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Welcome to MEAC
The Case for Midwifery Education & CPMs
MEAC believes that midwives provide care that is essential to the health of the nation. The future of midwifery depends on the education of midwives who are prepared to provide high quality care that is responsive to the needs of women, and who can participate effectively in the transformation of our system of maternity care.
Midwifery schools and programs accredited by MEAC prepare midwives for national certification as Certified Professional Midwives (CPMs). These midwives are earning recognition in ever-widening circles. Just this month, the Milbank Memorial Fund, a nonpartisan institute devoted to health policy analysis, issued a new report titled “Evidence-Based Maternity Care: What It Is and What It Can Achieve.” The report cites data from the landmark study of CPMs published in 2005 and concludes:
The low CPM rates of intervention are benchmarks for what the majority of childbearing women and babies who are in good health might achieve.
The report also cites an Issue Brief co-authored by MEAC this year that provides useful background information on CPMs, describes the organizations that support the credentialing and recognition of CPMs, and discusses midwifery and health policy issues.
We are pleased to report that the number of students enrolled in accredited midwifery programs is growing. MEAC currently accredits eight freestanding institutions and two programs that reside within universities, providing excellent midwifery education for more than 500 matriculating students. Four new schools have applied for accreditation within the last year and at least two others have indicated their intent to apply.
As the number of midwives is growing, legal recognition is also expanding. Nearly half of all states now regulate direct-entry midwifery, and at least fifteen other states are considering legislation. At the same time, midwives are working to improve access to care by tackling the complex challenges of insurance coverage, equitable reimbursement, and employment opportunities.
Scroll Down or Click Below to Read:
•The Issue Brief on Certified Professional Midwives
Milbank Report Reveals Serious Problems in Maternity Care Quality and Value
Overuse of Cesarean Section and Other Interventions Puts Women and Babies at Risk, Increases Costs
Over 31% of U.S. births are now by cesarean section although a 5% to 10% rate is best for mothers and babies. The extra cost is well over $2.5 billion per year. The excess cesareans buy no reduction in maternal and newborn deaths. But they cause unneeded exposure to the dozens of adverse effects more common with c-sections. This is just the most striking example of how health care provided to mothers giving birth exposes them to avoidable harm and expense. These conclusions are found in Evidence-Based Maternity Care: What It Is and What It Can Achieve, a report released today by Childbirth Connection, The Reforming States Group, and the Milbank Memorial Foundation.
To view the full Milbank Report titled, Evidence-Based Maternity Care: What It Is and What It Can Achieve, click here.
The report cites an extensive body of evidence to make the case that, despite paying top dollar, American women do not receive the best maternity care. It is the most comprehensive review to date of how maternity care is delivered, financed, and experienced by mothers, families, and health care payers. It concludes that maternity care can be significantly improved using evidence-based care.
Main Recommendations for Improvement
To speed adoption of evidence-based maternity care, the report recommends:
• Develop a standardized evidence-based set of maternity care performance measures to address overuse and underuse.
• Incorporate these measures into Medicaid quality improvement activities, and encourage private insurers and other entities to adopt them.
• Reform the reimbursement system – with such strategies as reducing payment for overused services, increasing payment for underused services, and rewarding high-performing providers and facilities.
• Support more research into evidence-based maternity care, including long-term effects of common maternity practices.
• Increase the use of evidence-based maternity care by educating a wide range of stakeholders.
“If implemented, these recommendations can help close the evidence-practice gap in maternity care,” said Maureen Corry, co-author and Executive Director, Childbirth Connection. “There’s a role for everyone - clinicians, health systems, payers, policymakers, consumers and the media. It’s time to seize the opportunities to ensure that all mothers and babies receive safe, effective and satisfying maternity care.”
“The report shows maternity care is one more example of what’s wrong with American health care. We’re paying too much and getting the worst results in the developed world because of unneeded care,” said Reforming States Group Vice Chair, State Senator Charles Scott of Wyoming. “The main causes are that providers earn more from unneeded care while fear of malpractice litigation encourages the same unneeded care. In my state nearly half the births are paid for by the taxpayers through the Medicaid program. If we can implement the recommendations of this report, we can both reduce costs and improve the care our mothers and babies get.”
Overused Maternity Practices
Cesarean section is one notable example of frequently overused maternity care interventions documented in the report. C-sections are now the most common operating room procedure in the US. Although clearly beneficial and life-saving in selected circumstances, the absolute indications for cesarean section apply to only a small proportion of births. Yet rates have steadily risen from 20.7% in 1996 to a record high of 31.1% in 2006, a 50% increase.
Wide variation in medical practice exists – for example, differences in rates of performing cesarean section vary across physicians, hospitals, or geographic areas. Just a fraction of these differences are due to differences in the health needs of mothers and babies. Rather, this variation reflects differences in professional styles of practice and other factors such as the number of providers and hospitals offering the surgery, concerns about being sued, and financial incentives that favor surgery. The evidence showed that areas with higher rates of cesareans had more inappropriate care and more surgery in healthier women.
The report clarifies that many other common maternity interventions, e.g. labor induction and epidural, are also overused. It can be accessed atwww.childbirthconnection.org/ebmc/
Underused Maternity Practices
The analysis also found underuse of many effective practices with few or no known adverse effects. These practices include continuous support throughout labor (such as provided by a doula), numerous measures that increase comfort and facilitate labor progress, upright and side-lying positions for giving birth, delayed cord clamping, and early skin-to-skin contact between mother and baby. More frequent use of these beneficial forms of care would lead to improved outcomes for many mothers and babies. Best available evidence also supports providing access to vaginal birth after cesarean (VBAC) for most women with a previous cesarean, but such access has fallen off sharply in recent years, despite demand from women, and more than nine out of ten women with previous cesareans now have repeat cesareans.
"Hundreds of rigorous systematic reviews of best evidence assess the safety and effectiveness of maternity practices," said Carol Sakala, lead report author and Director of Programs, Childbirth Connection. "Yet, all too often the evidence is ignored.”
Maternity Care is Major Segment of Hospital Market
Most maternity care provided to women who give birth in US hospitals — a large and primarily healthy population — is resource and technology intensive. Six of the fifteen most commonly performed hospital procedures in the entire population are associated with childbirth. Hospital charges for maternal and newborn care are greater than charges for any other condition: $79 billion in 2005, jumping to $86 billion in 2006.
Maternal and newborn care are the most costly hospital conditions for both Medicaid (which pays for 42% of all births in the country) and private insurers (shouldering 51%). And, the proportion of Medicaid-covered births is growing, making the quality and cost of maternity care a significant public policy issue. The report finds that lower intensity care, like that provided by midwives, is safe and effective, avoids many procedures with established risks, and is cheaper. Yet, just a fraction of women who give birth in hospitals today receive low intensity care.
And while the US spends much more on health care, its performance lags far behind other developed nations on quality indicators including low birthweight, perinatal and maternal mortality, and cesarean rates. The report spotlights the market influences and other factors contributing to what has been called the "Perinatal Paradox: doing more and accomplishing less" (Rosenblatt 1989).
To visit Childbirth Connection who provided the press release for this news story, click here.
To view the full Milbank Report titled, Evidence-Based Maternity Care: What It Is and What It Can Achieve, click here.
CPM Issue Brief - Certified Professional Midwives: An Asset to Health Care Reform
We are pleased to announce the release of an Issue Brief: Certified Professional Midwives in the United States.
The Midwifery Education Accreditation Council (MEAC) co-authored this important document with the Midwives Alliance of North America (MANA), the North American Registry of Midwives (NARM), and the National Association of Certified Professional Midwives (NACPM). These four national organizations have played essential roles in the conception, formation, promotion and maintenance of the Certified Professional Midwife (CPM) credential.
The United States faces a deepening crisis in the quality, cost and availability of health care. Maternity care in particular reflects the basic inefficiencies of the current model – on the one hand too many women receive unnecessarily expensive care due to the overuse of technology, while others cannot access even the most basic services. Midwives are poised to address this problematic distribution of care by providing essential health services that result in excellent outcomes at lower cost than typical care. Any plan for health reform should include support for and expansion of midwifery services.
Certified Professional Midwives (CPMs) are a fast-growing segment of the midwifery profession in the United States today. Certified Professional Midwives are trained and credentialed to offer expert care, education, counseling and support to women for pregnancy, birth and the postpartum period. They have particular expertise in out-of-hospital settings. CPMs practice as autonomous health professionals working within a network of relationships with other maternity care professionals who can provide consultation and collaboration when needed.
The purpose of this document is to provide information about Certified Professional Midwives: their qualifications, philosophy and scope of practice; the best available evidence regarding the safety and quality of their care; and a brief exploration of how increased utilization of their services will address America’s health care needs.
Click here to link to a pdf of the CPM Issue Brief
Do you have energy for an opportunity that is rewarding, fun, and advances the profession of midwifery?
MEAC is seeking candidates for our governing board and volunteers interested in training and serving on accreditation review teams. Board members are elected by the membership of accredited schools in MEAC. We require a resume and a letter of reference from two professional colleagues who have worked with you in midwifery or other professional committees, boards, or organizations. Once elected, MEAC board members make a commitment to a three-year term, and do several hours of work a month, along with traveling to 3-day Board meetings twice a year.
Board members must be willing to familiarize themselves with all MEAC documents and to learn about MEAC’s accreditation processes. We hope that you will also be interested in participating in accreditation activities, if qualified, in the following roles:
a) As a site visitor to institutions or programs seeking accreditation
b) As a member of the accreditation review committee (ARC) to write reports and make recommendations about whether or not to accredit a program or institution. (Most site visitors also serve as ARC members.)
If a MEAC board member becomes a site visitor and an ARC member, this commitment will add up to approximately five full days per year per school. We also expect each board member to participate in at least one MEAC committee per year.
Important Notice: The MEAC Office has Moved
Update your contact information for MEAC – the office has moved to La Conner, WA. To reach MEAC by mail for all correspondence, the new mailing address is P.O. Box 984 La Conner, WA 98257. The phone number for the new office is (360) 466-2080. The fax number for MEAC will remain the same, (480) 907-2936.
In addition to more rainfall, the move from Arizona to Washington involves new staff members. Jo Anne Myers-Ciecko is assuming a new role with MEAC – she has agreed to serve as our Executive Director. Jo Anne has been our Accreditation Specialist for nearly two years and will continue providing technical assistance to the schools, training volunteers, and supporting the Accreditation Review Teams, while also overseeing the day-to-day operations of the organization. Kristin Effland, a recent midwifery school graduate, also joins us at this time as MEAC’s new Administrative Assistant.
Jo Anne and Kristin hope that you will visit the new MEAC Office – call for the street address and consider dropping in during regular office hours Monday –Wednesday from 9 am – 4 pm, Pacific Time. Many of you are already familiar with Jo Anne as she has been has been a nationally-recognized advocate for community-based midwifery since she had her first baby at home in 1976. For more than thirty years, she has dedicated herself to the development of direct-entry midwifery in the United States. Jo Anne represented MEAC on the coordinating committee of the National Certification Taskforce, which established standards for Certified Professional Midwives in 1994. Most recently she co-authored the “Issue Brief: Certified Professional Midwives in the United States” with representatives from MANA, NARM, and NACPM.
Prior to assuming a staff position at MEAC, Jo Anne was employed as a midwifery school director, non-profit organization administrator, and midwifery educator. She is intimately familiar with our accreditation standards and processes. As a founding member of MEAC Board of Directors, she helped us to formulate standards and policies that led to our initial recognition by the U.S. Secretary of Education. She will now direct our efforts as we are once again in the midst of renewing that recognition.
Kristin Effland graduated from Seattle Midwifery School in June 2008. She sat for the NARM exam and the WA State licensing exam in August and plans to open her midwifery practice in Bellingham, WA in the fall. Prior to moving across the country in 2005, Kristin worked as Office Manager and then as Youth Program Director for a national non-profit organization in Washington, DC.
CPM Study
TITLE: Outcomes of Planned Home Births with Certified Professional Midwives: Large Prospective Study in North America
Click here to read the Study Abstract and for a link to the article.
