Dear Ms. True:

Thank you for publishing two articles on midwifery care. The front-page story, by Tiffany McClain, in the September 19 issue [“An Illegitimate Birth”] featured an unlicensed, direct-entry midwife. Another article, by Ben Joravsky [“Midwife Crisis”], addressed the proposed closing of the University of Chicago’s hospital-based nurse-midwifery program.

While McClain’s and Joravsky’s articles are unrelated, there is a central theme, i.e., the barriers women in Illinois face when searching for excellent maternity care. As Tiffany McClain reported, the benefits of midwifery care are recognized and endorsed by the American Public Health Association and the World Health Organization, yet families in Illinois find it increasingly more difficult to find such care. Recently our community has learned of another closing. Illinois Masonic hospital has announced the closing of its hospital-based alternative birthing center after 25 years of service.

Preserving and promoting the Midwives Model of Care is a complex public health issue requiring innovative solutions. The position of Dr. Arthur Haney, chairman, obstetrics and gynecology, University of Chicago, that current hospital economics render midwifery care “financially untenable” has been expressed by hospitals across the country. Similar explanations were announced with recent closings of hospital-based midwifery programs in New York, Georgia, Texas, California, Iowa, and Florida.

In addition to the demise of hospital-based midwifery programs, the law further limits access to the Midwives Model of Care. Illinois law effectively prohibits the existence of freestanding birth centers, and Illinois law does not recognize the certified professional midwife (CPM) credential or the certified midwife (CM) credential. The North American Registry of Midwives administers the CPM credential. The CM credential is administered by the American College of Nurse-Midwives. Both are nationally certified credentials for direct-entry midwives. For decades, Illinois consumer activists unsuccessfully have lobbied for legislative change that would enable direct-entry midwives to practice. Even with the support of prominent national and international public health organizations, the voices of the consumers have been ineffective against opposition from the Illinois State Medical Society.

The solution requires a public-private-consumer partnership dedicated to an evidence-based standard for maternal health practices. Public health and midwifery advocates must work together to assure access to all nationally certified midwives and to replace economic-based health care policy with evidence-based health care policy that puts the health and well-being of women and babies ahead of profits.

Michelle Breen, MHS

Executive director

Chicago Community Midwives