Our beloved Ina May Gaskin, midwifery pioneer, was interviewed by Amy Goodman on Democracy Now Monday, March 19th. Ina May is alarmed about the rising rate of maternal and infant mortality in the US. According to the Centers for Disease and Prevention ( CDC ) US infant and maternal mortality failed to improve between 2000 to 2005. This plateau represents the first time since the 1950s that infant mortality has seen no improvement. Ina May started The Safe Motherhood Quilt Project to commemorate the US mothers who have died in childbirth.
WHAT IS A MIDWIFE?
The word midwife comes from the Old English “mit wif,” which literally means with women. A midwife is a health professional who provides care to low-risk women during pregnancy, childbirth and postpartum. Many midwives also provide primary “well-woman” care. Though they are specialists in low-risk pregnancy and childbirth, midwives are trained to both identify and address high risk situations.
HOW MANY MIDWIVES ARE THERE?
In the US approximately 10,000 midwives attend just 10% of births, or 430,000 a year. If midwives attended 75% of births in the US, as they do in New Zealand—a country with better infant mortality than the US—we would need 75,000 more midwives.
Scientific evidence suggests that women with normal pregnancies should be cared for by midwives. On a global scale, a lack of midwives is a healthcare emergency. According to WHO, UNICEF and other groups, maternal mortality is the “highest health inequity in the world.”
WHAT ARE THE TYPES OF US MIDWIVES?
Certified Nurse Midwife (CNM): A registered nurse with two years postgraduate work in caring for pregnant and birthing women in a certified CNM program. Certified by the American Midwifery Certification Board (AMCB). Most practice in hospital setting.
Certified Midwife (CM): A midwife whose education is through apprenticeship and/or midwifery schools. Certified by the American Midwifery Certification Board (AMCB). Most practice in hospital setting
Certified Professional Midwife (CPM): A midwife whose education is usually through apprenticeship, midwifery school, training programs, and out of hospital experience. Certified by the North American Registry of Midwives (NARM). Most practice in home or birth center setting.
State Licensed Midwives: Twenty-six states in the US license, certify, register or grant permits to midwives. In these states, CPMs must have a state license in addition to their national credential.
ARE MIDWIVES COVERED BY INSURANCE?
Insurers are required by law to cover the services of CNMs and most cover CPMs as well. Most major health insurers contract with birth centers for reimbursement. In addition, midwifery practices and birth centers often offer sliding scales for those who are uninsured or not covered by Medicaid.
A 1998 study at San Diego Birth Center showed that midwife/birth center collaborative care saved parents 21 percent as compared with hospital birth. A study published in 1999 in the Journal of Nurse-Midwifery on the cost effectiveness of home birth revealed that the average, uncompicated vaginal birth costs 68 percent less in a home than in a hospital.
WHAT ARE THE LAWS?
Effectively, one can practice midwifery legally in 39 states; in 12 states one cannot. Twenty-six states license or certify midwives. In nine states, midwifery is legal by judicial interpretation. An additional four states do not regulate, but also do not prohibit midwifery. Nine states plus the District of Columbia actually prohibit midwifery and in another two, midwifery is legal but there is no certification process. The Midwives Alliance of North America (MANA) keeps active statistics on the legal status of midwives.
HOW CAN I BECOME A MIDWIFE?
Here are some resources for those who are considering midwifery as a profession:
For an aspiring midwife FAQ, see Midwifery Education Accreditation Council.
For information on Certified Professional Midwives, see The National Association of Certified Professional Midwives.
For information on Certified Midwives and Certified Nurse Midwives, see The American College of Nurse Midwives.
See if your community college offers midwifery education. Southwest Tech in Fennimore, Wisconsin is a model community college midwifery program.
Midwives are the health professional of the future. We need more now!
