Childbirth Without Fear Quotes

This week I finished reading a classic book about natural childbirth, Childbirth Without Fear, by Grantly Dick-Read. I typed up some quotes from it to share:

"A well–prepared woman, not ignorant of the processes of birth, is still subject to all the common interventions of the hospital environment, much of which places her under unnecessary stress and disrupts the neuromuscular harmony of her labor."

"It is for this reason that thousands of women across the country are staying home to give birth…Women are choosing midwives as attendants, and choosing birth centers and birthing rooms, in order to regain the peaceful freedom to ‘flow with’ their own labors without the stress of disruption and intervention. Pictures on the wall and drapes on the window do not mask the fact that a woman is less free to be completely herself in the hospital environment, even in a birthing room. The possibility of her being disturbed is still there."

"The women in labor must have NO STRESS placed upon her. She must be free to move about, walk, rock, go to the bathroom by herself, lie on her side or back, squat or kneel, or anything she finds comfortable, without fear of being scolded or embarrassed. Nor is there any need for her to be either ‘quiet’ or ‘good.’ What is a ‘good’ patient? One who does whatever she is told—who masks all the stresses she is feeling? Why can she not cry, or laugh, or complain?"

"When a woman in labor knows that she will not be disturbed, that her questions will be answered honestly and every consideration given her, then she will be better able to relax and give birth with her body’s neuromuscular perfection intact. The presence of her loving husband and/or a supportive attendant will add to her feelings of security and peace, so she can center upon the task at hand."

This book was originally written in the 1940's. The quotes above are just as relevant and true today.

--

Molly Remer

CfM Blogger

ICAN Conference

I know a lot of people who are getting ready for the International Cesarean Awareness Network (ICAN) international birth conference in Atlanta, GA on April 24-26 this year. I just checked out the website and it looks like it is going to be an amazing conference. There are many sessions of interest to any birth advocate/activist. Sarah Buckley and Pam England are two of the keynote speakers--both women I'd love to hear speak in person some day. CfM's President, Susan Hodges, is also one of the breakout session speakers!
--
Molly Remer
CfM Blogger

Grassroots Network: NEW! CfM Tool Kit: Stand Up for Home Birth

Dear Friends,

Citizens for Midwifery officially announces a new addition to our website, our Advocacy Tool Kit: Stand Up for Home Birth!

Take a look here. You will find a comprehensive collection of information, facts, links, how-to’s, talking points for any occasion, and other useful advocacy tools, organized in sections. We would recommend you start with the Introduction section, but also read the new articles in the Important Information section: About AMA & ACOG, Safety, and Rights. Also take a look at the Resources section within the Tool Kit.

CfM developed this Tool Kit in response to the American Medical Association’s anti-home birth “Resolution 205” (adopted last spring): “… develop model legislation in support of the concept that the safest setting for labor, delivery, and the immediate post-partum period is in the hospital, or a birthing center ….” as well as the American College of Obstetricians’ continued opposition against access to home births and the midwives that attend them. Neither organization has any reputable evidence to support these positions.

Our purpose was to provide information and tools for everyone to use to undermine the “authority” of the AMA and ACOG and make the case for access to home birth and home birth midwives. Some of the material is oriented for use with legislators, specifically to help them learn and understand more about the nature of ACOG and the AMA and why their motives and opinions should not be trusted, in addition to understanding the evidence and “bigger picture” regarding routine maternity care and midwife-attended home birth. However, virtually all of the material is useful for many situations and circumstances.

Please make use of the information, fact sheets, and links!

Sincerely,

Susan Hodges, “gatekeeper”

Grassroots Network additions about AP article

Dear Friends,

Breaking News: The Associated Press has just put out on the wire a very good (and accurate as far as I can tell) article "Home-birth advocates press pro-midwife campaign"! You can read it here.

This article is likely to be picked up by many newspapers, making many opportunities to comment in letter to the editor, on blogs, etc. Also, don't hesitate to mention it on e-lists, blogs, facebook, etc. and respond to what others write.

The article mentions The Big Push for Midwives, and particularly notes the Inauguration Day e-mail blast. Among other things, the author noted the high cost of hospital births, and the low costs of home births for healthy mothers.

Sincerely,
Susan Hodges, "gatekeeper"

AP article about homebirth and The Big Push

An Associated Press article has just been released that discusses homebirth and The Big Push campaign. Titled "Home-birth advocates press pro-midwife campaign," you can check the article out here and blog about it or link to it on your website or social networking page.

The Big Push also has a new website, make sure to take a peek!

Article addressing elective cesareans

I just wanted to quickly link to a new article by Jennifer Block about elective cesareans: Can we please stop blaming women for c-sections? It is a thought provoking and interesting piece (and also reinforces my own perspective on the questionable nature of terming cesareans "elective" when women do NOT really have choices--i.e. with regard to VBAC, etc.).

Please do be aware that the article is on the pro-choice website RH Reality Check.

Grassroots Network: Quotes needed for midwife guide book

Dear Friends,

Arielle Greenberg is CfM’s newest Board Member, and she is working on a book about choosing and having babies with midwives! Please read below her request for you to answer some questions that could contribute quotes for this book. You are welcome to forward this e-mail to other individuals and lists.

Please note: Please send your survey answers to Arielle here NOT as a “reply” to this e-mail!

Sincerely,
Susan Hodges,”gatekeeper”


FROM: Arielle Greenberg:

A Mom’s Guide to Giving Birth with a Midwife Survey

Dear friends,

I am putting together a book proposal for a guide to choosing, working and birthing with midwives, tentatively titled as above. I’ve got an agent for this project and am currently working up a sample chapter and other materials, and the organization of which I’m a board member, Citizens for Midwifery, is the “organizational author.”

I am hoping to include useful quotes from actual women who chose to work with and birth with midwives, and I am wondering if you would consider answering the following questions as fully and specifically as possible. My plan is to pull quotes from real moms that illustrate or help explain points throughout the book: I think this will greatly add to the book’s appeal and usefulness. Your input would be greatly appreciated. Feel free to skip any questions that don’t interest you or pertain to you; I know you’re busy, so please focus on the questions you most want to answer if you don’t have time to answer the whole thing. I’d rather just get a couple quotes from you than none at all. You can simply fill this survey out and email it back to me at the address below. There is no current deadline, but sometime before May 1, 2009 would be excellent, and any surveys I get back immediately will be used for the proposal itself, which would be extremely helpful

Also, if you have friends who you think would like to participate and be quoted in the book, please feel free to forward this survey to them. I am especially interested in hearing from underrepresented moms, including moms of color, working-class moms, young moms, etc., in order to get as wide a range of voices as possible, so forwarding this survey to such women would be very helpful to me. However, please know that women will be identified only by the first name of their choosing, so all answers will be semi-anonymous or anonymous. I am not including the real names of midwives, either, so if your answer contains your midwife’s name, I will change it to something else.

Thanks very much,
Arielle Greenberg
Email


1. Name You’d Like Used in the Book (first names only; you can use your actual first name or choose another one for better anonymity):


2. Children (please state in what setting each child was born, practitioners involved, and means of birth); e.g., Child A: birthing center, nurse-midwife and OB, vaginal birth):

Child A:
Child B:
Child C:
Child D:

3. Why did you choose the kind of midwife you chose (Certified Nurse-Midwife, Certified Professional Midwife, Lay Midwife, etc.)?


4. Why did you choose to hire a midwife?


5. How did you find your midwife? Why did you choose that particular one? What kind of questions did you ask at your interview? What did you want most in a midwife you chose?


6. What did you see as some of the advantages to working with your midwife?


7. What did you see as some of the disadvantages to working with your midwife?


8. Describe a typical prenatal appointment with your midwife.


9. Was there any advice that your midwife gave you, or anything she helped you with, that was particularly helpful or unusual or thorough?


10. Where did you have your baby? Please describe a bit about what the setting was like. What did you like or dislike about that setting?


11. Did you take a childbirth class? What kind? Did your midwife recommend it? What did you think about it?


12. Did you have a doula at your birth? Why or why not?


13. What was your midwife like at your birth? What did she do that was most helpful? Least helpful?


14. Describe a typical postpartum visit with your midwife.


15. Is there anything you wish you’d done differently, or said, to your midwife?


16. Is there anything you particularly loved or were grateful for about your midwife?


17. Since your birth, have you done any activism to support midwifery in the US? What have you done?


18. Anything else you want to say about choosing, finding or working with a midwife?


Thank you so much!

Birth & Breastfeeding in the Media

In Mothering Magazine this month I read a letter to the editor about a new film project called Laboring Under an Illusion: Portrayal of Childbirth in the Mass Media. I would love to see this! The filmmaker has a website, but it is not finished yet so I couldn't learn much more. I also read the film will be a part of the MotherBaby International Film Festival.

In a previous Mothering issue, there was an article about a similar project focusing on breastfeeding. See Reel Milk for more.

Molly Remer
CfM Blogger

Unnecessary Inductions

A not-very-surprising article about unnecessary inductions came to my attention this week:

"Concerns have been raised about pregnant women being induced 'unnecessarily', after a Scottish audit of 17,000 births."

"In more than a quarter of cases, researchers could not find a medical or other explanation for the procedure."

I wish these concerns would actually reach those who are perpetuating the problem! The person who sent me the link made the point that, "Public Health campaigns need to focus on this sort of information."

I also wanted to note that there are good blog posts at BOLD Thoughts and Unnecesarean about the recent Obstetrics & Gynecology study regarding the link between the rising cesarean rate and the rising rate of maternal complications (morbidity). You can also read the Chicago Tribune article about it here.

Molly Remer
CfM Blogger

Update from The Big Push

Thank you to everyone who emailed the Transition Team yesterday about including Certified Professional Midwives in federal healthcare reform. You totally rock!

While it's not possible to get an exact count, by all indications we not only met our goal of 5,000 emails, but exceeded it beyond even our most hopeful expectations.

Even better, our collective outreach efforts helped us extend beyond the usual networks of midwifery supporters to people outside of the traditional community of activists, to help them let the Obama administration know that access to the full range of maternity-care providers and settings is not a "fringe" issue but is important to people from all walks of life.

We have no doubt that there will be more opportunities in the near future to flex our grassroots muscle again and continue educating the new administration about the vital role that Certified Professional Midwives and out-of-hospital maternity care can play in healthcare reform. In the meantime, though, please pat yourselves on the back for a job well done!

And many thanks to Jane Peterson, Katie Prown and Susan Jenkins of The Big Push for Midwives steering committee for conceiving the idea, and to Sabrina McIntyre for using her Facebook skills to spread it far and wide. What we did together yesterday is just the tip of the iceberg!

_______________________________________________
Steff Hedenkamp | Communications Coordinator | TheBigPushForMidwives.org | 816.506.4630

More on Contacting Obama

From CfM Board Member Willa Powell:
--------------------
Subject: Contact President Obama TODAY!

CfM supports the The Big Push for Midwives and their "A New Birth of Freedom," campaign. To join the effort:

1) Clicking this here.
2) Cut and paste this sample message below
3) Fill in your name and send... and you are done!

Dear President Obama,

We are indeed celebrating "A New Birth of Freedom" as you assume office today!

And BIRTH is a really important element of health!

Please be sure to include Certified Professional Midwives (CPMs), who specialize in providing out-of-hospital maternity care, in federal healthcare reform.

We have a lot of very costly problems, harmful practices and poor outcomes in US maternity care, well documented in the new report “Evidence-Based Maternity Care: What It Is and What It Can Achieve” from Childbirth Connection (see here).

We desperately need other options. Certified Professional Midwives providing excellent maternity care with few interventions and excellent outcomes are a model of cost-effective maternity care and provide a safe alternative to hospital-based care for the majority of women. However, they must be recognized by the federal government for their potential to improve maternity care to be realized.

For more on consumer concerns and suggestions, please see Citizens for Midwifery’s “Maternity Care: A Priority for Health Care Reform: Lower costs, increase effectiveness, improve outcomes for mothers and babies” here.

Sincerely,

Grassroots Network: URGENT ACTION: e-mail Obama at Change.gov TODAY!

Dear Friends,

As our new President is inaugurated today, let's celebrate "A New Birth of Freedom" with e-mails to the new administration about birth and midwives!

The Big Push for Midwives posted this request this morning -- a great idea to hopefully get attention to the need to recognize CPMs at the federal level as part of health care reform. (Simply put, recognition at the federal level, as part of medicaid/medicare legislation, is the doorway to all insurance reimbursement.)

Read the post below, then send your message -- it can be brief, will only take you a minute. JUST DO IT! And don't hesitate to forward this message to other birth/midwife-friendly lists and friends!

Sincerely,
Susan Hodges, "gatekeeper"


From Steff Hedenkamp of THE BIG PUSH FOR MIDWIVES:

Greetings!

In honor of today's Inauguration theme, "A New Birth of Freedom," we at The Big Push for Midwives are asking all of you to take a few minutes to send an email with the subject heading "A New Birth of Freedom" to our new president today. Click on the URL below and send a very simple but powerful message to the Obama administration:
"Please be sure to include Certified Professional Midwives (CPMs), who specialize in providing out-of-hospital maternity care, in federal healthcare reform."
http://change.gov/page/s/healthcare [takes you to a window for e-mailing your message]

Our goal is to submit 5,000 emails by midnight today. That number will put us ahead of every other grassroots movement that has submitted comments to the Obama administration and will ensure that our issue expanding access to out-of-hospital births attended by CPMs gets the attention it deserves.

Please send a quick email notification to this list or to The Big Push for Midwives Facebook wall after you post your comment so we can keep a running tally.

Keep in mind that we are at a crossroads. Healthcare reform is now inevitable and will be based on the reimbursement categories and rates for Medicaid and federal employees. Private insurers are widely expected to follow suit. So if CPMs are not included as recognized providers in federal healthcare reform, there is a very real possibility that home birth families will not be able to receive insurance reimbursement, regardless of whether they have private or public healthcare insurance.

Please act now.
Thank you very, very much.

Steff Hedenkamp | Communications Coordinator | The Big Push for Midwives Campaign | 816.506.4630
steff@thebigpushformidwives.org
TheBigPushForMidwives.org

Envisioning a safer, less-costly model of maternity care in the U.S.

Grassroots Network: CfM’s maternity care reform message to Obama-Biden team

Dear Friends,

Citizens for Midwifery presents our recommendations to the Obama-Biden transition team: “Maternity Care: A Priority for Health Care Reform”, now on the CfM website here.

We have posted our statement to the Your Seat at the Table section of www.change.gov, (the place for organizations to submit white papers, recommendations, etc.). The document includes practical ideas for improving access to credentialed midwives in all settings, increasing evidence-based care, increasing accountability and transparency, and eliminating the legal/economic incentives to perform more and more interventions in childbirth.

Other documents have been submitted, for example by Childbirth Connection, “Health Care Reform Priorities for High Quality, High Value Maternity Care,” and by the Midwives Alliance of North America, “Reforming Maternity Care in America: Recommendations to the Obama-Biden Transition Team on Maternity Health Care," and probably others that we do not know of. As yet, searches of Your Seat at the Table at change.gov (childbirth, maternity care, midwife, midwifery, etc.) do not turn up any documents at all, and we are working to find out what the problem is.

These are valuable documents arguing for change in maternity care! Please read these documents, forward the links, quote from them, use them with your legislators and state policy-makers!

Sincerely,
Susan Hodges, “gatekeeper”

New Choices for Birth website

This week I received notice that MIDIRS (Midwives Information and Resource Service) has launched a new Choices for Birth website.

"MIDIRS is a Bristol based not-for-profit organisation offering a complete information service to all health professionals, non-statutory agencies or anyone involved in the care of women and their babies during and after pregnancy. Its organisational mission is 'to be the leading international information resource relating to childbirth and infancy, disseminating this information as widely as possible to assist in the improvement of maternity care'. Over 32,870 customers worldwide trust MIDIRS services to support their education, practice and professional development. Through a continuing commitment to information access, MIDIRS aims to help health professionals provide mothers and babies with the best possible care."

From the press release:

"Leading maternity information resource service, MIDIRS, today announced the launch of its new consumer website Choices for Birth which focuses on communicating key information surrounding pregnancy, birth and the postnatal period to women and their families. As the name reflects, Choices for Birth aims to provide women with the most recent evidence-based information relating to the pre-conception, pregnancy, birth and postnatal periods, that will assist them in making the right choices for themselves, their babies and families."

Grassroots Network Additions

From CfM President Susan Hodges via the Grassroots Network, here are some additions to my previous post (1/9/09):

Grassroots Network Message 901001
Research documents risks for elective cesarean prior to 39 weeks

Dear Friends,

The Wall Street Journal reported last week on a new research study just published in the New England Journal of Medicine. The study found significantly increased risks for babies when elective (no medical reason) cesareans are performed before 39 weeks of gestation, accounting for more than one third of cesarean sections. You can read the WSJ article here.

Many other news reports have picked up on this research report, including the National Partnership news, and I have been told the New York Times, the LA Times and USA Today, as well as many blogs.

Do read the WSJ article, and if this is picked up in your local paper, consider writing a letter to the editor. You could point out that Childbirth Connection’s Listening to Mothers Surveys have found that extremely few mothers ever ask for cesarean sections. Furthermore, no evidence has been presented that women are asking for early cesareans; this is an assumption being made by some OBs who clearly prefer to blame women instead of taking responsibility for the fact that OBs are not practicing according to evidence-based guidelines. Obviously it is to an obstetrician’s advantage to perform the cesarean before labor and eliminate both inconvenient timing and the possibility of a vaginal birth. Finally, why are OBs not accountable for performing cesareans too early and causing harm to babies?

Sincerely,
Susan Hodges, "gatekeeper"

And:

Grassroots Network Message 901002
"Births: Final Data for 2006" now available from NVS

Dear Friends,

National Vital Statistics at long last has released "Births: Final Data for 2006" which you can read here. The cesarean section rate of 31.1% did not change from the preliminary report issued last year.

The report notes (in the abstract) that "the cesarean delivery rate climbed to 31.1 percent, another all-time high. Preterm and low birthweight rates continued to rise..." and were not explained by births of multiples: "twin birth rate was unchanged for the second consecutive year; the rate of triplet and higher order multiple births declined 5 percent."

If you have not previously read one of these reports, take a look. A variety of interesting statistical information about birth and birth outcomes is included.

Now it is 2009. One wonders when we will get "preliminary data" for 2007?

Sincerely,
Susan Hodges, "gatekeeper"

Cesarean Articles, 20/20 Links, + Final Birth Stats

The week the Wall Street Journal published an article about research on elective cesareans before 39 weeks having significantly increased risks for babies. There was also an article in the National Partnership's newsletter that is based on the WSJ article. There has been "surprise" expressed that OBs have not followed ACOG's own recommendation to wait until 39 weeks for elective cesareans. There are also a number of incredible assumptions about patient choice being a driving factor behind elective cesareans (in the WSJ article it is stated that all these cesareans are about women wanting to make sure "their" OB does the delivery).

An article called "Elective C-sections performed too early 36% of the time" was also published in USA Today this week.

For those of you who didn't get to watch the 20/20 segment about "Extreme Motherhood" that included some content from the film Orgasmic Birth, here are some links to access clips (click the videos within the articles):

Unassisted birth and homebirth with midwives: The homebirth segment was only about 5 minutes and little distinction was made between homebirth and unassisted birth.

And a clip about Orgasmic birth.

There is a good analysis of the overall "Extreme Motherhood" show on this blog.

There was also an article in Huffington Post about Orgasmic Birth: The Natural Reality Beyond the Hype. Some of the comments have been about the dangers of birth and how it "best takes place in the hospital." One commenter remarked that watching the 20/20 segment felt like being in a "parallel universe." I appreciated the author's response to these comments: "I'd agree that you're a parallel universe; you're in one where every pregnancy is life threatening and painful and dangerous...and you see woman for whom birth is safe and enjoyable and even sexy. What's sort of weird is that you want to take these happy women out of their universe and bring them into yours, especially when they don't seem that interested in going. Have you considered that they might know something that you don't, not vice versa?"

The final birth stats for 2006, including a national cesarean rate of 31.1% were released by the CDC this week:

Results: "In 2006, births and fertility rates increased for most states, age groups, and race and Hispanic origin groups. A total of 4,265,555 births were registered in the United States in 2006, 3 percent more than in 2005, and the largest number of births in more than four decades. The crude birth rate was 14.2, up slightly from the previous year; the general fertility rate was 68.5, up 3 percent. Birth rates increased for women in nearly all age groups, with the largest increases for teenagers and for women aged 20–24 and 40–44 years. Teenage childbearing increased, interrupting the 14-year decline from 1991– 2005. The mean age at first birth for U.S. women was down in 2006, to 25.0 years. The total fertility rate increased to 2,100.5 births per 1,000 women. All measures of unmarried childbearing reached record levels in 2006. Women were less likely to receive timely prenatal care in 2006. The cesarean delivery rate climbed to 31.1 percent, another all-time high. Preterm and low birthweight rates continued to rise; the twin birth rate was unchanged for the second consecutive year; the rate of triplet and higher order multiple births declined 5 percent."

Finally, I wanted to link to Lamaze International's excellent press release: Best Practices in Maternity Care Not Widely Used in the United States.

Molly
CfM Blogger
(P.S. as of this posting, the NCHS website linked to above with the 2006 birth stats report appears to be down)

More about Fathers at Birth

I previously mentioned that I was looking forward to reading the new book Fathers at Birth by Rose St. John. Well, I finished reading it last week and it did not disappoint! This book is a valuable contribution to birth literature and I hope men, women, doulas, nurses, midwives, and birth educators all seek it out to read. Though it is specifically written to/addressed to men women with same-sex partners would likely find it has a lot to offer to them as well. I read it through the "lens" of a childbirth educator seeking to more fully engage the men in my classes. I found several good, practical ideas in this book that will help me reach out to men as well as just some general concepts and language that will enhance my ability to connect. So, though it is written for men at birth, it has a great deal to offer to anyone involved with supporting birthing women.

As I've developed as a birth educator, I find myself more and more interested in exploring the role of men during labor and the ways in which men can prepare for birth and for fatherhood and the things that educators can do to facilitate this process. I'm also interested in birth as a rite of passage for men as well as for women (see prior post). And, I'm also interested in the question, "do men belong at birth?" and, indeed, whether they want to be there--I've moved from feeling like all fathers-to-be should be at the births of their children, to recognizing that families have a variety of different circumstances and needs and that couples have different "personalities." Research has indicated that men take on one of three roles during labor the role of "coach" the role of "teammate" and the role of "witness." Most men take on the "witness" role--regardless of what their partners want/expect from them. Rose St. John's book offers two new roles--those of "warrior" and "mountain." These, to me, seem more empowering.

For a thought-provoking post about men in the birth place and whether or not they actually want to be there, check out this post: Men in the Labor Room: Do they want to be there.

Independent Childbirth also has a brief post about Men at Birth.

Another resource focused on men and fathers is Dads Adventure. I use their little magazine in my classes and find it useful to have something to hand out that is specifically written for men (and, in this case, addresses fatherhood).

In addition to the Birth Partner book I mentioned before, two other books specifically for men about birth are the older books Sharing Birth by Carl Jones and The Active Birth Partner's Handbook by Janet Balaskas.

I actually have a number of quotes marked to share from Fathers at Birth, but as this post is getting quite long already I'll save them for another time!

Molly Remer
CfM Blogger

Grassroots Network: Give health care reform feedback to Obama! There is still time!

Dear Friends,

This is the last Grassroots Network message for 2008, and Happy New Year to all of you!

There is still time to give your ideas about health care reform to the Obama Team.

First, there is still time to hold an "official" health care discussion in your community. While the Obama team encouraged us to have such meetings prior to Dec. 31, they will still be accepting feedback from such meetings through the first week of January (or so).

You can find out more about these discussion meetings here. Included on this page are links to the Moderator Guide, and the Participant Guide, as well as a link to sign up to hold one of these meetings. You don't have to have lots of people (they recommend not more than 15-20, and fewer is fine), and it can be very informal. But do officially sign up, and then submit your report afterward that is how you will get your group's feedback to the Obama team. You can have your meeting about health care reform in general, or you can specify a more focused topic, such as "Maternity Care: A Key Part of Health Care Reform" or whatever you come up with.

I didn't think I could do this, given a bad cold on top of the holidays etc., but brought up the idea with a couple of other people in my town, and as of today our discussion meeting is happening on Jan. 6. So get a couple of people to work with you. It really is not that much work and the Guides provided by the Obama team can be a great help.

Second, the Obama team is again soliciting questions (and votes on the posted questions) regarding a variety of issues. Go here.

Create an account (very easy) or log in if you already have one (you have to be logged in to vote or post a question). If you are interested in maternity care or midwives, select "Health Care" on the left side bar, and type in "midwifery" or "midwives" or "maternity care" or other topic of interest in the search bar at the top. Once you're logged in, you can click on the check marks by each question to vote yes/no for each one. It would be great for the Obama team to get the message that a lot of people think that changes in maternity care, and especially more midwives, are important! You can vote for as many questions as you want. You can also write your own questions!

Sincerely,
Susan Hodges, "gatekeeper"