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Resources for Policymakers

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Below you will find publications and resources aimed at providing indepth information for policymakers, staff and planners, particularly on the following topics:

  • the critical role maternity care plays in our nation's health care system
  • the current state of maternity care in the United States
  • what changes are needed to improve care for women and babies
  • midwifery's role in providing evidenced-based, high quality, cost effective, accessible care that has excellent health outcomes for mothers and infants
  • information on the Certified Professional Midwife (CPM) credential and scope of practice
  • the importance of providing choice of providers and birth settings to expectant families
  • issues related to out-of-hospital birth settings, particularly home birth

Home Birth: An Annotated Guide to the Literature

For those of you looking for evidence-based information on the outcomes of home birth, the Midwives Alliance has created an online version of Home Birth: An Annotated Guide to the Literature, http://mana.org/DOR/research-resources/ or as a pdf, http://midwifery.ubc.ca/files/2012/12/Home-Birth-Annotated-guide-to-the-literature.pdf.

This document, compiled by Saraswathi Vedam, RM, FACNM, MSN,SciD(hc) and colleagues, Associate Professor Division of Midwifery, University of British Columbia, Canada, was intended for policy makers and clinicians, but can provide anyone an indepth look at the growing body of research that shows that planned home birth is safe for women and infants, resulting in lower intervention rates for women choosing this birth setting compared with hospital birth. Home Birth: An Annotated Guide to the Literature assesses the study design and level of evidence of each piece of research, highlighting those research studies that are well designed and use the best evidence and those studies that have flaws that may give a disingenuous picture or provide misleading conclusions.

In addition, consumers, health care professionals, and policy makers should also watch for a peer-reviewed article being published this year that reviews the data in the MANA stats database, which is the largest dataset on home birth and birth center births in the United States. This article will look at all perinatal outcomes, including mortality and morbidity, and will support the growing body of research that shows that planned home birth is a safe option for women, infants and families. 

Evidence-Based Maternity Care: What It Is and What It Can Achieve

Milbank Memorial Foundation, Childbirth Connection, Reforming States Group (2011) http://childbirthconnection.org/pdfs/evidence-based-maternity-care.pdf

  • Milbank Memorial Fundis a foundation that works to improve health by helping decision makers in the public and private sectors acquire and use the best available evidence to inform health policy. The Fund has worked on significant health policy issues since 1905.
  • Childbirth Connection, founded in 1918, is a national not-for-profit organization that works to improve the quality of maternity care through research, education, advocacy and policy.
  • The Reforming States Group, organized in 1992, is a voluntary association of leaders in health policy from all fifty states, Canada, England, Scotland and Australia.

Blueprint for Action: Steps Toward a High-Quality, High-Value Maternity Care System

Childbirth Connection (2011) http://transform.childbirthconnection.org/blueprint/.

Who needs to do what, to, for, and with whom to improve maternity care quality within the next 5 years?

More than 100 leading experts set out to answer this question, reaching unprecedented consensus on the steps and actions needed to reform this critical and costly segment of the U.S. health care system. Five stakeholder workgroups collaborated to develop concrete solutions to the most pressing issues facing the U.S. maternity care system. The result is a detailed list of actionable strategies to improve maternity care quality and value centered on 11 critical focus areas for change:

Home Birth Consensus Summit, October 2011, Statements of Common Ground 

http://www.homebirthsummit.org/.

The Home Birth Consensus Summit brought a cross-section of the maternity care system into one room to discuss improved integration of services for all women and families in the United States. Delegates were a diverse multidisciplinary group of leaders with a passion for quality in maternity care and a commitment to work together to improve safety for women and babies across birth sites. The meeting was organized to explore diverse needs, to foster the discovery of common ground, and spark constructive action that will ultimately benefit all stakeholder groups. All perspectives and viewpoints were considered in this purposeful dialogue, while delegates explored every facet of the existing system and propose ways to move forward in the future.

Home Birth Summit delegates came to consensus on 9 Statements of Common Ground. These 9 spheres also constitute the basis for active work groups that are continuing to function as multistakeholder teams.
Home Birth Summit Delegates

The following stakeholder groups were identified. Delegates may belong to one or more of the following sectors, and had the opportunity to contribute their perspective from any they choose.

  • Home Birth Consumers (parents and potential parents considering this option)
  • Consumer Representatives (including doulas, childbirth educators, childbirth and women's health care reform and information agencies)
  • Home Birth Midwives (CPM, CNM, LM, CM, traditional, etc.)
  • Maternal-Child Health Collaborating Providers (including paediatrics, labor and delivery nursing, neonatal care providers, CNMs who facilitate access for hospital admission or consultation)
  • Obstetricians and OB Family Practice Physicians
  • Leaders with expertise in Health Care Models, Systems, and Hospital Administration
  • Insurance (Liability and Payors)
  • Health Policy, Legislators, Regulators, and Ethicists
  • Public Health, Research, and Education

Delegates were those who were in positions to inform and influence a change process, and/or commit to measurable steps within their stakeholder groups.

Health Care Reform Priorities for High Quality, High Value Maternity Care: An Essential Component of Women’s Health Care Across the Life Span

Childbirth Connection (2009) 
http://childbirthconnection.org/pdfs/maternity-care-in-health-care-reform.pdf

Statements to the Obama Transition Team

The following statements by the Midwives Alliance of North America, Citizens for Midwifery, and the National Association of Certified Professional Midwives were created for and submitted to the Obama Transition Team in January 2009.

Citizens for Midwifery (2009)http://cfmidwifery.org/pdf/CfMStatementObamaTeamFINAL200901_doc.pdf

Midwives Alliance of North America (2009)http://mana.org/pdfs/MANARecsToObamaHealthTeamJan09.pdf

National Association of Certified Professional Midwives (2009) http://www.nacpm.org/documents/NACPM-recommendations.pdf

Direct-Entry Midwifery Legal Status in United States

State-by-state chart detailing current status of Certified Professional Midwives, Midwives Alliance of North America (April 2009) http://mana.org/statechart.html

Issue Brief: Certified Professional Midwives in the United States

North American Registry of Midwives, Midwifery Education Accreditation Council, National Association of Certified Professional Midwives, Midwives Alliance of North America (2008)
http://mana.org/pdfs/CPMIssueBrief.pdf

Midwifery Licensure and Discipline Program in Washington State: Economic Costs and Benefits Health Management Associates (2007)

http://www.washingtonmidwives.org/assets/Midwifery_Cost_Study_10-31-07.pdf

Outcomes of Planned Home Births with Certified Professional Midwives: Large Prospective Study in North America

British Medical Journal (2005) 
http://www.bmj.com/cgi/content/full/bmj;330/7505/1416

Fact Sheet on Planned Home Births Study in British Medical Journal

Citizens for Midwifery (2005) 
http://www.cfmidwifery.org/pdf/CPM2000.pdf

Increasing Access to Out-of-Hospital Maternity Care Services through State-Regulated, Nationally-Certified Direct-Entry Midwives

American Public Health Association, Resolution Adopted by the Governing Council (2001)
 http://apha.org/legislative/policy/01_policy.pdf

The Future of Midwifery

Pew Health Professions Commission and University of California, San Francisco Center for Health Professions (1999) 
http://www.onlinelibrary.wiley.com

Mother-Friendly Childbirth Initiative

Coalition for the Improvement of Maternity Services (1996) 
http://www.motherfriendly.org/MFCI/

Outcome of planned home and planned hospital births in low risk pregnancies: prospective study in midwifery practices in the Netherlands

British Medical Journal (1996)
 http://www.bmj.com/cgi/content/full/313/7068/1309

Evidence Basis for the Ten Steps of Mother-Friendly Care in the Journal of Perinatal Education, 2007, Issue 16, a Special Supplement

The result of a 2 year research project by a team of maternity care experts, this important work reviews 15 years worth of scientific studies which found that the evidence supports complying with each aspect of the ten steps of Mother-Friendly Care.
 http://www.motherfriendly.org/pdf/CIMS_Evidence_Basis.pdf