Lynne Himmelreich, CNM, MPH, FACNM
Candidate for Region V Representative
See Lynne’s CV here
Question: What challenges to midwifery practice have you observed/experienced either nationally or in your region, and what solutions would you suggest or implement to eliminate that barrier?
Answer: I would like to thank the nominating committee for a very pertinent question. The most common challenges to practice I hear from midwives are related to laws requiring supervision or written collaborative agreements for practice or prescription authority, the inability to obtain full hospital admitting privileges, and reimbursement issues. The reimbursement issues include payers who reimburse midwives at a discounted rate compared to physicians as well as those who will not credential midwives at all. These are issues that have to addressed on the state level. It was clear to me early in my career that we needed strong state organizations to effect the changes we need at the state level.
During the last bylaws revision, I advocated strongly for the state affiliate structure and then spent the next 4 years assisting the transition to this structure. Over the last few years the national office has greatly increased their ability to assist the affiliates. I was on the committee to realign the regions and strongly supported adding a region so that region representatives are now responsible to only 7-8 affiliates. This should allow us the ability to develop improved relationships with the affiliate leadership and better support the affiliates in their efforts.
I have also been instrumental in working to establish relationships with the ACOG District leadership by attending and networking at the ACOG District Advisory Council Meetings. The goal of this is to facilitate ACNM state affiliate leadership to form relationships with ACOG state leadership. I believe it is through personal relationships that we can be most successful in obtaining support for our issues. In many states, ACNM and ACOG leaders are starting to dialogue. This worked here in Iowa, where the ACOG Section wrote a letter of support for a certificate of need for a proposed birth center at our request.
None of this is a quick fix for obtaining full practice authority, hospital admitting privileges, or equal reimbursement, but they are steps in the right direction. It takes hard work at the state level. My belief is that having strong affiliates that are well supported by the national leadership and the national office along with information sharing to learn from each other's successes and lessons learned is imperative to overcoming these challenges.