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The President's Pen
by Mary Ann Shah, CNM, MS, FACNM
Originally published in Quickening May/June 2003

In my January / February 2003 President's Pen, I called for a rededication of the membership to the hallmarks of midwifery espoused by this College. I would now like to go one step further and ask each of you to proactively promote our hallmarks as THE STANDARD for women's health care, one of the ACNM Board of Directors' (BOD) strategic priorities for 2003.

Before proceeding, however, I must share with you two profound consciousness-raising experiences I had during 2002. As a delegate to the 26th Congress of the International Confederation of Midwives (ICM) in Vienna, Austria and as a participant in a conference on professional midwifery and self-regulation in San Miguel de Allende, Mexico, it was both enlightening and inspirational for me to network with so many midwives and other women's health care providers who, despite vast differences in educational, experiential, and demographic backgrounds, seemed to share our high ideals.

What was most striking to me in Vienna was the level of sophistication that characterized the representatives of even the least developed nations ... in spite of the difficult working conditions that confront so many of them. The ICM delegates wholeheartedly supported the concept of evidence-based practice and endorsed an extensive list of validated knowledge, skills, and behaviors as essential competencies for midwives. Very few expressed the view that "The bar is too high. Lower it!" Rather, all agreed that we must all strive to make midwifery everywhere epitomize professional excellence.

Another insight was gleaned in Mexico when an internationally renowned physician and women's health care advocate publicly and passionately took exception to the inference that a commitment to safe motherhood, reproductive health, and the provision of safe, competent, compassionate, and satisfying care to women is the exclusive domain of midwives. After listening to speaker after speaker allude to the 'midwifery vs. the medical model of care,' he issued a provocative challenge to us, asking that we reframe the issues in terms of humanistic vs. technologic models; and, I must agree with him. It is not that we should avoid speaking in terms of the midwifery model; but, in so doing, we must be more inclusive and avoid offending those with whom we share a common philosophy. With that in mind, let us demonstrate to the world community that the ACNM's hallmarks of midwifery provide the right balance of art and science that is so integral to the 'humanistic' model of women's health care.

On the international front, we are fortunate to be represented by three ACNM Past Presidents: Joyce Thompson (1989-1993) who is in her second term as Director of ICM's Board of Management and Dorothea Lang (1975-1977) and Teresa Marsico (1993-1995) who serve as ICM's ACNM representatives to the United Nations; and, I have the honor of serving on the Editorial Advisory Group of ICM's publication, International Midwifery. In addition, outstanding consultative work by ACNM's Global Outreach team provides exemplary role modeling abroad. But, we cannot afford to sit on our laurels. We must relentlessly assert more leadership on a global scale.

At the national level, the contributions of another two ACNM Past Presidents must be gratefully acknowledged. The 4th edition of Varney's Midwifery will soon be released and, once again, Helen Varney Burst (1977-1981) will provide practitioners, educators, and students everywhere with both the state-of-the-art and scientific information essential to midwifery practice. Elizabeth Sharp (1973-1975) is similarly engaged in promoting our profession as she dually chairs the Leadership Section of the Division of Women's Health Policy & Leadership and the Ad Hoc Committee to Revise ACNM's Statement on Ethics. But, of course, what keeps us most viable, current, and relevant is the day-to-day work of the BOD, the ACNM Divisions and Committees, and the national office.

To further promote midwifery as the standard of care for women, the College is becoming more proactive in taking stands on controversial topics. Press releases, position statements, peer reviewed papers published by our very own Journal of Midwifery & Women's Health, and consumer-oriented materials (most notably, Every Baby) are among the strategies being employed prolifically to better communicate the risks and benefits of selected health options for women. However, individual CNMs and CMs must continue to document their care, interventions, and outcomes and must produce more scientific evidence that confirms what we all know to be true: that competent midwifery care is usually coupled with minimal interventions, good outcomes, and satisfied consumers. We must also improve our image as safe and competent practitioners by educating the public-at-large about what we can uniquely offer them. The latter may require a costly media blitz; however, it may be a necessary investment in the survival of our profession.

In the final analysis, our practices must command the respect of those we serve, those with whom we serve, those who wield the power, and those who control the purse strings. It behooves us to carve out a niche for ourselves, both individually and collectively - one that gives us a voice in the hierarchical decision-making within the institutions and communities where we live and work. We must form powerful and collegial alliances with those who share our conviction that midwifery care is humanistic care and that its hallmarks set the gold standard of care for the women of the world.