Where's My Midwife?

THE PROBLEM: Midwifery is old as human history. It's only in the last 120 years that midwives have been pushed back and pushed out by Big Medicine in the U.S., which tries to restrict midwifery and out-of-hospital birth to this day, the height of deliberate restraint of trade by physician competitors. This results in tragic outcomes for women and the U.S.'s dire maternal mortality crisis.

THE SOLUTION POSITIVELY CHANGING LIVES: Where’s My Midwife? helps families find midwives around them in their very own communities. Where’s My Midwife? talks about the need for workforce development of midwives, especially supporting/ teaching student midwives of color. Where’s My Midwife? educates about the need for greater access to maternity care by credentialed, licensed midwives in private homes/freestanding birth centers (with public/private insurance plan coverage in every state/territory). Where’s My Midwife? shares new voices/stories in the movement to make way for midwives.

In the richest nation on earth, moms are dying at the highest rate in the developed world—a rate that's rising. The U.S.—the world’s most expensive health care system—has an abysmal track record for maternal health and is an outlier among high-income nations.

• In New Zealand there are 1.7 deaths for every 100,000 births. 
• In France, which has among the highest maternal death rates in Europe, there are 8.7.
• In the U.S., the number jumps to 17.4. If you are a Black person in the U.S., the rate is a dismal 37.1. The rates are similarly high for Indigenous people.

While maternal deaths are perhaps the most shocking indicators of how our health care system is failing pregnant people, it would be remiss to not also look at rates of serious harm, injury or incidents where a person nearly dies during pregnancy and/or childbirth. These are similarly shocking and affect more than 50,000 women per year. And, while those who suffer these experiences survive, many experience lasting disability/are often forever changed by experiences of trauma.

Now consider that HOSPITALS are the most common place of birth in the U.S.—98.4% of births took place in a hospital in 2017.

Tens of thousands of families are asking loudly, “Where’s My Midwife?” To help answer this question, the Where’s My Midwife? initiative is helping to build back midwifery and community birth in the U.S. 

The Where’s My Midwife? Crowdmap launched in April 2020 to connect midwives trained in out-of-hospital birth with pregnant people wishing to give birth in community and out-of-hospital settings, such as private homes and freestanding birth centers. Where's My Midwife? A Podcast tells the stories of midwives and the families who love them. The trailer and first three episodes launched in April 2021.

The Where’s My Midwife? Crowdmap is deployed here, thanks to Ushahidi, a word that translates to “testimony” in Swahili, and which is a nonprofit social enterprise originally developed to map reports of violence in Kenya after the post-election violence in 2008. Since then, thousands have used Ushahidi's crowdsourcing tools to raise their voice. They provides software and services to numerous sectors and civil society to help improve the bottom-up flow of information.

Where's My Midwife? A Podcast is deployed here, thanks to Anchor.fm, (also, video on YouTube) and co-hosted by longtime activists for midwives and producers Kirsti Kreutzer and Steff Hedenkamp.

As we previously noted, tens of thousands of families are asking loudly, “Where’s My Midwife?” and to help answer this question, the Big Push for Midwives Campaign launched its new website for the Where’s My Midwife? initiative to help build back midwifery and community birth in the United States. To understand more about the target population whose lives we are working to directly and meaningfully improve, please consult this recent news article to understand more about the ways they are currently underserved:

"Consistent Devaluing of Black and Indigenous Lives Results in Poorer Health Outcomes

"Our health care system has suffered as much any other institution from this country’s history of systemic racism and gender oppression—with people who are at the intersection of both suffering the most. We can look at centuries of examples of mistreatment—from Tuskegee, to non-consented medical experimentation without anesthesia. The obstetrics profession itself has a horrifying history where advances were made through the torture of enslaved Black women and the displacement of community-based midwifery providers.  

"Generations of economic disinvestment in communities of color and under investing in health systems that serve people of color have had lasting negative impacts on maternal health care. In addition, numerous studies have described the unequal treatment of Black women when they arrive at health systems where calls for help are often ignored or devalued. It should be no surprise that this consistent devaluing of Black and Indigenous lives has resulted in poorer outcomes for them.

"Current Policies Fall Short

"Current U.S. health policies and practices contribute to high maternal mortality and injury rates by restricting pregnant people’s access to the health care. Currently, 12.5 percent of people in the U.S. are uninsured—and this number is rising as a result of the COVID-19 pandemic. Pregnant and birthing people here are not guaranteed to have health insurance throughout their lives, pregnancies and or into the post-partum period.

"Medicaid, the federal health insurance program for people with low incomes, covers nearly half (42 percent) of all births in this country.  In many states, Medicaid is difficult to qualify for—requiring recipients to have almost no income at all. While there are exceptions for pregnancy, they don’t last long. Medicaid coverage for birthing people runs out 60 days after birth in a lot of states—which is dangerous, as approximately half of maternal deaths occur in the post-partum period, up to one year after giving birth.

"We do not have enough midwives and ob-gyns overall—and we have far fewer midwives than similar countries. As a result, parts of the U.S., both urban and rural, are maternity care deserts, where people cannot find maternity care close to home.

"This short supply of midwives in the U.S. is compounded by insurance coverage complications, as coverage of midwives varies from state to state, making it an unaffordable option for many birthing people.

"It is also worth noting the U.S. has very few maternity care providers color—only 6 percent of midwives are Black and only 4 percent are Latino; while only 11 percent of ob-gyns are Black and 7 percent Hispanic.

"Where Do We Go From Here?

“With a new administration in the White House, we have a fresh opportunity to do better, and we should take it. A package of legislative proposals known as the Black Maternal Health Momnibus Act was re-introduced in Congress on Monday, but a path to becoming law is unclear and will require sustained leadership to keep this issue from being buried by competing priorities.

“There are long list of “shoulds,” there are a few that truly stand out:

• “We must address systemic causes of racial inequities so people of color and Indigenous people are not at risk when they are pregnant and giving birth.  This begins with us dismantling structural racism within the health care system and our communities. A tall order but one that begins with us enacting policies that will improve living conditions, invest in communities, and address inequalities in health care access, quality and safety. 
• “Insurance coverage is a key part of any solution. Expanding the Medicaid program in every state would assure that millions more people have health insurance coverage throughout their lives. This will mean starting pregnancy healthier, and also having the access to preventive care and postpartum care that is so critical to a healthy pregnancy and birth.
• “We need more maternity care providers, especially midwives. Rethinking laws and regulations that make it harder for midwives to practice autonomously and harder for insurance to pay for them is part of this. Investing in growing a diverse field of providers by supporting birthing centers led by people of color and providing pathways for people of color to enter the maternal health field is also essential.
• “Universal paid family leave would be a game changer for pregnant and birthing people in the United States. Allowing new parents to care for their babies and themselves without worrying about lost income would lead to significantly better outcomes for families.

“We have to do better for pregnant and birthing people in the United States. There’s no other option. Of course, we cannot erase the impacts of hundreds of years of race and gender-based oppression overnight. However, there are very real, concrete steps we can take to put the United States on the path to an anti-racist, equitable health care system where birthing people of all races and ethnicities have what they need for healthy, happy pregnancies and births.” 

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Like Ushahidi, we believe that if marginalized people are able to easily communicate to those who aim to serve them, then those organizations and governments can more effectively respond to their communities' immediate needs, while simultaneously bringing national / global attention to their problems through the aggregation of their voices. We wish to:

Grow the Crowdmap. A complete directory of U.S. midwives does not exist, but the established Big Push for Midwives Campaign community networks link midwives with pregnant people.

Grow the Podcast. Storytelling is the cornerstone to increasing access to excellent, evidence-based maternity care in out-of-hospital settings. Personal stories build empathy, compassion and help tell a broad story with a variety of voices. We feature midwives, parents, families, educators and researchers, health professionals, grassroots activists and community members.

The work of The Big Push for Midwives Campaign and the Where’s My Midwife? initiative is disruptive in its support of grassroots advocates who fight anti-midwife policies designed to deter midwives, limit their scope of practice, and prevent licensure, all of which are out-of-step/dangerously discordant today in the presence of the U.S. maternal mortality crisis. This work fights off the ongoing attempts by organized medicine to weaken and undermine midwives, all of which flies in the face of scientific evidence and increasingly urgent recommendations for midwives to be regulated through licensure, fully integrated into the Reproductive, Maternal, Newborn and Child Health (RMNCH) Continuum of Care in communities, and covered in public and private insurance plans in every state and territory.

Further endorsement of these recommendations can now also be found in new reports from two highly regarded U.S. think tanks, the Aspen Institute’s Health Strategy Group, Reversing the U.S. Maternal Mortality Crisis, and the Center for American Progress, States’ Essential Health Benefits Coverage Could Advance Maternal Health Equity.

The significance of licensing midwives and moving midwifery out from the underground market cannot be understated. While Big Medicine would like nothing more than for midwifery to disappear, growing coalitions of grassroots advocates and midwife supporters will persist in their statewide licensing campaigns.

“But for the work to restore the legality of midwives in one statehouse after another, in state after state across the U.S., we would not be in a position for midwifery and community birth to be recognized by studies like this as the preferred options to help improve the shameful maternal mortality rate in the U.S.,” Susan Jenkins, JD, The Big Push for Midwives Campaign Steering Committee member and Legal Counsel, said. “We are focused on state midwife societies and state consumer advocates who have been pushing for decades, even before our work and this movement took the name The Big Push for Midwives Campaign and before the Where’s My Midwife? initiative began.

“The Big Push, a national mutual-aid coalition of those state groups, just wants to take a moment to reflect on the fact that, but for licensed status now in 35+ states and D.C., with Illinois poised to be added, studies like these could not, and would not, talk about licensed midwives as viable options, much less the best hope for improvement, in maternity care,” Jenkins said. “That state tally represents years and years of hard-fought grassroots campaigns against organized Big Medicine and other opponents, including hospitals, trial lawyers, organized nursing, even some state agencies. The public education and advocacy provided by these state midwife societies and state consumer advocates has not only improved access to community midwives and birth centers, but has also created a public dialogue about midwifery and birth, consisting of public information, growing media coverage, and studies and reports like these. We know midwifery is the answer, but the Aspen Group and the Center for American Progress would not have learned that midwifery is the answer, or even considered community-based midwifery as a viable option, if U.S. midwives were still illegal and underground.”

BACKGROUND ON CERTIFIED PROFESSIONAL MIDWIVES (CPMs)

The Certified Professional Midwife (CPM) credential was developed in the late 1980s and was first issued in 1994 by the North American Registry of Midwives (NARM) to midwives with specialized training and expertise in providing safe, skilled maternity care in community birth settings. CPMs are the only U.S. midwives whose educational standards require them to undergo specialized clinical training in out-of-hospital settings as a condition of national certification. Many CPMs have encountered discrimination or exclusion from licensure despite being qualified by their training and education.

BACKGROUND ON THE BIG PUSH FOR MIDWIVES CAMPAIGN

Launched in 2008, The Big Push for Midwives Campaign educates about the need for regulation and license laws for CPMs in all 50 U.S. States, the District of Columbia, Puerto Rico, Guam, and the Virgin Islands. In states where CPMs are regulated through licensure, fully integrated into the Reproductive, Maternal, Newborn and Child Health (RMNCH) Continuum of Care, and covered in public and private insurance plans, those families enjoy better access to care and better outcomes than in states where CPMs are either unregulated or forbidden to practice. In U.S. states and territories where CPMs are not legally authorized to practice, they are at risk of criminal prosecution for practicing medicine or nursing without a license, which drives the practice of midwifery underground and creates barriers to access for women seeking maternity care. The Big Push supports the courageous leaders of state coalitions of midwives and consumers. From public education and advocacy for CPM legislation, to licensure laws and implementation, to full integration of CPMs into a community’s RMNCH Continuum of Care, to coverage in public and private insurance plans, the Big Push holds a new best-practices, evidence-based vision of U.S. maternity care: better outcomes for moms and babies as a result of expanded access to CPMs and the full range of birth options. Donations to the Big Push are helping to build back midwifery and community birth in the U.S. and increase access to more birth options, CPMs, and out-of-hospital birth and maternity care. The Big Push for Midwives Campaign is a fiscally sponsored project of the Sustainable Markets Foundation, a registered 501(c)(3) organization in New York, NY.

BACKGROUND ON THE WHERE’S MY MIDWIFE? INITIATIVE

One of the key ways that we are working to understand the needs of our target population and engage them as their communities work to develop the solutions of increasing access to midwives is through Where’s My Midwife? A Podcast. Storytelling is a key component to Where’s My Midwife? and the cornerstone to increasing access to excellent and evidence-based maternity care in out-of-hospital birth settings, in private homes and birth centers. Personal stories build empathy, compassion and help tell a broad story with a variety of voices. We feature new voices of midwives, parents and families, educators and researchers, health professionals, grassroots activists and community members each week on our social media channels. 

In addition, as midwives who provide out-of-hospital maternity care become increasing evident as the solution to address their needs, the Where’s My Midwife? Crowdmap provides visibility on where out-of-hospital midwifery care may be available to pregnant people. Midwives are invited to submit a report to the crowdmap to show their location in the PushNation, describe their credentials, license status, and the cities and counties they serve, as well as share their contact information and other helpful information. Pregnant people can review the map to see midwives near them. Only healthy, low-risk pregnancies are candidates for out-of-hospital birth with midwives who have capacity to provide maternity care in private homes and freestanding birth centers. The crowdmap enjoys the support of these organizations: Birth Monopoly, Birth Rights Bar Association (BRBA), Citizens for Midwifery (CfM), The Midwives Alliance of North America (MANA), The National Association of Certified Professional Midwives (NACPM), and the North American Registry of Midwives (NARM).

The problem we are addressing, the solution we have designed, and the population we are serving aligns with "Creating new public safety systems that ensure racial equity and provide alternatives to harmful technologies."

Big Medicine is harmful to pregnant and birthing people in the United States, especially those most vulnerable to inequity. The Where's My Midwife? Crowdmap and Podcast are “very real, concrete steps” we are taking to “put the U.S. on the path to an anti-racist, equitable health care system where birthing people of all races and ethnicities have what they need for healthy, happy pregnancies and births.”

The Where's My Midwife? initiative is likely be considered to be just moving out of the Launch period, and quickly moving into the Pilot stage of development. Currently, we are designing a new pilot project with the leadership of the coalition of grassroots activists who are working on the ground in Colorado to create a unique deployment of the Where's My Midwife? Crowdmap, which will show maternity care sector providers in the state. From midwives and doulas, to lactation consultants and lawyers, to birth centers and schools of midwifery, to maternity care deserts and oases, this pilot project will advance the Where's My Midwife? crowdsourced map considerably for residents of the state and provide them with new, enhanced layers of data. This pilot provides the opportunity to go where there is no path and leave a trail for other states to follow to map their midwives and birth sector providers.

Where's My Midwife? A Podcast is giving voice to grassroots advocates so they can share their stories about the importance of increasing access to safe, cost-effective, and increasingly popular maternity care that is provided by credentialed, licensed midwives in private homes and freestanding birth centers. Storytelling is the key to changing society, especially when it gives greater visibility to lived experience and relevant data. Every story is welcome, and sharing is a great way to open the dialogue for reaching change for birth in our nation. Together, we are working to bring midwives out from underground economies in states and territories, fully integrate them into the Reproductive, Maternal, Newborn and Child Health (RMNCH) Continuum of Care, and have midwives covered in public and private insurance plans in every community.

The Where’s My Midwife? Crowdmap is providing visibility on where out-of-hospital midwifery care may be available to pregnant people. By visually mapping midwives and other birth sector providers on community maps, and by piloting new projects with states as they work to identify and map more of their community birth assets, we are doing more to make way for midwives.

The Where's My Midwife? initiative is a new approach to the problem of a lack of midwives. The crowdmap and podcast projects of the initiative already are proving catalytic, and have captivated the interest of many new stakeholders. We absolutely expect Where's My Midwife? to change the birth sector and enable broader positive impacts from others in this space.

Related to the current number of people we serve, see "Pivoting to Childbirth at Home or in Freestanding Birth Centers in the U.S. During COVID-19: Safety, Economics and Logistics," published by Betty-Anne Daviss, David A. Anderson, and Kenneth C. Johnson in Frontiers in Sociology in March 2021.

"After a gradual decline from 1990 to 2004, the number of out-of-hospital births in the U.S. increased from 35,578 in 2004 to 62,228 in 2017, so that 1 of every 62 births took place in homes and freestanding birth centers (1.61%) (Macdorman and Declercq, 2019). By 2015, there were more home births in the U.S. than in any other industrialized country (Martin et al., 2017)4.

... "In the US in 2018, midwives attended 10.2% of births (Martin et al., 2019), with a home birth rate of <2%."

In 2020, there were 46 births for every 1,000 U.S. women (3.6 million births). With a home birth rate of <2%, it's calculated we currently serve 72,000 birthing families. But it's many more when those who may soon become pregnant are included.

To estimate how many people we'll be serving in one year, 3% more.

To estimate how many people we'll be serving in five years, we're accelerating the adoption of out-of-hospital birth: goal is additional 5% of deliveries occurring in private homes rather than in a hospital ("savings of $1.811 billion annually") and another 5% of deliveries occurring in freestanding birth centers rather than hospitals ("added savings of $959 million annually").

As the PushMap and PushChart indicate, CPMs can be licensed at the present time in only 36 states and the District of Columbia. In one other state, Missouri, CPMs may practice legally by statute, but are not able to be licensed. In the other 14 states, as well as Puerto Rico, the Virgin Islands, and Guam, licensed practice is not a legal option. In many of those states, unlicensed practice carries criminal penalties, and midwives practice in an underground economy, making consumer access to midwifery services problematic. 

The most desired successful outcome of the Where’s My Midwife? initiative is increased mapping and storytelling, and legislative enactment of bills to license CPMs in one/more states. Other desired outcomes include:

1. Increasing mapping and storytelling successes.
2. Serving states as they advance bills to enactment within legislative sessions.
3. Increasing the consumer base and allied organizations in active PushStates: Massachusetts, Illinois, Georgia, New York, Nevada that are pushing for licensing of CPMs.
4. Diminishing the power/influence of organized medicine opposition to state bills.
5. Achieving new collaborative, strategic alliances with partner organizations, including midwife and health care provider organizations, consumer advocacy organizations, women's health advocacy organizations, and public health entities such as maternal-child health advocates, state public health associations, and others.
6. Developing best-practice legislative guidelines that can be used by other states to counteract restrictive provisions advanced by legislative opponents.

All of these serve our largest impact goal to increase rates of home and freestanding birth center births by 5% (or more!).

2 paid FTEs, 2 paid interns, 5 part-time volunteers, and an army of grassroots activists and social media influencers.

Please review these short biographies of the Big Push for Midwives Campaign Steering Committee HERE. 

Our team is perfectly positioned to deliver the solution. Our collective skills, background, and experiences have completely and uniquely positioned us to deliver the solution and help solve this dire problem. We have worked for decades as a highly functioning strategic union, and the leadership of the Steering Committee of the Big Push prides itself on having provided vital “labor” support to the courageous advocates nationwide, who sacrifice so much in pushing forward the national movement for midwives and out-of-hospital birth options. The Steering Committee helps individuals and coalitions to expand the strength and reach of their shared message, as well as many other critically needed services. By providing public policy and public education experience, highlighting strategies and best practices that have worked, and discussing tactics to avoid that have proven ineffective, the Steering Committee helps empower states to educate more efficiently and effectively for CPM regulation and in the U.S. movement for midwives.

Red Quill Communications is my firm and has been retained by Big Push fiscal sponsor, Sustainable Markets Foundation (SMF), to serve the Big Push and Where's My Midwife? Red Quill provides consulting services to individuals, companies, nonprofits, and government—translating more than 20 years of experience of providing actionable approaches to help clients most effectively reach their target audiences through community involvement and stakeholder engagement for communications and advocacy/issue campaigns. SMF has retained Red Quill to provide public affairs and operations.

The Big Push for Midwives Campaign and Where’s My Midwife? Initiative acknowledge what The New Yorker recently reported: “midwifery is an overwhelmingly white profession at the moment, and so there's a dire need to diversify the profession itself if it's going to reach those folks who most need it.” This has not always been the case, and we acknowledge that historically, midwives from BIPOC communities were the traditional stewards of normal birth; there is an enduring relationship that exists between them and traditional birth care. The shoulders on which we stand are those of BIPOC midwives of the U.S. and the world. We acknowledge the painful history of oppression and forced elimination of their sacred professions, and we honor and respect the many diverse BIPOC people connected to normal birth for which we advocate from time immemorial. There is a dire need to diversify midwifery advocacy too, which is also overwhelmingly white.

We value diversity, equity, and inclusion. We’re committed to anti-racism in all the work we do. We are also deeply aware that diversifying a mostly white space needs to be done internally, without tokenization, and we’re giving the process what it needs so that BIPOC will find a space to show up and be seen/heard. We know we have to do this work to drive toward authentic inclusion/expansion. Doing first is the best way to attract BIPOC time, talent, and treasure to the movement for midwives, as well as uplift the workforce and national and state-level advocates.

Our driver for applying to Solve are the brave people of the PushStates, who are incredibly hard-working and dedicated volunteer advocates. They give the enormous gifts of their personal resources today so their children and grandchildren will have the freedom to select legal Certified Professional Midwives (CPMs )tomorrow. Their role is to educate and advocate about how CPMs provide affordable, quality, community-based care that reduces costly, preventable interventions. Advocates from participating PushStates are pooling their collective resources and experience, to coordinate and optimize advocacy efforts.

The Big Push is applying to Solve so we can better support the PushStates' needs: advocacy education, consultation regarding best practices for legislative content, ongoing advice/assistance for strategic planning, and amplification of their key messages with target stakeholders in the work to talk about what needs to be talked about.

The Big Push is applying to Solve so we can continue the heavy lift of facilitating the functionality of a unique national coalition of state-level advocacy and education organizations in the work to increase awareness of increasing numbers of maternity-care deserts, rising rates of maternal mortality, and out-of-control spending for terrible outcomes, as well as the logical, evidence-based solution of licensed and fully integrated midwives.

The Big Push is applying to Solve so we can move from an all-volunteer operation to a professionalized staff that can better serve to replenish the people on the frontlines on the battlefield who are doing this work and have done so for years and in some cases decades.

The Big Push teaches state advocates how to educate legislators, state government policymakers, media, and public about midwifery and the importance of access to community birth options. Big Push-trained advocates learn how to talk about and explain research and provide public education information to policymakers and the public, including how to spot the differences between absolute and relative risk, genuine research studies versus propaganda.

We train state advocates how to change state-level public policy from hostility or, at best, indifference, to the Licensed Midwives/Midwives Model of Care into positive endorsement of the benefits of midwife licensure/professional regulation.

We advance the number of states that license midwives, which increases access to and affordability of the Midwives Model of Care by making midwives eligible for provider status in government/private health plans, ranging from Medicaid/CHIP to ACA marketplace plans to private managed care plans. Our work toward opportunities for student midwives, including BIPOC student midwives, to be educated in their own communities are increased whenever a state makes midwifery legal and recognizes midwifery schools, programs, and apprenticeships in that state. 

The Where's My Midwife? Crowdmap connects licensed midwives and freestanding birth centers to pregnant people and advancing the Midwives Model of Care. The Podcast shares how this type of care changes lives. 

This is a nationwide movement conducted at the grassroots state level to overcome an entrenched opposition that uses misinformation to maintain its legislative dominance in order to inhibit CPMs from practicing legally and autonomously in each state. More consumer demand works.

We know that we would like to work with our existing technology partners, including Ushahidi, NationBuilder, Anchor.fm, and Sex Power Agency.

• Ushahidi - hosts our deployment of the Where's My Midwife? Crowdmap
• NationBuilder - hosts our deployment of the pushformidwives.org website
• Anchor.fm - hosts our deployment of Where's My Midwife? A Podcast
• Sex Power Agency - manages scheduling and production of the podcast

We imagine there are additional potential partners, including other organizations, MIT faculty or initiatives, and Solve Members who we would like to partner with related to public relations, monitoring & evaluation, and technology, and we are very open to meeting, planning, and working with any of them as desired and appropriate. We would really love to collaborate!

The Robert Wood Johnson Foundation Prize is perfectly suited for our work, as our systemic solution directly affects the health and well-being of people in the U.S., all of whom were born and many of whom will give birth.

Historically, opposition to licensing midwives has come from state medical societies. Recently, however, national physician organizations including ACOG and the AMA, have ramped up their levels of involvement in state licensure battles, using their deep pockets to provide a national anti-midwife, anti-consumer blueprint for restricting midwifery practice and consumer informed consent, including ACOG's 2015 Toolkit for opposing midwife licensing laws. The US MERA Agreement, unfortunately, has not resulted in a lessening of ACOG opposition; rather, it is the contrary in many states, sometimes advanced through the state medical society, as intended by the AMA's Scope of Practice Partnership with state medical societies and national physician specialty organizations. A stronger coordinated response to educate and advise state-level advocates is needed, and this project, and advocating for best-practice bill language is how the Big Push seeks to accomplish that goal.

Without the Where’s My Midwife? crowdmapping and storytelling project, licensure is a much harder push, and federal and state efforts directed toward mainstreaming midwifery, such as Medicaid provider status, student loans, and loan forgiveness options, and increasing access to birth centers and clinics will remain stalled. Without licensure, no protection exists for the practice rights of Certified Professional Midwives and the health care rights of midwife clients.

Let's put well-being back into birth.

The American Student Assistance® (ASA) Prize for Equitable Education is also well suited for our work, given the need for workforce development of midwives, especially supporting and teaching student midwives of color. 

As the PushMap and PushChart indicate, CPMs can be licensed at the present time in only 36 states and the District of Columbia. In one other state, Missouri, CPMs may practice legally by statute, but are not able to be licensed. In the other 14 states, as well as Puerto Rico, the Virgin Islands, and Guam, licensed practice is not a legal option. In many of those states, unlicensed practice carries criminal penalties, and midwives practice in an underground economy, making consumer access to midwifery services problematic.

So in 36 states and the District of Columbia, it is easier to make way for midwives. Our team would use this prize to help advance our solution and its workforce requirements in every county in every state of the PushNation. We could develop a digital solution tailored to U.S.-based primary and secondary classrooms that provides midwifery career exploration or experimentation. We would design a solutions that was embedded as part of core curriculum, utilize project based learning, and ensure equitable access. We would love to partner with ASA to help students know their midwifery career options, and make informed decisions to achieve their education and career goals.

The Elevate Prize for Antiracist Technology is a fit for our work, again given the need to create an antiracist and equitable future for birth in the U.S., and support the new generation of entrepreneur midwives, especially BIPOC midwives at work providing community birth. 

They say midwives are the oldest profession, and one could also say they are the original social entrepreneurs who deliver an impressive triple bottom line. If the aim is to elevate humanity on a national/global scale by funding, guiding, and scaling the platforms of social entrepreneurs, then investing in midwives and their out-of-hospital birth operations is a catalytic target.

This article published in March 2021 examines the "intersections of safety, economic efficiency, insurance, liability and birthing persons’ needs, which have become critical as the pandemic has ravaged bodies and economies around the world. Those interests, and the challenges and solutions discussed in this article, remain important even in less troubled times. Our economic analysis suggests that having an additional 10% of deliveries take place in private homes or freestanding birth centers could save almost $11 billion per year in the United States without compromising safety."

We interviewed the article's authors in the first episode of our podcast. When we all understand who attends out-of-hospital birth and the savings to the system if we make even just nominal adjustments to increase birth in out-of-hospital settings, we can begin to see where to invest, in whom, and how best to support emerging social entrepreneurs in our communities.

The Vodafone Americas Foundation Innovation for Women Prize is a great match for our work, since advancing the needs of women and girls and promoting a world where women's voices can be celebrated and HEARD to influence and change our society in entirely in our wheelhouse.

The Reproductive, Maternal, Newborn and Child Health (RMNCH) Continuum of Care includes integrated service delivery for mothers and children from pre-pregnancy to delivery, the immediate postnatal period, and childhood. Such care is provided in communities by Certified Professional (CPMs) is provided in out-of-hospital settings in private homes and in freestanding birth centers. The RMNCH Continuum of Care recognizes that safe childbirth is critical to the health of both the woman and the newborn child, and that a healthy start in life is an essential step towards a sound childhood and a productive life.

Our team would use the Innovation for Women Prize to do more of our crowdmapping and storytelling work to assist with the dimensions and importance of the U.S. RMNCH Continuum of Care.

1. The 1st dimension of the Continuum of Care is TIME – Connecting caregiving across the Continuum of Care for maternal, newborn and child health: includes pre-pregnancy, pregnancy, childbirth, early days/years of life.

2. The 2nd dimension of the Continuum of Care is PLACE – Connecting the places of caregiving to reduce maternal, newborn, and child deaths: can also reduce costs by allowing greater efficiency, increase uptake and provide opportunities for promoting related healthcare elements (e.g. postpartum/postnatal and newborn care).

   

The AI for Humanity Prize presents an interesting opportunity to advance our work in new and exciting ways.

In thinking about our solution of crowdmapping and storytelling, it becomes clear there are avenues we could pursue to leverage our data, through the use of artificial intelligence, and/or machine learning to benefit humans in the U.S. who are asking Where's My Midwife? We could plan to utilize these technologies through our customized deployment of the Where's My Midwife? Crowdmap, which is hosted by Ushahidi. We could design and deploy a concierge type of service to visits of the crowdmap to better assist them.

This type of work could significantly amplify our impact. We welcome the chance to work The Patrick J. McGovern Foundation in its efforts to create a thriving, equitable, and sustainable future for all.