane Australia.


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� �NARM policy onpreceptors with revokedCPMs:

It is NARM policy that midwiveswhose CPM certification has been re-voked by NARM may not serve as pre-ceptors for students applying for CPMcertification.

No clinical experiences or skillsdated past January 1, 2006, may besigned by a preceptor with a revokedCPM. After January 1, 2007, no clini-cal experiences from any date may besigned by a preceptor with a revokedCPM.

This policy will be sent by certifiedletter to midwives with revoked CPMs;will be published on the NARMwebsite, in the CPM News, and will bein future editions of the CIB, HTB,and the Application.

NARM Policy

CPMRecertification

All CPMs must submit theirrecertification forms and feesby the end of the month inwhich their certification ex-pires. A late rercertificationapplication will be accepted upto 90 days after expiration ifaccompanied by an additionalfee. CPMs may also elect tochoose Inactive Status yearlyfor up to six years.

CPMs who do not recertifyor who do not choose InactiveStatus will lose their certifica-tion and will be required toreapply and retest to reactivateat a later date. Recertificationforms and details are availableon the web at www.narm.org.Your recertification date ison your mailing label. Pleasepay attention to your expira-tion date!

ApplicationDocuments

Most NARM applicationdocuments are now availableon-line at www.narm.org. Can-didates may download andprint the application forms andinstructions, and submit theseforms with an additional $25processing fee. The printed andbound application packets maystill be ordered for $50 fromNARM Applications, P.O. Box420, Summertown, TN 38483.

� �Solo!A birth story by Abby J. Kinne, CPM

With her seventh pregnancy, Dianecalled at 3:25 a.m. saying she had beenhaving contractions since 11:30 andthey hurt�this was it. Since she wasonly 38 weeks gestation, I feared it wasanother false alarm like she had donewith so many of her previous pregnan-cies, but after talking to my midwiferypartner, and because I lived so faraway, I felt I should go.

I arrived around 5:00 a.m. Dianewas very quiet so she didn't look likeshe was in labor. I checked her andfound her cervix to be very posterior,thick and only 1 cm. dilated. In retro-spect, the only clue was a slightly bulg-ing membrane through a 1 cm. cervix.

I suggested she try to sleep. We de-cided I would sleep on the crib mat-tress on the floor next to their waterbedwhere she planned to give birth andTed would sleep on the couch down-stairs and greet six other children whowould soon awaken.

As I snoozed on the crib mattress, Iwas vaguely aware that Diane was pac-ing around the bedroom, as each foot-fall crackled on the plastic she had

spread over the new bedroom carpetingto protect it during the birth.

At about 7:35 I heard Diane grunt,"Abby" from the adjoining bathroom. Iforce myself to surface from my deepsleep fog and flew off the mattress�without my glasses�and ran into thebathroom. She was half squatting abovethe toilet with a fully crowned head inher hand!

I supported the perineum (no gloves)and as I eased Diane off the toilet thehead slipped out.

The baby's head was covered withthick meconium. I had no gauze, noblankets, no oxygen...no anything!

Diane and Ted had just moved intothis new house and there was almostnothing in the bathroom, not even tow-els!

I used toilet paper to wipe the meco-nium away, removed the cord fromaround the neck, and out she came!Since I did not have my glasses, I heldmy arm up so Diane so she could seemy watch and tell me what time thebaby was born.

I grabbed the only other thing withinreach�a dirty bathmat�to cover thebaby (it was cold in the bathroom!)and rub her. She had a 2/4 APGAR.Diane seemed to be in shock and wasunresponsive when I tried to get her torub and talk to her baby.

As the baby improved, I ran to thebedroom door, opened it and yelled forTed. I quickly grabbed some basic sup-plies from the bedroom and ran backto Diane and the baby. When Ted cameup to the bedroom, I asked him to getmy birth bag from my car.

As soon as the baby was stable, Icalled my midwifery partner and ourapprentice..What a relief when they ar-rived. Although everything was undercontrol by then�I was wasted!

� �Have a good birth story?

NARM would love to share yourbirth stories in the CPM News. Pleaseemail your story (and related photos)to [email protected].


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� �Whatever happened with Shaheeda Pierce�s BreechBirth Administrative Hearing?

The judge decided not to let most ofthese people testify, and made us nar-row the list to 2 other midwives fromWashington plus declarations from 2more, Holly Scholles, Dr MarsdenWagner, Dr. James Shuffield, Betty-Anne Daviss, Ida Darragh, the client,and her husband. He allowed variousevidence from the research literature,and breech birth training videos by InaMay Gaskin and Rahima BaldwinDancy/Valerie El Halta, also AnneFrye�s textbook chapter on breech. Asenior researcher from Washington Vi-tal Statistics contributed data showingthat for all the years Washington haskept records of breech births, breechbabies have been born outside the hos-pital, from 6 to 40 per year. Some ofthe testimony can be found on thewebsite below.

Victory for Washington Women!The judge accepts that women can

seek out midwives for out-of-hospitalbreech birth, which is a major victoryof this case. He says there is no ruleprohibiting it, and sufficient evidencethat midwives have been doing it herefor years. He says the state did notprove incompetency in Shaheeda�s at-

� �Indiana Midwife,Jennifer Williams, CPM

Jennifer Williamshas been a CPM for9 years, and has beenattending births for17 years, attendingapproximately 1500births. She attended abirth in June 05, andthe baby was un-avoidably still-born. She was sub-sequently arrested, but was not chargedor held culpable for the baby�s death inany way. The parents of the baby havebeen completely supportive, and haveopposed the prosecution. She wascharged with practicing medicine andpracticing midwifery without a license.Jennifer is a founding member of theIndiana Midwifery Taskforce whichhas been working on getting midwiferylicensure for 13 years, since 1993. TheIMT and other midwifery organiza-tions will be working again this fall ona CPM licensure bill when the IndianaLegislature is in session.

Practicing medicine without a li-cense is a very serious Class C felonyin Indiana, and practicing midwiferywithout a license is a Class D felony.Combined prison time for both felo-nies is 11 years. In addition the pros-ecutor has contacted the Attorney Gen-eral, and now Jennifer is battling theAttorney General to stop an injunctionagainst her practice.

Jennifer is incurring large attorneyfees. For updates on the case and whereto make donations please visit herwebpage at http://hometown.aol.com/birthroot1/JenniferWilliamsCPM.html

Midwives Under Attack

Shaeeda�s Pierce�s own storyBrief Background:

Shaheeda Pierce, LM, CPM was inves-tigated by the Washington Departmentof Health for �attempt of vaginalbreech birth at home�. TheDepartment�s stated position was thatShaheeda and other midwives shouldlose their midwife licenses for this.Home breech birth is not prohibited inWashington by any statute or adminis-trative rule.

Shaheeda took part in a hearing for5 days in September and November.The state paid a doctor and a formerWashington midwife to testify againsthome breech birth as an option for par-ents declining planned cesarean fortheir breech babies. It has been virtu-ally impossible to plan a hospitalbreech birth in the Seattle/Tacoma areafor the past few years. They are onlydoing cesareans. Department of Healthcould not find any licensed midwivesin Washington to take their money totestify, although they advertised.

On the other hand, the list of peoplewilling to testify for free in favor ofShaheeda�s license and non-surgicalbreech birth options were: the parentsinvolved in the case (mom and babyfine), other clients who have hadbreech babies, 7 midwives from Wash-ington, Ina May Gaskin, RahimaBaldwin Dancy, Mary Cronk, JaneEvans, Mabel Dzata, Anne Frye, HollyScholles, Alison Osborn, Dr. MarsdenWagner, Dr. James Shuffield, CarolinePeterson of ICAN, Ken Johnson, Betty-Anne Daviss, Ida Darragh, and others.

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tendance at previous frank and com-plete breech births.

However, the judge ruled that themidwife misdiagnosed the position ofthe baby and therefore was negligent.He accepted a definition of breech po-sition that does not coincide with mosttextbook and expert evidence. Accord-ing to the usually- accepted definitionsof breech positions, the midwife wascorrect in diagnosing the baby as a�complete� breech, rather than a �foot-ling� breech, as the judge chose to rule.The judge said that if there was any-thing in his initial decision that wethought was an error in fact or law, wecould submit a petition for him to re-consider his decision. Midwives AnneFrye, Alison Osborn, Shaheeda Pierce,and attorney Bob Meals prepared a pe-tition showing what we believed to bethe factual and legal errors of the deci-sion. The judge decided not to considerthe petition.

The ruling says that the midwifeshould have paid to have written trans-lation of clinic documents into Chi-nese for this client who had spokenEnglish for 30 years. No charges havebeen filed against the 4 midwives shesaw previously who didn�t do that, oragainst the other clinics who are notdoing that. He rules that only a mid-wife or doctor can decide when andhow a woman will go to the hospital-not the woman�s decision, and that themidwife was negligent for not decidingto go to the hospital before the clientdid, and for allowing the family timeto talk and pack a bag, as was theirwish. They had declined an ambulance,and both were doing fine.

Shaheeda is specifically permitted toattend �frank� and �complete� breeches(although we now wonder what thedefinition of a �complete � breech is!).She is specifically prohibited from at-tending �footling� breech births andhas been ordered to become an expertin �footling� breech births by obtain-ing an extensive training program in�footling� breech births to be approvedin writing by the Dept. of Health. They

have not approved her first twoproposals�they want to require atten-dance at 8 �footling� breech births,plus a page of other requirements.

The judge says his ruling does notpreclude other midwives from attend-ing �footling� breech births if theyhave more experience in attendingthem (undefined). The client in thiscase had a cesarean performed 3 hoursafter consult with the OB, and 2 hoursafter check-in at the hospital. No inves-tigation is pending for delay in cesar-ean or for undiagnosed severe spinalheadache of several days duration (dueto anesthesia). The woman was told bythe OB that her headache was due to�trying to push your baby out athome�. The judge put Shaheeda�s licenseon probation and fined her $1000.Shaheeda is not appealing what we be-lieve to be the errors in the judge�s deci-sion. It would be very expensive finan-cially and emotionally to appeal. Thelawyer says this would never happen toa doctor. He has worked with licensingissues for over 30 years in severalstates.

Thanks so much to everyone foryour attendance at the trial, yourprayers, for putting on and attendingthe fundraising dinner, cash donationslarge and small, auction items, websitehelp, massages and other healing work,soup and dinners brought, strategy ses-sions, organization skills, hotel roomsbought, phone calls, research and legalwriting, indymedia articles, stories ofyour breech births, childcare, pep talks,letters, videotaping, DVD production,data entry, use of pictures, a shoulderto cry on, and everything else you�vegiven.

Persecution of midwives in Washing-ton continues, with 3 of Shaheeda�smidwife friends currently known to beunder investigation. More have givenup their midwife licenses recently, dueto the political situation.

The website for testimony excerptsand viewing of other court documentsand declarations is:

www.shaheedapierce.com

� �State Updates

Wisconsin passed their bill on Janu-ary 31! The Governor signed the billon April 10 and Wisconsin became the22nd state to acknowledge the CPM.Way to go, Wisconsin!

Georgia�s Resolution for a MidwiferyStudy Committee passed without con-test on March 23rd. The committeeshould be appointed during the sum-mer.

Missouri has been working veryhard to pass a licensing bill this year. As we go to press, we have just learnedthat their licencing bill failed to pass.They have made a LOT of progress. Every cookie, every phone call, everyletter, every visit, every jar of apple but-ter has moved them a little bit closerto the finish line. They now havefriends all over the building and moreand more people are becoming awareof the safety of homebirth.

States that use all or partof the NARM certification

process for state licensure:AlaskaArkansasArizonaCaliforniaColoradoDelawareFloridaLouisianaMinnesotaMontanaNew HampshireNew JerseyNew MexicoOregonSouth CarolinaTennesseeTexasUtahVermontVirginiaWashingtonWisconsin

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�� Midwives Alliance News� �Marketing Midwives - - - What�s in a Name?News From the MANA Public Education Campaign

The Public Relations Committee andthe Board of Directors of Midwives Al-liance of North America have beenworking with our newly hired market-ing firm, Vermilion, to create a strategyfor public awareness and education.This is really an exciting time for youas it is the beginning of a long-termcommitment to increase public percep-tion about the practice of midwivesand to influence the choices womenmake about their birth.

As midwives we have so many strongopinions about how to stand out, ornot to, how to label ourselves, or notto, and how to talk about what we door do not do. In the past, this conflicthas been our stumbling block. Wecan�t agree on what we should say.How could we possibly? Birth�the es-sence of our work as midwives andwhat we know in our heart of hearts�iswell�indescribable. Recognizing this,the MANA decided to hire a firm inthe business of communications, im-age, and advertising�NOT midwives�tosort this out. As you can imagine, theprocess has been quite involved. Theyheld meetings with our group to hearcollective goals and challenges; theyreviewed our organizational strategicgoals; and they conducted consumerresearch. Out of months of work, theycreated a proposal and some excitingrecommendations for us.

One you have probably seen creepingin already is the recommendation touse our name and not our acronym(MANA) and to shorten it to �Mid-wives Alliance� in outside conversa-tion. This way our name has relevanceand carries some meaning in conversa-tion. Our plan is to begin to shift per-ceptions about midwives, and hearingthe word spoken is part of that process.

The marketing strategy is to promotethe unique and important balance of

Reported by Elizabeth Moore

MANA Board Liaison to the MANA Public Relations Committee

personalized care and professionalknowledge. So another recommenda-tion is to refer to ourselves as Profes-sional home birth midwives. We foundthat none of the common midwiferycredentials such as CPM, RM, LM, andCNM are easily understood or dis-cerned by the average woman consider-ing a midwife. What she wants toknow is that she is working with some-one who is the best, the safest, and thekindest in the field. So we need a namethat describes who this person is andwhat she does and encompasses mid-wives at various types of certification.The letters CPM or CNM would stillbe used following your name as anyletter of education, such as PhD andRN, and in circles where they arewidely understood. However, for thepublic campaign, we will use the termProfessional home birth midwife.

What about those midwives whopractice in other out-of-hospital set-tings, for example, birth centers? Wehave decided to be bold, to stand forsomething, and to market from the out-side in rather than the inside out.Rather than start with Midwives Alli-ance or Midwives Model of Care (andtry to explain that that can happen inany setting), we cast a bigger net andtry to get the attention of women mostlikely to be open to a home birth. Wefirst generate interest in the broadwidely accepted idea of healthy, naturalpregnancy, then we introduce the ideaof home births with a midwife. Slowlyshifting the perception of midwifery,educating and promoting home birthwill lead women to midwives in all set-tings. While not the main focus of thisprimary phase of the campaign, birthcenter midwives will benefit as womenbecome educated and perhaps decidethey may not be ready for a home birthbut would try a birth center.

We are currently considering whatwill be the branding or naming of thecampaign...like �Got Milk?� We arelooking for the idea that will grab theirattention about natural healthy preg-nancy and birth, then we will intro-duce the idea of home birth. Stay tunedfor the upcoming announcement andlaunch of our campaign, consumerwebsite, and 800 number!

If you have a desire to be involvedin, rather than just informed about theprocess, please consider joining theMidwives Alliance (MANA) Public Re-lations Committee and working on atask. We hope to have extended work-ing committee time at MANA 2006 inBaltimore, and we regularly meet byemail. We recognize it is a long road,and we need a lot of money before allthis will become a reality, but we areon the journey together! Help us raisemoney, buy coffee at the Midwives Alli-ance (MANA) website, and lend a handand your voice.

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June 15th-17th, 2006

MANA SoutheasternRegional Conference

�Sowing the Seeds�

Camp McDowellNauvoo, Alabama

Jennifer [email protected]

205-967-6585

SUMMER 2006, NORTH AMERICAN REGISTRY OF MIDWIVES 1 1� �

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� �Midwives Alliance Division of Research

What the Association Can Usethe Information For:

Use of the data by the account holderis not limited by the Midwives Alliancesince all of the data released to the stateorganization is completely de-identi-fied, in regards to both the mother andthe midwife. Consent to use the datafor the advancement of midwifery wasobtained prior to the data being en-tered into the database. However, theDOR reserves the right to close an ac-count if the data were being used inap-propriately.

How an Association Can Sign Up1) The association needs to promote

participation in the data collectionproject among its members. Theamount of data available to an asso-ciation is dependent upon the levelof participation in the Midwives Alli-ance Statistics Project by its mem-bers. No data is available on anybirths not entered through the cur-rent Midwives Alliance Statistics sys-tem. Workshops are available to helpshow members how to get going, andNARM can offer CEUs for atten-dance.

2) The association needs to make a de-cision that it wishes to obtain thiskind of account. The DOR wants tobe sure that no midwives feel theirdata is being shared with other mid-wives or used in any way withouttheir approval. The association mustmake the decision to open a data ac-count by whatever process it uses forMAJOR decision making.

3) The association then needs to con-tact the DOR ([email protected] [email protected]), on associa-tion letterhead, with the following:

Policies and Proceduresfor State Associationand Provincial DataAccounts

What Associations Can Get:A state or provincial association can

obtain selected aggregate statistics de-scribing births contained in the Mid-wives Alliance (MANA) database sub-mitted after the organization estab-lishes their account, by its members.These items include number of births,numbers of transfers, cesarean sections,etc. The numbers reported are totalsonly. The state report looks similar tothe midwife/practice statistics thatsingle contributors can access exceptthat the total number is based on allmidwife practices contributing data inthat particular state or provincial asso-ciation. In other words, a state associa-tion could see that its members at-tended 100 births and 10 were trans-fers. Access to the account is passwordprotected.

The Division of Research (DOR) willalso provide support in preparing orinterpreting reports for state and pro-vincial level activities.

What Associations Cannot Get:Information about individual births

or individual midwives is not availablethrough this type of account. For ex-ample, there would be no way to seewhich births were the transfers or howmany births an individual midwife hadattended. There would be no way to gettotals in categories beyond what themidwives themselves can see, althoughthis could change in the future.

There is no way the account holdercan get into the database to access anyother functions or data.

May 1, 2006

Report from the Midwives Alli-ance Division of Research

The main work of the Midwives Alli-ance Division of Research (DOR) con-tinues to be data entry and the develop-ment and refinement of our policies.The participation of midwives in thenew database has been steady so thedatabase is growing as expected.

Deren Bader, Director of the Re-search Education Section, attended theNational Institutes of Health (NIH)Consensus Panel on elective caesarianon behalf of the Midwives Alliance andthe DOR. Sarasw athi Vedam, Directorof the Research and Publication Sec-tion, will represent the Midwives Alli-ance Division of Research at theACNM annual meeting at the end ofMay, pursuing potential areas of col-laboration for further discussion.

The Research Education Section re-minds you that the DOR will have anumber of workshops at the meeting inBaltimore � look for them and sign up!

The Deep Review of the database con-tinues, with work being done on thedata form and on the consent form.Also what our data access policyshould be is now coming forward asan important decision for the DOR asa whole to make, since the database isgrowing so well.

We want to be sure everyone knowsthat state and provincial associationscan obtain an account to access aggre-gate statistics of their members. Thiswould be an ideal way to have numbersimmediately on hand and up-to-datefor legislative purposes.

Planning for future needs should bedone NOW, by getting your membersto participate and getting an accountthat you can use as needed, withoutany delay.

Below is a description of what youcan get and how to do it.

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a. A statement that the decision hasbeen made by the group

b. A list of participating membersc. The name of a contact person who

has been chosen to manage the ac-count

d. The name of the association offi-cial authorized to sign the contractfor the account

4) The DOR will then send a contractwhich contains two parts:a. The agreement between the associa-

tion and the Midwives Alliance forthe account

b. A Non-disclosure Agreementwhich prohibits inappropriate useof the data

5) The association needs to return thecontract to the DOR. Once it is re-ceived, the account will be set up.The contact person can log on to theaccount with a password and obtainthe latest totals of births that havebeen fully entered and reviewed.Births that have not been completelyentered or reviewed will not show upin the totals.

The data made available from theMidwives Alliance Statistics Projectcan be very useful for lobbying or regu-latory purposes. It puts the control ofthe data in the hands of the midwives.Having state level data can be usefulwhen trying to get a bill passed, but itcan also be useful to show that mid-wives are involved in self-assessment

and accountability. In other words, itshows your numbers but also that youare on top of things and will be in thefuture. It is much stronger than just aflash of numbers at bill-passing time,and might boost your chances of avoid-ing your regulatory board feeling theneed to monitor you in some otherway.

It�s good to consider getting startedon this process now rather than later,because births only begin being addedto the state organization�s statisticsonce the organization account is setup. A common mistake has been tothink of �getting some data� onlywhen it�s needed!

New Address forMANA Statistics

MANA StatisticsP.O. Box 6310

Charlottesville, VA 22906

[email protected]

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� �MEAC News

The MEAC office has moved againto a beautiful, recently renovated housein downtown Flagstaff. Please noteour new address below. Our phonenumbers and email will remain thesame. Thank you!

Jessica Burgett,Administrative Assistant

Midwifery EducationAccreditation Council

20 E Cherry AveFlagstaff, AZ 86001-4607

(928) 214-0997Fax: (928) 773-9694

[email protected]

� �Sixth North AmericanConference on ShakenBaby Syndrome

Announcing the Sixth North Ameri-can Conference on Shaken Baby Syn-drome, which features a wide range ofprofessionals in the field of shakenbaby syndrome (SBS). This conferencewill help to increase awareness of SBSby examining current practices, chal-lenges, public policy, family involve-ment and research needs related to SBSand discuss priorities for the future.

The four-day conference will befilled with insightful workshops, speak-ers and presentations featuring topicsrelated to SBS. There will also be anopen forum for families of victims whohave been affected by SBS. This confer-ence will be held in Park City, Utah onSeptember 13-16, 2006. Please visitwww.dontshake.com for more informa-tion.

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Midwives Alliance News

� �Looking forOpportunities toObtain CEU�s?

Don�t miss a great opportunity toearn CEU�s and have a great time do-ing it! Plan on attending MANA 2006in Baltimore, MD October 12ththrough October 15th.

Last year at MANA 2005 in BoulderCO, there were opportunities to earncontact hours during the regular con-ference plus additional contact hours ifyou attended a pre-conference work-shop.

In addition to obtaining CEU�s youand your family can visit the world�slargest indoor waterfall at the NationalAquarium and tour the ships and sub-marines of the Baltimore Harbor.

For more information, watch for an-nouncements about the conference onMidwives Alliance�s website atwww.mana.org.


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� �Meet the NARM Board of Directors

Left to right: Robbie Davis-Floyd (Public Member), Shannon Anton (Accountability), JoanneGottschall (retired), Ida Darragh (Testing Department), Carol Nelson (Applications), Debbie Pulley(Public Education and Advocacy), Sharon Evans (retired)

Who are the NARM Board of Directors?

Ida Darragh, CPM, LMBoard ChairpersonTesting Department

Carol Nelson, CPM, LMTreasurerApplications

Debbie Pulley, CPMSecretaryPublic Education & Advocacy1-888-84BIRTH

Shannon Anton, LM, CPMVice-ChairpersonAccountability

Robbie Davis-Floyd, Ph.D.Public MemberAnthropologist/Writer/Editor

Luna Armstrong, CPM(Nominee)

Ruth Cobb, CPM, GNM(Nominee)

� �NARM Board Members

Due to the retirement of SharonEvans last year, and Joanne Gotschallthis year, the NARM Board has been inneed of reinforcements! NARM BoardMembers must contribute at least tenhours of work per week, and oftenwork many more hours to complete thenecessary tasks. NARM Board Mem-bers must be capable of using the com-puter and must be able to travel occa-sionally to represent NARM, in addi-

tion to their usual department tasks.NARM needs volunteers who are intel-ligent, creative, and self-directed in ac-complishing their tasks. If you are in-terested in serving on the NARMBoard in the future, please arrange aninterview with us at the MANA Con-ference.

NARM has interviewed two new po-tential board members, LunaArmstrong of California and RuthCobb of Oklahoma. Ruth and Lunahave participated on our weekly confer-

ence calls, attended our Spring BoardMeeting, and begun to find their nichein board work. The current membersof the NARM Board would like tonominate Luna and Ruth for one-yearterms on the Board, with possible re-newal for four-year terms.

Luna Armstrong has been a midwifeon the northern California coast forthe past 24 years. She is the mother ofthree and grandmother of one, allhome born. She works with her localmidwifery community to promote edu-cation and choices for women andtheir families. Communication andgood relationships among midwives ofall backgrounds is a priority for her.

Ruth Cobb, CPM, GNM has prac-ticed homebirth midwifery in the Tulsa,Oklahoma area for the past 29 years. She has spent most of the past 20 yearsas either a MANA Board Memberand/or a Oklahoma MidwivesAlliance Board Member. She gavebirth to the first of her three childrenat home 30 years ago. Her heart�sgoal is committed to promoting andassuring that the generations ofwomen and their families have thesame wonderful opportunityto give birth with safe midwifery care.

NARM offers each CPM the oppor-tunity to confirm or object to these po-tential board members. If you wouldlike to have a voice in their nomina-tions, send your comments, or vote [email protected] or 5257 RosestoneDrive, Lilburn, GA 30047. Responsesshould be received by July 1, 2006.

� �NARM Workshops

NARM can offer a variety of work-shops to be presented at state midwiferyassociation meetings or regional con-ferences. The Preparing for Legislationworkshop is highly recommended formidwives and consumers in states thatare considering legislation that affectsmidwifery. Only CPMs may attend theQualified Evaluator workshop or theTest Writing workshop; all midwives,students, and consumers are welcome

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at other workshops. At least one of thefull day workshops must be offered �the Test Writing workshop of the Legis-lation workshop � other workshopsmay be added if desired.

There is a $75 fee for the QualifiedEvaluator workshop, but no fee for theother workshops. The sponsoring orga-nization is expected to provide housingand local transportation for theNARM instructor, but NARM will paythe airfare.

Continuing Education credits willbe awarded for all workshops. Formore information, call 1-888-353-7089or write [email protected].

Preparing for LegislationThis workshop is available as a full

day workshop for midwives and con-sumers who are preparing to lobby forlegislation to license midwives in theirstate. The workshop is an overview ofthe legislative process and lobbyingstrategies, and includes actual trainingfor lobbying, including writing factsheets, giving interviews, making thebest use of the 15 minute or 2 minuteopportunities for speaking with legisla-tors, giving testimony at public hear-ings and legislative committee sessions,and answering tough questions sponta-neously.

Test Writing WorkshopThis workshop can be done as a 7

hour (full day) or 10 hour (evening andfull day) workshop.

The test writing workshop bringstogether groups of CPMs to discuss themidwifery knowledge and skills thatare essential components of the prac-tice of midwifery. Based on real-life ex-periences, teams of midwives craft sce-narios related to problems they haveencountered in prenatal, birth, or post-partum situations, research these sce-narios in the reference texts, identifythe knowledge necessary to solve theproblem, and develop multiple choiceanswers to evaluate that knowledge.Discussions are lively and stimulating,and participants find the process to berewarding on a personal and profes-

sional level. Additionally, participationby CPMs in the development of testquestions is integral to the reliabilityand validity of the Certified Profes-sional Midwife credential. NARM Cer-tification was created by midwives, formidwives, and is administered by mid-wives on the NARM Board. TheNARM exam is written by midwives,with focus on the practical aspects ofmidwifery care and knowledge. Yourparticipation makes a better exam! Par-ticipants must be CPMs.

Qualified Evaluator TrainingThis 4-hour workshop trains CPMs

to administer the NARM Skills Assess-ment. This workshop is open only toCPMs with at least 2 years and 30births additional experience beyond theCPM. There is a $75 fee for the QEworkshop, but participants become eli-gible to administer the Skills Assess-ment, for which they are paid $75.

Midwifery EthicsIn today�s maternity services ethical

issues are everywhere, and yet there isoften a poor understanding of howpractitioners deal with them. Manyqualified midwives, while believing thatthey are ethical in their work and lives,might find it difficult to define whatthis means in practice. We all have tomake decisions everyday with clients,other health care providers and ourown families. While ethics is seen bysome as a theoretical issue, to be de-bated in classrooms and at confer-ences, the everyday import of ethicaldecision-making means that the theory-practice gap needs to be bridged. Ourexploration of ethical midwifery is acritical reflection of moral issues asthey pertain to maternal/child healthon every level. This 2-hour workshop isopen to anyone. It explores the ethicalissues that face midwives in today�sworld, as well as strategies for resolvingthese issues. Participants will discussthe ethical issues relating to account-ability, autonomy, confidentiality, in-formed consent, and the use of technol-ogy.

Preceptor-Apprentice Relation-ships

This 2-hour session is open to any-one. This workshop is designed to meetthe needs of both preceptors and ap-prentices and to help avoid commonproblems in the preceptor-apprenticerelationship. Discussion includes therole and responsibility of the preceptorand apprentice, advantages and disad-vantages to the apprenticeship model ofeducation, avoiding common misun-derstandings between preceptors andapprentices, and documenting the ap-prenticeship for the NARM applica-tion process.

NARM and the CPM ProcessThis 2-hour workshop is open to

anyone. It explains the development ofthe NARM process and the require-ments for CPM certification. The ses-sion is designed for apprentices whointend to apply for CPM certificationand for the preceptors who will trainthem to meet these requirements. It isalso a very valuable workshop for any-one who is interested in seeking legisla-tion to license midwives using theCPM process as a basis for licensure.Participants will become familiar withall routes of entry into the CPM pro-cess, how the criteria for certificationwere determined, and how each elementof the process contributes to the reli-ability and validity of the credential.

MANA Statistics � Web BasedData Entry

This 2-hour workshop is open toanyone. It explains the new MANAStatistics Collection Project, includingthe web based data entry system, so thatall midwives can enter their personalstatistics into the MANA database foruse in analyzing and publishing re-search on direct-entry midwifery. Par-ticipants will learn how to enter theirdate on the web (and options for notentering on the web), how this informa-tion may be used, and how to retrievetheir own personal or group statistics.

NARM Workshops�

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Can you help?NARM is seeking current addresses or contact information for these women. If you can reach any of these people,

please ask them to contact NARM at [email protected] or call 931-964-4234, or let us know how we may reachthem.

Gaines, KathleenGarassini, MercedesGerard, CynthiaGowans, KathyGriffith, PauletteGross, MarlaHarootunian-Cox, YanaHarrington, ChristineHauser, CammieKlassen, FlorenceLamphere, RubyLeMone, KathleenMalegus, ChandraMatthews, Mary JoMcColgan, KarenMcIver, MaureenMcNett, MarilynMiddlemiss, NancyMilliron, Annette

Baldwin, SarahBellows, ShirleyJennifer BennettBlaum, SusanBoehme, SherlyBreen, NicoleBuhler, JoniCanright, DianCook, BarbaraCoursey, ChristinaCrowley, AndreaDavidson, JoanDavis, CindyDexter, RhondaDolin, BetsiDuke, SuzanneFehr, ToniFriedricks, MickyFuller-Bey, Gloria

� �Upcoming Conferences

Following are upcoming conferencesthat members of the NARM Board willbe attending:

Midwifery Conferences:

Midwifery TodayPennsylvaniaMarch 23-26, 2006

SE Regional MANA ConferenceAlabamaJune 15-18, 2006

Idaho Midwifery ConferenceIdahoJuly 28-29, 2006

Midwives Alliance of NorthAmerica (MANA)

Baltimore, MDOctober 12-15, 2006

NARM also attends:

Council on Licensure, Enforce-ment and Regulation (CLEAR)

Charlston, NCJanuary 12-14, 2006

Coalition for Improving Mater-nity Services (CIMS)

Boston, MAFebruary 23-26, 2006

National Conference of StateLegislatures (NCSL)

Nashville, TNAugust 14-19, 2006

Council on Licensure, Enforce-ment and Regulation (CLEAR)

VirginiaSeptember 13-16, 2006

American Public Health Associa-tion (APHA)

Boston, MANovember 3-6, 2006

National Organization for Com-petency Assurance (NOCA)

Orlando, FLNovember 13- 18, 2006

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Moore, GayleNematbakhsh, SuzyNichting, SheliaNykiforuk, CarolynO�hara, MyraOlsthoorn, PeggyPliscou, ElizabethRamirez, CheriRarey, DonnaRodden, LindaScaia, JenniferSchulfer, AnnSmith, DianeTaranto, Mary AnnTennant, BarbaraWainer, NancyWalker, JulieWelch, Jill


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CPM2000� �Research Update from Betty-Anne Daviss, MA, RM and Ken Johnson, PhD

February 24, 2006

BMJ Follow-up � Good NewsFor State Legislation

As hoped, the CPM2000 study onhome birth published in the BritishMedical Journal (BMJ) in June has re-sulted in growing and untapped divi-dends. The CPM News only comes outperiodically. If you want to be keptinformed about what we are doingplease email us at [email protected] toget onto our list or phone us at(613)730-0282.

Using our new comparative system,we have been creating critical reportsin which we compare state stats withthe CPM2000 article. This has provento be an opportune strategy for statelegislation. We did this first to supportlegislation in Wisconsin. The legisla-tion passed through the house and thesenate Feb. 1. Midwives will now belegal in Wisconsin!! (See letter fromWisconsin in this issue.) Secondly weproduced a report on the data of themidwives who had collected with us forMissouri. We also edited and added totheir rebuttal to the Missouri physi-cians� attempt to undermine theCPM2000 study. (See Missouri reportthis issue.)

Court CasesWe continue to testify for hearings

and court cases, bringing evidencefrom the BMJ article and the disturb-ing trends issues about which we havebeen presenting and writing. The mostcritical cases recently have been inWashington State. CPMs are amongthe many midwives being investigatedin that state.

Our testimony for the ShaheedaPierce case contributed to a judgmentthat midwives can now do frank andcomplete breeches at home. Thismeans that vaginal breeches have beendeclared within the Licensed Midwife�sscope of practice in a state in whichphysicians do not do vaginal breeches

in hospital. (See report from ShaheedaPierce.)

NACC Study on VBAC and theTerm Breech Trial: Presentationsat ACNM, American PublicHealth Association and the Ca-nadian Association of Midwives

Following our critique of the Na-tional Association of Childbirth Cen-ters study that we published in theACOG journal (Letter to the editor:Obstet Gynecol. 2005 Apr;105(4):897-8) we were asked to present our critiqueof the NACC VBAC study as one of thetwo topics in June 2005 at ACNM50th anniversary in Washington, D.C.At both APHA and the ACNM conven-tions we expressed concern about theconclusions drawn from this studywhich were not based on the data. Theauthors had concluded:

�despite a high rate of vaginalbirths and few uterine rupturesamong women attempting VBACsin birth centers, a cesarean-scarreduterus was associated with in-creases in complications that re-quire hospital management. There-fore, birth centers should referwomen who have undergone previ-ous cesarean deliveries to hospitalsfor delivery.�

There was no evidence that thedeaths would have been averted in thehospital. 90% of the women who hadhad only one VBAC at home had simi-lar risk to women who had never had aVBAC. However, the data did indicatecertain parameters for increased riskwith specific criteria among womendelivering with a former cesarean(s), wehave suggested the following conclu-sions could be drawn from the data.(We have prepared talking notes on aPowerPoint presentation which wewould be happy to send you if youwrite to [email protected]):

�because in this study there was ahigh rate of vaginal births and fewuterine ruptures among womenattempting VBACs in birth centers,

�And because the perinatal mortal-ity of 2 per thousand in those witha single former cesarean section isvery low (consider the overall peri-natal mortality in the USA) there-fore, reflection for those planningVBACS in out of hospital birthsshould be more cautious if theyhave had two or more former cesar-ean sections or are >=42 weeks.

�Women should also be told aboutthe risk of cesareans along with therisks of VBACs and ruptures (oddsof infertility, miscarriage, ectopicpregnancy, placenta abruption, pre-via and accreta, respiratory prob-lems including persistent pulmo-nary hypertension, stillbirth insubsequent pregnancy).�

After we were well received by ap-proximately 250 midwives at the talk atACNM, we made a decision to submita proposal to the NACC conference inCalifornia in September to open upVBAC in Birth Centers again. As wewere told by one of the NACC Boardmembers that VBACs would not be al-lowed in future at birth centers unlessthere was a study going on, we pro-posed that they start collecting dataagain and start a new study. We under-stand that initial steps have been takento do this.

Term Breech Trial: Turning theBreech Issue Around

Besides presenting on VBAC atAPHA in 2005, we presented the con-clusions of the 2-year follow-up to theTerm Breech Trial. The original con-clusions were:


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�Planned cesarean section is betterthan planned vaginal birth for theterm fetus in the breech presenta-tion.� (Hannah et. Al, Oct. 2000,The Lancet)

With the new follow-up conclusions,these conclusions have been changedto:

�Planned cesarean delivery is notassociated with a reduction in riskof death or neurodevelopmentaldelay in children at 2 years of age.�(Whyte, Hannah et. Al Sept. 2004,AJOG).�

Who Did Episiotomies Nation-ally and in California?

The question of midwives doing epi-siotomies in California has become anissue. We used the CPM2000 databaseto do further analyses. We reported inthe CPM2000 article that among the5,418 intended homebirths, there were116 episiotomies (2.1% of births). Hereare previously unpublished stats wepulled out from the CPM2000 onthem.� 75 (1.4% of births) of the episioto-

mies were done by physicians (allbut 4 in hospital);

� 41 episiotomies (0.8% of births) weredone by midwives (all but 2 athome).

� Therefore, midwives did 35% of theepisiotomies, about one episiotomyin every 132 births.

As there has been a question raisedin California regarding whether mid-wifery schools adequately teach how todo episiotomies, we have suggested tothe authorities there that they are ask-ing the wrong question. As we candemonstrate how seldom midwives doepisiotomies and how frequently theyare done in hospital, without due causeor betterment of outcome, we have sug-gested they are asking the wrong ques-tion. Rather than ask whether a mid-wife knows how to use a pair of scis-sors, we have suggested they ask why

the physicians are doing unnecessaryepisiotomies.

Translations of the BMJ ArticleThe CPM2000 Study has been trans-

lated into German. We are workingtowards having it also translated intoSpanish and French, and think it is atleast partly done in Hungarian.

CPM2000 Individual StatisticsPackages

CPM2000 Statistics packages weresent in the early Fall to CPMs involvedin the BMJ study. The package includeda history of the project, highlights ofthe media attention the article gar-nered, a chronology of steps that led togetting the article published, a copy ofthe article, and 10 of the more interest-ing letters to the editor that were pub-lished (you can go see all 24 letters onthe BMJ.com website under the article(June 18th, 2005 issue and this week inthe BMJ sections.) If you sent morethan 5 births to us for the year 2000and did not receive your report or haveany questions about it please contactus.

Home Birth Makes the Hit Pa-rade in British Medical Journal Press Release: March 13, 2006

Home birth appears to be the secondmost popular subject for readers of theBritish Medical Journal (BMJ), secondonly to topics on how to treat heartdisease. The BMJ has just released its2005 annual top 10 list of articles re-ceiving the most attention on the webin the first week after publication.

(http://bmj.bmjjournals.com/preview_aboutsite/top-ten2005.shtml)

Outcomes of planned home birthswith certified professional midwives:large prospective study in NorthAmerica, published last June 18th,2005, was the third most popular ar-ticle among several hundred publishedin the BMJ in the year 2005.

Given that only a minority ofwomen in developed countries choose

home births, how is it that such an un-likely topic should hold such a promi-nent position in one of the most presti-gious medical journals in the world?The study is, in fact, timely. Homebirthers are statistically among themore educated in developed countriesand this study � the largest prospectivehome birth study ever published pro-vides the academic precision to criti-cally juxtapose home and hospital envi-ronments and their affect on normalbirth.

Hot on the tail of renewed interestin natural birth, studies are presentlybeing formulated to test instead, out-comes when every woman regardless ofrisk is offered a cesarean section. Popu-lar promotion of this form of child-birth capitalizes on women fear by of-fering them a way to get out of birth,while other women are shocked at sucha move so far from the unassisted vagi-nal birth that they still deliberatelychoose. In spite of the movement torender vaginal birth an extreme sport,it is still preferred by most women inorder to have more control and the sat-isfaction of engaging in a normal bio-logical function that women have per-formed for centuries. The outcomes inthis BMJ article suggest that women aremore likely to achieve this if they plantheir birth at home.

The BMJ editors� one paragraph sum-mary succinctly describes the research:

Giving birth: home can bebetter than hospital For women with low risk pregnan-cies in North America, giving birthat home bears similar risks of in-trapartum and neonatal mortalityas giving birth in hospital, butplanned home births are associatedwith lower rates of medical inter-ventions. In a prospective cohortstudy, Johnson and Daviss (p 1416)evaluated the safety of home birthsinvolving certified midwives in5418 women who intended to givebirth at home when labour began.


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The study participants experiencedsubstantially lower rates ofepidurals, episiotomies, forceps de-liveries, vacuum extractions, andcaesarean sections than womenwith low risk pregnancies who gavebirth in hospital.

In the last 12 days of June of 2005,6,500 different users accessed the articleon the web and in July an additional2,500 different users. Interest has beensustained since then � 1,250 to 2,000different users have gone to the articleeach month since the summer. The ab-stract has been accessed more than7,000 times, the full text HTML over25,000 times and over 6,200 copies ofthe article have been downloaded as aPDF. In total the article has been ac-cessed in some form almost 40,000times since publication.

The article and 24 letters to the edi-tor (rapid responses) from around theworld are available FREE OFCHARGE at BMJ.com. Go to past is-sues, choose June 18, 2005 and lookunder �This Week in the BMJ� to seethe summary from the editors and 5 ofthe letters to the editor from places asfar away as India. Go to the papers sec-tion of that issue to download a copy

of the paper and read 19 other letters tothe editor (below the article).

The authors can be contacted forcomment or interview [email protected] ,(613) 957-0339 or [email protected], (613) 730-0282.Other BMJ facts:

709,000 unique users go to the BMJwebsite every month; monthly page im-pressions: 6,763,200

The print version of the BMJ goesout to 107,000 subscribers in Britainand 15,500 subscribers internationally.

Local editions of the BMJ (in the lo-cal language) are published in China,Greece, the Middle East, the Nether-lands, Portugal, and Romania, SouthEast Asia, Turkey, and West Africa.

Outcomes of planned home birthswith certified professional midwives:large prospective study in NorthAmerica. Kenneth C Johnson, Betty-Anne Daviss. BMJ 2005;330:1416,doi:10.1136/bmj.330.7505.1416 [Ab-stract]2211 [Abridged text]699[Abridged PDF]230 [Full text]7681[PDF]2549

(http://bmj.bmjjournals.com/hitparade/20050618.shtml#PAPERS)

http://bmj.bmjjournals.com/cgi/content/full/330/7505/1416?ehom

NARM Updates

Did you know you canfind NARM updates onthe webpage?

Anytime there are anychanges or announce-ments, the information isimmediately posted to theweb. Be sure to check itregularly.

CPM News Alerts

NARM now offers youthe option of receivingthe newsletter via theinternet to save financialand environmental re-sources.

If you would like to trythis out, go towww.narm.org/cpmnews.html and openthe PDF file. You canprint it or save it.

If you would like to re-ceive an email notifyingyou that a new issue ofthe CPM News is nowavailable online in lieuof a paper copy, sendyour name, mailing ad-dress and email addressto [email protected].

Register TODAY forNARM Workshops Offered in Arizona

June 23-26, 2006

CEUs will be offered for all workshops.

For more information, contact Del Balgas [email protected] or 714-452-7985.

For CPMs:� Test Writing Workshop� Qualified Evaluator Training

For any participants:� Preparing for Legislation� Preceptor-Apprentice Relationships� Midwifery Ethics� Web-Based Statistics


�� NACPM News�

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� �News from NACPMMary Lawlor, CPM, LM

President, NACPM

Greetings from the NACPM Board!We have recently returned from our fallboard meeting in Boulder, Colorado inthe days before the MANA 2005 Con-ference. This was our second in-personmeeting of our newly elected board andwe continue to find working togetherexciting and productive.

Unfortunately, one of our new boardmembers, Kathy Acree from Louisiana,has had to resign from the board dueto the demands of a new job and thedemands on her time from her involve-ment with the victims of hurricaneKatrina. We are grateful to Kathy forher support and significant contribu-tion to the board. The board has madea donation to Project Hope for victimsof Katrina in Kathy�s honor. Ourhearts and prayers go out to those suf-fering from the hurricane in their ef-forts to rebuild their lives.

MANA 2005 was a wonderful con-ference and NACPM had a strong pres-ence there. On the Wednesday beforethe conference, the NACPM Board wasinvited to a meeting of our sisterboards where each board gave an up-date of their activities and work. Dur-ing the conference, NACPM had abooth in the exhibit hall where we hadthe opportunity to speak to manyNACPM members and others about thework and potential of NACPM. Visi-tors to the booth were invited to fillout a survey about what their most im-portant concerns are as a CPM. Wealso invited suggestions about what ad-vanced practice topics CPMs wouldlike NACPM to develop workshops toaddress. (You may download this sur-vey from our website and send it to usif you did not have a chance to fill itout at the conference.) The Third An-nual NACPM Membership Meetingwas held during the conference and theNACPM Board gave an update of thepast year�s activities and discussed with

those attending the strategies and goalsfor the next year.

We are pleased to announce thatNACPM, in responding to requests,now has two new non-voting groupsfor supporters to join: Friends forNACPM and Students for NACPM!

Either of these groups can be joinedby downloading the information andenrollment form from the website atnacpm.net. Your current students arethe future members and leaders ofNACPM. We encourage all CPMs tointroduce their students to NACPM sothat they can begin their involvementin their future professional organiza-tion. And we welcome all to join ournew Friends group.

Much work has been done in thepast few months on the NACPMwebsite to create a valuable and usefultool for our members. All membershipinformation and forms aredownloadable as are the EssentialDocuments including Standards ofPractice. Soon you will be able to usePayPal to join NACPM as a member orsupporter. News is updated regularlyon the site. For example, a NACPMPress Release for the publication of theCPM 2000 Study in the British Medi-cal Journal was posted for your use inpublicizing this landmark study toyour local media. New links have beenadded. For example, we are encourag-ing NACPM members to join MANA�sDivision of Research on-line data col-lection project by providing a directlink from nacpm.net to the applicationform. We invite you to explore theNACPM site and to send us your ideasto [email protected].

The board is working to streamlineand improve the membership process.Each new or renewing member will bereceiving a letter of acknowledgementand a membership card. If you are amember, you have received by e-mail areminder letting you know when yourmembership expires and inviting yourrenewal. Please rejoin NACPM whenyour membership expires: your contin-ued support is greatly appreciated and

is crucial to the work of NACPM! Toall CPMs who are not yet members:Please join now! You will be partici-pating in a rapidly evolving profes-sional organization whose sole purposeis to promote and support the workthat you do as a CPM! Write to uswith questions and ideas [email protected] or call us on our NewToll-Free Phone Number: 866-704-9844! And, if you are not a CPM butwould like to support the work ofNACPM, please join our Student orFriends support groups.

The Board is in the process of devel-oping a brochure with the theme:CPMs Make Good Public Policy! Webrought our ideas and a posterboardmock-up of the brochure concept forthe NACPM table in the exhibit hall atthe MANA Conference and got muchpositive feedback. We plan to have afinished professional brochure withina few months that will demonstratehow NACPM can serve CPMs and pro-mote them to legislators and regulators,insurance reimbursement companiesand health care policy developers.

The Board is also developing a pro-posal for an advanced practice pre-con-ference day-long workshop for nextyear�s MANA conference. Plan now toattend the MANA 2006 Conference inBaltimore on October 12 - 15 andlook for news about NACPM activitiesat the conference.

Again, go to NACPM.net to joinNACPM or to renew your membership.Or send in the coupon below and wewill send you a membership form.

Come to NARM�sWorkshops at the

MANA Conference!

� Legislative Workshop� Charting Workshop� Ethics Workshop� QE Workshop

CPM NewsP.O. Box 420Summertown, TN 38483

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P A I DSummertown, TN 38483

PERMIT NO. 9

MANA Conference 2006

Make plans now to attend MANA 2006in Baltimore, Maryland October 13-15, 2006.

� Visit the world�s largestindoor waterfall at theNational Aquarium.

� Tour the ships and sub-marines of the BaltimoreHarbor.

� Meet great midwives,earn CEUs, and eat thebest crabs in the coun-try!

� Join us at the WyndhamBaltimore-Inner HarborHotel

For more information about the con-ference, or to register, go towww.mana.org.