Barriers and Recommendations for Midwives in Independent Practice

December 7, 2017

grow midwives - identifying barriers to independent practice


In case you missed it, here is the video and transcription of the Webinar “Barriers and Recommendations for Independent Practice” with Ginger Breedlove from Grow Midwives on Thursday, November 30, 2018.

Below the video and at the bottom of the page, you can find a button to download the CHECKLIST TO REDUCE MIDWIFERY PRACTICE BARRIERS. If you haven’t signed up already, make sure to join our mailing list as well to keep up to date with all future news and webinar announcements from Grow Midwives.



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Ginger: I do want you all to know that our recordings are going to be transcribed as well as saved and placed on our website. So we welcome you to share that information with whoever you’d like to.

On behalf of Lesley and I, we want to say thanks for joining us. This is our second webinar since we’ve launched Grow Midwives. And our hope is to be able to bring our experience and recommendations that we’ve had through successes and challenges over our career with experiences you’ve had and then that hopefully will be shared. So we bring our real collective wisdom to conversations that are critically important to advancing midwifery in the country.

This presentation is really just touching on some highlights of things that we think could be valuable. Certainly, many of them will take a deeper dive than what we have time to really talk about today. But I think what we’re trying to do is highlight some key areas that we have experienced and knowing can be incredibly valuable and removing barriers to midwifery practice that all of us have experienced in some form of another, whether we’ve been practicing 30 or more years, or just trying to sort of enter the professional market and trying to find our way through what that all means.

We’re going to start with talking about ACNM, the American College of Nurse-Midwives. And I think it’s really important to start there because a few years ago, ACNM created a requirement that all states have a single affiliate. And the purpose of that was to take– states like mine in, Kansas where we had three chapters, they were designed by where people geographically located in the state. And we weren’t really talking to each other very much about key advocacy and legislative issues that almost always impact practice, if they are regulatory or legislative in nature.


When ACNM decided that all states had to move to an affiliate model, it really was to encourage any sort of mandate that needs to come together with one voice and to be aware of what was happening around the state in order to be more effective in the conversations that you have.

Of course, you know or you may not know there are various dues, rates, and payment methods based on your years as a midwife. The state affiliate you’re in sets state dues that come directly back to them. But the good news is you can also pay on a monthly basis. To me, being a member of ACNM, even if you don’t find yourself actively engaged in what’s happening on a national level gives you incredible leverage to engage in networking in the state that you’re in. And that engagement elevates your profile when you’re talking to people outside of this sort of silo of midwives when we talk to ourselves. It’s incredibly important that you know what’s happening in your affiliate when you begin to talk outside of that circle.

I want to give you what I believe is an incredible example of the state of Washington affiliate. They have a very dynamic website. But in particular, I wanted you to focus on their legislative advocacy page. Let’s see what happens if I jump there. This] should work for me, fingers crossed. So here you can see– give me a thumbs up or let me know if you can see the Washington affiliate page in the chatbox. A description of their legislative issues at the state level as well as what’s going on at the federal level. And the federal level, you can find this information really very easy on the ACNM website. I almost think you can find it without being a member. I’m not positive. I should know that but I don’t.

The state legislative efforts are incredibly important for you to know about when you’re talking about barriers to care because the last thing you want to do is be disseminating information the state does not agree on as an affiliate. It causes incredible confusion and makes you look much less informed and strategic in the conversations you’re carrying on. So another reason to be a member of your state affiliate.

So why ACNM and this is my last plug to try to get those non-members to join. Only about 52% of midwives in our country certified by AMCB joined ACNM. So let’s just say it’s a 50-50 split. The advocacy work that ACNM is doing for our profession at the national and state level impacts the career of every midwife, on a state level as well as a national level. And advocacy is the most expensive thing we do. I think if Lesley were on here, maybe she can type it in. The amount of money she and her birth center has spent just legislating and having lobbying assistance in South Carolina for birthing centers is unbelievable. And so, that money that you pay for state dues helps for the advocacy work.

It also provides a sense of community. Sometimes when we feel alone, we’re not making progress as quickly as we’d like to, we think we’re alone, all it takes is to step into an affiliate meeting and realize there are people all along the spectrum who have had years of experience like Linda Cole who’s on this webinar today, who you might sit on beside and give you a wealth of information that you really had no knowledge about before. So there’s incredible value in networking. And again, your awareness of what’s happening validates your voice. So wherever you are in the community, knowing what’s going on with the ACNM is critical.

The next thing we want to talk about is ACOG. And I’m going to encourage you to join the American College of OB-GYNs. And I’m very serious about that. Why? Some people may say it’s important to know what’s going on with potential opposition I would rephrase that to say it’s incredibly important to show, number one, that we’re colleagues in caring. That it’s important for us to know what ACOG is saying about the state of your state, which is on a district or state-by-state level, critically important to look at the barriers that you need to tackle. And there’s an incredible amount of legislative information, let alone practice-based information, that will be very valuable.

Sorting out what’s fact and fiction is part of how you accelerate your progress in finding work in your state. So it’s important to not believe everything you hear about ACOG and I’m here to say that they are not our enemy. They are not the dark side. There are many, many supporters in the ACOG organization of growing team-based care. And knowing what they’re saying personally, rather than other opinions, is critically important.

Another thing joining ACOG will do for you is you’ll find inroads into state and community leadership conversations. Sometimes it’s helpful if you’re on opposing sides, to start the conversation with, “You know, look, I’m an educational affiliate with ACOG. I’m really interested in how you’re leading healthcare in America. Can we have a conversation?” So you’re not approaching a difficult conversation with anger but some common ground in that you find their work in advancing best practices, perhaps not all practices, but certain the intentionality of advancing the health of women in our country.

And the other is to consider going to their fall and spring district meetings. Those are open. If you’re an educational affiliate, they are less expensive to attend. And that is where, typically in a relaxed environment, you can have conversations with people at the bar or at a buffet table that allow you to just have human-to-human contact. That the meeting is not designed to raise defenses on either side but it’s a relaxed setting where you honestly can get to know each other as an individual. It goes miles. We know that from the last several years of the ACNM regional reps attending every fall and spring meeting that ACOG actually pays our regional representatives to attend. They want to hear from midwives. You can also join as an educational affiliate. You don’t have to be a professional to join ACOG.

This next slide that I want to show you is something that ACNM and the National Association of Women’s Health Nurse Practitioners lobbied with ACOG to have reduced dues for ACNM members. That particular reduced dues window was open 4 to 6 weeks this fall and was a $240 typical rate, which is it today, brought down to $125. I decided to call the ACOG office while we were preparing the slideshow and asked them, with a little bit of leverage, that we are pushing people to join ACOG. Would they reconsider opening that reduced fee rate? And they are now taking it to higher leadership for conversation. So I would say, “Stay tuned.” If we get those ACOG membership dues lowered. We’ll post it on the Grow Midwives website. It’s looking very positive. I, too, think that they are interested in promoting the collegiality, and we’re going to have to be the ones who step forward because we know that’s typically not happening, coming from our community obstetricians.

Let’s talk about midwives for a minute. What is the state, or your state’s state, of midwifery? So what do I mean by that? Well, maybe it’s pretty simple. Midwives can do this and midwives can do that, and when we think that way, we’re probably thinking about our own professional credential and AMCB certificate. But is there any active or pending legislation that might be going on that could impact midwifery; the scope of practice? Is there discussion about adding the CM, certified midwife, credential in your state, which is now moving pretty rapidly across several states – I think maybe as many as five – where there’s active legislation being discussed? And what about the certified professional midwife? What is the state of legislation or pending legislation with the CPM? So we’re here to encourage you to engage in conversations so that you not only understand why there’s confusion in state legislative conversations when the word midwife is used but within those of us who use the terminology midwife, we often don’t have clarity on what’s going on, as well.

We’re giving you a resource that we believe is key for you to understand if you’ve not heard about US MERA, or US Midwifery Education Regulation and Association Group. There’s a website link here for you to spend just a little bit of time understanding what is US MERA. Why is this an important conversation for you to at least be aware of if you’re talking with a physician group or a hospital group about midwifery and they’re somehow confused because they’re not understanding what you mean when you say midwifery. It’s really important that there is clear articulation and discussion, and not myth and rumors that go about when we’re talking about all midwives in our state.

And the other is the certified midwife, which is a powerful group of about 100 AMCB certificants in our country that are pushing hard to grow the CM credential, which is a pathway into midwifery that does not require an RN degree. It’s important for you to know what’s going on with that CM credential, the initiatives from ACNM, to move active legislation across the country.

We need more providers. It is an anomaly to me that we have not been proactive or effective in getting this credential legislated across the country while we simultaneously talk about a healthcare provider shortage. It makes no sense and it needs to be brought up before every state affiliate.

Let’s move over to the scope of practice. How are the laws, rules, and regulations interpreted and implemented for midwives? So it’s important to know for an accountability frame of reference, for a liability frame of reference. I’ll give you an example in Kansas, which is a mess right now. We were under just the Board of Nursing. The legislation was passed in a very concerning way over a year and a half ago that allowed midwives to also go under the Board of Medicine, and we have to have malpractice insurance from the Health Care Stabilization Fund. I won’t go into the details of how that dichotomy is causing incredible chaos in our state for our midwives, for our doctors, and for our patients, but it is. And if you’re going to be an advocate to reduce barriers, you need to understand the nuances of all the laws, rules, and regulations about midwifery. When is the next opening, sunset, or revisions review coming up, and how active is your affiliate in that conversation? And how familiar are you with what the affiliate is saying?

And lastly, how much do physicians understand the scope, role, and practice of midwifery? Now, I’m sure all of us on this call could come up with a variety of responses to that. But sometimes, I’m going to take the side of when you don’t know, you don’t know how to frame your questions. It’s important that we don’t punish people for not knowing or not taking the time to understand.

What becomes more difficult is if you try to have conversations and you’re not offering any resources. So where do you find those resources? Well, there are state resources. This is ACNM members-only section of the website that takes you to a portal where every state has listed all the critical information about laws, and regulation, and current activity going on in the state. If you didn’t know about that, it’s important to look at, to read, and make sure it’s current.

What about talking about types of midwives? This conversation of the confusion over a midwife is a midwife is a midwife?

Just this fall, ACNM released an updated version and document of the types of midwives in the US, what their education is, what their credentials are, and, to some degree, what their scope of practice allows them to do. This is a really important document to have in your pocket and to be able to share with people who need to be educated and informed.

Understanding issues from the balcony view. So what do I mean by that? Sometimes a sort of looking at advanced practice, in general, helps us be able to use specific issues unique to the advanced practice of midwifery. And there is probably no bigger champion for advanced practice nurses than the Robert Wood Johnson Foundation. If you’ve read the Freakonomics podcast, or listened to it, and then read the comments, you could see a lot of physicians very angry with RWJ for what they had to say about nurses filling the gaps in care. I want you to know that this was published earlier this  year, but this is a sentinel document that is used by many nurse practitioners that helps educate legislators, hospital administrators, executive leaders, insurers about any audience you want to talk to, consumers, on the evidence and the value of nurse practitioners in our country, and is a really important article for you to be aware of when you’re sort of talking from the balcony view. What’s incredibly stunning about this article is a quote and a picture of Dr. Hal Lawrence, who’s the Chief Executive Officer of ACOG, and he has been for some time. And if you read this quote from Dr. Lawrence, you will find that although he uses the word nurse midwives, and they have talked about all midwives, he talks about midwives being a bridge to the gap between the supply of physicians and the demand for services. This is really critically valuable to sort of diffuse some of our more angrier opposition by reminding them that ACOG is a professional organization that does validate and support midwifery.

Understanding all of these things related to the scope of practice helps begin to frame, how do you get what you want? So you have to do your homework. One of the things that I have found that often happens, and this isn’t– this isn’t sort of saying that we’re not prepared adequately, but I do believe, especially those of us who came through the nursing profession, we tend to wait for things to happen for us or to us rather than believing we control our destiny, and that requires work.

You have to do your homework if you want to make a difference in what your career path is going to look like. So truly assessing the midwifery scope of practice in your state using the conversations and the tools that we’ve talked about is really important. I’m going to keep picking on Linda Cole because your mentors and your leaders that have been around a long time, you need to seek validation that your homework is correct, that you have the right dialogue, that you gathered the right evidence. And I can’t emphasize more to seek validation before you– especially if you’re going out independently into some tough, tough conversations.

You also need to identify who your support is from people like Lisa, consumers, dullas, to others midwives and physicians. And you need to identify who your barriers are before you start taking action.

Let’s talk a little bit about that. Your allies and your oppositions are labeled such, right? Because everything is about relationships and rapport whether that’s within our work environment, with our employers, with our family. There are times when my husband and I are in opposition about certain things. It doesn’t mean we can’t figure out how to agree. But to get there, it’s about how we conduct ourselves within the relationship and the kind of rapport we enter and exit with.

We’re going to give you some hints. The Harvard Business Review has some advice that I’ve cited here, that I just put up the six points for you. Because I think when you first look at it, you’re going to go, “Why the heck did Ginger pick an article that’s about entering another culture that doesn’t speak English?,” right? It’s because the analogy is so incredibly similar when midwives try to speak in a culture that is not similar, and we often speak different languages.

It’s important, I think, to apply these principles, that it doesn’t matter if the culture clashes to some degree. You need to learn each other’s language. You need to understand how people feel about their position. And you need to learn what their point of view is. So that is all about leaning in, not sitting back with your arms crossed, or tapping your finger, or being anxious in the conversation, but genuinely being willing to learn their point of view.

You also need to enter their world, right? When you enter the world of opposition, you’re typically dealing with someone you want to impress, right? Otherwise, you wouldn’t be there. So the way you do that is to sort of speak softly. Don’t be aggressive. Be sensitive to the words they’re saying, and find ways to reaffirm mutual goals.

Before you go into these other environments, before you go into this hospital or this physician’s office, you want to read about their culture. You want to know everything you can learn about the hospital. Do they participate in Leapfrog? Is their data transparent on their C-section rate, on physician C-section rate? What do other people think about them? What’s their reputation in the community? When you go with a little bit of homework, it may not be entirely accurate, but it gives you a lense to broaden your window about have you’re going to have a conversation. So it’s really important that you do a little bit of homework about their world.

They suggest you avoid jargon and employ body language, which is, go prepared clear objectives, a brief agenda. Don’t get lost in conversations that are full of emotion or sarcasm. It’s always been true in my experience in sitting in ACOG ward meetings in the past. If I said something that may have offended someone, as long as I say it in a respectful way and apologize if I was in error, you will gain that person’s trust more than if you say things that you know aren’t true and refuse to change your point of view. So very important to be willing to smile even if you disagree. It will show that you’re listening and you have interest in the conversation.

Find a translator or interpreter. This is an interesting concept that the Harvard Business Review studied. And they actually had some research done by some Fortune 500 companies and they talk about localization in the service industry, which means if you can find someone local who believes in what you’re saying, taking them with you can help translation sometimes beyond what you’re trying to do as the messenger. It’s not a mediator but it’s a third party to help avoid mistakes or misinterpretation, especially when you’re trying to establish new business relationships. So finding a translator to me could be interpreted as take an advocate with you. One that isn’t going to control the conversation but is available and can augment the conversation.

The next one is share a meal. If any of you have watched the TED Talk, Getting From No to Yes, you will hear this again. It is a principle from the Harvard Business Mediation Review Team, they have never dropped in all their publications. Sharing a meal with someone actually produces oxytocin. It makes us feel good. And it helps the connectedness and the attention during the conversation. One of the experiments that they did that they cited in the article says, “Negotiators who shared a meal walked away with an average of $6.7 million more in deals than those who did not eat together.” Now that’s pretty profound. It’s hard to stay mad at someone when you’re having a glass of wine together. And those were probably the best conversations I’ve had at the bar at the informal times when I’ve been around a lot of ACOG leaders.

The last one which often I think is contrary to what we initially feel is to relish the diversity. Trying to believe that always doing it our way in the birth culture has to be the only way or the right way. That really limits our opportunities. It makes the conversation more difficult. And you can’t get to breakthrough ideas that are mutually agreed upon if you don’t go in believing that diversity is actually a powerful opportunity for you to change a barrier.

So, start meeting. Once you’ve done your homework in all those different areas, reach out to some of your contacts. Suggest meals. They don’t have to be expensive. With other midwives, physicians, duelists, child work educators. Hold the consumer focus group in your home. Identify common aims as you begin to collect that data, and then put together a packet on what you’re trying to do. Right? The outcome, satisfaction, lower cost, fact sheets, all of those things are available on the ACNM website related to just about any topic that you want to be able to talk about.

What about ACOG? There is a joint practice statement on midwifery. There is a little bit of concern that the current ACOG president is getting some pressure from this, not because of ACOG but because of the American Medical Association. You can actually see in this joint statement, they described CNMs and CMs as independent providers who may collaborate. Those are pretty powerful phrases in this world of reducing barriers. And the last thing obstetricians want is the American Medical Society, their state society, on their backs. But today, it’s still there.

We have an active American Nurses Association who is now fighting back with the AMA. We seem to have cycles of this, getting more frequent than less frequent, but this is the latest article that you really do need to be aware of, put out just last week, a couple of weeks ago, on how the ANA is responding to the current battle with the American Medical Association. Lots of good facts in there. And we know, and there are probably others here, that there are key challenges in reducing barriers to independent practice in these particular states, high energy, and high angst.

How you navigate those conversations, if nothing else stay at the table in those conversations, it’s critically important. So how do you get started? I think for many of us, setting goals in a timeline is the best way to start moving forward, to not think it’s not going to happen for you or someone else is going to do it. In particular, if you’re trying to start your own practice or a birth center or change some kind of practice authority, waiting for other people to do a job that takes independent attention is not a good thing. In addition, evaluating frequently what your strategy is, talking to others about the strategy can be very very helpful.

We want to leave enough time to be able to have some Q&A here. So our question to you is, what are you waiting for? We have a checklist. I’ll scroll to that right now and then go back to the Q&A slide, but we put together a checklist of what we think could be a helpful tool for you. You may not need to do all of the elements on here, but it’s basically a guide to much of what we talked about today in terms of organizing yourself to change some of the barriers.

So, Lesley. I’m going to read what Lesley said, and then let’s see if there are questions that we can answer. So Lesley says, “Know your legislators. I was able to have a quick one-on-one with both Senator Tim Scott and Congressman Mark Sanford by recognizing them in the airport. They have both visited our birth center and are supportive of midwives and birth centers.

Midwives are perfect examples of excelling at the triple-A of healthcare. Legislators on both sides are impressed with what midwives can offer to improve the healthcare system. again, we go back to sometimes they don’t know what they don’t know, right? It’s interesting to go into a legislator’s office, especially, at the federal level, and talk about maternal mortality. And they look at you with eyes that– they’re changing now, right? The press is really on that but when they haven’t had frequent conversations about a topic then they don’t know. Really important to get to know people.

Do we have some questions? We’d love to be able to hear your experiences, things you’re concerned about, and use this 20 minutes to really make it interactive. So feel free to use the chat box and while we’re waiting, Lesley, do you other pearls that you want to emphasise that you can share?

Linda’s replying to Lesley and thanking her. I don’t know if you’re willing to share Lesley a ballpark figure of how much money has been spent on legislating for birth centers in South Carolina? But AABC is another organization you should absolutely join and you must join if your passion is to start a birth center. They too are working on active legislation at the federal level for changing reimbursement for birth centers.

So Lisa’s asking for a little more conversation about the CM credential. I can Lisa. One of the things that will help is if you go to that chat once we put the powerpoint up you’ll be able to link into all those URLs that help in a grid describe the differences in midwives.

The certified midwife credential came about many years ago to try to grow a non-traditional entry into the midwife path. Similar to but, not exactly, how midwives are trained in other countries, so we have a– boy I should know this. I’m going to be in trouble if some of my CM friends realize I don’t have the answer here. We have at least two, maybe three programs that train non-nurse to become certified midwives, so their curriculum is approved by the accrediting body that approves the same curriculum for certified nurse midwives. And when they complete that accredited program of study they take the same national board certification exam that certified nurse midwives take but they are not nurses. I hope that’s helpful for the short version and they are legal in five states and that’s growing on the East Coast, primarily.

So Lesley typed in, “Trying to get legislation passed without a lobbyist is like going to court without a lawyer.” Great, advice. “You can do it but it will be severely handicapped. We spent $30,000 on a lobbyist for one year of work.”

That’s why your memberships in these organizations are so incredibly important, and I will say whether it’s ACOG, ACNM, or AABC, you can join as typically a friend of or some reduced membership if you’re a non-professional. I know my husband is a member of ACNM. Obviously, he’s not a midwife. That all makes the difference.

It’s great to hear you’ve talked with your lobbyist about the CM credential. It will definitely help, as more CMs graduate, for them to be able to have employment opportunities across the country, especially in rural areas where we have severe provider shortages.

Other experiences, frustrations, lessons learned that can be shared?

Things that have triggered or resonated with you that, perhaps, you’re willing to take on that maybe you haven’t before. We’d love to hear if we’ve activated some excitement.

Lesley, can you type a little bit about what’s going on in the South Carolina affiliate where there are not a lot of midwives, let’s say, compared to the state of Washington where I gave you their website link? They have many, many midwives in the state of Washington in addition to CPMs practicing in that state.

Any advice when there are small numbers?

March for Moms. I was going to do that, Linda, probably at the end. Thanks, though, for the reminder.

Sometimes is difficult. And Lisa, you may be in one of those states where there aren’t a lot of midwife voices or the midwives are geographically so widely dispersed. It’s hard when you’re all busy and working, and you may have a family, and you may be volunteering in other areas of your life, to be connected, or as connected as you need to be, just because of the number of midwives in the state. And again, if half of our AMCB midwives are not AC&M members, then we have an even bigger problem.

So here’s a message from Laura. Thank you. “I’m currently a student and live in Illinois. Illinois will be an independent practice state in ’18. What can I do now besides forming relationships with other like-minded people to open up employment opportunities for me?”

So I’ll take a stab at it. And I’m going to ask Lesley to type in some things in response to that question. To me, Laura, it’s all about networking, whether that is at the affiliate meetings, if they have routine meetings, face to face, getting to know people, learning about what jobs might be available, if you have any connections in the birth world. Do you know any of the doulas, and do they know physicians that are inclined to think the way you do, who may not necessarily have an opening now, but may be willing to go to lunch with you to talk about possibly employing you? You kind of have to think forward and think about potential jobs that aren’t necessarily posted on the AC&M jobs career center. That takes courage and a lot of creative thinking, but a lot of people have been around for a while will say networking is one of your best friends, so that means you have to get out there and make yourself available. Create a very exciting resume, it’s also okay to have a business card. Present yourself as professionally as you can with the objectives of what you want.

Lesley says, “Some states like South Carolina have state prenatal associations.” Exactly. “Ours is called the South Carolina Birth Outcomes Initiatives. These state groups are usually open to consumers, providers, anyone interested in maternity care.” Excellent example.

March of Dimes is another group that has state events often, they have advisory boards, they have community grants that they distribute, they’re another initiative. Typically in these prenatal quality groups that are partners that you could also think about volunteering for or engage in.

Here’s from Heidi, “As a nurse-midwifery student I am looking to form relationships with OBs in my area. I work with some amazing OBs and I feel that they would really support midwifery. What are some tangible ways that I can continue to develop these relationships deeper?”

So Heidi, the only way they’re going to know you is to somehow find a way to get to know them, so every large city– and I don’t know where you’re at. Typically has an OBGYN society or the society for maternal-fetal medicine often does grand rounds in hospitals, academic centers. You need to start going to where they are and when you go where they are, and show interest in what they’re talking about it’s a perfect entree into getting to know people. You don’t have to be necessary, from some of these groups, a  staff member,  to be able to participate in their continuing education opportunities.

Do you have any other advice? Lesley on that one?

And then I’m going to go down to Rishell. “They’re some of us in Colorado– I’m not a nurse midwife, yet. Looking for deeper collaboration between all midwives. Increasing types of access, specifically allowing CNMs and CPMs to practice the birth setting together – somewhere to Utah. There’s also been advocacy from one of our few if only African-American CPMs to increase access to midwives in general, in Southern Colorado where we’ve activated conversations with Colorado Midwives Association, willingness to advocate the need for midwives in Southern Colorado. It’s been interesting to see the changes in the last few years, to say the least. And yes, we use the March of Dimes and other organizations to promote our messages.”

That’s wonderful, Rishell. It is critical even if we don’t agree on everything in our general midwifery world of subsets of midwifery to keep the conversations alive and respectful. That is how we’re going to advance midwifery for all pathways in our country.

Linda Cole shares, “Infant mortality and morbidity review groups.”

Absolutely, Linda. FEMA boards are in about half the states in our nation, they’re growing rapidly because of the maternal mortality bill is getting great traction at the national level. And that is absolutely advocating for femur boards in every state in our country, and those groups include diverse professionals as well as consumers.

From Heidi, “Shawnee Mission Medical Center.”

Great advice. Thanks, Heidi. We should know each other.

Lesley is saying, “Groups who oppose removing restrictions on midwives will feed into the differences between midwives. We cannot allow them to do this.”

It such a critical statement, Lesley. And a reason why being at every possible table is important. When I’ve been out on the circuit speaking, a lot of people hear me say, “If you’re not part of the conversation, you’re part of the problem.” That means all the conversations. Helping demystify and debunk myths is critically important.

Great conversations here, you guys. I would love to know any action steps some of you have been motivated or inspired to maybe try.

I did see Heidi say, “I will look up some of these meetings.” I think that’s a great first step.

Anything else people are willing or excited to share about your part in addressing and removing barriers?

While I wait for you guys to do some typing, I want to share a little bit about what Lesley and I will be doing going forward.

We are planning, at least for the next three months, to have a webinar every two weeks on topics we think are really important to growing midwives. Our next topic, Lesley will be leading on how to do an effective community assessment so that you know. You’ve done a lot of the homework we’ve been talking about today and can make that community assessment a tool that leverages what you want the message to be.

Linda is going to try to drive to Nashville for the state affiliate meetings.

Fantastic, Linda. Your wisdom and the history and all of the things that drive what happens is so important. Put somebody in the car with you on your way there.

We have to get our midwives more active in order for us to succeed in this effort.

Aome other things we’d like you to know about on our website, we will be having our wonderful team of marketing support transcribe this entire presentation. You’ll also have access to the recording and this checklist that we’ve talked about. It will be a tool that we would love for you to use and distribute.

Heidi says, “I think you really hit it on the head when you talked about being willing to listen and share ideas with OBs. I have advantage point of being a student right now, so I’m really working to gain trust and respect as an OB nurse and future midwife.”

Yeah, absolutely. A lot of my friends are obstetricians. And when I go get my checkups here a little more recently, I talk to my physician, Dr. Mcgee and kind of help him learn every time I go, why he needs to read this document like, “Did you know about this, Mike?” “I had no idea.”

Well, you know, they have to join ACOG to be a fellow in their organization, but that doesn’t mean they read the documents, the practice statements, the current evidence, the committee opinions, and that’s another reason why if you join ACOG, you have access to all of those materials by being a member. Sometimes they simply don’t know what their national association has said.

We also want to encourage you to share with your friends what we’re doing. This part of growing midwives is to provide a venue to talk, to share our information, to hear from you, and to motivate as much as we can, all of us the shared work that we need to do.

The last thing that I want to share with you is the March For Moms. If you haven’t heard about that group, Lesley and I both are on the board of the March For Moms. We have our second rally set for DC on May 6th of 2018. We just had a board meeting last night. We’re very excited to have a professional stage. We’re anticipating some top name celebrities coming and we’re working with improving  to have state and local community rallies on the same day as well as congressional lobbying and help briefing on the Monday following the rally. So, if you don’t know about the March For Moms, you can find us on the website which is actually being revamped right now and stay tuned for rest of the activities going on with that group.

Linda here has a plug for Frontier, “Incredible in helping us understand and compare position statements. Very eye-opening. Great conversation starter. Love the evidence.”

We’ll wait just a couple more minutes and see if there’s any other comments and then we’ll stop the recording and in behalf of Lesley and I, we appreciate you joining us and know that it takes all of us to do what we can to make a difference.

Lesley, any closing comments you want to type in? I’d love to let you do that.

“Midwives are trendy now, consumers are a great ally. When speaking to anyone about midwives, be prepared to share data from consumers.” Absolutely. Lisa, your website in Dakota is a perfect example of the power of consumerism, so we thank you for that and all of your groups too to help change maternity care in our country.



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