Australia Homebirth Video

This is a video with images drawn from a rally in Australia to protest the recent legislation that threatens to destroy homebirth midwifery:


~ we love homebirth ~

--
Molly
CfM Blogger

Maternal-Fetal Conflict

Critiques of homebirth sometimes rest on a (flawed) assumption of maternal-fetal conflict (which is also invoked to describe situations with substance abuse or other risky behavior). In the Fall 2007 issue of CfM News, Board member Willa Powell wrote about maternal-fetal conflict in response to an ABC segment on unassisted birth. She wrote:

[quoting the expert physician interviewed for the segment] "The few hours of labor are the most dangerous time during the entire lifetime of that soon to be born child. Because of this, I would argue, all soon to be born children have a right to access to immediate cesearean delivery, and women who insist on denying this right are irresponsible."

This was the only professional opinion in the program on unassisted birth, and he set up a typical expression of an obstetric community belief: the “maternal-fetal conflict.” The notion is that there are two “patients”, where the mother’s desires are sometimes in conflict with the well-being of the baby, and that the obstetrician has a moral/professional obligation to abandon the mother in favor of the baby.

I have to remind myself that Dr. Chervenak is setting up a false choice. In fact, this scenario is a “doctor-patient conflict”. The mother wants what’s best for herself and her child, but she disagrees with her doctor about what is, in fact, best. Women are making choices they believe are best for themselves and best for their babies, but those choices are often at odds with what doctors consider best for both, and certainly at odds with what is best for the obstetrician!

In the book Birth Tides, the author discusses maternal-fetal conflict:

According to obstetricians, the infant's need to be born in what they have defined as a safe environment, i.e. an obstetric unit, takes precedence over the mother's desire to give birth in what doctors have described as the comfort of her own home. It is a perspective that pits the baby's needs against those of the mother, setting 'overriding' physical needs against 'mere' psychological ones. It is rooted in the perception that the baby is a passenger in the carriage of its mother's body--the 'hard and soft passages,' as they are called. It is also rooted in the notion of the mind-body split, in the idea that the two are separate and function, somehow, independently of each other, just like the passenger and the passages. While women may speak about 'carrying' babies, they do not see themselves as 'carriers,' any more than they regard their babies as 'parasites' in the 'maternal environment.' If you see your baby as a part of you, there can be no conflicts on interests between you.

I previously linked to a book review that explores this concept of the more aptly described "obstetric conflict" in even more depth.

Tomorrow is Independence Day and I think it is fitting to remember that mother and baby dyads are NOT independent of each other. I have written before about the concept of mamatoto--or, motherbaby--the idea that mother and baby are a single psychobiological organism whose needs are in harmony (what's good for one is good for the other).

As Willa concluded in her CfM News article, "...we must reject the language that portrays a mother as hostile to her baby, just because she disagrees with her doctor."

--
Molly
CfM Blogger

Physicians & Birth

A few weeks ago, I read an older book titled Woman-Centered Pregnancy and Birth. I marked the following quote to share because I thought it succinctly summed up one of the primary issues in maternity care:

"The major problem which arose almost as soon as physicians started attending women in birth is the same problem which exists today in obstetrics: physicians use their medical techniques when they are not really necessary and their technology and practices often create more problems than they solve. It is possible to appropriately apply this criticism to nearly every form of technology which has been used by physicians on women in birth from the 1500's to the present."

I also noted an observation from the book Birth Tides: Turning Towards Homebirth: "To these people, it seems as thought the medical system has been reduced to a form of social control. [Another woman] makes the point, however, that controlling women has always been an intrinsic part of antenatal care."

I think the recent AMA resolutions I've posted about and the situation with private midwifery in Australia lend credence to the idea that the medical system is a form of social control!

--
Molly
CfM Blogger

Midwifery in Australia

As some of you may already know, legislation passed in Australia that effectively renders homebirth inaccessible and homebirth midwifery illegal. I haven't seen a lot of birth blog coverage of this distressing development, but news stories have been popping up in my Google Alerts like crazy:

Uninsured midwives face home birth ban

Tough new laws to make homebirths illegal

Law to stop midwives working outside hospitals

Fears on mid-wife impact with new birthing regulations

Maternity group slams midwife legislation

A few other international articles came to my attention recently also:

MIDWIFE CRISIS BRINGS MISERY TO THOUSANDS (UK)

Global Shortage of Midwives Deadly: WHO

Finally, I wanted to link to a recent New York Times article by a CNM about her experience during a stillbirth at a hospital: In a Lifeless Birth, a Midwife’s Opened Eyes

--
Molly
CfM Blogger

Birth Matters Virginia Video Contest Winners!

Birth Matters Virginia announced the winners of their video contest today. The first place winner was to Ragan Cohen for Prevent Cesarean Surgery:



Second place went to Laura Alvarez for The Nature of Natural Birth:



And Honorable Mention to Becky Carey for Misconception:



You can see the other finalists here.

Congratulations to the winners! What great contributions!

--
Molly
CfM Blogger

Grassroots Network: MAMA Letter-Writing Campaign

Dear Friends,

Please join the M.A.M.A. campaign effort to send an outpouring of personal letters to U.S. Senators and Representatives to their local district offices this week.

Sincerely,
Arielle Greenberg Bywater, "gatekeeper sidekick"

In this message:
A. Greetings and Background Information
B. Instructions for Letter Writing
C. Sample Letter

A. Greetings, mothers, midwives and supporters of maternity care choices!

We need all your energy and enthusiasm for our ambitious policy goals on behalf of pregnant women across the nation and the Certified Professional Midwives who can provide services to them. This is the MOMENT for action!

Just last week, the Midwives and Mothers in Action (MAMA) Campaign organized twenty midwives and consumers to visit their Congress members in Washington DC and tell them about midwifery care. This lobbying push is a vital part of the MAMA Campaign mission to increase all women's access to midwives and to quality, affordable maternity care by achieving federal recognition of Certified Professional Midwives (CPMs).

The MAMA Campaign was established by a coalition of six key national midwifery and consumer organizations.

Our immediate goal is to get an amendment into the health care bills currently moving through Congress to mandate federal Medicaid coverage for CPM services. Health care reform is at a pivotal point and we have an unprecedented opportunity to inform Congressional members about the skilled, high quality maternity care provided by CPMs and the cost savings CPMs can achieve. Congressional members are particularly interested in what their constituents are thinking.

So now we need your help …
• Please join the effort to send an outpouring of personal letters to U.S. Senators and Representatives to their local district offices this week. We've learned this is the best way to get their attention on fast-moving urgent policy issues.

• Please read further to see a sample letter you can use, and tips for writing. Your role in the MAMA Campaign is so important. Now is your chance to stand up and be counted!

Thank you for your support!


B. Writing Your Congress Members – Suggestions & Instructions

THANK YOU! Contacting your U.S. Senators and Representatives is important! Please mail your letters to their local district offices.
You'll find a sample letter below these instructions; use or adapt this language for your own personalized letter to your members of Congress. If you have any questions or need assistance please contact Evelyn deFrees, Campaign Manager (info@mamacampaign.org).

Eight points to remember when writing your own letter:

1. Ask: Please be sure to include the specific "ask," underlined in the first and final paragraphs of the sample letter (the "ask" is what you want your Senator or Representative to do).

2. Information: The second paragraph is an important part of the message. Feel free to use other words in paragraphs 3 and 4 to explain why Certified Professional Midwives should be added as Medicaid providers. See handout "Midwives and Mothers in Action: Improve Maternity Care Quality by Expanding Patient Choice"

3. Your story: A sentence or two about your "story" personalizes the letter; describe a birth or birth provider experience you or a family member or friend has had, or why you are passionate about this issue.

4. NOTE: Please ALWAYS write out "Certified Professional Midwife"; do NOT use "CPM" by itself (which is frequently misinterpreted with the more familiar "CNM").

5. CPM Facts: If you want to write about the CPM credential and/or education, please use the CPM FAQ sheet – please stick to that exact language, which has been carefully developed for this purpose.

6. Format: Neat, hand-written letters are the most effective – it shows that someone cared enough about the issue to take their time to personally sit down and write to their congress member. Typed, printed and signed letters are next best. Make sure your name and address with zipcode are on your letters as well as the envelope.

7. District Offices: Please send letters to your U.S. Senator and/or Representative's local district/state office (mail to their Washington office would take several weeks to get to them). For addresses: Visit www.house.gov and www.senate.gov ; once on these homepages, click on the search tool in the upper corners of the pages to find your own U.S. Senator or Representatives, and their websites and addresses for district offices.

8. Tell us you've taken action: Please send us a copy of your letter so we can track what policy-makers are hearing from constituents like you about the urgent need for federal recognition of Certified Professional Midwives. Please send a copy to info@mamacampaign.org or to MAMA Campaign c/o NACPM, 243 Banning Road, Putney VT 05346

C. SAMPLE LETTER for CONGRESS MEMBERS

[Date]
The Honorable [Full Name]
[Street Address]
[City], [State] [Zip]


Dear [Senator/Representative Last Name]:

Congress is now debating comprehensive health reform legislation. I urge you to ensure that the maternity care needs of millions of women and their families are addressed by your support for adding Certified Professional Midwives (CPMs)--who are licensed by their states--to the list of Medicaid-eligible providers recognized at the federal level. Health care reform must address the problems and high costs of maternity care in the U.S and ensure safe, qualified maternity care providers for all pregnant women.

Safe high-quality care: Today in many states across the country women seek safe, high-quality, health-promoting maternity care provided by Certified Professional Midwives who provide excellent childbirth outcomes with a fraction of the medical interventions (including cesarean section). I received my prenatal care and delivered my baby with the assistance of a Certified Professional Midwife and believe all women in our state and country should have this safe, cost-effective choice regardless of their income level.

Cost Effective: Pregnant women on Medicaid deserve access to the full range of maternity care providers including Certified Professional Midwives. The choice of Certified Professional Midwives is often restricted to those with private insurance coverage or the capacity to pay out-of-pocket. Adding Certified Professional Midwives to the Medicaid list would start reducing health care costs immediately.

Choice at lower cost: Childbirth is the number one reason for hospitalization in the US, accounting for $86 billion in annual expenditures in 2006. Much of that spending is driven by costly, overused and unnecessary interventions. Certified Professional Midwives can help Congress deliver on the basic goals of health care reform: preserving a patient's choice of health care provider while simultaneously improving quality and outcomes, at lower cost. Expanding Medicaid coverage to include services provided by Certified Professional Midwives is the equitable thing to do. The tremendous cost and quality advantages make it sound public policy.

Please support this important change to the law governing Medicaid so that Certified Professional Midwives who are licensed by their states are added to the list of Medicaid-eligible providers recognized at the federal level. Thank you for your time.


Sincerely,

[Your name]
[Address]
[Phone number]


Please visit the Midwives and Mothers in Action Campaign online.

Reducing Infant Mortality Film

A trailer is now available for Reducing Infant Mortality, a FREE film being made "about how our health care system is failing babies and mothers and what we can do about it." Here are some more details from the filmmakers:

The film will be out July 26th. It will be 10-12 minutes long, and is made for everyone one who wants to, to send to their representatives and senators. Our idea is that if people send the link to the film and the politicians receive many of them along with our personal messages about what kind of Health Care Reforms we want to see, we can help move toward a more humane way of bringing our babies into the world -- creating a model that includes an emphasis on skin to skin contact, bonding and breast feeding -- a model that supports the family and family connections.

The film is a carefully crafted proposal for a shift in the way we approach maternal infant medical care. Included in our proposal is the economic component, as well as the unnecessary cost of life and health. We go on to explain how the inclusion of midwives in the model makes sense on every level. It is all voiced by MDs with substantial degrees and positions, no one on the fringe, all with impeccable credentials. I believe that it helps our case to hear the words coming from people who are currently considered by the mainstream to be the experts on birth. It is, after all, the mainstream that we wish to influence. I did everything I could to make it totally credible for the fight that is happening in congress. All statistics have been researched. The March of Dimes gave us permission to use their graphics.

There are definitely a lot of experts interviewed for this film. It sounds like there are exciting plans for it to reach a wide audience.

--
Molly
CfM Blogger

Fetal Monitoring

I started to write about this in my previous post and then realized it actually belonged in its own post!

The author of Bearing Meaning spends an entire chapter analyzing Williams Obstetrics and the language of birth contained therein. In Williams fetal monitoring is referred to as an "elegant means" of "demonstrating the effect of the forces of labor and delivery on the baby's heart rate." However, as the author of Bearing Meaning (Robbie Kahn) notes, "The tracings don't record labor in a generic sense. They record it under specific conditions--the hospital...Thus, monitor tracings hardly are elegant, if elegant means imparting information at high levels of sophistication. Indeed, the monitor may be simply recording responses characteristic of a woman laboring under the conditions imposed in the hospital rather than imparting sophisticated information about childbirth in general." (emphasis mine).

This observation reminded me of Henci Goer's recent post on the Science and Sensibility blog: The Labor Environment: “Many things that count cannot be counted." In this post, she looks at a recent study published in the June issue of Birth, "gauging the effects of modifying the labor room to encourage mobility, reduce stress and anxiety, and discourage routine medical intervention." The labor environment impacts women's birth experiences in a number of ways (some that cannot be quantified for research studies) and my observation is that fetal monitoring is one of the most significant elements of the labor environment. It creates conditions for laboring women that then alters their normal, physiological, spontaneous responses to labor and thus cannot be seen as accurately reflecting the influence of labor on the baby.

Speaking of fetal monitoring, ACOG just issued new guidelines refining the fetal heart rate monitoring guidelines. The guidelines briefly refer to manual auscultation. Quoted in the release is the following comment: "'Since 1980, the use of EFM has grown dramatically, from being used on 45% of pregnant women in labor to 85% in 2002,' says George A. Macones, MD, who headed the development of the ACOG document. 'Although EFM is the most common obstetric procedure today, unfortunately it hasn't reduced perinatal mortality or the risk of cerebral palsy. In fact, the rate of cerebral palsy has essentially remained the same since World War II despite fetal monitoring and all of our advancements in treatments and interventions.'"

--
Molly
CfM Blogger

Breastfeeding Podcasts

Yesterday I discovered some podcasts on on the Motherwear blog. It is great fun to listen to podcasts while doing other work on the computer and I enjoyed finding some new ones. I listened to a thoughtful one by Penny Simkin called: Podcast: Early sexual abuse and breastfeeding. A point she makes that is that during labor if we suspect that a woman has an abuse history it isn't important to actually know if she does, she can just be treated as if she has an abuse history--and this only means she will be treated with more respect, more caring, more gentleness, and her needs are more likely to be met.

I haven't listened to any of the others yet, but I'm looking forward to all of them (especially the one about breastfeeding in the movies, which reminds me of the new film Laboring Under an Illusion that I'm looking forward to seeing):

• African American moms and breastfeeding, with Kathi Barber
• How do other mammals do it? With Dia Michels
• What's the problem with those formula company bags? With Alison Stuebe
• Starting solid foods, with Ellyn Satter
• Breastfeeding in the movies, with Sarah Rubenstein Gillis
• Low milk supply: Could it be your hormones? With Lisa Marasco
• So, you want to work in breastfeeding support (just me)
  
• Nursing in public and the law, with Jake Marcus
• Making more milk, with Diana West
• Hathor the Cow Goddess, with Heather Cushman-Dowdee
• Postpartum depression and breastfeeding, with Kathleen Kendall-Tackett
• MilkShare, with Kelly Faulkner
• The Milk Memos, with Cate Colburn-Smith

Coincidentally, I just bought The Milk Memos at the LLL of Missouri conference earlier this month. Also in my to-read pile is Diana West's other book Defining Your Own Success. I look forward to having these podcast preview from the authors while I wait to get a chance to read their books! Speaking of books, I just finished reading Bearing Meaning: The Language of Birth and I'm currently reading Sarah Buckley's Gentle Birth, Gentle Mothering.

--
Molly
CfM Blogger

Maternal-Child Health Careers Book Survey

A midwife is working a new book to help people interested in careers in maternal child health to find their best path. She is looking for survey responses from physicians, midwives, nurses, doulas, birth educators, lactation consultants, massage therapists, prenatal exercise specialists, chiropractors, naturopaths, and herbalists--anyone who works with women during the childbearing year!

If you are interested in completed her survey, click here.

--
Molly
CfM Blogger

Big Push Thank You Video

I recently posted about the launch of BigPushTube. There is a nice "thank you" video up right now that encourages the activism spirit!

Mindful Mama Videos

I previously linked to some video clips from the Mindful Mama Magazine "Rites of Passage" video project and contest. Here are some more links from Mindful Mama to some lovely and interesting videos!

-------
You're invited to participate in our efforts to engage parents in the Rites of Passage videos. Please forward these 5 links to your network and ask them to "Digg" it! If we get enough "Diggs", then hundreds of thousands of people across the US will see them! Thank you for helping us to build the "mom"entum around empowered childbirth!

The Safe Motherhood Quilt Project, Ina May Gaskin
Sarah Kraft talk to Ina May Gaskin, Certified Professional Midwife, about maternal death. Ina May is the founder and director of The Farm Midwifery Center in Tennessee (USA). She is the author of Spiritual Midwifery (1975) and Ina May's Guide to Childbirth (2003). She has been a home birth midwife for more than 35 years.

Sexual Intimacy After Birth, Elizabeth Davis
Sarah Kraft talks to Elizabeth Davis about how to keep the flame alive after baby arrives. Elizabeth Davis, Certified Professional Midwife, is co-founder of the National Midwifery Institute. She is the co-author of Orgasmic Birth (coming soon) and author of Heart and Hands: A Midwife's Guide to Pregnancy and Birth.

Asking the Right Questions, Marjorie Greenfield
Sarah Kraft talks to Marjorie Greenfield, MD, about finding the right obstetrician. Marjorie has been an obstetrician since 1987 and is an associate professor at Case Western Reserve University School of Medicine and University Hospitals Case Medical Center. She is the author of The Working Woman's Pregnancy Book.

Relieve Pain During Childbirth Without Drugs, Penny Simkin
Sarah Kraft talks to Penny Simkin about relieving pain during childbirth without drugs. Penny Simkin, Physical Therapist, co-founded DONA International and has specialized in childbirth education, labor support, and birth counseling since 1968. She is the author of many books on birth for both parents and professionals, including The Birth Partner.

Birth Models That Work, Robbie Davis-Floyd
Sarah Kraft talks to Robbie Davis-Floyd about birth around the world. Robbie Davis-Floyd, PhD, is a medical anthropologist specializing in the anthropology of reproduction. She is a senior research fellow at the University of Texas, Austin, author of Birth as an American Rite of Passage, and lead editor of 10 birth-focused collections.

Enjoy!

--
Molly
CfM Blogger

Happy Father's Day!

"Where once it was thought that the minds and bodies of men were hardly affected by fatherhood, today scientists are discovering that fatherhood changes men down to the cellular level." (emphasis mine, The Daddy Brain)

Giving birth, mothering, and fathering are tremendously significant events--biologically, individually, relationally, socially, and culturally!

I wanted to share a couple of father related links from previous posts:

My Father's Day post from last year.

Review of Pregnant in America DVD.

Review of Homebirth Dads DVD.

A post about Fathers at Birth and more about fathers at birth.

And a post that includes some information about The Father's Home Birth Handbook.

Happy Father's Day to all the homebirth dads out there! I hope you have a special day!

--
Molly
CfM Blogger

Another Interesting Attempt by the AMA

I already posted about the AMA's outrageous move regarding "ungrateful patients" (luckily, the resolution did NOT pass!). Though it isn't directly related to midwifery, I cannot help but post about the other quite arrogant maneuver also suggested recently:

AMERICAN MEDICAL ASSOCIATION HOUSE OF DELEGATES
Resolution: 605 (A-09)

Introduced by: Illinois Delegation

Subject: Removing the Word "Provider" in Reference to Physicians
Referred to: Reference Committee F (David C. Fleeger, MD, Chair)

Whereas, Physician status becomes eroded when addressed by the word "provider"; and

Whereas, The word "provider" conveys subservience, lack of independence, lack of authority, lack of decision making, lack of specialized knowledge, lack of separation from other ancillary personnel, lack of respect for the MD degree, servant status; therefore be it

RESOLVED, That our American Medical Association consider the generic terms "health care providers" or "providers" as inadequate to describe the extensive education and qualifications of physicians licensed to practice medicine in all its branches (New HOD Policy); and be it further

RESOLVED, That our AMA institute an editorial policy prohibiting the use of the term "provider" in lieu of "physician" or other health professionals for all AMA journals and publications. (New HOD Policy)

Fiscal Note: Staff cost estimated at less than $500 to implement.

Received: 05/05/09

-----------------

The most significant phrase is this, "The word 'provider' conveys subservience, lack of independence, lack of authority, lack of decision making, lack of specialized knowledge, lack of separation from other ancillary personnel, lack of respect for the MD degree, servant status..."

So, they would prefer a word that conveys "being the boss"? I think this resolution is further indication of a desired erosion of personal rights with regard to medical and health care decision making. Not only should women not be allowed to choose midwifery care or homebirth (according to the AMA), but they may also not view physicians as there to "serve" them, but instead as an ultimate authority and ruler supreme?! Hmm. As someone else on a discussion group noted, "I'm beginning to think that the ordinary citizen needs to rise up and [have a resolution] not to be called 'patients' because that implies a lack of independence, subservience, lack of authority about their own bodies, lack of decision making, lack or respect, servant status..." No kidding!

--
Molly
CfM Blogger

Birth Center Closure in Brazil

This message from a Brazilian midwife was passed along to me by Debra Pascali-Bonaro regarding the recent closure of a birth center in Brazil:

-------------------------------------------------------------------
We are in a very difficult moment in Brazil. We had our Rio de Janeiro Birth Center ( Casa de Parto David Capistrano Filho) closed today. They found a state law saying that a health institution can not exist without doctors! We know it's a politcal thing. New persons in the goverment and a big pressure for our local doctors. We have the support of the Brazilian goverment but we know that in this cases we never know what can happen.
We are pretty sure that it's time to call for HELP of our friends outside Brazil. We need emails against this attitude.We need to show the power of our movement to make birth a physiological process in a c-section country.

We are organizing ourselfs to go to the street and say we want our Birth Center back!!!
If you want more details from this wonderfull birth center go here.

Thank's alot,
We are sure that if we work hard and well, in the end we will be stronger than now.
( sorry about possible written english mistakes)

Canadian Birth Changes

The Society of Obstetricians and Gynaecologists of Canada has recently changed their position on breech birth to one of support for the option of vaginal breech birth. You can read more about in an article in The Vancouver Sun. There is some discussion about this on Uncecessarean as well as a comprehensive look at the flip-flop from Science and Sensibility.

--
Molly
CfM Blogger

BigPushTube

The Big Push Campaign for Certified Professional Midwives now has it's own "channel" on YouTube. Called BigPushTube, there are several clips already posted. One is a clip from the Congressional Briefing on the Hill May 21st '09.- -Jennie Joseph speaks on her study showing midwives improve outcomes and close ethnic disparities.

--
Molly
CfM Blogger

Breastfeeding Promotion Act

Here are some resources to help support and protect the Breastfeeding Promotion Act of 2009 (HR2819 / S1244) introduced in Congress on June 11, 2009 by Representative Carolyn Maloney and Senator Jeff Merkley.

This bill will bring breastfeeding mothers under the protection of the 1964 Civil Rights Act, require employers with over 50 employees to provide a private space and unpaid time off during the workday for mothers to express milk, and set standards for breast pump manufacture. It also will provide for tax incentives for employers that establish private lactation areas in the workplace and tax credits for nursing mothers.

Rep. Maloney's press release is here.

Advocate ONLINE:

Easy email tool from the United States Breastfeeding Committee that in 60 seconds allows you to enter your name and address including zip code+4 and have the USBC send emails to the appropriate representatives and senators asking them to co-sponsor the bill.

Facebook group that can be joined by your members to support the bill and spread the word to their friends about the above email tool and letters.

Advocate BY MAIL:

Letter that can be mailed or faxed to ask your state representatives and senators to co-sponsor the bill. (If the link does not take you directly to the letter, go to the Facebook group above and you will find it there.)

SPREAD THE WORD!!

Please forward this email to all supporters and related lists.

Grassroots Network: MAMA Campaign in Washington, DC!

Dear Friends,

Here is what the MAMA Campaign is up to! Don’t forget to go to the site to sign up for updates directly from the MAMA Campaign!

Sincerely,
Susan Hodges, “gatekeeper”


MAMA Campaign Bulletin from Washington DC

June 18, 2009

This week over twenty midwives and consumers traveled to Washington DC to visit their legislators and tell them about Certified Professional Midwives! The midwives are enthusiastically talking to key legislators about how they are part of the solution to our health care crisis. Today, the moms are passionately talking to key legislators about how the care they received with midwives gave them safe, healthy, cost-effective births.

Amber, a mom from Washington State who is in DC this week stated, “My birth with a CPM was covered by my insurance and I want to ensure that other women across the country have the same access I had in Washington State.” So we’ll be sharing how critical Medicaid and other coverage is to making the quality care CPMs provide accessible to women across the country.

Midwives and mothers who are constituents of key legislators were contacted by the MAMA Campaign over the past weekend. The response to invitations to come to DC this week­on very short notice­has been remarkable. With a few days, women found people to care for their kids, and midwives got their clients covered and dropped their lives to come and lobby their congressional members on behalf of CPMs.

Stay tuned for ways you can help too. In a few days we will be sending you information about what you can do to help the MAMA Campaign achieve federal recognition of CPMs.

Thank you for your support. Visit www.mamacampaign.org to sign-up with the MAMA Campaign and donate to the campaign.
The MAMA Campaign Steering Committee

The Midwives and Mothers in Action (MAMA) Campaign, is a partnership of the National Association of Certified Professional Midwives (NACPM), Midwives Alliance of North America (MANA), Citizens for Midwifery (CfM), International Center for Traditional Childbearing (ICTC), North American Registry of Midwives (NARM), and the Midwifery Education Accreditation Council (MEAC). www.mamacampaign.org

Grassroots Network: ICAN responds to AMA’s latest outrageous move

Dear Friends,

The American Medical Association is out-doing itself. The organization is opposing key parts of Obama’s health care reform plans, for which they are being roundly criticized even by physicians (letters to the editor in the New York Times). They are, of course, working on anti-CPM and anti-home birth “model” legislation to put into place their resolutions from last year.

But to top off their display of arrogance, the objective of a new proposed resolution seeks to punish patients who are not “compliant” with the idea that doctors should not have to put up with patients who seek to assert their right to make the final decisions on their own medical care.
International Cesarean Awareness Network (ICAN) has posted an excellent press release on this latest outrage, which I have also pasted below.

Sincerely,
Susan Hodges, “gatekeeper”



From ICAN:

AMA Resolution Would Seek to Label “Ungrateful” Patients

Redondo Beach, CA, June 11, 2009 - At the American Medical Association’s (AMA) Annual Meeting next week, delegates will vote on a resolution which proposes to develop CPT (billing) codes to identify and label “non-compliant” patients (1) [2]

The resolution complains:

“The stress of dealing with ungrateful patients is adding to the stress of physicians leading to decreased physician satisfaction.”

“This resolution is alarming in its arrogance and its failure to recognize, or even pay lip service to, patient autonomy,” said Desirre Andrews, the newly elected president of the International Cesarean Awareness Network (ICAN).

If approved, the resolution could hold implications for women receiving maternity care. For pregnant women seeking quality care and good outcomes, “non-compliance” is often their only alternative to accepting sub-standard care. Physicians routinely order interventions like induction, episiotomy, or cesarean section unnecessarily.

Liz Dutzy, a mother from Olathe, Kansas, delivered her first two babies by cesarean and was told by her obstetrician that she needed another surgical delivery. “My doctor told me that I needed to have a cesarean delivery at 39 weeks, or my uterus would rupture and my baby would die.” She sought out another care provider and had a healthy and safe intervention-free {home} birth at 41 weeks and 3 days gestation.

A recent report by Childbirth Connection and The Milbank Memorial Fund, called “Evidence-Based Maternity Care: What It Is and What It Can Achieve ,” (2) [3] shows that the state of maternity care in the U.S. is worrisome, driven largely by a failure of care providers to heed evidence-based care practices. For most women in the U.S., care practices that have been proven to make childbirth easier and safer are underused, and interventions that may increase risks to mothers and babies are routinely overused. The authors of the report point to the “perinatal paradox” of doing more, but accomplishing less.

The resolution proposed by the Michigan delegation of the AMA could threaten patient care and patient autonomy for several reasons:

• Billing codes that would categorize any disagreement and exercise of autonomy on the part of the patient as “non-compliance” “abuse” or “hostility” could create a pathway for insurance companies to deny coverage to patients
• Use of these labels fails to recognize patients as competent partners with physicians in their own care
• Tagging patients as “non-compliant” fails to recognize that there is not a “one size fits all” approach to care, that different opinions among physicians abound, and that patients are entitled to these very same differences of opinion
• Labeling patients as “non-compliant” may, in fact, be punitive, jeopardizing a patient’s ability to seek out other care providers

The resolution also fails to address how it would implicate patients navigating controversial issues in medical care, like vaginal birth after cesarean (VBAC). While a substantive body of medical research demonstrates that VBAC is reasonably safe, if not safer, than repeat cesareans, most physicians and hospitals refuse to support VBAC. (3) [4] The language in the resolution suggests that patients who assert their right to opt for VBAC could be tagged as non-compliant, even though their choice would be consistent with the medical research.

“The reality is that the balance of power in the physician-patient relationship is decidedly tipped towards physicians. The least patients should have is the right to disagree with their doctors and not be labeled a ‘naughty’ patient,” said Andrews.

About Cesareans: When a cesarean is medically necessary, it can be a lifesaving technique for both mother and baby, and worth the risks involved. Potential risks to babies from cesareans include: low birth weight, prematurity, respiratory problems, and lacerations. Potential risks to women include [5]: hemorrhage, infection, hysterectomy, surgical mistakes, re-hospitalization, dangerous placental abnormalities in future pregnancies, unexplained stillbirth in future pregnancies and increased percentage of maternal death.

Mission statement: ICAN is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery and promoting vaginal birth after cesarean. ICAN has 110 chapters in North America and Europe, which hold educational and support meetings for people interested in cesarean prevention and recovery.



(1) Resolution 710 “Identifying Abusive, Hostile or Non-Compliant Patients” [6]

(2) Evidence-Based Maternity Care: What It Is and What It Can Achieve [7]

(3) http://www.ican-online.org/ican-in-the-news/trouble-repeat-cesareans [8]