Learn more about Midwifery Modernization in Pennsylvania
Midwifery Modernization in Pennsylvania
PA-ACNM, the state affiliate of the American College of Nurse-Midwives, has proposed new statutory language to fully integrate midwives into Pennsylvania health systems, an effort that will improve maternal and neonatal outcomes. Currently, Pennsylvania ranks 39th out of 50 states and Washington, D.C., on a recent scale measuring midwifery integration. [1] Our citizens deserve better. With this Midwifery Modernization bill, Pennsylvania legislators have the opportunity to impact outcomes, access, and health for families across the Commonwealth.
Who are Certified Midwives (CM) and Certified Nurse-Midwives (CNM)?
- Licensed healthcare providers who have received accredited midwifery education, a master’s or doctoral degree, national certification by the American Midwifery Certification Board (AMCB), and state licensure
- 557 licensed Pennsylvania midwives work in settings that include free-standing birth centers, large academic institutions, rural community hospitals, community clinics, private GYN practices, and patients’ homes.
- Midwives not only provide direct patient care throughout the lifespan but they are also researchers, scholars, program directors, and global healthcare leaders.
How can midwives help with the maternal mortality crisis in the United States?
- Black Americans are approximately 3x more likely to die before, during, and after birth. [2]
- The midwifery model of care focuses on the whole person, including environmental and social challenges. [3]
- A 2012-2014 Center for Medicare and Medicaid Innovation project demonstrated the benefits of the birth center model and midwifery-led care:
- Lower rates of preterm birth, delivery of low-birthweight infants, and Cesarean birth across racial demographics [3, 4]
- A $2000 cost savings per mother-baby dyad compared to standard care [3, 4]
- Patients who received midwifery care reported increased trust and satisfaction with their providers’ listening to and addressing their concerns, compared with standard care. [3]
Can midwives support individuals with opioid use disorder?
- The PA Maternal Mortality Review Committee attributes a rising number of perinatal deaths to opioid overdose.
- Midwives have been recognized federally as appropriate providers of MAT.
- Increasing the number of MAT providers in PA will increase access to this critical service.
How can midwives be a solution to a declining obstetric workforce?
- ACOG projects a declining OB-GYN workforce over the next 20 years. [5]
- Midwifery is affordable, accessible, and sustainable.
- Licensure of CMs in addition to CNMs will provide increased access to maternity care in both urban and rural settings.
- OBGYNs and CNMs/CMs enjoy collegial relationships throughout the Commonwealth. Those relationships are described in the ACOG/ACNM Joint Statement of Practice Relations between Obstetrician-Gynecologists and Certified Nurse-Midwives/Certified Midwives, referenced below. [6]
All Pennsylvania stakeholders dedicated to improving outcomes for birthing individuals must advocate for better integration and a robust scaling up of midwifery into the system through this Midwifery Modernization bill.
References
- Vedam S, Stoll K, MacDorman M, Declercq E, Cramer R, Cheyney M, et al. Mapping integration of
midwives across the United States: impact on access, equity, and outcomes. PLoS ONE 2018;13(2): e0192523. doi.org/10.1371/journal.pone.0192523 - Centers for Disease Control (CDC). Maternal mortality rates in the Unites States, 2020. 2020. https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2020/E-stat-Maternal-Mortality-Rates-2022.pdf
- Centers for Medicare and Medicaid Services (CMS). Strong Start for Mothers and Newborns evaluation:
year 5 project synthesis. 2020. https://downloads.cms.gov/files/cmmi/strongstart-prenatal-finalevalrpt-v1.pdf - Centers for Medicare and Medicaid Services (CMS). Strong Start for Mothers and Newborns: evaluation of full performance period (2018): findings at a glance. 2018. https://innovation.cms.gov/files/reports/strongstart-prenatal-fg-finalevalrpt.pdf
- Rayburn WF. The obstetrician-gynecologist workforce in the United States: facts, figures, and implications. Washington, DC: American Congress of Obstetricians and Gynecologists; 2017.
- American College of Obstetricians and Gynecologists (ACOG). Joint Statement of Practice Relations
Between Obstetrician-Gynecologists and Certified Nurse-Midwives/Certified Midwives. 2018. https://www.acog.org/clinical-information/policy-and-position-statements/statements-of-policy/2018/joint- statement-of-practice-relations-between-ob-gyns-and-cnms