Baby Friendly Hospitals

"Baby-Friendly" is a nationally recognized designation created by the World Health Organization and UNICEF (the United Nations' International Children's Emergency Fund). Hospitals that fulfill the initiative's ten minimum steps are awarded the "Baby-Friendly" designation. There are only 63 officially Baby-Friendly hospitals and birth centers throughout the US! This is striking considering there are over 19,000 Baby-Friendly hospitals in the rest of the world (6,500 in China!).

Maternal Mortality

This month, Mothering Magazine published a fascinating (and sad) article by Ina May Gaskin called "Masking Maternal Mortality." The article explores the deaths of several women from postpartum hemorrhage in the days following the births of their babies and other who died of complications from their cesareans. In the US, there is no national procedure for tracking an accurate maternal death rate, whereas in Britain a comprehensive, 400 page report is published every 4 years on "Why Mothers Die." (The maternal mortality rate is lower in Britain as well, which becomes even more concerning when you consider that the CDC in the US admits that there is "so much misclassification in the US system of maternal death reporting that the actual number could be as much as three times greater than the number officially published each year.")

Also, the article reports that according the CDC, "There has been no improvement in the maternal death rate since 1982, when it was reported to be 7.5 deaths per 100,000 live births. Our current maternal death rate is four times as high as it should be, and this statement, remember, is based upon our underreported figure. According to the Department of Health and Human Services, the rate should not exceed 3.3 deaths per 100,000 live births, whereas the rate in 2004 was more than 13 deaths per 100,000 births." (Note that the cesarean rate has also doubled since 1982.)

Vocal opponents of homebirth and midwifery claim that babies should be born in hospitals for "safety" and that if even one death can be prevented by cesarean or by "mandatory" hospitalization for birth, then it is worth it. I think of our four times higher than it should be maternal mortality rate and the fact that these mothers lost their lives after their "safe" hospital births and wonder...

The article also makes the point that several of the mothers who died after their hospital discharge, would likely NOT have died if they had had postpartum follow up care (such as that provided by midwives). Instead, the women were completely ignored, with fatal consequences.

Read more about Ina May's Safe Motherhood Quilt Project here.

Newsweek article about midwifery

Newsweek published a long article on February 20 called "The Delivery Debate" that touches on homebirth, hospital birth, and midwifery care. The article has attracted a lot of comments and could really use some more voices represented in support of homebirth and midwifery!

Business of Being born on Netflix

Thanks to CfM Board Member Carolyn Keefe for bringing you the latest information on Ricki Lake's The Business of Being Born! Read below, and feel free to spread the word!

Sincerely,
Susan Hodges, gatekeeper

The Business of Being Born Coming to the Small Screen

The Business of Being Born is now available for rental and online viewing from Netflix starting $4.99 (depending on your Netflix plan). The DVD will contain a half-hour of bonus materials, including follow-up interviews with the filmmakers and their subjects.

Citizens for Midwifery congratulates producer Ricki Lake and director Abby Epstein on the success of The Business of Being Born. Not only have they created a compelling exploration of maternity care in the US, but their promotion of the film in the media has really helped to propel this issue into the mainstream.

The producers have also been incredibly generous in helping grassroots organizations bring the film to local communities and raise funds. While the Netflix rental is meant for private use only, the filmmakers are still helping local groups plan community events for March and April.

CfM's own Susan Hodges appears in the film, and several groups around the country have also directed some of the funds they raised to Citizens for Midwifery. We thank them for their generosity and support of CfM, which helps to cover expenses for networking and brings CfM and birth issues to new audiences.

DVDs will be available for purchase starting May 62008 for around $20 to $30. You can reserve an advance copy or multiple copies on The Business of Being Born website. They will contact you with the exact price and shipping dates as they become available.

This film is a wonderful tool for education and provides a terrific opportunity to discuss the state of maternity care. Having it available for rental, download, or purchase will expand the possible audience even more and help bring even broader awareness the issues around birth.

What OBGYNs overseas have to say about homebirth...

I was interested to learn from the Women in Charge blog that ACOG isn't the only organization of OBGYNs to have an opinion about homebirth. The Royal College of Obstetricians and Gynaecologists also has a statement about Home Births (a joint statement issued with the Royal College of Midwives, which tells you something right there!) which stands in dramatic contrast to the ACOG press release officially opposing homebirth.

Some interesting stuff from the Royal College of Obstetricians and Gynaecologists:

"There is no reason why home birth should not be offered to women at low risk of complications and it may confer considerable benefits for them and their families. There is ample evidence showing that labouring at home increases a woman's likelihood of a birth that is both satisfying and safe, with implications for her health and that of her baby."

Safe and satisfying. No kidding!

In a later bullet point:

"However, this is not to define safety in its narrow interpretation as physical safety only but also to acknowledge and encompass issues surrounding emotional and psychological wellbeing. Birth for a woman is a rite of passage and a family life event, as well as being the start of a lifelong relationship with her baby. Home births will not be the choice for every woman."

Rite of passage and a family life event. It is great to see this acknowledged as legitimate instead of dismissed as "trendy" by the ACOG statement.

And one more quote:

"Overall, the literature shows that women have less pain at home and use less pharmacological pain relief, have lower levels of intervention, more autonomy and increased satisfaction.1,12,18–20. The studied interventions included induction, augmentation, perineal trauma and episiotomy, instrumental delivery and caesarean section. These are not insignificant interventions and may have considerable impact on a woman’s long-term health and emergent relationship with her baby, as well as her satisfaction with her birth experience."

These are NOT insignificant interventions. This is also nice to see acknowledged. Too often women who have high-intervention births and express dismay about that are silenced by comments like, "well, at least you have a healthy baby. That's what is really important." It is most certainly possible to be happy and delighted with your healthy baby and simultaneously and legitimately grieve the loss of your birth experience or object to unnecessary and harmful interventions received.

USA Today & MSNBC Feature Ina May Gaskin

This weekend, USA Today and MSNBC published an article about Ina May Gaskin. Titled "Pioneering midwife crusades for natural birth" on the USA Today site and "Pioneering midwife touts 'orgasmic birth'" on the MSNBC site, the article is primarily a summary of Ina May's life and work. It also includes a mention of the rising maternal mortality rate in the US:

"Gaskin largely blames the nation's rising maternal death rate on the increase in Caesarean section births and the drugs sometimes used to induce labor. The National Center for Health Statistics reported last month that the maternal death rate for 2005 has risen to about 15 women per 100,000 live births, more than double the 1998 rate of 7. At least part of that increase is due to better reporting, but researchers say Caesareans also may be a factor."

The article closes with a mention of Ina May's new film project and an amusing quote from her about marketing birth:

"Now, Gaskin has a film in the works that is in keeping with her anti-establishment, freewheeling nature. 'We're doing a movie called The Orgasmic Birth,' she said. That's not a metaphor. Gaskin says that under the right circumstances women experience a sort of birth ecstasy. 'I mean, it's not a guarantee,' she said, shrugging her shoulders and smiling, 'but it's a possibility. It's the only way I can think to market it to (this) generation.'"

Only 63 comments on the USA Today article so far, so feel free to chime in with your own two cents! :-)

Note added 2/26--the same article is also on the Fox News site as "Unconventional midwife encourages couples to 'make out' during childbirth"

Induced Labor

A recent article has been making the rounds through various blogs and newsletter and I wanted to call your attention to it as well--Avoiding Induced Labor is More Beneficial to Moms and Babies, an article posted to Medical News Today and sent as a press release from Lamaze International.

Also in regard to induced labors we received a call to action from the Tatia Oden French Foundation regarding the continued off label use of Cytotec (Misoprostol) to induce labor despite documented deaths related to its use as a method of induction.

From the call to action:

"In Sept of 2007, through the Freedom of Information Act, the Tatia Oden French Memorial Foundation requested the FDA to supply the Medwatch Forms they received for the time period Jan. 2001 through Sept. 2007, dealing with the adverse events occurring from the use of Cytotec. We received a file containing 1746 records of adverse events. Three hundred and fifty (350), 20% of these adverse events were the result of cytotec being used to induce labor."

A letter from Searle (the manufacturer of Cytotec), was sent to over 200,000 physicians in August of 2000, but as the Medwatch forms show, off label use has persisted.

Birth Center Article

A friend and fellow midwifery advocate sent me a link to this interesting article from the Lansing City Pulse. The article is titled "Outside the hospital: local women discover natural birth."

One of the focuses of the article is on Greenhouse Birth Center, a freestanding birth center located in Okemos, Michigan. I looked up their website. The Center appears to be staffed by CNM's and looks like a wonderful facility!

The article is quite good overall and I enjoyed the following quote:

"The science behind their choice is hotly debated, but the joy they exude from opting out of the hospital system blows your hair back." :-D

Also interesting was the interview snippets with local OBGYN (the assistant director of the OBGYN residency program at Sparrow Health System) who was really supportive of natural birth (and had one of her seven children at home in her bathroom and another at Greenhouse Birth Center).

Some quotes about the physician:

"However, Herta said the cesarean section rate at Sparrow is 'something horrendous, almost 30 percent'— about the same as the American norm.

'We do have very medicalized birth,' she said. 'But it’s not out of a desire for control or something like that.'

Herta said fear of malpractice is the driving force.

'You just start intervening and covering and documenting. When we sit and talk about cases, there’s always that component of, ‘well, somebody looking back could sue you for this.'"

I thought it was notable to read that it isn't only midwifery advocates who recognize that fear of malpractice is a primary driving force in maternity care rather than the actual needs of mothers and babies.

New Faces for Old Friends

Several birth-related organizations have unveiled lovely new websites over the past several months or so.

We've been excited to see new looks for:

The Association of Labor Assistants & Childbirth Educators (ALACE)--this training program for childbirth educators and doulas has a fresh new site with bright colors and an attractive layout.

Childbirth & Postpartum Professionals Association (CAPPA)--launched their newly laid out site this month. This training program for childbirth educators, doulas, and lactation educators has a clean new design and a crisp, professional look.

International Cesarean Awareness Network (ICAN)--launched this month, the new ICAN site has clean, eye-catching appeal and is a helpful resource for both consumers and activists. There are a number of fact sheets available on the site.

International Childbirth Education Association (ICEA)--ICEA launched their attractive new site last year. ICEA has an extensive book catalog and this section of their site is easier to navigate than before.

2007 Year in Review

I should have posted this in January, but better late than never! Here are some excerpts from the fall issue of CfM News reporting on the activities of Citizens for Midwifery during 2007:

The Board of Citizens for Midwifery met for our annual in person board meeting in September. This year we met in Rochester, NY. It was a very productive and successful meeting during which the Board further fleshed out our strategic plan and made organizational priorities for the coming year.

We also held a membership meeting and a public meeting to discuss local and national midwifery issues. The public meeting was well attended and many interesting topics were discussed. A good deal of the conversation focused on working around or ways of getting rid of the written practice agreement currently mandated in the NY midwifery statutes.

Conferences:

• Co-sponsor of NAPW’s “National Summit to Ensure the Health and Humanity of Pregnant and Birthing Women” in January 2007.
• Participated in MANA, CIMS, ICAN conferences
• Sent Representatives/Partners to La Leche League, NYS Birth Coalition Summit, & FL Governor’s Conference on Women’s Health
• Materials and/or ads provided for conferences held by MANA, ACNM, Lamaze, NOW, International Center for Traditional Childbearing, CAPPA, & La Leche League

Activities:

• Continued the Grassroots Network – over 900 on list
• Collaborated with BirthNetwork National on conferences and MFCI Evidence Basis Summary fact sheet
• Collaborated with CIMS Transparency in Maternity Care project
• Signed on to several Amicus Briefs – working with National Advocates for Pregnant Women
• Supported legislative efforts in MO & KS (letters), AL (consulted), & SD
• Reprinted and continued to provide the Midwives Model of Care brochure
• Media – RH Reality Check website article, radio interviews in WY & CA.
  
• CfM President Susan Hodges featured in the film The Business of Being Born.
• Maintained fiscal health
• Developed online system for ordering products and membership
• Decentralized order fulfillment, membership processing, and newsletter editing!
• Finalized Core Values
• Added new Board member – Have full Board for the first time in 2 years
• Created My Space Page

CfM News is published twice a year and is a benefit of membership in Citizens for Midwifery.

2008 has started out as a VERY busy year for CfM already and I will post an update soon about what we've been working on lately!

More ACOG responses

Jennifer Block, the author of Pushed, has a thoughtful entry on her blog about the ACOG statement against homebirth. I appreciated this quote from her post:

"Finally, there’s a double standard lurking here: elective, medically unnecessary cesarean has been considered en vogue for some time. We know that major abdominal surgery carries with it major risks for both mother and baby, but when it comes to that cause célèbre, ACOG has vocally supported a woman’s 'right to choose.'"

For a little twist interjected into this recent flurry of press releases and blog posts responding to ACOG's statement, here is a parody of the statement from a HBAC (homebirth after cesarean) mother originally posted to Mothering.com.

A particularly salient point from the post was this: "Childbirth decisions should not be dictated or influenced by what’s fashionable, trendy, or the latest cause célèbre. Despite the rosy picture painted by hospital birth advocates, a highly medicalized labor and delivery can physically and emotionally scar both the mother and baby. Attempting a vaginal birth after cesarean (VBAC) at the hospital is especially dangerous because seemingly benign interventions such as epidural anesthesia or Pitocin augmentation can lead to complications with potentially catastrophic consequences for both the mother and baby, including death. Unless a woman is in a supportive birth environment that allows the birth process to unfold on its own schedule, she puts herself and her baby’s health and life at unnecessary risk."

CfM Response to ACOG Statement

CfM's rebuttal and extensive talking points in response to the recent ACOG press release about homebirth are now available on the CfM website!

Childbirth Connection Evidence Columns

We've previously mentioned some of the many great resources offered by Childbirth Connection and we'd like you to call attention to another one of them--Evidence Columns. This e-news summary is issued once every two months and is an excellent way to keep up with the latest research about maternity care and childbirth.

In the January/February 2008 issue there is an interesting graph visually contrasting the rising cesarean rate with the dropping VBAC rate and another interesting chart about costs of birth by setting (unfortunately it does not include home births). Birth activists can easily access both of the charts to print out as free pdf handouts after registering and logging in.

To sign up to receive the newsletter you may register (free) by signing up on the Childbirth Connection registration page. Registration is required to download pdfs.

Amnesty International & Maternal Mortality

We recently learned from well-known midwife Ina May Gaskin that research fellows from Amnesty International-USA are undertaking a research project documenting the rate and nature of maternal mortality in the US. They have noticed that US women face a greater risk of maternal mortality than women in other industrialized countries and that rates of death are much higher for African American and Latina women than white women. Ina May has done ongoing, persistent work exploring the rising maternal mortality rates in the US. Her ongoing memorial quilt project records the deaths of women in this country since 1982 who died from pregnancy related causes. She needs people to continue reporting maternal deaths to her so they can make quilt pieces for each woman.

The Amnesty International team will be documenting and gathering information on a broad range of issues related to direct and indirect causes of maternal deaths. They are especially interested in documenting the experiences of racial/ethnic minority women especially African American and Latina women and women living in poverty and exploring reasons for the high rate of maternal mortality among these groups of women.

"AIUSA is therefore reaching out to organizations and experts willing to share their knowledge and expertise. We are also seeking individuals willing to share their experiences."

"AIUSA is planning to produce a report on its findings, providing an overview of issues concerning maternal mortality rates and womens access to adequate and appropriate healthcare." (such as midwifery care!)

CfM Board members would also note that not only is rising maternal mortality important, but also other human rights issues around unnecessary interventions, informed consent, and hospitals not "allowing" VBACs!

There was a report recently about a maternal death in NY. It is frustrating to read that the mother who died was induced, which may have led to her death by amniotic fluid embolism (according to a study published in the medical journal The Lancet, "Medical induction of labour seems to increase the risk of amniotic-fluid embolism. Although the absolute excess risk is low, women and physicians should be aware of this risk when making decisions about elective labour induction.")

The U.S. ranks 41st in the October 2007 analysis of maternal mortality rates in 171 countries released by a group of U.N. public health experts.

Grassroots Network: PushNews Response to ACOG

Dear Friends,

Following up on ACOG’s anti-home birth press release, The Big Push Campaign has posted a press release--"ACOG: Out of touch with Needs of Childbearing Families." It does not address every objectionable point in the ACOG press release, but it presents a strong message that is positive about home birth and challenges ACOG’s position.

I will still post more “talking points” later tonight or tomorrow. It will be interesting to see just how much press attention ACOG’s press release actually gets…

Sincerely,
Susan Hodges, “gatekeeper”
-------------------------------------------------------
A few quotes from the PushNews press release:

"Trade Union claims out-of-hospital birth is “trendy;”
tries to play the “bad mother” card"

“'It will certainly come as news to the Amish and other groups in this country who have long chosen home birth that they’re simply being ‘trendy’ or ‘fashionable,’” said Katie Prown, PhD, Campaign Manager of The Big Push for Midwives 2008. “The fact is, families deliver their babies at home for a variety of very valid reasons, either because they’re exercising their religious freedom, following their cultural traditions or because of financial need. These families deserve access to safe, quality and affordable maternity care, just like everyone else.”

"Besides referring to home birth as a fashionable “trend” and a “cause célèbre” that families choose out of ignorance, ACOG’s latest statement adds insult to injury by claiming that women delivering outside of the hospital are bad mothers who value the childbirth “experience” over the safety of their babies."

"The Big Push for Midwives calls on ACOG to abandon these outdated policies and work with CPMs to reduce the cesarean rate and to take meaningful steps towards reducing racial and ethnic disparities in birth outcomes in all regions of the United States. CPMs play a critical role in both cesarean prevention and in the reduction of low-birth weight and pre-term births, the two most preventable causes of neonatal mortality."

.

Grassroots Network: ACOG Homebirth Statement

Dear Friends,

Well, some combination of press about Ricki Lakes film The Business of Being Born, the Big Push for Midwives press conference (across the street from AMA headquarters in Chicago), and active legislative efforts in a number of states, actually got the attention of ACOG! Yesterday they posted a press release opposing home births.

The main points are not really different from their Position statement (which is not publicly available on their website), but with added negative and misleading beliefs and downright lies. And of course, this press release is definitely meant for public consumption!

The press is quite likely to pick up this ACOG press release. You are encouraged to write letters to the editor, write on blogs, etc. To help, I am compiling a list of effective talking points, which I hope to post by tonight or first thing tomorrow morning.

Meanwhile, several responding press releases are being prepared by various organizations.

Sincerely,
Susan Hodges, gatekeeper

Homebirth in People Magazine

Today I read an announcement on the People Magazine website about the homebirth of Scrubs actor John McGinley's baby.

The article says the baby was born at "1:36 a.m. in a birthing tub at the couple's home in Malibu, with a midwife in attendance."

It then quoted McGinley as saying:

"Nichole was a mountain lion, a warrior in the birthing process. The birth was astonishing!"

I just love his comments. Every new dad should be able to see the mother of his baby like this! Can you imagine a culture of birth in which quotes like this are common and normal instead of surprisingly refreshing? :-)

Grassroots News: New Articles

Dear Friends,

Two new articles have come to my attention, both published on February 1. They are both good for midwifery, and you are encouraged to respond!

RH Reality Check (RH stands for reproductive health) has a new blog post about the Big Push for Midwives! "New Life For Midwifery Care" by Amie Newman. It is wonderful that RH Reality Check is posting about the need for access to legal midwives, because respectful, evidence-based and legal maternity care certainly is a reproductive right and this article continues to present good information about midwifery and childbirth to interested people who may not be aware of maternity care issues.

The Kansas City Star published a piece by Debbie Smithey, President of the Missouri Midwives Association. The argument she presents may be useful in your state also! Read "The Need for Certified Midwives" here. Scroll to the end to read comments or make your own.

Sincerely,
Susan Hodges, gatekeeper

Trust Birth Initiative

I discovered the Trust Birth Initiative several years ago through their "Take Birth Back" movement which meshes nicely with birth activism and also with supporting consumer interests in birth (the basic activity of "Take Birth Back" is handing out awareness cards on Labor Day). I distributed several hundred cards during 2006 (see image to right--front and back of card shown side by side).

Inspired by this card idea, advocates in Missouri designed a card for our own awareness-raising efforts for midwifery legislation. We distributed more than 10,000 of them around the state! Advocates threw them in parades, left them on tables in fast food restaurants, posted them on all kinds of bulletin boards etc. The cards are business card sized and the vertical format makes them stand out from other business cards. We ordered them from vistaprint for "free" (plus shipping cost) and found it was a low cost and effective tool.

In addition to Take Birth Back, Trust Birth has a powerful statement of beliefs as well as local facilitators who hold woman-to-woman support groups.

I deeply connect with the vision here and there are two statements I often quote from the beliefs statement: "birth should not be a time in a woman's life when she has to FIGHT for anything." I use this quote particularly when women are talking about how they are going to "negotiate" the hospital system and "advocate" for what they want and be "strong" about expressing their wants/needs for birth. I also like the statement that "interference with birth begins the moment she leaves her home and the minute she is in the hospital she is no longer in charge."

Trust Birth is also having the first ever Trust Birth conference in March!

Mother-Friendly Evidence Based Fact Sheet

I've referenced this fact sheet several times on the blog already, but I wanted to call attention to it in its very own post :)

In Sept. 2007, Citizens for Midwifery published a useful new fact sheet summarizing the evidence basis for the 10 Steps for Mother-Friendly Care. The fact sheet is two sided and packed with information. The Coalition for Improving Maternity Services (CIMS) has a mission “to promote a wellness model of maternity care that will improve birth outcomes and substantially reduce costs.” To this end, they created the evidence based
Mother-Friendly Childbirth Initiative (MFCI). This Initiative “provides guidelines for identifying and designating “mother-friendly” birth sites including hospitals, birth centers and home-birth services.” There are ten steps for mother-friendly care and ample evidence supporting each step.

CIMS also has a very useful consumer handout–”Having a Baby: 10 Questions to Ask“–that helps expectant couples ask questions of their health care providers to determine if the care they are receiving is the evidence based, mother friendly care all pregnant women deserve.

An award!

The Enjoy Birth blog just awarded CfM an "Excellent Blog Award." Thank you!

Also, Robin Elise Weiss (the pregnancy and childbirth guide at About.com) listed the CfM blog as one of the "Top 10 Blogs You Should be Reading." There are a lot of other great blogs on her list, so make sure to check it out! I already loyally read several of them, but some were new to me also.

Note added on 2/19, I just saw today that House of Harris also awarded CfM an "Excellent Blog Award" on 1/28. She says it was awarded "for helping to educate the general public about what they can do to give midwifery a voice in this country!"