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The President's Pen
by Katherine Camacho Carr, CNM, PhD, FACNM
Originally published in Quickening September/October 2004

As my term as president of ACNM unfolds, it is a very challenging time. The massive changes in the health care environment have produced many pressures on midwifery practice, education, administration, and research. Problems with obtaining affordable professional liability insurance have risen again and are impacting almost all obstetrical care providers, especially the CNMs/CMs practicing outside the hospital or in private practice. Regulatory change and consensus building within advanced practice nursing threaten to pull us into closer alignment with APNs. Obstetrical practice has become more and more technology oriented and the American College of Obstetricians and Gynecologists supports the notion of elective Cesareans, while CNMs/CMs are curtailed from attending vaginal births after Cesarean in many circumstances.

Midwives must feel like salmon swimming against the current of mainstream obstetric-gynecologic care, which is becoming more focused on interventions and increasingly litigious. What are we to do? We must, first and foremost, maintain a midwifery model of care in this country, holding onto the hallmarks of midwifery and strengthening our commitment to all women and "keep swimming." We must articulate the unique aspects and benefits of midwifery care for childbirth and women's health care through our research, public relations and marketing efforts. We must continue to make midwifery available by advocating for policy change and participating in the legislative process.

To accomplish our strategic priorities, ACNM needs to remain a strong and focused organization with a unified purpose while we represent a diverse membership. ACNM must continue to identify and serve member needs. As a profession, we have some important questions to ask ourselves, some important decisions to make, and some critical actions to take. How can we better serve women and infants in the changing health care environment? Do we continue to straddle the two worlds of advanced practice nursing and midwifery? How can we create synergy in our efforts to become accepted, even preferred, care providers for women? How can we work with other professional midwives to strengthen our common profession and meet the needs of women in this country and the globe, where safe motherhood, child survival and HIV/AIDS are even more important issues? How can we change our workforce and add more women and men from under represented ethnic and racial groups? How can we support our education programs and nurture our student midwives and new graduates? I promise that during my tenure we will be asking these and other important questions, as well as seeking the advice, expertise and assistance of members to create an action plan and move forward.

In 2003, the ACNM Board of Directors, under the leadership of Mary Ann Shah, established the following 11 strategic priorities (presented in alphabetical order, not order of importance):
· Advance and sponsor activities that develop business and leadership skills for midwives.
· Assess and evaluate the need for restructuring the organization to meet evolving membership needs.
· Expand capacity for grass roots activities that support the practice of midwifery.
· Expand leadership in women's health locally, nationally and globally.
· Expand membership opportunities, participation, recruitment and retention.
· Identify and address barriers to midwifery education.
· Promote and disseminate research that provides quantitative and qualitative evidence, which supports midwifery practice and education.
· Promote marketing and image building strategies.
· Promote the hallmarks of midwifery as the standard for women's health care.
· Pursue legislative remedies that address barriers to practice with a focus on Medicare reimbursement.
· Strengthen coalitions around areas of common concern with consumers, physicians, midwives, nurses and other groups.

While the strategic priorities are ambitious, the current Board of Directors, led by myself and the capable ACNM staff, are committed to moving them forward, using membership dollars wisely. The ACNM BOD, division chairs and other leaders of the College will meet this fall/winter to again strategize how we can best accomplish these goals. Of course, everyone's help is needed to accomplish these goals. There is too much at stake for these to be empty promises.