Supporting MAMAs

Access to women’s reproductive and sexual health care services in the U.S. is spotty at best and woefully poor at worst. Our country has a history of enacting barriers to women’s health care when it comes to services related to reproduction and sexuality. Interestingly, and maybe not surprisingly, whether we’re addressing abortion or childbirth our laws have spiraled every which way. Even more tellingly, the spirals began as concentric circles. 

In this country, it was the midwife who performed (legal) abortion until the early nineteenth century when states began to enact restrictions on abortion provision. By 1880, abortion was illegal in all states, except to save the life of the mother. Much of this legislative control, according to Our Bodies, Ourselves, arose parallel to women’s journey towards bodily and societal autonomy. When women began the fight for voting rights and birth control, specifically, both legislators and medical professionals fought back through the enactment of anti-choice laws. The American Medical Association (AMA) was primarily responsible for ensuring the illegality of abortion, in large part because of their opposition to midwives – health care providers who did not fall under the domain of the AMA or fit the male medical establishment’s definition of what a medical provider should be.

Margaret Sanger, founder of Planned Parenthood and heroine of modern women’s health care exemplifies these concentric circles of women’s health care – a midwife whose determination ensured that the pregnant and parenting mothers she cared for had the means to control their reproductive lives. Sanger’s drive to create and improve access to birth control for women in this country changed women’s lives forever but also can be seen as yet another reason why midwifery has been so stigmatized in this country.

I provide this quick backgrounder because, under President Obama – a leader who calls for both an exploration of common ground in the abortion debate and is spearheading the fight for health care reform – we have an opportunity to re-examine the gamut of women’s reproductive and sexual health care in order to improve access to all care.

One group is working hard at this moment in time to ensure that health care reform remember midwifery.  The MAMA campaign (Midwives and Mothers In Action) is a collaborative
effort between a host of advocacy and consumer organizations. MAMA is ramping up its energy now in order to do all it can to influence
the current health care reform measures making their way through
Congress. The campaign’s overall agenda focuses on gaining "federal
recognition of Certified Professional Midwives so that women and
families will have increased access to quality, affordable maternity
care in the settings of their choice." Right now they are zoning in on ensuring Medicaid coverage for Certified Professional Midwives is included in any health care reform. Why, you ask, is this necessary? 

It’s simple. Can we say that until all women in the U.S. have access to the full range of reproductive and sexual health care services – regardless of economics, race, class, ethnicity, language barriers, or sexual or gender identity – we have true choice? That is, do we include choice in childbirth options (where and with what kind of health care professional we birth) and medicaid coverage for certified professional midwives to be equally as important as abortion and contraception access for all women? Can we agree that ensuring these necessary options for women are included in health care reform is critical not only to bringing down health care costs for all but for improving women’s health? In 25 states in this country it is illegal to choose the care provider
or setting for your birth because Certified Professional Midwives are
outlawed as birth facilitators. The rise in cesarean sections and unnecesary medical interventions both contribute to poorer health outcomes for women and newborns. Is it just as important for a low-income woman to have access to the kind of birth she believes is best for her and her baby as it is for her to have access to safe, legal abortion or contraception? Currently, there is no federal regulation of certified professional midwives and so medicaid coverage for out of hospital birth varies from state to state leaving many women without any options at all.

The truth is, as The Big Push for Midwives puts it, "We can no longer afford a system that produces inferior results at premium costs." As we work towards immense health care reform, the question for all reproductive health advocates should be: How much longer will we tolerate a system in which women’s and babies’ health and lives are compromised, costs to the consumer are rising, access to childbirth care remains inequitable and Certified Professional Midwives must fight for their livelihood? Access to abortion care, contraception and childbirth care should be seen as concentric circles – they are all connected and all part of the continuum of womens’ reproductive and sexual health care with which reproductive heatlh and rights advocates should be concerned. 

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  • dltbhs

    Thank you so much for writing about this. It is not discussed enough. The C section rate in the United States is deplorable and the treatment of women birthing in the hospital environment is downright shocking. More and more women are being pushed into C sections by the use of pitocin and epidurals without being informed. The people they trust with their births neglect to mention that the use of pitocin causes the chances of needing a C section to skyrocket. And the few women that ARE informed about the risks are often treated with disdain and disrespect from their doctor.

    The right to a safe, legal and INFORMED birth is just as important as the right to a safe, legal and INFORMED abortion but advocated for much less often…

  • invalid-0

    Just to clarify, Certified Professional Midwives can not provide abortion services. Abortion care is not part of the CPM training or scope of practice, which is limited to providing maternity care during the childbearing cycle to the small percentage of women in the US who plan to birth at home each year.

    Certified Nurse-Midwives, by contrast, may undergo training to perform surgical abortions as part of their advanced clinical training, and as authorized prescribers in all 50 states, CNMs should have the ability to provide medical abortion services. However, most states only allow physicians to serve as abortion providers.

    Unlike Certified Professional Midwives, Certified Nurse-Midwives are primary care providers who care for women throughout their lifespan, from puberty to menopause, not just during the childbearing year, and the majority of CNMs deliver babies in hospitals, not at home.

    A critical component to expanding access to abortion care for women is to overturn laws that do not allow Certified Nurse-Midwives to practice under their full scope to provide both surgical and medical abortion services to women.

  • invalid-0

    Thank you, Aimee, for the information regarding the current effort of the MAMA Campaign and the Big Push for Midwives to obtain Medicaid coverage for the services of Certified Professional Midwives (CPMs). CPMs provide full materntiy care services within the childbearing cycle, including prenatal care, birth care, and postpartum care, with a special focus on out-of-hospital birth (homes and birth centers). However, CPMs do not, and have never, provided abortion services. Your comment about midwives and abortion was referencing pre-19th century traditions when community midwives provided most of the primary care in rural America, but does not reflect the current status of midwifery in the U.S. Thank you for the overall support of the efforts to include CPMs as Medicaid providers.

  • amie-newman

    I am sorry if my post was unclear. As I wrote, it was  midwives who performed abortions until the early part of the 19th century in this country but I should have prefaced the word "midwives" by writing "non-certified". As Ida writes, CPMs do not and have never provided abortions in the U.S. Thanks for the clarification!

    My post is focused on the importance of federal certification of Certified Professional Midwives (including ensuring Medicaid coverage for CPMs) so that we may be able to offer pregnant and birthing women true choice and options for where and with whom they would like to birth. 

    To the commenter, Eddie, who writes about CNMs (Certified Nurse Midwives), I agree that it would be appropriate and more than helpful to expand laws to allow CNMs to provide abortion care. I’d love for you to email me more information ( so I can write about this issue as well. 

    To all: the issue here is that regardless of what kind of reproductive or sexual health care about which we are referring (childbirth, contraception, abortion, prenatal, disease prevention) it is critical that women in the U.S. have expanded SAFE options for care. Right now, the United States has the worst newborn death rate and one of the highest maternal mortality rates of all industrialized nations in the world. Despite the fact that, as The Big Push for Midwives notes, we spend billions of dollars each year on maternity care. This is unacceptable.

    Thanks for the comments, thus far, and I hope we can continue this conversation on RH Reality Check. Again, please do send me your stories, news items, and issues so that I can continue covering. 

    Amie Newman

    Managing Editor, RH Reality Check

  • invalid-0

    Legal birth? Has there ever been illegal birth? That’s quite a stretch to try to connect abortion with giving birth to a child!

    There is never a “need” to intentionally and directly kill an unborn child. It is a want – the mother wants to kill her child because she doesn’t want it, be honest, please. I would have more respect if abortion supporters are at least honest that about it. If the mother’s health is at risk every attempt should be made to treat both the mother and child, if it is emergency treatment then treat the mother and if the child dies unintentially then that is an undesired and tragic consequence, but there’s no need to go in the mother’s womb and suck the child out or suck his/her brains out to intentionally kill them.

    • crowepps

      Has there ever been illegal birth?

      Yes, actually.  That was what the phrase ‘illegitimate’ meant.  Check Deut. 23:3.  Children born ‘illegally’ were excluded from the congregation and therefore damned.

  • richel8

    It’s really an informative article.Thank you for sharing this issue.I agree that we have the right of safe and legal birth procedures.I hope this kind of issue be resolve soon.


  • invalid-0

    Thank you, Aimee, for the information regarding the current effort of the MAMA Campaign and the Big Push for Midwives to obtain Medicaid coverage for the services of Certified Professional Midwives (CPMs).
    Colon Cleanse

  • acai-berry

    This is definitely a step in the right direction. So many people are without healthcare in this country and it has been like this for many decades.