International Women's Day

International Women's Day is coming up on March 8th. This holiday has been celebrated since the early 1900's, particularly in European countries. You can read about the history and purpose and watch a quick video here (the video is from Russia and so only addresses the holiday there and its connection to socialism). I did a quick search of the International Women's Day site for "midwifery" and "midwives" and came up with ZERO results. Then, I searched for "birth" and "childbirth" and came up with next to nothing. There is a section on the site where you can submit your own stories for publication on the site. I'm envisioning several people contributing thoughtful articles about midwifery care and maternal health in time to honor the 2009 International Women's Day. If you contribute something, please be sure to let me know!

Here is a press release I received about how some birth activists are planning to recognize International Women's Day:

FOR IMMEDIATE RELEASE
A celebration of International Women’s Day is planned on Sunday, March 8 at the Coudersport Public Library, highlighted by a screening of “Singing The Bones,”
a full-length movie that tells the story of three generations of women brought together by a single birth.

The celebration is the brainchild of longtime childbirth educator Donna Batterson, who is the coordinator of the Healthy Beginnings Plus program for Charles Cole Memorial Hospital. She brought the idea to Freda Fultz of A Way Out and Jane Metzger, a Coudersport Library trustee, who enthusiastically agreed to collaborate on this special celebration.

“We wanted to offer a time for women of all generations to join in celebration of this special day,” says Batterson. “We envision it as a time for mothers, daughters and grandmothers to spend time together celebrating our womanhood.”
-------------------------------------------

Perhaps there are other such events planned across the country--or, perhaps you could organize a recognition of your own! If not this year, maybe start planning for 2010.

--
Molly Remer
CfM Blogger

Articles

As always, interesting articles have come to my attention this week and I want to share some of them.

First, I just saw the cover of the September 2008 issue of Chemical & Engineering News in the letters to the editor section of Mothering Magazine. I think it is amazing! So, of course, I went looking for the accompanying article, which is available here. It is a dense and scientific read. I liked the final line in the conclusion: "Much still remains to be understood about how many of milk's natural components are synthesized and delivered, how synthesis is controlled, and the effects of the mother's diet on the final product. 'It is a remarkable fluid,' German emphasizes. 'It's extremely embarrassing how little we still know about it.'"

When people try to analyze mother's milk, I am always struck anew by the realization that no matter the hows and the whys and the chemical components, women's bodies all over the world make food for their babies day in and day out on their own and with their own inherent wisdom. She doesn't have to know how it works, or what exactly is in it. She lifts her shirt, baby nurses, and all is right with the world. And, of course, it isn't just human women who have this body wisdom, but female bodies all over the world are giving their babies species-specific milk right now--my cat is nursing her three new baby kittens in the lawnmower as I type (analyzing why she chose to give birth to them there can be the subject of another post...).

Returning to birth issues, The National Partnership Daily Women's Health Policy Report has posted an article about the Time article about repeat cesareans. Apparently this report is widely read by politicians involved in women's health policy and most of their stories are about abortion, contraception, and sex education. So, it is good to see birth and maternity care brought to their attention!

From the Robert Wood Johnson Foundation's Building Human Capital newsroom, there was a quick article about Laborists. It says, "In response to a shortage of obstetrician-gynecologists, some hospitals are turning to a new type of physician, dubbed a laborist or OB hospitalist, to provide hospital-based obstetric services.."

Hmm. I can readily think of another professional that is more perfectly poised to provide quality maternity care!

Finally, there was an article called Freebirthing published on the Examiner.com website yesterday.

--
Molly Remer
CfM Blogger

A Doula Story

CfM Board member Carolyn Keefe shared the following information about a moving film, A Doula Story, available online:

I heard about a wonderful video recently and took an hour to watch it last night. It touched me so deeply that I thought you would find it of interest. Entitled A Doula Story it's about an African-American doula named Loretha Weisinger in Chicago who works with teen moms. It is available to watch for free here.

Loretha is a true angel, incorporating love and support for "her girls" into her terrific doula care. She empowers these girls to "find their voice", breastfeed, and learn to care for their babies even before they are born, plus nurturing them through labor and birth. Loretha provides incredible care and support, weaving in Mother-Friendly suggestions that all of us will recognize but in terms "her girls" will get. She really is one of the true angels in a community in need. I was in awe watching her patiently and lovingly help these young women become mothers. The film itself is also beautiful and riveting, if sometimes hard to watch difficult lives these young women live.

I encourage you to watch this and pass on the info, it will really touch you and help you understand why it's so important that we work to make sure all women get access to respectful, nurturing, Mother-Friendly Care.

Carolyn Keefe
CfM/BirthNet/NYFOM

Grassroots Network: ICAN and TIME Magazine "The Trouble with Repeat Cesareans"

Dear Friends,

Finally, the problems with repeat cesareans and lack of access to VBACs is showing up in the national press! TIME magazine just ran a fantastic article: The Trouble With Repeat Cesareans, by Pamela Paul. Here is the link (however, you might get a page where you have to search by the title as this article has been archived).

The TIME article includes a terrific quote: "How can a hospital say it can handle an emergency C-section due to fetal distress yet not be able to do a VBAC?" asks Dr. Mark Landon, a maternal-fetal-medicine specialist at the Ohio State University Medical Center and lead investigator of the NIH's largest prospective VBAC study.

In addition, Paul wrote in the Huffington Post regarding her own background and how she came to write this article.

This blog includes a link to the TIME article, and many people are commenting.

At the same time, and mentioned in the TIME article, ICAN has announced the results of their latest survey: "The survey shows a near triple increase (174%) from November 2004, when ICAN conducted the first count of hospitals forbidding women from having a VBAC. In 2004, banning hospitals numbered 300. The latest survey, conducted in January 2009, counted 821 hospitals formally banning VBAC and 612 with 'de facto' ban." Read more at http://www.ican-online.org/ "Access to VBAC Shrinking".

Hope these resources will be useful as we continue work to improve maternity care in every setting!

Sincerely,
Susan Hodges, "gatekeeper"

Time VBAC Article Follow up

The author of the Time Magazine article about VBAC that hit the stands this week had a follow-up article published in The Huffington Post yesterday. Titled Childbirth Without Choice this article offers the companion back story to the Time piece. This article has a more dramatic and personal tone than the Time article and it was a good read.

An unrelated article about a birth center also caught my eye this morning. Published in The Orange County Register on Friday: Center's care is like giving birth in living room.

--
Molly Remer
CfM Blogger

Film Review: Homebirth Dads

From the Fall 2008 issue of CfM News, I wanted to share my review of the DVD Homebirth Dads.

DVD Review: Homebirth Dads: The Dad’s Perspective on Homebirthing, 1hr 10m.

Jorge Visions Unlimited Productions, 2007.

Reviewed by Molly Remer

Filmed in Ithaca, NY, in a question and response format, this video lets homebirth dads share their perspectives, opinions, and feelings about homebirth. Each dad is interviewed individually in his workplace (I had pictured all the men being together in one room in circle answering questions). The film cuts from father to father as they shared their responses to a series of questions about birth, homebirth, midwives, and midwifery. The fathers are a bricklayer, a massage therapist, a social worker, a doctor, a university administrator, and a museum director. This highlights a factor noted time and again in real-life midwifery circles--the homebirth population is an incredibly diverse one!

What I loved about this film were the great still photos of the dads with their babies at the opening and closing of each question scene. It made me realize how very little we see of loving daddies with their babies. I’m so absorbed by mothers, babies, and birth that I forget the awesome tenderness of a man with his newborn. We usually only see those pictures from our own families. It was very special to see those private peeks at other men’s vulnerable moments. Beautiful!

Another portion that I really enjoyed were the men’s responses to the question, "What did you realize about your wife?" I loved to hear the words they used to speak about their wives and the births of their children: Respect, amazement, awe, concentration, fortitude, stamina, amazing, admiration, endurance, self-sacrifice, gratifying, enormous, her ability to stay focused—guided us all, magical moment, clear, committed, challenging, extraordinary, full of admiration, trust, clear... One father summed up some of the magic of birth by saying, "Whole new arena—like opening a door in a house and discovering a whole new room."

One question in the series of questions is if insurance companies cover homebirth. This question needed more coverage (or a "footnote" along the bottom of the screen), because the answer from all the men was basically, "yes, insurance will cover it," which is far from true in many states.

The film is in basically in a "talking heads" format and is probably best viewed in several segments rather than all at once (there is no chapter select set up on the DVD).

I think the video fills a definite gap amongst birth films. It is also the only birth video I’ve ever seen that has NO WOMEN in it! While this might seem weird on one hand, this is also what makes this film fill a very specific gap (because men are usually on the periphery of other birth films, if they are really included at all).

As I watched it, I could think of several times when I would have liked to have a video like this available to birth classes. Homebirth Dads definitely has a useful place in the lending libraries of midwives, childbirth educators, and Friends of Midwives chapters.

Body Wisdom

Several interesting articles caught my eye this week. First, a 2005 article from Midwifery Today Honoring Body Wisdom addressing the question "who or what are we protecting the perineum from?" It has lots of food for thought about honoring women's instincts in birth and keeping one's hands to oneself.

Then, speaking of body wisdom and being upright, I came across this Women's eNews article 'Gravity Birth' Pulls Women to Ecuador Hospital. "Part of a model effort to lower maternal and infant mortality and attract more women to hospital deliveries, San Luis de Otavalo is the first public hospital in Ecuador to provide a so-called vertical maternity ward that connects indigenous birthing practices with access to modern medicine. The ward opened in April 2008."

"'It was a hard fight for us to get into the hospital and care for women with our ancestral wisdom and practices, with our teas and waters, our sacred cleansing rites," says Colta. "Everyone has bad energy. But we shoo it out at birth.'"

I also enjoyed reading an article about Poplar-Heights Birth and Wellness Center in the Kitsap Sun: For Expectant Moms, a Happy Medium Between Hospital and Home Births.

And then one titled Home Delivery in the Herald Tribune (FL).

Finally, a blog post with pictures from the LIFE photo archive has been making the rounds: Maude Callen: Hero Midwife. The photographs were taken in 1951 and follow a SC midwife as she attends a birth.

--
Molly Remer
CfM Blogger

ICAN in Time Magazine!

It is very exciting to see ICAN referenced in Time Magazine this week in an article called The Trouble with Repeat Cesareans. The print version will be on newsstands tomorrow. Even if coverage isn't perfect, it is amazing to me to see an article like this about birth, cesareans, and maternal health in a magazine with such a high profile as Time.

ICAN encourages you to blog about it, leave comments, post the link to social networking sites like Facebook, and email it to friends!

--
Molly
CfM Blogger

Grassroots Network: More organizations support out-of-hospital birth!

Note from Molly: The links to the midwifery editorial referenced below are kind of touch and go. If you have trouble accessing it, go here and then do a search for the editorial title (The 'Authorities' Resolve Against Home Birth) or for the author's name (Nancy Lowe), and you'll be able to read it that way!

Dear Friends,

The Big Push has issued a news release highlighting the fact that organizations including nurses and perinatal specialists have recently made statements supporting the use of midwives and the choice of out-of-hospital birth. In particular, the editorial by Nancy Lowe, editor of the Journal of Obstetric, Gynecologic, & Neonatal Nursing, the official journal of the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) here is an especially good statement.

Read the release below, forward it, and follow the links below to read the various statements!

Sincerely,
Susan Hodges, "gatekeeper"


PushNews from The Big Push for Midwives Campaign
CONTACT: Steff Hedenkamp, (816) 506-4630, steff@thebigpushformidwives.org
FOR IMMEDIATE RELEASE: Tuesday, February 17, 2009


Physician Groups Out-of-Step as the Number of Health Care Organizations In Support of Certified Professional Midwives (CPMs) and Out-of-Hospital Birth Rapidly Increases

Nurses, Perinatal Health Care Specialists Echo Consumer Reports Magazine in Calling for Integrating Midwives into U.S. Maternity-Care System


WASHINGTON, D.C. (February 17, 2009)Two major health care organizations have joined the growing number of groups calling on policy makers to increase access to Certified Professional Midwives (CPMs) and out-of-hospital maternity care. Acknowledging the large body of evidence supporting the safety of home delivery with CPMs, who are specifically trained to care for mothers and babies in out-of-hospital settings, nursing and perinatal health care organizations criticized the American Medical Association (AMA) and the American College of Obstetricians and Gynecologists (ACOG) resolutions calling for bans on CPMs and home birth. The groups also joined Consumer Reports magazine in highlighting the need for a major overhaul of the U.S. maternity care system.
"I am very proud to be an American, but I am embarrassed that our country, founded on the ideals of individual liberty and freedom, can also support 'authoritative' initiatives such as these by the ACOG and AMA, initiatives that are founded on neither science nor an understanding of the physiologic and psychosocial needs of mothers and babies," said Nancy K. Lowe in an editorial published in the Journal of Obstetric, Gynecologic, & Neonatal Nursing, the official journal of the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN). "What is most risky about home birth in the United States is that for most women who desire it there is a scarcity of qualified providers of home birth services." [Read the complete editorial here.

Consumer Reports magazine cited the desire for economic gain as one of the driving forces limiting access to CPMs and Certified Nurse-Midwives (CNMs), who are licensed in all 50 states and practice primarily in hospital settings, but who remain subject to anti-competitive regulations promoted by the AMA and ACOG. CPMs are legally authorized to provide out-of-hospital care in just half the states, while advocates working to reform the law in the remaining states face stiff resistance from physician groups seeking to establish a monopoly on the maternity care market in the U.S.

"Midwives provide a safe and cost-effective alternative to the current model, where the market is dominated by high-cost, high-tech specialists producing less-than-optimal outcomes," said Katie Prown of The Big Push for Midwives Campaign. "Babies delivered by midwives are far less likely to be pre-term or low birth-weight, which are two of the leading causes of neonatal mortality and of the enormous costs associated with long-term care. Midwives and out-of-hospital birth are an integral component of responsible health care reform, and the AMA and ACOG know this. That’s why they’re fighting so desperately to protect their turf, even if it means denying women maternity-care options in the process."

The National Perinatal Association (NPA) added to the growing list of organizations calling on the AMA and ACOG to end their vendetta against midwives and home birth and instead follow the World Health Organization’s (WHO) call to "'work in a spirit of recognition and respect for each other’s authority, responsibility, ability and unique contribution.'" [See their statements on place of birth and on midwifery here.

The Big Push for Midwives is a nationally coordinated campaign to advocate for regulation and licensure of Certified Professional Midwives (CPMs) in all 50 states, the District of Columbia and Puerto Rico, and to push back against the attempts of the American Medical Association Scope of Practice Partnership to deny American families access to legal midwifery care. Through its work with state-level advocates, the Big Push is helping to build a new model of U.S. maternity care built on expanding access to out-of-hospital maternity care and CPMs, who provide affordable, quality, community-based care that is proven to reduce costly and preventable interventions as well as the rate of low birth-weight and premature births.

Media inquiries: Steff Hedenkamp (816) 506-4630, steff@thebigpushformidwives.org.

Article on American Maternity Care

From Sociological Research Online: Born in the USA: Exceptionalism in Maternity Care Organisation Among High-Income Countries

Two quotes I liked:

"The use of sophisticated technology during normal, uncomplicated childbirth also helps to explain how the management of birth by physicians has come to be seen as 'heroic.' But in fact, for the majority of women, pregnancy and childbirth are neither rare, nor pathological, events (van Teijlingen 2005; Davis-Floyd 1987). The medicalisation of childbirth obscures this fact. Most lay people know nothing about how ordinary women experience birth, nor do they understand the many and varied ways of organising birth safely. Rather, the taken-for-granted idea of childbirth as a frightening and dangerous event constitutes the dominant cultural representation of pregnancy and birth. A society's understanding of birth as risky affects the way maternity care is organised, how care is delivered, and what women come to expect of maternity services and, ultimately, birth itself." (emphasis mine)

Regarding birth in the media: "To be sure, it would be simplistic to claim that most of the knowledge of birth that residents of US have comes from the media. Furthermore, this kind of media imagery is not unique to the US. Analysis of media portrayals of birth in the UK shows that having a child is unrealistically risky for a television character (Clement 1998). Nevertheless, it is evident that the framing of birth as risky and traumatic by media in the US is influential in shaping how people think and act."

--
Molly Remer
CfM Blogger

Love & Birth

Given the day, I'm prompted to share two quotes related to love and birth.

From the book Childbirth with Insight by Elizabeth Noble:

"Birth, like love, is an energy and a process, happening within a relationship. Both unfold with their own timing, with a uniqueness that can never be anticipated, with a power that can never be controlled, but with an exquisite mystery to be appreciated."

Then, from a beautiful article called The Origin of Love written by a father in LLLI's magazine New Beginnings:

"...instead comes a gesture: a small wave of the hand and caressing of the fingers as she slowly soothes our baby and he falls back to sleep. I do not think words are possible to explain this moment to any person who has never seen it. It is a moment in which after having given birth to life, a woman gives birth to love. A woman does not read this kind of expression in a book or hear it in an aria. This moment is the birth of love from eons of pressure that have been building. This one gesture in the darkness suggests the origins of love, for love is not just the opposite of something. Love is born of a mother's self-restraint. Love is the product of the pressure that builds in a woman at 3 am. For, at that moment, one could almost hear the carbon molecules slipping into position in some bedrock hundreds of miles beneath the earth's surface, creating the diamond that is every woman and is my wife." (emphasis mine)

Happy Valentine's Day!

--
Molly Remer
CfM Blogger

Grassroots Network: Consumer Reports

In October, I posted a notice from Childbirth Connection about the Milbank Report that included a link to an article and quiz in Consumer Reports based on the report. The article and quiz have caught renewed attention since then and here is some more information from the CfM Grassroots Network:

Dear Friends,

Consumer Reports has published an excellent article based on the report "Evidence Based Maternity Care: What It Is and What It Can Do" published last fall by Childbirth Connection, the Reforming States Group and Milbank Memorial Fund. The article summarizes the main points made in the much longer report.

The Consumer Reports article can be read here.

and includes a quiz. The first question is (answer true or false): An obstetrician will deliver better maternity care, overall, than a midwife or family doctor. Of course you all know the correct answer! Each question includes an explanation of the correct answer.

Since Consumer Reports is held in quite high regard, this will be a great article (and quiz!) to use with family, friends, legislators, and anyone you can think of! While the article does not emphasize midwives, it does a good job of pointing out the shortcomings of the standard, hospital-based high tech maternity "care".

Sincerely,
Susan Hodges, "gatekeeper"

Birth Fear

On February 10, I went to the Friends of Missouri Midwives annual Cookie Day event at the Capitol. In addition to all the yummy cookies, we had a really special treat this year. Jennifer Block (author of Pushed) spoke at our rally in the rotunda! You can read more about the event here.

I've read Pushed twice and meeting Jennifer in person prompted me to once more share a quote I had written down the first time I read her book:

"Why is it that the very things that cause birth related morbidity rates to rise are seen as the 'safe' way to go? Why aren’t women and their doctors terrified of the chemicals that are dripped into their spines and veins—the same substances that have been shown to lead to more c-sections? Why aren’t they worried about the harm these drugs might be doing to the future health of their children, as some studies are indicating might be the case? Why aren’t they afraid of picking up drug-resistant staphylococcus infections in the hospital? And why, of all things, aren’t women terrified of being cut open?"

Thinking about the women I speak with, many seem to simply be afraid of BIRTH. Afraid of pushing the baby out. When I reflect on what I was personally afraid of in birth, I realize that I was afraid of the very things she mentions above, which is part of why my baby was born at home!

--
Molly Remer
CfM Blogger

Birth Video Contest, Breastfeeding Posters, & Midwifery Editorial

You may have already heard that Birth Matters Virginia is having a birth video contest (you do not have to live in VA to participate). I'm sure it will be exciting to see the results!

I recently came across some very nice free educational posters and other breastfeeding resource materials from the British Columbia Baby Friendly Network (I originally found the link on the Passion for Birth blog)

Finally, I wanted to mention an editorial in the Journal of Obstetric, Gynecological, and Neonatal Nursing called The Authorities "Resolve" Against Homebirth. Written by a CNM it is a look at the AMA and ACOG's position against homebirth. I learned about this editorial from the Woman to Woman blog, which includes several good quotes from the editorial.

--
Molly Remer
CfM Blogger

Book Review: The Blue Cotton Gown

The Blue Cotton Gown: A Midwife’s Memoir
By Patricia Harman
Beacon Press, 2008
Hardcover, 290 pages
ISBN: 978-0807072899

Reviewed by Molly Remer

Patsy Harman is a CNM in West Virginia. She runs a busy women’s health practice with her husband Tom, an OB-GYN. Though obstetrics was once a rewarding part of their practice, they’ve stopped attending births due to unaffordable malpractice insurance rates. In addition to tales from the office, this compelling narrative follows Patsy through struggles with the IRS, fears over potential lawsuits, family complications, and uterine cancer. Since I usually come from a consumer advocate’s perspective, it was very interesting to have this intensely personal look at the other side of the coin—the deep fear obstetric professionals have of lawsuit.

The author told me in advance that this is not a book of birth stories, "it is about women giving birth to themselves." This is true—-there are almost no birth stories in the book (and in one of the few there is, I was surprised to read that the mother was induced with misoprostol!). However, this is actually what gives the book its absorbing edge. In it, you get to see another side of midwifery—-the "with woman" side that extends before and after pregnancy and childbirth. This is a side of midwifery that I haven’t yet seen explored in memoir format and it was incredibly engaging. Patsy’s clientele are women who have STDs or yeast infections, who need pap smears or well-woman exams, or who need a pregnancy diagnosed, but her care for them goes beyond the physical. The women’s lives are complicated, as is her own. Some of the stories are very sad and others are uplifting. If you are looking for birth stories, look elsewhere, if you are looking for a skillfully written and emotional look at the practice of nurse-midwifery and its dominating role in a woman’s multifaceted life, you will find a treasure in The Blue Cotton Gown. As it came to an end, I found myself wishing for Part Two.

NEW Membership Category: Become a "Citizen" for Midwifery!

As of February 1, CfM has a new membership option: donate just $10 to become a "Citizen" for midwifery! This membership does not include the CfM News; it is an inexpensive way to support the work of CfM promoting the Midwives Model of Care. Each "Citizen" will be acknowledged with an attractive postcard that includes the Midwives Model of Care definition and other important information and web addresses.

Our intent is to encourage more people to become CfM members, strengthening our numbers as we work on behalf of consumers. For many years we have asked midwives to sign up clients with CfM, and we appreciate each of you who have done so. We hope that this new membership option will encourage and enable many more of you to do so. And, while anyone can join as a "Citizen", we also hope that many people will continue to join and renew at the suggested level ($30) and receive the CfM News, our in-depth newsletter.

Articles

This week I finished reading a wonderful new book called The Blue Cotton Gown (more about this soon). It is a memoir by a CNM who runs a women's health practice with her husband, an OB-GYN. They do not attend births anymore because of malpractice insurance rates and one of the substories in the book is also about their fear of lawsuit. The same day I finished reading it, I came across a relevant and interesting article on EmpowHer, Women's Health Online about malpractice insurance rates closing birth centers: How Did Birth Become so Compassionless?

I also wanted to share a link from the British Medical Journal on quality of life after vaginal and cesarean birth. Unfortunately for me, I can't read past the first page (the article is a pdf and opens up strangely for me). So, hopefully someone else can read it and tell me what the conclusions actually are! :)

Finally, I wanted to share that the Our Bodies, Ourselves: Pregnancy & Birth book I reviewed for CfM News last year was chosen by the Library Journal as one of the 24 best consumer health books of 2008. Congratulations OBOS!

Molly Remer
CfM Blogger