Yes!! Such a great example of a cause that could have bipartisan support and make a huge impact on our collective well-being. (Also, one of my besties is a certified nurse midwife so I kinda feel like I am part of the club.)
We have predominantly midwife led care in the UK….probably because it’s the cheapest way to get good outcomes for mothers and babies as we’re state-funded 🤣 But it works! Completely agree that it’s something both sides of the political aisle could get on board supporting.
I think midwife led care should be the standard, and I say this as someone who has always ended up in consultant-led care due to medical reasons. Save the doctors for when there’s really a problem!
I completely agree with you. The UK has a great model (though I hear it's been understaffed and problematic in the NHS lately). That "Call the Midwife" model developed mid 20th century in the UK saved so many lives. It's definitely on my mind when I think about how we could change things here.
Oh definitely has its problems due to understaffing and general NHS issues, so some areas are more affected than others. But in principle it is a great model!
Midwifery is and should be bipartisan. In my view, midwifery is our birthright as humans. I know it's idealistic, but for me, the heart and soul of midwifery transcends it all: politics, borders, systems, everything. I know that's not the reality, but that's what I feel as a doula and a mother who has birthed with midwives.
I spent some time at the Texas legislature earlier this year, lobbying with the Association of Texas Midwives on their community lobby day, and I did find that it was, to some extent, bipartisan, even in this "red" state. We all trooped around in groups, wearing our babies on our backs, to talk to staffers about the midwifery bill that was in the legislature at the time. I know not every midwife and mom who was with me in the Capitol is liberal like me, but we were aligned in doing what we could to avoid additional regulations that would limit midwifery here in Texas. I hope to see more of that locally, on the state level, and nationally in the future.
I think it's also key to consider the regulations midwives have to practice under in each state (is there full practice authority for CNMs, are CPMs licensed and what are the conditions of their licensure, etc). There's quite a few blue states that have taken DECADES to pass legislation so CPMs can legally practice (hello, MA and IL!) and other red states (looking at you, AL!) where legislation and practice guidelines were so clearly made without any input from anyone who understands midwifery.
And not to come on your comment section and talk a lot about New Mexico again (lol) but one big reason that midwifery has thrived in NM is because, in the early 20th century, the government in NM partnered with midwives instead of trying to eradicate them. Felina Ortiz, a CNM and midwifery professor at UNM, has done a lot of research on this! https://www.sciencedirect.com/science/article/abs/pii/S152695230400577X
Thanks for your perspective! And for that tidbit about NM. I didn't know, but it makes sense that their history would differ from the rest of the country and it's anti-midwife rhetoric.
I wonder if the highly pathologized birth culture in American hospitals makes midwife integration especially hard, e.g. with women being induced so often. Because doctors are so involved we kind of don't believe in low risk pregnancies anymore, which makes it harder and harder for doctors to step back.
That's probably part of it. But as a midwife at a FQHC, I work with patients that might be considered "high risk" too--and when you're working with supportive obstetricians it's kind of the best of both worlds. There are so many places where midwifery is integrated! That's how I know it's possible!
This is all spot on, Ann! I've been thinking a lot about how midwifery is really THE key to so many elements of the maternal health crisis.
There are still so many barriers to access and training and funding and reimbursement across the country though. This conversation with Anu Sharma really opened my eyes to what we're working with when it comes to unlocking this absolutely no-brainer solution - https://maternalstressproject.substack.com/p/is-mom-centric-perinatal-care-even
Yeah, I loved that conversation! Especially the part about "how would we even make more midwives?" It's frustrating for me because I do train student midwives and find they really struggle to find jobs, despite being really great candidates. One student of mine who is bilingual, incredibly smart and has ten years of nursing experience finally got a CNM job 2 years after graduation. A local health system got so much feedback that patients wanted midwives that they finally decided to open a practice. We'll see how it goes-I just find the institutional support and follow through are not always there. So I'm hopeful for her but also not holding my breath...
ugh, this is crushing. To be in this limbo state where health systems haven't fully integrated (and accepted) midwifery while you still have GREAT midwives being trained. AND quality maternity care continues to be decimated across the country. WTF, America?!
No midwives were available to me back in the day and I wanted that. Took Bradley childbirth classes, had a doula before the word was known, protested for more birth options. Did not have the natural births I wanted. Jump forward and a woman I knew from local breastfeeding task force managed to get midwifery care in Peoria IL area mostly by herself. It’s now widely available here. My daughter had two amazing natural births in Chicago-area hospitals with midwives. I served as her lay doula. Her care was far superior to mine. Everything I fought for had become the norm.
My wife just gave birth to our second about two months ago. I went very differently than the first, though I think we all know all pregnancies and deliveries can be very different. My question is: at what point in the process does a CNM come in? Would they replace the RNs that come in to adjust the monitors? Would they be permanently assigned to a room/mother? You state they could help with breastfeeding, does that mean they follow the mom into the postpartum wing?
So we CNMs can work in different settings but we work in clinics and give prenatal care, but also attend births (usually in hospitals). With my work setting, we take shifts in both settings. If someone's in labor during my call shift, I'm caring for them during that 12 hours. If they're my prenatal patient, I'm seeing them for most of their visits, and maybe (hopefully) attending their birth but it could be one of my coworkers as well, and could be an OB/GYN if a c-section is necessary.
Yes!! Such a great example of a cause that could have bipartisan support and make a huge impact on our collective well-being. (Also, one of my besties is a certified nurse midwife so I kinda feel like I am part of the club.)
Woo hoo! There are only around 14000 practicing CNMs so you're lucky to know one ;)
We have predominantly midwife led care in the UK….probably because it’s the cheapest way to get good outcomes for mothers and babies as we’re state-funded 🤣 But it works! Completely agree that it’s something both sides of the political aisle could get on board supporting.
I think midwife led care should be the standard, and I say this as someone who has always ended up in consultant-led care due to medical reasons. Save the doctors for when there’s really a problem!
I completely agree with you. The UK has a great model (though I hear it's been understaffed and problematic in the NHS lately). That "Call the Midwife" model developed mid 20th century in the UK saved so many lives. It's definitely on my mind when I think about how we could change things here.
Oh definitely has its problems due to understaffing and general NHS issues, so some areas are more affected than others. But in principle it is a great model!
Midwifery is and should be bipartisan. In my view, midwifery is our birthright as humans. I know it's idealistic, but for me, the heart and soul of midwifery transcends it all: politics, borders, systems, everything. I know that's not the reality, but that's what I feel as a doula and a mother who has birthed with midwives.
I spent some time at the Texas legislature earlier this year, lobbying with the Association of Texas Midwives on their community lobby day, and I did find that it was, to some extent, bipartisan, even in this "red" state. We all trooped around in groups, wearing our babies on our backs, to talk to staffers about the midwifery bill that was in the legislature at the time. I know not every midwife and mom who was with me in the Capitol is liberal like me, but we were aligned in doing what we could to avoid additional regulations that would limit midwifery here in Texas. I hope to see more of that locally, on the state level, and nationally in the future.
I think it's also key to consider the regulations midwives have to practice under in each state (is there full practice authority for CNMs, are CPMs licensed and what are the conditions of their licensure, etc). There's quite a few blue states that have taken DECADES to pass legislation so CPMs can legally practice (hello, MA and IL!) and other red states (looking at you, AL!) where legislation and practice guidelines were so clearly made without any input from anyone who understands midwifery.
And not to come on your comment section and talk a lot about New Mexico again (lol) but one big reason that midwifery has thrived in NM is because, in the early 20th century, the government in NM partnered with midwives instead of trying to eradicate them. Felina Ortiz, a CNM and midwifery professor at UNM, has done a lot of research on this! https://www.sciencedirect.com/science/article/abs/pii/S152695230400577X
Thanks for your perspective! And for that tidbit about NM. I didn't know, but it makes sense that their history would differ from the rest of the country and it's anti-midwife rhetoric.
I wonder if the highly pathologized birth culture in American hospitals makes midwife integration especially hard, e.g. with women being induced so often. Because doctors are so involved we kind of don't believe in low risk pregnancies anymore, which makes it harder and harder for doctors to step back.
That's probably part of it. But as a midwife at a FQHC, I work with patients that might be considered "high risk" too--and when you're working with supportive obstetricians it's kind of the best of both worlds. There are so many places where midwifery is integrated! That's how I know it's possible!
This is all spot on, Ann! I've been thinking a lot about how midwifery is really THE key to so many elements of the maternal health crisis.
There are still so many barriers to access and training and funding and reimbursement across the country though. This conversation with Anu Sharma really opened my eyes to what we're working with when it comes to unlocking this absolutely no-brainer solution - https://maternalstressproject.substack.com/p/is-mom-centric-perinatal-care-even
Yeah, I loved that conversation! Especially the part about "how would we even make more midwives?" It's frustrating for me because I do train student midwives and find they really struggle to find jobs, despite being really great candidates. One student of mine who is bilingual, incredibly smart and has ten years of nursing experience finally got a CNM job 2 years after graduation. A local health system got so much feedback that patients wanted midwives that they finally decided to open a practice. We'll see how it goes-I just find the institutional support and follow through are not always there. So I'm hopeful for her but also not holding my breath...
ugh, this is crushing. To be in this limbo state where health systems haven't fully integrated (and accepted) midwifery while you still have GREAT midwives being trained. AND quality maternity care continues to be decimated across the country. WTF, America?!
Very interesting analysis!
No midwives were available to me back in the day and I wanted that. Took Bradley childbirth classes, had a doula before the word was known, protested for more birth options. Did not have the natural births I wanted. Jump forward and a woman I knew from local breastfeeding task force managed to get midwifery care in Peoria IL area mostly by herself. It’s now widely available here. My daughter had two amazing natural births in Chicago-area hospitals with midwives. I served as her lay doula. Her care was far superior to mine. Everything I fought for had become the norm.
My wife just gave birth to our second about two months ago. I went very differently than the first, though I think we all know all pregnancies and deliveries can be very different. My question is: at what point in the process does a CNM come in? Would they replace the RNs that come in to adjust the monitors? Would they be permanently assigned to a room/mother? You state they could help with breastfeeding, does that mean they follow the mom into the postpartum wing?
P.S. Congratulations on #2!!!
So we CNMs can work in different settings but we work in clinics and give prenatal care, but also attend births (usually in hospitals). With my work setting, we take shifts in both settings. If someone's in labor during my call shift, I'm caring for them during that 12 hours. If they're my prenatal patient, I'm seeing them for most of their visits, and maybe (hopefully) attending their birth but it could be one of my coworkers as well, and could be an OB/GYN if a c-section is necessary.