Thursday, May 03, 2012

Childbirth Today Blog Carnival Guest: Tara Tulley CPM

A New Era Of Maternity Care in the United States
by Tara Tulley CPM, MSW:

I attended the NACPM Symposium in March and also participated in the lobby day in Washington DC. This is my report to the Utah Midwives on the outcome of the conference.

Birth care in the United States has reached a level of crisis. The current system of standard obstetrical care is unsustainable both in delivery of services, and in financial viability. The world wide recession and need for Medicaid and Medicare reform is changing the view of how maternity care is seen by the major players in federally funded programs. For the first time in modern US history midwives are being seriously looked at as a viable and evidence-based solution to both improving the quality of services to pregnant women, while also reducing the per ca pita spending to lower the amount of total GDP being spent on health care. Astoundingly, end-of-life care, and birth care are the largest areas of spending in hospital-based services.

An estimated 43% of annual births in the US are funded by Medicaid, and the cesarean section rate is now over 30%. The United States ranks 41st in maternal mortality and 28st in infant mortality.  Medical Administrators who control which providers are able to access these funds are embarrassed by these numbers. They are seeing the truth that midwives have long held to: American obstetrical standards are not currently using evidence-based practices, yet we spend more than countries on these services then do countries with much better outcomes.

The speaker panel of this historical symposium included: representatives from ACNM, MANA, and NACPM;  Dr Stephen Cha, MD Director of Health for Medicaid and Chip;Dr. Patrick Kelly, Director of the Board on Global Health at the U.S. Institute of Medicine; Dr. Tim Fisher, and obstetrician affiliate of ACOG; and many other key researchers, educators, and midwives who are looking to direct-entry midwives and out-of-hospital birth as a solution to solve the current crisis in maternal in infant health care.

Strong organizational initiatives are moving nationally and globally to unify all midwives and to secure a voice at the table for innovations being discussed in the health care system. There is a great need to create more midwives to fill the gaps in maternal health care and to create the educators and preceptor to train a minimum of 20,000 new midwives in the United States by 2020.

The statistics report given by Ida Darragh, CPM, show that there are about 10,000 CNMs in the United States, 2000 CPM certificates have been issues and 1549 CPMs in active current practice. The UK has about 11,000 registered midwives, and if all of our CNMs and CPMs moved to the UK we would barely meet the need for their minimum recommend number of midwives needed to care for the population of birthing women in the UK. The United States is short at least 20,000 midwives to fill our needs and a number of 30,000 is probably more accurate. By my estimate, this means each state needs to produce 600 new midwives in order to be able to optimally be able to serve women in all settings.

The International Confederation of Midwives (ICM) estimates that the shortage of midwives necessary to reducing maternal health care disparities and infant mortality world-wide of at least 350,000. There is much room for growth, and as a 29th Institution for educating new direct-entry midwives, my organization, Birth Rite Women's Center, and our community midwifery school that has emerged and is evolving has joined the Association of Midwifery Educators (AME) to increase access and funding for midwifery education.

Kristi Ridd-Young, current president of Midwives' College of Utah was voted in as vice-president of the Midwifery Education Accreditation Council (MEAC) board. Kristi and I both committed to working together to make midwifery education more available and accessible in Utah, and working with communities around the nation who are innovators in maternal healthcare and midwifery education.

Susy Meyers, Founder of Seattle School of Midwifery, and current president of NACPM is making headway into making midwifery education available in public colleges and universities in Washington State.

The NACPM symposium included a working day and focus groups to help us decide what needs our joined attention, and what we will do individually to help promote a unified front of midwives in our country. I agreed to join a committee of educators with an AME board to look at how to bring midwifery education to community schools, and access federal funding for education. There is also now a state chapter of NACPM in Utah, and currently I serve as the liaison to help strengthen education and build a strong community of midwives and birth professionals in Utah. I support and am working with our newly reorganized state organization the Utah Midwives' Association (UMWA) to help these initiatives move forward. I have provided links to the reports and numbers given by the speakers at the symposium in the following paragraph:

 Millbank report on evidence-based maternity care and innovations in maternity care, and looking at Crossing the Quality Chasm:

Strong Start Initiative:

International Confederation of Midwives standards for core competencies and education for midwives, and State of World's Midwifery Report:


Looking at adult learning theory and implementation of education models for midwives:

For more of the notes and presentations from specific Speaker session, visit the NACPM Symposium Website:

Birth Rite Women's Center Focuses on providing education, complete care in emotional, spiritual, and physical health of pregnant women and their families:

No comments: