mid registry of midwives news - narm · i am a "new" midwife in austin texas and have had...

of North AmericaVolume XI, Issue 1, Winter 2008

Providing certification standards for

Certified Professional Midwives

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• •Inside This IssueAn urgent notice to all NARM precep-tors or preceptors . . . . . . . . . . . . . 1

NARM has a job (analysis for YOU! 1Letters to the Editor . . . . . . . . . . . . . 2Midwives in crisis settings . . . . . . . 3

Committee Reports:Applications Department Report . . . 4National Provider Identifier Redefined5

Practice GuidelinesPractice Guidelines . . . . . . . . . . . . . 6Suggestions for Documentation ofClinical Experience . . . . . . . . . . . . 7

Job AnalysisJob Analysis to be done in 2008 . . . 8Legislative Tricks and Tips: Lobbyist 8National Conference of State Legisla-tures . . . . . . . . . . . . . . . . . . . . . . . 9

Organizational NewsCfM announces new fact sheet . . . 10Midwives Alliance: Find a midwife 10News from NACPM . . . . . . . . . . . 10In Memoriam . . . . . . . . . . . . . . . . 11

Midwifery StatisticsGet Started with Stats . . . . . . . . . . 12Stats Report . . . . . . . . . . . . . . . . . 12

Legislative UpdatesIowa . . . . . . . . . . . . . . . . . . . . . . . 13Maine . . . . . . . . . . . . . . . . . . . . . . 13Massachusetts . . . . . . . . . . . . . . . . 13Missouri . . . . . . . . . . . . . . . . . . . . 13North Carolina . . . . . . . . . . . . . . . 15Pennsylvania . . . . . . . . . . . . . . . . 15SouthDakota . . . . . . . . . . . . . . . . . 15Virginia . . . . . . . . . . . . . . . . . . . . 15Wyoming . . . . . . . . . . . . . . . . . . . 15

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Wisconsinlegal!

• •NARM has a Job (Analysis) for YOU!!!

The 2008 NARM Job Analysis is underway and you will soon have an oppor-tunity to play a vital role in the continued development and refinement of theCPM credential. It is vital that we have your participation in this important pro-cess of defining what exactly CPMs do for a living!

For those CPMs who have not had the opportunity to participate in the jobanalysis process before, this is a great chance to learn what other midwives inNorth America include in their daily practice.

For experienced CPMs who have been through this process before, this timearound will both impress and amaze you! NARM has been working exhaustivelyto develop a web-based survey that will save you time, while not sacrificing any ofthe important details that go into this analysis of the CPM job description.Please see our full article on the Job Analysis on page 8.

• •An urgent notice to all NARM preceptors orpreceptors: It’s time to review

Did you know that charts are legal documentation of the care of a client? Didyou know that the CPM application is a legal document validating a student’seducation? In both cases accuracy is of primary importance. Legal documentationis a layer of protection, and in a court of law if it is not written down, it didnot happen. Without the accuracy, honesty, and integrity of preceptors andstudents, the NARM application process can not work. In order to uphold thequality and reputation of the credential for all CPMs, failure to meet these basictenets must result in removal of preceptor privileges for CPMs and suspension ofapplications for students.

The NARM application process was developed and is maintained by NARM inorder to uphold the vital essence of midwifery education: mentoring relationshipsbetween midwives and students. The core components of the NARM applicationare the validation of experience and competency of entry level midwives by experi-enced midwives who take responsibility for ensuring the capability of the nextgeneration of midwives. Competency in midwifery includes more than just clini-cal skills. The CPM also needs to be able to sufficiently document the care thatshe provides as well as the care she teaches others to provide. The NARM applica-tion is part of that documentation.

The NARM applications department has been seeing an increase in the numberof poorly documented applications. Many of these mistakes or inadequaciescould be avoided if preceptors had a better understanding of their responsibilitieswhen reviewing and signing students’ applications. NARM has put together a fewsuggestions for preceptors that will hopefully clarify the process and make surethat the student has reflected your participation accurately. Please see page 7 forthe NARM Suggestions for Documentation of Clinical Experience.

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CPM NewsCPM News is a newsletter of the

North 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: [email protected]

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

• •Contact Information

NARM General Information888-842-4784Fax: 404-521-4052

Applications & Recertification:NARM Applications Department:P.O. Box 420Summertown, TN [email protected]

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

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

CPM News Editor:Brynn Potter, CPM1208 Bland CirCharlottesville, VA [email protected]

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• •Letters to the EditorDear CPM News,

Thanks for your great newsletter! I'mwriting to you hoping to get in touchwith other midwives who know PatConnor. Pat is an incredible midwifeand midwifery educator in El Paso,Texas, and some of her former studentsare organizing a fund and a scrapbookto honor her and acknowledge howmany lives she's touched over her ca-reer. We have a website,www.welovepat.org, and we're hopingthat readers who know Pat will visit thesite, or email Rinn or Nechama [email protected] [email protected]. Networking is ourbiggest challenge, and we would lovehelp in getting the word out. Patdoesn't know about this, but we hopethat we can get in touch with as manyof her friends and former students aspossible. Thank you for your help.

Nechama Wildanah, CPM

The following letter is in re-sponse to an interview withRuth Cobb in the SpringCPMNews:

I am a "new" midwife in AustinTexas and have had my own practicefor the last two years. I trained with amidwife who knows that it takes atleast 50-75 (with at least 20 as primary)births, if not more, before the aspiringmidwife can really call herself one. Shealso always looks deeper than just thenumbers and taught me much aboutthe power of intuition regarding themothers and their babies. I feel so grate-ful to have been trained in a way thathonors all aspects of becoming andbeing a midwife.

I have now assisted over 40 familiesas primary midwife and I really canconnect to what Ruth is saying abouther energy being so drawn to the fami-lies that want this experience of home-birth. It is sacred, spiritual and power-

ful. Some births I am more neededthan others.

Some women have all the right cir-cumstances in alignment for a birththat is so flawlessly easy that I wonderwhether I could have taught the dadthe handle it himself!! Then there arethe ones that every bit of my training,common sense, stamina and memoryare called into play. I also keep AnneFrye's latest book in my kit so that ifit's really late and I'm really stumped Ihave the wisdom of many midwives inmy back pocket!

In my community I believe that mid-wives do seem to tolerate each other'sdifferences. We must be different fromeach other in order to effectively servethe population of home birthing fami-lies. Without diversity, we fail the com-munity because as each midwife's ap-proach is different, each woman'sneeds are different. Some women prefera more hands-on, quasi-medical ap-proach to pregnancy and birth. Thereare midwives here able to provide thatservice. Other women prefer a morelaid-back hands-off approach. I knowthere are midwives who can providethat energy as well. Usually, what I seeis that each woman seems to choose theright midwife for her for the care sheneeds.

It is even more important now thanever to provide a wide spectrum of mid-wifery options in our community asthe CNM's were removed from the lo-cal hospital several years ago. I believethat this act has put more pressure onthe birth centers of our community asthey tend to receive the borderline casesmore than the homebirth midwives do.

Some women are just not goodhomebirth candidates, yet they wouldgreatly benefit from midwifery wisdomsurrounding nutrition and herbal rem-edies. As well, these women deserve thesacred moment of birth to be just thatas do home birthing mothers. I amhoping that one of the hospitals in ourcommunity will eventually invite themidwives back in.

I do not believe that a midwife's in-nate sense of "knowing" has gone by

Letters to the Editor

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the wayside. I check into my own in-tuition before and during every birth.Sometimes my intuition just slams mein a dream or during my yoga practiceI'll just get a "hit" about one of my cli-ents. I am usually right and never dis-appointed about following thesehunches. Many of my colleagues em-ploy their intuition as well, so I wouldlike to reassure you, Ruth, that thislong-honored skill is not being thrustaside in favor of numbers.

I know I am not an "old" midwife,but I resonated with many of Ruth'scomments and felt instantly compelledto respond.

Good luck on your journey throughthe change, of becoming a wise cronemidwife. We young ones need you andyour wisdom.

Blessings,Vicki Meinhardt, LM, CPM

Wholistic Birthwayswww.wholisticbirthways.net

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NARM Board of DirNARM Board of DirNARM Board of DirNARM Board of DirNARM Board of Directorsectorsectorsectorsectors: Shannon Anton: Shannon Anton: Shannon Anton: Shannon Anton: Shannon Anton, CPM, LM (Vice Chairperson, Accountability) BrynneBrynneBrynneBrynneBrynnePPPPPotterotterotterotterotter, , , , , CPM (CPM News, Special Projects) Robbie Davis-FloydRobbie Davis-FloydRobbie Davis-FloydRobbie Davis-FloydRobbie Davis-Floyd (Public Member), Ida DarraghIda DarraghIda DarraghIda DarraghIda Darragh,CPM, LM, Board Chairperson (Testing Department), CarCarCarCarCarol Nelsonol Nelsonol Nelsonol Nelsonol Nelson, CPM, LM (Treasurer,Applications), Miriam Atma KhalsaMiriam Atma KhalsaMiriam Atma KhalsaMiriam Atma KhalsaMiriam Atma Khalsa, CPM (Policy Management), Debbie PDebbie PDebbie PDebbie PDebbie Pulleyulleyulleyulleyulley, CPM (PublicEducation and Advocacy, Secretary)

• •Midwives in CrisisSettings • •

Upcoming Conferences

Following are conferences that NARM Board members will be attending:

Midwifery Conferences:

Midwives Alliance of NorthAmerica (MANA)

Traverse City, MIOctober 16-19, 2008

NARM also attends:

Council on Licensure,Enforcement and Regulation(CLEAR)

Charleston, NCJanuary 10-12, 2008

Coalition for ImprovingMaternity Services (CIMS)

Kissimmee, FLMarch 6-8, 2008

National Conference of StateLegislatures (NCSL)

New Orleans, LAJuly 22-26, 2008

Council on Licensure,Enforcement and Regulation(CLEAR)

Anchorage, AKSeptember 24-27, 2008

American Public HealthAssociation (APHA)

San Diego, CAOctober 25-29, 2008

National Organization forCompetency Assurance(NOCA)

San Francisco, CANovember 19-22, 2008

Circle of Health International(COHI) is a US-based NGO workingwith midwives in crisis settings. COHIhas worked in post-tsunami Sri Lanka,post-hurricane Louisiana, Tibet, Tanza-nia, Israel, Palestine, and hopes to ex-pand to South Sudan in 2008. COHI'smembership is midwives, nurses, OB/GYNs, public health professionals, re-searchers, and activists. COHI is al-ways looking for Board members andfield volunteers. Please visitwww.cohintl.org if you'd like to learnmore about our work, or send an emailto [email protected].

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• •NARM Applications Department ReportCarol Nelson, LM, CPM-TN, Director of Applications, Summertown, TN

Committee Report s

Greetings from the NARM Applica-tions Department. We hope you are allhaving a wonderful new year. We con-tinue to get busier every month.

As of Deember 1, 2007 the NARMApplications Department has receiveda total of 89 applications for 2007.

We have total of 106 applicants cur-rently in CPM process.

35 PEP Entry Level applicants10 PEP Special Circumstances appli-

cants59 MEAC applicants 1 Registered Midwife from the

United Kingdom applicant 1 Certified Nurse Midwife appli-

cant

There were 89 applications sent outto people requesting application pack-ets.

100 New CPM certificates were is-sued so far in 2007.

31 PEP Entry Level 5 PEP Special Circumstances50 MEAC 11 State Licensed 3 Certified Nurse Midwives

The total number of CPM Certifi-cates issued as of December 1, 2007 is1341!

TABLE OF COMPARISONTotal number of CPM’s

2007 13412006 12152005 11072004 9962003 8932002 8042001 7242000 624

RecertificationThe policy for recertifying is that ev-

ery CPM is required to send in CEUverifications with their RecertificationApplication.

The Applications Department nowhas a Recertification Table to keeptrack of incoming and outgoing recer-tifications. We will be sending out re-minders a few months before your re-certification is due. We had 241 CPM’srecertify last year.

Table of Comparison2007 2412006 1922005 2142004 1682003 1262002 1432001 1482000 72

Inactive StatusWe have had 15 people take advan-

tage of the inactive status last year,making a total of 65. Inactive CPMswill continue to receive the CPM Newsand may recertify within a six year pe-riod. Inactive status must be estab-lished within 90 days of the CPM expi-ration, and is maintained annually forup to six years. Inactive status is re-newed each year by filing an intent tobe inactive and a fee of $35.00. Dur-ing this period, inactive CPMs will re-ceive all NARM mailings, but may notuse the CPM designation or refer tothemselves publicly as a CPM, or ascertified by NARM. During the sixyear period, an inactive midwife mayrenew the certification by submittingthe recertification form and fees($150.00, 25 continuing educationhours, five hours of peer review, plusthe recertification form documenta-tion.).

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 to be recertified.

All of NARM’s policies regardingrecertification, certification status, orreactivation are available on the web atwww.narm.org.

AuditsThe Applications Department gener-

ates random audits from all applicantsand CPM’s recertifying. One (1) out ofevery five (5) applicants will be audited.Items requested for audit are PracticeGuidelines, Informed Consent docu-ment, forms and handouts relating tomidwifery practice, Emergency CarePlan, and Peer Review verification.

Delinquent ApplicationsIf, at the end of one year the applica-

tion is either incomplete or an exami-nation is not scheduled, a letter will besent to the applicant giving notice ofexpiration of the extension. An appli-cant may request an additional sixmonth extension on the applicationprocess by submitting the following:

· A letter of request with an expla-nation of the need for an addi-tional time.

· Resubmit two copies of a currentdriver’s license.

· Resubmit two copies of a currentCPR card.

· Resubmit two copies of currentphotos.

· Submit additional fee (money or-der or Cashier’s check) in theamount of $200.00

Failure to respond or submit addi-tional requirements will result in theapplicants file being closed and theapplication being archived. The appli-cant will have to resubmit a new appli-cation with appropriate fees.

All of NARM’s policies are availableon the web at www.narm.org.

The Applications Department is hereto help you with any questions.

NARM ApplicationsP.O. Box 420Summertown, TN [email protected]

Please include your CPM number inany correspondence.

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• •National Provider Identifier (NPI) MidwifeCategories Redefined!

The Administrative Simplification provisions of the Health Insurance Portabil-ity and Accountability Act of 1996 (HIPAA) mandated the adoption of standardunique identifiers for health care providers and health plans. The purpose of theseprovisions is to improve the efficiency and effectiveness of the electronic trans-mission of health information. The Centers for Medicare & Medicaid Services(CMS) has developed the National Plan and Provider Enumeration System(NPPES) to assign these unique identifiers.

ApplicationDocuments

Most NARM applica-tion documents are nowavailable on-line atwww.narm.org. Candi-dates may download andprint the applicationforms and instructions,and submit these formswith an additional $25processing fee. Theprinted and bound appli-cation packets may stillbe ordered for $50 fromNARM Applications,P.O. Box 420,Summertown, TN 38483.

There has been some confusion inthe past about which category to regis-ter under. The good news is CPMs willno longer have to decide between "Cer-tified Midwife" and "Lay Midwife"when applying for a National ProviderNumber (NPI). The previous "Mid-wife, Certified" classification haschanged to "Midwife" and has a newdefinition. If you previously registeredas "Lay Midwife" you may go in andedit your classification to "Midwife."The address to register is: https://nppes.cms.hhs.gov/NPPES/Welcome.do

Under the Other Service ProvidersType the definition and the title for theMidwife, Certified Classification waschanged to:

MidwifeA Midwife is a trained professional

with special expertise in supportingwomen to maintain a healthy pregnancybirth, offering expert individualized care,education, counseling, and support to awoman and her newborn throughout thechildbearing cycle. A Midwife is a skilledand independent practitioner who has un-dergone formalized training. Midwives arenot required to be nurses and may betrained via multiple routes of education(apprenticeship, workshop, formal classes,or programs, etc., usually a combination).The educational background requirementsand licensing requirements vary by state.The Midwife may or may not be certifiedby a state or national organization.

Source: The National UniformClaim Committee

2008 California Association of Midwives Conference

”Circle of Life, Center of Light”

Come join us May 16 -18 in Occidental, California for an inspiring weekend filled with fun and education. This

conference is open to anyone interested in birth work including, professionals, students and doulas. Speakers

this year include Pam England (Birthing From Within), Robbie Davis-Floyd (medical anthropologist specializing

in reproduction), Mary Jackson with Ray Castellino (Womb Surround process work), Gail Hart and many

others. CEUs are available to LMs, CPMs and RNs.

We also offer enticing vendors, stimulating entertainment, great midnight stories, and the latest about California

midwifery politics. This will be one of the best and affordable conferences this year. Your fee includes lodging,

food and entertainment for the entire weekend!

Volunteers and seniors will receive discounts. For more information contact Fawn Gilbride at (707) 251-8747

or [email protected]


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Practice Guidelines�

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• •Practice Guidelines

Certified Professional Midwives uti-lize documentation throughout theirpractice. They document skills andknowledge in order to attain their cre-dential, and they continue to use docu-mentation in their practice. Documen-tation helps them inform their clientsof who they are and how they practice,and it is used to verify clinical assess-ments and care plans throughout thepregnancy and birth process. Whileindividualized practice is a hallmark ofthe midwives model of care, standard-ization of document language can helpmidwives to clearly communicate withclients and peers. In order to supportCPMs and CPM candidates, NARMwill be publishing articles in the CPMNews that will hopefully clarify stan-dards for documentation.

Examples of Practice Guidelines canbe found at www.narm.org/practiceguidelines.htm.

We don’t actually have any examplesthere yet, just the description of whatpractice guidelines are from the CIBwhich is reprinted below in the newslet-ter.

Midwives need to understand theterms standards, clinical guidelinesand protocols so they can use them inthe same way that others in the medicaland legal fields do. This is a mecha-nism by which to protect the midwife,her practice and the midwifery profes-sion.

The term protocol is confusingsometimes because it is used differentlyfrom location to location, state tostate. In general, protocols need to becarefully written, or midwives can dam-age themselves legally. The midwifeshould be certain that the way she prac-tices and interacts with clients fitswithin her protocols. For example, aprotocol in Florida between a CNMand a physician serves as a contract tolimit the midwife's practice. Should shedeviate from working within the proto-col (in this case as determined by theagreement she has with the physician),she may be liable for damages in a mal-

practice claim and may be unable toget insurance coverage for her defense.The same is true for a midwife whosepractice uses written protocols. Most ofthe time protocols are decided by agroup of practitioners and serve to in-sulate the group from legal actionshould one of the members deviatefrom them.

The terms Guidelines and Standardsshould NOT be interchanged. Stan-dards provide the midwife with process.Clinical guidelines provide research-based information. Standards are rigid.Clinical guidelines may be flexible tomeet client needs and the particularcircumstances. Clinical guidelines donot take the place of standards, butrather provide research-based optionsfor decisions.

Clinical Guidelines are:• Operational tools to assist in clini-

cal decision-making• Detailed and client-focused• Based on procedures or clinical

conditions• Recommended courses of action

and/or practices for meeting stan-dards of care

• Sources of continuity, quality ofcare and a range of acceptable

practices and options that can beadapted to specific needs— Suzanne Hope Suarez, excerpted

from "Protocols vs. Guidelines,"Midwifery Today Issue 73

From the NARM CandidateInformation Bulletin:

All Certified Professional Midwivesare required to have a written PracticeGuidelines document. Practice Guide-lines are specific descriptions of pro-tocols that reflect all of the caregiven by a midwife from the initialvisit throughout pregnancy, birth,postpartum and newborn care. APractice Guidelines document is differ-ent from a midwife’s Informed Con-sent document or client handouts.Practice Guidelines vary in length de-pending on the amount of detail re-garding the scope of a particular mid-wifery practice.

Practice Guidelines are based uponthe standards, values and ethics held bythe midwife and inform the actionstaken by the midwife in specific situa-tions. They should ref lect the MidwivesModel of Care. Standards, values, andethics are more general than PracticeGuidelines, as they ref lect the philoso-phy of the midwife. NARM recognizesthat each midwife has specific prac-tice protocols that reflect her ownstyle and philosophy, level of experi-ence, and legal status Practice Guide-lines may vary with each midwife.NARM does not set guidelines for allCPMs to follow, but requires that theydevelop their own written PracticeGuidelines document.

Practice Guidelines contain specificdetails about the way a midwife con-ducts her practice, under both normaland abnormal conditions, and maycontain absolutes such as, “I will notaccept as a client a mother who doesnot agree to give up smoking,” or mayoutline conditions under which a mid-wife will make decisions, such as: “Iwill accept a client who smokes only ifshe agrees to cut down on smoking,maintains an otherwise exceptional

Practice Guidelinesare specificdescriptions ofprotocols that reflectall of the care givenby a midwife fromthe initial visitthroughoutpregnancy, birth,postpartum andnewborn care.


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diet, and reads the literature on smok-ing that I will provide for her.” (Theseare given only as examples and are notmeant to convey that smoking must becovered in a midwife’s practice proto-cols.) Another example of a protocolcould reflect action taken when a cli-ent is postdates. The guideline couldstate that at 42 weeks, the client will bereferred to a back-up physician for fur-ther care. Or the guideline could readthat at 42 weeks the client will be giveninformation on the risks and benefitsof continuing to wait for labor, or op-tions such as home induction or refer-ral to a physician.

State law or rules and regulationscan be used as the basis for PracticeGuidelines, understanding that a lawdefines the scope of practice and thatPractice Guidelines are the specifics ofhow a midwife practices within the law.

NARM recommends that the mid-wife base practice documents on thefollowing resources:

• The NARM Written Test Specifi-cations in the Candidate Infor-mation Bulletin

• The Midwives Model of Care• The MANA Core Competencies• The MANA Standards and

Qualifications for the Art andPractice of Midwifery

• The MANA Statement of Valuesand Ethics

• Core Competencies for BasicMidwifery Practice

• Standards for the Practice ofNurse-Midwifery

• Code of Ethics for Certified-Nurse Midwives

• NACPM Core Documents• Rules and regulations governing

the practice of licensed mid-wifery in the midwife’s state, iflicensed

MANA documents can be found atwww.mana.org.

ACNM (Certified Nurse-Midwife)documents can be found atwww.acnm.org.

The Midwives Model of Care canbe found at www.cfmidwifery.org.

• •Suggestions for Documentation of ClinicalExperience

In response to multiple requests for clarification about the role of the Precep-tor in the NARM application/certification process, NARM has developed thefollowing step-by-step guidelines based on the instructions set forth in the Can-didate Information Bulletin. These guidelines are suggestions for successfulcompletion of the application documentation.

will use. Students should not de-velop different codes for the sameclient.

7. Preceptors need to be sure theirforms show that the student par-ticipated as primary under super-vision and that the preceptor waspresent in the room for all itemsthe preceptor signs. For example:the arrival and departure times atthe birth should be documented onthe chart for both the applicantand the preceptor. At the time ofclinical experience preceptors andstudents should initial each visit.

8. Applicants should have access toor copies of any charts listed inthe application, Form 112a-f andForm 200 with Code # in case ofaudit.

The Informed Consent documentused by the apprentice/student shouldnot indicate that she is a CPM, even ifshe is in the application process. TheCPM designation may not be used un-til it is earned.

Preceptors who sign off on experi-ences they did not witness risk losingtheir ability to sign as a preceptor inthe future and also risk losing theirNARM certification.

1. The preceptor and applicant to-gether, should review the three (3)separate practice documents re-quired by NARM--Practice Guide-lines, Informed Consent, andEmergency Care Plan.

2. Review all client charts (or clinicalverification forms from a MEACaccredited school) referenced onthe NARM Application. Confirmthat the preceptor and applicantnames appear on each chart/formthat is being referenced.

3. Confirm that the signatures/ini-tials of the applicant are on everychart/form for: initial exam, his-tory and physical exam, completeprenatal exams, labor, birth andimmediate postpartum exam, new-born exam, and complete follow-up post partum exams listed on theNARM Application. Be sure thenumbers written on the applica-tion forms are the same number ofsignatures/initials on the charts/forms.

4. Check all birth dates and dates ofall exams for accuracy

5. Check all codes to make sure thereare no duplicate code numbers.Each client must have a uniquecode. If there is more than onebirth with any given client theremust be a different code assignedfor each subsequent birth.

6. If a preceptor has more than one(1) student (applicant) each chartmust have a code that all students

JOIN THE GRASSROOTS

NETWORK EMAIL LIST

Visit the Citizens for Midwifery

website at www.cfmidwifery.org


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Indiana

Job Analysis• •Job Analysis to be done in 2008

The knowledge and skills that mustbe demonstrated by each CPM candi-date are determined by the Job Analy-sis, a survey of knowledge and skillsthat is done every 6-7 years. This is notunique to the CPM, but is a requiredstep in the development of every certifi-cation credential. The first NARM JobAnalysis was done in 1995, and thesecond in 2001. Now it is time to doit again. The purpose is to confirm thecurrent knowledge and skills for theCPM credential and to ascertain ifthere have been any significant changesto the role of the CPM since the lastanalysis.

There are two steps to the NARM JobAnalysis. The first step is to expandthe list of possible tasks to include ev-erything a midwife might need to do orknow. The second step is to survey allCPMs and ask them to rate the list oftasks according to how important thattask is to their job as a midwife. Tasksthat rate high become part of theKnowledge and Skills Checklist that isthe curriculum for apprentice educa-tion and are also the basis for theNARM exam, and tasks that rate loware not included. NARM does notstate that the low-ranking tasks are notpermitted, just that they are not re-quired for the CPM.

To develop the 2008 survey, we haveasked a focus group to look at the cur-rent job list and consider what mightbe added to the survey. The focusgroup was made up of CPMs who rep-resent a variety of geographic locations,practice sites, and years of experience.The participants have added to the listof NARM knowledge and skills for thepurpose of expanding the survey. AllCPMs are invited to respond to the sur-vey for the purpose of editing the listdown to the knowledge considered es-sential for certification.

In 2001, the 50 page survey wasprinted and mailed to all CPMs with apre-paid return envelope. The cost ofprinting and mailing was significant,as was the scoring of every page re-turned. In light of the tremendous ad-vances in technology available to mostmidwives, we are going to do the 2008Job Analysis electronically. Not onlywill that save the cost of printing andmailing, but it will allow the results tobe tabulated by a survey program, thuseliminating the tedious hand-scoring.There will still be expenses involved insoftware and professional consultationand analysis, but the advantages will besignificant.

As this newsletter goes to print, theelectronic survey is still being format-

• •Legislative Tricks and Tips: Lobbyist

Hiring a Professional LobbyistA professional lobbyist can be a great help, but is also very expensive. Fees vary from state to state, and are usually based

on how much work you expect to get from your lobbyist. Most lobbyists expect a bill to take several years to pass. Theymay charge a smaller fee in the first year or two and then charge much more during the year you expect to really pass thebill. Even if you are raising some money, you won’t likely have enough to hire a lobbyist. But you can interview several lob-byists as though you were looking to hire, and then explain that you won’t have nearly that much money. Do these inter-views well before the session, when they aren’t so busy. Most states require the lobbyists to register, so you can get a list andtalk to some of them. Some do pro-bono work, and might meet with you several times to give advice before and during thesession. Even if you can’t officially hire one, you might get a lot of benefit from talking with them. Write thank-you notes,even for a phone call, and ask them to keep your issues in mind even though you can’t hire them, and let them know youwould welcome any advice any time. Seek contact with lobbyists who have as clients other grass-roots organizations. Also,identify the medical lobbyists. You might not want to seek their advice the same way, but it could be helpful to talk to themonce the real lobbying starts. Once the opposition starts to speak, you might want to catch their lobbyist in the halls andhave impromptu chats about getting them to back down.

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ted. Once we go live there will be a no-tice on our website. CPMs will be ableto click a link to enter the survey siteand will be asked for a membershippasscode, which will be their CPMnumber. The best part is midwives willbe able to fill out the survey at theirown pace and then click submit whencompleted. Midwives who do not haveaccess to the internet may request aprinted copy. If you would like to re-ceive the Job Analysis survey on paperrather than participate on the web,please e-mail [email protected], or call1-888-353-7089.Your participation inthis survey is essential for the ongoingdevelopment of the NARM Certifica-tion Process. What makes NARMunique is that every CPM has the op-portunity for input, in identifying theknowledge and skills that are manda-tory components of midwifery train-ing. The requirements for certificationare based on what the midwives are ac-tually doing in practice. We need forevery CPM to fill out this survey sothat it truly does reflect the knowledgeand skills of the midwife.

Stay tuned for a formal announce-ment of the new, web-based NARM JobAnalysis, or check the web regularly!


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• •Looking for Opportunities to Obtain CEU’s?

Don’t miss a great opportunity to earn CEU’s and have a great time doing it!Plan on attending MANA 2008 in Traverse City, MI October 16th through 19th.

Last year at MANA 2007 in Clearwater, FL, there were opportunities to earncontact hours during the regular conference plus additional contact hours if youattended a pre-conference workshop.

For more information, watch for announcements about the conference on Mid-wives Alliance’s website at www.mana.org.

• •The National Conference of State LegislaturesDebbie Pulley, CPM, NARM Public Education & Advocacy

The National Conference of State Legislatures (NCSL) was held August 5-9 inBoston Massachusetts. Over 9,000 legislators and legislative staff attended theconference. Representatives from MANA and NARM working at the MidwivesModel of Care booth were Carol Nelson, Miriam Atma Khalsa, Ida Darragh,and myself. Our goal was to talk with as many legislators from target states aspossible, which was accomplished. Ida has sent follow-up letters to those whorequested information. We have also put together a database of names and for-warded the information to state midwives for follow-up. The most excitingthing this year was how many legislators actually sought us out. Next year weplan to get one page FAQ sheets from each state to hand to legislators and staffso they can see what is happening locally.

Carol Nelson, Miriam Atma Khalsa, Debbie Pulley and Ida Darragh

From Susan Hodges of Citizensfor Midwifery:

My experience is that a professionallobbyist is similar to a contractor.When you are building a house andhiring a contractor, you are not onlyhiring his/her experience in construc-tion, you are also hiring his/her rela-tionships with subcontractors. Thecontractor knows who is good andwho isn’t, and the subcontractor ismore motivated to do good, timelywork because future work with thiscontractor depends on doing a goodjob. Similarly, when you hire a lobby-ist, you are not only hiring his/her ex-pertise in finding the way around thecapitol and just spending the time togo talk up your issue with the rightpeople, you are also hiring thatperson’s relationships with the legisla-tors and staff (aides, etc – very impor-tant). The legislators and staff are morelikely to pay attention to someone theyalready know, who has provided trust-worthy information before, etc, thansomeone new, coming in green. Thismay be especially significant for anissue that many will perceive as“fringe”. It may be that you can findsomeone who is already lobbying forsimilar causes that you can hire parttime. It might be worthwhile asking asenator if there is a professional lobby-ist they might suggest. Even if you can’tafford to hire a professional lobbyist,you might be able to consult with onewho is sympathetic. If you can makefriends with one of the regular lobby-ists, one or more may keep an eye outfor you; give you some useful informa-tion, etc.

After your bill passes it can also bevery helpful to keep a professional lob-byist on a small retainer in order to getthe service of a “watchdog” in the yearsto follow. Having an interested partywho is already attending health relatedhearings at the Capital each year willhelp to ensure you stay aware of poten-tial unfriendly legislation or new lawsthat licensed midwives must follow.

*Come to NARM’s Workshops at MANA Conference!

• Legislative Workshop• Charting Workshop• QE Workshop

• Apprentice/PreceptorRelationships

*Tentative

1 0 NORTH AMERICAN REGISTRY OF MIDWIVES, W INTER 2008��

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Find a MidwifeAs part of the growing public educa-

tion campaign, the Midwives Allianceof North America (MANA) haslaunched a consumer website: MothersNaturally (mothersnaturally.org). Thisconsumer-based site will serve as avaluable resource to mothers to be seek-ing natural advice. A big feature of thewebsite is to connect these mothers to

Citizens for MidwiferyAnnounces New FactSheet

“Evidence Basis for the Ten Steps ofMother Friendly Care” was publishedlast winter as a Supplement of the Jour-nal of Perinatal Education (Vol 16,Supplement 1, Winter 2007).

Now a new fact sheet: “Mother-Friendly Childbirth – Highlights of theEvidence” is available as a pdf file athttp://cfmidwifery.org/pdf/MFCevidencehighlights13B.pdf .

Citizens for Midwifery (representedby Carolyn Keefe and Susan Hodges)and BirthNetwork National (repre-sented by Victoria Macioce-Stumpf) to-gether produced this fact sheet, withfeedback from the authors of the studyand board members of Lamaze Interna-tional and the Coalition for Improv-ing Maternity Services (CIMS). The 2-sided fact sheet summarizes the mainfindings for each of the steps and theappendix (“Birth can safely take placeat home and in birthing centers”) withthe intent of making the findingsmuch more easily accessible to every-one. It includes a complete citation forthe publication, as well as informationon how to get copies (on-line and or-dering a paper copy) and where to findout more about the Mother-FriendlyChildbirth Initiative. If you wantprint a copy, you may find that yourprinter shrinks the file to make widermargins, causing the type size to bequite small. To avoid this, especially ifyou are making any quantity of copies,have your local copy store print di-rectly from the pdf file (you can copythe file to a CD if needed).

On-line Ordering for CfM Litera-ture and Memberships

You can now order Midwives Modelof Care brochures and other items atwww.cfmidwifery.org using your owncredit card, no PayPal account needed!Ordering is quick and convenient foryou, and CfM can turn around yourorder more promptly. Brochures, videosand other items that can be ordered areall described at http://cfmidwifery.org/store.

If you have not visited the Citizensfor Midwifery web site for awhile, gotake a look! In addition items you canorder, a variety of items are freely avail-able: in “Resources” find a list of allour resource items, or you can scrolldown below the list for categories, suchas “Fact Sheets” or “CfM News Re-prints.” A recent fact sheet, “Out-of-hospital Midwifery Care: Much LowerRates of Cesarean Sections for Low-riskWomen” can be found at: http://www.cfmidwifery.org/pdf/cesarean2x.pdf.The results of several studies simplypresented in a table, with citations,clearly demonstrate the title of the factsheet. Many of these are useful forreaching out to potential clients, andfor informing legislators and the press.

midwives. The mother will type in herlocation and get a list of midwivesserving that area. Please help us pro-vide resources for all these women.The cost is $50 for the first year forMANA members. If you are not a cur-rent member of MANA you may joinup and ask to be listed all at the sametime. With your participation we canconnect women to the provider of theirchoice and move midwifery forward!

Contact Elizabeth Moore:[email protected]

News from NACPMThe tide is turning at last in the

United States for health care reform!Just in the last few months, a growingnumber of states have proposed oradopted plans to provide universal ac-cess to health care for their citizens,and several federal legislative proposalsare on the table. It has become clearthat national health care reform will bethe number one domestic topic of the2008 presidential campaign.

This rapidly rising tide of reformpresents an immediate opportunity toCertified Professional Midwives to par-ticipate in the design of these reforms,to integrate CPMs into a reformed na-tional maternity care system, and toradically increase women’s access tomidwifery care. NACPM is workingnow to assemble the tools that will beneeded to ensure that midwifery aspracticed by CPMs will be viable intothe future, and that it will hold a secureplace in our health care system as itemerges from the current health carereform efforts.

To these ends, NACPM has launchedthe NACPM Strategy for IncreasedAccess to Midwifery Care. We havefashioned bold initiatives to achieve thegoals of increasing women’s access tothe care of CPMs, and to supporting

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CPMs by removing barriers to ourcare. The key elements of this newstrategy are to ensure that CPMs areat the table as the health care reformmovement redefines health care in theU.S., and to achieve federal recogni-tion of the CPM through our federallegislative agenda to support insurancereimbursement of CPMs. The first is-sue of our new newsletter describesthis strategy and the work that is beingdone. We invite you to read the com-plete newsletter at www.nacpm.org. Ifyou are not already an NACPM mem-ber, we invite you to join now at ourwebsite, and to become involved in thisexciting work!

The NACPM Board believes thatthese are exciting times for mid-wifery, and that the health care reformmovement presents a unique opportu-nity to bring the dream of a midwifefor every mother closer to reality thanever before. We believe that CertifiedProfessional Midwifery is poised totake its rightful place in our health caresystem and in the lives of the womenand families in our states and ourcountry. We welcome your ideas andyour participation in this work ofNACPM.

Mary Lawlor, CPM, LM, MAPresident, NACPM

NARM Updates

Anytime there areany changes or an-nouncements, the in-formation is immedi-ately posted to theweb. Be sure to checkit regularly.

www.narm.org

• •In Memoriam:

This column is intendedto honor the passing ofthose people who havetouched our communityof midwives in some way.

Lora BurgessApril 2007

Lora Burgess was a 30 year old singlemother of two beautiful young chil-dren. She was also a passionate homebirth midwife candidate. She hadplanned to sit for the August 2007NARM Exam. She was beloved by areamidwives, birth professionals andbirthing women for her passion andher humor.

Jennifer Wollheim, CPMJune 2007

On June 23, 2007, Jennifer gavebirth to a healthy, beautiful baby girl,Lila Jennifer. She died on the same dayof complications related to her preg-nancy and her planned hospital deliv-ery. Jennifer, a 2004 graduate of theFlorida School of Traditional Mid-wifery, will be missed greatly by herhusband Neal, her family, and many,many people whom she touched withher love, caring and beautiful soul.

Gail Mraz-GoddardAugust 2007 at the age of 71

Gail was a lifelong Minneapolis resi-dent and mother of nine, was a pioneerin home-birthing and helped reestab-lish the practice across Minnesota. Shedelivered more than 250 babies, two ofthem her own granddaughters. In 1975,Mraz co-founded Genesis, a Twin Cit-ies midwifery group, and also helped towrite the care standards used as mid-wives were again being licensed in thestate. Her middle child, son Paul Mraz,said he remembers the basket of prena-tal care equipment his mother wouldkeep by their door, ready to grab andhead out whenever she got the call froman expectant mother. "When my mom

saw someone in need, that transcendedall other things that she might see inthat person," he said. Her desire to helpothers extended to her many years ofwork as a nurse at Mount Olivet Nurs-ing Home in Minneapolis and to hervolunteer efforts with the poor andhomeless, which included several sum-mers in Olivia, MN, working at aclinic for migrant farm workers.

Paula J MandellMay 14, 1959 - January 4, 2008

Paula was involved with Citizens forMidwifery since 1996, when she volun-teered to help with the CfM News, asimple black and white photocopiedpublication at the time. She was in-volved with the development of the newlogo, newsletter design and website de-sign, and their implementation, in2000. She also filled a vacancy on theBoard of Directors in that year andserved on the Board through 2005.Over all those years she continued toformat the newsletter, keep the websiteupdated, and administer the GrassrootsNetwork. She also created ads, signsand fliers as needed.

Prior to 2000 Paula was an indepen-dent midwife for 12 years in Nebraskaand Arkansas. She also did volunteerwork for a local domestic violence shel-ter for 6 years, and later volunteeredwith a home-hospice care organization.

CPM News AlertsNARM now offers you the op-

tion of receiving the newsletter viathe internet to save financial andenvironmental resources.

If you would like to try thisout, go to www.narm.org/cpmnews.html and open the PDFfile. You can print it or save it.

If you would like to receive anemail notifying you that a newissue of the CPM News is nowavailable online in lieu of a papercopy, send your name, mailingaddress and email address [email protected].


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Get started with Stats!Peggy Garland, Midwives Alliance Division of Research

MANAStats has been online nowsince 2004 and gets easier and easier touse, due to awesome software upgradesand helpful feedback from users. If youhaven't joined, ask someone who usesit to show you how, and show you howyou get your own stats back instantly.You can use these numbers for yourclients’ informed consent, for yourown practice improvement, for poolingwith other midwives in your practiceor your state. It’s up to you. Soon youwill be able to customize the reportsyou see, by limiting the fields or thetime frames. For example, you couldsee only your transfers for a certaintwo year period, or all your births be-tween April and June. And then changethe menu and get a different report –say the same information for anotheryear. You can comply with state regula-tions using this information. Youcould even get your own raw data anddesign a small study for your ownpractice.

Another new feature is a midwiferyorganizational account. There are quitea few states now that have so manymembers collecting their stats with thissystem that they want to pool them au-tomatically. So now, any midwifery or-ganization can decide to obtain an ac-count to view the aggregate stats of itscontributing members. This is anony-mous data that is added up by the soft-ware. Imagine the usefulness of being

able to go to your state Medicaid officewith your state CPM transfer, induc-tion and c-section rates! Negotiate aplace at the table for your group in apublic health commission onbreastfeeding by showing yourbreastfeeding rates! The sky’s the limit!

We do not want our contributors’data to be used without their consent,so we've developed a fair process bywhich organizations can decide andobtain an account. That’s the easy part.The more important part is to get yourmembers to become contributors andto support them to stay current. Themore contributions we get, the higherquality of data because it becomesmore representative of practice. Also,the more births in the system, the moresignificant the rates and percentages,especially for outcomes that don't hap-pen very often.

As if that weren't reason enough,there is going to be more and more em-phasis on transparency and qualitymeasurement in health care as we bar-rel headlong toward health care reform.With MANAStats you will be in theforefront of this important trend.

"To enroll in MANAStats, go towww.manastats.org

To inquire about organizational ac-counts, email Peggy Garland [email protected]

••Stats ReportKen Johnson and Betty-Anne Daviss

Educating Legislators and Pro-viding Testimony for MidwivesIn Court

The CPM2000 study continues to beaccessed from the BMJ website by morethan 1,000 different individuals everymonth. With Wisconsin using the BMJarticle in their legislative effort to makethe case for the safety of CPM attendedout-of-hospital births.1. A record number of states have

turned towards legislation (11 atlast count) We have produceddocumentation to educate agencystaff and policymakers for SouthDakota, Wisconsin, Indiana, Cali-fornia, Missouri, New York, Min-nesota, and Maine so far, and willcontinue to develop and make pre-sentations when requested.

2. At least 10 midwives are presentlyunder investigation. We have pro-vided testimony for four courtcases over the last two years.

3. We presented “Evidence Used, Evi-dence Ignored: the case of homebirth policy,” at the American Pub-lic Health Association meeting inWashington, D.C. in November.

We want CPMs to know that we areavailable for presenting state-focusedstatistics for the purpose of educatingagency staff and policy makers and fortestimony for individual midwives. Wedo not charge for this service. It is im-portant to understand that meaningfulstatistics require more than a simpletabulation of births. They require com-parison to a control group and formidwives attending home births, theCPM2000 study serves as the bestcomparison group for either the indi-vidual midwife or for the state as awhole. Thus we are able to provide themidwife and the courts with high qual-ity, statistically valid information onbirth outcomes from a highly reputablesource that any judge/prosecutor/law-yer can download from the BMJ

Midwifery St atistics

MANAStatistics Address

MANA StatisticsP.O. Box 6310

Charlottesville, VA [email protected]

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website. We realize that there are fewepidemiologists who can offer this typeof support to midwives who are ontrial because it is time consuming, gen-erally involves dropping everything elsewhen suddenly asked to produce a re-port in a very tight time frame on thespecific case, and requires specific ex-pertise.

Other CollaboratorsCPMs who are doing research in

Florida, Michigan, Oregon have ap-proached us about collaborating withthem. They are obtaining their owngrants.

The website (understandingbirthbetter.com) has an updated home page,an improved data entry system in threelanguages, and the BMJ article has beentranslated into Spanish, German, andFrench. The Spanish one has been up-loaded to the BMJ site and we are work-ing on uploading French and Germanversions.

Questions About BMJ ArticleSome of you have written emails to

us asking questions about the BMJstudy. We have responded to these ques-tions by placing a section called “An-swers to Questions” on our website atUnderstandingBirthBetter.com. Jenni-fer Block also consults with us periodi-cally, as we were quoted frequently inher new book “Pushed.” Because of herpopularity, we are posting answers toquestions coming to her on the websiteas well.

The best way to find the articlequickly is to Google “BMJ Daviss”.Shortly after our attendance at the NIHconference in 2006, the CPM2000study began to be used as a benchmarkfor rates of caesarean sections andother interventions, in particular byChildbirth Connections.

For those who are interested in find-ing out more about what we are doing,you can email us at [email protected] sign up to received periodic newsemails from the Midwives, Mothers,and Researchers Network.

Legislative Updates• •Legislative UpdatesIowa

Melanie Moore, A CPM in Iowa,was arrested in May and charged withpracticing medicine without a license.She was scheduled to go to trial in Au-gust (a very long, expensive process,and very difficult to win). Three daysbefore the trial, she was offered a pleabargain: no jail or trial in exchangefor a guilty plea, fines of over $700,and 25 hours of community service.She must also, of course, discontinueworking as a midwife. Consideringthe alternative, she made the prudentdecision and accepted the offer. Mid-wives and consumers in Iowa are work-ing to change the laws and make mid-wifery legal. A Legislative Workshopwas held September 22 to prepare forthe process of proposing legislation.Led by Ida Darragh from NARM, theworkshop helped participants to orga-nize both the tasks and the volunteersthat will be necessary for work this fall,and to learn effective lobbying tech-niques, including speaking and letterwriting.

MaineThe midwives of Maine presented

arguments in favor of a voluntary li-censure bill for CPMs in a sunrisehearing at the Department of Profes-sional Regulation in August. TheDepartment’s focus was to assesswhether the public interest would beserved by licensing direct-entry mid-wives. DEMs are unregulated, but con-sidered legal in Maine. The proposedbill would allow licensed CPMs tocarry and administer medications, butwould not alter the legal status of mid-wives who remain unlicensed. SeveralCPMs spoke of their hope that licen-sure would improve relationships withdoctors and hospitals when advancedmedical care became necessary, andthat the availability of medicationscould make home birth safer. IdaDarragh, from NARM, testified to thetraining and education of the CPM

and to the advantages of licensing mid-wives as evidenced in other states withlicensure programs. The DPR will con-tinue to gather information and willmake a recommendation on the pro-posed bill this fall.

MassachusettsA bill to license CPMs and CNMs

under a joint board has made progressagain during the 2007-2008 legislativesession. The bill was approved in No-vember by the House and Senate JointCommittee on Public Health. Morelegislative hearings will occur in Janu-ary.

In addition to the states listed above,midwives and midwifery supporters areworking toward or considering legisla-tion to license midwives in these states:Alabama, Georgia, Delaware, Illinois,Kentucky, Indiana, North Dakota, andIdaho. Friends of Midwives in thesestates have continued to meet with leg-islators during the summer, but therally for legal midwifery will peakagain this winter as the legislaturesconsider proposals to license direct-entry midwives.

MissouriAugust 23, 2007 Press Release from

Missouri:Midwifery supporters join Attorney

General’s Office and file appeal toMissouri Supreme Court on mid-wifery lawMissouri Supreme Courton midwifery law

(Jefferson City, Mo.) – Missouri’smidwifery supporters today joined withthe Office of the Missouri AttorneyGeneral to file an appeal to the Mis-souri Supreme Court in order to recon-sider the permanent injunction on thestate’s new midwifery law. The coali-tion of Missouri homebirth familiesand their midwives said they are mobi-lizing for the appeals process andpraised the actions of Attorney GeneralJay Nixon’s office.

“Our members very much appreciatethe decision of the Attorney General toappeal this injunction to the Supreme

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Legislative Updatesmoney is also a factor. While living inother states where midwifery is a legallyrecognized healthcare profession, ourcare was covered by my Boeing insur-ance with $5 co-pays. But when we re-located to Missouri, we discovered thatsince midwives are felons here my in-surance was useless.”

Jessica Mattingly is a Blue Springs,MO mother due in September whowanted the midwifery law to stand asshe had hoped to use a Certified Profes-sional Midwife to deliver her baby. Shecites skyrocketing c-section rates as oneof the primary reasons that motherslike her are looking for alternatives.“Right now, if you are a pregnantwoman delivering at a hospital, youhave a 1 in 3 chance that you willcome out of that hospital having hadmajor abdominal surgery. Beyond theadditional risks for mothers and babiesthat c-sections create, what does a c-section rate of more than 30 percentdo to our insurance rates, and how re-liant are doctors and hospitals on theseincreasing revenues?”

The decision to go to the SupremeCourt is also strongly supported byLaurel Smith, President of Friends ofMissouri Midwives. “Physicians’groups don’t seem to realize that fami-lies today are not willing to suffer onthe battlefield of their turf wars,” shesaid. “The days of medical groupspouring money in to ensure that otherhealth professionals cannot performservices for which they are trained arecoming to an end.”

Ueland agreed with the notion thatorganized medicine’s misuse of “Scopeof Practice” laws impairs healthcareaccess and increases costs to consum-ers, especially those who reside in ruralareas or who are disadvantaged. “Mis-souri families who want safe, healthy,and economical healthcare have longbeen frustrated by the choke-hold thatorganized medicine has maintained onchildbirth in our state. At a time whenthe majority of the country – and theworld – allow midwives to practice asprofessionals rather than felons, Mis-

Court,” said Mary Ueland, GrassrootsCoordinator for the Friends of Mis-souri Midwives. “We are hopeful thatthe Supreme Court will reverse this un-fortunate judicial ruling, and Missouriwill at long last decriminalize the prac-tice of

Certified Professional Midwifery, do-ing away with the threat of felonycharges and seven years in prison forpracticing midwifery.”

On August 8 Circuit Court JudgePatricia Joyce disallowed the CertifiedProfessional Midwives provision con-tained within HB818 regarding port-ability and accessibility of health insur-ance. Judge Joyce ruled the provisionwas unconstitutional and unrelated tohealth insurance.

Assistant Attorney General John K.McManus and Midwifery Coalitionattorney Jim Deutsch argued in circuitcourt less than one month ago that de-criminalizing midwifery does indeedrelate to health insurance, recallingthat the Missouri Supreme Court hasalready ruled health insurance is inter-dependent on health services, and thetwo subjects are related. Deutsch citednine other states where Medicaid covershomebirths attended by Certified Pro-fessional Midwives and many otherswhere CPMs receive private insurancereimbursement. Both McManus andDeutsch argued that families obviouslycannot get health insurance reimburse-ment for their midwives if their provid-ers are considered felons by the state.They agreed that legalizing CertifiedProfessional Midwives is a first step tohomebirth families being able to havetheir maternity care providers coveredby insurance. They also cited the lowercost of midwifery care, which in turncould encourage insurance companiesto lower their rates for healthy women.

Allan Schwarb, father to five chil-dren born at home and a Boeing em-ployee, is glad for the news of the ap-peal. “The judge was wrong to decidethat legal midwifery is not part of ac-cess to health insurance,” he said.“While safety is the number one reasonmy wife and I chose homebirths,

souri is strangely out of step with therest of civilized society.”

She added that people move to Mis-souri from states like California,Florida, or Tennessee where CertifiedProfessional Midwives are in the YellowPages and ask her what the problem iswith Missouri and midwives.

“The root problem is tough to pin-point. One could criticize the state leg-islature for cowering to the threats oforganized medicine for several decadesso that they never passed midwifery leg-islation before now,” Ueland said. “Orone could make a fairly compellingargument that Judge Joyce’s service onthe Board of Directors for St. Mary’sHealth Center in Jefferson City is amighty conflict of interest given herruling on the case. But instead of fo-cusing on this water under the bridge,we are looking forward to having theSupreme Court recognize not only theconstitutionality of the midwifery pro-vision, but also the value of midwivesto the public good and their signifi-cant contributions to more consumerchoice, increased healthcare access anddecreased costs within a top-tierhealthcare system.”

As national attention to the Mis-souri midwifery case grows, midwiferysupporters from across the country aregetting involved to show their supportof the Supreme Court appeal. A recentstudy on direct-entry midwifery pre-pared by the Georgia legislature re-ported that, “When a state has an un-derground network of healthcare pro-viders, it has a responsibility to dealwith the problem through regulationrather than prosecution.”

Ueland said she agrees with the Geor-gia study and that the time is now forMissouri to deal with midwifery anddecriminalize the profession. “We arehopeful the Supreme Court will rulethat legal access to midwives relates toaccess to health insurance. And withthis ruling that will decriminalize Cer-tified Professional Midwives and re-move the threat of prosecution, Mis-souri finally will join the 40 other


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states where professional midwives areallowed to assist homebirth families.”

The Certified Professional Midwiferydefendants and midwifery supporterswho are listed on the appeal to the Mis-souri Supreme Court include:• Friendsof Missouri Midwives (FoMM). A non-profit organization representing theinterests of Missouri families whochoose to have safe, alternative, out-of-hospital childbirth options. FoMM wascreated to support, promote and pro-tect the rights of Missouri families tomake choices about how, where, andwith whom their babies will be bornand to promote access to the midwiferymodel of care.• Kelly & Dallion Rehm,and Eric & Jessica Kerr. Two familiesexpecting babies to be born after Au-gust 28th, the day the new law was totake effect. They were planning homebirths with legal, well-trained CPM’s.Now the new law has been struckdown, they will have to choose betweenbreaking the law, birthing at homewithout a trained attendant or the ex-pense and interventions of a hospitalbirth.

• Columbia Community Birth Cen-ter, Kim James, CPM; Ivy White, CPM;and Dr. Elizabeth Allemann, MD. Co-lumbia Community Birth Center is theonly licensed birth center in the stateof Missouri. The Center is a placewhere families give birth in a comfort-able home-like setting. James and Whitereceived their CPM credentials in 1995.Dr. Elizabeth Allemann is Medical Di-rector of the birth center.• MissouriMidwives Association. An organiza-tion dedicated to promotion, protec-tion, support and education for mid-wives in Missouri.

North CarolinaThe North Carolina Friends of Mid-

wives has been very active this summer,producing the play, BIRTH and host-ing a Red Tent event on labor day.They are organizing for legislative ac-tivity this fall, and will have a studybill in the legislature this year since

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speakers this summer to go around thestate bringing together groups of con-sumers and legislators to talk aboutmidwifery legislation. This was a verysuccessful way to get more consumersinvolved in the legislative issues sincemany cant travel across the state to ameeting held in only one location.

A two-hour workshop was held onlegislative strategies, followed by a din-ner and public session to which thelegislators were invited.

The more formal program includedpresentations by Dr. Heather Margaretabout the safety of home birth from aphysician’s point of view, and by IdaDarragh of NARM about the CPM cre-dential. Debbie Pease, president ofSDSCO, and Paul Levijoke, homebirthdad of 9 children, spoke about theconsumer’s interest in birth options.Several legislators attended the meet-ings, and the dialogue was very produc-tive.

This very organized and active groupof consumers has continued to visitwith legislators and organize letterwriting campaigns all summer, top-ping it off with a state birthing confer-ence in September. They are proposinga licensure bill for CPMs in the 2008legislative session.

VirginiaAs of October 1, 2007, CPMs will be

eligible to be enrolled as Medicaid pro-viders. Contact Brynne Potter CPM,Policy Coordinator for Common-wealth Midwives Alliance, for moreinformation on the enrollment pro-cess.

WyomingA midwife in Wyoming was charged

in June with involuntary manslaughterand practicing medicine without a li-cense following the death of a newbornin 2006. She pled not guilty in August.In November, she pled guilty and re-ceived probation and a $3,000 fine inexchange for agreeing not to practicein the future.

2008 is the “short” session. Led bythe rousing new voice of Russ Fawcett(husband of North Carolina CPM LisaFawcett) – who goes by the moniker“midhubby”, the consumer group iscoming up with many amazing ideas,from speaking to the Women’s Studiesprograms at the local university to urg-ing the Dept of Emergency Manage-ment to recognize the value of CPMsin attending births outside of hospitalsin the event of hurricanes or epidemics.In December, their request for a legisla-tive Study Committee was granted, andwork in that area will begin in January,2008.

PennsylvaniaDiane Goslin, a CPM in Pennsylva-

nia, was charged last year with practic-ing medicine without a license andpracticing midwifery without a license.

Her legal process was an administra-tive hearing by the Board of Medicinein September. The Pennsylvania Boardof Medicine has found Diane to be inviolation of the Medical Practice Act of1985 by practicing medicine without alicense and practicing midwifery with-out a license. She has been ordered toCease and Desist from midwifery andfrom attending births and has beenfined $11,000.

She has closed her clinic and hopesto attend births as a doula while sheappeals this decision to the Pennsylva-nia Supreme Court.

This outcome combined with theCease & Desist orders and fines appliedto two other Pennsylvania CPMs lastyear, set an unfavorable precedent forthe midwives in that state. A legislativeworkshop was held in Harrisburg lastMarch, and a Friends of Midwivesgroup is organizing to support legisla-tive efforts.

NARM signed on to an Amicus Cu-ria brief in support of Diane’s appealin November of 2007

South DakotaThe South Dakota Safe Childbirth

Options group organized a group of

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NARM NEEDS YOU

Questions for the NARM exam are written and reviewed by teams ofItem Writers who take a training workshop. In the 2-day workshop, welearn how to write good multiple-choice questions and then spend timewriting questions.

NARM would like to have several Item Writing workshops in 2008. Ifyour state organization will sponsor an Item Writing Workshop forCPMs, NARM will provide a trainer, CEUs, and prizes forparticipation. For more information, contact Ida Darragh [email protected].