Widening the Impact of CPMs and the Midwives Model of Care™
by Peggy Garland, CNM, MPH
Director of Administrative Section, MANA Division of Research
The CPM credential is a competency-based midwifery certification, designed to demonstrate that the bearer has the skills and knowledge for safe practice. Beyond the initial certification, CPM practice is enhanced through increased experience and continuing education.
Many midwives have a role in the community beyond the scope of care to our clients. Many teach childbirth classes, health education classes in schools or normal childbirth to EMTs. They participate in the community’s emergency preparedness systems, offer doula services for women planning hospital births, offer presentations on birth options to the public, and guest lecture in women’s studies classes at local colleges. These represent a rich palette of ways a midwife can use her experience and her credential to impact a wider audience than her own clients, if she chooses.
But as midwives, can we imagine even more? What if we want to conduct research? What if we want to take leadership in our local or state public health department? Influence legislation and regulation at the state and national level? Have an impact on national health policy? Reduce maternal mortality? Lower health care costs? What tools could a midwife acquire that would facilitate this level of activism?
Some midwives have found avenues to move in these areas, especially if they come from a background of community activism. Some midwives come to their CPM training with graduate degrees in education, public health or public policy or other social sciences, and have already accumulated the knowledge to participate in these activities. But most of us haven’t come from these backgrounds. What does graduate education have to offer the CPM and what sort of program would provide the best addition to her midwifery practice skills?
The tools learned in graduate study in any discipline are the tools of research: theory, data collection and analysis. The goal of research (in any discipline) is to dispute or refine generally accepted knowledge about a subject-- a body of ideas about how things work. Each discipline is organized around sets of facts and related concepts that focus and define the knowledge base. These facts and concepts are always changing, refined by the efforts of researchers who seek to bring the discipline ever more in line with the underlying truth. That truth itself is frequently dynamic and not fixed. I want to emphasize that graduate study is NOT about accepting a body of knowledge, accepting the status quo, but about critically evaluating it.
Yes, graduate study tends to require becoming at least minimally comfortable with statistics. The techniques of analysis appropriate to the subject – qualitative or quantitative- will be core content.
In my opinion, the ideal graduate discipline for midwifery is public health – the study of health in populations. It allows the midwife, coming from her unique perspective, to analyze whole populations of women and families, how their needs are being met or not met, how to understand maternal and child trends over time, how to distinguish differences in different populations, how the health care systems affects health processes and outcomes, how to design programs to meet identified needs, and how to influence policy to maximize healthy outcomes.
Midwives have made important inroads into the public health world and have become mainstays in the branch of public health called Maternal and Child Health. Our natural sensibility favors using appropriate resources to maximize the health of the most women and families – this is public health at its best. While nurse-midwives have led this move into public health, there is still a lot of room, indeed a need, for more midwives in public health. CPMs can fill that need.
Imagine CPMs as epidemiologists, clinical researchers, health care finance experts. Envision midwives sitting on Boards of Health or in a position of decision-making at a state or federal agency dealing with maternal child health. Imagine CPMs designing and obtaining funding for programs for rural or inner city women, for women trying to maintain traditional practices, programs designed to preserve normal birth. Using public health tools, you can find solutions to the problems you see around you in your communities, in the country, or even in other lands.
Public health schools are widespread. They are frequently located in public institutions. They often cater to working professionals. And there is scholarship and loan support available. I encourage any CPM who is considering graduate work to consider public health. Make a major contribution both to midwifery and the health of families here and around the world!