Midwifery and the Crowning of Health Care Reform

Abstract

In July 2009, the American College of Nurse-Midwives (ACNM) sent a letter to members of Congress opposing the federal recognition of certified professional midwives (CPMs) under the Social Security Act. The Social Security Act is the piece of legislation that provides for national health care coverage, such as Medicare and Medicaid, for elders, the socioeconomically disadvantaged, military personnel, and persons with disabilities. Although the Social Security Act was signed by President Roosevelt in 1935, certified nurse-midwives (CNMs) were not included in coverage by this act until 1988. Only in the past 10 years was the act expanded to include coverage for the full scope of care provided by CNMs and certified midwives (CMs). CNMs/CMs have struggled valiantly to create a recognized, fairly reimbursed, autonomous profession in the face of political and economic opposition from nurses and physicians. Part of their success in forging the CNM/ CM profession is attributable to the academic model they developed to train midwives. In the letter to members of Congress, ACNM contended that midwifery services provided by CPMs should not be covered under the Social Security Act because graduation from an accredited program is not a requirement for national CPM certification by the North American Registry of Midwives (NARM). To be eligible to sit for the NARM written examination, individuals may complete their education through an apprenticeship, a Midwifery Education Accreditation Council (MEAC)-accredited education program, or an ACNM Accreditation Commission for Midwifery Education (ACME)-accredited education program. If a midwife passes the NARM examination, no distinction is made in her CPM credential based upon her route of education. The concern ACNM expressed to Congress members is only with midwives who are not trained through an accredited program. However, it is difficult to substantiate ACNM’s concern because CPMs are not differentiated based upon educational route. While graduation from an accredited education program is the standard preparation for health care providers in the United States and other countries, the question remains: Is midwifery preparation through an accredited education program inherently better than midwifery preparation through an unaccredited apprenticeship process? Unfortunately, no data are available to answer this question.