North American • Midwives • Registry of Midwives news of North America Providing certification standards for Volume VIII, Issue 1, Winter 2005 Certified Professional Midwives •• — Interview with Kristie White: The 1000th CPM!

by Robbie Davis-Floyd Kristie, why did you decide to become a midwife? ••SUPPORTER Inside This Issue Well, I have always been very passionate about women’s issues, especially sur- rounding women and their children. It always seemed so natural to have chil- Interview with Kristie White: The 1000th CPM! ...... 1 dren, breastfeed them, and love them. I decided to become a midwife after the Tribute to Carrie Abbott ...... 2 birth of my third child. I had had hospital births with my first two children. The second birth was very traumatic for me because I was treated very badly by hospi- Heeding Women’s Call: An Interview with Maggie Bennett, CPM ...... 3 tal staff. When I became pregnant again, I Catch the vision of ...... was completely devastated at the idea of hav- The Future of Birth ...... 4 ing another hospital birth so I began looking Results of National Study of Vaginal Birth for options. I found out about midwives and after Cesarean in Birth Centers . . . . 5 began prenatal care with a wonderful midwife A Critique of NACC VBAC Study . . . 5 in California. I had a beautiful home birth. Legislative News: During that pregnancy I had to really fight to get insurance coverage for the birth. I even Moving the CPM Credential Forward through Midwifery Legislation . . . . 7 went to an administrative hearing over the Texas News ...... 8 matter. I realized how unfair it is for women that we cannot choose out-of-hospital birth Pennsylvania News ...... 8 without paying out-of-pocket. After the deliv- Utah News ...... 8 ery, I knew this was what I wanted to do and Legislative Conference Calls ...... 9 a year later I moved to Miami to go to mid- Midwife Needed in Virginia ...... 9 wifery school. Committee Reports: Applications Department Year End What educational routes did you choose into midwifery, and why? 2004 Report ...... 10 Change in Policy for MEAC Graduates10 I had looked into nurse-midwifery as an option because I wanted to start my Testing Department Year End 2004 Master’s degree and I also knew that employment options would be more readily Report ...... 11 available. I chose to become a Licensed Midwife instead because the concept be- Treasurer Year End 2004 Report . . 12 hind the program was down-to-earth and back-to-basics. That’s really how I am Accountability Committee Year End on the inside and I appreciated that philosophy of midwifery care. 2004 Report ...... 13 After many conversations with Justine Clegg, director of the Miami-Dade program, I decided to make the move to Florida. Upon arrival I was embraced by Notices & Announcements: many wonderful and experienced licensed midwives—Leticia Juan, Corina Fitch, NARM Workshops ...... 14 Deborah Stein, Sharon Hamilton, Janis Heller, and Joni McCann, as well as The Quality Vital Statistics Alliance 15 Diann Gregory, CNM. Related Organizations: What is important to you about becoming a CPM? What do you see Midwifery Statistics ...... 16 Report from CfM ...... 17 as the significance of the CPM for you and in a larger sense? NACPM News ...... 18 I became a CPM with the hope that one day it would be our nationwide certifi- Preceptor Survey ...... 18 cation, equating to state licensure to practice midwifery as for CNMs today. I MANA 2005: Standing Tall, Growing Together ...... 20 think midwives are under-utilized in this country. The medicalization of birth has — — — — CPM News — — served our patriarchal nation well as it •• keeps women unfamiliar with their — Tribute to Carrie Abbott bodies and their strength. By oppress- CPM News ing midwives, the country oppresses On Sunday February 20, Carrie CPM News is a newsletter of the those who can and always have acted Abbott passed away from cancer. Car- North American Registry of Mid- as agents of empowerment to women. rie served for many years and in vari- wives (NARM) published twice a Nationwide acceptance of CPM licens- ous capacities in MANA and NARM, year, Winter and Summer. We wel- ing along with federal laws that guar- and as a midwife in Utah. She dedi- come submissions of questions, an- antee provider status to licensed CPMs cated her life to her children and her swers, news tips, tidbits, birth art, would give midwives the muscle we momma’s, and had friends all over the photographs, letters to the editor, etc. need to start making changes and get- country. Carrie will be sorely missed Deadlines for submissions are De- ting the message out that there are op- by the midwifery community, however cember 1 and June 1. Send all news- tions when it comes to pregnancy and she spoke often of how she missed her letter material to: Joanne Gottschall, childbirth. husband (who passed a way a few years 200 N. Jasper Avenue, Margate, NJ ago), and how she couldn’t wait to be 08402 or [email protected] Now that you are a CPM, how with him again. The views and opinions expressed and where do you plan to prac- by individual writers do not necessar- tice? ily represent the views and opinions of NARM. For now, I plan to stay in Miami. I am at the beginning stages of my own ••practice. I also will soon begin work- Contact Information ing on my PhD in International Rela- tions. I am also very interested in pro- NARM General Information moting midwifery and would like to (or to order How to Become a CPM) work on increasing and protecting our 888-842-4784 rights to practice in the United States. Fax: 404-521-4052

Applications & Recertification: NARM Applications Department: P.O. Box 420 If you would like to send a note, her Summertown, TN 38483 daughter Randa’s address is 1160 Sego — Lilly Dr. Sandy, UT 84094. NARM Board Debbie Pulley, CPM 5257 Rosestone Drive CPM News Alerts Lilburn, GA 30047 888-842-4784 [email protected] NARM now offers you the option of receiving the newsletter via the internet to save financial and envi- Test Department information: Ida Darragh, CPM ronmental resources. If you would like to try this PO Box 7703 out, go to www.narm.org/cpmnews.html and open Little Rock, AR 72217-7703 the pdf file. You can print it or save it. 888-353-7089 If you would like to receive an email notify- [email protected] ing you that a new issue of the CPM News is now CPM News Editor: available online in lieu of a paper copy, send your Abby J. Kinne, CPM name, mailing address and email address to 58 South Center Street [email protected]. West Jefferson, OH 43162 614-879-9835 [email protected] — — — 2 NORTH A MERICAN REGISTRY OF MIDWIVES, WINTER 2005 — Maggie Bennett Sage Femme — ••— I saw that the train was pulling out of Heeding Women’s Call: the station and going faster and faster An Interview With Maggie Bennett, CPM down the track. So, I jumped on board at the last minute and passed the Cali- fornia Certification. I was the Chair- by Robbie Davis-Floyd woman of the California Association When, how, where, and why did you become a midwife? of Midwives during the development of Like many of my contemporaries, I became a midwife through my experiences the Certification Process and years as a pregnant woman. My husband and I planned a homebirth with novice leading up to the passage of our licens- birth attendants. We belonged to an organization called Birthcenter, which met ing legislation in 1993. I have great to share experiences and give advice to folks who were planning to birth at home respect for midwives who refuse to get without professional help. The first time I attended a Birthcenter meeting I had a licensed for political reasons. But I cosmic experience. My recollec- loved achieving my Birthcenter Certifi- tion is of incredibly beautiful cate, I felt recognized by my peers women in flowing dresses, backlit when I got my California Certifica- by the sunset pervading the tion, and I have grown to love my li- room. I knew I would do any- cense to practice midwifery in this thing to be with these and other state. Being able to participate in the women. I was impassioned to be activism that led to the writing and with them in birth. I became a passage of our law was a great gift in midwife because of this pivotal my life. The truth is, a relatively small experience in my life. These group of women wrote a certification women, whose names I no longer process, created a model of legislation know, but whose image is indel- that was adopted by a senator, rallied a ible in my memory, were my call- consumer group, and managed to nego- ing to midwifery. tiate with the government of a really I stepped onto the birthwork big, conservative state and get a law path in 1975. During the next passed that has made it better for four years, I worked with a num- women and families in our state. It is ber of women and men of the corny, I know, but I learned from some Birthcenter as we recreated safe amazing women that participation in and sensible ways to manage to our form of government can sometimes birth at home. We created a study work! path for ourselves and later trained other women. We did not call ourselves mid- wives for a few years, nor did we charge money at first. We were part of the do-it- What forms has your midwifery yourself, power-to-the-people movement and were pretty anti-professional any- activism taken, and why did you thing. The basis of our community effort was primarily education. For many become an activist instead of years parents who came to our classes and ultimately invited us to their births just focusing on practice? learned really basic midwifery skills such as how to deliver a breech baby, how to resuscitate a baby, and how to stop a hemorrhage. We always emphasized that At a certain time, we needed to have homebirth was do-able and that our history was grounded in parents being able a person who didn’t offend anyone too to birth on their own. much and who could get people to see It was only after years of going to births that I taught a class in which three a common vision and pull our organi- couples planned to birth alone. I was very concerned for them all. It was then zation together. I was the one. Just as I that I realized that I had crossed some invisible line and had become a profes- was called to be a midwife in my com- sional midwife. I knew that my presence at birth made success and harmony munity, I was called by my midwifery more likely. I realized that great parent education and sense of responsibility community to play a certain needed to be matched by the presence of a wise and experienced midwife. role. There are brilliant women who organized CAM and designed the origi- Did you support legalization and licensure for midwives in Califor- nal certification model. Word-mis- nia? If so, why? tresses wrote our law and communica- tion pros negotiated with the medical At first I did not, because I realized that licensure meant government control. board and the legislature. The job I got However, I am a fairly smart cookie and realized I would be getting left behind. — — — WINTER 2005, NORTH A MERICAN REGISTRY OF M IDWIVES 3 — CPM News —

was to be present with all of them rep- — what went wrong in my own birth ex- — be sure that no woman in my care resenting the vision we all shared. perience. My first birth, in a hospital, would ever have an unnecessary c-sec- was a beautiful, orgasmic experience, in tion. I love it still when I know I You have been observed doing spite of the fact that I was alone, sur- helped a woman beat the knife. I love art at MANA meetings. Also, rounded by cold personnel and turning babies, catching twins, or help- strapped down on a delivery table. My many of us own copies of your ing women have VBACS. There has al- second birth at home, with a partner ways been a new thing to learn, a new work. What does art mean to who loved me, friends who supported skill to acquire and a new fear to be you? me and a serious vision should have faced. These challenges keep me been amazing. Instead, I had a interested. Mostly though, it is the I was born an artist. It is my gift. I planned cesarean because my doctor women themselves. I worship women have a Degree in Fine Arts from the said my baby was too big to be born. I still. I love their growing bodies, their University of Illinois and did post- was made vulnerable by motherhood growing sense of self, and the privilege graduate work in printmaking at Long and disempowered by his fear of my of being present with them as they find Beach Sate. I taught art for nearly fif- having a homebirth. I spent years un- their way through the unique challenge teen years and had overlapping careers derstanding cesarean birth in all its that labor and birth present to each for about seven years before I gave up political and private permutations. My mother. teaching for a total midwifery practice first goal as a fledgling midwife was to — in 1987. I am sorry to say I was such a fa- •• natic about midwifery that I put my art Catch the vision of...The Future of Birth work on hold for many years, only making an occasional painting when something inside of me erupted and •Michel Odent, MD, OB, author of “Birth Reborn“ & “Water Babies” couldn’t be denied. I had a turning- •Ina May Gaskin, CPM, Author of “Guide to Childbirth” point conversation with an artist •Heidi Reinhart, MD, OB and Rudi Fedrizzi, MD, OB friend who also makes quilts. She men- former birth center physicians tioned that she had made 300 quilts of •And other birth Visionaries different sizes at a time when I had been to about 300 births. I realized that if I had painted as many paintings April 30 - May 2, 2005 as I had been to births, I would be a in Columbia, Missouri pretty good artist. So I decided it was time to tie the threads of my life to- TOPICS FOR ALL PROVIDERS gether—that my midwifery should in- AND FRIENDS OF BIRTH form my art and my art should reflect what I believe about women and ”The Future of Birth-Opportunities birth. So, I am on a mission to create for the next 20 years” at least 300 paintings. I want to be a really good artist by the time I am ”New Reasons and New Ways to done and a really good midwife also. I Study Birth Physiology” love that lots of people actually collect my work—that is very inspirational. I ”The First Hour Following Birth- rarely sell the originals, because I love Bonding and Breastfeeding:” the idea of multiple images being dis- played all around the country. (My ”The Scientification of Love”-Odent’s book printmaking background!) on birth’s power to save civilization

What draws you on year after ”Birth Centers-A Safe Home for Midwifery” year? In the beginning, I just wanted to For More Information: find out what made birth work, to un- www:wholehealthcolumbia.com or derstand the physiology behind the (573)445-0100 miracle. Then I wanted to understand — — — 4 NORTH A MERICAN REGISTRY OF MIDWIVES, WINTER 2005 — —

•• Results of National Study of Vaginal Birth After Cesarean in Birth Centers Ellice Lieberman, MD, DrPH1, Eunice K. Ernst, CNM, MPH2,3, Judith P. Rooks, CNM, MPH4, Susan Stapleton, CNM, MS5 and Bruce Flamm, MD6 From the 1Department of Obstetrics and — METHODS.: We prospectively col- — CONCLUSION: Despite a high rate Gynecology, Brigham and Women’s Hospital, lected data on pregnancy outcomes of Boston, Massachusetts; 2National Association of vaginal births and few uterine rup- of Childbearing Centers, Perkiomenville, 1,913 women intending to attempt tures among women attempting VBACs Pennsylvania; 3Frontier School of Midwifery VBACs in 41 participating birth centers in birth centers, a cesarean-scarred and Family Nursing, Hyden, Kentucky; between 1990 and 2000. 4 uterus was associated with increases in University of South Florida College of Public Health, Tampa, Florida; 5Reading complications that require hospital Birth and Women’s Center, Reading, RESULTS: A total of 1,453 of the management. Therefore, birth centers Pennsylvania; and 6Department of Obstetrics 1,913 women presented to the birth cen- should refer women who have under- and Gynecology, University of California, ter in labor. Twenty-four percent of gone previous cesarean deliveries to Irvine, California. them were transferred to hospitals dur- hospitals for delivery. Hospitals should Address reprint requests to: Ellice Lieberman, ing labor; 87% of these had vaginal increase access to in-hospital care pro- MD, DrPH, Department of Obstetrics and births. There were 6 uterine ruptures vided by midwife/obstetrician teams Gynecology, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115; e-mail: (0.4%), 1 hysterectomy (0.1%), 15 in- during VBACs. [email protected]. fants with 5-minute Apgar scores less than 7 (1.0%), and 7 fetal/neonatal LEVEL OF EVIDENCE: III OBJECTIVE: Some women wish to deaths (0.5%). Most fetal deaths (5/7) avoid a repeat cesarean delivery and be- occurred in women who did not have For more information go to lieve that a midwife-supported vaginal uterine ruptures. Half of uterine rup- www.greenjournal.org: VOL. 104, NO. birth after cesarean (VBAC) in a non- tures and 57% of perinatal deaths in- 5, Part 1, November 2004 hospital setting represents their best volved the 10% of women with more Please monitor the Green Journal chance to do so; there is a small, persis- than 1 previous cesarean delivery or website for editorial responses from tent demand for out-of-hospital VBACs. who had reached a gestational age of 42 Susan Hodges (CfM), and Ken Johnson We conducted a study to obtain the weeks. Rates of uterine rupture and fe- and Betty-Anne Daviss. data necessary to formulate an evidence- tal/neonatal death were 0.2% each in based policy on this practice. women with neither of these risks. ••— — A Critique of the NACC VBAC Study By Susan Hodges The recently published “VBAC in — with increased risks to the baby com- — choice for women with prior cesarean Birth Centers,” (Lieberman et al, Ob & pared with VBACs after only one cesar- deliveries,” and the strongly stated rec- Gyn. Vol. 104, No. 5, Nov. 2004) has ean section or less than 42 weeks gesta- ommendation that no VBACs should provided some good information about tion. This is important new informa- take place in birth centers. I have read the safety of VBACs. In my opinion, tion that should be made available to and reread the paper, and I just do not however, the data did not at all support both mothers and caregivers. The Con- see how the data presented support, jus- the authors’ conclusion that “out-of- clusion section also pointed out that tify or make a case for this conclusion hospital birth is not safe for first cesarean sections should be and recommendation. womenwith prior cesarean deliveries” avoided, although this was not men- The comparison of birth center (BC) or the recommendation that no VBACs tioned in the abstract. VBACs and hospital VBACs in the take place outside the hospital. The paper should have just reported studies cited did not demonstrate that The results of the study actually the findings of the study, noted that hospitals overall are safer for all showed that birth centers work really further research is needed for verifica- women with a prior cesarean or even well for VBACs. The success rate was tion and to determine the causes be- for their babies. The primary basis for high, transports were made appropri- hind the observed results, and suggested the conclusion that BC VBACs are ately, and the data strongly suggested that women be advised of the findings “not safe” was the comparison of BC that “large babies” do not appear to as part of informed consent. VBACs with several selected hospital pose added risk for uterine rupture. Unfortunately, the paper did more VBAC studies that were somewhat simi- The data did strongly suggest that than just report the findings. Of great- lar to birth centers in their VBAC man- VBACs after more than one cesarean, est concern is the strong statement that agement practices. Data were not pro- and after 42 weeks, were associated — “out-of-hospital birth is not a safe — vided addressing whether or not the — — WINTER 2005, NORTH A MERICAN REGISTRY OF M IDWIVES 5 — CPM News —

differences in perinatal mortality were — the paper “advises” that no VBACs — the remaining three, two had more statistically significant. What was should take place in birth centers. For than one prior cesarean section. found was a possible increased risk this advice to be valid two additional Therefore, among the reported 1271 only for perinatal death for VBACs in assertions must be true, assertions that women who were both less than 42 birth centers compared ONLY to hos- are very significant but not stated. One weeks and had had only one cesarean pitals that offer VBAC, and, in the assertion is the conclusion: For babies section, there was, in fact, only one studies cited, have one or more of the of mothers with prior cesarean sec- death likely attributable to the cesarean following: extensive midwifery tions, any hospital in the country is scar, for a perinatal mortality rate of program,VBAC policy of no induction, safer than any birth center. The data 0.7/1000. We cannot tell from the pa- no augmentation and/or no restric- reported in the study clearly do not per if this is statistically significantly tions on gestational age. We know that support this statement, since the data different from the rates reported in the such policies are rare in hospitals to- from only a few selected hospitals that hospital studies, an essential question day, and that many hospitals do not offered and supported VBACs was for events occurring at such a low fre- “allow” VBACs at all in which case all used. The second assertion is the value quency. There is a good chance that prior cesarean section mothers are sec- judgement: ANY risk to the fetus or the risks, very low to begin with, are tioned. It would seem to me that before baby is always more important than the same. The data from this one study any one can declare that no VBACs are any risk to the mother. This is neither simply do not support the authors’ as- “safe” in birth centers, one must com- acknowledged as a value judgement nor sertion that NO VBACs at all should pare VBAC outcomes in birth centers supported in any way by the data pre- be in birth centers on the basis of the with outcomes for women with prior sented in the paper, nor is it legally risk regarding perinatal mortality. Even cesarean sections in hospitals in gen- valid. Furthermore, it essentially re- including women with 2 prior cesar- eral including those that induce, aug- duces the mother to a baby-container eans and women past 42 weeks, the ment, restrict by gestational age, don’t whose present and future health and risk for the baby is the same as the re- have midwives, or don’t allow VBACs well-being are not valued. The serious ported and accepted risk of fetal loss at all, since these are the conditions problems with these two assertions un- due to amniocentesis. Many women women with prior cesareans will find dermine the validity of the paper’s con- deciding to undergo amniocentesis are as the alternative to a birth center. clusion and recommendation. balancing the risk to the fetus with The primary criterion for “safe” in For me, this paper raises the ques- other risks and their own fears. What is this study appears to be focused only tion: what is “safe” enough? In the different about women who have had a on the issue of perinatal mortality. VBAC study, there were seven perinatal prior cesarean section, especially when However, “safety” involves more than deaths, two of which clearly were not they fall into the lower risk group re- this one outcome and more than just caused by having a scarred uterus. The ported on in this paper? Should these the outcome for the baby. The paper fact that these two babies died possibly women not have the opportunity to did point out that the VBAC success was related to the births taking place in weigh the risks and benefits of birth rate is considerably higher for BCs a birth center, but this risk also would center vs. hospital and make their own than for hospitals. The paper did not be experienced by all non-VBAC births decision? address the short- and long-term risks in birth centers with the circumstances The authors did not demonstrate that of adverse outcomes for mothers and of these two births, so these two should there was any statistically significant babies resulting from additional cesar- not reasonably be included as part of difference between VBAC outcomes in ean sections that would occur in hospi- an added risk due to prior cesarean. birth centers and VBAC outcomes in tals with their lower VBAC success rate Looking only at perinatal deaths that hospitals that support VBACs. They (or no VBACs at all). The increased are or might be associated with the certainly did not demonstrate that any risks of death, infection, injury, etc. for scarred uterus, we find five in 1453, or hospital is safer for VBAC than any both mother and baby, in this birth 3/1000, a rate the same as the average birth center. Strong recommendations and in future pregnancies, must be in- national risk of fetal demise for amnio- that limit women’s choices regarding cluded in any consideration of overall centesis (eOb.Gyn.News. July 1 2002 maternity care and virtually condemn “safety.” So, the conclusion that VBACs • Volume 37 • Number 13), a rate them to serious abdominal surgery are not safe in birth centers must at the that is considered so acceptable that should never be made on the basis of a very least be qualified as possibly “less women are expected to make their own single study, especially one that does safe” for the baby, while lack of “safety” choices regarding this test. Going not even have good evidence to support for the mother was not demonstrated. back to the VBAC study data, of the its recommendation. Birthing women Based on this assertion that “out-of- five perinatal deaths that are or might deserve better. hospital birth is not a safe choice for be associated with the scarred uterus, women with prior cesarean deliveries,” two were more than 42 weeks, and of — — — — 6 NORTH A MERICAN REGISTRY OF MIDWIVES, WINTER 2005 — Legislative News — •• Moving the CPM Credential Forward through Midwifery Legislation

Nineteen states license direct-entry — confirmation. Congratulations go out — wifery is the practice of medicine and midwives using all or part of the to the Utah midwives! replace it with a statement that the NARM process. Thirteen states with Wyoming has submitted a bill to POM law will not prohibit a mother licensure programs that predate the exempt direct entry midwifery from the from giving birth in the setting and CPM have adopted the NARM written Medical Practices Act and provide for with the caregiver of her choice. We examination as the state licensure registration with apparently no regula- have no updates on the status of this exam. Six states that have passed recent tion as long as midwife clients are seen bill. legislation have adopted the CPM cre- by a physician at least twice. The bill Midwives in Alabama, Illinois, dential as the eligibility criteria for li- has passed the House and is being re- Georgia, Ohio, and Connecticut are censure. Each year, more states work viewed by the Senate where it is consid- drafting legislation this year, which toward passing legislation to permit or ered “controversial.” may or may not progress toward sub- license direct-entry midwifery using the Wisconsin has a bill in the hands of mission to their respective legislatures. CPM as the basis for eligibility. The a sponsor who is getting ready to take Their plans will continue to move the NARM Board stays in communication it into the legislative process. After a legislation forward into next year’s ses- with all of these states to offer advice scurry of activity in the fall, the mo- sions. Illinois is also working on get- and to insure that the CPM is repre- mentum has slowed a bit at the request ting a resolution in support of direct- sented accurately in any proposed legis- of the sponsor. Unlike many states, the entry midwifery. lation. Wisconsin legislature meets year Midwives in Kansas, and Indiana This has been a very active year for round, so there is no particular hurry have been working on the legislative legislative activity related to the CPM about the progress of the bill. Support- process but have not drafted or submit- and midwifery. Midwives in thirteen ers of the bill feel optimistic about ted recent legislation. Successful legis- states have been discussing licensure their chances this year, but are ready to lation usually takes several years to legislation, and many have taken de- work on it next year if necessary. pass, and it takes a lot of work from finitive steps toward seeking licensure Massachusetts has submitted a bill midwives and consumers before a bill for direct-entry midwives using the to create a board to license both is actually proposed. Hopefully, these CPM credential as the basis for licen- CNMs and CPMs. The bill is stalled states will continue to work on the sure. The most progress has been seen over issues of funding, as are many — process in 2005. in Virginia and Utah, the states that bills in MA this session. It is came quite close to passing licensure the only live bill this year that legislation last year. Updates come on will establish a joint board for a daily basis, and this information is both CNMs and CPMs and is correct at the time we go to press. By supported by both groups of the time the newsletter is in your mail- midwives. It would have a box, the outcomes in Virginia and good chance of passing if not Utah, and possibly other states, will be for budget constraints. known. Check NARM’s website for Nebraska submitted bills to final details. permit CNMs to attend home Virginia legislation has passed the births and to license CPMs. House and Senate committees and Both bills have stalled in com- floor. As of this writing, it is sitting mittee and probably will not on the Governor’s desk for final con- move further this year. firmation. Eight years of hard labor South Dakota submitted a have finally paid off in Virginia! licensure bill but it was re- Utah legislation will offer voluntary jected by the senate committee. licensure for midwives who want to Missouri submitted a bill carry specific medications but will ex- intended to exempt direct en- empt all direct-entry midwifery from try midwifery from the Medi- the Medical Practices Act. This bill has cal Practices Act. The bill also passed the House and Senate and would remove the specific lan- is on the Governor’s desk for final guage that states that mid-

— — — WINTER 2005, NORTH A MERICAN REGISTRY OF M IDWIVES 7 — Legislative News —

••me that (judging by the reactions on — mom (in PA) who was attempting a Texas News — the faces of the TMA members present VBAC to the hospital because the mom Beth Overton, CPM at these meetings) they were caught elected to go. President, Association of Texas Midwives completely off guard by all of this In August of 2004, Karen was sum- The Texas Sunset Commission meet- news. I am sure we can expect opposi- moned by the Commonwealth of Penn- ings were held in Austin on Dec 14th tion during the legislative session to sylvania Bureau of Professional and and 15th, 2004. this new bill. However, it will be inter- Occupational Affairs to a hearing to The Sunset Commission voted esting to see exactly how TMA chooses show cause of practicing midwifery *unanimously* to present a bill at the to oppose us in light of the support we without a nurse midwifery license. next legislative session which will in- currently have from these legislators. Karen acted as her own attorney and clude the following: They are also less likely to fight us as even brought a witness to testify who much since the medical members of the cited the 1990 Fornelli ruling in the • Change the title of all Texas’ board were left in place with this pro- Lucille Sykes case. midwives to ”Licensed Mid- posed configuration of board member- In December of 2004, Karen received wives” (currently “Documented” ship. a notice of withdrawal to show cause. midwives) and remove any refer- The final Sunset report should be The notice stated, “The practice of mid- ences to “Documented Mid- published at the following web link wifery is not limited to individuals wives” from our Act. (although last I checked it was not yet holding a nurse midwife license. “ • Remove the current language in published). For more details contact Karen Carr our Act that says only one mid- http://www.sunset.state.tx.us/79.htm @ (410) 467-4586. wife board member may be a “li- censed health care professional”. We owe a BIG thank you to Roland •• • Change the Midwifery Board Leal for a really great job at talking to Utah News membership to consist of 5 Li- these legislators on our behalf over the Suzanne Smith, CPM censed Midwives, 1 OB/Gyn, 1 past few months. He is doing a really pediatrician or family practice good job on our behalf. We also owe After an intense battle, the Direct- doctor with knowledge of pedi- thanks to various ATM and TfM mem- Entry Midwife Act finally passed the atrics, and 2 public members bers who have volunteered time in Aus- Utah legislature and is awaiting the sig- (one of which must be a mid- tin and in other ways to help educate nature of the governor. It was four wifery consumer). This configu- the Sunset Commission about our is- years in the making, and it all came ration will give our board a ma- sues and concerns. We still have a lot down to a single vote. A hostile sena- jority representation of its licens- of work ahead of us but we can at least tor tried and temporarily succeeded in ees (midwives). [Note for those go into the 2005 legislative session on substituting his own gutted version of not familiar with the Texas Mid- more a positive note. the bill, but our sponsor managed to wifery Board: The current con- Roland tells me that when/if these get it reversed the next day and the figuration of our board is 3 changes are made law, the earliest we original bill passed 15-14 during the documented midwives (only one could expect them to be put into effect last three hours of the session on of which may be a licensed is in September of 2005. But first we March 2, 2005. We are so grateful to health care professional), 1 OB/ must get through the upcoming legisla- all the legislators, midwives, students, Gyn, 1 pediatrician or family tive session. friends, relatives, everyone who contrib- practice doctor with knowledge Please check the ATM website http:// uted to achieving this monumental of pediatrics, one Certified Nurse texasmidwives.com/legislative_info.htm feat. Midwife (CNMs are not regu- for ongoing updates. We will try to up- So what does this mean for the mid- lated by this board) and 3 public date the site on a regular basis for your wives of Utah? All midwives, as of members (one of which must be benefit and also send out emails when May 2, 2005 when the bill takes effect, a midwifery consumer).] there is breaking news. will be able to legally provide prenatal, Association of Texas Midwives: intrapartum, postpartum, newborn, We should all work diligently to sup- www.texasmidwives.com and limited well-woman care (includ- port this bill because it addresses the ing pap smears and diaphragms). We issue of licensure of midwives and be- will be able to order lab work and ul- cause it gives us a majority representa- ••trasounds, recommend herbs, tion on our board (something we have Pennsylvania News homeopathics, foods, etc., resuscitate a never had before)! Roland Leal (our leg- In August of 2003, Karen Carr (a newborn with oxygen, in short, do the islative consultant and lobbyist) told CPM from Maryland) transported a things midwives need or want to do, — — — — 8 NORTH A MERICAN REGISTRY OF MIDWIVES, WINTER 2005 — —

all without a license and without regu- — ing the development of a bill and/or — bursting with many young families lation. the process of obtaining support within and pregnant couples. It is even joked If a midwife wants to legally use the midwifery community, the con- that the pure clean water of our area is medications besides oxygen, however, sumer community, and the legislative bound to get you pregnant. Many she must license. Requirements for community. Local midwives will share couples in the area are wanting to have licensure are the CPM plus an ap- information about what is happening homebirths. There is only one other proved pharmacology course. Medica- in their state and receive constructive CNM servicing our county, who also tions all licensed midwives can use feedback and new ideas from people services eight other counties, and is are: oxytocin (protocol written into who have been involved with midwifery completely booked. She can’t service all the bill), Rhogam, vitamins, eye oint- legislation on state and national levels. those in need. Many couples feel dis- ment, vitamin K, sterile water, and oxy- This will be a good starting point for couraged from having the homebirths gen. Licensed midwives may obtain those considering legislation in the they were hoping for and feel that hos- and administer any other drug as long next year or two or be a strategy ses- pital care may be their only option. as a licensed health care provider who sion for those who have a bill currently We are calling out to all midwives can legally prescribe that drug approves in the legislative process. who might be interested in opening a it. If an unlicensed direct-entry mid- If midwives and/or midwifery advo- practice within our area. There would wife uses medications, the crime has cates in your state are considering leg- be plenty of work for you. The rate for been reduced from a 3rd degree felony islation and would like to talk with services in the area is about $2500 per to a class B misdemeanor. members of the above boards (and birth. There are three hospitals in the The midwifery board is independent other key people this group feels may area for back up assistance. CNMs are (not under the Medical Board), consist- be able to provide helpful contribu- legal in VA, and legislature is now ing of four licensed direct-entry mid- tions to the conversation), please call making progress to legalize CPMs. wives and a member of the public. Debbie Pulley, MANA Legislative The state legislature voted on January There is no physician supervision of Chair, at 888-842-4784. Please be pre- 25. In the past we have had lay mid- midwives, licensed or not, under the pared with the names and phone num- wives service the area with an under- Utah law. bers of two or three midwives (or activ- cover profile. As of January 15, two We estimate the licensure portion of ists) on your legislative committee and OBs have closed up their practices, a the bill will take a year to 18 months a few possible dates for the phone call. third seems to also be leaving. Women to implement. If you want to read the The legislative calls are usually on Sun- are receiving care through the Health bill, you can find it at: day night, but other arrangements may Department, with no prospect at this http://www.le.state.ut.us/~2005/ be possible. It would also help the time for a homebirth. I know of sixteen htmdoc/hbillhtm/hb0025.htm committee if you could email or fax pregnant moms currently in this situa- your draft bill if you have one, to tion. We are welcoming anyone with • [email protected] or 404-521-4052. midwifery training that would feel Legislative Conference comfortable attending births in the ••area. Calls Midwife Needed in Our community is so longing for Is your state working on legislation? such care that we would be willing to Never drafted a bill before? Are you Virginia help with relocation expenses and help considering legislation? Do you know find appropriate housing (which ranges where to start? Do you have questions Hello! I’m writing you from Floyd from $300-$500 per month for a nice on how to proceed? We might have County, Virginia. Floyd is a very beau- rental.) some answers for you. tiful area nestled in the Blue Ridge The Joint Boards of MANA, MEAC, Mountains. It is a very scenic and ru- If you are interested, please feel free to NARM, and CfM invite all midwives ral area with easy access to Roanoke, respond. Thank you for your time! and midwifery activists in states con- Blacksburg, Christainsburg, and sidering or pursuing legislation to a Radford. Our community is very Happy Birthing, conference call. Representatives of the friendly and conscious. It is an area Joint Boards will join a call to discuss filled with arts, craftspeople, lots of Meredith Klein midwifery legislative issues with two or music and liberal minded folks. There PO Box 249 three midwives and activists from a is a lot of access to organic foods and Floyd, VA 24091 state working on legislation. They can alternative healthcare. Our community discuss their current progress (or lack lately is at a great loss for our beloved phone 540-789-2013 thereof) or any other issues surround- midwife has retired. Floyd County is email: [email protected] — — — — WINTER 2005, NORTH A MERICAN REGISTRY OF M IDWIVES 9 — Committee Reports —

••tification by submitting the recertifica- NARM Applications Year End 2004 Report — tion form and fees ($150.00, 25 con- tinuing education hours, five hours of Carol Nelson, LM, CPM-TN, Director of — partment, can look in the recertifica- peer review, plus the recertification Applications, Summertown, TN tion Table, should a CPM want to form documentation). A letter will be In the year 2004 the NARM Applica- know their status, or if the recertifica- sent to all inactive CPM’s to remind tions Department received a total of tion information has been sent to the them of their inactive status coming up 131 applications. In 2003 we had re- Certification Department for process- for renewal. ceived 72 applications. ing. A notice letter is sent to all CPMs There were 235 applications sent out to remind them that their CPM Cre- Expired CPMs dential is coming up for recertifica- to people requesting application pack- CPMs whose certification has been tion. ets. expired for more than 90 days, or who There were 57 candidates who took have not declared inactive status, will TABLE OF COMPARISON the February written exam, 11 were re- be given expired status and will be re- 2004 173 taking the exam and 7 candidates wait- quired to follow the new policy on re- 2003 126 ing to take their skills exam. activation in order to be recertified. 2002 143 There are 8 application files waiting All of NARM’s policies regarding re- 2001 148 for some piece of information, i.e. ref- certification, certification status, or 2000 72 erence letters, current CPR cards, tran- reactivation are available on the web at script or diploma etc. to complete their Inactive Status www.narm.org CPM application. As of January 1, 2005 we had 28 There are 40 files where we have re- people take advantage of the new inac- Finances ceived information (reference letters, tive status. The Applications Department re- transcript or diploma etc), but so far Inactive CPMs will continue to re- ceives fees for application packets, have not received the CPM application. ceive the CPM News and may recertify CPM applications, and recertifica- There are 7 applicants who have within a six year period. Inactive sta- tions. In 2004 a total of $124,130.00 passed their written exam and are wait- tus must be established within 90 days was processed through the Applications ing for their graduation from a MEAC of the CPM expiration, and is main- Department. accredited school. tained annually for up to six years. In- active status in renewed each year by Audits CPMs filing an intent to be inactive and a fee The Applications Department gener- 105 New CPM certificates were is- of $35.00. During this period, inactive ates random audits from applicants sued in 2004. CPMs will receive the CPM News and and CPM’s recertifying. Items required all NARM mailings, but may not use are Practice Guidelines, an Informed TABLE OF COMPARISON the CPM designation or refer to them- Consent document, forms and hand- Total number of CPM’s selves publicly as a CPM or as certified outs relating to midwifery practice and 2004 996 by NARM. During the six year period, an Emergency Care Plan. 2003 893 an inactive midwife may renew the cer- 2002 804 — 2001 724 2000 624 ••NARM Updates Change in Policy for Recertification MEAC Graduates Did you know you can find NARM updates on the The Applications Department now has a Recert Table to keep track of in- MEAC graduates must apply for webpage? coming and outgoing recertifications. NARM certification within three years It became necessary to create the addi- of graduation. If application for certi- Anytime there are any tional database table for the Certifica- fication is made after this time NARM changes or announcements, tion and Applications Departments to will require documentation of ten the information is immedi- check recertification information sent births, twenty-five hours of continuing ately posted to the web. Be and received between the two depart- education, and five hours of peer re- sure to check it regularly. ments. Additionally, Debbie Pulley, view within the three years prior to ap- Public Education and Advocacy De- plication submission. — — — 10 NORTH A MERICAN REGISTRY OF MIDWIVES, WINTER 2005 — —

•• Test Department Year End 2004 Report Ida Darragh, Director of Testing

Major Tasks of the Test Depart- — NARM Testing — year. All questions are reviewed again ment in 2004 included: The NARM Skills Assessment was by two teams of item writers. Final administered to 33 PEP candidates in reviews are done by the NARM Board. 1. Maintaining yearly renewal of 2004. The assessment was taken by NARM’s accreditation by the National candidates from 13 states, Canada, and NARM Participation in Commission of Credentialing Agencies one from Ireland who traveled to the NOCA and CLEAR (NCCA), the accrediting arm of the US to complete the NARM certifica- The NARM Test Department and National Organization for Compe- tion process. Board of Directors participates in the tency Assurance (NOCA). The NARM Written Examination national conferences of both the Na- 2. Presenting Item Writing Work- was given to 135 candidates in 2004. tional Organization for Competency shops at the MANA Conference in Eighty-two candidates were taking the Assurance and the Council for Licen- Portland, and in Wisconsin in Novem- exam to complete the CPM certifica- sure, Enforcement, and Regulation. In ber. Thirteen new Item Writers were tion process and fifty-three candidates 2004, Director of Testing Ida Darragh trained in 2004, bringing our current were taking the exam for state licen- attended the NOCA conference in Mi- total (since 2002) to 40 and represent- sure, though many who receive the ami in November, and the CLEAR ing 18 states. Questions are now being CPM apply for licensure and many conference in Kansas City in Septem- written and reviewed for Form I of the who receive licensure then apply for the ber and business meeting in New Or- exam, which will probably debut in CPM. Eleven states currently adminis- leans in January. In addition, Ida August of 2005. ter the NARM Written Exam as a state served on the NOCA Program Com- 3. Working with the CPM in states licensure exam. These states are Alaska, mittee, and on CLEAR’s Exam Re- considering licensure. Representatives Arkansas, Arizona, California, Colo- sources and Advisory Committee and from the NARM board spoke with the rado, Louisiana, Montana, New Credentialing and Examination Issues regulatory board in Rhode Island in Mexico, South Carolina, Texas, and Committee. January in support of the CPM as an Washington. An additional eight states avenue for licensure, and met with con- require the CPM or the Exam portion Goals for 2005 sumers and midwives in Wisconsin in of the CPM for licensure: Delaware, Test Department goals for 2005 in- November in preparation for their leg- Florida, Minnesota, New Hampshire, clude: islative work. NARM board members New Jersey, Oregon, Tennessee, and Ver- Training and working with more regularly participate in e-mail and tele- mont. NARM currently offers the Item Writers to create a larger databank phone discussion with midwives in Written Examination at the eleven state of test questions. states seeking licensure. agencies and at ten University Testing Continue working with NOCA and 4. Training and recertifying Centers in Florida, Idaho, Iowa, Mas- CLEAR, and maintaining our certifi- NARM’s Qualified Evaluators, who sachusetts, Maryland, Ohio, Oregon, cation with NOCA. administer the NARM Skills Assess- Tennessee, Utah, and Vermont. Revision of the Qualified Evaluators ment to the PEP candidates. Fourteen training manual and the Item Writer’s new QEs were trained, bringing our Test Development training manual. Presentation of Item total of active QEs to 66. Two item writing workshops were Writer workshops and Qualified Evalu- 5. Administering the NARM Skills given as part of the ongoing process of ator workshops. Assessment to 33 PEP candidates test development. Five CPMs attended Participation on the weekly NARM (more than twice as many as in 2003), the workshop at the MANA conference Board phone calls and annual meet- and the NARM Written Examination in October, and eight CPMS attended ings. to 135 candidates. the workshop in Wisconsin in Novem- Scheduling of NARM Skills Assess- 6. Attending the annual NOCA and ber. This brings to 40 the number of ments as needed, and of the NARM CLEAR conferences, and participating CPMs who have been trained to write Written Examination on the third on the NOCA Program Committee test questions since 2002. Test ques- Wednesdays of February and August at and the CLEAR Program Committee tions are written by teams during the regional sites and again at the annual and Credentialing and Exam Resources workshop and many writers continue MANA conference. Committee. to submit questions throughout the Arranging translation of Form H in Spanish. — — — — WINTER 2005, NORTH A MERICAN REGISTRY OF M IDWIVES 11 — Committee Reports —

••ganization for Competency Assurance NARM Treasurer Year End 2004 Report — (NOCA), Insurance, Office Expenses Carol Nelson, Treasurer and Supplies. We are looking forward to NARM’s The year 2004 was a good year for — cations Office and our Testing Com- continued growth and a balanced bud- NARM from a fiscal standpoint. We pany. Legal Fees to be sure we stay le- get in 2005. ended the year with money in the bank gally defensible, Printing, Postage, Tele- With the growth of our certification and all expenses paid. The certifica- phone, Conference and Exhibit fees process and more Certified Profes- tion process has taken a lot of finan- (educational booths at midwifery and sional Midwives each year, we feel hon- cial resources and continues to take other related organizations conferences ored to be doing our part to move mid- more as we grow in numbers. By the to promote CPMs and the Midwives wifery forward and to promote the time this newsletter comes out we will Model of Care), Dues/Membership in Midwives Model of Care. be over 1000 CPMs! NARM was in- organizations such as the National Or- — corporated in 1992 and to date we have spent over $1,360,000.00 on the Certi- •• fied Professional Midwife process. Our Meet the NARM Board of Directors total income for 2004 was $173,788.00. NARM’s main sources of income are from Test Sales and Applications. Ap- plications include requests for applica- tions, certifications, and recertifica- tions. Our income from the Applica- tions Department last year was $124,130.00. Test Sales are from the states that use the NARM written exam in their Licensures/Certification pro- cess. Income from the Test Department in 2004 was $41,145.00. Occasionally we will get a grant for a specific project such as the 1995 and 2001 Job Analy- sis. A Job Analysis every five years or so is necessary to remain state of the art in testing. We also have income from brochure sales, frames and re- tained income in 2003 that came to Left to right: Robbie Davis-Floyd (Public Member), Shannon Anton (Accountability), Joanne $8,513.00. Gottschall (Special Projects), Ida Darragh (Testing Department), Carol Nelson (Applications), Debbie As the Treasurer for NARM, I believe Pulley (Public Education and Advocacy), Sharon Evans (Policy Management) a balanced budget is the only fiscally responsible way to run our organiza- Who are the NARM Board of Directors? tion. We need to not only be balanced but we must think ahead to projects of Ida Darragh, CPM, LM Shannon Anton, CPM the future and be saving money for Board Chairperson Vice-Chairperson those projects. Another Job Analysis Testing Department Accountability in a few years is one such project. To remain state of the art in testing, this is Carol Nelson, CPM, LM Joanne Gottschall, CPM a must. Other projects include contin- Treasurer Special Projects ued work on our test such as Item Writ- Applications ing and Cut Score workshops, recertifi- Sharon K. Evans, CPM, CDM cation work with the Qualified Evalua- Debbie Pulley, CPM Policy Management tors and the Skills Assessment for a few Public Education & Advocacy examples. Secretary Robbie Davis-Floyd, Ph.D. Our expenses closely run the same as 1-888-84BIRTH Anthropologist/Writer/Editor our income. A few of our main ex- Public Member penses are: Consultants for our Appli- — — — 12 NORTH A MERICAN REGISTRY OF MIDWIVES, WINTER 2005 — —

••— •• NARM Board Remains Receptive What’s on the Website:

The NARM CPM credential was cre- — like to attend, contact NARM for de- ated during the Certification Task tails. Site Sections Force meetings. These meetings were Individuals wishing to submit pro- conducted over a three year period and posals or suggestions to the NARM participation remained open to all Board are encouraged to contact • Contact NARM midwives. Policies and guidelines for NARM in writing. Proposals may be the future of the CPM credential were made at any time. Attendance at a made by strict consensus process and NARM Board meeting is not required. • About NARM continue to guide the actions of the If you would like to serve on the NARM Board today. NARM Board or a committee, please • How to Become a CPM Continuing the spirit of open ac- contact us directly. The NARM Board countability, observers may attend welcomes your participation! NARM Board meetings. The NARM • Candidate Information Board usually meets in person twice a North American Registry of Midwives Bulletin year. The Board will meet for several 5257 Rosestone Dr. days prior to the MANA Conference in Lilburn, GA 30047 Boulder, CO this fall. If you would phone toll free 1-888-842-4784 • CPM Recertification — e-mail: [email protected] ••• CPM Inactive Status NARM Accountability Committee Year End 2004 Report • Policy and Procedures Shannon Anton, Director of Accountability — Mechanism, and the midwife’s CPM was revoked. • Professional Accountability NARM Accountability Committee One complaint originating in 2003 follows Peer Review and Grievance was potentially resolved in 2004 • Peer Review Mechanism policies and addresses through local peer review. The midwife complaints against CPMs. Legal advice was given four recommendations for is sought when appropriate. NARM improving her practice. • CPM State Information Board receives regular updates regard- Since the beginning of the CPM cre- ing the activities of Accountability dential in 1995, this committee has re- • OSU Testimony Committee. ceived eighteen formal (written) com- NARM accountability processes plaints appropriate for NARM ac- work to address concerns regarding countability processes. Three CPM cre- • 1995 Job Analysis competent midwifery practice. The dentials have been revoked; each of the NARM Board reserves the right to midwives faced at least three separate evaluate, at its sole discretion, the ap- complaints. • Application Deadlines propriate application of NARM’s Peer Two complaints remain on file and Review and the Grievance Mechanism. must be cleared before those midwives • CPM Stat Forms Complaints received by the NARM may apply for recertification. Board that do not involve issues relat- The outcome of two complaints ing to competent midwifery practice heard in Peer Review found no fault • CPM Newsletters Online will not be addressed through the Peer with the CPM; in one of these in- Review and the Grievance Mechanism stances the consumer was dissatisfied that NARM has established. with that outcome and filed a second www.narm.org In 2004 NARM received three com- complaint to initiate the Grievance plaints against a midwife who had pre- Mechanism. The outcome of the Griev- nism. Of those, three had their CPM viously received Peer Review recommen- ance Mechanism proceedings reached credentials revoked. dations in response to a 2002 com- the same conclusion. NARM has revoked three CPM cre- plaint. The NARM Board reviewed the Four midwives have had complaints dentials, one in 2000, one in 2003 and complaints using NARM’s Grievance that proceeded to the Grievance Mecha- one in 2004. — — — — WINTER 2005, NORTH A MERICAN REGISTRY OF M IDWIVES 13 — Notices & Announcements —

•• — Preceptor-Apprentice Relation- NARM Workshops — ships: This session is designed to meet the needs of both preceptors and ap- NARM can offer a variety of work- prentices and to help avoid common shops to be presented at state midwifery problems in the preceptor-apprentice association meetings or regional con- relationship. Discussion includes the ferences. If a minimum of 9 CPMs role and responsibility of the preceptor will attend the Test Writing workshop, and apprentice, advantages and disad- there will be no fees charged for any vantages to the apprenticeship model of workshops except the Qualified Evalua- education, avoiding common misun- tor workshop which has a $100 fee. derstandings between preceptors and Without the Test Writing workshop, administer the NARM Skills Assess- apprentices, and documenting the ap- there may be fees necessary to cover ment. This workshop is open only to prenticeship for the NARM applica- travel and lodging expenses. Continu- CPMs with at least 2 years and 30 tion process. ing Education credits will be awarded births additional experience beyond the for all workshops. For more informa- CPM. There is a $100 fee for the QE NARM and the CPM Process: tion, call 1-888-353-7089 or write workshop, but participants receive a This workshop explains the develop- [email protected]. copy of the new edition of the Practical ment of the NARM process and the Skills Guide for Midwives (a $60 value) requirements for CPM certification. The Test Writing Workshop can be and become eligible to administer the The session is designed for apprentices done as a 7-hour (full day) or 10-hour Skills Assessment, for which they are who intend to apply for CPM certifica- (evening and full day) workshop. paid $75. tion and for the preceptors who will The test writing workshop brings train them to meet these requirements. together groups of CPMs to discuss the The following 2-hour workshops are It is also a very valuable workshop for midwifery knowledge and skills that open to anyone: anyone who is interested in seeking are essential components of the prac- legislation to license midwives using tice of midwifery. Based on real-life Midwifery Ethics: In today’s mater- the CPM process as a basis for licen- experiences, teams of midwives craft nity services ethical issues are every- sure. Participants will become famil- scenarios related to problems they have where, and yet there is often a poor un- iar with all routes of entry into the encountered in prenatal, birth, or post- derstanding of how practitioners deal CPM process, how the criteria for certi- partum situations, research these sce- with them. Many qualified midwives, fication were determined, and how narios in the reference texts, identify while believing that they are ethical in each element of the process contributes the knowledge necessary to solve the their work and lives, might find it dif- to the reliability and validity of the cre- problem, and develop multiple choice ficult to define what this means in dential. answers to evaluate that knowledge. practice. We all have to make deci- Discussions are lively and stimulating, sions everyday with clients, other Charting: One of Your Most Criti- and participants find the process to be health care providers and our own cal Skills and Your Legal Defense rewarding on a personal and profes- families. While ethics is seen by some Midwives often view documentation sional level. Additionally, participa- as a theoretical issue, to be debated in as a necessary chore, but one that is tion by CPMs in the development of classrooms and at conferences, the ev- not as important as providing hands- test questions is integral to the reliabil- eryday import of ethical decision-mak- on care. Yet documentation is one of ity and validity of the Certified Profes- ing means that the theory-practice gap the most critical skills that a midwife sional Midwife credential. NARM needs to be bridged. Our exploration of will perform. Although we tend to ap- Certification was created by midwives, ethical midwifery is a critical reflection proach documentation casually, our for midwives, and is administered by of moral issues as they pertain to ma- entire career could depend on the accu- midwives on the NARM Board. The ternal/child health on every level. This racy and completeness of our charting. NARM exam is written by midwives, workshop explores the ethical issues How much should be charted and why? with focus on the practical aspects of that face midwives in today’s world, as In documenting, we need to keep in midwifery care and knowledge. Your well as strategies for resolving these is- mind the possible legal and ethical participation makes a better exam! Par- sues. Participants will discuss the ethi- complications, and the legal relevance ticipants must be CPMs. cal issues relating to accountability, of malpractice. Failure to document autonomy, confidentiality, informed appropriately has been a pivotal issue Qualified Evaluator Training: (4 consent, and the use of technology. in many malpractice cases. hours) This workshop trains CPMs to — — — — 14 NORTH A MERICAN REGISTRY OF MIDWIVES, WINTER 2005 — —

Preparing for Legislation: available •• as both a 2-hour workshop and a full — The Quality Vital Statistics Alliance day workshop. This workshop is for (QVS Alliance) midwives and consumers who are pre- Sharon K. Evans, CDM, CPM paring to lobby for legislation to li- cense midwives in their state. The 2- The NARM Board received a letter — ceived and analyzed, the survey will go hour workshop is an overview of the dated April 12, 2004, from the State out to all the states. Each state in the legislative process and lobbying strate- Registrar and Director of the Colorado pilot project is required to handle the gies. The full day workshop goes into Office of Vital Statistics. NARM was survey tool and to offer it to others in more depth and includes actual train- invited to participate in the planning their state. ing for lobbying, including writing process for a national advisory group The QVS Alliance is seeking to im- fact sheets, giving interviews, making called the Data Providers Certification prove communication and cooperation the best use of the 15-minute or 2- Project Team (DPCPT). The purpose of between midwives, hospital staff mem- minute opportunities for speaking with the group is to improve the quality of bers, Obstetricians, MD’s, labor & de- legislators, giving testimony at public birth data collection as well as educat- livery departments, medical records hearings and legislative committee ses- ing midwives and doctors on the cor- and vital statistics. Recently the QVS sions, and answering tough questions rect data entry on birth certificates. As Alliance requested Pam Crowl, CPM, spontaneously. of November 2004 the DPCPT was and myself to help seek a term/terms given another name: Quality Vital Sta- for out-of-hospital birth attendants. MANA Statistics – Web Based Data tistics Alliance or the QVS Alliance. The following has been suggested: Entry: (2 hours) This workshop ex- The QVS Alliance is also responsible A line that says “title.” Following plains the new MANA Statistics Col- for making sure that accurate informa- that, circle all that apply or underline lection Project, including the web tion is placed on the birth certificate. the title: CPM, CDM, LM, RM, CNM, based data entry system, so that all The National Association for Public MD, Other midwives can enter their personal sta- Health Statistics (NAPHSIS) and the NARM is very interested in your tistics into the MANA database for use National Center for Health Statistics feedback on the title issue. We need to in analyzing and publishing research have given the QVS Alliance formal be ever cautious about revealing the pri- on direct-entry midwifery. Participants endorsements for the creation of a cer- vacy of midwives living in illegal and/ will learn how to enter their data on tificate program. So far, several forms or unfriendly jurisdictions. I know we the web (and options for not entering have been created; the Birth Registrar all have been frustrated by the limited on the web), how this information may Training Survey, the Birth Registrar information on birth certificate data be used, and how to retrieve their own and Midwife Training Survey, the State/ sheets. People need to know that out- personal or group statistics. Local Vital Records Training Survey, of-hospital birth is safe. Please feel free and Sample Prenatal and Delivery Data to e-mail your comments to me at: ••Collection forms. A sixteen-page in- [email protected]. Suggestions will be Looking for struction manual called Recommenda- sent to the QVS Alliance. Opportunities to tions, Collection, Registration and Future goals include a more national Data Integrity for the Certificate of scope in the correct collections of birth Obtain CEU’s? Birth has been compiled as an instruc- data. After the Pilot Project, survey Don’t miss a great opportunity to tion guide for the various survey forms. forms will be sent to all hospitals, doc- earn CEU’s and have a great time do- The first step in the process has be- tors and midwives. It is our desire ing it! Plan on attending MANA 2005 gun. Four areas were chosen for the that documentation regarding birth in Boulder, CO September 30th first of a two-part project. They are will be correctly applied to each state’s through October 2nd. California, Colorado, New York City statistics. I believe we will prove that Last year at MANA 2004 in Port- and Utah. They have been chosen to midwives’ statistics will reveal the low- land, OR, there were opportunities to fill out the survey(s) and provide feed- risk status in out-of-hospital births that earn contact hours during the regular back to the QVS Alliance. Once re- we all know is true. conference plus additional contact — hours if you attended a pre-conference workshop. For more information, watch for an- nouncements about the conference on MANA’s website at www.mana.org. — — — WINTER 2005, NORTH A MERICAN REGISTRY OF M IDWIVES 15 — Related Organizations —

••sions: research and publication, educa- — piled and reported back to the midwife Midwifery Statistics — tion, administration, data collection, for her own practice, and also for any and web based database development. group practices or associations that she For more than ten years, MANA The data that has been collected since identifies for her statistics reports. Re- midwives have voluntarily turned in the year 2000 on paper forms is being searchers will have access, with permis- their birth statistics for research and entered into the computer by the data sion of the DOR, to the data relevant analysis by Ken Johnson and Betty collection division. The most exciting to their research project, and will not Anne Daviss. Most of these have been part of the DOR is the web based sys- know the identity of the midwives or retrospective, meaning they are turned tem of data entry that will allow mid- the clients. Clients will be identified in after the births occurred. While this wives to enter their information di- only to the midwife, and even then data is helpful in our own understand- rectly by computer into a web based only by the client code chosen by the ing of birth and of our own practice data collection system. This will allow midwife. styles, that information is not as valu- midwives to see instantly what they To contribute to the statistics project, able for research purposes because of have submitted and what still needs to each midwife must ENROLL into the the possibility that only the good out- be entered, and it can be done through- system. Even if you participated in the comes are being reported. For research out the pregnancy with the final infor- previous data collection, you must en- purposes, data must be collected pro- mation entered after the birth. This roll into the new one. To enroll, go to spectively, meaning that the births are will also be a faster system of data col- www.manastats.org. At this web site, listed as the clients come into the lection, thus allowing research to be you can read about the data collection midwife’s care (or at least before the carried out with a minimum of delay. system and download an enrollment birth) and all births logged are reported The data that has been submitted pre- form. The form must be filled out and after the birth. This assures that all viously on paper forms will be entered mailed in, and then the midwife will be outcomes are included in the statistics. into the same system, but only prospec- assigned a Midwife Code. At that This is the only kind of data that will tive data will be offered for certain point, clients may be listed on the pro- be accepted as serious medical research. kinds of research. Retrospective data spective log on the web or by mail. For this reason, NARM CPMs partici- will be valuable for a midwife’s own Data cannot be entered until the mid- pated in a one-year mandatory statis- statistics summary or for more general wife is enrolled, so ENROLL TODAY. tics collection project in the year 2000. analysis of midwife styles and skills. If you do not have access to the web, All CPMs logged their births prospec- All the older data will eventually be a you may receive all necessary informa- tively and turned in dataforms after the part of the master database for these tion from: birth. That data was entered into com- purposes. The important factor for fu- puter programs and analyzed by ture data collection is to get as much MANA Statistics Johnson and Daviss, who presented data as possible about midwife-attended P.O. Box 6310 reports on their work at yearly MANA births entered prospectively on the new Charlottesville, VA 22906 conferences and also at yearly confer- web based system. Midwives who do ences of the American Public Health not have access to the web, or who pre- It is very important that all CPMs Association. That research has now fer the paper dataforms, can still sub- participate in the collection of statis- been written and submitted to profes- mit their data by mail and the DOR tics. Please get started as soon as pos- sional journals. The process of writing division of data collection will enter sible. It is easy and very rewarding! and submitting is different for each the data into the database. Eventually, CPMs can also get Continuing Educa- journal, and each application takes sev- all data that has been submitted will be tion credit towards recertification for eral months before it is accepted or re- combined with all the newer data, and submitting their birth data to the statis- jected, and then the process starts all we will have a huge database of valu- tics project (see the recertification over again. We fully expect that the able information that will provide the forms on www.narm.org). CPM 2000 statistics results will be kind of statistics we need to demon- published in a reputable public health strate the outcomes of midwife care. CHECK IT OUT! or medical journal in the year 2005. For this to be a successful venture, GO TO THE WEB TODAY! Many midwives continued to submit WE NEED FOR ALL MIDWIVES TO statistics after the year 2000. The re- SUBMIT THEIR STATISTICS. All per- search work of Johnson and Daviss sonal data will be kept confidential DOWNLOAD YOUR continued to focus on the CPM 2000 and the identity of the midwife will not ENROLLMENT FORM! project as the highest priority. Mean- be released except to the midwife herself while, MANA created the Division of and to whichever group practices she www.manastats.org Research (DOR) composed of five divi- — agrees to join. Statistics can be com- — — — 16 NORTH A MERICAN REGISTRY OF MIDWIVES, WINTER 2005 — —

••with your check or money order. Re- Report from Citizens for Midwifery — member, you must be a CfM member Susan Hodges, President in order for us to accept your order. If you are not already a member, you may Congratulations to all who partici- — involved. As midwives, we would ap- include your membership (form and pated in the development of the re- preciate any help you can give us to check) with your order to qualify you cently adopted Essential Documents of identify people who are potential active for this special. the NACPM! They are outstanding participants. “Born in the USA” (released in 2000) and will prove invaluable wherever ef- Do you have clients that like to surf was created by a home birth couple forts are underway for legal recogni- the internet? Who like to write or edit? who are professional documentary tion of CPMs. Can you think of a client who enjoys film-makers. If you are not familiar calling people up to get information? with “Born in the USA,” read a review Your Clients and Citizens for Perhaps you’ve kept in touch with some at http://www.cfmidwifery.org/re- Midwifery clients from a few years ago who might sources/cfm/item.asp?ID=6 or more CfM Board members Carolyn Keefe have more time now than when they descriptive information at http:// and I saw many of you at the MANA had a newborn? The CfM Board has www.fanlight.com/catalog/films/ conference in the fall. At the confer- already identified a number of straight- 297_bitusa.shtml. This film is just as ence more midwives expressed their de- forward tasks that any number of timely and effective now as it was when sire to have their clients become mem- people could do to help CfM and be it first came out. It is a very effective bers of CfM, a good way to help your more involved, with the newsletter and educational tool, for public meetings clients be more informed and more with our website. For example, a good as well as classroom use. ready to take action for midwifery website needs regular systematic check- when needed. There are a number of ing to catch out-of-date information Quality Assurance for Midwives? and dead links, and then follow up to ways to “sign up” your clients, includ- Do you have a system for getting obtain new information and current ing a special price break if you are feedback from your clients? How do web site addresses; in particular, many signing up your clients and paying for you assess your practice (both clinical of our State pages are either undevel- their first year of membership – you and other aspects, such as emotional oped or have out-of-date information. can do this at the “special” rate of $20 support) in terms of how it measures For the CfM News, we could use re- instead of the suggested rate of $30. up to the ideals contained in MANA’s porters for the state by state section, Please do not hesitate to e-mail or or the NACPM’s Essential Documents, and we welcome thoughtful articles on phone CfM if you need information or the Mother-Friendly standards, or the birth- and midwifery-relevant topics, as suggestions on ways to do this. And if Midwives Model of Care? We are all well as reviews of books, articles, useful you think of anything CfM can do to human, and having an effective way to websites, etc. Please contact me make this easier for you, or a handout get meaningful feedback from your cli- ([email protected]) if some good that you would find especially helpful ents can help anyone to keep “on people come to mind, or if you have for your clients, please let us know! We track”. any questions about these opportuni- really appreciate your work and your I am interested in exploring the pos- ties. efforts to inform your clients and in- sible development of a feedback ques- troduce them to Citizens for Mid- tionnaire, with input from both mid- wifery. Born in the USA wives and consumers. The need for Through a special arrangement with such feedback is clear if you read posts CfM Development Fanlight Distribution members of Citi- from women who have had less than At our annual in-person board meet- zens for Midwifery can now obtain the satisfactory experiences with home ing this fall, the CfM Board realized made-for-public-TV documentary “Born birth midwives, many of whom feel be- that we need more midwifery advocates in the USA” for only $89.00. This is a trayed because their midwife did not to be more involved with the work of tremendous savings over the list price provide care that lived up to their ex- CfM for our organization to continue of $200.00. The special price offer pectations of the Midwives Model of growing and making an impact for originally was available only through Care. They may never have had an op- birthing women and midwives. We are December 2004; while this deadline has portunity to give their midwives mean- developing a Strategic Plan, and know been extended, the offer is likely to be ingful and concrete feedback about already that we need to further develop time-limited, so get your order in now! their care or how their midwife’s ac- the Board and have clearly defined vol- Print out an order form from the tions or behavior impacted them. unteer opportunities to make it easy CfM website http://www.cfmidwifery. Do you have a questionnaire or form org/pdf/orderform.pdf and send it and inviting for more advocates to get — — you ask your clients to fill out when — — WINTER 2005, NORTH A MERICAN REGISTRY OF M IDWIVES 17 — Related Organizations —

care is completed? Do you have any •• suggestions for or thoughts about such — ICAN Conference a questionnaire? I hope you will share them by e-mailing to April 29th - May 1st [email protected] or send- ing to the CfM PO box, attention “questionnaire”. San Diego, CA Reported by Susan Hodges http://conference.ican-online.org [email protected] www.cfmidwifery.org 1-800-686-ICAN •• NACPM News tial in the groundbreaking effort in — said in a previous newsletter: The Massachusetts to legislate a joint power of NACPM to support the work Hello to all CPMs! The Board of CPM-CNM board of midwifery. The of CPMs will grow as its membership Directors of NACPM is pleased to an- Board has heard from midwives and grows. The power of NACPM to en- nounce that the members of NACPM consumers from other states inquir- sure that CPMs are included in the de- have voted to adopt the Essential Docu- ing about the Standards document. livery of maternity care in any of the ments, including Standards of Practice. NACPM members also voted to national health care reforms that are The final draft is available on the add to the Essential Documents en- being considered, its power to increase website: www.nacpm.net. This vote dorsements of the Midwives Model of communication among midwives, its was the culmination of a two and one- Care (© 1996-2004 Midwifery Task power to advocate for midwives in is- half year project by the NACPM Stan- Force), the Mother Friendly Child- sues such as insurance reimbursement, dards Committee. The document was birth Initiative (© 1996 Coalition for its power to influence national health drafted by the Standards Committee Improving Maternity Services) and policy and legislation, and its power to and was circulated for comments to all the Rights of Childbearing Women work with other national organiza- CPMs, the Standards Advisory Com- (© 1999 Maternity Center Associa- tions and groups to ensure that women mittee, as well as other interested par- tion, Revised 2004). and families are afforded the opportu- ties. The final revisions were made at NACPM Board members were nity for natural childbirth, will develop the MANA Conference 2004 in Octo- elected in December as well. Mary and grow as the number of CPM s con- ber, with particular help and input Lawlor and Dolly Browder each have tinues to grow, and as the membership from members of the NARM Board. one year of their terms remaining. of NACPM grows. Please join now. The Standards Committee carefully Suzy Myers was reelected to the You will find membership information considered every comment that was re- Board, and Marilyn Green of Tennes- on the website, www.nacpm.net, includ- ceived, and the NACPM Board consid- see, Kathy Acree of Louisiana, and ing a membership form to download. ers the final document to be a strong Edie Wells of Wisconsin were newly You may also request a membership and powerful articulation of the phi- elected. NACPM welcomes and con- form from Mary Lawlor at the above losophy and practice of the members of gratulates these new board members! address. We look forward to hearing NACPM. Special thanks and apprecia- A late-spring board meeting is being from you! tion goes to all of the CPMs who con- planned to take place in Seattle to tributed, as well as to the members of develop the agenda for NACPM for the Standards and Standards Advisory the next year. •• Committees. The membership of these In preparation for the spring meet- Preceptors committees is also available on the ing, the Board will be reviewing In the last several issues of the CPM website. agenda suggestions that members have News, notice was given that preceptors As many of you may know, the Stan- contributed over the past couple of in the NARM Preceptor Table were dards of Practice are already proving years. If you have suggestions you sent a survey letter requesting informa- their usefulness. The midwives and would like to be considered, please tion such as address confirmation, consumers from Wisconsin contacted send them to Mary Lawlor at numbers of births attended, etc. In an NACPM in the fall to say that this [email protected] or mail them to effort to update the vital information document may just make the difference her at 234 Banning Road, Putney, VT in this table, NARM is requesting that in the success of the legislative effort to 05346. all CPMs who are or who anticipate license CPMs in their state. These We invite any CPM who has not becoming a preceptor in the next year documents are also considered essen- yet done so to join NACPM! As we please fill out the enclosed survey ques- — — — — 18 NORTH A MERICAN REGISTRY OF MIDWIVES, WINTER 2005 — —

tionnaire. If you have already filled the — A preceptor for a NARM PEP appli- — In addition preceptors are asked to survey out thank you. You will not cant is required to affirm they are a affirm the length of time (fill in the have to do it again. If you know of a primary midwife, that the applicant date) they have been a primary midwife non CPM midwife who is a preceptor, acted as a primary under supervision, and the number of births they have at- please encourage that midwife to par- and they were physically present in the tended as a primary midwife. ticipate by volunteering, the informa- same room in a supervisory capacity NARM may request additional infor- tion. The letter and survey is as fol- during that care in which the applicant mation from preceptors, such as client lows: acted as primary under supervision. charts. On Verification of Birth Experience Preceptors may also be audited for Dear Midwife Preceptor: Form (114), preceptors also affirm the Practice Guidelines, Informed Consent Your name is in our database be- following number of procedures with Documentation, forms and handouts cause you are listed as a preceptor for the applicant: relating to midwifery practice and at least one NARM CPM applicant. · Number of births emergency care plan. Refusal to pro- We are contacting you to obtain neces- · Number of initial prenatal exams vide additional information may de- sary additional information for our · Number of prenatal exams tain the application process or may be database of midwifery preceptors. · Number of newborn exams grounds for denial of application ap- NARM is dedicated to the preserva- proval. tion of apprenticeship and the Mid- NARM greatly appreciates your co- wives Model of Care. With that goal Preceptors must affirm they are: operation in this matter. in mind, a Preceptor Database has been · A nationally certified midwife By being a midwifery preceptor, you developed for the purpose of research to (CPM, CNM, or CM); or are part of a growing movement with prove the validity of competency based · Legally recognized in a jurisdic- each one of you making a difference in education. tion, province, or state as a practi- midwifery and access to midwives The purpose of this letter is twofold: tioner who specializes in maternity across the nation, regardless of the 1) To inform you of the require- care, or route of entry you have chosen into the ments for preceptors of NARM · A midwife practicing as a primary profession. Together we can make a PEP applicants. attendant without supervision for a difference in midwifery availability for 2) To obtain general information minimum of three (3) years and out grandchildren and for their chil- to update the database. fifty (50) out-of-hospital. dren.

— — NARM Preceptor Survey Name: ______Date ______

Address:______Phone: (W) ______

City: ______State: ____ Zip: ______(H) ______

I am/am not a credentialed midwife (circle one). (If applicable) my title is:_____ (Please spell out if different from the list of titles below) ______Are you interested in becoming a CPM at this time? ______If not please share your reasons for this decision. ______I am: q A nationally certified midwife (CPM, CNM, or CM); or q Legally recognized in a jurisdiction, province, or state as a practitioner who specializes in maternity care, or q A midwife practicing as a primary attendant without supervision for a minimum of three (3) years and fifty (50) out-of-hospital births. I have been a primary midwife since (fill in date):______I have been preceptor for (fill in number)______of NARM CPM applicants. I have attended (fill in number)______births as a primary midwife.

NARM greatly appreciates your time in this matter. Please either send the information to the Applications Department via email [email protected] or mail it to NARM Applications Department.

— — WINTER 2005, NORTH A MERICAN REGISTRY OF M IDWIVES 19 •• MANA Conference 2005 Standing Tall, Growing Together Join · the Midwives Alliance of North America · the Colorado Alliance of Independent Midwives, and · the American College of Nurse Midwives - Denver Chapter

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Sept. 30 through October 2, 2005

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