CPMs and Midwifery Educators:
Contributing to a New Era in Maternity Care

We are at an unprecedented moment in time

Certified Professional Midwives are gaining significant momentum as primary maternity care providers in the U.S. and educators are positioning themselves to create the expanded CPM workforce for the future. As we look out on the landscape, both in the states and on the national level, it is clear that something “big” is happening in professional midwifery that reflects national trends in policy, health care, and education:

  • In March, 2011, the first bill to increase women’s access to CPM care was introduced in the U.S. House of Representatives (H.R. 1054).
  • CPMs were among 40 national leaders recently invited by the Administrator of the Centers for Medicare and Medicaid Services (CMS), Dr. Donald Berwick, to a symposium to help inform the direction of CMS for improving perinatal outcomes in the U.S.
  • The Chief Medical Officer for Medicaid in Washington State has stated that the quickest way to improve birth outcomes and reduce costs is to increase access to midwives and out-of-hospital birth.
  • A new interest in out-of-hospital birth is coming from African-American women who understand that the system is not working for them and who are looking for another model.
  • Interest from emerging midwifery education programs indicates that the number of accredited midwifery schools could increase by as much as 60% in the next two years.
  • After a gradual decline from 1990 to 2004, the home birth rate in the U.S. rose 20% between 2004 and 2008, suggesting an approaching sea change that is going to require more midwives.
  • CPMs own over half of the birth centers in the U.S.
  • In the first six months of 2011, legislation securing the position of licensed midwifery and increasing access to CPM services has passed in Idaho, Vermont, Colorado and Oregon.

We are on the verge of a tipping point in the U.S. CPMs are not just knocking on doors, but are being invited in. What does this mean for us as midwives and educators? What do we need to be thinking and doing to fulfill this promise and potential? We want and need to spread the “buzz” about this explosion of opportunity, inviting the CPM community, educators and their allies to reflect and plan together for our future.

From these opportunities our challenges arise:

  • How are we going to meet the growing demand for more midwives?
  • How are we going to create the needed workforce while preserving the integrity of the model we have already brought forward?
  • What changes will need to be made to current reimbursement systems in order to accommodate our midwifery model? As we achieve reimbursement, what impact could this have on that model?
  • How do we overcome the obstacles to creating a path to licensure for CPMs in half of the states?
  • How can we create diversity in the CPM workforce that reflects the diversity of our country?
  • How can CPMs make a significant contribution to addressing disparities in birth outcomes?
  • Where and how can we align and collaborate to maximize our potential to help reform maternity care in the U.S.?

These challenges require new approaches:

Together at the CPM Symposium, we heard from leaders in education, public policy, and legislation about national and global trends that form the context for CPM practice and education, and we heard from our peers in states across the country whose successes and challenges reflect our experiences and influence our thinking about the future of the profession.  Together, we experienced the palpable excitement of the momentum that is growing for Certified Professional Midwifery, while also experiencing the frustrations and discomfort that come from breaking open typical discussions in the search for new solutions.   Together we took the brave step of working with facilitators and new social technologies being used in forums all over the world to find new ways forward, to grapple with our challenges and difficult issues, and to seek out and learn a new style of effectiveness.  With this facilitation and new methodologies, one hundred and fifty people were able to work together to identify themes and issues that most need our shared attention, create work groups to addresses these topics, and develop action plans for moving these issues forward.