Hydration during pregnancy

While we also are living with the backdrop of a global pandemic, turning to the great outdoors feels more essential than ever. However, in West Michigan we are stepping into our ninth consecutive 90 degree day. A phenomenon that has not happened since the ten day stretch in 1953. It’s hot!

Each year around holidays and sunshine filled weekends, we see certain patterns among our clientele. We get many more calls, emails, texts reporting a myriad of uncomfortable symptoms. So while we love to see you all outdoors, we’d like to recommend some helpful safety tips for your time outside. 

Hydration

In pregnancy we would recommend drinking approximately 100 oz of water per day. It sounds like a lot, but simply carrying your water bottle around with you throughout the day can make it an easier task. 

A few simple guidelines are: 

• Drink most of your water outside of meal times. When you drink a lot with a meal it dilutes your stomach acid levels and can lead to heartburn, as well as undigested vitamins, minerals, and protein. Stomach acids levels are important and are high for good reason; it also will kill off any pathogens that may have wandered in by mistake. 

• Caffeine is a diuretic, meaning it will make you pee a lot. You can’t count your cup of tea or morning coffee towards hydration. In fact, you’ll need to have two times the water to make up for the amount of your caffeinated drink (ONE cup of coffee means you need to drink TWO cups of water)

• Sport drinks are not the same as electrolyte drinks. Stay away from drinks like Gatorade, Powerade, or other dyed and sugary fakes. 

• Aim for your pee to be clear when you go, this is a great visual cue to keep track of throughout the day. 

*Some vitamins can change the color of your pee, like B vitamins, making it neon yellow. This is because they are water-soluble vitamins, whatever isn’t used by the body is excreted through urine. You’ll see this with the first 1-2 bathroom trips after taking your supplements but it should become clear with adequate hydration as the day progresses.

If you become dehydrated during pregnancy you can experience a variety of symptoms such as those listed below.

• Swelling 

• Thirst after drinking

• Dry mouth, lips, skin

• Decreased urination

• Dark coloured urine

• Lack of sweating when hot

• Weakness

• Elevated heart rate

• Constipation

• Headaches

• High blood pressure

Causes of dehydration, other than not drinking enough, are morning sickness/vomiting, breastfeeding, or illness. Dehydration can lead to an increase in Braxton Hicks contractions, decreased amniotic fluid levels, increased risk of urinary tract infection, constipation, lightheadedness, decreased milk supply, preterm labor. 

Electrolytes

Your body tries to maintain homeostasis, a balanced and optimal functioning of all systems. When you drink too much, or too little, it disrupts this careful internal balance and can cause your electrolyte levels to change. Electrolytes regulate nerve and muscle function, hydrate the body, balance blood acidity and blood pressure, and help rebuild damaged tissue. Sodium, calcium, magnesium, potassium, phosphate, and chloride are all electrolytes.

The best thing you can do is drink water and/or electrolyte beverages frequently throughout the day to avoid dehydration altogether; and the first thing to do when you notice signs of dehydration is grab a tall glass of water and drink up!

Keep quality electrolytes on hand for daily or situational use. We recommend Dr. Berg’s Electrolyte Powder and Liquid I.V. Hydration Multiplier, learn more about Liquid IV here: https://www.liquid-iv.com/. You can also make your own at home using the following simple recipe! 

DIY Electrolyte Beverage Recipe

• 32 oz water

• 1 tsp maple syrup or honey

• 2-3 tsp apple cider vinegar or fresh lemon juice

• ¼ - ½ tsp salt, preferably mineral rich like Himalayan or Celtic 

Mix all ingredients together in a quart sized jar, give it a hearty shake, and enjoy. Can be refrigerated for 24 hours. 

Oral vs. I.V.

Intravenous rehydration is both a conventional medical treatment and a supportive treatment within the holistic health field. Generally dehydration is treated in hospitals with an I.V. drip to directly boost blood levels. Outpatient clinics are becoming popular for rehydration as a means of keeping people out of the hospital when not strictly required, and making quality hydration and supplements available to the general public. 

I.V. hydration affects the body differently than oral hydration. Instead of being processed through the digestive system, a time and energy consuming process, it is injected directly into the bloodstream. This allows for 100% of the nutrients in the formula to be absorbed by the body, rather than the low bioavailability of oral supplements, sometimes only 20% of what you ingest is absorbed!

At Simply Born we highly recommend Revived Hydration, located at 1059 Wealthy St. SE, Suite E, Grand Rapids, Michigan; phone: 616-888-5006. 

This business offers quality I.V. and supplement products to the public by appointment, concierge, or walk-in appointments. Registered nurses administer the I.V. to clients and facilitate a friendly environment. Their Pregnancy Drip is full of valuable electrolytes for hydration and is boosted with anti-nausea medication for those suffering morning sickness.  Check out their link for more information https://www.revivedhydration.com.

Vitamin D

When it comes to vitamin D, people often consider it “the sunshine vitamin”, while this is in part true, it isn’t the whole story. In fact vitamin D behaves more like a hormone in the body than the average vitamin. While most vitamin D found in the body was generated from the sun, it also can be obtained through diet and supplementation.  According to studies, roughly 80% of Americans are vitamin D deficient! Vitamin D works on many levels of the body supporting hormonal health, blood sugar regulation, cardiovascular health, immune function, dental and bone health, and decreased weight gain - among many other functions. 

Deficiency can lead to some nasty consequences for the mind and body such as increased risk of developing:

• Cardiovascular disease

• Hypertension

• Diabetes

• Asthma

• Depression

• Multiple Sclerosis

Living in Michigan alone puts you at risk of becoming vitamin D deficient simply based on geography and the angle of the sun. Because Michigan is above the 35° latitude marker, it is physically impossible to generate enough vitamin D via the sun year round. We aren’t alone up here, in fact, ⅔ of the United States is at a latitude too high to produce vitamin D year round. 

For more information, check out this fantastic app developed to help people optimize their vitamin D generation! http://dminder.ontometrics.com 

How Can We Help?

At Simply Born, we have implemented universal lab testing of our clientele to assess vitamin D status as early as we can during pregnancy. Levels that fall at or below 30ng/mL are considered diagnostic for deficiency. However, optimal levels are suggested to be between 50-80ng/mL. Currently the RDA (recommended daily allowance) for vitamin D in adults is 600 IU per day. Though the International Institute of Medicine disputes this and suggests that adults need 10 times this amount, closer to 6000 IU daily to meet body needs. We recommend having your levels checked with lab work to determine what dose best suits you, in consultation with a healthcare provider. 

*Disclaimer: always check with a health care provider before taking high doses of any substance. 

Sun Safety

Sunscreen effectively blocks UVA and UVB which are in large quantities harmful to our cells. On one hand this is great as it prevents burning when used properly. On the other hand, by blocking UVB so well it also blocks 95% of vitamin D production. We aren’t talking about  high SPF either, even just 30 SPF creams are capable of this. 

We are not recommending that people shouldn’t use sunscreen, you certainly should protect your body. With ozone layers thinning we now more than ever need to ensure adequate sun protection measures. What we are suggesting is short exposure to the sun without sunscreen during peak hours (to generate vitamin D), and then applying a safe, non-toxic sunscreen for prolonged time in the sun or time outside peak generating hours.

We recommend using the helpful EWG Skin Deep Cosmetic Database to assess product safety before using it on yourself or family. This can apply to cleaning products, cosmetics, sunscreens, and more. Some good starting options are Goddess Garden, Thinksport and Badger. 

Dietary Considerations

Just like humans, cows generate vitamin D from the sun. As it is a fat-soluble vitamin, it is found in cow's milk and other dairy products. Not all dairy is a good source of vitamin D, cows need to have been grass-fed and pasture raised to have adequate levels in their milk. Low-fat dairy does not prove a good source of vitamin D and has lower levels of vitamin D than full fat dairy options. For context, the average glass of milk in the United States only contains ~100 IU of vitamin D. Most milk is fortified with vitamin D, among other nutrients after it is pasteurized, but always be sure to check the label and the source for the full story.

Studies show that in individuals who aren’t currently supplementing vitamin D, 90% of the vitamin D found in the body comes from sun exposure, not through the diet. If you are supplementing vitamin D, make sure to be using D3 specifically, and take it with a meal containing fat, remember this is a fat-soluble vitamin! 

A few simple guidelines are:

• The sun's UVB rays (essential for generating vitamin D) are at their peak roughly between 11 am and 4 pm. This changes depending where you live and the season. This is the most effective time to be outdoors to generate adequate levels in your body. 

• Be aware that you should only spend a short time in the sun unprotected, this time will look different for everyone depending on age, skin tone, skin type, geography, etc. Once you have spent a short time unprotected to generate your vitamin D, make sure to apply sunscreen for the remainder of your time outdoors for protection. 

• Be sure to use the D Minder app to learn more about vitamin D based on your particular geography. 

• The more skin exposed, the more vitamin D you will generate. 

• Lighter skin hues will generate vitamin D quicker and in larger quantities.

• Darker skin tones typically require 3-6 times more, simply due to more melanin in the skin!

• The heavier and the older you are, the more challenges you will have in generating your own vitamin D, and require longer periods in the sun.

Stay safe, and have fun! 

Love from your midwifery team. 

References and resources

https://www.costco.com/liquid-i.v.-hydration-multiplier%2C-30-individual-serving-stick-packs-in-resealable-pouch.product.100301223.html

https://lilynicholsrdn.com/10-things-you-didnt-know-about-vitamin-d/

https://dripdrop.com/blogs/news/pregnancy-dehydration-causes-and-complications

https://medlineplus.gov/fluidandelectrolytebalance.html 

Caring for yourself during the COVID-19 pandemic

Self Care Amidst a Global Pandemic

Our worlds have been flipped upside down in short order, all across the globe. While it has in some way impacted the lives of everyone in our global community, at SimplyBorn we are especially focused on supporting our pregnant, postpartum, and newborn clientele. 

Our team is exposed to the same level of scary media as you are, and because of this, we think it’s time to talk about solutions. Not solutions to rid the world of COVID-19 (though we would if it were that simple!). We want solutions for supporting mental wellbeing - especially amidst this increased trauma exposure for everyone. 

In this post you will be able to find some self-care tips, local resources that are now available virtually, and hopefully some peace of mind. These are trying times, let’s band together and remember the glowing community we are lucky to be a part of. That community is still out there, and with the advancements of technology we can come together (while at a distance) to give love, praise, support and comfort to our sisters, our brothers, mama’s and papa’s. 

Doula Coverage 

You can still have your doula and keep your social distancing too!

• Ginger Blossom Doula - https://www.gingerblossomdoula.com

Now offering online sessions, Ginger Blossom Doula Services has a variety of Birth Support Packages as well as Postpartum Support Packages. They are running virtual consults and prenatal sessions at this time.

• Rebekah Reese, Postpartum Doula. - 616-389-3185

Sweet spots are troubleshooting moods, postpartum nutrition, and twins. Rebekah will be doing phone calls at no cost through April. Don’t let the current health concerns prevent you from reaching out for help. You’ve got this and you’re not alone. Please text first and we’ll set up a call.

• Gold Coast Doulas - https://www.goldcoastdoulas.com 

A local organization of doulas, sleep consultants, lactation consultants and more. Currently they have moved to virtual platforms for providing support (zoom, facetime) for consults, prenatal visits, postpartum visits, virtual sleep consultations, mini childbirth education courses, pumping classes, breastfeeding classes, etc. Because local hospitals are currently not allowing additional support people on hand for hospital births, they are offering in-o home support before clients move to the hospital, and virtual labour support once at the hospital. 

Local Organizations

• Grand Rapids Natural Birth and Pregnancy - https://www.grnaturalbirth.com

Raquel Knack has been a lactation professional for 18 years, and is also a certified Bradley method instructor for childbirth education. She offers online Bradley method classes, breastfeeding basics classes, and individual support and troubleshooting sessions. Her website is full of educational videos as well!

• Moms Bloom - https://momsbloom.org 

Normally this organization offers in-home volunteer based support for mothers and newborns. Their business has adapted to a virtual model during the COVID-19 outbreak. We're here for you. No matter what your situation is, your emotional health is important. MomsBloom has now trained several volunteers who are ready to provide a listening ear and non-judgmental support to you! Even those of us with supportive people in our lives may find it hard to be honest about our true feelings. You may feel guilty sharing about your challenges right now because you know there are others who are struggling so much more. We invite all parents with young children to sign up for virtual visit services! 

After you sign up, you'll be matched with a trained volunteer who will spend about an hour on the phone with you each week. You can schedule the calls for a time that's convenient for you. We look forward to hearing from you!

Counselling Services 

• Pine Rest Christian Mental Health Services - https://pinerest.org 

offering psychiatric urgent care, inpatient, and addiction counselling and care. As a result of COVID-19 their urgent care has moved to 100% telehealth communication. For schedualing an appointment as a new patient, call 866-852-4001. They at this time have capacity and are accepting new patients for their inpatient services. 

• Bethany DeBlaay, Limited Licensed Psychologist, LLP - https://www.psychologytoday.com/us/therapists/bethany-ackley-deblaay-grand-rapids-mi/341556

Specialized in trauma counselling and somatic psychotherapy. Bethany DeBlaay currently has adapted her practice to telehealth in accordance with CDC recommendations. She currently has availability for new patients for virtual sessions. 

• Postpartum Men - http://postpartummen.com

This is a designated “safe space” specifically for men dealing with anxiety and depression following the birth of a child. Filled with resources for self-care, community and support. 

• Spectrum Health - https://www.spectrumhealth.org/about-us/classes-and-events/postpartum-emotional-support 

A free postpartum emotional support group for mothers and fathers to find community and support. Normally held in person on tuesdays 7 - 9 pm, they may have resources available for coping during COVID-19. Phone 616.391.5000 to get more information about social distancing options during the pandemic. 

State & National Organizations

• Disaster Distress Hotline - 1-800-985-5990 

https://www.samhsa.gov/disaster-preparedness 

• National domestic violence hotline - 1-800-799-7233

• https://www.thehotline.org/

• Michigan Sexual Assault Hotline - 855-864-2374

• https://www.michigan.gov/voices4/ 

• Centers for Disease Control, Coronavirus - https://www.cdc.gov/coronavirus/2019-ncov/index.html 

Self care 

Providing love for ourselves, our families, and our friends in a time of great need is of the utmost importance. There are lists to be found everywhere of what steps and precautions must be taken to physically protect ourselves from the novel coronavirus, but what about our hearts, and our minds.. 

Get some sleep - Nap - Hydrate - Nourish your body with healthy foods - Learn a new recipe - Check the news, but don’t linger - Consider news sources from outside the  United States (CBC, BBC) - Screen Free time - DIY projects - Take a walk, enjoy nature - Put reasonable parameters on social media - Read a book - Stay positive - Connect with loved ones virtually - Support local businesses when you can - 

Keep things in perspective 

Additional Online Resources

• Resilience Strategies During a Pandemic https://pinerest.org/resilience-strategies-during-a-pandemic-blog/ 

• Five Ways to View Coverage of Coronavirus Coverage https://pinerest.org/five-ways-to-view-coverage-of-coronavirus-blog/ 

• Self Care for Traumatic News https://pinerest.org/self-care-for-traumatic-news-blog/ 

• Coping With Stress During Infectious Disease Outbreaks https://store.samhsa.gov/sites/default/files/d7/priv/sma14-4885.pdf 

Prospective Clients, COVID-19 and Late Transfer Clients with SimplyBorn

In light of the global threat of COVID-19, maternal and newborn health and wellness operations are in turn under threat. The World Health Organization, cCenters for Disease Control, North American Registry of Midwives, and other global maternity organizations are adjusting their recommendations for safe pregnancy, birth, and postpartum amidst the COVID-19 pandemic. 

We have altered some aspects of clinical care to preserve community health as best as we can. This involves shifting the majority of non-essential appointments to telemedicine to lower risk factors for staff, providers, and clients. The current recommendation is for pregnant women to discontinue work, in order to self-isolate. If you need support in facilitating this, we are able to write exemption letters for our current clients. For further information please email us at simplyborn@yahoo.com, we are frequently updating our policies and recommendations in suit with the WHO and CDC guidelines in these challenging times. 

Please be advised that recommendations are subject to change with short notice and as of March 19th, 2020 these are the parameters we are working within at Simply Born to protect the health and wellbeing of patients, providers, and staff. 

Prospective Clients 

At Simply Born we are being contacted by prospective clients looking for information regarding out-of-hospital birth as an alternative option during our current global health crisis. While we have some availability, we do have strict requirements for those requesting a late transfer of care. Below are current guidelines which are subject to change. 

• All pregnant clients transferring care at or beyond 34 weeks are required to birth at our birth center location (802 Merritt St, Grand Rapids, MI). (This helps eliminate increased risk to our staff and clients.)

• Clients are required to provide medical health records containing recent lab work, maternal vitals, and recent ultrasound records prior to birth;

  •  if unavailable clients must receive adequate monitoring and lab work at onset of care prior to birth

• Reduced financing options available, details can be discussed over the phone with staff. We do take HSA and FSA. We also work with an insurance biller.

• Please realize we cannot guarantee a spot on our client roster without payment finalized due to the increased volume of prospective client inquiries we are receiving. 

• SimplyBorn is able to provide letters stating medical exemption from work for our clients. 

• This service is for low-risk clients

• Please note out of hospital birth is limited to hydrotherapy for pain management, we do not offer epidurals

Low Risk Pregnancy

Certified Professional Midwives are trained and credentialed to offer expert care, education, counseling and support to women for pregnancy, birth and the postpartum period. They have particular expertise in out-of-hospital settings. CPM’s working out-of-hospital are able to support clients with low risk pregnancy and birth. 

Conditions which risk clients of out care within the SimplyBorn as determined by the Michigan midwifery license are but not limited to:

• Unresolved hypertension in pregnancy, labor or birth

• Maternal cardiac event 

• Placental growth abnormalities such as placenta previa

• Uncontrolled gestational diabetes

Birth Recommendations

Please be aware that women are encouraged to labor at home as long as possible to reduce exposure risk; whether in hospital or out of hospital. 

Women who have been diagnosed with COVID-19 should birth in hospital, in order to have access to higher level care.

How you can help

At this time, Michigan licensed, certified professional midwives (LM, CPM) are not recognized by all insurance providers for partial or full coverage. We must all, collectively fight for insurance to pay for all out of hospital birth, be it home or birth center. We intend to continue to reach out to our representatives to request that the State of Michigan put something in place. Having services we provide, covered by insurance, would help many women with making birth choices that are best suited for their family. 

Complaints can be filed by contacting Governor Whitmer and filing complaints through the insurance commissioner's office. Use the following form: https://www.michigan.gov/difs/0,5269,7-303-12902_12907---,00.html?fbclid=IwAR3Oh3oH1u5v08neM74gFhOZIeW6qx8qZXTW3UbLl33RAtw_ux6HOdi9Xak 

We strongly encourage all out-of-hospital maternity care supporters to follow these actions to put the pressure on for insurance recognition, and coverage of services. 

For 2020 births, this is our current open availability:

March - 0

April - 3/4 Depending on postpartum needs, only Birth Center

May - 2, only Birth Center

June - 3

July - 2

August - 3

September - 6

October - 6

November - 9

December - Open

SimplyBorn Midwifery Services response to COVID-19

Answers for maternal health and COVID-19.

In response to the growing threat of COVID-19 and it’s recent pandemic status, we at SimplyBorn would like to provide pregnant clients and their families with reliable information as it pertains to COVID-19 and the childbearing year. If you are pregnant we anticipate you are concerned about COVID-19 for yourself, baby, and your family. Please be advised, the CDC is the most reliable outlet for new information and developments relating to COVID-19. 

If you have questions or concerns please direct them to our simplyborn@yahoo.com email, or call for further information. Please note this is educational information, and you can access SimplyBorn policy changes through our clinic staff. 

---

 Basic hygiene practices to remember:

• Wash your hands often, with soap and water (normal soap is adequate) for minimum of 20 seconds (Sing happy birthday while washing.)

• Avoid touching eyes, nose, mouth, face with unwashed hands 

• Cover your nose and mouth with a tissue when coughing or sneezing

• Avoid handshakes

• Avoid contact with sick individuals

• STAY HOME WHEN YOU ARE SICK

• Limit social interactions, large groups of people, and work from home when possible

• Regularly clean and disinfect frequently touched surfaces (doorknobs, cellphones, keyboards, light switches)

• Access services as much as possible online and via phone

Symptoms to be aware of:

Reported illnesses have ranged from mild symptoms to severe illness and death for confirmed coronavirus disease 2019 (COVID-19) cases.

The following symptoms may appear 2-14 days after exposure.*

• Fever

• Cough

• Shortness of breath

For more information regarding symptoms and more serious symptoms to be aware of utilize the CDC website: https://www.cdc.gov/coronavirus/2019-ncov/about/symptoms.html

Things to consider…

Should you go to the clinic/office for visits

It is your right to inquire with your healthcare provider what measures they are implementing to contain transmission of illness, including COVID-19. If you have COVID-19, or cold or flu symptoms, call the office before you go in to your appointment. Let them know you are sick and they will provide further instruction for the health and safety of all clients and staff. Aggressive containment is an appropriate public health measure to slow the pandemic spread of COVID-19. 

Working with an out of hospital midwife, and planning an out of hospital birth does NOT eliminate risk of contracting illness including COVID-19. Holistic care is often considered lower risk, and less “sterile” in terms of public health measures; while in some respects this can be proven true, that is not a smart way of thinking when you are trying to prevent the spread of infection to yourself or to others. 

We realize that healthcare is a unique service which often requires in-person interaction and physical contact. Midwifery is no different in this and we do require clients to have physical assessments regularly to assess maternal and fetal wellbeing through pregnancy. However, whenever possible we do recommend telemedicine for low-risk, non-urgent client needs and assessment. With this in mind SimplyBorn may reduce clinic location appointments in the foreseeable future to protect the health of clients and staff. Please reference our COVID-19 policy guidelines for further information. 

Birthing location considerations

SimplyBorn has already been contacted several times by prospective clients considering out of hospital birth amidst fears of COVID-19 exposure in hospital. 

Hospitals are equipped and have implemented public health protective measures to protect patients during the COVID-19 pandemic. These measures are for the patient’s safety and are not put in place to be intentionally limiting of the patient's personal birth desires.

At this time there is no medical reason to avoid hospital birth due to COVID-19. However, women are encouraged to labor at home as long as possible to reduce exposure risk. Women who have been diagnosed with COVID-19 should birth in hospital, in order to have access to higher level care as needed.

Maternal health

With the limited available data, as this is a new viral infection, data shows that women tend to get less severe presentations of COVID-19 than their male counterparts. This includes pregnant women. Generally pregnant women are more susceptible to respiratory infections and comorbidities as a result of immunosuppression. Research and data developments are moving quickly, but at this time pregnant women do not appear to be at higher risk of severe disease from COVID-19. 

Newborn health

Studies are inconclusive whether maternal fever from COVID-19 increases risk of birth defects in babies. Adequate supplementation of folate (minimum 400 mg) during early pregnancy can prove a protective and supportive measure in proper fetal development in the first trimester.  

At this time there is no evidence linking COVID-19 to increased rates of miscarriage or stillbirth; while other Coronavirus such as SARS or MERS did. There is no data indicating vertical transmission or infection of baby during labour or birth. COVID-19 has not been detected in amniotic fluid, cord blood, or breastmilk. 

Breastfeeding

At this time COVID-19 has not been detected in breast milk, This means it is relatively safe for an infected, or symptomatic mother to breastfeed her newborn if she takes adequate precautions. The primary concern in breastfeeding is hand hygiene and transmission from respiratory droplets.

These precautions are: wash hands thoroughly before each feeding and interaction with baby, wear a face mask when interacting with baby, do not kiss baby, follow proper breast pump cleaning recommendations, and consider having a different healthy individual feed baby with expressed milk in a bottle. 

What to do if you think you may be sick

Remember that risks for maternal and newborn health are currently low for those infected with COVID-19. If you become symptomatic, or have reason to believe you have COVID-19, call your midwife or OB to inform them. If you need to be tested or seen by a medical provider, remember to call the facility before you arrive to allow them to provide instruction and prepare their facilities. This is to protect staff, and other pregnant clients/patients. 

The CDC has provided excellent resources and insight as well: https://www.cdc.gov/coronavirus/2019-ncov/about/steps-when-sick.html

Steps to follow for getting tested

First contact your primary care physician, if they are unable to assist with immediate testing and you live in Kent County, call the Kent County Health Department at (616) 632-7228. Please note, both primary care physician offices and the Kent County Health Department are being flooded with calls. Exercise patience and know they are available to support the efforts for testing and containment.

For more information regarding testing in your State:

https://www.cdc.gov/publichealthgateway/healthdirectories/healthdepartments.html

References:

• https://www.cdc.gov

• MDHHS, COVID-19 Recommendations

• Government of Canada, www.gc.ca

• https://avivaromm.com/covid-19-pregnancy-breastfeeding/ 

• https://www.michigan.gov/mdhhs

How to Navigate Michigan Midwifery Licensing

Michigan Midwifery License

What is a midwife in Michigan, now that we have licensing? The long debated licensing has passed and now you don’t know what to ask or how that affects you. Hopefully this will clear some of that up!

As of August 1, 2019, you need a license to work as a midwife in the whole state of Michigan. The licensing process is fairly easy if you have all of the requirements needed. 

How to Obtain Midwifery Licensing 

A midwife must be a graduate of one of the MEAC recognized institutions in order to be recognized by midwifery licensing standards within the state of Michigan. There are currently only eleven MEAC accredited programs in the United States. These schools are listed below.  

• Bastyr University, WA

• BirthWise Midwifery School, ME

• National College of Midwifery, NM

• Nizhori Institute of Midwifery, CA

• Birthingway College of Midwifery, OR

• Florida School of Tradition Midwifery, FL

• Midwifery College of Utah, UT

• National Midwifery Institute, VT

• Southwest Wisconsin Technical College, WI

• Mercy in Action College of Midwifery, ID

• Commonsense Childbirth School of Midwifery, FL

Why was MEAC Accreditation Chosen?

MEAC accredited schools offer many benefits to midwifery students. They offer a didactic curriculum that is standardized among these institutions, there are internal boards to maintain order among students as well as an MEAC committee for overseeing all their accredited schools. 

In order to meet MEAC standards, an institution must comply with the following guidelines. 

• Measures the students success with respect to the schools mission;

• Bases its course of education on nationally recognized standards;

• Utilizes qualified faculty for its didactic and clinical education;

• Maintains appropriate facilities, equipment, supplies, and other resources

• Practices sound financial management;

• Provides appropriate student services;

• Establishes policies and procedures regarding student affairs;

• Includes minimum lengths of didactic and clinical education;

• Has a mechanism for responding to complaints;

• Is in compliance with title IV of the higher education act, if it chooses to participate 

For further information please refer to the following video http://youtu.be/h2q3Ec_vSo4

Some of the many reasons to choose to enroll in a MEAC accredited program

For current and prospective students - 

• Serves a consumer protection purpose by providing assurance that the school or program has been evaluated and has met accepted standards established by and with the profession;

• Assists prospective students in identifying acceptable programs or institutions;

• Assures students that the school does what it promises on its website and promotional materials;

• Ensures that the education the student receives is well-rounded and comprehensive for entry level midwifery practice;

• Determines that a midwifery education program has set objectives for students who enroll, has provided services that enable these students to meet those objectives, and can in fact show that students have benefited from the learning experiences provided;

• Facilitates the process of becoming a Certified Professional Midwife (CPM) through the North American Registry of Midwives. Allows students to participate in federally-funded financial aid programs at participating schools;

• Assures students that the school continually undergoes quality-improvement process that includes both self-evaluation and feedback from peers, including other midwifery educators and school administrators;

• Improves the chance that a graduate will be able to transfer credits or degrees to another institution for further education or graduate education;

• Enhances employment opportunities for graduates in states that base eligibility for licensure upon graduation from an accredited school or program or within midwifery practices that want to see the MEAC “seal of approval.”

For practicing midwives —

• Advances the profession by promoting standards of practice and advocating rigorous preparation;

• Provides assurance to existing midwifery practices that new midwives entering the group will be trained in the essential knowledge and skills needed to be a competent partner midwife;

• Ensures consistency of skills among midwives;

• Recognition of profession within health care profession (accreditation is a piece of contemporary American professionalism);

• Fosters accountability and therefore, credibility;

• Fosters cohesion within the profession (no us vs. them);

• Access to financial aid opportunities to increase the numbers of practicing midwives; and

• Acts as scaffolding for the next generation – helps the profession to come together to share resources, develop standards, education then means that students are being trained in a forward-thinking system.

Midwifery Certification 

In the United States we experience a unique model of midwifery care. There are several midwifery credentials available for practitioners. 

The most often seen would be CPM (certified professional midwife), obtained through the NARM (North American Midwifery Registry). A CPM must recertify through NARM every three years; this is a process involving continued education credits and maintaining an active status with CPR and NRP certificates.

In Michigan a midwife must first obtain her CPM credential, and then proceed to apply for a state specific license. As of Aug. 1 2019, you need a license to work as a midwife in the whole state of Michigan. The licensing process is fairly easy if you have all of the requirements needed. You will first need a CPM credential from NARM (North American Registry of Midwives). This along with: application fees, criminal background check, good moral character questions, human tracking training, social security number, verification and certification of licensure, completion of an education program that is MEAC accredited, evidence of holding an active CPM credential, and proof of passing NARM exam. 

What has Michigan Midwifery licensing achieved?

This licensing has achieved easier access to lab work and laboratory facilities, easier access to ultrasound facilities, and has further integrated licensed CPM’s into the healthcare system. Midwives also have a defined list of medications that are within their scope to safely use out of hospital. This affords protection for the midwife from litigation of practicing medicine without a license. Prior to state licensing of midwives, Michigan was considered an “unregulated state”. This means that a midwife was not granted the ability to bill insurance companies for client compensation, along with other restrictions of practice. Being unregulated can be dangerous for both expectant parents as well as providers. Licensing has provided a definitive scope of practice for all licensed midwives in Michigan. Allowing for safer transfer of care to hospital facilities by facilitating a stronger professional standing between providers. This license also allows consumers and prospective clients to be assured that their midwife has met the minimum requirements to practice safely in this state. 

If you know me, you will be aware that I did fight against licensing of midwives in Michigan. This is because my previous experience with licensing tied the hands of midwives from providing good solid care, and in giving options to women that the medical community denied to them. I believe that our licensing, for the most part, has been done well. The few grievances I have are minor and so far have been resolved. 

For midwives who are working outside the protective measures of the CPM credential and the LM (licensed midwife), they can be charged with practicing midwifery without a license, and risk legal action. It is a felony to misrepresent yourself as a licensed midwife; these people are at risk of substantial fines, and jail time. Those working with or under an unlicensed midwife, risk the same legal ramifications as the “posing-midwife”. In essence, you are also practicing as a midwife without a license, whether you are a student midwife, or birth assistant. 

Alternative Birthing Choices 

Michigan licensing still does allow for unassisted birthing. This was an important thing for me because it allowed choice for the birthing women. I think that with self-education and self-evaluation, unassisted births are a valid choice for a family who is choosing to take on full responsibility and autonomy. I am glad that they left this choice open. I do however, feel that not all people should choose this, that this takes a highly self reliant, and well informed person to make this personal choice. 

Although my personal belief is that this should be a choice, there are people who are convoluting this, such as birth keepers, indiebirthers, and some doulas’. Essentially, any of these people, who go by different titles, will say you don’t need to have a professional present in order to safely give birth. They represent themselves to be competent in providing “midwifery-like services” without having completed any formalized or approved education in this field. While it is fine to invite them into your birth space, it is important to make sure you are not relying on them to provide any medical related assessment or management. 

Final Thoughts

In this day and age, we have so much knowledge at our fingertips that choosing the right person to attend your birth is sometimes harder, the information overload can be tricky to weed through. Knowing how it works and what questions to ask is an important part of the pregnancy process. My hope is that this information helps clarify some of the things you need to be aware of in that choice making. I would love to know if there are still things you want to know about the midwifery process, education, or licensing! Send your inquiries to simplyborn@yahoo.com 

Sources

http://meacschools.org