Colorado Midwives Association statement on Unassisted Birth in the Community
Colorado’s registered midwives are currently in their sunset year, working hard to maintain the RM credential and access to homebirth midwives. One of the biggest assets to CPMs and CNMs, as well as our community, is our doulas. Doulas see the quality of care midwives provide to birth families. Doulas are a deeply valuable resource for the community.
Recently however, a few doulas have become vocal in their encouragement of unassisted birth and advertising of unassisted birth support. When doulas encourage and suggest birth families have an unassisted birth, they are putting that birthing person and baby at risk because they are not qualified to determine what is low risk. Risk assessment is providing medical advice, medical advice can be viewed as practicing medicine without a license.
Doulas work collaboratively with midwives and form professional relationships with midwives in the community. Doulas suggesting unassisted birth and seeking advice and information from midwives during their support at an unassisted birth, puts midwives across the state at risk of losing their licenses and credentials.
We stand with midwives in Colorado. Midwives exhaustively work to provide accessible homebirth care for our community. Talk with your midwives to find the right fit for you.
Unassisted childbirth, occasionally referred to as freebirth, is defined as “intentionally giving birth without a midwife or doctor present.” A very small portion of families who choose homebirth, choose to forgo the care of homebirth-based health care practitioner.
Midwife is defined as a medically trained provider who assists in childbirth. Midwives in Colorado are trained in one of two ways. The direct entry model, currently requires midwives to obtain their national credential through the North American Registry of Midwives, certifying as a professional midwife (CPM) allowed them to license with the state as Registered Midwife. The nurse midwifery model, allows nurses to complete an advance practice degree and earn their Certified Nurse Midwife credential. Both paths require continuing education, certification, and both types of midwives may attend homebirths in Colorado.
Doula is defined as a trained companion, who is not a healthcare professional, who supports families through their birth experience.
The Colorado Midwives Association believes in the Midwives Model of Care as defined by the Midwifery Task Force via Citizens for Midwifery. https://www.citizensformidwifery.org/mmoc
“The Midwives Model of Care includes:
Monitoring the physical, psychological, and social well-being of the birthing person throughout the childbearing cycle
Providing the birthing person with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
Minimizing technological interventions
Identifying and referring women who require obstetrical attention
The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section.”
We believe homebirth is safest when attended by skilled out of hospital healthcare providers. More information can be found in the following links:
Today we have made a public statement in response to being called out on our missing the mark once again.
On behalf of the Board of the Colorado Midwives Association we know we missed the mark with connecting with the community of color in Colorado, and have broken trust. We acknowledge that our white privilege has allowed us to drag our feet for decades.
Demetra Seriki and China Tolliver, thank you for holding us accountable. Your love, passion, and dedication to the community is unparrelled and we will all aim to be as dedicated and committed. We apologize for not acting with accountability thus far.
We also want to apologize for the boards’ actions that harmed you in the past, as well as present. The CMA board commits to defer to our black midwives and birth workers in how to support our community of color.
I know these just feel like words but we assure you that they are backed by sincerity and commitment to changing birth in Colorado.
We are not coming forward with this statement to protect the CMA. We are not worried with how we look but rather worried about the community and the POC we have hurt and let down. We are worried about the disparities and what we can do as an organization to represent the midwives of Colorado, especially the midwives of color.
We screwed up, we hurt people, and we know that is not acceptable!
As a board, we are committed to learning and taking steps to change the flawed structures within the CMA to ensure we are an anti-racist organization. We are looking forward to work as allies with our communities of color. We know we will likely make mistakes and we’re looking to our allies for continued feedback and accountability to remain an anti-racist organization. We need to support our black midwives, students, and birth workers of color.
As an organization and as the current president, we are done with dragging our feet, we are done not being accountable. We will no longer perpetuate racism within our organization. We’re excited for upcoming changes to our website and organization and hope they show our investment in our community.
We humbly apologize.
Black Lives Matters, BIPOC mothers and babies Matter! Birth Workers of Color Matter.
Our hearts are heavy witnessing Black and Indigenous/People of Color (herein known as BIPOC) fighting for their lives. Witnessing the death of George Floyd has rocked the country. It’s important for the nation to remember him, and all those who have died at the hands of racial injustice, such as Sandra Bland, Philando Castile, Tamir Rice, Emmitt Till, Korryn Gaines, Alton Sterling, Breonna Taylor, David McAtee, and so many more. There have been centuries of trauma and devastating loss that needs to stop.
It is not just systemic injustice that takes the lives of BIPOC. Their lives are on the line from the moment they’re born and it is unacceptable. As birth workers, we often feel helpless, despite our empathy and compassion because we struggle with how to help. Black women are four times more likely to die in childbirth in comparison to their white counterparts. Black babies are twice as likely to die during their first year of life compared to their white counterparts. These disparities are significantly reduced with the access and care of midwives. Most importantly, access to midwives of color.
On behalf of the Colorado Midwives Association, we cannot remain silent for our BIPOC families and community members. Our minimal funds raised are primarily dedicated to legislative efforts, keeping midwifery legal as well as our laws current to meet the needs of birthing families in Colorado. This is the passion and purpose of the CMA. However, we can do more. We must do more.
The CMA will be donating throughout the year to BIPOC centered organizations, with a focus on organizations that support the development and education of student midwives of color. At this time we are donating @projectmotherpath (venmo), owned by Rebecca Polston at Roots Community Birth Center in Minneapolis. They have been directly impacted by the tensions between protests and law enforcement. Please consider donating as well.
Melissa Sexton, CPM, RM, President of the Colorado Midwives Association
I want to thank all of the Colorado Midwives who attended the last CMA meeting on November 19, 2018 who voted me in as President for this two-year term. It is an exciting time to be working as your president. I will strive to help the CMA grow, continue advocacy for midwifery care, homebirth, and safety, as well as continuing education and communication for CMA members. Thank you for all your patience over the last few months. Every board position has been filled with new and hard-working volunteer midwives, including some of the midwives’ students. I look forward to bringing enthusiasm to the new board members and midwives and keep an energizing atmosphere. We hold open board meetings monthly on the 4thWednesday of the month. The meetings are currently being held at 3760 Vance St. Suite 200B, Wheat Ridge, CO 80004.
We are working on 2 conferences this year. The first conference will be this spring in April 12 and 13that the Douglas County Library in Castle Rock. So save the date! Speakers are to be announced.
This year, 2019, starts pre sunset talks and legislative work. Sunset is set for 2021. Get ready to raise awareness for homebirth midwifery.
Also I would like to say congratulations to all the newly registered midwives.
Midwives from August 2018 – February 2019
Heidi Hennigan, CPM, RM 8/21/18 Aurora, CO
Astrid Grove CPM, RM 12/6/18 Longmont, CO
Tiffany Miller, CPM, RM 12/21/18 Colorado Springs, CO
Namonie Donahue CPM, RM 12/24/18 Del Norte, CO
Victoria Engelhard CPM, RM 12/24/18 Frederick, CO
Felicia Chavando CPM, RM 1/28/19 Longmont, CO
Julia Amend, CPM, RM, BSN, RN 2/8/19 Englewood, CO
I would like to also introduce to you our new active board
Melissa Sexton CPM, RM, President
Jennifer Barr, CPM, RM, Vice President
Kattie Jones CPM, RM, Treasurer
Natalie Baca CPM, RM, Secretary
Julia Amend CPM, RM, BSN, RN, Conference Committee Chair
Jennifer Dossett RM, Membership
Samantha Venn, Student Midwife to Melissa Sexton, Website and Social Media Chair
Althea Hrdlichka, CPM, RM, Member at Large, Newsletter Chair
Jan Lapetino CPM, RM, Member at Large, Legislative Advisor
Thank you to everyone for their support in keeping midwifery legal in Colorado, and I look forward to my term as your president.
All regulatory professions are reviewed periodically by the legislature. The Direct-Entry Midwives Practice Act will be reviewed by the Colorado state legislature in 2016. The Department of Regulatory Agencies (DORA) Office of Policy, Research and Regulatory Reform presents a report to the legislature summarizing the history of the program including previous sunset review recommendations and changes to the law. Recommendations for the 2016 review are also made. This report will be written this summer and presented to the legislature in the fall. All interested parties are interviewed for this report.
Registered Midwives from many parts of the state met on Saturday, February 28th to discuss the upcoming sunset review of our law in 2016. The meeting was held to see what midwives want addressed during the review of our program. A list of our top priorities was determined from contacting all of the Registered Midwives in Colorado. The CMA has submitted this list to the policy analyst.
As the end of 2015 approaches, we will begin preparing for the legislative session with the help of a lobbyist. As the organization that pushed for legalization of direct-entry midwives 23 years ago and lobbied to keep the statute updated, the CMA will need the help of all supporters of direct-entry midwives during the next legislative session. Please consider a monetary donation by clicking on our Donate link.
Article 12-37-105(12) of the Colorado Revised Statutes requires Colorado Registered Midwives to report, at the time of renewal, the following information:
• The number of women to whom care was provided
• The number of deliveries performed
• The Apgar scores of delivered infants
• The number of prenatal transfers
• The number of transfers during labor, delivery and immediately following birth
• Any perinatal deaths (and beginning in 2011, the cause of death and a brief description of the circumstances)
The Colorado Department of Regulatory Agencies (DORA) Office of Direct-Entry Midwifery Registration collects this information via a survey administered each year to midwives seeking renewal. Through 2005, Midwives Registration reported 3 or fewer perinatal deaths associated with homebirth per year. In 2006, the survey reported 5 perinatal deaths; in 2007 it reported 5; in 2008 it reported 7; and in 2009 it reported 9. Over the last 6 years, Colorado has averaged between 40 and 60 Direct-Entry Midwives attending between 500 and 700 homebirths per year.
Much about the numbers collected by DORA over the years is unreliable. The surveys did not ask when in the pregnancy, birth or postpartum the demise took place. The term “perinatal” was not defined. The survey didn’t ask where the actual birth took place, who was managing the birth, or the reason for the demise. Because the information collected by DORA has never been refined to be used as statistical data, statistical inferences cannot be made from it.
Indeed, the Midwives Sunset Review written in 2000 recommended the Colorado General Assembly should eliminate the reporting requirements contained in §12-37-105(12), C.R.S. That review noted “the data collected by theprogram on renewal notices has been found to be inaccurate, and not useful in analyzing theprogram” and concluded, “the usefulness of the information is questionable.”
For the 2009 renewal period, Colorado Registered Midwives gave care to 936 women and attended 637 homebirths. They reported 9 perinatal demises for that year. The Colorado Midwives Association collected brief stories about the situations surrounding the demises and they are summarized below:
Premature Births: Two babies were born premature; one stillborn a week after transfer of care to a physician due to maternal hypertension, and the other died at 24 weeks in the hospital after preterm labor.
Serious Anomaly Deaths at Term: Three babies had serious anomalies incompatible with life. One died in-utero at 32 weeks and was stillborn at the hospital. Two were born in hospital weeks after transfer of care following discovery of the anomalies during routine ultrasound.
Other Deaths at Term: Three babies developed nonreassuring heart tones during labor and all were transferred to hospital. Two died before birth; pathology noted an infection in the placenta of one of those babies. One died within hours after birth with an enlarged heart noted on the autopsy.
The final baby was born precipitously at home in a rural part of the state before the midwife arrived, although she was in contact with the parents during the birth. The baby wasn’t doing well, an ambulance was called and arrived but the baby could not be resuscitated and the parents requested no autopsy be performed.
In summary, setting aside the babies that had malformations incompatible with life or were born prematurely (since Colorado statute rules out premature babies for home birth) the non-malformation deaths at term comprised:
One stillbirth with infection present but no autopsy was done.
One stillbirth with no identified cause and autopsy refused.
One neonatal death where autopsy revealed an enlarged heart.
One neonatal death after precipitous birth, with no identified cause but no autopsy.
Based on the information provided, these data suggest that planning a home birth can be ruled out as a causative factor in the death in all but one stillbirth during labor, although even with this one it is not clear whether intervention such as a Cesarean section would have saved the baby, a fact which the refused autopsy may or may not have revealed. The baby born with an infection in the placenta did not receive intervention that changed the outcome even though born in hospital. The baby with the enlarged heart was also born in hospital and this apparent cause of death was not able to be treated there. The neonatal death without explanation (also with autopsy refused) was precipitous and occurred in a rural area; this baby would have likely been born out of hospital, and suffered the same fate even if a hospital birth had been planned.
Based on numerous studies already published comparing home and hospital births, it’s clear that two deaths in 600 or 700 births are not outside expected outcomes for planned homebirth of healthy low-risk women and babies attended by trained direct-entry midwives.
The mission of the Colorado Midwives Association is to support and promote the option of homebirth for childbearing families in the state of Colorado. The Colorado Midwives Association declares and affirms that homebirth continues to be a safe and viable choice for women with healthy, low-risk pregnancies when attended by a Colorado Registered Midwife.