# ACOG's 2007 Midwifery Year in Review: OB/GYNs strategy against Midwives and Homebirth



## 17754 (Jul 28, 2004)

American College of Obstetricians and Gynecologists= ACOG...it is the OB/GYNs professional society.

Below is a leaked memo that details ACOG's assessment of midwifery in 2007.

Keep up your activism, we are getting to them! 
Let's not forget the State Legislatures answer to US, the people, not them!!! 
I think they are getting that the gig is up, and they are not in control of midwifery or our birth choices. The link and text is below...

Also, here are the State Bills they watched in 2008- Under "Midwives" , also seem to be keeping their eyes on Naturopaths closely....
http://www.acog.org/departments/stateleg/midwives.pdf

~~~~~~~~~~~~~~~~~~~~~~~ACOG Midwifery Year in Review 2007~~~~~~~~~~~~
http://www.acog.org/departments/stat...Review2007.pdf

ACOG STATE LEGISLATIVE UPDATE 
YEAR IN REVIEW (AUGUST 2007)

'Lay' Midwives & Home Birth 
Troubling Trends in State Legislation: 
¦ Home birth bills on the rise. 
¦ Least qualified direct-entry midwives gaining licensure. 
¦ The midwives' advantage. 
¦ ACOG on the defensive.

Home Birth Bills on the Rise

We are seeing an increase in 'lay' midwifery bills in the states. Backed by individual 
State Midwifery Guilds and by the Midwives Alliance of North America (MANA) and its 
credentialing unit, the North American Registry of Midwives (NARM), these bills are 
being introduced - and passed - in more and more states.

For example, in Virginia in 2005, certified professional midwives (CPMs) finally 
prevailed in what had been a decade-long campaign for licensure and legalization of 
home birth. New Republican majorities in the Virginia General Assembly helped assure 
the midwives' victory. This year, it was the Missouri midwives who prevailed in their 
perennial battle for licensure. (A lawsuit has been filed to block the new Missouri law.)

What's behind this trend?

A legislative handbook developed by MANA provides insight into the midwives' 
strategy. The 96-page handbook is full of lobbying advice, tactics and propaganda. It 
includes a detailed step-by-step primer on getting a home birth bill passed.

The American Legislative Exchange Council (ALEC), an influential 2,400 member 
organization of conservative state lawmakers, recently endorsed a model bill for the 
licensure of certified professional midwives (CPMs) which was crafted by 
MANA/NARM. Model legislation developed by ALEC gets wide attention in state 
legislatures across the country.

The 'lay' midwives' internal philosophy on state regulation and licensure appears to have 
shifted. In the past, their position on licensure reflected the dominance of midwives who 
did not want to be regulated, opposed state licensure, and defended within their 
individual guilds the right to stay unlicensed and practice underground. While there are 
midwives who still do not want to be regulated and who do not support the current 
licensure campaign, for the most part you don't see them speaking publicly against 
licensure in the legislature or elsewhere. Even the nurse-midwives no longer can be 
counted on to speak publicly against home birth or lesser trained midwives.

ACOG . 
GOVERNMENT RELATIONS . 
[email protected]

ACOG STATE LEGISLATIVE UPDATE 
YEAR IN REVIEW (AUGUST 2007)

Least Qualified Direct-Entry Midwives Gaining Licensure

. 
More states are adopting the CPM credential for midwife licensure, not CM.

. 
Only New York has one unified framework for licensing all midwives.

. 
ACOG does not support midwives who are not certified by ACNM.

The term direct-entry is used to refer to midwives who enter the profession of midwifery 
directly without earning a nursing degree. Both certified professional midwives (CPMs) 
and certified midwives (CMs) are considered direct-entry midwives, although their level 
of education and training varies markedly.

CPMs are largely self-taught and their training is typically through apprenticeship. CPM 
was the title chosen by MANA and NARM in the mid-1990s for their credentialed direct-
entry midwives.

By comparison, CMs must undergo three years of university-affiliated training, and while 
there is no nursing prerequisite, these direct-entry midwives must complete the same 
science requirements and sit for the same certification exam as a nurse-midwife. (See, 
ACOG Statement of Policy, Midwifery Education and Certification, February 2007)

New York is one of the few states that recognizes the CM credential and requires all 
midwives to meet this minimum level of education and training. New York has one 
unified framework for licensing all midwives - both nurses and direct-entry midwives. 
But this is the exception to the current trend, and, in fact, the New York rules pre-date 
the establishment of the CPM credential.

More states are adopting the CPM credential as a requirement for midwifery licensure, 
and not the CM credential which both ACOG and ACNM recognize. Of the roughly 21 
states that license midwives to attend home births, all use the CPM credential. By their 
lack of training and because they do not work collaboratively with hospital-based 
obstetric providers, CPMs are the least qualified midwives to attend a home birth.

The Midwives' Advantage

. 
Strong support among conservative lawmakers. 
. 
Different titles for midwives & different levels of training foster public confusion 
and work to the midwives' advantage in the legislative arena. 
. 
Legislators respond to the home birth "choice" message.

A clear trend shows support for home birth among conservative and Republican 
lawmakers who don't see much difference between home schooling and home birthing. 
Where these lawmakers hold the majority, home birth bills get passed.

ACOG . 
GOVERNMENT RELATIONS . 
[email protected]

ACOG STATE LEGISLATIVE UPDATE 
YEAR IN REVIEW (AUGUST 2007)

The American Legislative Exchange Council (ALEC), an influential 2,400 member 
organization of conservative state lawmakers, recently endorsed a model bill for the 
licensure of CPMs. Model legislation developed by ALEC gets wide attention in state 
legislatures across the country.

Legislators often cannot distinguish between different types of midwives.

The different titles for midwives - direct-entry, independent, certified midwives, certified 
professional midwives - foster public confusion. This tends to work to the midwives' 
advantage in the legislative arena. Legislators often cannot distinguish among different 
categories of midwives and have a distorted impression of the actual qualifications of 
these practitioners.

The different credentialing standards for nurse-midwives, certified midwives, and 
certified professional midwives are not well understood by legislators. ACOG's joint 
statement of policy on nurse-midwives and certified midwives is being misused by 
midwifery advocates to support other midwives and home birth.

There is wide variability in the legal status and level of practice authority of midwives 
across the country. States in the northeast and northwest, along the southern border, and 
in the Appalachian region have long-recognized lay midwives in some legal or quasi-
legal capacity. This situation complicates our advocacy. For example, in their testimony 
before state legislatures, midwives frequently cite Washington State because it has 
relatively liberal laws on lay midwife practice as compared to the rest of the country.

Legislators respond to the home birth pitch - "choice" and "safety".

To bolster their case for licensure, midwives like to cite European countries' experience 
with midwives and home birth. This may play well with an uninformed public, but the 
analogy is flawed. The conditions that make home birth relatively safe in some countries

- the Netherlands for example - do not pertain to much of the US. The Netherlands is a 
geographically small, densely populated country where everyone lives within 20 minutes 
of a hospital. 
In their recent testimony to state legislators, midwives have been citing a 2005 study on 
the safety of home births by direct entry midwives in the US. (Johnson KC, Daviss B. 
Outcomes of planned home births with certified professional midwives: large prospective 
study in North America. BMJ 2005;330;1416) This study concluded, "certified 
professional midwives achieve good outcomes among low risk women without routine use 
of expensive hospital interventions." ACOG continues to assert that studies comparing 
the safety and outcome of births in and out of the hospital are problematic, not 
scientifically rigorous, and unconvincing. (See, ACOG Statement of Policy, Home Births 
In The United States, May 2007.)

ACOG . 
GOVERNMENT RELATIONS . 
[email protected]

ACOG STATE LEGISLATIVE UPDATE 
YEAR IN REVIEW (AUGUST 2007)

Midwifery proponents in the state legislatures don't fit any single profile.

Recently, we've seen some odd-ball coalitions. Missouri exemplifies a nascent trend 
among the states. In 2005, a midwife bill (HB 36) was championed by an unusual 
coalition - Republicans, including the Speaker of the House, home schooling proponents, 
the religious right, and the state's Amish and Mennonite communities. The bill language 
was deceptive in its simplicity. It said,

"Nothing in Missouri law shall encroach on a mother's right to give birth

in the setting and with any caregiver of her choice."

ACOG on the Defensive

. 
Bills don't get defeated on the merits.

. 
Midwives show-up in huge numbers & their testimony plays to a sympathetic

public and press.

. 
Nurse-midwives are a fickle ally.

. 
Physician back-up and declining availability of VBAC complicates ACOG's

advocacy.

ACOG is playing defense on most of these bills. It's the rare situation where we can 
defeat these bills on the merits.

For example, in Missouri, 'lay' midwife bills get introduced year after year. These bills 
have been stopped - up to now - mainly by deft political maneuvering and hardball 
tactics employed by the State Medical Society, not by any persuasive testimony about 
comparative safety or quality of care.

In more and more states, doctors have been out-maneuvered in the legislative hearing 
room. Midwives tend to show up in huge numbers (and not just on the day of the hearing 
but almost on a daily basis throughout the session) and their testimony plays to a 
sympathetic public and press. In a few states, a show of force by the medical community 
might clinch victory; but in most it only reinforces a perception among lawmakers that 
this is just a turf battle between doctors and non-doctors and the final vote tends to favor 
the latter.

Nurse-midwives - a fickle ally.

The American College of Nurse-Midwives (ACNM) and its state chapters are divided on 
their response to state legislation that would license CPMs and legalize home birth. This 
complicates ACOG's advocacy. Whereas nurse-midwives have been ACOG's front-line 
defense against these bills, that's no longer a sure thing. Today, you don't see nurse-
midwives speaking with any consistency against home birth or the certified professional 
midwives (CPMs). There is a widening internal debate within the American College of

ACOG . 
GOVERNMENT RELATIONS . 
[email protected]

ACOG STATE LEGISLATIVE UPDATE 
YEAR IN REVIEW (AUGUST 2007)

Nurse-Midwives over education and training standards for midwives, and ACNM and 
MANA do not agree on certain aspects of education and practice.

Physician back-up.

Physician back-up for midwives and out-of-hospital deliveries is a growing concern in 
some states. In Wisconsin, the professional medical ethics of physicians who choose to 
back-up CPM-trained midwives were in dispute over home birth legislation that got 
approved in 2006 over the objections of the Wisconsin ACOG Section, the state AAP 
Chapter, and the State Medical Board. The bill passed with the support of the State 
Medical Society and an ob-gyn serving in the state legislature.

Another example is California. In 1993, California licensed midwives to do home 
deliveries under physician supervision. But implementing regulations for the 1993 law 
were only recently finalized after years of wrangling over key issues including the 
physician supervision requirement in the authorizing legislation. Medical liability 
insurers in the state were refusing to cover physicians who back-up midwives and 
midwifery proponents in the legislature threatened to waive the requirement for physician 
supervision altogether.

Declining availability of VBAC.

The situation with hospitals declining to do VBAC deliveries has complicated our 
advocacy efforts on midwives. ACOG Fellows in California, Washington and other 
Western and Rocky Mountain states report that women are seeking out alternatives, 
including home birth with midwives, in their desire for a VBAC. The VBAC issue was 
one of several sticking points in California as stakeholders weighed-in on regulations to 
implement a midwife licensure law.

ACOG . 
GOVERNMENT RELATIONS . 
[email protected]


----------



## Turquesa (May 30, 2007)

Quote:

For example, in Missouri, 'lay' midwife bills get introduced year after year. These bills
have been stopped - up to now - mainly by deft political maneuvering and hardball
tactics employed by the State Medical Society, not by any persuasive testimony about
comparative safety or quality of care.
So basically ACOG is admitting that without any substantive testimony or genuine democratic support, docs are starting to play dirty.


----------



## hotmamacita (Sep 25, 2002)

And now the AMA is jumping in to play dirty too.


----------



## hotmamacita (Sep 25, 2002)

And now the AMA is jumping in to play dirty too.

http://www.mothering.com/discussions...1#post11496175


----------

