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Gena Bigler: Recognizing Kentucky midwives, using Medicaid to pay for births makes sense

If there is a way to save hundreds of millions of dollars on health care costs, shouldn’t we explore it? By licensing Certified Professional Midwives and allowing Medicaid to pay them to care for healthy low risk mothers, hundreds of millions of tax dollars could be saved while expanding mothers’ birth options.


Midwifery care is common across the globe. Many nations that embrace midwives as primary caregivers for low risk pregnancies have much better maternal and infant outcomes than our own.
Though we as a country spend more than any other developed nation on health care, we rank surprisingly low on infant outcomes. Norway, Ireland, Sweden, Cuba and Guam all have better outcomes (more healthy live births) than here in the U.S. All the countries that enjoy better maternal and infant mortality rates than the U.S. have both universal health care and midwives attending the majority of births. In the U.S., we have a cesarean section rate of roughly 33 percent while hospital-based Certified Nurse Midwives have a much lower 10 percent rate. Because they are not nationally recognized, there are no comparable record for CPMs.
This does support that, as studies have shown, the midwifery model of care results in fewer costly interventions.Washington State is one of the first states to authorize Medicaid payments for CPM care and has shown sizeable savings. Officials report that the current Medicaid plan is estimated to have saved well over $3 million in just two years thanks to CPM care. The chief medical officer of Washington’s Medicaid program, Jeff Thompson, MD, MPH, estimates that the average uncomplicated licensed midwife attended birth costs about $2,500 compared to the average uncomplicated hospital birth cost of about $10,000.
Thompson has said, “Midwives have a central focus in our strategic plan. We are hoping Washington State can double out-of-facility births in the next two or three years.”
Twenty-seven states license CPMs and of those 11 permit Medicaid payments to CPMs. Kentucky should join this growing trend. As our stated budget staggers under the weight of Medicaid, we need to expand our thinking and return to our roots.
Kentucky has a rich heritage in midwifery care. Internationally renowned Frontier Nursing University founded by Mary Breckinridge is the oldest continually operating midwifery program in the U.S. and is located in the tiny Appalachian town of Hyden. It is the home of nurse midwifery and the first family nurse practitioner in the nation.
One of the instigating forces in the creation of Frontier Nursing University was the need for better rural care. The need for rural care has not changed. Kentucky still suffers a lack of adequate care in many rural areas and licensing CPMs could dramatically improve care options in many of these rural areas.
Homebirth has grown significantly in the past few years. The Centers for Disease Control estimates the growth at 29 percent over the past several years. It wasn’t that long ago that being born at home was the norm. Respected doctors like Marsden Wagner and Aviva Romm are vocal in their support of homebirth and frequently cite the evidence that confirms the safety of birthing at home. More women are choosing to birth at home. Licensing CMPs would provide them better care and reduce costs.
Recognizing Certified Professional Midwives in Kentucky and allowing Medicaid payment for care just makes good financial sense. We should join the majority of states that already recognize CPM care and become one of the leading states that permits Medicaid payment for CPM care.
While Kentucky was once a leader in women’s care, we are lagging behind and it is costing us millions. Licensing CPMs is good for moms, it is good for taxpayers and it is good for babies.
Gena Bigler is passionate about public service and credits her time serving nonprofits in AmeriCorps and Volunteers in Service to America (V.I.S.T.A.) with teaching her extreme budgeting and bargain shopping. Gena is now CFO of McNay Settlement Group and serves on the board of the Lactation Improvement Network of Kentucky (L.I.N.K.). Gena would be happy to hear from you at lgbigler@gmail.com.


Click here to read more columns from Gena Bigler.

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