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Delivering Better Outcomes: Midwives in Illinois

Guest Author
October 10, 2014
We’re pleased to share a guest post this week, from Health & Medicine Board Member Gayle Riedmann, CNM. In addition to her work at Health & Medicine, Ms. Riedmann is a midwife at West Suburban Midwife Associates in Oak Park.

An interesting article from the Huffington Post this week notes the shortage of maternity care providers in the U.S.  Yet only 11% of U.S. births are attended by midwives.

In Illinois, there are just under 300 Certified Nurse Midwives (CNMs) licensed to practice, most of whom are in the greater Chicago area.  The number of births attended by Illinois certified nurse midwives is about half of the national average.  Almost 99% of Illinois births occur in the hospital, the remaining 1% at home.  

Alternate choices for place of birth—birth centers or home birth—are severely limited in Illinois, contributing to difficulty in accessing maternity services. Limitations and restrictions of midwifery practice also contribute to the problems in provision of maternity services. Here are three of the main issues we face:
  1. It took 25 years to pass legislation establishing freestanding birth centers in Illinois, and there is still only one birth center on target to open in 2014. Birth centers are ideal for safe, accessible, quality care for women throughout Illinois. Illinois needs more birth centers in maternity service shortage areas and rural areas.
  2. Planned home births are legal in Illinois, but the only providers allowed to deliver babies are physicians and certified nurse midwives. Due to a requirement for written collaborative agreement (WCA) with a physician, there are only a few home birth nurse midwifery practices addressing the demand for home birth.  Pregnant women are turned away from the few home birth practices that exist.  Some of these women choose to have unattended home birth, which is unsafe.  We need to remove the WCA requirement for certified nurse midwives (and all advanced practice nurses) to eliminate the obstacles facing CNMs attending out-of-hospital birth.
  3. Certified Professional Midwives (CPMs), who primarily attend home births, are practicing in many other states but are not legally allowed to practice in Illinois. This further restricts access and choice for women across the state. CPMs have been trying to gain legislative approval to practice in Illinois for over 20 years. We need to recognize the safe practice and value of CPMs and pass the necessary legislation to allow this practice in Illinois.
The advice I often give to my pregnant patients when they are unsure about midwives, natural birth, place of birth, and the safety is this: "When in doubt, think globally and think historically."

First, the global perspective:
  • Midwives attend 90% of births outside of the U.S.  
  • Home birth and birth centers are commonly accepted alternatives to hospital birth in most countries.  
  • Cesarean section rates and infant mortality rates are lower in other countries.  That is the global perspective.  
Conclusion: We need more midwife-attended births in the U.S., and particularly in my home state, Illinois. And we need more birth centers and home birth options.

For the historic perspective…I like to recall the reading from a very popular source: Exodus 1:16-20.
The king of Egypt said to the Hebrew midwives, whose names were Shiphrah and Puah, 16 "When you help the Hebrew women in childbirth and observe them on the delivery stool, if it is a boy, kill him; but if it is a girl, let her live." 17 The midwives, however, feared God and did not do what the king of Egypt had told them to do; they let the boys live.18 Then the king of Egypt summoned the midwives and asked them, "Why have you done this? Why have you let the boys live?"19 The midwives answered Pharaoh, "Hebrew women are not like Egyptian women; they are vigorous and give birth before the midwives arrive."20 So God was kind to the midwives and the people increased and became even more numerous.21 And because the midwives feared God, he gave them families of their own.

Conclusion:  Midwives have been attending births since the beginning of time… lets bring them back in great numbers to practice at their fullest capacity and scope.

Happy National Midwifery Week!