Does Health Care Reform Do Anything for Midwifery?


This post is one in a series of pieces RH Reality Check is publishing to highlight National Midwifery Week 2010 (Oct 3- 9).

Most midwives would agree that The Patient Protection and Affordable Care Act has several concrete benefits for the midwifery profession. The act establishes reimbursement for certified nurse-midwives (CNMs) at 100 percent of the Medicare Part B fee schedule, which means that as of January 1, CNMs will be reimbursed at the same rate as physicians. The law also recognizes freestanding birth centers under Medicaid, which allows birth centers to receive reimbursement for their facility fees.

But since these parts of the legislation have not yet gone into effect and do not affect all midwives, does health reform really mean anything for the thousands of US midwives and their patients?

The answer is yes! To the prospective midwifery student, I can now say that more money will be available for graduate nursing education and that there will be more help with loan repayment for midwives who practice in maternity care shortage areas. When I am asked how reform legislation has affected midwifery practice thus far, I can say it has brought the evidence forward as we move towards some major changes and improvement in care for women and infants.

There is a new focus on evidence-based practice, which I believe is the direct result of health care reform legislation. A dialogue is taking place among the stakeholders in this country about how we can do better for mothers and newborns. This year, Childbirth Connection published two reports in addition to hosting a symposium called Transforming Maternity Care: A High Value Proposition. One of the reports, the Blueprint for Action, reinforces the importance of evidenced-based maternity practices. The American College of Nurse-Midwives is about to release a PowerPoint presentation entitled Evidence-Based Practice: Midwifery Pearls, to help midwives spread the facts about evidence-based practice. Evidence-based practice in maternity care is definitely in the limelight. Also, the National Institutes of Health (NIH), discussed vaginal birth after cesarean (VBAC) at a Consensus Development Conference.

But there is still more work to be done. Passage of the “Maximizing Optimal Maternity Services for the 21st Century Act (MOMS 21)” is the next step to help move this nation forward as we create a focus on maternity services. If the bill passes, there will be expanded federal research on best maternity practices and support for the education of a more culturally diverse interdisciplinary maternity care workforce. There will also be a national consumer education campaign to inform women about evidence-based maternity care practices.

For midwives, this legislation has brought renewed hope to a system of care that spends more than double per capita on childbirth than other industrialized countries, yet ranks far behind almost all developed countries in perinatal outcomes. For years midwives have been the champions of reducing risks in childbirth and eliminating disparities in communities of color. We have fought hard over the past several years to have federal legislation address concerns of midwives and the women we serve. A major barrier for women who want a midwife has been inadequate reimbursement for services. We know that midwives provide health care services to women of all ages and play a significant role in access to quality, affordable primary care, gynecology, family planning, and maternity services. Passage of MOMS 21 will enhance the viability of midwives as well as increase the incentive for hospital and physician practices to employ them.

The times, they are a’ changing, and we have renewed hope that the four million women who give birth in this country will have many safe, affordable maternity care options— and that the care they receive will be based on the evidence of best practices.

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