Illinois became the 36th state to allow for CPM licensure in 2021, with the stated route to licensure as graduation from a program accredited by the DOE-recognized Midwifery Education Accreditation Council (MEAC). However, no such program currently operates in Illinois. To address the CPM education gap in Illinois, Holistic Birth Collective (HBC) proposed the establishment of a new Career Technical Education (CTE) Associate of Applied Science program within the City Colleges of Chicago (CCC) system. As envisioned, this nationally-accredited educational program will meet the new Illinois statutory guidelines for licensure as a midwife (LCPM) and national requirements for the Certified Professional Midwife (CPM) credential.
Since early 2022 HBC has been in talks with Chicago Community Colleges as an implementing partner and educational institution that will house the CPM program. HBC will provide support and direction to the implementing partner as they complete the new program application and approval process. As such it will cover the development criteria used by the CCC system for review of new programs outlined in the Illinois Community College Board Program Approval Manual. HBC will be the central coordinating organization driving the development and launch of the Licensed Certified Professional Midwifery program and taking the steps necessary to put this plan into action.
The Certified Professional Midwife (CPM) credential was created in response to a national need which was not being filled by obstetricians, nurse-midwives, or other maternity care providers – that of a midwife focused solely on people with healthy pregnancies planning to give birth at home or in a freestanding birth center. Known as Licensed Certified Professional Midwives (LCPM) in Illinois, CPMs work within the community; their education is distinct from nursing, by focusing low risk, out-of-hospital midwifery care and incorporating elements of doula, lactation consultant and birth assistant training.
The CPM is often confused with the Certified Nurse-Midwife (CNM). Although the two professions share the designation “midwife,” each has a unique educational pathway with separate national accreditation and certification agencies; they are regulated in the state by different professional boards under separate licensing acts, and have overlapping but not identical scopes of practice. CPMs undergo clinical and didactic training to prepare them as specialists in the provision of maternity care in community settings. The program that Holistic Birth Collective (HBC) envisions would prepare students to qualify for the national board exam for the CPM credential and meet all requirements to obtain their Illinois midwifery license.
There are currently no accredited Certified Professional Midwifery education programs in Illinois although this is specified as the route to licensure per state statute (2021). There are only nine accredited CPM midwifery programs in the entire US that are currently accepting new students. The closest is located in a technical college in Wisconsin, but in the rural southwest corner of the state far from Chicago. Tuition at accredited programs can be prohibitive, ranging from a total of $12,100 for the National College of Midwifery Associate Degree correspondence program to $27,938 annually for a 3-year Masters-level program offered by Bastyr University. Students in many of these programs are not eligible for Title IV funding, FASFA or Pell grants, as some programs are not degree-granting, and only the midwifery programs at Southwest Wisconsin Technical College and Bastyr University are housed within regionally-accredited college systems, thus limiting the articulation of credits obtained.
The CPM program in Chicago Community Colleges will fill this educational need. In comparison to the programs offered at private proprietary schools of midwifery, the credits within the state community college system articulate with those of all accredited universities, the CCCs are degree-granting, students are eligible for loans and grants, and their programs fit the description of “affordable and accessible.” Students can enter without prior college credits and achieve licensure in two years. LM programs attract adult learners, particularly those who have prior experience as doulas, childbirth educators, or Community Health Workers. Kennedy King College, which already offers allied health programs, has the commensurate infrastructure needed for support of the general education, health-specific and laboratory courses incorporated into an LM program.
In its 2018 Illinois Maternal Morbidity and Mortality Report, the Department of Public Health reported that Black women were 6 times as likely to die from a pregnancy-related condition as white women, and that in Illinois, 72% of pregnancy-related deaths and 93% of violent pregnancy-associated deaths were deemed preventable. IDPH also found that between 2016 and 2017, Black women had the highest rate of severe maternal morbidity with a rate of 101.5 per 10,000 deliveries, which is almost 3 times as high as the rate for white women.
The area where we propose the CPM Program is in Illinois Hospital Regions A-3 and A-4 on the South Side of Chicago. As you can see from this map (Figure 1), residents in this area are 75%-97% Non-Hispanic Black.
Not only does this area have one of the highest maternal mortality rates in the state, this area also has the highest infant mortality in the state (see Figure 3).
Kennedy King College (KKC) students are over 90% Black and Latinx.
Figure 2. Student enrollment by race and Ethnicity Malcom X and Kennedy King College, FY 2021 | Not displayed: American Indian students [KKC = 0.2%; MXC = 0.1%] and Hawaiian/Pacific Islander students [KKC = 0.1%; MXC = 0.1%] | Source: click here
Contributing to the sobering maternal mortality statistics for Black women in Illinois, is the fact that the South Side of Chicago is a perinatal health desert in dire need of perinatal health care at the community level. Since 2016, the south side of the city has lost four of its OB units as well as two in the suburbs. Dr. Amanda Bennett (presentation from March 17, 2022) reports that the OB units that closed in 2016-2021 accounted for 27% of the delivery volume in South and Southwest Chicago.
In the maps (Figures 1 & 3) we include Malcolm X College on the North Side of Chicago, because in 2016 the Chicago City Colleges migrated all allied health programs to the north side of the city in Malcolm X College, creating racially stratified opportunities within City Community Colleges while ignoring the racially segregated nature of Chicago, and thereby creating additional human resource barriers for this perinatal health desert on the South Side. HBC believes the Licensed CPM educational program should be located in multiple sites, especially schools in the CCC system that are in neighborhoods with inadequate health care on the South Side such as Kennedy-King or Olive-Harvey as the first site.
The 2021 State of the World Midwifery Report is a call to action for investment to grow the midwifery workforce in populations that need it most. Additionally, growing the CPM workforce aligns with JHPIEGO’s work on task shifting that “has been adopted extensively around the world in an effort to expand the reach of lifesaving services to the women, newborns, and families who need them.” According to JHPIEGO, task shifting is ideally “considered as a part of the larger health system that needs to be designed to equitably meet the needs of mothers, newborns, children, and families.” With the recent Momnibus and the White’s House’s newly released Blueprint for Addressing the Maternal Health Crisis there is no better time in the US for task shifting utilizing CPMs.
Black midwives and Black midwifery students report racism in schools, apprenticeships, accreditation systems, and conferences, and have said that the CPM community is unsafe and unwelcoming for them. This has been documented in writings by BIPOC midwifery students, such as “Owning the Shadow: White Patriarchal Culture in the Preceptor and Student Relationship,” the Black Student Midwives Speak series, and many others. Keisha La’Nesha Goode’s dissertation “Birthing, Blackness and the Body” also highlights several of these dynamics. Our program aims to build a cadre of BIPOC midwives with shared lived experience to reduce the racist harm BIPOC midwifery students face and to create a space of learning where BIPOC midwifery students feel a sense of belonging and thereby thrive.
Dill and Duffy (2022) examine health care work as “a critical arena in which Black women are located at the intersection of racism and sexism” and wherein the career trajectory of Black women in the US is determined by structural racsim tracing back to slavery. They show that Black women are overrepresented in healthcare jobs in the US workforce when compared to women of other races. Within health care jobs and when controlling for education, marital status, age, or immigration status, Black women are disproportionately more likely to be in low paying, high risk and labor intensive occupational health care categories such as licensed practical nurse or aide as opposed to higher paying categories such as RN, physician, advanced practitioners, therapists or technical health workers. Our CPM Licensed Certified Professional Midwifery Program will build career ladders and address racism in the healthcare pipeline by building career ladders for Black and other BIPOC professionals currently mired in low paying healthcare jobs.
The long term impact we seek is higher racial, cultural and social concurrence of care resulting in improved outcomes for Black birthing people. Many studies show Black healthcare providers increase access to healthcare for Black communities, reduce race-based health disparities, spend more time with Black patients, and earn the trust of Black patients more effectively than White providers. One study found a 50% reduction in perinatal mortality when Black babies are cared for by Black doctors. Many Black healthcare providers have named how midwives specifically have been crucial to Black community health throughout US history. Jennie Joseph has data showing dramatic reduction of health disparities in Black families using her model of care. HBC’s CPM program will address racism in the system that perpetuates poor outcomes. Only about 2% of all contemporary midwives in the United States are Black (Vedam et al, 2019).Our community birth worker to CPM pipeline program will increase the number of racially, culturally and socially concurrent CPMs working in their communities and inturn will improve outcomes for BIPOC people seeking care.
