March 31, 2020

Dear Mayor Bowser,

We are writing to request emergency action to increase accessibility for District families seeking care from a Certified Professional Midwife (CPM) during the COVID-19 crisis. The Certified Professional Midwife Act of 2019, which was passed unanimously by the Council on March 3rd, 2020, is currently under your review. Pending your signature and approval by Congress, the law is to come into effect on October 1, 2020. Unfortunately, COVID-19 is a crisis right now already claiming over 2100 lives in the United States while continuing to threaten the health of pregnant people and their babies. The District must immediately grant licensure to Certified Professional Midwives to practice within their full scope without waiting for appropriations.

The rapid spread of COVID-19, as well as subsequent quarantine measures, has led to an unprecedented surge in birthing people seeking out-of-hospital (OOH) birth in the DC Metro Area. By licensing CPMs immediately, you can reduce the burden on DC hospitals and increase available hospital beds. This moment of crisis has created a situation where two of the following scenarios are likely to intersect: 1) healthy pregnant people wish to avoid hospitals in order to minimize the risk of COVID-19 exposure to themselves and their newborns, and 2) hospitals’ diminished capacity to care for Labor and Delivery patients in the face of vastly increased admissions due to COVID-19. Policymakers must ask themselves which health care providers will assume care of these families in this scenario?

CPMs are currently collaborating with each other and with DC Area hospital providers to ensure that all transfers and delivery of care are safe and accessible to families eligible for this option. As frontline healthcare providers, CPMs are in need of adequate personal protective equipment (PPE) to ensure the safety of ourselves and the families we serve. As you know, PPE protects both the wearer and those around them from the transmission of various infections, including COVID-19. There is a shortage of PPE at this time. CPMs in the District have no official access to PPE as it becomes available. We are small practices and the only way we can obtain PPE is to buy what we can in small quantities from stores or the small (and overwhelmed) midwifery supply companies that we usually rely on or to request that our broader communities share what PPE they have. We are asking that you classify OOH midwives practicing in the District as emergency personnel so that we may be included in the roll-out of any PPE that the District has, once it becomes available.

In regards to the issue of accessibility, to date, this is limited to families that have the financial resources to pay the out of the pocket cost for OOH care. Certified Professional Midwives are the only health care professionals trained specifically in the management of out-of-hospital birth clients. The 35 states that legally authorize CPM practice are better prepared for the imminent need to attend home birthing mothers in their states. Healthy women (in defined risk categories) achieve excellent outcomes with low-intervention for planned OOH birth (https://www.ncbi.nlm.nih.gov/pubmed/24479690).

We are here ready to work and serve the families in need at this time. We deeply appreciate all of the hard work you, DC Health, and the City Council are doing to keep the people of the District of Columbia safe.

Collectively Signed,