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Sample Follow Up E-mail

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Dear [insert legislative aide or legislator first and last name],

My name is [insert your first and last name], and I am the midwife from [insert your home city] who you spoke with earlier. I wanted to write and thank you for taking the time to speak with me to discuss some of the important benefits of midwifery care.

I invite you to call me if you have questions about the midwifery profession, or the delivery of and access to quality women’s health services.Below are a few expanded key points from our conversation to assist you in recalling our message for future legislative considerations. For more specifics regarding current legislation, please contact our ACNM Federal Representative Patrick Cooney at (202) 347-0034 or[email protected].

Thank you for your continued support of both midwifery and women’s healthcare.


[insert your first and last name and credentials]

Fast Facts about Midwives

  • Midwifery is legal in all 50 states, the District of Columbia, American Samoa, and Guam.
  • The vast majority of US midwives—more than 12,000—are certified nurse-midwives (CNMs) and certified midwives (CMs).1
  • CNMs/CMs attend more than 300,000 births annually, and provide primary care services, including annual exams, writing prescriptions, patient education, and reproductive health services.2,3
  • More than 50% of CNMs/CMs list physician practices or hospitals/medical centers as their principal employers. Of CNM/CM-attended births, 96.1% occur in hospitals, 2% occur in freestanding birth centers, and 1.8% occur in homes.4

Midwives Provide High Quality Care

Women cared for by midwives compared to women of the same risk status cared for by physicians have: 5,6

  • Higher chance for a normal vaginal birth
  • Lower rates of cesarean section
  • Reduced rates of labor induction and augmentation
  • Significant reduction in incidence of third and fourth degree perineal tears
  • Higher rates of breastfeeding
  • Lowered risk of neonatal mortality, low birth weight, and infant mortality
  • Less use of epidural anesthesia
  • Shorter length of stay in the birth facility

Midwives Provide Cost Effective Care

  • Midwifery care results in fewer cesarean births than physician care for equally low-risk women.2 The average costs for vaginal birth are approximately 50% lower than those for cesarean birth.7 Every 1,000 women who avoid unnecessary cesarean births amounts to over $7 million in health care cost savings.8
  • During pregnancy, 9% fewer women in collaborative care than in physician only care make costly visits to the Emergency Room.9
  • Each day in the hospital is a significant cost. Of women cared for by midwives and physicians working collaboratively, 28% are discharged before 24 hours.9
  • Compared to women cared for exclusively by physicians, 6% fewer women cared for by midwives and physicians collaboratively have stays longer than 72 hours.9

Midwives are a Solution to the Health Care Workforce Shortage

“Ob-gyns working collaboratively with midwives is a way to address the gap between the supply of ob-gyns and the demand for women’s health care services.”
-Richard N. Waldman, MD, FACOG, Past President, American College of Obstetricians & Gynecologists10

“The US population is growing, yet the number of new medical graduates has basically plateaued—hiring nonphysician clinicians is a good solution to accommodate the health care needs of the growing population.”
-The Obstetrician-Gynecologist Workforce in the United States 201111

“CNMs should be better utilized to address the projected health care workforce shortages.”
-Women’s Health Issues, January 201212


1. American Midwifery Certification Board

2. Hamilton BE, Martin JA, Ventura SJ, et al. Births: final data for 2009. Natl Vital Stat Rep. 2010;59(3):1-19. Accessed March 26, 2012.

3. Schuiling KD, Sipe TA, Fullerton J. Findings from the analysis of the American College of Nurse-Midwives’ memberships surveys: 2000-2003. J Midwifery Womens Health. 2009; 50(1):8-15.

4. American College of Nurse-Midwives. The ACNM Core Data Survey, 2010. Accessed April 19, 2012.

5. Newhouse RP, Stanik-Hutt J, White KM, et al. Advanced practice nursing outcomes 1990-2008: a systematic review. Nurs Econ. 2011;29(5):1-22.

6. MacDorman MF, Singh GK. Midwifery care, social and medical risk factors, and birth outcomes in the US. J Epidemiol Community Health, 1998; 52(5):310-317.

7. Thomson Healthcare. The healthcare costs of having a baby. Published June 2007. Accessed March 28, 2012.

8. Health Insurance Association of America and National Association of Childbearing Centers Annual Survey Data, 1995.

9. Jackson, DJ, Lang, JM, Swartz WH, et al. Outcomes, safety, and resource utilization in a collaborative care birth center. Am J Public Health. 2003; 93(6):999-1006.

10. American College of Nurse-Midwives, News Release: Ob-Gyns and Midwives Seek to Improve Health Care for Women and Their Newborns, March 31, 2011. Accessed April 19, 2012.

11. Rayburn, WF. The Obstetrician-Gynecologist Workforce in the United States: Facts, Figures, and Implications, 2011.

12. Johantgen M, Fountain L, Zangaro G, Newhouse RP, Stanik-Hutt J, White KM, et al. Comparison of Labor and Delivery Care Provided by Certified Nurse-Midwives and Physicians: A Systematic Review, 1990 to 2008. Women Health Iss. 2012;22(1):e73-e81.


ACNM's Legislative Tracking Tool

American College of Nurse-Midwives.
8403 Colesville Rd, Suite 1550 | Silver Spring MD 20910
Phone: 240-485-1800 | Fax: 240-485-1818
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