Congress Moves Toward Equitable Payment for Midwifery Services

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					Volume 38, Number 4                                                                                                                     Fall 2007

              Quickening           Official Newsletter of the American College of Nurse-Midwives

Congress Moves Toward Equitable                                                                       Election information

Payment for Midwifery Services                                                                        is on pages 20-22.

under Medicare                                                                                        ACNM
M      idwives are closer than ever to
       receiving 100 percent reimburse-
                                                  “The CHAMP Act can have a profound
                                                impact on health coverage for children
                                                                                                      Partners With
ment from Medicare with the U.S. House          and improves women’s access to mid-         
of Representatives’ passage of the              wifery services under the Medicare pro-
“Children’s Health and Medicare                 gram,” says ACNM President Kitty Ernst,               by George Hamilton
Protection Act of 2007 (CHAMP)”                 CNM, MPH, DSc(Hon), FACNM. “The                       ACNM Associate Director for Membership
(H.R.3162), which expands health care           legislation would ensure that many of

                                                                                                                CNM has entered into an agree-
coverage to pregnant women and their            our nation’s uninsured children have                            ment with to
children and addresses a long-standing          access to vital health care coverage                            promote midwifery to a national
inequity in reimbursement for services of       through the State Children’s Health                   audience. As part of the agreement, ACNM
certified nurse-midwives (CNMs). The            Insurance Program (SCHIP). It will also               members will receive a discount on their
American College of Nurse-Midwives              improve access to care for children in       provider listing.
(ACNM) thanks its members and their             underserved areas, help reduce minority          is an interactive direc-
supporters for making this happen.              health disparities, and protect the                   tory Web site that matches women with care-
                                                                                continued on page 9
                                                                                                      givers who most closely meet their needs.
                                                                                                      Patients and providers answer the same list
Pennsylvania Midwives are Granted                                                                     of questions for the matching feature. The
                                                                                                      unique and most beneficial feature of
Prescriptive Authority                                                                       is that the site places mid-
                                                                                                      wives and physicians in the same provider
                                                                                                      pool. This provides the opportunity for
T     he hard work of Pennsylvania’s mid-
      wives paid off on July 20, 2007,
when Governor Edward G. Rendell
                                                                                                      women to be matched with midwives, based
                                                                                                      on their profile, even if they hadn’t previous-
signed a law that grants prescriptive                                                                 ly understood that a midwife could provide
authority to the state’s certified nurse-                                                             the birth or health care experience they were
midwives. Pennsylvania is the last state                                                              seeking. In this way, the site is not only a
to grant prescriptive authority to CNMs.                                                              business generator but also a midwifery mar-
   “Pennsylvania will become the 50th                                                                 keting tool that exposes midwives to a wider
state to allow nurse-midwives to pre-           First row, from left to right, Pennsylvania State     audience of health care consumers.
scribe medications to the women they            Rep. Ron Waters, Rep. Mike Sturla, and                    MyBirthTeam encourages education,
                                                Governor Edward G. Rendell; Second row, Vivian
care for,” said Vivian Lowenstein, CNM          Lowenstein, CNM, Rosemarie Greco, Director of         communication and satisfaction for both
of Pennsylvania. Lowenstein and many            the Office of Health Care Reform, and others at       users and providers. “By asking women
                                                signing of the bill to grant Pennsylvania midwives
other midwives in the state lobbied for         prescriptive authority on July 20, 2007.              what they want in their care provider,
prescriptive authority for years.                                                            prompts women to
   “The legislation for prescriptive author-    providers to get the bill passed. Now,                consider that a CNM or CM may be the
ity is part of Governor Rendell’s initiative,   nurse-midwives look forward to working                best choice for their birth team,” said
Prescription for Pennsylvania,”                 with the Pennsylvania Board of Medicine               ACNM Executive Director Lorrie Kline
Lowenstein said. “Nurse-midwives in             to update the regulations for the legisla-            Kaplan. “We’re thrilled to have the sup-
Pennsylvania worked together with the           tion for prescriptive authority so that               port of to help raise the
Governor’s Office of Health Care Reform,        CNMs may begin to prescribe.”                         visibility of midwifery care and we
legislators and other health care                                              continued on page 31                              continued on page 31

2   Wo r k i n g w i t h Yo u

    Moving into High Gear                                                                                                   ®   by Lorrie Kline Kaplan, Executive Director

                                                                 • Focus on Members. ACNM is a

        came to ACNM with lots of ideas and
        energy. Fortunately, I knew I’d have to                    membership organization. We work for                           Please Join Me
        take it one step at a time. As I settle into               you. I want to hear more members                               at one of these upcoming events:
    the responsibility of managing this wonder-                    say, “My ACNM membership benefits                              October 13-14: ACNM Leadership
    ful organization, I’d like to share some of                    me every day.”                                                 Seminar, Seattle, WA
    the priorities and perspectives I’ve been                    • No Stepping on Toes. The President                             October 26-27: A.C.N.M.
    focused on during my first four months.                        and the Executive Director of a mem-                           Foundation Board Meeting,
    • Stabilize ACNM Staffing. Many                                bership association can form a power                           Service Directors Network/Directors
      members have expressed understand-                           team—or a real power struggle! They                            of Midwifery Education Meeting,
      able concern about ACNM staff                                must respect and trust each other, have                        Fort Myers, FL
      turnover during the past year. When a                        a shared understanding of roles, and                           November 3-4: ACNM Leadership
      strong, long-time leader leaves, it’s nat-                                                                                  Seminar, Kansas City, MO
      ural for others to do so as well, but it
      is upsetting and difficult for members                              We have no shortage                                     house. The sooner we embrace that,
      and those who remain. Our first priori-                                                                                     the sooner we’ll start to record success.
      ty has been to help ACNM staff feel                                  of debate within our                                 • Focus, Focus, Focus. By narrowing our
      positive about this organization again.                                own community,                                       focus, ACNM can better demonstrate
      We’ve tried to retain the great staff we                                                                                    tangible successes to you. This year,
      have, and bring in new and energetic                               but our biggest threats                                  we’ve focused on winning our longstand-
      individuals to support a culture of                                 lie outside our doors,                                  ing battle for equal reimbursement—and
      innovation and ideas to help us better                                                                                      we’re closer to victory than ever. Please
      serve members in the future. I believe                                 not in the house.                                    add your voice to the grassroots cam-
      that the turnover is ending, and the                                                                                        paign, so we can grab the brass ring and
      ACNM “smile meter” is moving in the                                                                                         move on to the next battle!
      right direction.                                             play to each others’ strengths. As Kitty                     • Restructuring—or Evolution? The
    • Listen—Really Listen. Being a new-                           Ernst and I start this dance, we find we                       word “restructuring” has been on the
      comer has down sides and up sides.                           have a lot in common: a passion for                            ACNM airwaves for a long time. Every
      The down side is that you have to ask                        midwifery and drive to serve our mem-                          organization needs to regularly update
      a lot of questions. The up side is that                      bers; strong opinions and a willingness                        its bylaws to reflect changing needs.
      you have “fresh ears” for the answers                        to debate them fiercely; energy and                            These and other changes are a process
      and you try to really listen. Along the                      curiosity; a belief in the power of mes-                       of ongoing evolution that every organi-
      way, I’ve had some wonderful “eureka                         sage and image; and best of all, a deep                        zation should engage in all the time. You
      moments.” You have my commitment                             respect for each others’ strengths.                            don’t restructure and then stop. You
      to staying in listening mode. I want to                    • Row Together. ACNM’s list of strategic                         evolve or you die. Let’s embrace con-
      hear more members say, “ACNM hears                           priorities “expires” this year. In                             tinuous evolution at ACNM just as we
      me and understands me.”                                      September, our Board, Division,                                embrace the natural forces of life.
    • Reach Out. Changes in leadership cre-                        Committee and staff leadership came                          • Leverage our Resources. How do we
      ate opportunities to revisit relation-                       together in a joint meeting. We need to                        deploy our program, publication, and
      ships and explore new ones. We are                           row together in the same boat. While                           advocacy strengths to build a more pos-
      reaching out with an open mind and                           we have no shortage of debate within                           itive, visible, contemporary, and accu-
      open message. I predict some interest-                       our own community, our biggest                                 rate image of midwifery? We’re looking
      ing partnerships down the road.                              threats lie outside our doors, not in the                      at everything we do through that lens—
                                                                                                                                                                   continued on page 38
    Quickening (ISSN 0196-3805) USPS 514030 is published quarterly provided to members only, by the American College of Nurse-Midwives, 8403 Colesville Road, Suite 1550, Silver
    Spring, MD 20910-6374; 240.485.1800. Periodicals Postage Paid at Silver Spring, MD and at additional mailing offices. POSTMASTER: Send address changes to Quickening at 8403
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    whatsoever, including entering into electronic databases, without written permission.

                                                                                                                                                 Quickening             Fall 2007
                                                          T h e P r e s i d e n t ’s P e n                                                     3

Are You Ready for
Guerilla Marketing?                                                                       by Eunice K. M. Ernst, CNM, MPH, DSc(HON),
                                                                                          FACNM, ACNM President

                                               of continuous effort, Illinois passed legis-   Cassidy; or Birth Crisis by Sheila

       all is in the air. In between the fun
       of summer we, your Board of             lation to allow birth centers in the state!    Kitzinger. Arrange for a fundraiser screen-
       Directors and national office staff,    Pennsylvania became the last state to leg-     ing of Ricki Lake’s “The Business of Being
have been on a mission to get your pro-        islate prescription privileges for nurse-      Born” ( or
fessional organization operating as effi-      midwives (see article on page 1). We are       support a local BOLD event, an adapta-
ciently and effectively as possible. Our       reaching a “tipping point” for advancing       tion of the Broadway play “BIRTH”
Executive Director Lorrie Kline Kaplan is      midwifery. Just as evidence-based prac-        ( This “guerrilla
working magnificently with many new            tice started with obstetrics, health reform    marketing” can keep pace with slick and
and wonderful staff. Jan Kriebs and Helen      must start with the care of mothers and        expensive marketing campaigns if we all
Varney Burst have organized an extensive       babies. Women make most of the health          commit to participating.
network for getting member input on the                                                          Our marketing message to legislators,
bylaws revision, which will be sent to the                                                    providers, consumers and health plans
members for a vote before the next                     Women should be                        should be that midwifery is different—
Annual Meeting. I’ve met with Lorrie and                                                      not less than or more than— the prac-
staff, as well as with Jim Dalton, our con-             in a leading role                     tice of obstetrics. It is an evidence-based
sultant working with us to refocus our                                                        and needed component in the delivery
                                                     in health care reform                    of care to women and childbearing fami-
work for the members. I was impressed
by Jim and am confident that he will help                and midwives                         lies. Put copies of books in hospital call
ACNM face the journey that lies ahead.                                                        rooms. Make up an abstract and give it
Great progress is being made!
                                                    can provide them with                     to your clients, childbirth educators, stu-
   I attended the Program Committee                  the evidence to do it.                   dent nurses, physicians, hospital nursing
meeting in August as they designed the                                                        staff and administrators. Send birth
education program for the ACNM 53rd                                                           announcements to your legislators. Form
Annual Meeting in Boston next year. I          care decisions for their families, and the     alliances with other providers.
have worked on a lot of programs in my         childbearing years are a natural place to         I recently joined old and new friends to
day but was never as organized as they         inform and instruct, not only about safe       celebrate nurse-midwifery education at the
are. The Annual Meeting will have great        and satisfying childbirth, but on nurtur-      University of Florida. Betty Hilliard was
content for everyone as well as a sprin-       ing the health of the family. Women            honored for her pioneering work in found-
kling of fun. In October, I meet with the      should be in a leading role in health care     ing the program. Dr. Charles Mahan—a
Service Directors Network and the              reform and midwives can provide them           well-known public health obstetrician and
Directors of Midwifery Education to            with the evidence to do it.                    pioneer in the development of midwifery
learn more about their important work.                                                        and birth centers—described a “gathering
   There has been activity at both the         Become a Guerrilla Marketer!                   storm” of consumer discontent with the
state and national levels regarding licen-     We can’t do it alone. ACNM works with          delivery of care to women and childbear-
sure and reimbursement. After 20 years         ACOG, APHA, JCAHO, American                    ing families. Dean of Nursing Dr. Kathleen
                                               Association of Birth Centers, and other        Long praised the work of Alice Poe and
                                               physician, nursing and midwifery profes-       her nurse-midwifery faculty for innovative
     8403 Colesville Road, Suite 1550          sional organizations. We—and you—also          recruitment through collaboration with
      Silver Spring, MD 20910-6374             have a responsibility to work at the grass-    other institutions. Through perseverance,
           phone: 240.485.1800                 roots level. Several new books, films and      patience, politeness, and positive energy,
             fax: 240.485.1818
                                               theatrical events provide opportunities to     the University of Florida achieved a six-
                 Please visit
                      propel discussion on the role of mid-          fold increase in midwifery program enroll-
      for direct dial phone numbers.           wifery in the health care system. Consider     ment! In a meeting with the students,
       To contact Quickening’s editor,         hosting a discussion group on new books        extraordinary practitioner and student pre-
          e-mail               like Born in the USA by Marsden Wagner;        ceptor Mary O’Meara emphasized these
                                               Pushed by Jennifer Block; Birth by Tina
                                                                                                                        continued on page 37
Quickening       Fall 2007
4   Regional Reports

                                                                        book simultaneously and could not wait to tell each other about
                 Region I Update                                        it. If you give yourself one gift this fall, make it Fierce
                  (CT, ME, MA, NH, RI, VT, Non-US Locations)            Conversations: Achieving Success at Work and in Life One
                  by Barbara Fildes, CNM, MS                            Conversation at a Time by Susan Scott. Read it and pass it around
                                                                        to your colleagues. Conduct a chapter meeting or midwifery
                                                                        gathering using a book club format. Discuss the principles of

    I  f you get more than two midwives in a room, lamentations
       begin about our lack of visibility. I believe that increasing
    midwifery’s visibility or, as our Executive Director Lorrie Kline
                                                                        fierce conversation and how midwives can practice these to fur-
                                                                        ther the profession and better meet the needs of the women and
                                                                        families we serve. Finally, make change one conversation at a
    Kaplan calls it “expanding our conversation,” is not something      time. Do not underestimate the power of this approach.
    that can or should be completely outsourced—even to our                The Values Proposition Survey conducted last year named “pub-
    national office. I believe that this must be done at many levels    lic relations advocacy activities” among the top priority for ACNM
    in many ways by many of us. I am calling upon each midwife          members. Let’s begin here at home. Let’s live our values. Q
    in Region I to select an assignment from the list below and
    accomplish it between now and May 2008.
       “Macro” Assignment: Enter the Web Challenge (see details on
    page 32). Many members have contacted ACNM about under-                            Region II Update
    taking a national media campaign about midwifery along the                         (DE, NJ, NY, PA, PR, VI)
    lines of the Johnson & Johnson television spots about nursing.                     by Dawn Durain, CNM, MPH
    ACNM looked into this; to say that such a campaign is cost-
    prohibitive is the understatement of the century. Money aside, I
    have my doubts about the mainstream media approach. Those
    J&J nursing vignettes do bring tears to my eyes and inspire me,
    but as I sit in front of our TV, the four 16–25 year olds in our
                                                                        D     id you hear the corks popping from Philadelphia on July
                                                                              20? No, it was not a late Independence Day party—it was
                                                                        the celebration of the signing of the Prescriptive Authority
    house are listening to their iPods, watching DVDs or TiVo, and      Legislation for CNMs in Pennsylvania! This long-awaited bill
    using their computers and cell phones. They aren’t watching         was part of Governor Ed Rendell’s 2007 “RX for PA,” a far-
    commercials! My children are precisely the age group that           reaching plan for state health care reform. Nurse-midwives,
    needs to learn about and value midwifery. Such was the think-       nurse practitioners and clinical nurse specialists were all recog-
    ing of Michele Helgeson, CNM when she put together the Web          nized as important components of any well-designed effort to
    Challenge. She had the idea, developed it, and is making it         improve the delivery of health care services in the state. The
    happen. Midwives in Maine, Rhode Island, Connecticut,               work of CNMs in Pennsylvania has long been recognized by
    Vermont, and Maine have a jump on this assignment and New           the Governor and his Office of Health Care Reform, especially
    Hampshire midwives should take this opportunity to create a         in some rural areas of the state, where CNMs deliver up to 50
    Web site. If Michele’s dream comes true, those sitting at home      percent of the babies. Congratulations are in order for the
    and “Googling” will have one spectacular hit after another any      CNMs and midwifery supporters who worked so hard, for so
    hour of the day or night—all featuring midwives and what we         many years, to achieve this victory. Now CNMs can prescribe
    bring to the world.                                                 medications in every state! Pennsylvania midwives know the
       “Mezzo” Assignment: In Chicago, I heard ACNM President           halls of the state capitol all too well and are now hard at work
    Kitty Ernst say, “Everyone should read Guerilla Marketing.” Do      writing the regulations that will ultimately allow CNMs to put
    it. Assign one member of your chapter to find a copy of the         ink to prescription pad. Well done Pennsylvania CNMs! See
    book or the newer companion 4-CD set Guerilla Marketing in          you at the Lobby Day in Harrisburg on October 22, 2007 (find
    30 Days by Jay Levinson and Al Lautenslayer. Pass it around to      more information at
    chapter members, midwifery supporters, and friends. Schedule           New Jersey CNMs and CMs are working with their new
    a fun brainstorming session in a comfortable place with lots of     lobbyist to set a legislative agenda for the coming year (find out
    food and a slew of young people. Spend a few minutes review-        more at It is not often that we see CNMs
    ing the tenets of “guerilla marketing” and the tools on the         as members of the licensing boards in a state, however
    ACNM Web site to help you plan for National Midwifery Week          it is very exciting to report that Karen Criss, CNM has been
    (many of which can be used for any event throughout the             re-elected as Vice President of the New Jersey State Board of
    year). Spend the bulk of the time on a LOCAL plan.                  Medical Examiners. Karen was re-appointed as a member of
    Assignments must be specific, manageable, and short-term.           the BOME in 2006 and has worked tirelessly on behalf of
    Midwives are too busy to undertake long and complex projects        New Jersey midwives and all licensees governed by the Board.
    and we all surely need to have some fun!                            Congratulations Karen!
       “Micro” Assignment: Mickey Cordell, CNM and I discovered a          New York midwives seem to be the event planners of our

                                                                                                             Quickening       Fall 2007
                                                                                                   Regional Reports                         5

region! On October 7, the SUNY Downstate celebration of “75
Years of Continuous Midwifery Education” was held. This sym-
                                                                                  Region IV Update
posium and gala were preceded on October 6 by the 5th annu-                       (DC, IL, IN, KY, MD, MI, OH, VA, WV, WI)
al Miles for Midwives 5K run and walk (see more at                                by Cathy Collins-Fulea, CNM, MSN, FACNM These two events are inspirations to us
all to start planning for next year’s National Midwifery Week!
   I look forward to meeting more of you as I continue to learn
the ropes of regional representation. Please contact me with the    I  t is the end of a wonderful summer. As the days get shorter and
                                                                       cooler, we welcome new students into our circle. The students are
                                                                    our future. Without them, we will all need to work until we are 100!
dates of your upcoming meetings and events. Happy Midwifery
Week 2007 to you all! Q                                             Consider precepting a student in your practice. If that is not possi-                                           ble, then mentor a student. We sometimes forget how awe inspiring
                                                                    it is for a student to meet and talk with midwives in practice. For
                                                                    our students, we encourage you to be active in the profession. Seek
               Region III Update                                    every opportunity you can to understand the profession as well as
               (AL, AR, FL, GA, LA, MS, NC, SC, TN)                 the practice. We are all responsible for moving the midwifery profes-
               by Cecilia Jevitt, CNM, PhD                          sion forward for the betterment of women, children, and families.
                                                                        On August 27, Illinois Governor Blagojevich signed into law
                                                                    “The Safe Childbirth Act-Freestanding Birth Centers” (SB 264)!

S   OUTHERN SENATORS NEEDED! The 18 senators from Region
    III need a flurry of requests to support the House-approved
increase in Medicare reimbursement included in the SCHIP legisla-
                                                                    Now the work of writing the rules and regulations will begin.
                                                                    But for now…lets CELEBRATE a new safe birthing option for
                                                                    the women of Illinois. They are also working on a revision of
tion. Let them hear you need 100 percent reimbursement!             the Nurse Practice Act.
   The Mississippi and Louisiana chapters haven’t met as                The DC and Maryland chapters held a joint meeting in June.
chapters since Hurricane Katrina devastated their coasts two        The Maryland chapter legislative goal for the coming year is to
years ago. Jacquelyn Chapman, CNM, Mississippi Chapter              work on changing the written collaborative agreement for the state.
Chair and I talked about a future retreat weekend for the               Kentucky midwives held a retreat at the Boone Tavern in
Mississippi and Alabama chapters located centrally on their         Berea, Kentucky September 28–29.
shared border.                                                          Michigan is still in negotiations with CMS to get the state to
   The Alabama Board of Medical Examiners plans to charge each      reimburse according to the national guidelines.
physician in a collaborative agreement with a nurse practitioner        I spoke with the Northern Virginia midwives by conference
or CNM $100 per year for each agreement. The agreements of          call in July. The Virginia chapter is dividing into smaller groups
physicians not paying the fee will be suspended. The fee ostensi-   called Regional Midwife Groups (RMG) for monthly/bimonthly
bly pays for the state audit of agreements. Alabama CNMs and        meetings. In the past, they found poor attendance at chapter
NPs will work together to resist this regulatory challenge.         meetings due to distance. With the RMG they are already hav-
   The Vanderbilt Nurse-Midwifery Program is opening a new          ing more participation than ever. Virginia is also working to
faculty practice. Births will be attended at Nashville General      create two birth centers within the state in underserved areas.
Hospital, which hasn’t had a midwifery presence in some years.          West Virginia midwives have been collaborating with the
The Tennessee chapter will be reviewing its bylaws in               West Virginia Nurses Association (WVNA) on legislative efforts
September with a focus on supporting the membership.                toward revisions of APN prescriptive authority and insurance
   The Emory University Nurse Midwifery Service/Grady Health        practices. The WVNA has encouraged their members to sup-
System and the Nurse-Midwifery Education Program at Emory           port the CHAMP bill.
University received “With Women, for a LifetimeTM” awards on            In Wisconsin, a statutory change that “bundles” renewal of
September 10. The Emory midwifery service has provided care         the CNM and RN license into one package looks like it will pass
for 37 years and the education program celebrates 30 years of       along with the rest of the state’s budget bill. Their next step is to
teaching.                                                           get the APNP (prescribing) license added to the bundle. A bill
   The University of Florida Nurse-Midwifery Program received       has just come out of drafting that removes the requirement for a
a “With Women, for a LifetimeTM” award on September 7 to            written collaboration agreement, removes all statutory language
honor 25 years of midwifery education. The Florida ACNM             that makes reference to mandated collaboration, and allows the
Chapters held their annual CEU meeting/fundraising gala on          CNMs to attain independent admitting privileges
October 6 at the Hard Rock Café in Fort Lauderdale. A day of            Finally a quote from Margaret Mead: “Never doubt that a small
CEU presentations, statewide chapter meetings, breakfast,           group of thoughtful, committed citizens can change the world.
lunch, and a dinner dance was enjoyed by many. Q                    Indeed, it is the only thing that ever has.“ Q                                    

Quickening        Fall 2007
6   Regional Reports

                                                                               sponsorship. I would also like to strongly encourage students to
                   Region V Update                                             attend. You are our future and we need your creative input. After
                   (AZ, CO, IA, KS, MN, MO, MT, NE,                            listening to your student report at the Annual Meeting, I know
                   NM, ND, OK, SD, TX, UT, WY)                                 you are eager to be involved and this is a great way to start.
                   by Lynne Himmelreich, CNM, MPH                                 Due to the generous support of the A.C.N.M. Foundation, we
                                                                               are able to offer 8 contact hours for only $35 ($25 for students).
                                                                               You can download the registration form at To

    I  thought it might be fun to take a look at some of the num-
       bers in our region as we continue looking at the structure of
    the College and talking about who we are as an organization.
                                                                               make this even more attractive, the Kansas City Chapter is spon-
                                                                               soring a Surgical First Assisting Workshop on Friday, November
                                                                               2nd from noon to 6 p.m., also at the Embassy Suites Hotel. This
    Region V has 15 states, 23 chapters and 1150 members. Our                  late start should decrease the need for another night in the hotel.
    region includes education programs at Baylor University in                 So maximize those continuing education dollars and I hope to
    Dallas, The University of Colorado at Denver and Health                    see you in Kansas City in November. Q
    Sciences Center in Denver, The University of Kansas in Kansas    
    City, The University of Minnesota in Minneapolis, The
    University of New Mexico in Albuquerque, and The University
    of Utah in Salt Lake City.                                                               Region VI Update
       Our region encompasses a large and geographically diverse                             (AK, AS, CA, Guam, HI, ID, NV, OR, WA)
    area with diverse practice types, and I believe our region has                           by Leslie Cragin, CNM, PhD, FACNM
    the largest number of midwives working in the Indian Health
    Service. We have much to offer each other and the national and
    international midwifery community. The state numbers are:
    Minnesota: 1 chapter/150 members; Iowa: 1 inactive chap-
    ter/51 members; Missouri: 2.5 chapters/54 members; Kansas:
                                                                               R     egion VI was proud to host its second ACNM Leadership
                                                                                     Seminar October 13-14, in Seattle, WA. Past President
                                                                               Katherine Camacho Carr, CNM arranged for a wonderful meet-
    1.5 chapters/49 members (Kansas and Missouri share a chap-                 ing room at Seattle University and Barbara Hughes, CNM led
    ter); North Dakota: 1 chapter/6 members; South Dakota: 1                   the seminar.
    chapter/20 members; Nebraska: 1 chapter/25 members;                           This year our region, led by Heather Bradford, CNM, Chair of
    Oklahoma: 1 chapter/29 members; Texas: 5 chapters/216                      the Government Affairs Committee and Region VI Legislative
    members; Montana: no chapter/28 members; Wyoming: no                       Affairs Committee Representative, was successful in bringing on
    chapter/10 members; Colorado: 3 chapters/186 members;                      nine of the 36 co-sponsors to our midwifery reimbursement
    New Mexico: 1 chapter/117 members; Utah: 1 chapter/92                      bill. In the August issue of The Advocate, Ginny Gladwin, CNM
    members; and Arizona: 3 chapters/117 members.                              wrote about the successful effort of the Los Angeles Chapter in
       Despite our diversity, we are all facing a variety of legislative and   getting sponsorship from two key members of Congress. She
    regulatory barriers on the state level that impact our ability to          involved the whole chapter! Our bill was included in Section
    practice and the quality of care available for women and their fam-        603 of HR 3162 (the “Children’s Health and Medicare
    ilies. I have heard from a number of you who are working hard to           Protection Act” of 2007), which passed the House on August
    challenge those barriers through your chapters and individually.           1st. The next step is the Senate. This ought to be an easier job
    A perfect place to begin the development of a strategic plan for           for our chapters – only two meetings per state! California
    addressing the barriers in your state is the ACNM Leadership               kicked off this effort by meeting with the staff of Sen. Barbara
    Seminar. It will be held at the Embassy Suites Hotel in Kansas             Boxer in San Francisco, organized by Katrina Nardini, SNM.
    City November 3-4. At the completion of the seminar, partici-                 This summer, Oregon midwives led an effort to oppose a bill
    pants will:                                                                that would have supported the efforts of the AMA’s Scope of
    • Understand the concept Personality, Style and Leadership                 Practice Initiative and potentially limited the practice of NPs
       and complete a personal DISC assessment tool.                           and CNMs in Oregon. The bill’s author, alerted to this potential
    • Identify the key responsibilities of a Chapter including:                in the hearing process, amended her bill to remove some of this
       - Building a team of chapter volunteers                                 risk, but the NPs and CNMs continue to oppose the bill. The
       - Recruiting and retaining high-quality volunteers                      bill remained in committee at the close of the legislative session.
       - Developing strategic partnerships in your community                      Many other chapters held regular meetings over the summer
    • Begin development of a Chapter Strategic Plan                            and had activities during Midwifery Week. For example, President
    • Have a deeper understanding of the ACNM strategic plan.                  Kitty Ernst was honored at the Santa Rosa, CA BOLD 2007 pro-
       Barbara Hughes, CNM, is the faculty for the seminar, and                duction of Birth the Play on September 23, hosted by the Santa
    Roberta Poirier, CNM and I will be there to assist in the discus-          Rosa Birth Center. I am looking forward to hearing about other
    sions. Having several chapter members there maximizes this                 inventive ways to celebrate midwifery in our communities. Q
    opportunity, so you might want to think about some chapter       
                                                                                                                     Quickening Fall 2007

      JMWH Now Accepts
      Manuscripts Online
      T    he Journal of Midwifery & Women’s Health is pleased to
           announce that manuscripts are now being accepted online.
      Elsevier Editorial System (EES) is fast, efficient, and offers step-by-
      step guidance through the submission process. Authors can view
      their submission and correspondence history and can monitor the
      progress of their manuscript as it goes through the peer review
      process. Peer reviewers will have a record of manuscripts reviewed
      for convenient CEU tracking. To submit a manuscript online, visit jmwh/. First time users will need to complete
      a quick registration to receive a username and password. Q

                           ACNM Board of Directors and Staff
 The Board of Directors                        ACNM National Office Staff                        Department of Membership
 President -                                   Executive Office                                  Associate Director for Membership-
   Eunice K.M. Ernst, CNM, MPH, DSc(Hon),      Executive Director -                                George Hamilton
   FACNM                                         Lorrie Kline Kaplan                             Membership Coordinator -
 Vice President -                              Director of Operations -                            Bethany Holliday
   Melissa Avery, CNM, PhD, FACNM                Kathleen Przybylski                             Membership Representative -
 Secretary -                                   Associate Director of Meetings                      Meaghan Airel
   Ginger Breedlove, CNM, PhD, ARNP, FACNM       and Industry Relations -
 Treasurer -                                     Sharon Kirksey-Walcott, CMP                     Department of Communications
   Tanya Tanner, CNM, MS, MBA                  Information Technology Manager - Fausto Miranda   Communications Manager -
 Region I Representative -                     Receptionist/Admin Assistant - Angela Telesford    Rebecca Jacob
   Barbara Fildes, CNM, MS                                                                       Communications Specialist -
 Region II Representative -                    Journal of Midwifery & Women’s Health              Eleni Hailu
   Dawn Durain, CNM, MPH                       Editor -
                                                                                                 Department of Professional Services
 Region III Representative -                     Tekoa King, CNM, MPH, FACNM
                                                                                                 Director -
   Cecilia Jevitt, CNM, PhD                    Deputy Editors -
                                                                                                   Lisa Summers, CNM, MSN, DrPH, FACNM
 Region IV Representative -                      Patty Aikins Murphy, CNM, DrPH, FACNM
                                                                                                 Senior Technical Advisor -
   Cathy Collins-Fulea, CNM, MSN, FACNM          Francie Likis, CNM, DrPH, NP
                                                                                                   Leslie Ludka, CNM, MSN
 Region V Representative -                     Editorial Coordinator - Jennifer Singleton
                                                                                                 State Policy Analyst -
   Lynne Himmelreich, CNM, MPH
                                               Department of Finance & Administration              Joanna King, Esq.
 Region VI Representative -
                                               Director -                                        Senior Staff Researcher -
   Leslie Cragin, CNM, PhD, FACNM
                                                 Christine Tate, MBA                               Kerri Schuiling, CNM, WHNP, PhD, FACNM
                                               Staff Accountant -                                Federal Lobbyist -
                                                 Sharon Shaw                                       Patrick Cooney
                                               Financial Specialist/Program Coordinator -        Education Projects Manager -
                                                 Lizette Hutchins                                  Elaine Germano, CNM, DrPH, FACNM
                                                                                                 Education Manager -
                                               Department of Global Outreach
    Members are welcome                        Director -
                                                                                                 Continuing Education Coordinator -
    to attend any open                           Deborah Gordis, MPH                               Melinda Bush
    session of a Board of                      Senior Technical Advisors -                       Program Coordinator -
                                                 Sandy Buffington, CNM, MPH, FACNM; Annie          Monica Greenfield
    Directors meeting.                           Clark, CNM, MPH; Diana Beck, CNM, MS;
                                                 Holly Blanchard, CNM, MSN                       A.C.N.M. Foundation, Inc.
    2007 Meetings:                             Program Manager -                                 President -
    November 30-December 2,                      Duncan Muguku                                     Carolyn Gegor, CNM, MS, FACNM
      Teleconference                                                                             Program Manager -
                                                                                                   Andrea Watkins
                                                                                                 Development Consultant -
                                                                                                   Lisa L. Paine, CNM, DrPH, FACNM

Quickening       Fall 2007
8   State Legislative News

    The Imperative of Political Involvement
    by ACNM Members                                                                                  by Joanna M. King, Esq.
                                                                                                     ACNM State Policy Analyst

    The marvel of all history is the patience     ply a good idea, it is patently necessary.     pleasantly surprised at the extent to
    with which men and women submit to                Remember: you possess the knowl-           which joining in was neither intimidating
    burdens unnecessarily laid upon them by       edge that will help the legislators and reg-   nor unduly time-consuming. Several of
    their governments.—William H. Borah           ulators who have control over your daily       you have been activist role models on
                                                  work lives care enough to make policy          state as well as federal issues; many more

              ne of the most pernicious prob-     changes. You bear the brunt of outmoded        of you need to take the plunge.
              lems we face in attempting to       laws and can impart compelling accounts            Testimonials from constituent health
              modernize state laws is that        of the unfairness that you and other mid-      care professionals have an unparalleled
    elected officials by and large do not         wives needlessly face. You must raise your     impact in advocacy for needed changes to
    know what our member midwives do              voice, contact your state representatives      laws and regulations governing CNMs
    and what lofty levels of education and        to share your experiences and expertise,       and CMs. When lawmakers hear specific
    clinical training they attain. But lawmak-    and then keep on contacting them.              stories about the harm caused by sky-
    ers ought not to be faulted for this; they    Relationships with elected officials and       rocketing professional liability insurance
    are inordinately busy people who may          their staffs—as with anyone—must be            rates, supervisory and written collabora-
    have greater experience with some pro-        built and nurtured over time.                  tive agreement requirements, the absence
    fessions than others. Across the nation,          And lawmakers are just folks. They         of admitting privileges, the inability to
    midwifery still suffers under a cloak of      grocery shop, attend religious services,       prescribe independently the full spectrum
    invisibility that must be addressed, and it   decry the high cost of fueling their cars      of medications clients may need, etc.—
    is midwives themselves—you as ACNM            and worry about their families’ well-          and when they hear that as a result of
    members in your capacities as con-            being—right alongside the rest of us. As       these barriers health professionals may
    stituents and business people—who             policymakers, they can do something to         not be able to stay in business, that they
    must continue to lead the effort to chip      help and, armed with that knowledge,           may in fact have to leave the state to prac-
    away at that impediment.                      they can convince other lawmakers that         tice in a jurisdiction where the laws are
        As someone who’s been lobbied (dur-       change is warranted. Many of you have          more sensible and respectful of independ-
    ing my tenure at the New York State           seen this dynamic in your outreach to          ent practice (as with the much-publicized
    Senate) as well lobbied others (in private    hospital or clinic administrators; result-     ob/gyn practitioners’ flight from and
    practice and trade association capacities),   ant changes in policy invariably benefit       shortages in certain states)—they will be
    I can assure you that there is no mystery     health care providers as well as their         motivated to dismantle outmoded barriers
    or magic to becoming politically active.      clients and patients at a given facility.      and even create incentives to keep practi-
    For ACNM members to survive and                   Midwives, inspired by their politically    tioners in business. Q
    flourish, political involvement is not sim-   active colleagues, have reported being

                                The QuickInfo Series is Growing!
      Visit and click             • Administration of                            •    National Practitioner Data Bank
      “Continuing Education and Practice            Midwifery Practices                          •    Provider Numbers
      Resources” to view new and updated          • Caring for Men                               •    Reentry to Midwifery Practice
      informative QuickInfo documents on:         • Federally Qualified Health Centers           •    Scope of Practice
                                                  • Immunizations

                                                                                                                 Quickening      Fall 2007
                                                                                   Federal Legislative News                                     9

Midwives Take Advantage of National
Midwifery Advocacy Month                                                                                   by Patrick Cooney
                                                                                                           ACNM Federal Lobbyist

                                               received a tour, learning more about mid-      increase their support of midwifery care.

    n August, ACNM staff challenged
    members to invite members of               wifery care and issues of interest to             While ACNM urged midwives to meet
    Congress to their clinics, birth cen-      Minnesota midwives. “The key is persist-       with their elected officials during the
ters, or hospitals to educate your officials   ence. We had a lot of fun educating            month of August, while the Congress was
on midwifery practice and to build rela-       Senator Klobuchar’s staff person and felt      in recess, ACNM encourages its members
tionships. Reaching out to policy makers       she went away from the experience with a       to utilize the information provided on the
and their staffs is an important compo-        new found understanding of midwives            Web site to initiate and organize visits from
nent in building lasting relationships that    and the challenges they face,” says Stoyke.    elected officials at your clinic, birth center,
can benefit the practice of midwifery. It is      In Washington State, Heather Bradford,      or hospital throughout the year. More
also a nice way to get publicity for your      CNM, Chair of ACNM’s Government                information can be found about National
practice and services.                         Affairs Committee, Chris Hunter, CNM,          Midwifery Advocacy Month by visiting
   Several ACNM members took up the            Cheri Van Hoover, CNM, and Laura      and clicking “Legislation
challenge. For example, two CNMs from          Denmark, CNM initiated visits from the         and Health Policy,” “Grassroots Program.”
Minnesota, Linda Gellerman and Brielle         staffs of Senators Maria Cantwell (D-WA)          ACNM stands ready to help you with
Stoyke, invited staff from Senator Amy         and Patty Murray (D-WA). Both are              this effort. Please contact Patrick Cooney
Klobuchar’s (D-MN) office to tour the clin-    cosponsors of legislation that is important    at 202-347-0034 for guidance in setting
ic and hospital where they practice. Rose      to midwives. While they are already            up these important educational visits for
Bauman, Outreach Director from Senator         cosponsors, it is important for the staff in   your elected federal officials. Q
Klobuchar’s office visited with them and       these offices to continue to learn about and

Congress Takes Step                            H.R.864/S.507. The CHAMP bill did not          achievement, and celebrates the passionate
from page 1                                    include this provision. CMs are presently      advocacy of midwives who helped achieve
                                               licensed in New York, New Jersey, and          this important victory,” says Ernst. “It’s
Medicare program for the long term.”           Rhode Island. ACNM’s strategy is to work       critically important that we maintain this
   The work is not over, as the bill’s pas-    with Senators from those three key states      momentum to ensure strong support in
sage in the Senate is still necessary to fix   to gain support for including the CM pro-      the Senate for this provision so that it is
the Medicare reimbursement inequity.           vision in the final legislation that the       finally enacted into law.”
ACNM is asking members to urge their           Congress will pass and send to the                More information about how you can
Senators to sign on to the “Midwifery          President to be signed. More information       get your Senator’s support for this bill is
Care Access and Reimbursement Equity           on this effort can be found on ACNM’s          available at Q
Act of 2007” (S.507). As of September 3,       Web site.
eleven Senators had signed on to the bill.        “Expanded access to midwifery care in
   CNMs are currently limited to receiving     other countries has produced better out-
65% of the Medicare fee, and many              comes at lower cost and is supported in
Medicaid and private health plans follow       this country by 80 years of outcomes
Medicare fee schedules, further reducing
access to care for vulnerable populations.
                                               research on midwifery care,” says Ernst.
                                                  ACNM also supports provisions within           Read about
Under H.R.3126, as of April 1, 2008,           the SCHIP portion of the bill that will           Midwifery Week events
CNMs would join the ranks of physicians        allow states to apply outreach procedures
and other health professionals already         and programs to all children and preg-            on the Web at
receiving equitable (100%) reimbursement
for their services under Medicare.
                                               nant women and provide states the
                                               option to expand and add coverage of
   ACNM is continuing to work for the          pregnant women under SCHIP.
recognition of CMs to bill for services           “ACNM congratulates the House of
under Medicare, as contained in                Representatives on this tremendous

Quickening       Fall 2007
10   Professional Connection

     Midwife to Midwife                                                                           by Leslie Ludka, CNM, MSN
                                                                                                  ACNM Senior Technical Advisor

                                                     maybe I’d find the answer there.             had been raped. One weekend I attended

                t the beginning of the summer,
                ACNM announced my appoint-              That first locums job began the process   both a 13-year-old girl and an almost 50-
                ment as Senior Technical             of opening my eyes to the vast dimen-        year-old grandmother. I have seen mid-
     Advisor, along with a brief profile. This       sions of our exceptional care of women.      wifery at some of its finest moments, and
     might make interesting break room read-         Heart disease, diabetes, obesity, alco-      Mother Nature at some of her worst.
     ing but the important question is: why          holism, drug addiction, oppression, and      Midwives are overcoming nearly insur-
     should it matter to you? If a new advisor       domestic violence are common diagnoses       mountable obstacles to provide the high-
     joins the national office staff, what differ-   for Native American women. In spite of       est quality of care, sometimes in an
     ence does it make to your life in Tucson,       all that, these women are birthing some      atmosphere where they feel professional-
     Brooklyn, or Wolf Point?                        of the most beautiful babies I have ever     ly isolated and/or underappreciated. I
        It can make a significant difference.        seen. That profound experience devel-        have worn your scrubs and I know how
     ACNM is the connection point for all of         oped into a six-year locums business that    valuable your experience is to all of us.
     us. Let’s use this connection point to                                                          Like you, I truly believe that birth is a
     “midwife” one another. I would like to                                                       normal process and that midwives are the
     create a forum where we can freely share          In 2001, I asked myself                    normal childbirth experts. I believe that
     our knowledge, struggles, questions and                                                      birth is a natural, joyful, healthy event
     concerns, a safe place that benefits each
                                                        the question that we all                  most of the time. When it isn’t is when
     of us. To do this, I need your help.              ultimately ask ourselves:                  midwives do some of our best work. Most
        I am asking you to share your ques-                                                       of all, I believe that midwives provide
     tions, stories, wisdom and worries with
                                                      Do I really want to continue                excellent quality care to women and new-
     your midwife colleagues in our new                     to be a midwife?                      borns. Unfortunately, we do not always
     “Midwife to Midwife” column in                                                               take such good care of ourselves and each
     Quickening. With this column, I want to                                                      other. We don’t take the time to share our
     be a responsive voice that represents and       has taken me thousands of miles.             collective wealth of experience. “Midwife
     addresses your individual needs.                  I’ve fished the Missouri River in          to Midwife” is our opportunity to do that.
        As your sister midwife, I will work to       Montana with pregnant women; stood              The ACNM national office is a relatively
     bring your stories to the forefront. My         on an icy grass runway at 38 degrees         small operation. I have been amazed at the
     work as clinician/director in the high vol-     below zero waiting for the pilot to          productivity of this group on a very limited
     ume, high tech teaching institution at          sober up and the plane to thaw out so I      budget. We have many new faces at head-
     Brigham and Women’s Hospital in Boston          could get home; hiked through the            quarters; faces who bring new ideas. ACNM
     taught me that I have a lot to learn from       rainforest of Molokai, Hawaii, to see the    is incorporating new ideas and change to
     other midwives. Struggles, ideas, hard          “birthing rock;” coached transition in       improve our profession and to increase
     work, successes, and failures happen in         ambulances; ridden to births in the          access to our care. I’m thankful to have the
     every practice. But if we support one           pouring rain on a moped; hiked to the        opportunity to be part of this change, and
     another, we will achieve great successes        Ancestral Pueblo ruins of the Anasazi,       I’m asking you to be part of it, too.
     for ourselves and for our profession.           whose women were attended by mid-               Write to me. Share your stories, your
        Why do I think I can help us find that       wives. I have attended the births of         joys, your fears, your successes and, yes,
     voice? Because I have walked in your labor      babies addicted to meth, Navajo babies       even your failures. Send those questions
     clogs and I want to listen to you. In 2001,     facing east to Father Sun, Martha’s          that you know so many others want to
     I asked myself the question that we all ulti-   Vineyard babies during a fishing derby,      ask. Identify yourself or make it anony-
     mately ask ourselves: Do I really want to       rural babies in the pitch dark after the     mous and in strictest confidence. Your
     continue to be a midwife? I took a year off     power failed, and water babies in birth      questions and experiences will benefit us
     from midwifery to ponder that important         centers. And I have been embarrassed         all. If you’re not a writer, call to tell me
     question. In early 2002, a midwife friend       by large egos at board rounds.               your story and we’ll write it together.
     called from a Native American reservation         I’ve hugged with sadness and joy in           Let’s make “Midwife to Midwife” our
     asking if I would work as a locums tenens       midwifery practices all over this country.   forum to midwife each other. Q
     (fill-in) midwife for three months. I had       On my 55th birthday, I cared for and
     never been on a reservation and thought         cried with three separate women who
                                                                                                               Quickening        Fall 2007
                                                                   Marketing and Public Relations                                              11

Buzz Beyond Babies:
How We Got the Word Out About Midwifery                                                                   From Winger and Associates

                                            and downtown near the

           s the Illinois Chapter of ACNM
           prepared to host the 52nd        convention.
           ACNM Annual Meeting in              We wanted the mid-
Chicago, they were eager to create a        wives to feel welcomed to
buzz about certified nurse-midwives         Chicago and also get
throughout the state. With money saved      some high visibility in
from years past and a clear idea of what    key locations for their
they wanted to achieve, they hired us,      profession’s message:
Winger and Associates, Ltd, a public        “With Women, for a
relations firm.                             LifetimeTM.” Next, we
   The chapter is working to change         were lucky enough to
the perception that CNMs provide a serv-    work with the local NPR
ice that’s old fashioned or inferior        affiliate, WBEZ Chicago.
to other options.                           NPR chose not only to
   “How do you break through the            cover the convention but
notion that only physicians give med-       began work on an exten-
ical care?” asks Barbara Havens, CNM,       sive documentary on the
chair of the chapter and a staff nurse-     topic. Finally, we’ve
midwife at the University of Illinois at    worked with editors at
Chicago. “In Illinois, we feel invisible.   newspapers, magazines
We want to get the word out so we are       and online to place sto-
seen and known as legitimate and safe       ries about midwifery.
health care providers.”                        Our efforts continue.
   The staff at Winger and Associates       We re-launched our ban-
came at the perception problem from a       ner campaign downtown
few directions. We identified our target    for National Midwifery
audience and came up with a strategy for    Week in October. Our
reaching them. We found that many           plan is to have the banners
young women were aware of the value of      hanging prominently in
receiving care from a CNM. But how did      the city and then rotate
we reach out to an older population? It     them through various
was a large challenge. We had to rely       neighborhoods. We are
heavily on media coverage as we had a       currently exploring a pub-
minimal advertising budget.                 lic transportation advertis-
   Our strategy took form visually, audi-
                                                                                    of the Illinois Chapter of ACNM
                                            ing campaign and expect to Members made to welcome midwives to thestand in front of the ban-
                                                                          ners they                                 52nd Annual Meeting
bly and in print. We launched the cam-      see a large feature story in in Chicago.
paign with a massive press kit mailing to   the Pioneer Press in a few
area and national media contacts; then      weeks, with a distribution covering about           now switched to seeing a CNM. We
we followed up intensively with editors     50 neighborhoods along Chicago’s affluent           guess the campaign is working on us!
via phone. While that was in the works,     North Shore. The upcoming article will              This marketing campaign encompasses
we teamed up with a local graphic           play a role in dispelling many of the myths an important, even urgent, step for mid-
design team, Distortion Design. Beautiful   about CNMs.                                         wifery, and we applaud the Illinois
over-sized banners were created and            At Winger and Associates, our entire             Chapter for taking the initiative to elevate
hung at O’Hare International Airport        office is women and half of our staff has           their message. Q

Quickening Fall 2007
12   Membership

     Membership News                                                                           by Bethany F. Holliday,
                                                                                               ACNM Membership Coordinator

     Meaghan Airel Joins the                         For more information, see the story on    wifery. You touch lives each day with your
     Membership Department                        page 1, visit or e-      dedication to women and children. By
     Meaghan Airel has joined ACNM as the         mail MyBirthTeam President Cyndi Gross       taking care of your patients following the
     new Membership Representative. A grad-       at                    midwifery model of care, you strive to
     uate of Villanova University with a                                                       make a difference. We would like to offer
     degree in Psychology, Airel has been         Online Renewal                               you the opportunity to nominate your fel-
     working in the non-profit field for three    ACNM offers the option of paying your        low midwives to be featured in the
     years. She worked as an AmeriCorps           ACNM Annual Dues online at www.mid-          Membership Department’s column in
     VISTA volunteer at a Habitat for    by clicking on “Member Services”    future editions of Quickening. We will fea-
     Humanity affiliate in Colorado, and most     and “Renew Your Membership.” You can         ture up to three members per edition. If
     recently worked as a Program Specialist      make your payment any time that you          you believe one of your fellow midwives
     for the Girl Scouts of Central Maryland.     have an open Dues Invoice, which is          exemplifies the values of midwifery, please
     In her role at ACNM, Meaghan will be         anywhere between 120 days before your        nominate them! This is a great opportuni-
     providing customer support for members       membership expiration date to one            ty to share inspirational stories about mid-
     and will respond to any emails and           month after your expiration date. All you    wifery and to honor your colleagues.
     phone calls to the Membership                will need for login is your Member ID           Please send your submissions to bholli-
     Department. Additionally she will main-      number and your password, which is the You may also send sub-
     tain member records and compile and          first four letters of your last name fol-    missions in the mail to Bethany
     distribute membership materials. Airel is    lowed by your Member ID number.              Holliday’s attention at the ACNM
     excited to be a part of this organization.      If your membership category is chang-     National Office. Q
     She is available at 240–485–1824 and         ing, you will not be able to use the                             online renewal system. It is based on the
        Bethany F Holliday (formerly Bethany
                  .                               amount of dues already billed in your
     Farra) is now the Membership Coordinator.    member record. When making a change
     She continues to answer your membership      of category you may either use the gener-
     inquiries, in addition to managing Holliday is available at
                                                  ic membership application online or send
                                                  your payment in the mail when you               We want to
                                                  receive your paper renewal notice. Please
     240–485–1825 and
                                                  make a note of your change of status on
                                                  your renewal form when you send it in
                                                                                                  hear from you Member
     Benefit                                      with your payment.
                                                     If your membership has lapsed and
     ACNM has recently joined forces with                                                         Send information and pictures, a unique Web site           you want to re-activate your member-
     where prospective patients can search for    ship, you will need to use the member-          from your chapter’s meetings
                                                  ship application online at
     providers that suit their wants and needs                                                    and events to
     for pregnancy-related and women’s            “Member Services” and “Join ACNM.”
     health services. Until November 30,          The renewal site will no longer recognize       for inclusion in Quickening.
     ACNM members will receive a special          you because of your lapsed status.
     introductory discount of $200 off the           Please direct any online payment ques-
     regular provider listing fee of $695 for a   tions to or 240–485–1825.
     12 month listing. Provider listings pur-
     chased after November 30 will be at the      Members of the Season:
     regular ACNM discounted rate of $595.        Nominate Your Fellow Midwives
     Listings purchased before November 30        The Membership Department values the
     will also lock in the $495 annual rate for   work that you do in your support and
     your renewal next year!                      empowerment of women through mid-

                                                                                                              Quickening Fall 2007

Congratulations and Welcome…
Newly Certified Midwives                                        Elicia A. Kaplan, CNM       Stacy C. Reid, CNM
(January—June 2007)                                             Beth A. Kelley, CNM         Julie L. Rischar, CNM
                                                                Maraya K. Kennedy-          Carmen M. Rivera, CNM
                                                                  Friedman, CNM             Nancy C. Robertson, CNM
Congratulations to the following                                Mary R. Korduner, CNM       Sky Y. Rogers, CNM
                                                                Tracie L. Kreider, CNM      Charlotte A. Rollie, CNM
professionals for recently passing the                          Mary E. Kwiecinski, CNM     Lynneece M. Rooney, CNM
AMCB Midwifery Certification Exam.                              Joy L. Lackey, CNM          Michele L. Rothwell, CNM
                                                                Penny C. Lane, CNM          Deidre M. Russell, CNM
                                                                Kathryn S. Leggitt, CNM     Karen A. Sandock, CNM
Kirsten L. Aexel Handley, CNM   Kathy L. Errthum, CNM           Michelle N. Lehmer          Deanna J. Schwake, CNM
Sarah A. Akers, CNM             Melicia Escobar, CNM              Chiafulio, CM             Thecly H. Scott, CNM
Melissa L. Allred, CNM          Amy P. Farmer, CNM              Chillon A. Loen, CNM        Jodi M. Scott, CNM
Magdalene L. Antill, CNM        Vernetta J. Ferrell, CNM        Julie M. Lundman, CNM       Sheila G. Seyster, CNM
Jennifer H. Atzen, CNM          Tiffany S. Fisher-Avalos, CNM   Tara L. Lynchard, CNM       Jessica L. Simmons, CNM
Cynthia A. Beale, CNM           Jody A. Ford, CNM               Bergen C. Mahoney, CNM      Nina S. Simon, CNM
Kimberlee M. Beasley, CNM       Tanya M. Foster, CNM            Nicole T. Masters, CNM      Susan A. Siniard, CNM
Theresa A. Belfiore, CNM        Christina M. Francis, CNM       Lior Mayer, CNM             Kira L. Smith, CNM
Nicole A. Black, CNM            Barbara J. Francis, CNM         Christine K. McBride, CNM   Denise C. Smith, CNM
Julie H. Blackman, CNM          Ellen M. Franklin, CNM          Megan K. McCrossin, CNM     Ellen C. Solis, CNM
Stephanie R. Bonhaus, CNM       Shaina M. French, CNM           Alyn R. McGee, CNM          Cara E. Starkey, CNM
Lorraine A. Bowen, CNM          Bethanie S. Genre, CNM          Jennifer H. Meyers, CNM     Kathryn J. Steckel, CNM
Laura E. Boyle, CNM             Nikole D. Gettings, CNM         Mary M. Milkey, CNM         Julie A. Stembridge, CNM
Amanda N. Breed, CNM                      .
                                Monica F Giardino, CNM          Amy R. Morton, CNM          Cari L. Stemig, CNM
Bethany J. Brown, CNM           Bess A. Greevy, CNM             Alyssa S. Mull, CNM         Jennifer R. Sunderland, CNM
Jayme L. Burford, CNM           Lauren S. Guehl, CNM            Heather R. Murphy, CNM      Jill Tellez, CNM
Nicole S. Carlson, CNM          Elizabeth A. Gutierrez, CNM     Amanda B. Murphy, CNM       Carol A. Thomas, CNM
Stacie B. Carter, CNM           Jodee A. Gutierrez, CNM         Violet M. Near, CNM         Lynn-Della H. Trotter, CNM
Amy T. Clark, CNM               Meka S. Hall, CNM               Abigail B. Neff, CNM        Leilah M. Tyree, CNM
Amanda M. Clark, CNM            Jolene M. Hamann, CNM           Jennifer R. Nelson, CNM     Filomena C. Vagueiro, CNM
Peggy R. Cobb, CNM              Jessica L. Hamilton, CNM        Cheryl L. Newbold-          Rebecca M. Van De Water, CNM
Karen A. Collins, CNM           Melanie Hartman, CNM              Thompson, CNM             Lyric C. Walsh, CNM
Desiree R. Connelly, CNM        Penny R. Hauser, CNM            Ha H. Nguyen, CNM           Julie J. Ward, CNM
Sarah J. Corrales, CNM          Diana L. Herrick, CNM                   .
                                                                Maria F O’Donnell, CNM      Katie A. Weart, CNM
Tammy L. Cote,’ CNM             Tracy B. Herrmann, CNM          Wendy R. Olsen, CNM         Lisa M. Weppler, CNM
Amanda C. Cripe, CNM            Lindsey M. Hill, CNM            Laura J. Olsen, CNM         Mary C. Wheeler, CNM
Lisa M. Cucinella, CNM          Adrienne D. Hines, CNM          Lynn M. Olson, CNM          Cynthia T. Williams, CNM
Marilyn A. Curl, CNM            Christa L. Howell, CNM          Julie A. Omar, CNM          Tamar L. Windsor, CNM
Tina M. Dawdy, CNM              Rebecca W. Huneycutt, CNM       Christy E. O’Reilly, CNM    Amanda S. Winters, CNM
Jessica E. Densmore, CNM        Marecha V. Jackson, CNM         Angela M. Osgood, CNM       Renee M. Worrell, CNM
Elizabeth Dixon, CNM            Tiffany A. Jackson, CNM         Annette R. Payot, CNM       Margaret A. Wright, CNM
Kerry A. Dixon, CNM             Rachel Johanson, CNM            Colleen M. Pham, CNM        Alison M. Wurst, CNM
Bethany L. Domzal, CNM          Laurie L. Johnson-Driese, CNM   MaryLou Phillips, CNM       Kristen J. Young, CNM
Lauren A. Dutton, CNM           Mary K. Jones, CNM              Susan M. Rannestad, CM      Erin M. Young, CNM Q
Suzanne S. Endriga, CNM         Sondra R. Kalczynski, CNM       Patricia M. Reddy, CNM

Quickening Fall 2007

     ACNM Welcomes New Staff
                                                    Projects Manager. In this position,           selected to serve as the Director of
     I n August, Melinda Bush joined
       ACNM’s Department of Professional
     Services as the Continuing Education
                                                    Germano will be responsible for leading
                                                    the implementation of the work plan that
                                                                                                  Finance. Since 1999, Tate has been a
                                                                                                  financial consultant to various
     Coordinator. Bush provides support for         emerged from the 2005 ACNM                    Washington-based for-profit and non-
     the continuing competency assessment           Education Summit. Germano has been            profit organizations, serving as acting
     (CCA) and continuing education pro-            involved in midwifery education               controller, providing budget assistance to
     grams. She also supports the home study        throughout her career, including as a         non-profits, and assisting clients with
     programs for the JMWH. She holds a             midwifery education program coordina-         complex reconciliations and financial
     bachelor’s degree in Health Promotion          tor at Los Angeles County/University of       projects. Tate has been acting as ACNM’s
     and Education from the University of           Southern California (LAC/USC) Medical         Interim Director of Finance since mid-
     Cincinnati and has experience coordinat-       Center from 1982–1986 and as Director         June, competing against other leading
     ing and managing continuing education          of the Nurse-Midwifery Education              candidates in the final selection process
     programs for non-profit organizations.         Program at Georgetown University from         for a permanent Director. She can be
     She can be reached at          2002-2005. She can be reached at              reached at
       Elaine Germano, CNM, DrPH, FACNM                                  ACNM also welcomed Meaghan Airel.
     has accepted the position of Education             Christine A. Tate, MBA has been           Read about Airel on page 12. Q

     Request for Input on DOA Criteria Revision
                                                    • Policies and Procedures Manual                  Please send your comments to DOA
     I n the fall of 2007, the ACNM Division
       of Accreditation (DOA) will initiate the
     formal document review process, which
                                                    The DOA requests your comments and
                                                    recommendations regarding these docu-
                                                                                                  at ACNM, 8403 Colesville Road, Suite
                                                                                                  1550, Silver Spring, MD 20910. The
     takes place every five years, relating to      ments. We especially want your input          DOA Governing Board will begin work
     the DOA criteria documents. The four           regarding the specific criteria. The cur-     on the draft revisions starting in October
     documents that will be reviewed are the:       rent documents can found online at            2007 and adopt the final version of these
     • Criteria for Programmatic Accreditation “About ACNM,”                 documents in October 2008. We greatly
     • Criteria for Programmatic Preaccreditation   “Divisions,” “Divisions of Accredation.” in   appreciate your input and look forward
     • Criteria for Institutional Accreditation     the box on the right side of the page.        to hearing from you. Q

                         January is the Deadline for the
                         Hattie and Kitty Award Nominations
                          This is your chance to nominate an exceptional midwife for a national
                          award. Visit and click “About ACNM,” “Awards” to down-
                          load the nomination form for the Hattie Hemschemeyer and Kitty Ernst
                          awards. The nomination deadline is January 11, 2008. These awards will
                          be given at the 2008 Annual Meeting in Boston, May 23–28, 2008.

                                                                                                                Quickening Fall 2007
                                                                                                           Global Outreach                           15

HBLSS Follow Up in Haiti                                                                                  by Suzanne Stalls, CNM, MA and
                                                                                                          Candace Kugel, FNP, CNM, MS

                                                learning. They

    n November 2006, Suzanne Stalls,
    CNM and Candace Kugel, CNM                  had mastered the
    returned to Jeremie, Haiti, to conduct      content of the
monitoring and evaluation of the imple-         curriculum
mentation of a Home-Based Life Saving           except for a
Skills (HBLSS) program, which began in          reluctance to
February 2006. The ACNM Department              compare local
of Global Outreach (DGO) provided the           beliefs and prac-
initial training to KOMBIT staff, a             tices to those
USAID-funded child survival program.            being introduced
   Haiti is the poorest country in the          in the course.
Western hemisphere and faces enormous              In another
challenges in maternal and child health.        aspect of per-
The maternal mortality rate (MMR) was           formance evalua-
estimated in 2003 (by WHO) to be                tion, 27 of the
680/100,000; the neonatal mortality rate        matwons (tradi-       Haitian midwives role-play a woman in childbirth during an HBLSS training
                                                                      in Haiti.
36/1,000 and the infant mortality rate          tional midwives)
80/1,000 (Haitian Demographic and               who received
Health Survey, 2000).                           HBLSS training were tested on their               complications, interviews will be done to
   KOMBIT is associated with the Haitian        retention of knowledge. The master                ascertain which of the HBLSS actions
Health Foundation (HHF). In addition to         trainers were taught how to conduct               were implemented in each case. Trainers
primary care clinics and a maternal wait-       complication audits, a mechanism used             learned how to gather and document
ing home, HHF has trained “health               to determine use of HBLSS information             “birth stories” and performed 65 practice
agents” in the communities of the               in the field. In the event of childbirth          interviews with women who had given
Grand’Anse Department. The work of the                                                                                        continued on page 32
health agents is health education and
community mobilization surrounding
issues such as breastfeeding, immuniza-
tion, and nutrition. HBLSS, with its
emphasis on community education with
a demonstrated impact on maternal mor-
tality, dovetails perfectly with the existing      Donation
programmatic infrastructure.
   The purpose of this follow up visit was         Annie Clark, CNM,
                                                   ACNM Senior Technical
to perform a formal evaluation of the              Advisor presented Ambo
program in terms of performance, case              Hospital in Ethiopia with
                                                   an ultrasonic Doppler
management, coverage, community sup-               donated by Cooper
port, and quality of care at the referral          Surgical. “I would like to
                                                   express my appreciation
site. The evaluation was performed dur-            and that of my staff for
ing a three-week visit by the consultants.         Cooper Surgical’s donation
                                                   of an ultrasonic Doppler.
   HBLSS trainers were observed for three          Our Doppler has not been
days as they discussed and taught prob-            functional for more than
lem recognition, home-based first aid,             two years,” said Dr.
                                                   Adamu Bayissa, Director,
emergency care planning, and referral for          Ambo Hospital. In the pic-
pregnant women. They had effectively               ture (right) a doctor uses
                                                   the Doppler to do an
integrated traditional teaching techniques         ultrasound on a patient.
of songs, story telling and role playing to
assist their low-literacy audience with

Quickening       Fall 2007

     Ohio CNMs Maximize
     Visit from the Governor                                                                            by Sue Sommer, CNM

                hio Governor Ted Strickland vis-
                ited the nurse-midwives of Bay
                Park Women’s Services at the
     Sutton Center in Port Clinton, Ohio as
     part of his statewide tour to promote his
     budget, which includes funding to
     improve health care for Ohioans.
        The Governor’s visit was during a very
     busy week for our practice. I had been at
     the ACNM Annual Meeting in Chicago
     and received word of his visit on my first
     day back to work. We wanted to take
     advantage of this wonderful opportunity
     to address issues that are important to
     the nurse-midwives in our state. With
     very little time to think about the multi-
     tude of pressing health concerns that
     affect our practice, I phoned the ACNM
     national office for guidance.                   Ohio Governor Ted Strickland (center) met with CNMs during a visit to the Sutton Center in Port
                                                     Clinton, Ohio, May 31, 2007.
        I worried that the national office would
     be deserted since most of the staff was
     still at the convention. It was my good        opinion about the sta-
     fortune that Joanna King, the ACNM             tus of health care in
     State Policy Analyst, had just returned        our community.
     from Chicago. She was gracious enough             The Governor’s
     to speak with me and together we out-          agenda was to build
     lined the most pressing issues facing          support for his pro-
     CNMs in Ohio. I phoned Joanna at 11            posed budget. Our
     a.m. and the Governor was arriving at 1        agenda was to make
     p.m., so we worked quickly!                    him aware of barri-
        The Governor arrived with an                ers to providing
     entourage that included administrators         midwifery care. The
     from local service organizations, secret       nurse-midwives
     service agents, and the press. During his      were able to ask
     visit he had questions for CNMs Judy           Governor Strickland
     Lamp and Kay Smith that included, Who          for his support for     The midwives of Bay Park Women’s Services, Certified Nurse Midwives of
     do we serve and what services do we            increasing reim-        Toledo are, from left to right, Kay Smith, CNM, Judy Lamp, CNM, Sandy
                                                                            Nuzum, CNM, and Sue Sommer, CNM.
     provide in our office? What barriers to        bursement for
     health care do we see in caring for our        CNMs in our state,
     patients? What age groups of women do          conferring admitting privileges and                to the Governor along with a picture
     we care for? and What changes would            expanding access to care.                          commemorating the Governor's visit that
     enhance health care services for the              While our visit with the Governor was           appeared in our local newspaper.
     women in our area?                             short, he met with the CNMs in our                    Many thanks to Joanna and the staff at
        After his questions were answered, he       office, leaders of community service               the national office for their help. We
     thanked us for providing health care to the    groups and with families struggling to             truly enjoyed the whole experience and
     women in our city. It is an incredible feel-   access health care.                                would do it again any time. Q
     ing to know that the Governor wanted our          Afterwards, we sent a thank you letter

                                                                                                                        Quickening Fall 2007

Bylaws Revision 2007                                                                                  by Jan Kriebs, CNM
                                                                                                      ACNM Bylaws Committee Chair

Current Bylaws Allow Voting By Mail and Electronic Ballot
                                              cussions on various emidwife discussion        which is the largest subcommittee with

         uring the 2007 Annual Meeting
         in Chicago, ACNM members             groups, the motions during the Annual          11 members including chairs of state
         approved revisions to one article    Meeting, and other member input, Jan           organizations, current and past chapter
of the bylaws as proposed by the Board of     Kriebs, CNM, Bylaws Committee Chair,           chairs, current and immediate past
Directors and Bylaws Committee Chair.         and Helen Burst, CNM, Chair of the             Board members, and a representative
   Article XVII, section 2 of the bylaws      Working Group on Bylaws Revision,              from the military.
was amended to allow for mail and             developed a new draft template. This              The subcommittees have been sent
electronic voting between Annual              template is also available for review at the   detailed “charges” with issues and ques-
Meetings with 60 days notice. The             ACNM Web site.                                 tions to be addressed and are encouraged
Article now reads:                                                                           to address any other issues they identify.
   “These bylaws may be amended by a          Subcommittees to Address Key Issues
two-thirds (2/3) affirmative vote of the      Subcommittee on Board Issues (tem-             The Role of First Reviewers
voting members present at any Annual          plate Articles VI, VII, VIII, IX, and          Following the subcommittees’ report, an
Membership Meeting of ACNM duly               X). Jan Kvale is chair of this subcom-         identified group of reviewers including
called and held, provided that the pro-       mittee, which has seven members, all           the ACNM Board of Directors as well as a
posed changes have been sent to the           current or former Board of Directors           number of members who have expressed
members sixty (60) days before such a         members, including one past president          interest in the work, will comment on
meeting; or, a two-thirds (2/3) affirmative   (Judith Rooks).                                the complete document.
vote of the members voting by mail or         Subcommittee on Nominations and
electronic ballot. Proper written notice      Elections. Carol Howe is chair of this         We Value Your Input
under this Article shall be a complete        subcommittee, which has six members            We encourage members to read the
copy of the text of the proposed amend-       including the immediate past chair of the      template and contact us at
ment, including any relevant explanatory      Nominating Committee, Alex Schott.    and
materials, transmitted by mail, e-mail, fax   Subcommittee on Membership and        You can also discuss
transmission, or other appropriate means.     Fees (template Articles III and IV).           concerns through the bylaws forum,
Notice shall be deemed sufficient if sent     This subcommittee will address the issue       which is linked from the ACNM Web site.
to the last postal address, e-mail address,   of non-CNM/CM Associate Membership.
or fax number furnished to the Secretary.”    Sue Stone is chair of this subcommittee,       Looking Ahead
   The June 2007 bylaws are available at      which has five members including a CM          The Bylaws Committee will have a final
the ACNM Web site.                            and a student.                                 review and propose a new bylaws docu-
                                              Subcommittee on Structure (Article             ment to the membership. Because the
What happened after the meeting?              V). This Subcommittee will address the         membership supported electronic and mail
Combining the bylaws revision drafted         national structure of ACNM including           votes on bylaws issues, our plan is to have
this spring, the comments sent to the         state and chapter organizations. Francie       this vote in the winter or early spring. Q
ACNM Bylaws Committee Chair, the dis-         Likis is the chair of this subcommittee,

     Nurse-Midwifery Today Is Online
     Nurse-Midwifery Today, an online handbook summarizing the laws and regulations governing CNMs
     and CMs in the United States is available to ACNM members at, click
     “State Legislative and Regulatory Information.” The topics in this handbook include the identity of the
     regulatory board, scope of practice, prescriptive authority, tort reform, breastfeeding, and other statu-
     tory provisions governing the practice of midwifery. Questions, comments and updates should be sent
     to Joanna King at

Quickening Fall 2007

          Spotlight Education
     University of Pennsylvania                                                                     by Dawn Durain, CNM, MPH

     Celebrates 25 Years of                                                                         Associate Director, Nurse-
                                                                                                    Midwifery Program
                                                                                                    University of Pennsylvania

     Midwifery Education
                                                    personally, and enthusiastically supports        gration semester internationally; and

              he nurse-midwifery program at
              the University of Pennsylvania        student clinical experiences in out-of-hos-   • Faculty participation in international edu-
              celebrated 25 years in December       pital practices.                                 cational initiatives in Botswana, Central
     2006. The program was founded in 1980             In 2001, the program merged with the          America, Guyana, India, Japan, Niger,
     by Joyce Thompson, CNM and is cur-             Women’s Health Nurse Practitioner                Nigeria, Thailand, and Ukraine
     rently directed by Bill McCool, CNM.           Program at the University of Pennsylvania.       Students can also take advantage of the
     The 2006-2007 class graduated a record         CNM and WHNP students are educated            following innovative community initiatives:
     21 nurse-midwifery students (and 17            side by side by both CNM and WHNP             • An elective course, “Women and
     Women’s Health Nurse Practitioner stu-         faculty. Upon graduation, CNM students           Incarceration,” that includes classroom
     dents).                                        are eligible to sit for both CNM and             seminars and student-led health educa-
        The UPenn midwifery program is              WHNP certification examinations.                 tion seminars with women incarcerated
     unique in many aspects. It is grounded in         The faculty and the School of Nursing         in the Philadelphia County women’s jail;
     the philosophy that midwives must              have a strong commitment to interna-          • Participation in a Student and
     understand the impact of public policy         tional health and have incorporated the          Midwifery Faculty task force whose aim
     on midwifery practice and offers a course      following initiatives into the program:          is to establish a Birth and Women’s
     in “Public Policy and Leadership.”             • Elective courses in Thailand and               Health Center in West Philadelphia; and
     Additionally, the faculty believes that           Central America;                           • Participation in a student initiated
     graduates must be prepared with a wide         • An option for students to do the inte-                                 continued on page 24
     array of skills required for clinical prac-
     tice, and thus teaches courses ranging
     from “Complementary and Alternative
     Modalities in Women’s Health” to “Fetal
                                                     Reentry to Clinical Practice Pilot
     Evaluation”. These required courses, com-       Program: The First Graduate
     bined with clinical and science courses,
                                                                                                     The anticipated completion of the pilot
     result in graduates who are well-rounded
     clinicians and articulate advocates for our
                                                     C     ongratulations to Trish Payne, CNM
                                                           of Chapel Hill, NC for successfully
                                                     completing all program requirements to
                                                                                                  phase of the program is in 2008. Findings
                                                                                                  from the pilot will be shared with ACNM
     profession. Clinical sites include hospi-
                                                     reenter clinical practice in the area of     members. Participation in the pilot is free.
     tals, birth centers and home birth prac-
                                                     antepartum care. A thank you is also in      The links to the draft Reentry to Clinical
     tices in Pennsylvania, New Jersey and
                                                     order for her participation in the pilot     Practice documents can be found in a
     Delaware, as well as recent additions of
                                                     and helping staff and volunteers work        QuickInfo on reentry in the Continuing
     international sites.
                                                     out the program’s bugs. When asked for       Education and Practice Resources section
        The UPenn program credits the unwa-
                                                     feedback, Payne commented, “I think          of Specific questions
     vering support of the local midwifery
                                                     the process was great; it really helped      about reentry to clinical practice can be
     community with their continued ability to
                                                     me define what I needed to do and gave       directed to Karen Schelling, Chair of the
     offer such a wide variety of excellent clin-
                                                     me a prepared document for the creden-       Continuing Competency Section at
     ical placements. The entire midwifery fac-
                                                     tialing office at Duke.”            Q
     ulty has long supported the full range of
     birth settings, both professionally and

                                                                                                                 Quickening Fall 2007

When Something Old is Suddenly New:
Repackaging Midwifery Care
                                                                                               by Lorraine B. Sanders, CNM, DNSc

                                                liability and to ensure a safer birth envi-       Hospital systems, it seems, respond

     n 2006, the Wall Street Journal pub-
     lished an article titled, “New Practices   ronment, which included the adoption of        first and foremost to economical issues.
     Reduce Childbirth Risks.” The new          a common definition of terms to improve        More and more hospitals are looking for
practices were astonishing to me as a           communication between doctors and              ways to reduce spending while market-
midwife of 16 years. They were the              nurses, mandatory consultations for            ing themselves as institutions that deliv-
adoption of hospital policies to discour-       inductions of labor, and guideline driven      er quality care. Along with lobbying our
age or prohibit inductions of labor prior       care to standardize procedures.                politicians we need to lobby our hospital
to 39 weeks unless medically necessary,            Where was midwifery in this article? It     systems. When you prepare to visit your
limiting the use of oxytocin to induce or       was where it remains most of the time—         local politician to discuss midwifery
augment labor, and limiting the use of          invisible. Why not discuss the fact that       care, pick up the phone and schedule an
forceps and vacuums to hasten or assist         CNMs/CMs have excellent outcomes in            appointment with your local hospital
in the delivery of the baby.                    relation to safer births with fewer inter-     administrators as well. Be persistent. Let
   I was astonished that the author             ventions? Many of the hospitals men-           the facts speak to the bottom line.
labeled these practices as new! Of course,      tioned employ CNMs/CMs. But when               Change is never easy but change doesn’t
what these practices were was midwifery         hospital systems adopt new interventions       come if we expect someone else to do
care repackaged and labeled as innova-          to reduce adverse outcomes in birth,           the work for us! Q
tive by the hospital systems. These hospi-      why are CNMs/CMs not considered the  
tals included Intermountain Healthcare          first line of defense? Which profession is
in Utah and Idaho; Premier, Inc., an            expert at managing births using these          Sources
alliance of over 1,500 hospitals;               practices? Midwives! What does this            Landro, L. New Practices Reduce
Ascension Health of Missouri; and Kaiser        mean for CNMs/CMs across the country?          Childbirth Risks. The Wall Street Journal
Permanente, a national health care organ-       It is a call for action! A window of           July 12, 2006 pg. D1–2.
ization. The motivating factor was not          opportunity has opened but that means
improving care for the sake of families         work at all levels. This opportunity can                        ,
                                                                                               MacDorman, MF Singh, GK. Midwifery
but to reduce liability costs. The costs are    quickly pass if it is not seized upon. And     care, social and medical risk factors, and
high, accounting for 8.1% of all physi-         although it is in response to the issue of     birth outcomes in the USA. J Epidemiol
cian malpractice payments annually. The         liability in childbirth, it is an opportuni-   Community Health. 1998
author of the article summarized the new        ty for CNMs/CMs to promote their prac-         May;52(5):310–7.
practices were put into place to reduce         tice in relation to safety statistics.

FSMFN to Receive Grants from HRSA
                                                year to support the expansion of the           to enroll at FSMFN and work towards
T   he Frontier School of Midwifery and
    Family Nursing (FSMFN) has been
awarded two grants from the Health
                                                ADN-MSN Bridge option at FSMFN.
                                                Two additional years of funding total-
                                                                                               the Master of Science in Nursing
                                                                                               (MSN) degree.
Resources and Services Administration           ing over $400,000 is recommended by               FSMFN will also receive $107,950
(HRSA) of the Department of Health and          HRSA and will be awarded following             from the Advanced Education Nursing
Human Services.                                 satisfactory progress reports and suffi-       Traineeship program. This funding will
  The Advanced Education Nursing                cient budget appropriations. The ADN-          be passed through directly to FSMFN
Program grant from HRSA will provide            MSN Bridge option allows nurses with           students eligible for the federal aid. Q
over $285,000 in funding over the next          an Associate Degree of Nursing (ADN)

Quickening Fall 2007
20   2008 Elections

                                    2008 ACNM Elections:
                                     Members Choose their Future Leaders                                               Candidates
                                    by Suzan Ulrich, CNM, Chair, Nominating Committee
                                                                                                                       Vice President

                                   W       ith the success of online voting during the past four elections, ACNM
                                           is pleased to announce that we are continuing to offer online voting.
                                By voting online, members can read expanded candidate information, save
                                                                                                                       Melissa Avery
                                                                                                                       Elaine Diegmann

                         paper and vote with the convenience of a few clicks.                                          Region I
          In early January, members with an e-mail address on file at ACNM will receive an e-mail from our             Representative
       elections provider. This message will have a link to a secure elections page. The elections provider            Lynette Hamlin
       guarantees safe and secure online elections.                                                                    Linda Nanni
          Members without e-mail addresses will be mailed information on how to vote online as well as a paper         Region VI
       ballot. Members that prefer a paper ballot can request one by calling the national office at 240-485-1800.      Representative
          Additional information about the candidates and a forum where you can ask questions of the candi-            Candace Curlee
       dates will be available at in December.                                                         Alex Schott
          We look forward to your participation as we aim for a record number of voters to elect new members
       to the Board of Directors. Your membership and your vote are vital to the strength of the ACNM. Q

     For the following statements, the candidates were asked to answer this question: ACNM has a priority to gain and retain members.
     What issues do you identify that affect the growth and retention of ACNM members? How can you as a board member improve
     member satisfaction and thus increase membership in our professional organization?

                  Melissa Avery, CNM, PhD, FACNM                            more nimble and responsive to a fast-paced environment,
                  Candidate for Vice President                              including effective mentoring of emerging leaders.
                                                                             In the 2006 Values Proposition Survey (Quickening, Spring
                  A       CNM is in a position to gain and retain
                          members by listening to midwives, increas-
                    ing transparency and responsiveness, and contin-
                                                                         2007), members identified the four ACNM activities they val-
                                                                         ued most. These were 1) representation to federal agencies and
     uing to embrace technology for the benefit of our members. We       Congress to effect policy change, 2) representation to state leg-
     must strongly encourage every one of our students to become         islators and regulatory bodies to remove barriers to practice, 3)
     and remain members through a partnership among the ACNM             public advocacy promoting women’s options related to the cul-
     Board of Directors, ACNM staff, educators and practicing mid-       ture of birth and understanding midwifery care, and 4) advoca-
     wives. The following are key issues that I believe affect member    cy for our profession to organizations that regulate medical
     growth and retention:                                               education and policy. As a board member, I would aim to
     • Cost of dues for midwives that are employed part time,            increase the value of ACNM membership so that every
        currently not employed in midwifery, or retired                  CNM/CM wants to be a part of a forward thinking, flexible
     • Concern about employment security                                 organization that can anticipate trends and change to meet the
     • Lack of awareness of, or disagreement with, the ways ACNM         evolving needs of our membership. Q
        supports midwives day to day.
     I believe there are important strategies that can be implemented                  Elaine Diegmann, CNM
     to enhance member satisfaction and increase membership in the                     Candidate for Vice President
     College. The International Center for Civic Engagement recently
     highlighted a number of emerging trends that professional associ-                 I   ssues in Health Care today are legion and they
                                                                                           continue to increase: soaring healthcare costs;
                                                                                        lack of multicultural sensitivity in care; racial dis-
     ations must address to remain viable to members and to society
     in the future. Particularly germane to ACNM are the following:      parity in prematurity and low birth weight rates; the soaring
     • Demonstrating value to members for their investment in            cesarean section rates; the malpractice crisis; etc. However; it is
        ACNM, including improving our ability to respond to chang-       not “all bad”. Some changes, such as the technological revolu-
        ing member needs                                                 tion; genetic testing and mapping; innovative treatment for all
     • Valuing differences in background, practice styles, education-    kinds of diseases are wonderful and preserve the quality and
        al approaches, and perspectives and then using those differ-     quantity of life. How will a balance be achieved in the next 50
        ences to strengthen ACNM                                         years to insure the growth and longevity of midwifery in this
     • Enhancing synergy among generations of midwives by utilizing      ever changing healthcare arena?
        the experience of senior members in combination with an             The ACNM must be in a position to address the issues and
        appreciation for the needs and enthusiasm of younger midwives    we, the members, must be the voice that is heard. Who does
     • Adapting the College governance structure to one that is          the ACNM serve: the membership or the women for whom we
                                                                                                                Quickening Fall 2007
                                                                                                          2008 Elections                      21

care? We must serve both. What can the ACNM do to bring               issues, the ACNM completed a Values Proposition Survey
future midwives to swell the membership ranks and encourage           (ACNM, 2007). The majority of respondents completing the
current midwives to join and stay active? The ACNM and the            survey indicated they are active in clinical practice (94%). The
board members must continuously ask a simple question,                top four areas identified by these members as priority areas are:
“What’s so special about the ACNM that I should join?” The            1)Represent the profession to federal agencies and members of
ACNM has already made the initial outreach by polling the                Congress to work towards policy changes through advocacy,
members on what issues they would like the organization to               lobbying and the Midwives-PAC.
focus. This should be just the beginning. Part of the organiza-       2)Represent the profession to state legislators and regulatory
tion’s involvement with the membership must be an ongoing                bodies that govern midwifery to remove barriers and expand
commitment to provide the venue for leadership development,              access to midwifery services.
evidence based continuing education options, mentoring for            3)“Public relations public advocacy activities”. Combining these 2:
new midwives; and to advertise the success stories, the stable           a. Take a leading public advocacy role promoting and defend-
practices, the satisfied customers and good outcomes.                       ing women’s options around the culture of birth.
   The ACNM must create a repository to record clinical out-             b. Support ACNM members and the profession with public
comes to provide data for evidence based research to measure the            relations activities that promote accurate understanding
effectiveness of midwifery care. An important task of the ACNM              and expand demand for midwifery services.
board will be to identify resources to finance such research.         4)Represent ACNM and advocate for the profession of mid-
   What will be the focus for women’s health care? How will the          wifery to organizations and agencies that regulate medical
midwifery model of care fit in and meet the needs of the mod-            education and policy.
ern woman? We must define the midwifery model of care in                 The theme of these priorities is relationship building, from
terms that the public and future midwives can embrace.                national and local audiences with policy-making influences, to
Midwifery practice must offer alternative birth experiences and       our professional colleagues, to our consumers. Members want
well woman care which will be satisfying to the women of today        to protect the profession and the women we care for.
and congruent with current life styles. The ACNM should con-             As a board member and Region I Representative, I believe the
tinue to work for equitable reimbursement for all aspects of          most important characteristics of a leader are communication,
midwifery care and fight the medicalization of birth. Most of all     inclusiveness, trust, and valuing. It is important to maintain
we must meet the needs of the women we serve. Our focus has           open lines of communication, such as being able to receive and
never and should never change. As Ruth Lubic said, “Begin with        listen to feedback from members about the organization. It is
the needs of the people you serve.” And that means our mem-           also important for a board member to be inclusive in decision-
bership and the women for whom we care.                               making, whereby Region I members feel that their input is
   Our challenges remain constant. We will have to work harder        sought out and communicated to the national office staff and
proactively to support the philosophy of midwifery practice;          leadership and a local impact can be felt.
advocating for technological intervention in the birth process           In order to increase and retain membership, CNMs and CMs
only when necessary; providing informed consent regarding             must value membership in our national organization and find that
management options such as cesarean sections, inductions,             their membership is cost-worthy. The leadership of ACNM needs
epidurals, etc. We must guard the women we serve to make              to act as facilitators of the profession to advocate for not only the
sure that their birth remains in their control.                       profession but each individual member of the profession. Q
   The issues must be prioritized based on feedback from the
membership. Public relations and advertising must be a priority                     Linda Nanni, CNM
to keep midwifery in the public eye. Recruitment of students                        Candidate for Region I Representative
and keeping educational programs solvent are our hope for the                         One of the ACNM’s priorities is to gain and retain
future. The ACNM must work with education directors to make                           members. There are several issues that influence
certain that educational curricula meet the public needs and                          that goal. The organization must be a recognized
keep midwives competitive in the health care market. Midwives         leader in all matters of women’s health regionally, nationally
must stand guard as our foremothers did and advocate for              and internationally. The organization needs to be responsive to
women and an equitable health care system for all. Q                  its members’ concerns and the organization must be supportive
                                                                      to its members by providing tools that will advance the mem-
              Lynette Hamlin, PhD, RN, CNM, FACNM                     ber’s professional growth and development.
              Candidate for Region I Representative                      As a Regional Representative, I can help the organization achieve
              The American College of Nurse-Midwives has              these goals. I see this role as an ambassador for the profession and
              placed priority on growing its membership and           for its members in the region. Communication with members in
              retaining its members. The issue of declining           the region on the matters important to the ACNM through chapter
membership cannot be summed up in a simplistic manner – it            chair correspondence and regional meetings and bringing regional
is truly a multifactorial issue. In order to define and address the   issues back to the board would be my main goal.

Quickening Fall 2007
22   2008 Elections

        There are several aspects to my career and personality that          advocacy and education.
     suit me well for this job.                                                ACNM has done a great job for midwifery and for women, but
        I have nearly 25 years of clinical experience as a CNM. I have       individuals want to know that they are getting their money’s
     started a chapter, been a chapter chair of that chapter twice, and      worth. We need to find ways to clearly and vigorously communi-
     was involved in the initial attempts to develop and maintain a          cate that to those who are members and prospective members.
     regional peer review mechanism involving the Rhode Island and           We also need to encourage our members to be active participants
     Massachusetts chapters. I was instrumental in and worked dili-          in the work of our organization. As a board member, I hope to be
     gently along with others to get prescription privileges and third       an active participant in a two-way communication fashion that
     party reimbursement for CNMs legislated in the state of Rhode           will continue with ACNM’s excellent track record and continue to
     Island. I sit on the Advisory Council for Midwifery in Rhode            make it an even better advocate for women and midwifery. Q
     Island that advises the Director of Health on all midwifery
     issues. I have been a preceptor for countless students clinically                     Alex Schott, CNM
     and have been a professional role model for them as well.                             Candidate for Region VI Representative
        I direct a busy and successful collaborative practice that                          Region VI is the largest region in the ACNM organi-
     requires business, organizational and communication skills. I                          zation. It covers states with vastly different and yet
     experience the day-to-day workload of a midwife and see the                            similar midwifery challenges. As this country strug-
     value of our work every day. I am acutely aware of the clinical         gles with inadequate and ineffective health care systems, all mid-
     and professional barriers that still exist and work actively to         wives, regardless of location, face similar barriers to practice.
     break them down.                                                        These may include archaic credentialing procedures, restrictive
        Although most of my professional attention has been focused          licensing regulations, and the public’s misperceptions of our abili-
     locally, I can extend these efforts to the regional level in the role   ties, unsupportive physician colleagues and exclusive reimburse-
     of Regional Representative and believe that I will be a valuable        ment language. Each midwifery community in each state within
     leader for midwives.                                                    this region has discovered a way to meet the challenges previously
        I this way, as Regional Representative, I will do my part to         mentioned. The diversity of Region VI provides a unique opportu-
     gain and retain members for the ACNM. Q                                 nity for modeling successful solutions to share with other mid-
                                                                             wifery communities experiencing similar problems. This effort
                   Candace Curlee, CNM, MS                                   invites solutions that go beyond geographic, educational and cul-
                   Candidate for Region VI Representative                    tural boundaries. For example, in Idaho certified nurse-midwives,
                   ACNM provides an authoritative voice in the health        midwives and professional midwives joined together to move mid-
                   care arena through our standards of practice. We          wifery practice and legislation forward. A Regional Representative
                   have had many successes promoting optimal health          will be able to share these types of regional successes. I envision a
     care for women and the practice of midwifery. Our organization          regional network that shares midwifery resources across state and
     stands on the principle that we must listen to women.                   professional lines. I believe that when ACNM and MANA mem-
        Our leaders within the organization and other individual             bers and nonmembers work together toward local and state solu-
     members have achieved successes through public and political            tions both professional organizations will benefit with an increase
     announcements as well as quiet negotiation. We provide evi-             in membership growth and retention. Midwives will experience
     dence based practice and education through research and have a          how effective and successful it can be to work in tandem within
     globally respected journal. At, we have further com-        an organizational structure that can provide necessary resources
     municated what we are about with women, other healthcare                and information. Part of that organizational structure is the
     providers and the general public. We must provide not only a            Regional Representative. I will translate what support the organi-
     strong voice for midwifery, but also the kinship that helps us          zation can provide and be available as a resource.
     work through issues that can affect our practice. We must con-             I have been an ACNM member for a long time. I have seen it
     tinue to provide opportunities for continuing education and be a        grow and change as the climate of health care spirals out of
     resource for practice guidelines, basic legal advice, political         control. I was a member when malpractice insurance cost less
                                                                             than $100 per year. Now it is in the thousands. I believe that
                                                                             our professional organization understands the concerns of its
      Candidates for the Nominating Committee                                membership. How a growing organization conveys its role as
      Voting members will have the opportunity to select two mem-
                                                                             we members meet the constraints within our health care system
      bers of the Nominating Committee. The Nominating Committee
                                                                             is the job of the Regional Representatives. The Regional
      helps shape the future of ACNM. The two candidates with the
      most votes will be elected for three year terms. Biographies of        Representative is not only responsible to the organization but to
      these candidates are available at                     her region’s members. I would be honored to work toward sup-
      Patricia Caudle, CNM, DNSc, FNP                                        porting midwifery within my region and providing responsive
      Thomas Chappell, CNM                                                   strategies in meeting member challenges. Q
      Joanne Davis, CNM
      Fran Ventre, CNM
                                                                                                                    Quickening Fall 2007

Fellowship in the American                                                                        by Helen Varney Burst,

College of Nurse-Midwives                                                                         CNM, MSN, DHL (Hon.), FACNM
                                                                                                  Chair, FACNM Board of Governors

                                              Fellowship is automatically conferred        of the Fellows are on the ACNM Web site

          pplications are now available for
          one of the highest forms of         upon all ACNM Presidents and Hattie          and clearly represent our professions
          recognition offered by ACNM,        Hemschemeyer Award recipients.               finest. Each has done something special to
Fellowship in the American College of         Honored Fellowship was a special recog-      bring honor to our profession and has
Nurse-Midwives (FACNM). Established in        nition bestowed by the FACNM Board of        made a unique contribution to their com-
1994, the FACNM designation is a highly       Governors to midwives who had accrued        munity and the women we serve.
sought after recognition, honoring mid-       outstanding achievements during a career        Also on the ACNM Web site are the
wives whose demonstrated leadership,          that spanned several decades. This mech-     criteria and application form for becom-
clinical excellence, outstanding scholar-     anism was retired in 2004. Each year, the    ing a Fellow. If you wish to apply to the
ship, and professional achievement have       Board of Governors accepts applications      Fellowship or nominate a colleague,
merited special recognition both within       for Fellows-at-Large and elects ten new      please visit, click on
and outside the midwifery profession.         Fellows from a slate of candidates whose     “About ACNM: Awards” and then on
FACNM represents our commitment to            applications have been processed through     “Fellowship in the American College of
honor our own. New Fellows are induct-        a current sponsoring Fellow and the          Nurse-Midwives.” You may also contact
ed at the Annual Meeting and their con-       applicant’s regional governor.               your regional governor (see list of
tributions, which also help document our        The FACNM Board of Governors is            Fellows online) for more information.
history as a profession, are summarized in    looking forward to selecting the next           It is not easy to become a Fellow in the
the Journal of Midwifery & Women’s Health.    group of honorees and urges the member-      American College of Nurse-Midwives,
   Fellowship is currently awarded via        ship to help identify colleagues who they    but it is an honor worth pursuing. Q
two different mechanisms. Distinguished       feel deserve this recognition. The names

DOR Announces Award Winners
The Division of Research and                  Best Poster Presentation
International Health Committee grate-         of Research
fully acknowledge and thank all of the        “Barriers and Facilitators to Condom
researchers who presented their work in       Use: Evidence From Focus-Groups
research forums and poster sessions.          in Malawi”
The following researchers won awards          Clara H. Chipeta, MRNM, MS PhD(c),
at the ACNM Annual Meeting in
Chicago. These presentations were
                                              Kathleen F Norr, PhD, Marie L. Talashek,              Do you
                                              RN, EdD, Chrissie P. N. Kaponda,
judged as particularly outstanding in
their respective categories.
                                              MRNM, PhD                                           have a story
Best Forum Presentation of
                                              The Division of Research and the                      idea for
                                              International Health Committee would
Research                                      like to extend thanks to all of the peer         Quickening?
“Self-Diagnosis of Vaginal Infections by      reviewers and judges who make these
Active Duty U.S. Military Women”              awards possible.                                 Send information about practice
Nancy K. Lowe, CNM, PhD, FACNM,                                                              openings, awards, celebrations,and
FAAN, and Nancy Ryan-Wenger, PhD,             Lisa Hanson, DOR Research Dissemination         anything related to midwifery and
Oregon Health & Science University            Section and Christine Hunter and Catherine         ACNM to
School of Nursing                             Carr, International Health Committee

Quickening Fall 2007

     Notice Inviting                               University of Pennsylvania
                                                   Celebrates 25 Years
                                                                                                  one half of our class is comprised of
                                                                                                  UPenn BSN students, many of whom
     Third Party                                   from page 18
                                                                                                  come to us directly from our accelerated
                                                                                                  BSN program. This 18 month program is
     Comments                                        Doula program that trains students and       designed for students with a college
                                                                                                  degree in a field other than nursing.
     T    he following midwifery education
          programs are scheduled to be
     reviewed by the Division of Accreditation
                                                     other interested community members
                                                     as Doulas and provides an on call serv-      These students are drawn from a national
                                                                                                  applicant pool and come with very
                                                     ice for local women and their families.
     (DOA) Board of Review in January 2008.          The UPenn program faculty believes           diverse backgrounds ranging from science
     Please send any written third party com-      that their ability to continue to thrive and   to art to theology and bring their life and
     ments to DOA at ACNM; 8403 Colesville         grow is a result of strong support from        professional experiences as important
     Road; Suite 1550; Silver Spring, MD           the School of Nursing, UPenn alumni and        contributions to midwifery. Our school
     20910 by December 14, 2007. Your              local CNMs who offer students the ability      strongly believes that there are many
     comments will be included with other          to participate in their practices. The com-    avenues to nursing and to midwifery!
     program materials at the January 2008         bined CNM and WHNP program also                Our goal is to enable graduates to provide
     meeting. In all instances, your comments      provides graduates with expanded               the best of women’s health care that is
     must directly relate to the accreditation     employment options and a faculty rich          congruent with the needs and desires of
     of the program and the DOA Criteria for       with expertise. Program Director Bill          women in their community, whether it is
     Programmatic Accreditation, October           McCool said, “We are proud of our              rural, urban or in another country.” Q
     2003 (revised November 2006). Please          diverse student body and that there is no
     cite the particular criterion of concern in   typical UPenn midwifery student. About
     your comments. The criteria can be
     found online at by click-
     ing “About ACNM,” “Divisions,”
     “Divisions of Accreditation.” in the gray
     box on the right side of the screen.
                                                        Coding Corner
     Stony Brook University                             Triage/After Hours Billing Part II
     (continuing accreditation)                         After hours and triage visits may be billed in addition to global obstetrical
     Nurse-Midwifery Education Program                  charges. In the last Coding Corner, we discussed billing an Evaluation and
     Stony Brook, New York                              Management code for these visits based on History, Physical Exam and
                                                        Medical Decision Making.
     Wayne State University                               At times, when the woman presents for a problem that requires ongoing
     (initial accreditation)                            assessment and management, Observation Codes may be more appropriate.
     Nurse-Midwifery Option                               Observation Codes require at least a detailed history and physical be per-
     Detroit, Michigan                                  formed and documented. Also, facility charges must match professional
                                                        charges, so be sure to indicate to the organization that the patient was
     University of Puerto Rico                                                “admitted to observation.”
     (continuing accreditation)                                                 • For observation less than 8 hours on the same
     Nurse-Midwifery Education Program                                             day use codes 99218–99220.
     San Juan, Puerto Rico Q                                                       • For observation greater than 8 hours on the
                                                                                       same calendar day use codes 99234–99236.
                                                                                  • If the patient is in observation that extends

              Been in                                                               over 2 calendar days—use 99218–99220 for
                                                                                    the first day and 99217 on the day of discharge

             the News?                                                                     from observation.
                                                                                                        Remember, observation that
            We want to know.                                                                           results in admission within 24
                                                                                                          hours is not billed separately
          Send your news clips                                                                             but is considered part of the
           to                                                                                  admission. Q

                                                                                                                Quickening Fall 2007

Quickening Fall 2007
26   A.C.N.M. Foundation

     Foundation News
                                                                                                           by Carolyn Gegor, CNM, MS, FACNM
                                                                                                           A.C.N.M. Foundation President

                                                      Target 2007 CFC Donations to Benefit              For more information about these sim-

               lready, 2007 has been an excit-
               ing and fruitful year for the          Foundation Programs                             ple, easy ways to make year-end gifts to
               A.C.N.M. Foundation. We began          The Combined Federal Campaign (CFC)             the A.C.N.M. Foundation, feel free to
     this year by looking back on our accom-          fund-raising drive is in motion once again.     contact us by phone at 240-485-1850, or
     plishments of the past 40 years. It has          Midwives and midwife supporters who are         by e-mail at Q
     been remarkable. As we celebrate our             federal employees (military and non-mili-
     40th year, we are looking forward to the         tary) may designate all or a portion of
     next 40 to making midwifery care avail-          their 2007 CFC contribution to the
                                                                                                      Nominations for the 2008 Dorothea M. Lang
     able to all women! Our quarterly list of         A.C.N.M. Foundation, Inc. by using the
                                                                                                      Pioneer Award Now Being Accepted
     donors keeps growing and growing!                CFC code #11297. Please encourage eligi-
                                                                                                      The Foundation’s most prestigious recognition,
     Thank you! We have been able to award            ble colleagues, family, friends and clients     the Dorothea M. Lang Pioneer Award, honors
     a record-breaking amount of money for            to support the Foundation in this way!          an exceptional CNM/CM who:
     grants and scholarships this year, all in                                                        • Is an ACNM member
     the spirit of the Foundation’s mission, “to      Know How the Charitable IRA                     • Has been certified at least ten years
     promote excellence in health care for            Rollover Can Benefit the Foundation             • Has not been a recipient of the Hattie
     women, infants and families worldwide            A unique giving opportunity exists for             Hemschemeyer Award
     through the support of midwifery.”               charitable donors over age 70. The Pension      • Has demonstrated vision and leadership in or is
        As the year draws to a close, I want to       Protection Act of 2006 created a new char-         innovatively working within the following criteria:
     remind you of a few of the following             itable Individual Retirement Account (IRA)         • Pioneering midwives who, after 1958
                                                      rollover opportunity that does not increase           demonstrated what midwives could and
     ways that donors of all ages can partici-
                                                      the donor’s taxable income. Under the PPA             should be on the health team.
     pate in year-end giving. Year-end giving
                                                      2006, a traditional or Roth IRA owner age          • Pioneering efforts to integrate midwives/mid-
     can lower the tax burden for working                                                                   wifery into the health care system within the
     and retired donors, but it can also be a         70 or older may make direct tax-free trans-
                                                                                                            United States or internationally.
     time of great satisfaction for new donors        fers to a charity in any amount up to
                                                                                                         • Unsung heroes who
     who are just starting their lifetime of giv-     $100,000 per year. This option will end               initiated/rescued/enhanced/saved midwifery
     ing. Just think what your gift can do            December 31, 2007 unless reauthorized by              services or educational programs or are
     when it is joined with others!                   Congress, so now is the time to act. This             working to accomplish these goals.
                                                      option will not apply to many readers, but         • Visionaries who encouraged/created
     Watch for the Foundation’s Annual                it might for someone you know, so pass                open-minded pathways in education for
     Appeal Letter                                    the word along!                                       professional midwives or are working to
     Again this year we will include an inform-                                                             accomplish this goal.
     ative and colorful newsletter in our holi-                                                          • Energetic anticipants who have furthered
                                                      Watch for more information about the
     day annual appeal letter. The newsletter                                                               or are furthering the legislative agenda for
                                                      availability of applications for 2008 grants,
                                                                                                            ACC certified midwives – CMs/CNMs full
     will summarize some of the highlights of         awards and scholarships*, including:
                                                                                                            scope of practice on the team
     our 2007 awards, grants and scholarships,        The Dorothea M. Lang Pioneer Award
                                                                                                         • Pioneers in other unique ways, with the approval
     and profile past winners. Information will       Varney Participant Award
                                                                                                            of the Dorothea M. Lang Pioneer Committee.
     be included about how cash and non-cash          Basic Midwifery Student Scholarship
                                                                                                         Nominations for the 2008 Lang Award are
     donations can be made to our general             A.C.N.M. Foundation Fellowship for Graduate
                                                                                                      being accepted now through February 4, 2008.
     fund or to our restricted funds and special                                                      Nominations must be made by ACNM members
                                                      W. Newton Long Award
     initiatives. Midwives can generate even                                                          using the official application form, which can be
                                                      Excellence in Teaching Award
     more support by giving newsletters and                                                           obtained from the A.C.N.M. Foundation website
                                                      Hazel Corbin-Childbirth Connection Grant for
     donation envelopes to colleagues, friends                                                        at: (click “Awards”,
                                                        Evidence-Based Midwifery Care
     and family. So, when your newsletter                                                             then click “Dorothea M. Lang Pioneer Award” to
     arrives, don’t hesitate to contact our office.                                                   download application). The 2008 Dorothea M.
                                                      *see the ACNM Web site (
     We will be happy to send you more!                                                               Lang Pioneer Award will be given at the ACNM
                                                      support.cfm) and the monthly issues of
                                                                                                      Annual Meeting in Boston.
                                                      ACNM Quick eNews

                                                                                                                       Quickening Fall 2007
                                                                                                  A.C.N.M. Foundation                          27

                            Gifts to the A.C.N.M. Foundation, Inc.
                                                   Donors June 1, 2007 – August 31, 2007

 Corporate/Foundation          Cathy Emeis                 Elaine Mielcarski            Kate McHugh                  Eunice K.M. Ernst
 Donations                     Janet Engstrom              Margaret Montgomery          Patricia Morrow              Carolyn Gegor
 The Charles Engelhard         Paula Eveleigh              Cheryl Moran                 Margaret Nally               Barbara Hughes
  Foundation                   Elizabeth Fairchild         Lonnie Morris                Terri Presnell               Marsha Jackson
 Rubena Flores Associates      Jane Fields                 Madge Mulkey                 Diane Reynolds               Jan Kriebs
 Childbirth Connection         Kate Fouquier               Lisa Paine                   Barbara Roberman             Ellen Martin
                               Celeste Frazier             Alice H. Poe                 Martha Rohrer                Elaine Mielcarski
 Individual Donations -        Rebecca Freeman,            Roberta Poirier              Ruth Roser                   Lisa Paine
 General Fund                    in memory of NCB          Marilyn Rhodes               Paulette Schalck             Kay Sedler
                                 Founder & Midwives -      Leissa Roberts               Leslie Stewart               Lara Slattery
 Mary Breckinridge Club -
                                 Terese Dondero,           Paulette Schalck             Martha Tower                 Suzanne M. Smith
                                 Sonja Dowie and           Mary Shean                   Katherine Winkler            Pamela Spry
 Barbara Fildes
                                 Sue Ellen Baird &         Lynn Sibley                  Patricia Woollcott           Sally Tom
 Barbara Hughes
                                 Nancy MacDougall          Claudia Sittler
 Jan Kriebs                                                                             Memorial/Honorary Gifts
                               Elaine Germano              Marsha Stalcup, in honor                                  Jeanne Raisler
 Kay Sedler                                                                             Jane Fields, in honor
                               Lynn Grylls                   of Robert Stalcup, Alice                                  Memorial Fund for
                                                                                          of Ruth Lubic, CNM
 Gifts of $250 - $750          Laraine Guyette               Redish and Sarah Redish                                   International
                                                                                        Kay Kronsted, in honor
 Patricia Lee                  Martha Hackett              Linda Stinnett                                              Midwifery
                                                                                          of the retirement of
 Linda Lonsdale                Hellen Haney                Susan Stone                                               Norma Raisler
                                                                                          longtime midwife
 Heather Sankey,               Lisa Hanson                 Catherine Tanksley                                        Margery Fisher
                                                                                          Royda Ballard, CNM
   in honor of Lois Palmer’s   Michele Helgeson            Tanya Tanner
                                                                                        Janice Kvale, in memory
   retirement                  Denise Henning              Kai Tao                                                   Bonnie Westenberg
                                                                                          of Becky Najera, CNM
 Donna Scheideberg             Marcella Hickey,            Nell Tharpe                                                 Pedersen
                                                                                        Ronnie Lichtman, in
                                 in memory of Delores      Joyce Thompson                                              International Midwife
 Every Member Campaign -                                                                  memory of Al Decker,
                                 Kirkland, CNM             Leona VandeVusse                                            Award
 $100                                                                                     beloved husband of
                               Lynne Himmelreich           Diana VanKirk                                             Patricia Reddy
 Mary Akers                                                                               Barbara Decker, CNM
                               Jerrilyn Hobdy              Lisa Veach
 Cathryn Anderson                                                                       Christine Nuger,
                               Carol Howe                  Linda Walsh                                               Midwives of Color-
 Melissa Avery                                                                            Congratulations to
                               Rosalie Kaleda              Terrie Watkins                                              Watson Scholarship
 Vera Jo Bahry                                                                            Jain Lattes, CNM and
                               Ruth Keen, in honor of      Ann Weathersby                                            Jomeka Betty
 Karen Baldwin                                                                            Douglas Thayer on the
                                 Mary Barger, CNM          Claire Westdahl                                           Family Centered
 Royda Ballard                                                                            birth of their baby, and
                               Maureen Kelley              Mary Widhalm                                                Midwifery Care
 Mary Barger                                                                              Congratulations to
                               Janet Kirsch                                                                          Nivia Fisch
 Mary Bidgood-Wilson                                       Gifts to $99                   Tonja Santos, CNM and
                               Nancy Kraus                                                                           Marsha Ford
 Joy Boscove                                               Stephanie Beasley              Trisha Loomis on the
                               Kathryn Kravetz                                                                       Pamela Hicks
 Diane Boyer                                               Ruth Beeman                    birth of their baby
                               Cara Krulewitch                                                                       Marsha Jackson
 Ginger Breedlove                                          Kathleen Belzer              Deanne Williams,
                               Janice Kvale                                                                          Yolanda Meza
 Dorothy Ann Brewin                                        Sylvia Blaustein               Captain Helen L. Smith,
                               Gloria Lelaidier                                                                      Sheri Small
 Patricia Burkhardt                                        Helen Burgess                  CNM in honor of her
                               Amy Levi                                                                              Carmen Smidy
 Nancy Campau                                              Michelle Champagne             retirement from the
                               Nancy Lowe                                                                            Patricia Whyte
 Kim Campbell                                              Hsiu-Li Cheng                  United States Navy
                               Vivian Lowenstein,                                                                    Shirley White-Walker
 Sue Lynn Campbell                                         Dorothy Gilbert              Deanne Williams and
                                 in honor of
 Barbara Camune, in honor                                  Anne Grove                     the Brownells,
                                 Sr. Teresita Hinnegan -                                                             Margaret Edmundson
   of Becky Najera, CNM                                    Susan Hooper                   in honor of
                                 a wonderful mentor                                                                   Memorial Scholarship
 Catherine Carr                                            Susan Jenkins                  Nancy Jo Reedy,
                               Phyllis Lynn                                                                          ACNM Region V, Chapter
 Mei Ka Chin                                               Elizabeth Johnson              CNM winning the
                               Miriam Mahler                                                                          III, in memory of
 Mary Collins                                              Maria Kammerer                 “Hattie Award”
                               Diana Maize                                                                            Pam Furr, CNM and
 Elizabeth Cooper                                          Barbara Kern-Pieh
                               Ruth Mankoff                                                                           Laura Edison, daughter
 Miriam Cordell                                            Jane Knight                  Individual Donations -
                               Teresa Marchese                                                                        of Cheryl Wakeman, CNM
 Candice Curlee                                            Kathryn Kravetz              Restricted Funds
                               Jane Mashburn
 Katherine Dawley                                          Barbara Kremer
                               Margaret McMahon                                         Deanne R. Williams Public
 Sandra DeGroot                                            Laura Eileen Manns-
                               Kathleen Menasche                                        Policy Fellowship
 Susan DeJoy                                                 James
                               Gretchen Mettler                                         Lia Brownell and Family
 Elaine Diegmann                                           Anita Martinez
                               Jeanne Meurer                                            Althea Davis

Quickening Fall 2007

     Keeping in Touch
                                                    7 1bs. 2 oz. The family thanks Cathy          Susan A. Paterson, CNM is delighted to

        I    f you would like to submit an
            announcement to “Keeping in
        Touch,” please draft a short descrip-
                                                    Heffernan, CNM, Jane Mills, CNM, and
                                                    the folks at the Ballard House Birth
                                                                                                  be the first certified nurse-midwife cre-
                                                                                                  dentialed by Community Memorial
                                                    Center in Portland, ME for their excellent    Hospital, a critical access hospital serving
        tion of the award, appointment,             care and support.                             rural Oconto County in northeast
        birth, or obituary and send
                                                                                                  Wisconsin. She practices full-scope mid-
        it to Submissions
                                                    Practice Announcements                        wifery at the Center for Women’s Care in
        may be edited to accommodate
                                                    Joy Windebank, CNM and Gloria                 collaboration with her physician partner,
        space requirements.
                                                    Glidewell, CNM have joined the UNT            Dr. Judith Bowers.
                                                    Health OB/GYN department in Fort
     Birth Announcements                            Worth, Texas. They join Kathleen              Jennifer Taylor, CNM is warmly wel-
     Rebecca Campau Brown, MD and Shane             Donaldson, CNM, and Tania Lopez,              comed by CommuniCare Health Centers
     Methal, DDS announce the birth of their        CNM in full-scope midwifery practice,         in Davis, California. She joined Anne
     son, Jagger Brown Methal, on July 27,          including joint faculty appointments with     Cooper, CNM, Christi Stone, CNM and
     2007. Jagger was born into the loving          UNT Health Science Center. Windebank          Mariana McCamy, NP in the
     hands of his grandmother, Nancy                and Glidewell completed their midwifery       CommuniCare Perinatal Program.
     Campau, CNM. He weighed 7 1bs. 9 oz.           training at the Parkland School of Nurse-     CommuniCare Health Centers are federal-
     The family thanks the Park Slope               Midwifery and earned master’s degrees         ly qualified health centers in the Yolo
     Midwives, and especially Rosanne               from Texas Women’s University.                County, California area serving women at
     Seminara, CNM.                                                                               four practice sites. Births are lovingly
                                                    Suki Brooks, CNM has joined Valley            attended at Sutter Davis Hospital in Davis.
     April Ward Kimball, CNM and Jeremy             OB-GYN, PC in Saginaw, MI. She joins
     Kimball welcomed their daughter into the       Ann Graham, CNM and Marilyn Filter,           Election
     world on July 12, 2007, after a rapid labor    CNM in a nurse-midwifery service that         Dianne S. Moore, CNM (SUNY
     at home. Genevieve Violet weighed 8 lbs.       was started in 1983. The practice             Brooklyn 1978) is Executive Dean of
     4 oz. and was 21 inches long. The family       includes seven physicians, two nurse-         Nursing at West Coast University in
     thanks the midwives who made this lovely       practitioners and one physician assistant.    Southern California. In 2006, she was
     water birth possible. They are also grateful   The providers and clients are thrilled to     elected as the Director of Education for
     to the doctors and nurses who cared for        welcome Brooks.                               the American Nurses Association of
     mom during her brief hospital stay.                                                          California. In 2007, Moore was elected as
                                                    Women’s OB-GYN in Saginaw, MI is              President of the California Association of
     Ann Malinoski-McCarthy, CNM and                pleased to welcome Lyric Walsh, CNM to        Colleges of Nursing and was appointed
     John McCarthy announce the birth of            their practice. She joins Kelley Hammis,      to the Board of Directors of Hollywood
     their daughter, Veronica Lynne, on             CNM, Mary Jo Goodchild, CNM, six              Presbyterian Medical Center and the
     January 5, 2007. Veronica was born into        physicians, and four nurse-practitioners in   Hospital’s Credentials Committee.
     the wonderful caring hands of Ellen            caring for the ob-gyn needs of women in
     O’Neal, CNM and Lori Albright, CNM.            the Saginaw valley area.                      Award
     The family thanks all of the CNMs at The                                                     Lorraine Sanders, CNM is the recipient
     Midwife Center in Pittsburgh for their         Topeka OB/GYN Associates in Topeka,           of the outstanding poster presentation
     excellent care.                                Kansas welcome Denise Nickel, CNM to          award from the National Institute of
                                                    their practice. Nickel is a recent graduate   Mental Health’s Annual International
     Charlie Kathleen McLellan, daughter of         of the University of Kansas Nurse-            Research Conference on the Role of
     Elizabeth Eisele and Tom McLellan, was         Midwifery program and will be joining         Families in Preventing and Adapting to
     warmly welcomed into the waiting hands         Manya Schmidt, CNM, Kim Keen,                 HIV/AIDS. Her presentation was entitled
     her grandmother, Nell Tharpe, CNM.             CNM and four physicians in caring for         “The Lived Experience of Pregnancy after
     Charlie was born during a lovely water         the obstetrical and gynecologic needs of      Diagnosis with HIV: Women’s Voices.” Q
     birth on July 5, 2007 and she weighed          women in the Topeka area.

                                                                                                                 Quickening Fall 2007

     Midwife                                   in
                                                the           Spotlight
NYC Midwives Award First
Student Scholarship
                                              (FBC). As a midwifery student, Freytsis

          YC midwives are pleased to
          announce that they awarded the      maintained her commitment to FBC
          first Region 2, Chapter 1 student   and participated in advocacy, outreach
scholarship at the June 12th chapter          and fundraising efforts.
meeting that was held at Mount Sinai             Her extensive international work has
Hospital. The recipient of the $1,000         been focused on improving reproduc-
scholarship, Maria Freytsis, was selected     tive health services for women through
from a very competitive pool of highly        the provision of direct clinical services
qualified applicants. Maria completed the     as well as training local health care                Maria Freytsis
SUNY Downstate Midwifery Education            providers. Her travels have taken her to
Program in August.                            the US/Mexico border, rural Peru, and
   Prior to embarking upon her mid-           Guatemala, Albania, Tibet, and Indonesia.         health care system of this country.”
wifery studies, Maria had already demon-         In her application for the chapter                Kudos go to the dedicated Student
strated impressive professional leadership    scholarship Maria wrote, “My commit-              Scholarship Committee. Committee
and long-standing involvement in mid-         ment to advocacy and finding creative             members are Karen Burgin, Pat
wifery advocacy and international public      solutions to the challenges that midwives         Burkhardt, Abby Howe-Heyman, Aleida
health. Her local activities included co-     face, will help move the midwifery pro-           Llanes-Oberstein, Nancy Moley, Asya
founding and serving as President of the      fession forward in the ever more complex          Portnaya, Nancey Rosensweig, and
board of Friends of the Birth Center          and highly political birth culture and            Suzanne Schechter. Q

                                                             Vermont’s Longest Running
                                                               Midwifery Partnership
   Join your regional
   eMidwife discussion
   group and stay in
   touch with your
   colleagues. Visit
   for more details.
                                                   Vermont CNMs Sue Hoffman and Anea LeLong were featured in The Caledonia Record and
                                                   their hospital newsletter for having the longest running midwifery partnership in Vermont.
                                                   Hoffman and LeLong practice at Northeastern Vermont Regional Hospital Women's Wellness
                                                   Center, where they have worked together for over 13 years.

Quickening Fall 2007

          Worth Your Time
     Group Prenatal Care Study Featured in           Healthcare 411. Healthcare 411 is meant           concerns that nursing infants may be at
     August Green Journal                            to help keep people informed of the               increased risk of morphine overdose if
     Group Prenatal Care and Perinatal               Agency’s latest health care research find-        their mothers are taking codeine. In rare
     Outcomes: a Randomized Controlled Trial,        ings, news, and information. Listen to the        instances, a woman may have a genetic
     of which three of the co-authors are            podcasts at                trait which causes her to metabolize
     CNMs, was published in the August                                                                 codeine at an abnormally rapid rate.
     2007 issue of Obstetrics & Gynecology           CDC Publishes Influenza Guidelines                Although nursing mothers have used
     (Obstetrics and gynecology 110:2;               On July 13, 2007, the Centers for Disease         codeine safely for many years, and ultra-
     August 2007 pg 330-339). The abstract           Control & Prevention published the most           rapid metabolizers are rare, the FDA is
     is online at   recent guidelines on the Prevention and           taking steps to raise awareness of this
     content/abstract/110/2/330. The article         Control of Influenza from the                     possible health risk in order to prevent
     demonstrates that group prenatal care           Recommendations of the Advisory                   morphine overdose in nursing infants.
     reduces preterm births, enhances psy-           Committee on Immunization Practices               The agency will now require manufac-
     chosocial outcomes and increases breast-        (ACIP). These guidelines cover the groups         turers of prescription codeine medicines
     feeding initiation at no added cost. Claire     of persons for whom vaccination against           to include information about codeine
     Westdahl, CNM, Heather Reynolds,                influenza is recommended, chemopro-               ultra-rapid metabolism in drug package
     CNM, and Sharon Schindler Rising, CNM           phylaxis for exposure to influenza, and           inserts, and information about this issue
     are three of the co-authors.                    updated information on how to use the             is now on the FDA website for health-
                                                     two vaccines. This report and other infor-        care provides and consumers.
     ARHQ Offers Free Health Care                    mation are available at CDC’s influenza           Information for Healthcare Professionals,
     Information                                     website at                a Public Health Advisory, and a Q&A
     The Agency for Healthcare Research &                                                              document are available at
     Quality (AHRQ) has published a free             Codeine May Pose Risks to Nursing Infants
     health care information audio series,           The FDA has issued a warning regarding            /drug/infopage/codeine/default.htm. Q

     Money Matters: A Regular Column
     from Your Treasurer                                                                               by Tanya Tanner, CNM, MS, MBA
     Our Financial Reserves                                                                            ACNM Treasurer
                                                     your questions about ACNM financial               which indicates our ability to meet short

         have several goals for my term as
         treasurer of ACNM. My first goal is to      matters. This month’s topic is our finan-         term financial obligations. Companies are
         increase the financial transparency of      cial reserves.                                    considered to have good short-term finan-
     the organization. Secondly, I plan to              At the Annual Meeting in Chicago, a            cial strength if this ratio is greater than
     implement a project-based budgeting sys-        member asked me why we were “going to             2:1. The $3 million we have in reserves
     tem. Lastly, I want to have a positive          go out of business with $3 million in the         ensures our long term financial viability.
     impact on the activities of the College. To     bank.” I can assure you that ACNM is not          Organizations like ours put money in the
     accomplish these goals, I will host a           going out of business! ACNM’s 2006                bank in the form of cash deposits and/or
     “Money Matters” column in Quickening            financial audit revealed total revenue of         investments when revenues are greater
     and encourage you to send your ques-            $4,532,508, an increase of $406,187 from          than expenditures. This fund is then used
     tions to This is an             the previous year. In 2006, our net assets        for a “rainy day” or for a specific purpose.
     email address for me to use to directly         were $2,689,210. Our healthy financial            The use of this fund is governed by the
     address member concerns, and an                 condition is also indicated by our ratio of       organization’s spending policy.
     opportunity for you to get answers to           current assets to current liabilities of 2.5:1,                              continued on page 38

                                                                                                                      Quickening Fall 2007

                                                                                        Pennsylvania Midwives
                                                                                        from page 1

                                                                                           The new law took effect on September
                                                                                        18, 2007. The Pennsylvania State Board
                                                                                        of Medicine (BOM) has up to twelve
                                                                                        months from that date to finalize regula-
                                                                                        tions to implement the law. Once those
                                                                                        rules have been formally adopted by the
                                                                                        BOM, CNMs may begin writing prescrip-
                                                                                        tions according to those specifications.
                                                                                           “Pennsylvania’s mothers and babies
                                                                                        deserve the same care that women
                                                                                        throughout the United States enjoy,”
                                                                                        said Lorrie Kaplan, ACNM Executive
                                                                                        Director. “This is a win for
                                                                                        Pennsylvania women who use certified
                                                                                        nurse-midwives as their health care
                                                                                        professionals. The passage of this bill
                                                                                        will decrease waiting times to fill pre-
                                                                                        scriptions, reduce unnecessary burdens
                                                                                        on other health care professionals, and
                                                                                        increase access to care. ACNM
                                                                                        applauds the hard work of the
                                                                                        Pennsylvania midwives in getting this
                                                                                        important bill passed.”
                                                                                           The text of the bill and additional
                                                                                        information about its implementation is
                                                                                        available at by clicking
                                                                                        “Legislation & Health Policy.” Q                            months. They want to make it as easy         your own practices, visit
from page 1                                as possible for members to be repre- to explore the site
                                           sented in every community, bringing          and sign up for your discounted provider
encourage our members to take advan-       midwifery to all women.                      listing. Be sure to select ACNM as your
tage of this opportunity to build their        MyBirthTeam President Cyndi Gross,       referral source to initiate your discounted
businesses and promote the midwifery       CPSS, CD says, “Most women are not           listing price!
model of care.”                            aware that a large majority of midwives           Contact MyBirthTeam President
    ACNM has negotiated a discounted       are working in medical office and hospi-     Cyndi Gross with your questions about
annual provider listing price of $595      tal settings, not just in the home. When at
for our members, a $100 discount from      women become aware of the excellent Cyndi will be
the regular list price of $695. In addi-   care provided by midwives, they will         happy to provide you with her consumer
tion, if you list yourself as a provider   begin to ask for them… and where             marketing plan and respond to any other
on before                  there is a demand, hospitals and insur-      inquiries you may have.
November 30, 2007 you will receive         ance companies will have to fill it!”             Change will come from educating
an additional $100 discount, bringing          However, in order for this change to     women about their choices. We hope you
your annual provider listing price         happen, we need to have midwives as a        will seriously consider making yourself
down to $495 and locking in that           choice in every state, county and city. To   one of the provider choices on
price for your renewal next year!          become a part of this very exciting! Q offers the option      approach to putting midwifery in the
of spreading out your payments over 12     minds of mothers and draw patients to

Quickening Fall 2007

     Introducing the                                               by Michele Helgeson, CNM
                                                                                                   HBLSS Follow Up in Haiti
                                                                                                   from page 15

     Web Challenge                                                                                 birth in recent months.
                                                                                                      Of the original 43 KOMBIT and HHF
                                                                                                   staff trained in HBLSS, 11 had been
                                                                                                   active in holding trainings in the rural

             he ACNM Massachusetts Chapter
             is issuing a national challenge to                                                    villages surrounding Jeremie. Between
             all chapters: Promote the profes-                                                     March and November 2006, 16 five-day
     sion of midwifery by developing and                                                           and 5 shorter courses were taught to 878
     marketing a state Web site!                                                                   participants, including 210 matwons.
        How many of you still have to answer                                                       The midwives receive supervision and
     these questions: Is midwifery legal? Do                                                       supplies through KOMBIT and HHF        .
     you deliver at home? After you explain                                                           Community support was assessed
     what you do, do you hear I am too old                                                         through focus groups conducted in five
     for a midwife, or I am done having my                                                         village communities. Participants
     children, or I plan to have drugs in labor                                                    reported very positive responses to the
     so I don’t want to use a midwife?                                                             knowledge and skills they had gained
                                                    about midwifery locally and nationally.
        The Web offers a powerful way in                                                           through HBLSS. Many had already had
                                                      Each state will have the opportunity to
     which to reach millions of women and                                                          the opportunity to experience results
                                                    • Get the word out about midwifery,
     with the use of social marketing tech-                                                        that they saw as empowering and even
                                                      especially bringing attention to local
     niques; the Web offers a means to cre-                                                        life-saving.
                                                      achievements or problems
     ate change.                                                                                      HBLSS and other KOMBIT programs
                                                    • Enhance community involvement
        We believe that this medium can be                                                         have resulted in an increase in referrals
                                                    • Provide timely up-to-date information
     utilized to expose more people to mid-                                                        of complications to the Jeremie hospital,
                                                      about midwifery
     wifery and in doing so bring our profes-                                                      a facility which operates under serious
                                                    • Provide current women’s health infor-
     sion closer to the goal of making mid-                                                        personnel and material shortages.
                                                      mation especially pertaining to
     wifery the first choice for women for their                                                   Discussion took place on how to work
                                                      informed decision-making, i.e. elective
     obstetric and gynecologic healthcare.                                                         with the hospital to address their com-
                                                      primary cesarean, minimizing inter-
                                                                                                   mon concerns.
                                                      ventions and poor outcomes
                                                                                                      KOMBIT was established to address
     The Present State                              • Address local public health concerns
                                                                                                   the issue of maternal mortality in a rural
     A review of the ACNM Web site found              i.e. Katrina, health disparities, obesity,
                                                                                                   area. Community mobilization efforts
     that approximately 32 percent of the             and access to care
                                                                                                   have included maternal child health pro-
     states have Web sites and some of these        • Promote legislative consumer aware-
                                                                                                   motion activities, the development of
     Web sites contain outdated information.          ness and involvement.
                                                                                                   evacuation plans and an ambulance serv-
                                                                                                   ice for childbirth complications, and
     The Challenge                                  Winning the Challenge                          placement of cell phones with the village
     For each state to develop a new Web site       By the set deadline (TBA), each state will
                                                                                                   health agents. Imparting critical informa-
     or update an existing Web site for the         submit their Web site and marketing
                                                                                                   tion to women about how to prevent and
     purpose of consumer education. States          plan to a panel of judges (comprised of
                                                                                                   manage childbirth through HBLSS has
     with more than one chapter are encour-         midwives and consumers). The amount
                                                                                                   become an integral part of their impact
     aged to join forces to have a single state     of money raised will determine the mon-
                                                                                                   on the health of women and babies in
     Web site. Identifying chapter representa-      etary award for the “Best State Web Site.”
                                                                                                   the region. The implementation of
     tives to form a working committee and          Presently, a $1000 donation has been
                                                                                                   HBLSS in this organization has demon-
     serve as liaisons back to the chapters at      made to award the state winner and
                                                                                                   strated how the incorporation of multi-
     large can serve to accomplish this.            $500 to the runner up.
                                                                                                   level strategies can facilitate improve-
        In addition to the Web site, the chal-        Visit to learn the six
                                                                                                   ment of maternal-child health in one of
     lenge includes the development of a mar-       basic steps to form your Web site, how to
                                                                                                   the more challenging health environ-
     keting strategy outlining a plan of how the    get started, Web site design and coming
                                                                                                   ments in the world. Q
     Web site will be marketed to the public.       up with your marketing plan. Q
        The goal is to set in motion a far-reach-   GOOD LUCK!
     ing strategy to increase public awareness

                                                                                                                  Quickening Fall 2007

                                                                                             by Erica Schwartz, MSN, CNM

Increasing Patient Safety                                                                    Division of Standards and Practice,
                                                                                             Quality Management Section

                                               3. Raise standards and expectations for       • Magnesium sulfate toxicity

       atient safety is freedom from acci-
       dental injury or harm to patients          improvements in safety through the         • Eclampsia
       from care that is intended to help         actions of oversight organizations,        • Amniotic fluid embolism
them. Medical error is the failure of             group purchasers, and professional         • Postpartum hemorrhage
planned action to be completed as                 groups; and                                • Disseminated intravascular coagulation
intended or the use of the wrong plan to       4. Create safety systems inside health        • Return to surgical suite after cesarean
achieve an aim. Thus, as medical errors           care organizations through the imple-        birth
increase, patient safety decreases and pre-       mentation of safe practices at the         • Admission o the intensive care unit
ventable adverse events prevail: injury           delivery level.
attributed to error caused by medical             Patient safety indicators (PSIs) have      Fetal/Infant
management rather than the underlying          been shown to contribute to the ongoing       •  Nonreassuring fetal heart rate pattern
disease or condition.                          process of making the clinical environ-       •  Prolapsed umbilical cord
   Leapfrog is a member supported pro-         ment safer. Failure to rescue is a PSI        •  Vasa previa rupture
gram aimed at mobilizing employer pur-         defined as the inability of clinicians to     •  Second stage intolerance to pushing
chasing power to alert America’s health        save a hospitalized patient’s life when he    •  Shoulder dystocia
industry that big leaps in health care         or she experiences a complication that        •  Emergent cesarean birth for nonreas-
safety, quality and customer value will be     was not present on admission or the fail-        suring fetal status
recognized and rewarded. An Institute of       ure to diagnose and treat in a timely fash-   • Low Apgar scores at 5 minutes in the
Medicine (IOM) report found that               ion. PSIs in obstetrical care have been          term neonate
98,000 Americans die every year from           determined by the Agency for Health           • Umbilical cord blood values suggestive
preventable medical errors made in hos-        Research and Quality (AHRQ). They                of academia
pitals alone. The prevalence of preventa-      allow a system focused review sensitive to    • Term infant admitted to the ICU
ble adverse outcomes compounded by             time (provider identification, decision       • Subgaleal hematoma
society’s litigious nature has directly        making, and intervention), communica-            Missed diagnosis and treatment are
impacted the increase of malpractice pre-      tion patterns, and a comprehensive analy-     failure to rescue processes despite an
miums. In order to afford to practice,         sis of where the breakdown(s) occurred.       optimal outcome. The overall healthy sta-
errors need to be avoided.                        The rescue process is the coordinated      tus of childbearing women may mask
   Following the publication, To Err is        act of health care participants to monitor,   many medical errors. The historic nature
Human, the IOM encouraged the devel-           identify, and perform timely execution of     of peer reviews based solely on adverse
opment of a patient safety culture.            appropriate interventions based upon          outcome occurrences is inadequate to
Members prioritize patient safety, engage      designated member roles. Through meas-        uncover medical errors, especially related
in non-punitive reporting, and focus on        uring and evaluating the responses for        to the time elements of rapid identifica-
fixing the system rather than ascribing        pertinent obstetrical indicators, areas of    tion and intervention intervals.
individual blame for improvement of            improvement can be identified and reme-          It is imperative that midwives incorpo-
patient safety. A four-tier approach has       died. Selected maternal and fetal compli-     rate strategies and review processes with-
been recommended:                              cations/emergencies during labor and          in clinical environments to develop a cul-
1. Establish a national focus to create        birth appropriate for rescue process eval-    ture of patient safety. Familiarize the
   leadership, research, tools, and proto-     uation include the following:                 health care team with patient safety indi-
   cols to enhance the knowledge base                                                        cators and devise guidelines to review
   about safety;                               Maternal                                      systematic processes which contribute to
2. Identify and learn from errors through      •   Uterine hyperstimulation                  errors. Refer to AHRQ, IOM, HEDIS, and
   immediate and strong mandatory              •   Positive culture for GBS                  Leapfrog websites for a more comprehen-
   reporting efforts, as well as the encour-   •   Placental abruption                       sive review of current quality improve-
   agement of voluntary efforts, both with     •   Uterine rupture                           ment measures.
   the aim of making sure the system           •   Preterm labor resulting in unexpected
   continues to be made safer for patients;        preterm birth
                                                                                                                        continued on page 36

Quickening Fall 2007

     Quickening Fall 2007

                                                    Wonderful collegial relationship with col-       a model for providing exceptional health
Employment                                          laborating Obs. Full benefits/competitive        care to the women and children of Texas.
GASTONIA, NC - A thriving, well                     salary. Contact Wendy Kaggerud, CNM              Interested Certified Nurse Midwives
established, private OB/GYN practice                , 1100 Wescott Dr., Suite 105,                   are encouraged to submit their resumes
with 5 board certified OB/GYN physi-                Flemington, NJ 08822, 908–788–6469               to: Carolyn Nelson-Becker,
cians, 1 nurse practitioner and 1 nurse                             Ed.D.,C.N.M., director, UTMB Regional
midwife wishes to add a second mid-                                                                  Maternal and Child Health Program,
wife. The candidate should have gradu-              TEXAS—The University of Texas Medical            The University of Texas Medical
ated from an accredited midwifery                   Branch is seeking CNMs for its Regional          Branch, Department of Obstetrics and
school and have at least 2 years experi-            Maternal and Child Health Program                Gynecology, 301 University Blvd.,
ence working as a midwife. The practice             which provides health care to women and          77555–0587 or call (409)772–2388.
is located in a suburb of Charlotte,                children in approximately 50 counties in         UTMB is an equal opportunity affirmative
North Carolina offering easy access to              Texas. The program’s 30 clinics offer pre-       action employer that proudly values
both the mountains and the beaches,                 natal care, family planning, child health,       diversity. Candidates of all backgrounds
with a great year round climate.                    dysplasia, and breast and cervical cancer        are encouraged to apply.
Forward CV to: Practice Manager,                    screening services to women and their
P. O. Box 3764, Gastonia, North                     families, as well as access to CNM attend-       HOUSTON, TX—Well established, pri-
Carolina 28054-3764, Or fax to                      ed in-hospital birth center births for low-      vate, full-scope midwifery practice in the
704-854-3619, Or email to                           risk women. Nurse-midwives practice as           Texas Medical Center in Houston. Position                         part of an interdisciplinary team through-       available for a CNM committed to sup-
                                                    out our clinic system and provide around-        porting families and to the midwifery phi-
WESTERN NEW JERSEY—Busy, pri-                       the-clock staffing for our birth center at       losophy of care. Competitive salary and
vate Ob/Gyn practice in western New                 our main campus in Galveston and other           benefits. Please email resume’ to tde-
Jersey is seeking another full-time CNM             sites. Creativity and solid cooperative or
to add to our 3 1/4 FTE CNMs.                       working relationships make this program          call us at 713–4253750.

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Quickening Fall 2007

     Patient Safety
     from page 33

     Leap Frog

     Johnson, C., Handberg, E., Dobalian, A.,
     Gurol, N., Pearson, V. (2005). Improving
     perinatal and neonatal patient safety: The
     AHRQ patient safety indicators. Journal
     of Perinatal & Neonatal Nursing.

     Simpson, K. (2005). Failure to Rescue:
     Implications fro evaluating quality of
     care during labor and birth. J Perinat
     Neonat Nurs, 19(1): 24–34.

     Young, Thomas. (2005). Presidential
     address: Human error, patient safety and
     the tort liability crises: The perfect
     storm. American Journal of Obstetrics and
     Gynecology, 193(2). Q

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       new products at

                    Quickening Fall 2007

The President’s Pen
from page 3

same qualities and the important role they
have played in her own successes.
   When I reflect on my last 50 years, I
see these qualities as the necessary char-
acteristics for nurse-midwives. But it’s
also clear to me that we never do any-
thing alone. Nurse-midwifery would not
have happened in Florida without the
help of at least one leading public
health-oriented obstetrician and a Dean
of Nursing who opened the doors of
graduate education for midwifery. Nor
would the formal education for direct
entry midwifery have been established.
We have negotiated these alliances across
the country. We need to preserve and
continue to expand these alliances for all
of midwifery because, as Helen Keller
said, “Alone we can do so little -
Together we can do so much.” Q

                                             Quickening Fall 2007

                                    Working with You
                                    from page 2

                                      and we see lots of exciting possibilities.
                                    • Moving Out. Our internal team is
                                      stronger, stabilized, and more positive.
                                      Work is well underway to calibrate all
                                      the moving parts of our organization
                                      and create a robust 2008 budget to bet-
                                      ter serve you. A big focus for me over
                                      the next six months will be to get out
                                      on the road more to meet and listen to
                                      ACNM members. Please join me at one
                                      or more of the upcoming events listed
                                      on page 2, or, if you can’t, please help
                                      me listen to you by contacting me at
                                      240-485-1810 or by email. Q

                                    Money Matters
                                    from page 30

                                       ACNM has a spending policy govern-
                                    ing the use and maintenance of these
                                    reserves. Reserves may be used for capi-
                                    tal expenditures and other specific
                                    events not typically in the annual budg-
                                    et, such as restructuring expenses. It is
                                    becoming apparent that we are utilizing
     We want to                     more of our reserves to fund the activi-
                                    ties of the College, which is not sustain-
     hear from you                  able on a long term basis. At the Board
                                    of Directors meeting in May, we voted to
     Send information and           implement two relevant policies. The
     pictures from your             first limits the amount of money in each
                                    fund in our portfolio to 15 percent of
     chapter’s meetings and         the total value of the portfolio. The
     events to       board also voted to limit the percentage
     for inclusion in Quickening.   of money that we may spend from our
                                    reserves to 4 percent of the rolling bal-
                                    ance in our accounts from the previous
                                    3 years. This is a widely accepted finan-
                                    cial strategy to maximize the longevity
                                    of our investments. We realize that
                                    exceptional circumstances may warrant
                                    the reevaluation of this policy, but are
                                    committed to growing our reserves to
                                    ensure our continued financial viability.
                                       As I hope you can see, ACNM is in a
                                    good financial position. I’d love to hear
                                    your thoughts and suggestions! Q

                                                   Quickening Fall 2007

Quickening Fall 2007

  American College of Nurse-Midwives
  8403 Colesville Road, Suite 1550
  Silver Spring, MD 20910-6374



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