Pew Recommendations for
THE FUTURE OF MIDWIFERY
1.
Midwives should be recognized as independent and collaborative
practitioners with the rights and responsibilities regarding scope of practice
authority and accountability that all independent professionals share.
2.
Every health care system should integrate midwifery
services into the continuum of care for women by contracting with or employing
midwives and informing women of their options.
3.
When integrating midwifery services, health care
organizations should use productivity standards based on the midwifery model of
care and measure the overall financial benefits of such care.
4.
Midwives and physicians should ensure that their
systems of consultation, collaboration and referral provide integrated and
uninterrupted care to women. This
requires active engagement and participation by members of both professions.
5.
State legislatures should enact laws that base
entry-to-practice standards on successful completion of accredited education
programs, or the equivalent, and national certification; do not require
midwives to be directed or supervised by other health care professionals; and
allow midwives to own or co-own health care practices.
6.
Hospitals, health systems, and public programs,
including Medicare and Medicaid, should ensure that enrollees have access to
midwives and the midwifery model of care by eliminating barriers to access and
inequitable reimbursement rates that discriminate against midwives.
7.
Health care systems should develop hospital privileging
and credentialing mechanisms for midwives that are consistent with the
profession’s standards, recognize midwifery as distinct from other health care
professions, and recognize established processes that permit midwives to build
upon their entry-level competencies within their statutory scope of practice.
8.
Education programs should provide opportunities for
interprofessional education and training experiences and allow for multiple
points at which midwifery education can be entered. This requires proactive intra- and
interprofessional cooperation between colleges, universities and education
programs to develop affiliations and complementary curriculum pathways.
9.
Midwifery education programs should include training in
practice management and the impact of health care policy and financing on
midwifery practice, with special attention to managed care.
10. The
profession should recognize and acknowledge the benefits of teaching the
midwifery model of care in a variety of education programs and affirm the value
of competency-based education in all midwifery programs.
11.
The midwifery profession should identify, develop and implement
mechanisms to recruit student populations that more closely reflect the
12. Midwifery research should be
strengthened and funded in the following areas:
§
Demand for maternity care, demand for midwifery care, and numbers and
distribution of midwives;
§
Analyses of how midwives complement and broaden the
woman’s choice of provider, setting, and model of care;
§
Cost benefit, cost-effectiveness, and cost utility
analyses, including the relationship between knowledge of economic/cost
analyses and provider practices;
§
Midwifery practice and benchmarking data (among
midwives) with a goal of developing appropriate productivity standards;
§
Descriptions and outcome analyses of midwifery methods
and processes;
§ Analysis of midwifery practice outcomes, from pre-conception through infancy, using an evidence-based perspective;
§ Normal pregnancy, normal labor and birth, healthy parent-infant relationships, and breastfeeding; and
§ Satisfaction with maternity and midwifery care.
13. Federal and
state agencies should broaden systematic data collection, which has
traditionally focused on medicine and physicians, to include midwifery and
midwives.
14. A research
and policy body, such as the
§
Workforce supply and demand;
§ Coordination of regulation by the states;
§ Funding of research, education and training; and
§ Coordination among the federal agencies whose policies affect the practice of midwifery.
Taken
from: Joint Report of the Pew Health
Professions Commissions and the