50+ Shades of Green

by PushGirl Friday on May 21, 2013

2013 Big Push for Midwives_PushMap

Now that we have gone EMERALD and our PushStates are immersed in 50+ Shades of Green, the Big Push for Midwives  is pleased to officially recognize INDIANA, our 28th State, making it five states in the five years since our original launch on PushDay on January 24, 2008—Maine, Missouri, Idaho, Wyoming, and Indiana.

If we look back to 2005, and add in three more states (from which activists were among the Big Push founders)—Utah, Virginia, and Wisconsin—we can look back with pride on eight states in eight years. The newly updated PushChart shows us these newly licensed states represent nearly 30 percent of the total 28 states where Certified Professional Midwives are legally authorized to practice (yes, even we can do math), in a process that began back in the 1970s.

The lessons we draw from this really hard work are that results demonstrate compromise—sometimes deeper compromise than we want—but states working together in the Big Push for Midwives are making slow and steady progress that averages out to about one state per year … slower progress maybe than Dr. Friedman might demand for labor, but steady progress nevertheless.

Green is the color of growth, hope, and new beginnings.

Our new 50+ Shades of Green PushMap makes us hopeful, not only because of all the states that are now EMERALD, but also because of all the states still represented in other shades of green. All in all, we see Pushers nationwide who are pushing for bills, developing bills, developing supporters, and watching for their time.

There is hope in the air too because we recognize that, while not all state laws are perfect, the Big Push for Midwives Campaign has become a proven resource for older EMERALD states when it comes time to defend or improve their existing laws or rules. Recent examples include Colorado, which won the right for midwives to carry and administer life-saving medications during its Sunset process in 2012, or South Carolina and Texas, both of which confronted and handily defeated hostile bills that would have crippled CPM practice in their states. Several states, including Arizona, California, and Oregon, have now joined with the Big Push while they work  on necessary revisions to their laws or practice regulations.

What’s more, we recognize that a few other EMERALD states also need to go back to their respective legislature or regulatory agency to fix problems that limit access to CPM care or limit CPM autonomy.  In all these efforts, the Big Push, a sisterhood of state activists, is there to provide support, advice, strategic planning, and love.

So, Indiana, today is your day, and this is your season! Congratulations and welcome to your new status as the 28th EMERALD PushState. We are so very proud of your hard work and successes. After a bit of PushBubbly, we are back in the saddle, picking up the reins on the campaign trail to provide strategic planning and message development for state consumer and midwife groups that are actively working on legislation to license Certified Professional Midwives. The Big Push is here for all states with laws that need making and mending! Together, we are envisioning the day when CPMs are licensed in all 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, and Guam. Standing shoulder to shoulder, we are pushing hard for legal Certified Professional Midwives NOW!

{ 6 comments… read them below or add one }

Adrienne May 26, 2013 at 12:31 am

South Carolina has not defeated any hostile bills, yet. There are now two bills in House subcommittee with the potential to dramatically alter CPM practice. Most likely they won’t go anywhere this year, but will still be very much alive in January 2014.

I’m finding the varying shades of green map confusing to read at-a-glance because the 28 legal states are in the middle of the color spectrum.


PushGirl Friday May 27, 2013 at 5:28 pm

Thank you for correcting our information. We sincerely hope the SCMA and state consumers with continue to work with us until any negative provisions get defeated, and good laws and rules substituted.

On the shades of green, thank you again, we are working on adding texture.

PushGirl Friday


Ruhiyyih Bradley July 1, 2013 at 7:01 pm

First of all, I love you guys and thank you so much for all the good work you do! I do have to offer a correction however, as I believe it is misleading to show that CPMs are legal to practice in Montana. This could lead to some frustration for, example, for a midwife who was a CPM and licensed in Vermont (where licensure is based upon the CPM credential), who later wanted to move to Montana and might expect to be legal there and easily be licensed. Unfortunately or not, this is not the case. While Montana does utilize the NARM exam as the final written componant for apprenticing midwives seeking licensure here, it is not based upon the CPM in any other regard. A midwife who is licensed here may be a CPM or not; the state is only concerned that they meet the Montana requirements. I am a student and recently did part of my clinical studies at a NARM approved out-of-country site. While the births I attended there count toward my qualifications for my school and so also towards my eventual CPM credential, the board here reviews it individually. Each birth experienced was supervised by an experienced CPM, but the board needs evidence of licensure and that licensing state must have requirements equal to or greater than the Montana requirements (such as Washington State) so none of the births were counted. Luckily I knew this could be the case before I went, so I was not overly disappointed. I think you need a 6th category for Montana, as well as some other states, where the NARM written exam may be used, but being a CPM doesn’t neccessarily mean legal to practice. This would be helpful for midwives and aspiring midwives.


PushGirl Friday July 2, 2013 at 6:16 pm

Thank you Ruhiyyah for describing one of the many challenges facing not only Certified Professional Midwives (CPMs) but mothers and families in trying to navigate the patchwork of laws governing licensure of midwives. However, in our experience, having a chart or map that put each of the different states into a slightly separate category is even more confusing to legislators and the public. The overall goal is to have 50 licensure laws that are in line with licensure laws for other professions, i.e. based on holding the professional credential, in this case the CPM. While we are not there yet, it is important to keep legislators and the public focused on that goal. Hence the map. Perhaps one day there will be 50 state licensure laws that allow the type of reciprocity available to most other health care professionals. For now, the map reflects states where it is possible for CPMs to practice legally.

Your comment also points out a problem faced in many states – standards for education or licensing that add to or are otherwise different from NARM standards. Many state consumer and midwife groups have begun work to improve state practice laws and/ or rules, joining the ranks of PushStates working for their first license law. The Big Push is a Big Tent. If you folks in Montana want to join your sisters from Oregon, California, Arizona, Colorado, Delaware, and South Carolina to work on amending your state practice laws like they are, you would be most welcome to join the Big Push and work alongside us. Get involved with your state activists and come join us.


Kristen Benoit October 30, 2014 at 8:26 pm

I would like to mention that it is misleading to state that CPMs are legally recognized in NY. This is not true. There is a route to licensure for non-CNM’s, but the CPM credential in and of itself is not recognized in NY, and there is no straightforward way for a CPM to get licensed as with other states. It should not be emerald green on this map.


PushGirl Friday November 25, 2014 at 12:59 am

Thanks for getting in touch, Kristen. We use the phrase “legally authorized to practice” precisely because many states, like New York, include other requirements or an equivalency process for CPMs. But the point is that a CPM could legally provide maternity care in that state if she met those requirements, as opposed to states where there is no avenue to legal practice for CPMs short of becoming licensed as a Nurse-Midwife or MD.


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