Current Maternity Care Legislation Supports the Principles of the Mother-Friendly Childbirth Initiative

 This month at Blossom Birth we are highlighting Mother Friendly Childbirth Initiative (developed by the Coalition for Improving Maternity Services (CIMS),  an evidence-based, wellness model of maternity care that is a comprehensive response to birth advocates' analysis of the serious gaps in maternity care services of the time. The information below is taken from the latest CIMS e-newsletter- it is a comprehensive summary of the current and upcoming key health care legislation, a great way for us to follow the progress of these very important bills and encourage our Senators and House Representatives to support them. After more than a decade birth advocates are finally seeing maternity care legislation that promises to address the health needs of mothers and infants.

Started in July 1996,  31 individuals and 26 organizations representing over 90,000 members ratified the Mother-Friendly Childbirth Initiative (MFCI).  The MFCI outlined several areas that still need improvement today: higher perinatal morbidity and mortality and a higher maternal mortality rate than many other industrialized countries; disparities in access to care and health outcomes; high rates of cesareans and inductions of labor; lack of access to midwifery care; the routine use of non-evidence based birth practices which expose mothers and newborns to avoidable harms; increased use of technology which undermined womens confidence in their innate ability to give birth; lack of support for breastfeeding and birth practices that met providers needs rather than womens needs.

Current health care law and forthcoming legislation is now addressing the very issues highlighted for change in the MFCI. CIMS is proud that many of our organization members are actively involved in developing and promoting pending maternity care legislation. They include AABC, ACNM, Birth Matters Virginia, Childbirth Connection, Citizens for Midwifery, AWHONN, MANA, NACPM, NARM and The Tatia Oden French Memorial Foundation. 

Patient Protection and Affordable Care Act (HR 3590) On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act into law. This bill includes major provisions to increase women's access to healthcare insurance, evidence-based care and maternity care providers of their choice. The far-reaching bill eliminates health insurance practices that discriminate against women and recognizes the importance of focusing specifically on women's health needs by creating and funding federal offices of women's health. In addition, the bill does away with several Medicaid and Medicare reimbursement inequalities against midwives and birth centers across the country. Included in H.R. 3590 are these key provisions: Women will have direct access to the obstetrician/gynecologist, certified nurse midwife or certified midwife of their choice;  Women will have access to insurance coverage before, during and between pregnancies; Women will no longer be denied health coverage due to pre-existing conditions such as being pregnant, having had a cesarean section, or being a victim of domestic violence; Low-income women and their children can now benefit from prenatal and postpartum nurse home visits; Employers with over 50 hourly-wage employees now have to provide nursing mothers the opportunity to take unpaid breaks to pump breast milk in an appropriate and private place on location; Women will be covered for a range of preventive services including screening for diabetes and heart disease as well as mammograms;  Freestanding birth centers in all 50 states will be reimbursed for providing care to women covered by Medicaid; All licensed caregivers who provide services in licensed birth centers for women with Medicaid will be reimbursed; As of January 1, 2011, the Medicare Part B reimbursement rate for Certified Nurse Midwives increased from 65% to 100% of the fee schedule.  Funds will be made available to cover screening, education, treatment and support for postpartum depression; To ensure that women's particular health needs are addressed in all Federal health initiatives Women's Health Offices will be created in five Federal agencies: the Agency for Healthcare Research and Quality, the Health Resources and Services Administration, the Centers for Disease Control and Prevention, and the Food and Drug Administration.  For a summary of the bill see OpenCongress.          For a comprehensive assessment of the impact of this bill read U.S. Health Care Reform Legislation Offers Major New Benefits to Childbearing Women and Newborns by Carol Sakala, PhD, MSPH on Childbirth Connections new website, Transforming Maternity Care.  Partnering to Improve Maternity Care Quality Act of 2010 (HR 6437)  This bill, introduced by Representative Eliot Engel (D-NY) in November of 2010 is being amended and has not yet been reintroduced in the 2011 session of Congress. This legislation is designed to promote optimal maternity outcomes by making evidence-based maternity care a national priority.  If passed it would:  Ensure the development of national, evidence-based quality measures for maternity care in Medicaid, as well as a process to collect this data; Create and implement a national patient survey of women to assess their experience of maternal care Establish a demonstration project to develop effective alternative payment models aimed at simultaneously improving health outcomes and reducing costs; Authorize an Institute of Medicine report to identify a package of essential evidence-based services for childbearing women and newborns.  This bill includes many key provisions recommended in two Childbirth Connection reports: Evidence-Based Maternity Care: What It Is and What It Can Achieve  andBlueprint for Action: Steps Toward a High-Quality, High-Value Maternity Care System.   Follow the progress of this bill on OpenCongress.         MOMS for the 21st Century Act (H.R. 5807)  Introduced by Congresswoman Lucille Roybal-Allard, the Maximizing Optimal Maternity Services for the 21st Century Act places a national focus on evidence-based maternity care practices to help achieve the best possible maternity outcomes for mothers and babies.  This bill would:  Expand federal research on best maternity care practices; Authorize a public awareness media campaign to educate the public about the best proven maternity care practices; Pinpoint areas with shortages of maternity care providers and create incentives for providers to fill those gaps; Improve the maternity care workforce by developing interdisciplinary core curriculum for training and increasing workforce diversity.  Follow this bill on OpenCongress. For additional information see Amnesty International,Deadly Delivery: The Maternal Health Care Crisis in the U.S.A.: One Year Update  Maternity Care Improvement Act of 2010 (H.R.6318) Representative Lois Capps (D-CA) introduced this bill. If passed it would:  Increase government accountability and coordination of efforts related to maternal health by designating a national coordinator of programs related to maternal health; Create a national registry of maternal and infant health data, and ensure that data is collected in a way that is standardized and disaggregated by race; Improve the maternity care workforce by enhancing education and training for nurses, creating an interdisciplinary maternity care core curriculum to promote best practices in evidence based, woman-centered, culturally competent, collaborative care that will prevent complications and reduce disparities; Improve the diversity of the maternity care workforce by awarding grants to increase recruitment of underrepresented minorities into the maternity care workforce.  For additional information see Amnesty International, Deadly Delivery: The Maternal Health Care Crisis in the U.S.A.: One Year Update  Maternal Health Accountability Act of 2011 (H.R.894)  This legislation was introduced by Representative John Conyers (D-MI) on March 11, 2011 and referred to a subcommittee on health on March 11.  If passed the bill would:  Provide funds for States to establish Maternal Mortality Review Committees, to collect data on pregnancy-related and pregnancy-associated deaths; Identify ways to lower maternal mortality rates Require that states reduce or eliminate disparities in maternal health outcomes; Health professionals and facilities would be required to report pregnancy-related deaths; A national definition of severe maternal complications would be developed; Each maternal death would be investigated All findings and recommendations would be disseminated. Follow this bill on OpenCongress. You can also join MomsRising in writing to Congress in support of the Maternal Health Accountability Act.  For additional information stream Childbirth Connection's Webinar, Disparities in Maternity Care   Access to Certified Professional Midwives Act of 2011 (H.R. 1054) Introduced on March 10, 2011 by Representative Chellie Pingree (D-MN), the bill provides access and reimbursement to certified professional midwives (CPMs) for services provided to women enrolled in the Medicaid program. Congressman Rodney Alexander (R-LA) will be the first Republican to cosponsor this important Medicaid payment legislation. This bill adds the services provided by Certified Professional Midwives as a new category of mandated health service under the federal-state Medicaid program. If passed, it would: Require all states that license, register, or legally authorize CPM practice to make CPM services available to all pregnant women who receive Medicaid; Add the services of a Certified Professional Midwife as a new category to the existing categories of providers (such as hospitals, nurse practitioners, certified nurse midwives and birth centers) eligible for Medicaid payment. Only CPMs who practice in a state where their services are "legally authorized by State law" would be eligible for Medicaid payment. Licensed or registered direct-entry midwives who are not CPMs would not be eligible. Follow this bill on OpenCongress. The PREEMIE Act of 2006  The PREEMIE Act was signed into law on December 22, 2006 and will expire at the end of 2011. It is designed to reauthorize P.L. 109-450 and expand research, education and intervention activities related to reducing preterm birth - the number one killer of newborns. If reintroduced in 2011 and passed the specific provisions of the bill would: Expand and coordinate federal research related to preterm labor and delivery, and the care and treatment of preterm infants; Require the development of a Preterm Birth Research, Education and Intervention Programs Action Plan for the Department of Health and Human Services; Authorize demonstration projects to test promising preterm birth prevention and treatment interventions; Establish a National Educational Media Campaign to promote healthy pregnancies and help prevent preterm birth. The Senate champion of the PREEMIE Act is Lamar Alexander (R-TN) and the House champion is Anna Eshoo (D-CA). Take Action Take action to help pass the legislation that you support. Contact your senator and your congressman or congresswoman in the House of Representatives to encourage them to pass these important bills.