Alliance for the Improvement of Maternity Services (AIMS)

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The Maternity Information Act, enacted into law in New York State in 1989 and the Midwifery Practice Act enacted in 1992 are proof that women's advocacy and consumer groups can win against tremendous opposition if members of the groups understand the importance of their active participation in the effort. If you would like to you learn how to shepherd a bill through the legislative process read "Working with Other Consumer Groups to Get a Bill Enacted into Law" below.


The Maternity Information Act was enacted in the State of New York in 1989 to provide expectant parents and the public with information relative to the hospitals they are considering for the birth of their babies. The Act directs the New York State Commissioner of Health to require that every hospital distribute a maternity information pamphlet directly to each prospective maternity patient at the time of pre-admission and, upon request, to the general public. The format of pamphlet is prescribed by the Commissioner and contains state reviewed information giving the rate that various maternity related procedures are performed at each respective hospital and such other information as is deemed appropriate by the Commissioner. We were able to document that this information was already being collected by the State Dept. of Health but had not previously been available to the public.

The law requires hospitals with obstetric services in the New York State to make public via a State designed brochure their annual rates of:

  1. cesarean sections, primary and repeat

  2. women with previous cesarean sections who have had a subsequent successful vaginal birth

  3. deliveries in birthing rooms

  4. deliveries by certified nurse-midwives

  5. fetal monitoring listed on the basis of auscultation, external and internal.

  6. births utilizing forceps, listed on the basis of low forceps and mid forceps delivery

  7. births utilizing breech vaginal delivery

  8. vaginal births utilizing analgesia

  9. vaginal births utilizing anesthesia including general, spinals, epidural and paracervical

  10. births utilizing induction of labor

  11. births utilizing augmentation of labor

  12. births utilizing episiotomies; and

  13. mothers breast feeding upon discharge


In 1992 the New York State Midwifery Practice Act established the first State Board of Midwifery in the United States. The law (a) established midwifery as a separate profession in New York State, (b) provided an appropriate regulatory body for midwifery practice and (c) facilitated the development of four year direct-entry midwifery educational programs allowing women to be educated and licensed as professional midwives without first having to obtain a nursing degree.

Both bills were strongly opposed by the New York District II of the American College of Obstetricians and Gynecologists, the New York State Medical Society, the State Nursing Association and the State Hospital Association. Organized medicine was stunned when the women's advocacy groups won against such strong, well heeled opposition.



Having an effect on your state's legislation is not as complicated as most women assume. Many women are put off by the term "lobbying", thinking it is something men do in the interest of big business. In fact, lobbying in its purest form is the process of educating legislators as to the need for a proposed bill. While lobbying a bill may require one or two visits to the state capitol, much can be done from home.

A simple handwritten letter or note from a constituent to her respective State Representatives or State Senators carries far more weight than one might assume. Legislators are interested in issues that are popular among their voting constituencies. While trips to the state legislature will become necessary as the bill goes through the process of becoming a law, it does not require bus loads of women to do the lobbying. Above all else, it takes team work and a willingness to fight again if the bill doesn't make it through the legislature the first year it is introduced (most bills take more than one year to become enacted into law).

Bringing about changes in the law regulating maternity care does not require a huge organizational effort. It is important that you gather a core of volunteers who agree to be responsible for keeping in touch with the other consumer groups who are supporting the bill, and keeping them informed as to the progress of the bill.

When communicating with the legislators be accurate and concise. Fortunately, women have an advantage when lobbying for legislation affecting maternity care, because they have gained insights from their own experiences with childbirth.

If a legislator is going to plead your cause by sponsoring or signing on as a secondary sponsor for the bill you are proposing the following steps are recommended:

  1. Obtain a printed guide to the legislature of your state. One with photographs of the legislators is helpful. Your local newspaper editor can tell you how to get one, or call your State League of Women Voters.

  2. Organize your thoughts. Prepare a concise "Memorandum of Support" listing the reasons the bill is needed. Keep it short and easy to scan, not more than two pages.

  3. Write the bill in your own words. Don't try to sound like a lawyer - if a legislator agrees to sponsor your bill his or her aide will do that for you.

  4. Make a list of groups you think might support your bill. Send each group a copy of your proposed bill and your Memorandum of Support.

  5. Don't be in haste to send the proposed bill to the legislators. Make sure that the bill is well constructed and says exactly what you want it to say.

  6. Be realistic. Is the implementation of the bill practical? Is it likely to get through the Ways and Means Committees - what are the likely financial costs to the State if the bill is passed? Is passage of the bill likely to save the state money?

  7. Determine where opposition to the bill will come from. Try to look at the implications of the bill from the opposition's point of view and do your best to find information which will help to overcome their objections.

  8. It is essential to the success of any consumer bill that you convince those who share your concerns of the importance of letting their respective legislators know how they feel about the bill by contacting them at their home office or in the state capitol.

  9. Try to choose your primary sponsors of the bill from the leadership of both houses of the legislature. For example, if the majority of the members of the State House of Representatives or Assembly are Democrats, ask a Democrat to be the primary sponsor of the House or Assembly bill. (The primary sponsor of the bill must be willing to work for the bill's passage). If the majority of the Senate members are Republicans then ask a Republican to be the primary sponsor of your bill in the Senate.

  10. Ask the sponsors of your bill to send you copies of any letters or Memorandum of Support and of Opposition they receive in regard to your bill. Then update your own Memorandum of Support, addressing the opposition's complaints and send copies to the legislators sponsoring the bill and to those from whom you are seeking support.

  11. Keep your colleagues current and informed. Send each group a copy of your updated Memo of Support and any Memo of Opposition you receive and ask them to send copies to their colleagues. It is important that they are made to feel that they are an integral part of the effort. There is nothing like a Memo of Opposition from your opponents to keep the "troops" moving forward.

  12. When the time comes for your colleagues to contact their respective legislators, remind them that if they are not sure of the name of their respective State Senators and Representatives (or Assemblyman) they can obtain that information from their local newspaper office or League of Women Voters.

  13. Remind your colleagues that it is always best if they speak directly with their legislators. A Legislative aides may agree wholeheartedly with the logic of your bill, but the cold fact is that the legislator may be being pressured by opposing factions that are politically important to him or her. Persisting until you talk to the legislator directly will help to impress upon him or her the urgency of your concern.

  14. When the time comes to show up at the Capitol it is of utmost importance that you and your colleagues look professional - no slacks, no knapsacks, etc. While some mothers may want to take along their babies it is important that most of your colleagues be free to go back and forth between the Senate and the House (or Assembly) to speak to the legislators as they travel between their offices and legislative floors.

  15. To make the most of your colleagues' time at the legislature suggest that they prepare in advance little notes with their respective signatures which read, "May I speak with you for a moment?" The legislator's name can then be written in above the note in the same pen and handed to one of the remarkably obliging Sergeants at Arms. He or she will deliver your note to the legislator with whom you wish to speak. It is amazing how agreeable legislators are to being called from the floor to speak to members of the public in the lobby. If you have not met the legislator before, try to find his or her picture in the Legislative Guide so you can quickly identify the legislator when he or she comes to the lobby to speak with you.

As mentioned previously, much can be done by women's groups without their members having to leave home, but there are certain critical times when it may help to be near the scene of action. For example, a bill may be held up by opposing legislators in the Rules Committee of either house. The Rules Committee determines whether a proposed bill is in conflict with other laws on the books. If there is no such conflict or opposition the bill is then referred to the legislative floor to be voted on.

Sometimes a bill will be held up in the Appropriations Committee on the grounds that the implementation of the bill would be prohibitively costly. It's up to you to show that it would not be.

The bill comes to the floor for a final vote within a few days after the Rules Committee puts it on the Legislative Calendar. If your bill is passed, remind the groups who participated in your mutual effort to let those legislators who actively supported your bill know how much their efforts are appreciated.

In the successful effort to pass the Maternity Information Act the support of the following groups was absolutely essential: the New York Public Interest Research Group, the National Women's Health Network, the International Childbirth Education Assoc., the Cesarean Prevention Movement, the Black Women's Health Project and the American Foundation for Maternal and Child Health.

If you have had success in getting a patient advocacy bill enacted into law, please send us your success story and a copy of the law resulting from your efforts. Email us at:


2000 by Doris Haire, President

American Foundation for Maternal and Child Health