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All the news that's fit to print The ACNM sets the record straight
ALLm~?HA-rsFlTTo~ The ACNM Sets the Record Shaight
As the pro&ion of nufze-midwifery looks toward the 21st century, ow growth seems limitIfs arid ow cornmitment to women’s health care boundless Yet, on octasion. we are forced to pause, refl& and respond when the very essence of our vocation is brought unjust& into question; unfor&unately, we are in the midst of just such a crisis. A series of aticles published in March 1995 by The NW York 7lmes (1) maligns midwifery as a major contributor to New York City’s poor perinatai outcomes, when, in facf it is the city’s overburdened public health rare system that should bear the respotnibiify. fts exceajve maternal and infant mortality and morbidity raw de+y modem techndcgy while its entire spkm of medid education and practice is being redelined to fit curlEnt market forces Yet, The Tim ties insinuates that the city’s vast health care problems Ii-e morewitbthemidurivgthantithe system.Howironicitisthatonly2 years ago, The New Yorlc Times fea+ turedanarlklewGttenbyitss&nce editor. Jane Brady, chroni&ng the midwife-led * revolution in quality oldebic care ’ (Z)! Euenthemostarrsoryreviewof dW?1995NeWY~Gl@Setid
atlicks reveals serious tlaws in the methodology of the research employed by 77t.e Trmes’ investigators. Published in a format that lacks scieni& evidence of validity and I&ability, thii study does not give the reader enough information to analyze its finding objectively; mthe-r, its tabloid tactics allow one to question if the unsubstantiatefl conclusions are truly fif to print SuspUon about the motives be. hind this publication is raised when requests to receive copies of the btudy’s methodological design and data set are repeatedly denied A call for independent review is particularly appropriate in light of a 1981 Journal of Num+Midt+y IJNM) report (3) on more than 2,600 b&s at North Cenbal Bronx Hos@al (NCB), the my same institution that The Times chcxetovihfy.TheJNb4reportre~ vealeda.nov43aI!@natalmo&ty l2betiUCISfWtOnlylOWWthi3llttbe
nationaiavemgeatthatt4me,butalso bwerthanthemleforalloulerpublic haspitakcombinedaswellasforthe entire city of New Ymk during the studyperiad;ofsp&dn.otei.sthe facttlxlt83%ofthesebiKtl?s,highriskandlow-tiskatiku.we7eattended by oatified nurse-midwhxs (CNMS) andwithenwable~
Failwe of The 77~1~s to put&h a fair sampling of Ihe large volume of mail it received from phytjciapss, scientists, national foundations, consiinia and advocqg groups, and other concerned tzitbms in support of nurse-midwifery practice does not speak well of its abii b provide objective reporting. Instead, The TIW chose to print only four W-rs in response to its three-parl f 1 t page spreads indicting midwifery we. Not even the response from the very group of midu.4ves they !qedf&& dgried, NCB, nor one fmn the official organization representing nurse-midwifery in this counby, the Arnhmn College of Nurse-Miakvives (ACNM), wx allorted space to rebut the alfegations as printed in The 7hes. Because of this inequitable jotlrMUcp~,maryofthe~ pubtishedle&ers!oONewYork fimesed&rshavebeenin&&din thisissueofJNMun&rthePro&+ sional Atiain Exchange cdumn; iruly,theyserwasariidatetroioes
ofslJppmtreason.arKi~ wBhregardtodk?skatlsof~wifely inthelh-&dslatestoday.
Thesdentiric~ ushMy’ cast sldlus ckalbis ,“L abiblyoffheNeWYcvkTiwneSs clk+ady~~theprobkmsar
&,epejb~s&uatsdNewYcek’s pubQchf?alh~~.m thesanedaytbatthe~T-ffck atAewa5pubkhed?kkY0~ Tsnec bfqpdne section induded a cmnm&yby~hankel(4)depktingtklackofprofe&onakfn usedbythema&awiwnteferrngt0 “F E @ and fur& -0utmmas. ousa&onisusua&howthernertia distmt fmm a vast numeric shortfalf’ (4), accading to Frankel it is an iniutice to the nurse-midwives. the doctors, the t-r= and, mast importan+, the mothers and babies in New York for the 7lmes to commit the sins of @-wtrneracy that Frankel’s a&k so aptly disclosed while per pebatlng the sloppy use of numbers that leaves readers “vulnerabk to journalistic hype, political demagoguery and commercial fraud” (4). The irresponsible use of numbers in this particular series is dramatically exemplified by 7&e Times report of an 80% higher neonatal death rate in city hospit& than in private facilitles~ Althouqh mathematically correct, the actual statistic being contrasted is 1 twonatal death per 1,000 live births in the private sector versus 1.8 In the public health care system. Although neither is an acceptable rate, one must question the motive of such a shock&e-public style of reporting. It is reminiscent of another period in history when OUI midwifery foremothers were also sacrifidal lambs on the economic and political stakes of their times The care of women in chfdbiti has long been the domain of midwives throughout the world. Yet, unlike other similarly industrialized countrks with iower maternal and infant morbidity and mortality rates. the United States has failed to recognize midwives as the profession that is best prepared to meet the essentidy normal health care needs of women before, during, and after the chlldbeatlng cycle. When our ancestors came to this county, the midwives came too. Although their edu-
cation and bainkq varied. these ----by theirlackdacontmon~ and,ultknateqr,ttteir~coorganize on a national level. Their iaudedge vf things unspeakable andth&rabf!ttytocurefrequentfy mackthenttaIg2tsdorhefgmups anxioustoqaina~ofauthortty in a developing counby. Passibfy, the anal insurmountable obstack for these early midwives was the deveopment of a sy3kn-1 of medical education that denied entrance to women. The education and livelihood of physicians became dependent upon the number of patients who could be convinced to receive care from a physician in a hospital. The safety of midwifery practice and home birth came under serious attack, as did the motives of any woman seeldng an education. But 21st century nurse~midwiues in the United States have abilities and opportunities beyond those of our ancestors. We speak a common tanguage; we are educated in a system equivalent to other professionals; we provide quality, cost-effective care. and we can prove it: we have not abandoned our commitment IO our nation’s most vulnerable populations; we have the respect of our colleagues; we know the importance of a good publrc rebtiohs campaign; we are recogniwd for our commitment to improving women’s h&h care; and we have organized on a national level. 1995 marks the 70th year of nurse-midwifery practice in the United States and the 40th anniversay of the founding of the American College of Nurse-Midwives. Gmduates horn 41 nurse-midwifery educational progmms are in great demand; and, a sevc~~-folrf increase in the number of nurse-midwifey attended hospital births has been documented between 1975 and 1992. In contrast to The New York rimes’ recent disparaging of midwifery, the number of professional
aldcatE#m-nk.nEdm(idesd ling tile conmbutws mi~cacetotbeheallhd~
d
nurse-
diUl’SfEdkSlMS~b
aeasedovertheyears,espeda& wi&intbepastdeQdeAs00Iiya§ 1951, the t+kmp&m ufe hsuancecompany(5)~thattsre mawnalmorta&yrateamcmgEBltc Bednurse-mfdtuifedientsinthe~ difficuk of circumstances was s&E lower (1.2 per 1,000) than the Mtional average (3.4 per 1.000). Sub sequent&, the or+ stucty to monhor the outcomes be-fore, during, and foflowing the estabiishment of a nursemidwifery service occurred in Madeira County, California. horn 1959 to 1966 (6). This study clearly documented the abiljty of nurse-midwives to significantly reduce rates of prematurity and infant mortakty in a vukterable population and, s&y. also documents not only the lack of commftment on the part of p0licynakers to continue the provision oi prenatal care to this underserved population, but also the dramatic increase in poor outcomes to the families of this county once tie midwiky service was discontinued. In 1989, the New England Journal oj Medicine pubbhed a landmark study involving midwifery care in birth centers (7). The research examined the records of more than 11,000 births nationwide and again demonstrated the high level of care provided by certified nurse-midwives while docamenting. with impressive statistics, their excellent maternal and neonatal outcomes. Numerous other research papers have documented the contribution of nurse-midwifery care in decreasing the Incidence of ceswean sections, episi~tornirs, and lowbirth-weight babies. Most recently, he Journal oj Nurse-MidtiM pubfished a report on more than 30,CK@ CNM-atknded births in Los Angetes Gunty with no inbaparhxn maternal or fetal deaths (8). Throughout these reports, it is the nurse-midwifery commitment to servtng OUT Jion’s
mcra-~dalk brolgbt-pdessiDo~W praipe YisafJlddyde9tha4ffrebrr paadtllelwkt5andturIkstnthe paihwayahead~hule~d euery--theBy.&kssaltiwetake& OliSlyOUll&BaS
-WC
irictws,andp&kreUws~ sentaitues. No one can support rnl~andduYi~Ekewe canlheohltgatimofevery~e totheFtldmimrfni3tatleasteqd theaxmnkwntwegivetowery rnotlwrandbaby.lnhis19!Mariide litkd, “A crosoNational Anal* cd h-ficlwifery Polilic~ Sii Lessons for Midwives” (9), Eugene De&q desaibes the componenh of buiIding for the future sun&al and growth of midwifery. His paper challenges us to grow away from polikal naive@ and into a sophisticated arena of public policy involvement Of particular note, is Dedercg’s emphasis to be prqme4l bebre a u&s omm We must know who our a&s are, have abundant rewuch outcomes ready to support a variety of midwifery
Am&n
College of Nurse-Midwives
REFERENcEs
8.GreulkhB,Pab~McCfainC,
1. BaquetD, Friti J. New York public hospitals fail, and babies are the vctins. The New York Times 19% March
!3argetMKEdwrckN.hdRTwelue years and more than 30,000 nursemidwife attended birtk tk Lb5 Ang&s Counl+Jnive&y of Southem C&forI&I Women’s Hospitall3ii Centerexpe-
5-7. 2. Brocly J. Mi*lidwiveslead a rwolutin in quaky obt&ic care.The New York lin-m 1993April 28. 3. i-hire DM lmprovkg the oukomes
tieoce.J NurseMhiby 1994;?@1&596. 9. Dedeq ER A crosnacorrel a&-
01 pregnancy dw0ugh irtc4
midwivesMidwifery1994;iO:Z32-7.
ul&a~
@s of ddwifeiy
p&ics: six Iem
Erratum An e~rcu in the abs&act of the articleenti!!ed “Factors that Predict Performance on the National Gwification Examination for Nurw-Midwives” appears on page 19 of the JanuarylFebruaty 1995 isue of JNM. The last six words should be sbkken. and the fast sxmterwx of the absbxt shou!! read as folows: “Vatiabl~ that were not predictiw of performancemch~cled maritalstatis, U.S. WIWShign edwdticmeitherIII nursing or in midwifery,and academiclevel of the registerednursing educational prqam” This error appears only in the abstract; the text of the article is accurate. The authors regret this error.
for
As the pro&ion of nufze-midwifery looks toward the 21st century, ow growth seems limitIfs arid ow cornmitment to women’s health care boundless Yet, on octasion. we are forced to pause, refl& and respond when the very essence of our vocation is brought unjust& into question; unfor&unately, we are in the midst of just such a crisis. A series of aticles published in March 1995 by The NW York 7lmes (1) maligns midwifery as a major contributor to New York City’s poor perinatai outcomes, when, in facf it is the city’s overburdened public health rare system that should bear the respotnibiify. fts exceajve maternal and infant mortality and morbidity raw de+y modem techndcgy while its entire spkm of medid education and practice is being redelined to fit curlEnt market forces Yet, The Tim ties insinuates that the city’s vast health care problems Ii-e morewitbthemidurivgthantithe system.Howironicitisthatonly2 years ago, The New Yorlc Times fea+ turedanarlklewGttenbyitss&nce editor. Jane Brady, chroni&ng the midwife-led * revolution in quality oldebic care ’ (Z)! Euenthemostarrsoryreviewof dW?1995NeWY~Gl@Setid
atlicks reveals serious tlaws in the methodology of the research employed by 77t.e Trmes’ investigators. Published in a format that lacks scieni& evidence of validity and I&ability, thii study does not give the reader enough information to analyze its finding objectively; mthe-r, its tabloid tactics allow one to question if the unsubstantiatefl conclusions are truly fif to print SuspUon about the motives be. hind this publication is raised when requests to receive copies of the btudy’s methodological design and data set are repeatedly denied A call for independent review is particularly appropriate in light of a 1981 Journal of Num+Midt+y IJNM) report (3) on more than 2,600 b&s at North Cenbal Bronx Hos@al (NCB), the my same institution that The Times chcxetovihfy.TheJNb4reportre~ vealeda.nov43aI!@natalmo&ty l2betiUCISfWtOnlylOWWthi3llttbe
nationaiavemgeatthatt4me,butalso bwerthanthemleforalloulerpublic haspitakcombinedaswellasforthe entire city of New Ymk during the studyperiad;ofsp&dn.otei.sthe facttlxlt83%ofthesebiKtl?s,highriskandlow-tiskatiku.we7eattended by oatified nurse-midwhxs (CNMS) andwithenwable~
Failwe of The 77~1~s to put&h a fair sampling of Ihe large volume of mail it received from phytjciapss, scientists, national foundations, consiinia and advocqg groups, and other concerned tzitbms in support of nurse-midwifery practice does not speak well of its abii b provide objective reporting. Instead, The TIW chose to print only four W-rs in response to its three-parl f 1 t page spreads indicting midwifery we. Not even the response from the very group of midu.4ves they !qedf&& dgried, NCB, nor one fmn the official organization representing nurse-midwifery in this counby, the Arnhmn College of Nurse-Miakvives (ACNM), wx allorted space to rebut the alfegations as printed in The 7hes. Because of this inequitable jotlrMUcp~,maryofthe~ pubtishedle&ers!oONewYork fimesed&rshavebeenin&&din thisissueofJNMun&rthePro&+ sional Atiain Exchange cdumn; iruly,theyserwasariidatetroioes
ofslJppmtreason.arKi~ wBhregardtodk?skatlsof~wifely inthelh-&dslatestoday.
Thesdentiric~ ushMy’ cast sldlus ckalbis ,“L abiblyoffheNeWYcvkTiwneSs clk+ady~~theprobkmsar
&,epejb~s&uatsdNewYcek’s pubQchf?alh~~.m thesanedaytbatthe~T-ffck atAewa5pubkhed?kkY0~ Tsnec bfqpdne section induded a cmnm&yby~hankel(4)depktingtklackofprofe&onakfn usedbythema&awiwnteferrngt0 “F E @ and fur& -0utmmas. ousa&onisusua&howthernertia distmt fmm a vast numeric shortfalf’ (4), accading to Frankel it is an iniutice to the nurse-midwives. the doctors, the t-r= and, mast importan+, the mothers and babies in New York for the 7lmes to commit the sins of @-wtrneracy that Frankel’s a&k so aptly disclosed while per pebatlng the sloppy use of numbers that leaves readers “vulnerabk to journalistic hype, political demagoguery and commercial fraud” (4). The irresponsible use of numbers in this particular series is dramatically exemplified by 7&e Times report of an 80% higher neonatal death rate in city hospit& than in private facilitles~ Althouqh mathematically correct, the actual statistic being contrasted is 1 twonatal death per 1,000 live births in the private sector versus 1.8 In the public health care system. Although neither is an acceptable rate, one must question the motive of such a shock&e-public style of reporting. It is reminiscent of another period in history when OUI midwifery foremothers were also sacrifidal lambs on the economic and political stakes of their times The care of women in chfdbiti has long been the domain of midwives throughout the world. Yet, unlike other similarly industrialized countrks with iower maternal and infant morbidity and mortality rates. the United States has failed to recognize midwives as the profession that is best prepared to meet the essentidy normal health care needs of women before, during, and after the chlldbeatlng cycle. When our ancestors came to this county, the midwives came too. Although their edu-
cation and bainkq varied. these ----by theirlackdacontmon~ and,ultknateqr,ttteir~coorganize on a national level. Their iaudedge vf things unspeakable andth&rabf!ttytocurefrequentfy mackthenttaIg2tsdorhefgmups anxioustoqaina~ofauthortty in a developing counby. Passibfy, the anal insurmountable obstack for these early midwives was the deveopment of a sy3kn-1 of medical education that denied entrance to women. The education and livelihood of physicians became dependent upon the number of patients who could be convinced to receive care from a physician in a hospital. The safety of midwifery practice and home birth came under serious attack, as did the motives of any woman seeldng an education. But 21st century nurse~midwiues in the United States have abilities and opportunities beyond those of our ancestors. We speak a common tanguage; we are educated in a system equivalent to other professionals; we provide quality, cost-effective care. and we can prove it: we have not abandoned our commitment IO our nation’s most vulnerable populations; we have the respect of our colleagues; we know the importance of a good publrc rebtiohs campaign; we are recogniwd for our commitment to improving women’s h&h care; and we have organized on a national level. 1995 marks the 70th year of nurse-midwifery practice in the United States and the 40th anniversay of the founding of the American College of Nurse-Midwives. Gmduates horn 41 nurse-midwifery educational progmms are in great demand; and, a sevc~~-folrf increase in the number of nurse-midwifey attended hospital births has been documented between 1975 and 1992. In contrast to The New York rimes’ recent disparaging of midwifery, the number of professional
aldcatE#m-nk.nEdm(idesd ling tile conmbutws mi~cacetotbeheallhd~
d
nurse-
diUl’SfEdkSlMS~b
aeasedovertheyears,espeda& wi&intbepastdeQdeAs00Iiya§ 1951, the t+kmp&m ufe hsuancecompany(5)~thattsre mawnalmorta&yrateamcmgEBltc Bednurse-mfdtuifedientsinthe~ difficuk of circumstances was s&E lower (1.2 per 1,000) than the Mtional average (3.4 per 1.000). Sub sequent&, the or+ stucty to monhor the outcomes be-fore, during, and foflowing the estabiishment of a nursemidwifery service occurred in Madeira County, California. horn 1959 to 1966 (6). This study clearly documented the abiljty of nurse-midwives to significantly reduce rates of prematurity and infant mortakty in a vukterable population and, s&y. also documents not only the lack of commftment on the part of p0licynakers to continue the provision oi prenatal care to this underserved population, but also the dramatic increase in poor outcomes to the families of this county once tie midwiky service was discontinued. In 1989, the New England Journal oj Medicine pubbhed a landmark study involving midwifery care in birth centers (7). The research examined the records of more than 11,000 births nationwide and again demonstrated the high level of care provided by certified nurse-midwives while docamenting. with impressive statistics, their excellent maternal and neonatal outcomes. Numerous other research papers have documented the contribution of nurse-midwifery care in decreasing the Incidence of ceswean sections, episi~tornirs, and lowbirth-weight babies. Most recently, he Journal oj Nurse-MidtiM pubfished a report on more than 30,CK@ CNM-atknded births in Los Angetes Gunty with no inbaparhxn maternal or fetal deaths (8). Throughout these reports, it is the nurse-midwifery commitment to servtng OUT Jion’s
mcra-~dalk brolgbt-pdessiDo~W praipe YisafJlddyde9tha4ffrebrr paadtllelwkt5andturIkstnthe paihwayahead~hule~d euery--theBy.&kssaltiwetake& OliSlyOUll&BaS
-WC
irictws,andp&kreUws~ sentaitues. No one can support rnl~andduYi~Ekewe canlheohltgatimofevery~e totheFtldmimrfni3tatleasteqd theaxmnkwntwegivetowery rnotlwrandbaby.lnhis19!Mariide litkd, “A crosoNational Anal* cd h-ficlwifery Polilic~ Sii Lessons for Midwives” (9), Eugene De&q desaibes the componenh of buiIding for the future sun&al and growth of midwifery. His paper challenges us to grow away from polikal naive@ and into a sophisticated arena of public policy involvement Of particular note, is Dedercg’s emphasis to be prqme4l bebre a u&s omm We must know who our a&s are, have abundant rewuch outcomes ready to support a variety of midwifery
Am&n
College of Nurse-Midwives
REFERENcEs
8.GreulkhB,Pab~McCfainC,
1. BaquetD, Friti J. New York public hospitals fail, and babies are the vctins. The New York Times 19% March
!3argetMKEdwrckN.hdRTwelue years and more than 30,000 nursemidwife attended birtk tk Lb5 Ang&s Counl+Jnive&y of Southem C&forI&I Women’s Hospitall3ii Centerexpe-
5-7. 2. Brocly J. Mi*lidwiveslead a rwolutin in quaky obt&ic care.The New York lin-m 1993April 28. 3. i-hire DM lmprovkg the oukomes
tieoce.J NurseMhiby 1994;?@1&596. 9. Dedeq ER A crosnacorrel a&-
01 pregnancy dw0ugh irtc4
midwivesMidwifery1994;iO:Z32-7.
ul&a~
@s of ddwifeiy
p&ics: six Iem
Erratum An e~rcu in the abs&act of the articleenti!!ed “Factors that Predict Performance on the National Gwification Examination for Nurw-Midwives” appears on page 19 of the JanuarylFebruaty 1995 isue of JNM. The last six words should be sbkken. and the fast sxmterwx of the absbxt shou!! read as folows: “Vatiabl~ that were not predictiw of performancemch~cled maritalstatis, U.S. WIWShign edwdticmeitherIII nursing or in midwifery,and academiclevel of the registerednursing educational prqam” This error appears only in the abstract; the text of the article is accurate. The authors regret this error.
for