Why Alabama Needs Why Alabama Needs Certified Professional Certified Professional

MidwivesMidwives

What Is A Midwife?What Is A Midwife?““A midwife is a person who, having been A midwife is a person who, having been regularly admitted to a midwifery regularly admitted to a midwifery educational program, duly recognized in educational program, duly recognized in the country in which it is located, has the country in which it is located, has successfully completed the prescribed successfully completed the prescribed course of studies in midwifery and has course of studies in midwifery and has acquired the requisite qualifications to be acquired the requisite qualifications to be registered and/or legally licensed to registered and/or legally licensed to practice midwifery. She may practice in practice midwifery. She may practice in any setting including in the home, the any setting including in the home, the community, hospitals, clinics or health community, hospitals, clinics or health units.”units.”Adopted by the Adopted by the International Confederation of Midwives 19 July 2005 19 July 2005

Why Families Choose Out-of

Hospital BirthPersonal or religious

reasons

Why Families Choose Out-ofHospital Birth

Personal or religious reasons

Concern about the medical model of care and/or

hospitals

Why Families Choose Out-ofHospital Birth

Personal or religious reasons

Concern about the medical model of care and/or

hospitalsGeographic Issues

Why Families Choose Out-of

Hospital BirthFinancial Considerations

Who Uses Midwives?Who Uses Midwives?

Low risk, healthy women who:Low risk, healthy women who: Desire natural childbirth—the medicated Desire natural childbirth—the medicated

rate in hospitals is 90%rate in hospitals is 90% Dislike the institutional atmosphere and Dislike the institutional atmosphere and

lack of autonomy in a hospital.lack of autonomy in a hospital. Want individualized, family-centered care.Want individualized, family-centered care. Do not have health insurance and seek Do not have health insurance and seek

cost effective options.cost effective options. Must travel great distances, in labor, to Must travel great distances, in labor, to

give birth.give birth.

““Those who do not Those who do not understand history…”understand history…”

In the 1970’s, Alabama, like In the 1970’s, Alabama, like the rest of the nation, was the rest of the nation, was experiencing a renaissance experiencing a renaissance of out-of-hospital birth. of out-of-hospital birth. Mothers were seeking Mothers were seeking health care alternatives. health care alternatives. These mothers were largely These mothers were largely Caucasian, middle class and Caucasian, middle class and educated. They wanted birth educated. They wanted birth to be safer and more to be safer and more comfortable than what was comfortable than what was being offered in hospitals at being offered in hospitals at the time. As granny the time. As granny midwives like Onnie Lee midwives like Onnie Lee Logan neared retirement, Logan neared retirement, the clients they had lost to the clients they had lost to Medicaid-funded hospital Medicaid-funded hospital births were largely replaced births were largely replaced with these mothers.with these mothers.

Inspired by traditional midwives, some Inspired by traditional midwives, some midwives chose to enter the field directly midwives chose to enter the field directly

without first becoming nurses. without first becoming nurses.

They organized themselves into professional They organized themselves into professional groups and formulated standards of groups and formulated standards of

practice. The Midwives Alliance of North practice. The Midwives Alliance of North America (MANA) was founded in 1982 and America (MANA) was founded in 1982 and the North American Registry of Midwives the North American Registry of Midwives

(NARM) in 1987. Seeing the need for a (NARM) in 1987. Seeing the need for a national standard and a psychometrically national standard and a psychometrically sound testing process, NARM created the sound testing process, NARM created the

Certified Professional Midwife (CPM) Certified Professional Midwife (CPM) credential in 1994 to aid midwives seeking credential in 1994 to aid midwives seeking

licensing and regulation.licensing and regulation.

What Is A CPM?What Is A CPM? The Certified Professional Midwife (CPM) The Certified Professional Midwife (CPM)

credential is accredited by the National credential is accredited by the National Organization for Competency Assurance, Organization for Competency Assurance, which which alsoalso accredits the Certified Nurse accredits the Certified Nurse Midwife (CNM) credential.Midwife (CNM) credential.

CPM credential is backed by nationally CPM credential is backed by nationally recognized and psychometrically sound recognized and psychometrically sound assessment.assessment.

The CPM credential is legally defensible.The CPM credential is legally defensible. The The onlyonly profession which specializes in profession which specializes in

out of hospital births.out of hospital births. Promotes the Midwives Model of CarePromotes the Midwives Model of Care

How do Certified Professional Midwives

Receive Their Credentials?

The Certified Professional Midwife (CPM) credential is issued by the North American Registry of Midwives (NARM) and is recognized internationally.

The CPM credential is accredited by the National Commission for Certifying Agencies (NCCA).

This competency-based education is accomplished by the most efficient method of learning: a one-on-one tutor, or preceptor. This preceptor must be approved by NARM.

The CPM must document competent performance of over 750 skills. The student attends a minimum of 40 births -- 20 as a student and 20 as the primary midwife while still under supervision.

All CPMs MUST have a minimum of:

40 out of hospital births 75 prenatal exams20 initial exams 20 newborn exams 40 postpartum examsCurrent Adult CPRInfant CPR or Neonatal ResuscitationThe student trains for a minimum of one year, and training is the equivalent of 1350 clinical hours. After completing the rigorous educational and training process, which usually takes 3 to 5 years, the student must pass a hands-on Skills Assessment exam that is administered by a NARM Qualified Evaluator. Upon passing the Skills Assessment, the student must pass an eight hour written exam.

Each CPM Must Develop: • Informed Consent Document and

Practice GuidelinesAn Emergency Care PlanNARM Requirements for Re-Certification, which occurs every 3 yearsCurrent CPR Certification for Adult & Infant CPR or Neonatal Resuscitation5 hours of Peer Review25 hours of Continuing Education or re-take NARM ExamTwenty-six states currently require passing the NARM exam for licensure as a direct-entry midwife.Alabama is one of only 10 states that actively prohibit CPMs from practicing.

What Does Midwifery What Does Midwifery Care Include?Care Include?

Prenatal carePrenatal careContinual risk assessmentContinual risk assessmentNutritional counselingNutritional counselingCommunity based resourcesCommunity based resourcesAvoiding unneeded interventionsAvoiding unneeded interventionsMonitoring throughout labor Monitoring throughout labor Continuous on-site careContinuous on-site careFamily-centered careFamily-centered carePostpartum care for the mother and childPostpartum care for the mother and child

The Midwives Model of Care is based on the The Midwives Model of Care is based on the fact fact

that pregnancy and birth are normal life that pregnancy and birth are normal life processes.processes.

Midwives Model of CareMidwives Model of CareThe application of this woman-centered model of The application of this woman-centered model of

care has been proven to reduce the incidence care has been proven to reduce the incidence of birth injury, trauma, and cesarean section.of birth injury, trauma, and cesarean section.

Midwifery Care vs. Midwifery Care vs. Obstetrical CareObstetrical Care

Midwifery CareMidwifery Care Unrestricted access to Care Unrestricted access to Care

Provider.Provider.

Continuity of care– Mother sees Continuity of care– Mother sees the same healthcare provider the same healthcare provider for every visit.for every visit.

Low stress delivery Low stress delivery environment – mother chooses environment – mother chooses setting, pace, attendants, and setting, pace, attendants, and circumstances.circumstances.

Technology used only when Technology used only when appropriate AND informed appropriate AND informed consent is given.consent is given.

Mothers choose the most Mothers choose the most comfortable, safe position for comfortable, safe position for delivery. delivery.

The average midwife spend 60-The average midwife spend 60-75 contact hours with clients 75 contact hours with clients during pregnancy and birthduring pregnancy and birth

Obstetrical CareObstetrical Care Access by appointment during Access by appointment during

business hours only.business hours only.

Mother sees whomever is on call Mother sees whomever is on call for delivery.for delivery.

Mother forced to abide by Mother forced to abide by hospital regulations, with nurses hospital regulations, with nurses and doctors juggling multiple and doctors juggling multiple births.births.

Technology used as matter of Technology used as matter of course, informed consent often course, informed consent often IMPLIED.IMPLIED.

Mother’s delivery position limited Mother’s delivery position limited by hospital protocol or doctor.by hospital protocol or doctor.

The average physician spends The average physician spends less than 10 hours with patients less than 10 hours with patients during prenatals, labor and during prenatals, labor and postpartumpostpartum

Over 30% of babies born in the United Over 30% of babies born in the United States are surgically delivered from States are surgically delivered from

their mothers’ bodies.their mothers’ bodies.

Cesarean section rates in the United Cesarean section rates in the United States has more than States has more than quadrupledquadrupled in the in the past 30 years, with past 30 years, with no corresponding no corresponding improvement in neonatal outcomes.improvement in neonatal outcomes.

The Mehl StudyThe Mehl StudyA Comparison of Hospital and A Comparison of Hospital and

Home BirthsHome BirthsLewis E. Mehl, M.D. conducted a study of hospital Lewis E. Mehl, M.D. conducted a study of hospital births and home births to determine the relative births and home births to determine the relative safety of each. 1,046 home births were randomly safety of each. 1,046 home births were randomly matched and compared with 1,046 hospital births. matched and compared with 1,046 hospital births. The women were matched for:The women were matched for:

AgeAge ParityParity Socio-economic statusSocio-economic status Gestational lengthGestational length EducationEducation Individual risk factorsIndividual risk factors

Virtually all of the couples in both groups had taken Virtually all of the couples in both groups had taken childbirth education classes. The babies’ birth childbirth education classes. The babies’ birth weights were not statistically significantly different, weights were not statistically significantly different, so this does not enter into the results.so this does not enter into the results.

The Mehl StudyThe Mehl StudyA Comparison of Hospital and A Comparison of Hospital and

Home BirthsHome BirthsIntrapartum PeriodIntrapartum Period““Intrapartum” means “during the birth”Intrapartum” means “during the birth” The home births had 83% less fetal distress.The home births had 83% less fetal distress. The home births had 80% less elevated blood The home births had 80% less elevated blood

pressure and/or pre-eclampsia.pressure and/or pre-eclampsia. The home births had 71% less meconium staining.The home births had 71% less meconium staining. The home births had 16% less stalled labor.The home births had 16% less stalled labor. The home births had 87% less shoulder dystocia.The home births had 87% less shoulder dystocia. The hospital births had 73% less bleeding during The hospital births had 73% less bleeding during

labor.labor. The hospital births had 66% less retained The hospital births had 66% less retained

placental fragments.placental fragments.

The Mehl StudyThe Mehl StudyA Comparison of Hospital and A Comparison of Hospital and

Home BirthsHome BirthsNeonatal OutcomesNeonatal OutcomesThe definition of “neonatal” used here is that The definition of “neonatal” used here is that period of time which begins at birth and period of time which begins at birth and ends on the 28ends on the 28thth day of life. day of life. The home births had 57% less neonatal asphyxia.The home births had 57% less neonatal asphyxia. The home births required 73% less neonatal The home births required 73% less neonatal

resuscitations.resuscitations. The home births had NO birth injuries. In the The home births had NO birth injuries. In the

hospital births, there were 30 birth injuries, hospital births, there were 30 birth injuries, including skull fractures, facial nerve palsies, including skull fractures, facial nerve palsies, brachial nerve injuries, and severe brachial nerve injuries, and severe cephalohematomas.cephalohematomas.

The home births had 83% fewer neurologically The home births had 83% fewer neurologically abnormal infants.abnormal infants.

The Mehl StudyThe Mehl StudyA Comparison of Hospital and A Comparison of Hospital and

Home BirthsHome BirthsApgar ScoresApgar ScoresApgar scores are measurements of a baby’s physical Apgar scores are measurements of a baby’s physical well-being. A score of 0, 1, or 2 is given for each five well-being. A score of 0, 1, or 2 is given for each five areas; heart rate, respiration, muscle tone, reflex areas; heart rate, respiration, muscle tone, reflex irritability, and color. A “perfect” score is 10. Below irritability, and color. A “perfect” score is 10. Below is a comparison of the Apgar scores of the home is a comparison of the Apgar scores of the home births and the hospital births.births and the hospital births.

Apgar ScoreApgar Score HomeHome HospitalHospital

1-minute score 1-minute score << 4 4

20 (1.91%)20 (1.91%) 36 (3.44%)36 (3.44%)

1-minute score 1-minute score << 7 7

56 (5.35%)56 (5.35%) 116 (11.09%)116 (11.09%)

5-minute score 5-minute score << 4 4

3 (0.29%)3 (0.29%) 8 (0.76%)8 (0.76%)

5-minute score 5-minute score << 7 7

11 (1.05%)11 (1.05%) 23 (2.20%)23 (2.20%)

The Mehl StudyThe Mehl StudyA Comparison of Hospital and A Comparison of Hospital and

Home BirthsHome BirthsProcedures UsedProcedures Used The home births had 56% less Oxytocin used The home births had 56% less Oxytocin used

during first stage, 76% less during second stage, during first stage, 76% less during second stage, and 74% less during third stage.and 74% less during third stage.

The home births had the SAME number of 1The home births had the SAME number of 1stst--degree lacerations as the hospital, the hospital had degree lacerations as the hospital, the hospital had 58% fewer 258% fewer 2ndnd-degree, home had 81% fewer 3-degree, home had 81% fewer 3rdrd--degree, and home had 93% fewer 4degree, and home had 93% fewer 4thth-degree -degree lacerations.lacerations.

The home births had 90% fewer cervical The home births had 90% fewer cervical lacerations.lacerations.

The home births had 88% fewer episiotomies.The home births had 88% fewer episiotomies. The home births had 95% less anesthesia and 97% The home births had 95% less anesthesia and 97%

less analgesialess analgesia The home births ended up in 67% fewer caesarean The home births ended up in 67% fewer caesarean

sections.sections. Infant death rate low in both home and hospital, Infant death rate low in both home and hospital,

essentially the same.essentially the same.

The home births The home births were found to have were found to have significantly better significantly better

outcomes.outcomes.

““Home Birth Versus Hospital Birth: Comparisons of Home Birth Versus Hospital Birth: Comparisons of Outcomes of Matched Populations.” By Dr. Lewis Mehl, Outcomes of Matched Populations.” By Dr. Lewis Mehl, Presented on October 20, 1976 before the 104th annual Presented on October 20, 1976 before the 104th annual meeting of the American Public Health Association. For meeting of the American Public Health Association. For

further information contact the Institute for Childbirth and further information contact the Institute for Childbirth and Family Research, 2522 Dana St., Suite 201, Berkeley, CA Family Research, 2522 Dana St., Suite 201, Berkeley, CA

9470494704

Is this the ONLY Option?Is this the ONLY Option?

Most babies are born to mothers who are Most babies are born to mothers who are numb from the waist down and tangled in numb from the waist down and tangled in a web of tubes and wires.a web of tubes and wires.

39 of 67 Alabama Counties 39 of 67 Alabama Counties Currently Have No Currently Have No

Maternity CareMaternity CareDespite this birthing Despite this birthing

technology, the US technology, the US maintains one of maintains one of the highest rates the highest rates of maternal and of maternal and neonatal mortality neonatal mortality among all among all developed nations. developed nations. Alabama ranks Alabama ranks 4343rdrd nationally in nationally in infant mortalityinfant mortality

Why We Need Midwives In Why We Need Midwives In AlabamaAlabama

Scientific studies show midwifery care and out of Scientific studies show midwifery care and out of hospital birth to be AS SAFE as physician assisted hospital birth to be AS SAFE as physician assisted hospital births for most women.hospital births for most women.

Many families prefer to receive the more Many families prefer to receive the more personalized care of a midwife.personalized care of a midwife.

Midwife-assisted births are significantly less Midwife-assisted births are significantly less expensive than hospital births.expensive than hospital births.

Midwives offer care in BOTH urban and rural Midwives offer care in BOTH urban and rural areas, and to all socioeconomic groups.areas, and to all socioeconomic groups.

Many Alabama counties have no providers of Many Alabama counties have no providers of maternity care.maternity care.

Many Alabama counties do not have hospitals Many Alabama counties do not have hospitals equipped to offer maternity care.equipped to offer maternity care.

What About Other What About Other States?States?

Midwives are licensed or regulated Midwives are licensed or regulated in 26 states in the U.S.in 26 states in the U.S.

Integrate Licensed Midwives as part Integrate Licensed Midwives as part of Emergency Preparedness Systemof Emergency Preparedness System

NO state that has adopted the CPM NO state that has adopted the CPM has EVER rescinded it.has EVER rescinded it.

Every state that allows CPMs has Every state that allows CPMs has better neonatal/maternal outcomes better neonatal/maternal outcomes than does Alabamathan does Alabama

Licensing Trends of Licensing Trends of CPMsCPMs

Midwifery Makes Good Midwifery Makes Good CentsCents

In 2007, the typical total cost for pregnancy In 2007, the typical total cost for pregnancy through postpartum was approximately through postpartum was approximately $3000.00$3000.00

The cost for physician-supervised prenatal The cost for physician-supervised prenatal care and hospital care began around care and hospital care began around $12,000.00—the cost is higher for C-section$12,000.00—the cost is higher for C-section

Some Celebrity Women Some Celebrity Women Who Chose Homebirth in Who Chose Homebirth in

the U.S.the U.S.Lisa BonetLisa BonetCindy CrawfordCindy CrawfordTyne Daley’s DaughterTyne Daley’s DaughterTania Joy Gibson – Miss IllinoisTania Joy Gibson – Miss IllinoisWoody Harrellson’s WifeWoody Harrellson’s WifeMrs. Val KilmerMrs. Val KilmerCarol KingCarol KingRicki Lake – in training to be a Ricki Lake – in training to be a

midwifemidwifeMrs. Michael LandonMrs. Michael LandonPamela Anderson Lee – twicePamela Anderson Lee – twiceMrs. Kenny LogginsMrs. Kenny LogginsLindsey Wagner – The Bionic Lindsey Wagner – The Bionic

WomanWomanSupermodel Stella TenantSupermodel Stella TenantEvery US President until Jimmy Every US President until Jimmy

CarterCarter

Demi MooreDemi MooreSinger Nellie FurtadoSinger Nellie FurtadoLiberty Phoenix – River’s sisterLiberty Phoenix – River’s sisterKenny Preston – wife of John Kenny Preston – wife of John

TravoltaTravoltaTracy Reiner – Rob Reiner and Tracy Reiner – Rob Reiner and

PennyPenny Marshall’s daughterMarshall’s daughterKenny Roger’s second wifeKenny Roger’s second wifeJohn Schnieder’s wife, EllieJohn Schnieder’s wife, EllieMrs. David SoulMrs. David SoulMeryl StreepMeryl StreepMrs. Richard ThomasMrs. Richard ThomasKathleen Kennedy Townsend – Kathleen Kennedy Townsend –

Bobby Kennedy’s daughterBobby Kennedy’s daughter80% of the people 80% of the people currently on currently on

the planetthe planet

What We Must DoWhat We Must Do Alabama citizens should join the Alabama citizens should join the

consumer grassroots organization, the consumer grassroots organization, the Alabama Birth Coalition, to help Alabama Birth Coalition, to help increase access to midwifery care.increase access to midwifery care.

Write, then call, your insurance Write, then call, your insurance provider and request coverage.provider and request coverage.

Contact your Legislator to let him/her Contact your Legislator to let him/her know that you want this option.know that you want this option.

Become involved in local effort to Become involved in local effort to educate the public and encourage educate the public and encourage natural childbirth options in your natural childbirth options in your communitycommunity

Alabama Families Want Alabama Families Want Safe HomebirthSafe Homebirth