Posted by on November 6, 2012 - 11:23am

While the country struggles to provide affordable, quality health care to all Americans, a primary focus has been on women and children. However, one group of care providers is rarely discussed by health policymakers despite their significant contributions to health care: Midwives.

Certified nurse-midwives (CNMs) and certified midwives (CMs) provide high quality primary and maternity care to women and families. CNMs are recognized under federal law as primary care providers for women. They provide family planning services, gynecology services, primary care, childbirth and postpartum care, care of children for the first 28 days of life, and treatment of male partners for sexually transmitted infections. Midwives also use their credentials to prescribe medication, admit, manage and discharge patients, and interpret laboratory and diagnostic tests. These skills allow midwives to offset many of the primary and maternal care functions of MDs, and do so with lower costs.

The Institute of Medicine published in its report The Future of Nursing that critical workforce shortages are being seen across all health care systems, especially in primary and maternity care. There is a vast amount of literature that suggests CNM and CM professionals provide a high-value, cost-effective, patient-centered form of care in exactly those arenas. As 2014 and greater implementation of the Affordable Care Act nears, access to midwives is ever increasing, with the Affordable Care Act granting midwives 100% reimbursement under Medicare Part B. Further, new nondiscrimination requirements have been employed to ensure that individual and group health insurance plans must cover these services for women.

Nevertheless, many stakeholders including clinicians and policymakers are unaware of or fail to discuss the significant role midwives will play in health reform. Nor are they adequately addressing how barriers to their practicing medicine continue to play out in the medical world. It’s about time we make sure all women’s preventative and maternal services are given full attention and made effective.

Posted by on June 4, 2011 - 10:58am

Vermont Gov. Peter Shumlin recently signed into law legislation requiring health care insurance policies to cover midwifery services and home births. Supporters of the law said this law is critical in improving access to comprehensive health services for women, reducing system costs and strengthening the quality of care that mothers receive during pregnancy and childbirth.

“Access to midwifery care and home birth should not be limited only to those who can afford those services out of pocket,” Gov. Shumlin said. “This law will ensure that all expectant mothers get the coverage and care they want and deserve.”  The Governor also noted that the change will help hold down health care expenses.  Advocates, including the Vermont Public Interest Research Group, said that because pregnancy is not an illness and 84 percent of births are low-risk, there is no reason to restrict coverage to hospitalization for low-risk labor and delivery.

Midwifery services for home births are currently covered by Medicaid and the Vermont Health Access Plan. New Hampshire and New York also have similar laws on the books.  In some states, the main objector to midwifery and home births is often the state medical society.  While safety is certainly a primary concern, home births using a midwife are generally less expensive and avoid large hospital costs, questioning the real rationale for fighting home births in low risk women. Any thoughts?