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

As reported in the September/October 2003 issue of Quickening and on ACNM's website www.midwife.org, the status of H.R. 2980, the Medicare Payment Update for Certified Nurse-Midwives Act, remains in limbo. Passage of this legislation has become one of the ACNM's strategic priorities, not only because it would increase the availability and quality of care for women with disabilities, but also because it would pave the way for more equitable fees for midwifery services across the board. While our Medicare reimbursement rate is only 65% of the physician fee schedule - a totally incomprehensible and infuriating reality, especially since nurse practitioners and physician assistants receive 85% allocations - our current goal for CNMs and CMs is 95%.

The ACNM Political & Economic Affairs Committee (PEAC) and the national office staff are to be highly commended for their unyielding efforts to achieve increased reimbursement for midwives. And, all of you deserve to be congratulated for your sustained grass roots efforts. So many of you have deluged your congressional representatives with telephone calls, personal visits, E-mails, and letter campaigns that we are finally becoming a force to be reckoned with on Capitol Hill. ACNM's Regional Representatives have even thrown down the gauntlet by issuing a Medicare Challenge among the six regions of the College - and the response is intensifying. In addition, many of you have dug deep into your pockets to help subsidize the recent hiring of a CNM to focus solely on advancing our legislative agenda; for this, we owe you a deep debt of gratitude. While no one can accuse us of not giving this our all, we cannot afford to let down our guard for a minute!

What occurs to me at this juncture is that our 'friendly persuasion' of the nation's legislators must intensify exponentially in the days ahead. In so doing, we need to be able to credibly respond to the 'why CNMs and CMs' queries. The answer is simple. Women with disabilities desperately need health care providers who will care for them competently and compassionately and advocate for them vociferously and passionately. Put very simply, they are a group with very few visible champions and we are a group dedicated to the service and advocacy of vulnerable populations.

So, what's stopping us from aggressively recruiting women with disabilities into our practices? I suspect that some may be fearful of treading into the world of the unknown - a feeling I experienced firsthand in 1984 when I pioneered a Human Sexuality Program in New York City for youngsters with physical, mental, and sensory deficits. I remember well how unchartered the waters were then and how unsure I was of setting into action what I knew in my heart had to be done. However, through self-imposed exercises with a wheelchair, arm restraints, blindfold, earplugs, and marbles, I become more sensitized to the special needs of the disabled and began to better understand some of the frustration that accompanies the inability to see, hear, communicate, walk, or use one's hands. Over the next 11 years, I discovered that the midwife in me was perfectly suited for working with this population and that the rewards were so mutually satisfying. In 2000, I was invited to speak at the 1st World Congress on Disability in Atlanta. How honored I was to be a spokesperson for a group that society has silenced for so long!

Some among us may feel insecure about how to adapt our services to the myriad of disabling conditions we might encounter. But, truthfully, there are no rights or wrongs. Usually, it simply involves allowing the woman herself, her family members, or her caretakers to guide us in managing her care appropriately.

The March/April 2002 issue of Quickening (pp12-14) featured an exemplar of an interdisciplinary and barrier-free service. The Comprehensive Healthcare Center for Women with Disabilities at Pittsburgh's Magee-Women's Hospital recruited Cathy Caton, CNM to join their steering committee because of the expertise she had derived from her prior work with a Home-Based Gynecologic and Breast Care Program for Women with Multiple Sclerosis. She is an inspiration to us all.

Our journal has also published some excellent resources that can aid us in becoming more clinically competent in caring for women with disabilities. See Carty EM et al. 'Comprehensive Health Promotion for the Pregnant Woman Who Is Disabled.' JNM 35(3):133, 1990; Nosek MA et al. 'Barriers to Reproductive Health Maintenance among Women with Physical Disabilities.' JMWH 45(4):505, 1995; Schopp LH et al. 'Removing Service Barriers for Women with Physical Disabilities: Promoting Accessibility in the Gynecologic Setting.' JMWH 47(2):74, 2002.

Most important, women with disabilities need to become better informed about the midwifery option. Once they do, I am confident that they will clamor for access to CNMs and CMs for all of their 'well woman' health care needs - and we must be ready to receive them with open arms.