Your legislator wants to hear from you.  Legislators like to know what you're concerned about and they have issues that mean a great deal to them.  It's important then to understand what your legislator cares about, so you can tie home birth to those issues and connect with him or her more effectively.

 

      This can be done by a few birth advocates, or through an organized campaign in your state coordinated with your state midwifery organization, Friends of Midwives groups, birth networks or other relevant organizations.  Even if a campaign is not underway, try to reach out to those advocates in your state who understand this issue and your legislature for more insights.  In states with active CPM licensing legislation efforts under way, it is really important to be part of the team, so overall strategy can be coordinated. To find activists in your state, go to CfM's state by state pages or contact CfM directly.

 

      This section of the tool kit includes suggestions from CfM. Use what works for you in your state. We have included links to additional resources with tips and suggestions for influencing your legislators.

      You can stand up for homebirth choice whether you had one or not.  This action is NOT about the homebirth experience. It IS about retaining our individual ability to decide where we will give birth and to not be penalized for exercising it. 

 

      We know that you understand the importance of this issue, but the more you know the better. Take the time to read the articles in the Important Information page, the Talking Points, and the materials we recommend including in packets for legislators.  If you decide you need to know more, check out the Resources page.

 

     Along with the key message points, briefly telling your story about why this issue is important to you can be very powerful.  However, if you had or are planning a home birth:

• DO NOT focus on how wonderful your "experience" was, since that tends to be one way the medical groups dismiss us (with the assumption that we put "experience" over safety.)
• DO explain that you chose a midwife-attended home birth because this is a health-promoting choice, and make it clear that you made this choice consciously with plans should the hospital be needed. 

      Whether or not you had or planned a home birth, or even if you would never make that choice for yourself, DO explain why it is inappropriate and dangerous for the medical trade associations to be controlling these decisions for anyone.

 

      Don’t hesitate because you think you don’t know enough, or don’t have time to communicate in depth and detail; even a brief handwritten letter gets attention.  The idea is for legislators to hear from a lot of us, because they are certainly hearing from lobbyists for ACOG and AMA and their state chapters.

 

PAGE CONTENTS

•    How to Find & Reach Your Legislator
•    Tips for When & Where to Talk to Your Legislator
•    Tips for How to Talk to Your Legislator
•    Framing the Issue
•    Follow Up
•    To Learn About Your State
•    Advocacy Resources

 

 

How to Find & Reach Your Legislator

• To identify your state (and federal) legislators, and candidates running for election, go to Project Vote Smart and enter your zip code. Keep in mind that zip codes and Districts don’t overlap perfectly, so you may need to double check if you get more than one name for a particular office.
  
• Project Vote Smart includes legislators’ (and candidates’) complete contact info, their official websites, and some info about campaign finances, positions, and votes (can be useful, but can also take up time).
• Use the "Find Your Elected Officials" tools for the American Public Health Association for information about their positions on health related issues.
• To set up an appointment, call the legislator’s District Office nearest you and ask when might be the soonest time you can meet with your legislator or a member of the staff about important issues regarding maternity care.  If you are a constituent, say so; also know your legislator's title and use it!

 Return to Top

 

Basic Tips For When & Where To Talk To Your Legislator

• The best way to make friends with your legislator is to help with their campaign, even a little.  Then go see them as soon as possible after the election.
• To get your legislators' attention, visit them in the District offices rather than in your state’s capitol or in Washington, DC. 
• Talk to an aide who works on health care issues, if your legislator is not available.
• Try to reach them before the legislative session begins. 
• Talk to one or more of the candidates for the legislative office, also either before Labor Day or after Election Day, especially if you know your legislator is retiring or the seat is likely to change hands.
• Start with your own legislator(s) and/or their staff – state and federal.  They are most open to the concerns of their own constituents. 
• Once you have met with your own legislators, you can identify and target other key legislators in your state – the chairs of the various state legislature’s committees that oversee health issues, leaders within the legislature like majority and minority leaders and whips (for each house), and if possible the governor’s office.  To be effective, find one or more constituents of those legislators and bring them up to speed on this issue if they aren’t already. Ask them to make appointments with the target legislators; go to the appointment together where the constituent will introduce you and essentially tell their legislator they want him/her to listen to what you have to say.
• Once you have connected with legislators, you may want to meet with folks in the health department and possible allies, primarily nursing/midwifery Boards or organizations that comment on possible legislation, plus those who work on women’s health, maternal child health, and reproductive health (where productive).
• Check out the APHA's "Tips for Making a Visit to Your Policy Maker" pdf

 

 Return to Top

 

Tips for How to Talk to Your Legislator

Before you go, think through your approach. Assume your legislator trusts doctors!  Ask yourself: 

• What issues are priorities for your legislator?
• What legislation did he/she introduce and/or help pass in the last year or so?
• What committees is he/she on? What positions does he/she have on women’s health, reproductive rights, fetal rights, the medical profession? (some of this can be found through Project Vote Smart and the APHA website.)

Use some of this information to start the conversation in a friendly, appreciative way that aligns you with the legislator; he/she will be much more open to your message if you start this way. You want your “audience” to be really interested in the issue and ready to learn more about it; if you find yourself just slinging facts and figures, it probably is time to pay attention to what else is going on and ask more questions and listen! Also:      

• Know your legislator's title and use it.  
• Identify yourself as a constituent (if you are).
• Arrive on time and bring at least one or two other people with you if possible; have one person take notes so you know what to follow up on, etc.  
• Look neat and somewhat professional.
• Connect the home birth issue to issues and positions that your legislator already cares about (see “framing the issue” below) and to his or her District. 
• Ask open ended and clarifying questions to draw out the legislator (for more on this, read Keys to the Art of Persuasion).  Examples: What would you think if… ? How do you make decisions about bills?  What are your thoughts on this? etc.
• Use suggested language to help present and convey the Key Message ideas.
• Listen carefully and notice body language so you can address concerns and fears.
• Ask if he or she has been approached about this issue and what they think about the issue.
• Speak calmly, don't overstate the case, don't exaggerate, and don't be argumentative or confrontational.  DO NOT rhapsodize on your birth experience. Do focus on your decisions and how your choices promoted your and your baby’s health.
• Be prepared to answer questions and be willing to say "I don't know, but I can get back to you on that." Then do.
• Make it clear that you are not attacking doctors, but their lobbyists.
  
• Make your case in clear, simple language (preferrably in under 5 minutes) and be explicit about what you want the legislator to do.
  

 

  Return to Top

Framing the Issues

• Framing means presenting your issue in a way that will interest the person you are talking to. Use everything you know about the legislator’s interests and passions to get them interested in this issue.  Here are some ideas for how you might accomplish this:
  
  
• For a legislator who has strong environmental interests, home birth with a midwife is a “green birth”; ACOG and AMA would limit our ability to give birth safely in a way that is also kinder to the environment than a hospital.
  
  
• For a legislator who strongly supports family values, home birth with a midwife strengthens the family by closely involving family members in their home, while also promoting healthy mothers and babies.
  
  
• For a legislator who works for women’s rights, this can be a reproductive rights issue.  And so on.
  
  
• You can use this knowledge to open the discussion while acknowledging the positive work of the legislator. For example:
  
• “I really appreciate all the work you put in on XX bill. Like you, I believe that , or I’m concerned that ….
•  I’ve become aware of a similar problem – similar to xxx, people are being harmed with poor quality maternity care, and I’d like your help to address this…”

• Most legislators are very aware of budget issues in their state. You can prepare ahead of time with useful information about health care and maternity care costs in your state. See "to Learn About Your State" below.
  
  
• Introduce some of the alarming facts with phrases like –
  
• Did you know that….?
  
• I was upset to learn recently that…
• The latest report/study/data show some trends that are alarming…
• I know it is hard to believe, but in today’s maternity care clinical practices are not based on science, and women and babies are being harmed as a result. One of the problems is that AMA and ACOG lobbyists are…
• In fact, they are even working to keep out anyone but themselves from being in charge of maternity care, regardless of the evidence! Is that what we want in our state

• When the legislator acknowledges that there might be a problem, that is your opportunity to say what exactly, you want the legislator to do.  You can say something like: so here is how you can help women and families in our state…” The main point is that you don’t want to just go in and complain, you want to be clear about what you want the legislator to DO, and ask him/her to do it.  Some examples would be:

• "I'm asking you to question the agendas of the AMA & ACOG (and their state chapters), and be skeptical about the motives and evidence used by medical lobbyists."
• Please consult with all stakeholders when crafting health policy, expecially maternity care policy.
• Please stand up for policy based on scientific evidence, not what the medical trade union "believe."
  
• "Take the time to look closely this issue and investigate why our outcomes are so poor -- we need healthier moms and babies, and it's not happening now."

 

• Use “I” statements:  When I hear (that AMA and ACOG are working to get rid of midwives, I feel really angry, but I want to do something constructive …

• Use questions:  What if…?  What do you think when you hear these statistics?  Given this problem, what would you like to see happen? What can you do to address this problem? Etc.

• Relate the issue to the legislator’s overall responsibilities as a legislator:Bring up all the info about ACOG & AMA and put it in terms of “I am your constituent and need your help on this.”
•  "Women are going to choose home birth regardless, so it is important to make sure they have well-trained attendants."  
• "ACOG and AMA are going after home births because it is a challenge to their market share and control over maternity care, not because they are actually unsafe etc."  
• "With all the problems surrounding maternity care outcomes, why are ACOG & the AMA targeting less than 1% of births?"

 

 

• Relate to problems and offer solutions:When thinking about framing an issue for a targeted legislator, you have to think like the legislator, stand in their shoes, figure out what is THEIR problem. This might be related to committees they sit on, or bills they have initiated or supported.  Some examples of possible problems and solutions to bring up:
  
  
• Problem -- Are poor outcomes and high mortality of interest to, or perceived by your legislator to be a serious problem? Then you can acknowledge that this is a problem, even though most births take place in hospitals with doctors, and bring up your ideas for a solution...   The Midwives Model of Care results in fewer interventions and improved outcomes.
  
  
• Problem -- Most legislators are really concerned about the economy, and the fact that in hard times less tax revenue is coming in.  You can offer a solution that increases health and decreases costs for the state.  Find out how much your state government is paying out for Medicaid births, and suggest the savings if just some of those women didn't have cesareans. Over 40% of births paid by Medicaid, and costs are increasing. Solution -- Midwifery care and the Midwives Model of Care can help keep costs down, while improving outcomes, by reducing unnecessary interventions, improving patient education and nutrition, and increasing breastfeeding rates.
  
  
• Problem -- Is your state suffering from a shortage of OBs? Many doctors are leaving obstetrics, and costs for training new doctors are very high.  Solution -- midwives cost less to train and will reduce costs and improve outcomes.
  

• Relate to other issues that the legislator cares about.  Some examples include:
• Costs -- Planned home birth is far less expensive and less likely to lead to infections, medical errors and the ongoing health problems caused by high cesarean rates.  Profit incentives in hospital-based health care also have an impact -- see Susan Hodges article on the Effects of Hospital Economics on Maternity Care.
• Breastfeeding -- Nearly all mothers who give birth at home breastfeed their babies, which promotes healthy babies.  Not only do they tend get much more effective support for breastfeeding (and are less likely to be handed sample supplements), they are better educated about the effectiveness of breastfeeding.  Most importantly, they are less likely to be subject to unnecessary medical intervention that can interfere with breastfeeding.  Also homebirth moms are more likely to breastfeed longer, reducing the many risks associated with formula feeding.
  
• Reproductive Rights (only when this would be effective) -- Reproductive choices don't end with the decision to continue a pregnancy to term, but include where, with whom, and how to give birth.
  
• All Hazards Preparedness -- We need to ensure that women have a safe place to give birth with qualified experienced attendants during an emergency.
• Environmental Concerns -- Healthier birth, especially home birth, reduces the excessive use of medical products, increases breastfeeding rates, and decreases the carbon footprint.
• Other Options:
• Parental Rights
  
• Equal Access to Appropriate Care
  
  
• Some effective phrases include:
  
• "This may seem hard to believe, but …"
• "Even though childbirth has been made into a very medical event, it actually is a normal healthy process and medical interventions are rarely needed"
• "The medical lobbies like the AMA and ACOG …"
• "I wanted a healthy baby and I wanted to be healthy enough to take care of my baby."

Follow Up:

• If the legislator/aide asks for further info or needs clarification on anything, provide it as quickly as possible after the meeting. If you cannot find the information in the resources section, please do not hesitate to contact Citizens for Midwifery with the question.
  
• Everyone likes to be thanked, and legislators and their aides are no different.  Thank them while you are there and take a few moments to write a letter after wards to thank them for meeting with you.
• In your letter, reiterate only your primary message, and offer to answer any further questions they may have.  “Please consider us a resource as you work on this issue” or something like it is a good way to conclude. 
  
  

To Learn About Your State

• Get a “Complete Snapshot” from the State Summaries Data Viewer of the March of Dimes Peristats website
• Take a look at the March of Dimes “Healthcare Costs of Having a Baby” which breaks down costs by type of payment and region
• Know the status of Direct Entry Midwives in your state
• Know whether midwifery legislation is pending
• Try to do some cost research on HCUPNet

  Return to Top

 

Advocacy Resources

•  Communicating with Legislators from CfM
• The Big Push for Midwives
  
•  Keys to the Art of Persuasion from CfM
•  American Public Health Association Advocacy Tools: Tips for Making a Visit to Your Policy Maker and Hill Visit Do's and Don'ts (can apply to state legislative visits as well)

TOOLKIT CONTENTS -- Main Sections

• Introduction to the CfM Tool Kit to Stand Up for Home Birth
  
• Important Information -- About AMA & ACOG, Safety, & Rights
• Main Talking Points
• Contacting & Communicating with Your Legislator
• Resources -- AMA & ACOG Statements, Responses, Research, etc
• Making the Case -- Sample Language for Letters, Phone Calls, and Meetings
• Simple things you can do
• Problem Legislation to Watch Out For
• Materials for Packets -- Midwives Model of Care Folders are now available!

 

 Do you find this information useful?  Learn more about CfM and consider Joining CFM.