A Talk with Mary Lawlor, Midwife Policy Advocate

We sat down with Mary Lawlor to talk about how midwifery improves maternal healthcare and how policy determines which midwives get paid.
Mary Lawlor is a Certified Professional Midwife, owner of the Monadnock Birth Center in Vermont and Executive Director of the National Association of Certified Professional Midwives.

EMC: Mary, most people are familiar with Certified Nurse Midwives (CNM) who predominantly practice in hospitals, although some provide services in birth centers and at home. Tell us what a Certified Professional Midwife (CPM) does.

Mary: I like to describe it that Certified Nurse Midwifery grew out of public health nursing. Certified Professional Midwifery grew out of the consumer movement to reclaim natural birth in the 60s and 70s. Consumers rose up and said, “You can’t forcibly drug us, tie us to the table, or separate us from our babies anymore.” A group of these women decided to stay home to have their babies, and out of that group grew the first credentialed direct entry midwives in the U.S. CPMs study midwifery directly rather than studying it through a nursing program. They’re qualified to practice in all settings, but have special training for birth center and home births.

EMC: How many CPMs are practicing in the U.S. today?

Mary: Almost 3000 credentials have been issued since the first CPM was awarded in 1994. We’re licensed in 27 states and working on more. Currently, we’re Medicaid providers in 12 states, but there’s no federal mandate for Medicaid reimbursement for CPMs. CNMs, on the other hand, have been federally mandated Medicaid providers since the 1980s. That means they face fewer hurdles than CPMs do in terms of where they can practice and how they can bill for services.

EMC: What is the NACPM doing about that?

Mary: We’ve been working on securing federally mandated Medicaid reimbursement for CPMs since 2009, which would mean that CPMs would be reimbursed by Medicaid in all states where they are licensed. We tried to have this provision included in the Affordable Care Act, but we were new to Federal advocacy. Senator Cantwell gave us a ‘partial victory’ by including a mandate for Medicaid reimbursement for state licensed providers offering services in licensed birth centers. Now we’ve gone back to the drawing board for an amendment that would apply to all licensed CPMs regardless of setting.

EMC: What would be the value to women if CPMs could practice legally in all 50 states?

Mary: If CPMs could practice and bill insurance for their highly skilled, highly credentialed service to women, that would dramatically open up women’s access to high quality care at significantly lower costs. Just look at the work Jennie Joseph is doing in Florida and you recognize how great the need is all over the country. CPMs have demonstrated that when women have access to our care, quality goes up and costs go down. Studies performed in Washington State over a two-hear period of time looked at the impact of just 2% of births that were done by CPMs. They discovered that their care saved the healthcare system half a million dollars in prevention of C-sections alone and 3.1 million dollars in healthcare expenses overall. That’s an excellent example of how our current medical system fails women. We over-use medical interventions and under-use healthy interventions like the kind midwives commonly use that result in significant harm reduction.

EMC: Similar data from the Birth Center Study was published a couple of years ago.

Mary: Right. It showed that when you take the same population of healthy women, their C-section rate in a birth center is 6%. In a hospital, it’s at least 28%. What’s the difference? Midwives.

EMC: Will the NACPMs advocacy increase midwifery access?

Mary: That’s our goal. We’ve put a lot of energy and fundraising into our priorities, which are both to serve women in their childbearing years and to influence policy so that women have greater access to the midwifery care they deserve. We’re collaborating with CNMs, to overcome longstanding historical differences and strengthen midwifery as a profession. We have renewed our efforts this year to amend the Social Security Act to provide for Medicaid reimbursement for CPMs. That would open up opportunities for greater midwifery access, for more women of color to become midwives and for healthcare provider payment provisions that would benefit both CPMs and CNMs.

EMC: Ultimately, like all midwives we know, you’re working for the benefit of the mamas.

Mary: We feel a responsibility to all childbearing women and we know that the greater access all mothers have to the right kind of healthcare, the better it is for everyone.

Thanks Mary. Click the link to learn more about CPMs and the National Association of Certified Professional Midwives.