Grassroots Network: Birth Survey reviews now available!

I already made a brief post about The Birth Survey. Here is a more detailed message and press release fthat was posted to CfM's GRN:

Dear Friends,

The Coalition for Improving Maternity Services (CIMS) has just announced: The Birth Survey Now Offers Access to Reviews of Local Maternity Care Providers and Facilities.

Many of you already know about The Birth Survey, part of the Transparency in Maternity Care Project of the Coalition for Improving Maternity Services CIMS). The Birth Survey involves an "an on-going online consumer survey that asks women to provide feedback about their pregnancy and birth care specific to the particular doctor, midwife, hospital or birth center that served them." The Birth Survey has been collecting these surveys, and now has these reviews available on-line, for reviews from across the country!

Read the informative press release below, or find it and more information about the Birth Survey and the rest of the Transparency in Maternity Care Project here.

Sincerely,
Susan Hodges, "gatekeeper"


FOR IMMEDIATE RELEASE

CONTACT: Denna Suko, Executive Director
Coalition for Improving Maternity Services
Tel: 919.863.9482
dsuko@motherfriendly.org

Choosing a Birth Care Provider? The Birth Survey Now Offers Access to Reviews of Local Maternity Care Providers and Facilities.

Raleigh, NC (April 28th, 2009)-CIMS, the Coalition for Improving Maternity Services, a group working toward transparency in maternity care, today announced that consumer survey results rating health care providers and birth facilities are now available online.

The CIMS Transparency in Maternity Care Project: The Birth Survey is the first ever consumer ratings website dedicated solely to providing feedback on obstetricians, midwives, hospitals, birth centers, and home birth services. The consumer reviews include overall ratings and recommendations for birth facilities and care providers, and also a seven-item set of questions on providers' interpersonal and communication skills, facility intervention rates, and information on finding good care. A national average of ratings is also displayed to provide comparison with individual ratings.

"While consumers have long been sharing information online about products and services, more data was available for the purchase of a digital camera than had ever been available to women as consumers of maternity care. The Birth Survey directly addresses that information deficit," said Robin Elise Weiss, LCCE, author of The Complete Illustrated Guide to Pregnancy and member of The Birth Survey Committee.

The Birth Survey is a user-friendly, free Website where mothers who have given birth within the last three years can provide detailed, anonymous feedback about their experiences. The survey questions are based upon the Mother Friendly Childbirth Initiative, an evidence-based model of high quality maternity care. Additionally, the interpersonal and communication questions are based upon an AHRQ survey, which represents a well known set of questions currently used by doctors and hospitals.

More than 17,500 ratings for providers and 6,500 ratings for facilities have been submitted since the national launch in August 2008. Now, parents-to-be can retrieve the pooled reporting on local providers and facilities.

The national averages of the consumer feedback collected indicate that midwives were rated more highly than the physicians. For example, 58 percent of respondents would recommend their doctors to family and friends, compared to 90 percent who would recommend their midwives. Across all providers, 77 percent of women reported that they had their questions answered completely, and 73 percent felt they were as free as they wanted to be in making their own decisions about their care. Averages, however, varied widely between individual providers.

The Website ratings pages also provide links to hospital and birth center obstetric intervention rates, such as c-section, for facilities in nine states. This information is part of The Birth Survey's nationwide campaign to make facility-level intervention data available to the public. This kind of public reporting supports informed choice
and fosters transparency, which improves outcomes.

Consistent with a new series of government Public Service announcements that encourage consumers to get involved in their health care and ask questions of their care providers, The Birth Survey offers links to information on how to choose and evaluate providers, including the "CIMS Ten Questions to Ask." B y offering more than a conventional five-star rating, The Birth Survey offers information that is vital for women to make more informed decisions.

"A woman who looks at a list of names from her insurance company is often choosing a provider on nothing but blind luck. Where and with whom to give birth are important health care decisions. Research shows that both provider and location have a significant impact on birth outcomes. CIMS wants expectant parents to ask questions of their providers and facilities, and have access to more information about their local options," said Elan McAllister, founder of Choices in Childbirth in New York City and Co-chair of the The Birth Survey committee.

The Birth Survey is an ongoing project. In the summer of 2009, free-text responses will be displayed on the website, and in 2010, detailed information on patients' experiences with prenatal, labor, birth and postpartum care will be added to the website as searchable custom reports.

###

For more about The Birth Survey, to view intervention data for each
state, the survey results, or to take the survey, log on to
http://www.thebirthsurvey.com <http://www.thebirthsurvey.com/> .

About the Transparency in Maternity Care Project: The Coalition for Improving Maternity Services CIMS) through the Transparency in Maternity Care Project developed The Birth Survey so families can share information, learn about the choices and birth experiences of others, and view data on hospital and birth center intervention rates and practices. It is also designed to help providers and facilities improve the quality and transparency of their care. At the heart of the project is an on-going online consumer survey that asks women to provide feedback about their pregnancy and birth care specific to the particular doctor, midwife, hospital or birth center that served them. Responses are made available online to other women in their community who are deciding where and with whom to birth. Paired with this experiential data, are official statistics from state departments- of-health listing obstetrical intervention rates at the facility level.

About the Coalition for Improving Maternity Services: The Coalition for Improving Maternity Services (CIMS) is a coalition of individuals and national organizations with concern for the care and well-being of mothers, babies, and families. Our mission is to promote a wellness model of maternity care that will improve birth outcomes and substantially reduce costs. This evidence-based mother-, baby-, and family-friendly model focuses on prevention and wellness as the alternatives to high-cost screening, diagnosis, and treatment programs. For more information, log on to http://www.motherfriendly.org/.

Denna L. Suko
Executive Director
Coalition for Improving Maternity Services (CIMS)
1500 Sunday Dr Ste 102
Raleigh, NC 27607
Tel: 919.863.9482
Fax: 919-787-4916
dsuko@motherfriendly.org

Grassroots Network: PushNews: Flu and need for out-of-hospital midwives

Dear Friends,

The news of a pending flu epidemic is alarming. Even more so is the fact that national and state disaster preparedness plans have not given much attention to childbirth in the midst of any disaster, including an epidemic.

The Big Push has addressed this issue in a new "PushNews." You can read it here.

With health care reform around the corner, this is a great time to write letters to the editor, or op ed pieces for your local newspaper, and this is a newsworthy angle. Any positive mention of midwives (of any kind) in the newspaper is good! You can quote from the press release, and/or if you know a reporter at your local paper, you can give them a copy. When you write a letter to the editor, be sure to find out the word limit for your paper (so you can do any editing!). Find some "Tips for Writing Letters to the Editor" 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."

If you haven't already, to take a look at the Big Push website and you can sign up for PushAlerts here.

Sincerely,
Susan Hodges, "gatekeeper"

Grassroots Network: Petition: "Support Evidence Based Midwifery Education in the US"

Dear Friends,

You may have already seen this on other lists; if not, please read the note below and consider signing the petition. Citizens for Midwifery has endorsed NARM's statement, and nearly 2000 individuals have already signed on.

The CPM credential is the point; whether you acquire your skills, knowledge and experience through an accredited program or through other means (documented through the Portfolio Evaluation Process) does not make a difference, nor is one better or worse than the other. A CPM is a CPM.

In the end, as women and families, we need all the midwives we can get, in every setting, and women should be able to choose the provider and setting that is best for them. The ACNM has every right to make position statements about the certified nurse midwife credential, but should refrain from taking positions about other credentials and their requirements, especially when such a position creates barriers for qualified midwives to practice and women to access them.

Sincerely,
Susan Hodges, "gatekeeper"


From the North American Registry of Midwives (NARM):

Dear Friends-

A recently revised Position Statement from the American College of Nurse Midwives (ACNM) seeks to limit recognition of midwifery providers to those who have received their training through government accredited programs. The North American Registry of Midwives (NARM) oversees the credentialing of midwives who have received their training through time honored and evidenced based systems that emphasize clinical competency over all other criteria (Certified Professional Midwives-CPMs).

NARM has posted an online petition in an effort to organize our voices and convince the ACNM to reconsider its position on apprentice trained midwives. This letter seeks to unite US Midwifery under the common goal of providing women with access to the provider and setting of their choice for birth.

We ask that individuals as well as state and national midwifery and birth advocacy organizations sign this petition.

There are many great opportunities mounting to move midwifery forward on both the state and national level. We must stand together as a community of midwives if we are going to have a real voice for change in maternity care. Whether you are a CPM, CNM, a midwifery consumer, advocate, or none of the above, please go here to read more details about this issue and sign the petition to make your voice heard.

Respectfully,

The NARM Board of Directors

The Birth Survey Results are In!

I have posted several times about The Birth Survey (an amazing project of CIMS). Well, now the results of the Survey are available online! Go to The Birth Survey site and click on View Survey Results by the word Connect. Remember that if you've given birth within the last three years, you are still eligible to take the survey and add your data to the nationwide results. My baby will be three next month and I completed the survey earlier this year.

A little more about the purpose of The Birth Survey:

"For years, consumers have enthusiastically shared online reviews of movies, restaurants, products and services, but readily available information about maternity care providers and birth settings was nearly unattainable--but no longer. The Birth Survey is now available to all women in the US who have given birth in the last three years. Women can now give consumer reviews of doctors, midwives, hospitals, and birth centers, learn about the choices and birth experiences of others, and view data on hospital and birth center standard practices and intervention rates."

--
Molly
CfM Blogger

Grassroots Network: Action Alert: Help Birth Centers!

Dear Friends,

The American Association of Birth Centers is asking everyone to help with grassroots support in their efforts to get federal legislation that would include birth center facility fees for Medicaid reimbursement. Without this, many birth centers, especially those that serve many Medicaid clients, would have to close. While some state Medicaid programs have reimbursed birth centers in the past, more recently the federal government has taken actions to stop states from including this reimbursement because it is not specified in federal legislation. You can find more information about birth centers and the bill at "Materials to Help You Communicate with Your Legislators."
.

Please read the message below, which spells out exactly what is needed. All it will take on your part is a couple of phone calls to help make sure that freestanding birth centers can continue to offer women an excellent choice for maternity care.

Thanks for your help!

Susan Hodges, “gatekeeper”

From the American Association of Birth Centers:

How to Help AABC Lobby for the Birth Center Medicaid Bill

The American Association of Birthing Centers (AABC) is seeking federal legislation that would add freestanding birth centers to the list of health professionals and providers eligible for payment under the federal-state Medicaid program. Medicaid is the primary source of payment for maternity care services for low income women; in many states, nearly half of all pregnant women are Medicaid beneficiaries. The Federal law that lists all Medicaid-eligible providers is section 1905(a) of the Social Security Act. Although hospitals, physicians, nurse-midwives, clinics, and others are among those listed, birth centers are not. This means that birth centers cannot be reimbursed for the facility fees they charge, which are like hospital facility fees, but much less money.

Next week, AABC’s bill will be introduced in the U.S. House of Representatives by Rep. Susan Davis (D., CA) (San Diego). It will then be assigned a bill number and an official name. We will let you know when that happens, but don’t wait to make your calls. AABC is asking all birth professionals, birth advocates, and supporters of improving maternity care to help us lobby for this bill. Grassroots support phone calls to Congress is the single most important element in whether a bill like this becomes law.

Please help. It’s easy. (See #4 below for how to find out who your Congresspeople are.) Here’s all you have to do:

1. Call the Washington, D.C. office of your Congressperson to ask if he or she will co-sponsor Rep. Davis’ bill. We particularly want co-sponsors who are members (Dem. or Rep.) of the House Energy & Commerce Committee. (Find a list of the members (with state indicated) at http://energycommerce.house.gov , click on “About the Committee” to get to the list of members, and see if your Representative is on this important committee.)

2. Call the Washington, D.C. office of your Senator and ask if he or she will introduce the bill in the Senate. If he/she doesn’t want to do that, then ask if he or she will co-sponsor the bill. (Find a list of members of the Senate Finance Committee at http://finance.senate.gov/sitepages/about.htm.)

3. When you make your call, ask to speak with the Health Legislative Assistant for the Senator or Congressperson. Tell him or her:

· how important this bill is to Medicaid mothers and babies,

· how great birth center outcomes are, and

· how important it is to keep birth centers as viable options for low income women.

Please take a look at the "Materials to Help You Communicate with Your Legislators" at:
http://www.birthcenters.org/legislative-alerts/index.php?id=24 for more background information about birth centers and our bill these materials will provide some good talking points.

4. Everyone knows their federal Senators, but you may not be so sure about your Congressperson There are many search engines online that will allow you to simply type in your address and find out all your federal and state representatives. ACNM has a good one (www.midwife.org). Here are links to the Senate and House search pages: http://www.senate.gov/general/contact_information/senators_cfm.cfm OR http://www.house.gov/house/MemberWWW_by_State.shtml

5. Call, do not email. Phone calls are the most valuable tool for grassroots lobbying. If you get a busy signal, call back. Right away. Use speed-dial. You’ll get through. Identify yourself as a constituent, and then tell them what you want.

6. AABC’s lobbyist is Karen Fennell. Her phone number is 301-830-3910. Her email is karenfennell50@yahoo.com. Give this information to the Health L.A., and then send Karen an email to tell her who you are, who you called, and what they said. If they want more information, tell them Karen will follow up.

7. Ask your spouse, partner, families members, friends, co-workers to call. It’s good practice for health care reform later this year.

Thanks so much for your help.

Language of Birth

I have a long term interest in how the language we use to talk about birth impacts our actual experiences of giving birth, as well as in the differences in the language used by the medical model and the midwifery model. For quite some time, I've wanted to share a section from the Our Bodies Ourselves: Pregnancy & Birth book on this subject:

The language used to describe pregnancy and childbirth reflects assumptions about women that set the stage for different styles of maternity care. Woman-centered terminology portrays women as active, healthy, and powerful, and labor as 'natural' and 'normal,' In this view, associated traditionally with the midwifery model, providers 'attend' women, 'assist' at births, and 'catch' babies. In contrast, some medical language depicts women as passive subjects, putting doctors in the role of 'managing labor' and 'delivering babies.' Medical terms such as 'failure to progress,' 'inadequate pelvis,' and 'incompetent cervix' imply that something is wrong with a woman's body. This influences how we see ourselves, how providers see us, and how the media portray birth.

On a related note, I've had the book Bearing Meaning: The Language of Birthon my Amazon wishlist for quite some time. I have a birthday coming up, so perhaps I'll finally get to read it! :)

--
Molly
CfM Blogger

Happy Earth Day!

Peace on Earth Begins with Birth.

This phrase keeps turning around in my head today as I spent Earth Day outside with my two children and our friends. I wanted to share some quotes from the Midwifery Today book The Heart & Science of Homebirth (in the article "Remembering Why We are Midwives" by Judy Edmunds):

"...I believe in the beauty and dignity inherent in all women. I am awed by their strength and power and am fortunate to be able to attend births where these qualities are so clearly displayed. Having a share in drawing out that power, respecting that dignity and nurturing the spirit of courage is being privy to a bit of creation itself. It is an incredible privilege."

"Midwives try to convey these simple truths: Birth is not a clinical exercise. It is not a medical procedure. In nearly every instance, it should not be major surgery. Nor should it even routinely include minor surgery. Rather than being a time of weakness with beds, shots, fasting, IVs and wheelchairs, it is time of energy and strength. Raw power. Mightiness. Courage."

This is a beautiful summation. If more women and babies began their journeys together with this attitude towards birth behind them, perhaps we really would have peace on earth!

I also wanted to link to two great blog posts I read today. First, at Stand & Deliver, a review of the book Policing Pregnancy that includes a thought-provoking analysis of using the term "obstetric conflict" instead of "maternal-fetal conflict." Second, at The Unnecesarean a discussion about a new British study "Maternal Request Not Reason for Rising Cesarean Rate."

--
Molly
CfM Blogger

Grassroots Network: New home birth study from the Netherlands

Dear Friends,

As many of you may have heard, a very large study of home birth in the Netherlands was just published last week. The abstract is below, as well as the link to the abstract on the website of BJOG (an International Journal of Obstetrics & Gynecology). The study concludes that giving birth at home is as safe as hospital (if the birth is planned, with a well-trained midwife, and there is adequate transportation to and communication with medical services). It anticipates a similar study out of the UK that will be forthcoming. Mary Newburn, head of research and information at the National Childbirth Trust, commented that the study "makes a significant contribution to the growing body of reassuring evidence that suggests offering women a choice of place of birth is entirely appropriate."

Molly previously posted some additional links regarding this study. A comment to Rixa's blog included a link to a letter to the editor of the British Medical Journal from Madeleine Akrich, PhD and Bernard Bel, PhD, Collectif interassociatif autour de la naissance), that included these comments:

"We do share Visser & Steegers' concern about high transfer rates in low-risk births. As suggested in their paper, bad rates point at the detrimental effect of discontinuity of care, rather than at unforeseen serious complications. In their words, "healthy pregnant women need care, not cure."

"Besides, the transfer rates of home births seem to be rising in the Netherlands. They were 40% and 9% for nulliparae and multiparae respectively in 2002. It is also significant that these rates were even higher from polyclinics to hospital: 43% and 19% respectively, as deducted from the enclosed graphs. (The leftmost bars indicate home and polyclinic births and the central ones indicate transfers from home and from polyclinics.)

"Midwives comment that they feel more under pressure to accelerate labour when working closer to "the machines". This observation remains consistent with the conclusions of Wiegers and colleagues comparing midwifery practice at home and in hospitals: Outcome of planned home and planned hospital births in low risk pregnancies: prospective study in midwifery practices in the Netherlands (TA. Wiegers, MJNC. Keirse, J. van der Zee, GAH. Berghs). BMJ 1996;313:1309-1313"

The bottom line is that the vast majority of women, especially for first births, benefit from continuous support during labor, not more medical attention.

In addition, you may also find it useful to read CfM's article about ACOG and the AMA here and a discussion of "safety" here.


Sincerely,
Arielle Greenberg Bywater and Susan Hodges


Article Citation:
de Jonge A, van der Goes B, Ravelli A, Amelink-Verburg M, Mol B, Nijhuis J, Bennebroek Gravenhorst J, Buitendijk S. Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births. BJOG 2009. Accepted 26 February 2009. Published Online 15 April 2009.

ABSTRACT

Objective: To compare perinatal mortality and severe perinatal morbidity between planned home and planned hospital births, among low-risk women who started their labour in primary care.

Design: A nationwide cohort study.

Setting: The entire Netherlands.

Population: A total of 529 688 low-risk women who were in primary midwife-led care at the onset of labour. Of these, 321 307 (60.7%) intended to give birth at home, 163 261 (30.8%) planned to give birth in hospital and for 45 120 (8.5%), the intended place of birth was unknown.

Methods: Analysis of national perinatal and neonatal registration data, over a period of 7 years. Logistic regression analysis was used to control for differences in baseline characteristics. Main outcome measures Intrapartum death, intrapartum and neonatal death within 24 hours after birth, intrapartum and neonatal death within 7 days and neonatal admission to an intensive care unit.

Results: No significant differences were found between planned home and planned hospital birth (adjusted relative risks and 95% confidence intervals: intrapartum death 0.97 (0.69 to 1.37), intrapartum death and neonatal death during the first 24 hours 1.02 (0.77 to 1.36), intrapartum death and neonatal death up to 7 days 1.00 (0.78 to 1.27), admission to neonatal intensive care unit 1.00 (0.86 to 1.16).

Conclusions: This study shows that planning a home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system.

================================================

Vitamin D and Cesareans

Several people have sent me a link to news articles about a recent study linking Vitamin D Deficiency to Increased C-Section Rate.

Amy Romano, blogging as a guest on the Giving Birth with Confidence blog, has a really fabulous analysis of the study: Rotating Theories of the Increasing C-section Rate: Vitamin D Edition

Her conclusion is particularly astute:

"Another red flag for bias? One of the study’s four authors is a paid consultant to none other than Quest Diagnostics, the company that made me listen to an ad for vitamin D blood testing while I was on hold.

Debunking this study doesn’t mean that vitamin D deficiency is harmless or that there aren’t other potential public health benefits to preventing and treating vitamin D deficiency in pregnant women. But we need a lot more information before we start blaming the increasing cesarean rate on vitamin D. It’s tempting in the face of a cesarean epidemic to assume that women’s bodies are deficient in something or another, or to just assume that women are asking for it. These theories direct attention away from the systemic problems that keep the cesarean rate marching higher and higher."

Speaking of the Giving Birth with Confidence blog, Amy also has an in-depth post there looking at the new homebirth study from the Netherlands that concluded giving birth at home is at least as safe as giving birth in the hospital. Rixa at Stand and Deliver also has a good post about this homebirth study, including lots of links to the difference media coverage of it. Make sure to check these out!

--
Molly
CfM Blogger

Emotional & Physical Impact of Cesareans

As I've mentioned previously, April is Cesarean Awareness Month and I would like to share a couple of more related thoughts before April draws to a close.

Midwifery Today recently published a two part article by Pam Udy. The first article addresses the physical impact of cesareans and the second article addresses the emotional impact of cesareans. As the author notes, a cesarean "can scar her heart, as well as her uterus."

Among a variety of physical effects, "Mothers who have cesareans are less likely to breastfeed, for many reasons. Often mother and baby are separated, which means a delay in getting baby to breast. The mom is dealing with pain, fatigue, possibly stress, and even trauma. The incision itself causes the mom difficulty in finding a comfortable position in which to nurse. The baby may have respiratory issues." You can read an excerpt from the Physical Impact article here.

I particularly enjoyed this quote from the Emotional Impact article (which you can read a longer excerpt from at Midwifery Today):

In the continuum of life, pregnancy, birth and the postpartum period are milestone events. These experiences profoundly affect women, babies, fathers and families. They have important and long-lasting effects on society.

When a woman give birth, she has to reach down inside herself and give more than she thought she had. The limits of her existence are stretched...As she does it, she becomes someone new: a mother. If the birthing process is skipped or occurs in a hostile situation, or if the interventions become overwhelming, she becomes a different mother that she would have been if she had only a supportive, midwifery model of care.

The transition to motherhood is challenging on its own without adding in a host of additional physical and emotional recovery factors. Obviously, we are glad for cesareans when they are necessary, but as a country we can definitely do better than launching so many new mothers into an intense new role while they are simultaneously trying to heal in body and mind.

--
Molly
CfM Blogger

Media Assortment

+ A Spanish Bed Commercial that features a homebirth has been airing all over Spain: “La cama no es un lugar solo para dormir; en ella también vivimos algunas de las experiencias más importantes de nuestra vida, incluso el comienzo de la misma--The bed isn't just a place to sleep..it is also where we live some of the experiences most important of our lives...including the beginning of said life!

+ A recent Cochrane evidence review came out on Maternal positions and mobility during first stage of labor:

So why would staying out of bed shorten labor and reduce pain?

"Women who are upright and mobile are able to change their positions more easily," said Annemarie Lawrence, lead review author and a research midwife at the Institute of Women's and Children's Health at Townsville Hospital in Queensland, Australia.

"The ability to change positions, to utilize a wider variety of positions, and try other options, such as hot showers, birthing balls and beanbag supports, may help reduce overall pain and give women a greater sense of control over the progress of their labor," she said.

+ I was interested to read the article Abu Dhabi doula about a multicultural doula training conducted by Debra Pascali-Bonaro.

+The Sierra Vista Herald published an article about a midwife: Bisbee midwife has assisted at hundreds of births

+ And, the Chicago Tribune weighed in on the Atlantic breastfeeding article I've posted about previously:

Breast-feeding's debate not related to infants' health:
But the guilt and the angst over whether to breast-feed is her problem, as is her perception that she'll be less than an uber-mom if she gives her baby a bottle. Who told her she had to be an uber-mom, anyway? The reality is, moms make trade-offs over what they do for their babies all the time in light of their time, energy, abilities and financial and emotional resources.

--
Molly
CfM Blogger

BBC Articles

I wanted to share links to two articles that I accessed on the BBC News website today. The first, Home births 'as safe as hospital', shares that "The largest study of its kind has found that for low-risk women, giving birth at home is as safe as doing so in hospital with a midwife. Research from the Netherlands - which has a high rate of home births - found no difference in death rates of either mothers or babies in 530,000 births."

The second was originally published last month: Women 'unprepared for childbirth'. From the article's opener: "Many women are going into labour vastly underestimating how painful it can be and overly optimistic that they will be able to manage without drugs, a study suggests. How has this happened?"

As a childbirth educator, I definitely have lots of thoughts about this. In fact, there is a very telling segment later in the article: "Much evidence suggests, however, that women who are well supported by midwives and partners throughout their labour and made to feel at ease are the ones who manage their pain the most effectively and require the fewest drugs."

My short take on the question "How has this happened?" is that many hospitals simply do not support the six care practices that support normal birth (care practices that greatly add to women's ability to cope with labor) and that women's access to the Midwives Model of Care is very limited!

--
Molly
CfM Blogger

Susan Hodges is a Women's Health Hero Nominee!

As a follow-up to my previous post, Citizens for Midwifery President Susan Hodges has been nominated for a "Women's Health Hero" Award. You can view the nomination here.

From OBOS:

"One winner will be chosen by the staff and Our Bodies Ourselves' Board of Directors, while the other winner will be determined by the public through a ratings system located on the contest website. Public voting ends May 8, 2009 and the entry that receives the highest overall ranking will receive the Audience Choice Award. So don't forget to ask friends, family and co-workers to rate your entry. "

--
Molly
CfM Blogger

OBOS Women's Health Heroes

Our Bodies, Ourselves is seeking nominations for their "Women's Health Heroes" contest. I can think of many women I'd like to nominate and hope to have a chance to do so soon. Here is some more information about the contest from OBOS:

When you hear the words "Women’s Health Hero," who comes to mind? Your 9th grade health teacher who taught you about sexually transmitted infections? The midwife who sat with you through 15 hours of labor? The young Nigerian activist you read about who’s working to end gender discrimination in her country? Or maybe the neighbor who counter-protests at the abortion clinic every Saturday morning?

Whoever your heroes are, we want to know about them! We’ve created the Our Bodies Ourselves Women’s Health Heroes awards to honor those who make significant contributions to the health and well-being of women. It’s a great way to publicly recognize people who make a difference in your life or the lives of others.

Nominations are now being accepted. Please visit http://www.ourbodiesourselves.org/heroes.asp for more information.

Contact Wendy Brovold, Communications and Marketing Manager at wendy@bwhbc.org or 617-245-0200x13 with questions.

Grassroots Network: Big Push for Midwives Action Alert

Dear Friends,

Health Care Reform is coming FAST! We are hearing from multiple sources that bills are being drafted now, for voting during the summer. Therefore, we are forwarding along this Action Alert from The Big Push for Midwives (see below). To find out more about The Big Push for Midwives campaign, visit their site.

A couple of suggestions to add to the Big Push's Action Alert information: First, In approaching your Senator and Representative, consider that "health care reform" is a huge topic, and only 1% of women are giving birth at home. Therefore, start with the bigger picture: the high importance of reforming Maternity Care in order to improve birth outcomes (a problem in the US), lowering costs (inexcusably high in the US), and addressing "Comparative Effectiveness" (the new buzzword for studying what works and what doesn't in health care, for which funds have already been earmarked). CPMs certainly have an important role to play (as noted in the Big Push action alert), but you may be more effective if you start with the "big picture" issues.

Second, in addition to the BigPush FAQ flier linked below, Citizens for Midwifery has material that you may find very useful, for background information, ideas, or in some cases to give to the legislator or include with a letter. Among the many resources on our website, the following may be particularly useful:

CfM's Health Care Reform Recommendations to Obama Transition Team

Out-of-Hospital Midwifery Care: Much Lower Rates of Cesarean Sections for Low-Risk Women

State of American Childbirth--2005 and 2006 Data [note: this is the most recent data available]

And don't forget: if you are not able to personally visit your US Senator or Representative, write a letter! The sooner the better! CfM has some tips for writing letters to legislators. Developed for writing to state legislators, this guide can easily be adapted to this situation, and the basic tips all apply. Find this at:
Anyone Can Write to Their Legislator - It's Easy
Basically, hand write your letter, and keep the letter short and to the point (you can always include an additional fact sheet or two).

Sincerely,
Susan Hodges, "gatekeeper"
****************************************
From The Big Push for Midwives:

Urgent Request for Action!

WASHINGTON Must Hear Direct From Grassroots America

Folks, I have some urgent news to report. PushScouts who have attended White House town-hall health care meetings across the country with policy wonks and DC insiders have all returned with the same message:

Federal health care reform is moving fast and *the window of opportunity for including Certified Professional Midwives is rapidly closing.* Bills are being drafted now and any providers who aren't on "the list" by September
will be left behind.

The time to act is now.

*We need each and every Pusher* to schedule an in-district meeting with their member of Congress and two Senators today. Both chambers are in recess, and members are in their home districts until April 19th. This is a
*golden opportunity* to begin educating our federal representatives about CPMs and to make sure all of us are doing everything we can to *make sure that CPMs are included in the final reform package*.

Scheduling a meeting is easy, but many other groups are competing for face-time and the available *slots are filling up fast.* So please follow the instructions below and *call* your federal delegation today!

*Midwives, please forward this important information to your clients,* past and present, and ask them to schedule a visit with their federal representatives. Also, it's important that CPMs represent their profession at the federal level, so please *pick one or two clients you would like to accompany you to a visit* and ask them to join you.

Attached you will find a two-page FAQ that includes each of the messages your representatives need to hear. You can also download it from the PushSite.

All you need to do in the next week is *1)* pick one or two of your favorite points to talk briefly about, *2)* record any questions they may have that you are unable to answer to pass along for follow-up, *3) *leave the FAQ
sheet with their staff and *4)* report back to other Pushers about your meeting!

Because there is strength in numbers, we ask you to recruit one or two supportive allies to go to the meeting with you: community leaders, local clergy, physicians, nurses or other providers, a neighbor or member of your
family. It is important that our members of the Senate and Congress understand that *access to CPMs is important to Americans from all walks of life,* not just to those of us who choose this model of care or are CPMs ourselves.

*SCHEDULING AN IN-DISTRICT MEETING IS AS EASY AS A-B-C: *

All you need to do is identify your U.S. representative and two U.S. senators and contact them!

A. Use this link to determine your full zip code, which is your ZIP+four code.

B. Use this link and type in your ZIP+four code to determine your U.S. representative.

C. Use this link to determine your two U.S. senators.

Please make the call today! *We have 10 days* until their April recess is over.

Below is a list of tips and pointers to help you plan a smooth and easy visit with your federal representatives. Remember, they work *for you*!

*Tips for Visiting Your Members of Congress in Their District Offices*

§ When you call to make the appointment, be sure to *mention that you are a constituent*, where you live and that you would like to briefly discuss the importance of including Certified Professional Midwives, who are specialists in out-of-hospital birth, in federal health reform.

It may take more than one call to get an appointment. Don't be shy about calling more than once!

§ Meeting with the staff person in charge of health care is every bit as effective as meeting with your member of Congress. Don't be discouraged if your representative can't meet with you—convincing staff that your issue is worthwhile is *a huge step forward* in getting your representative to support you.

§ Take a look at your representatives' web pages and get some background on their issues of interest or any legislation they support that you do, too.

§ *Recruit at least one other person in your community to join you*, but appoint one lead spokesperson for the meeting.

§ Be sure to wear business-casual clothes—no jeans or t-shirts, please!

§ Be considerate of their time. Make sure you keep track of your time and articulate your position without running over your allotted time.

§ After you have briefly made one or two points about the importance of including CPMs in federal health care reform, *ask if they have any questions*.

§ If you don't know the answer to a question, tell them you will pass it along to *The Big Push for Midwives Steering Committee
* for follow up.

§ After you've answered any questions, *ask them if they have a position on CPMs and out-of-hospital birth.* Offer to provide them with more information if they haven't yet taken a position.

§ Even if they are non-committal, *ask them for advice about what you can do to get CPMs included in federal health care reform.* Legislators and staff appreciate being asked to share their expertise and insight about
the legislative process with constituents.

§ It is appropriate to take notes about any questions they may want follow up or about advice they are offering. Save notes on the rest of the discussion for after your meeting.

§ Be sure to leave staff with your contact information and make sure you have theirs.

And of course, please don't forget to thank everyone for their time!

*The Final Push*

After you leave, sit down and conduct a brief review with others at the meeting. Assign someone to take notes and write down any key information or questions such as the legislator/staff's position, questions they have, objections they raised and any advice they offered.

Write legislators and staff after the visit to thank them for their time. Remind them of anything they may have agreed to do and send any additional information they may have requested.

*Report back to The Push Team*!* *Please forward notes and questions to Steff at Steff@TheBigPushForMidwives.org and share your experience, thoughts and tips with others at The Big Push for Midwives Facebook Discussion board.

Don't be shy about staying in touch with legislators and staff with alerts or other relevant news or information about CPMs. Effective advocacy at the legislative level is all about relationships—it's important to start building them now with your federal representatives and their staff.

More Birth Podcasts

After enjoying a large number of great podcasts from the La Leche League website, I discovered today that MIDIRS also has a selection of fabulous podcasts available as well (do be aware that you have register for the site in order to access the podcasts). They have several by Ina May Gaskin as well as other good speakers. I'm listening to one now called The Importance of a Smile: "In this cameo podcast, Ina May recalls her first images of a labouring woman, particularly the woman's face - her "rosiness" and "beauty" during labour and birth. Ina May uses this example to highlight the importance of midwifery care that increases the body's levels of neuroendorphins (nature's opiate)."

I get so much good information from the Passion for Birth blog--thanks, Teri, for tipping me off about these podcasts.

--
Molly
CfM Blogger

Impact of Birthing Practices on Breastfeeding Podcast

Last year I wrote a post about birth practices and breastfeeding. I recently found out that La Leche League has a free podcast available with Linda Smith (co-author of Impact of Birthing Practices on Breastfeeding). During the podcast she mentions midwives and also talks about doulas.

In the past I've also written about Diane Wiessinger and her wonderful presentations about mammals, birth, and breastfeeding. So, I was very excited to see that LLL also has a free podcast available from Diane! The podcast is called, "What other mammals can tell us about nursing."

There are many more wonderful podcasts available for free on the LLLI website. What a great resource!

--
Molly
CfM Blogger

Case Closed: Breast is Best

Peggy O'Mara of Mothering magazine has written a wonderful response to the breastfeeding article in The Atlantic that I posted about a few days ago. Called Case Closed: Breast is Best, the article closes with these excellent thoughts:

"Hanna Rosin's article exposes the dichotomy between the high value we place on breastfeeding and the low value we place on mothering, but it is cowardly to blame breastfeeding. Slandering breastfeeding because our society makes it inconvenient is like vacillating on equal pay for women because it's difficult to achieve."

"This is no time to waver: Powerful economic and political forces are continually undermining breastfeeding progress. Surely, we need state and federal protections for breastfeeding—that's a given. To achieve our national health goals, we—like our sisters around the world—also need guaranteed health care, paid family leaves, and caregiving credits. Bottle-feeding is an old-school feminist solution to inequality. The equal-rights arena of today is breastfeeding."

--
Molly
CfM Blogger

Scottish Government Nomalizes Birth by Putting Midwives in Charge

Today I was fascinated to read about the Scottish Government's approach to normalizing birth for women--by using midwives as the first choice! What a very different attitude than the U.S. holds.

The article is called GPs to be bypassed in move to 'normalise' childbirth and opens as follows:

WOMEN will no longer see their GP during pregnancy following a controversial Scottish Government decision to cut medics out of maternity services.
The decades-old tradition of women visiting their family doctor to have their pregnancy confirmed and undergo health checks will be scrapped and the job taken on by midwives.

The new rules, to be launched throughout Scotland later this year, are aimed at healthy women with normal pregnancies who are not experiencing any complications.

But GPs last night expressed their 'anger and frustration' at the scheme, insisting they are best placed to spot potentially dangerous problems. When GPs conduct the first antenatal appointment, health and any child protection issues are usually discussed.

Under the new system, women who have tested positive in a home pregnancy test and are phoning their GP surgery for an appointment will be booked with a midwife unless the woman voices a specific objection or has serious health problems such as diabetes or obesity.

The move is part of a Scottish Government strategy, Keeping Childbirth Natural and Dynamic, aimed at 'normalising' pregnancy, and putting midwives in charge of most women.

GPs will be asked to send relevant health records to midwives whose job it will be meet the woman and carry out a risk assessment of the pregnancy by around six weeks of her pregnancy.

If she is assessed as being 'normal' then she will continue to see her midwife but she will be referred to an obstetrician if the midwife deems it necessary.

I was particularly interested in the "Keeping Childbirth Natural and Dynamic" government strategy, so I looked that up. There is a whole section on The Scottish Government website.

Keeping Childbirth Natural and Dynamic "...aims to maximise opportunities for women to have as natural a birth experience as possible, through: providing evidence based care; reducing unnecessary intervention; ensuring informed choice; and developing multiprofessional care pathways. Key objectives are to support the following at NHS Board level:

· Implementation of national referral criteria and care pathways

· Implementation of the midwife as the first point of professional contact in pregnancy

· Implementation of the lead maternity professional based on risk

· Implementation of normal birth pathways regardless of birth setting"

--
Molly
CfM Blogger

Media Coverage of Birth Issues

A lot of good stuff came my way this week. In the Poughkeepsie Journal on March 29: Modern medicine increasingly intervenes in the birth process. The article opens with this: "In the decade through 2002, something momentous happened to babies in the wombs of American women, especially white women. The average time fetuses spent there decreased from 40 weeks to 39. The decline, reported in a 2006 study in the medical journal Seminars in Perinatology, appears to have little to do with nature."

"Instead, earlier births may be the outcome of 'increased use of induction (of labor) and other obstetric interventions such as cesarean delivery,' said a January report by the U.S. Centers for Disease Control. Prematurity rose 20 percent since 1990, the report said, and the rate of low birth-weight babies hit a 40-year high."

"'We are shortening the gestational age,' said Dr. Carol Sakala, program director for the research and advocacy group Childbirth Connection. 'That is a big interference with mammalian evolution, human evolution.'"

The article then sidelines into a discussion of elective cesareans and concludes with a short paragraph subheaded, enjoyably, "Advantage of Midwives."

In the Livingston Daily was a short article titled Midwife mom discovers best of both worlds.

I also found out that midwifery was covered on a radio program called Health and Health Care Forum: Midwifery.

Then from The Journal of Perinatal & Neonatal Nursing there was this article about second stage: Best Practices in Perinatal Nursing: Implementing Safe and Effective Practices for Second-Stage Labor (recommending against "purple pushing" [closed glottis/ forced/directed]!)

Jennifer Block was on the scene in a timely manner yet again with her newest piece in The Huffington Post. Titled Extreme Birth, Indeed, this article is a reaction to the "Extreme Birth" article that was recently in New York magazine. A good quote from Block's article: "The truth is, standard maternity care is not evidence-based care (see this recent report.) And this is why more women are interested in giving birth at home. Not just so they can have candles and music and a better 'experience,' but because they know that checking into a hospital means exposure to preventable risks."

Speaking of some of the evidence for people with questions about the methodology and findings of the well-known BMJ homebirth study, you can get answers: BMJ Homebirth Study: Questions and Answers

And finally, I enjoyed reading this blog post: My Thoughts on the Midwifery Model of Care

--
Molly
CfM Blogger

Cesarean Awareness Month!

As the recent Grassroots Network message referenced, April is Cesarean Awareness Month. There is an article available from Associated Content about it here. There is also more at ICAN, the home of cesarean awareness, prevention, and advocacy.

Appropriately, articles about cesareans have been catching my eye this week. From a newspaper in Sydney, Australia we have: Caesarean beliefs 'misguided.'

From the article: "WOMEN who choose to have an elective caesarean in the belief that it will prevent incontinence and genital prolapse are 'misguided' and may be putting their health, and that of their baby, at unnecessary risk.

That is the view of Jenny King, a urogynaecologist at Westmead Hospital, who questions the right of women to choose surgical births to avoid pelvic floor problems.

Evidence is mounting that repeat caesareans cause harm and there are doubts that they provide the protection they were thought to provide, she said."

From a completely different perspective there is also a recent article called In praise of the c-section: I'm not sorry I didn't have a natural birth. There is a lot of food for thought within this article and I hope to have a chance to post about more it soon. There are fundamentally different worldviews among women when it comes to birth and birth issues (a medical model/view and a normal/health/holistic/midwifery model/view). Though it can be extremely difficult to read "the other side" and try to really "hear" what someone from that worldview is saying, I think it is really important to pay attention to differing perspectives. Having your "ideology" challenged causes you to deepen, refine, evaluate, and analyze your perspective and beliefs (and sometimes to change them).

There is also a cesarean awareness video called Frozen Smiles linked to from the Passion for Birth blog (this is one of my favorite blogs to check in with every week!).

--
Molly
CfM Blogger

Grassroots Network: Cesarean Awareness Month

Dear Friends,

The International Cesarean Awareness Network Team wants to remind you that April is Cesarean Awareness Month (CAM). This year's theme is "Real Women. Real Lives" and is all about all of our stories!!

The ICAN community is counting on all of you bloggers, twitterers, and Facebookers to help us spread the word! Please share your story and asking others to share theirs on your page, and of course link to ICAN and tell about all of the different types of support that we have to offer.

ICAN has discounted subscription rates this month to honor CAM:

Individual $25
Professional $50
5 year Childbearing $100
10 year Childbearing $200
Organization $75

If you have a local chapter of ICAN, contact them to subscribe as part of the subscription fee will stay with the chapter! There will be recognition for the chapter who has the most new subscribers during CAM. Otherwise, subscriptions can be purchased through the ICAN bookstore online.

For more info, go to ICAN online.

Sincerely,
Arielle Greenberg Bywater, "sidekick"

Grassroots Network: Midwifery Legislation Triumph in Idaho!

Dear Friends,

The Big Push for Midwives campaign, TheBigPushforMidwives.org, has issued a press release with the following very exciting announcement:

Idaho Pushes Midwife Movement to the Tipping Point
Physician and Midwife Groups Forge Unprecedented Alliance as Idaho Becomes the 26th State to Pass Legislation to Legalizing Certified Professional Midwives

BOISE, ID (April 1, 2009) Governor C.L. Butch Otter signed into law today a bill to license and regulate Certified Professional Midwives, making Idaho the 26th state to legally authorize them to provide out-of-hospital maternity care. In a notable reversal of longstanding anti-midwife policies, medical groups worked together with legislators, midwives, and advocates to reach consensus on a law that provides for independent practice, mutual collaboration, and the rights of parents to choose where and how their babies are born.

"This is a great day for midwives and home birth advocates all across the country," said Kyndal May of Idahoans for Midwives. "We truly have reached the tipping point, breaking through the medical lobby's longstanding opposition and developing a legislative consensus model that other states are looking to follow."

Certified Nurse-Midwives (CNMs), who practice primarily in hospital settings, are legally authorized in all 50 states, while Certified Professional Midwives (CPMs), who specialize in out-of-hospital birth, until today were legally authorized to practice in just half the states. Representatives from The Big Push for Midwives Campaign noted that Idaho typifies recent legislative trends across the country, as a growing number of states come closer to passing CPM legislation.

And here's a bit more on the Big Push:

Through its work with state-level advocates, the Big Push is helping to forge 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.

Also, the Big Push is convening this summer in Alabama. For more information, go to: http://pushsummit.eventbrite.com/.

Sincerely,
Arielle Greenberg Bywater, "sidekick"

CfM Achieves All Maternity Care Goals!

Citizens for Midwifery is pleased to report that, with an extra bit of effort, we have achieved all of our organization's stated aims over the course of the last two months. The following goals have been met:

--All women now have equal access to high-quality care that follows the Midwives Model of Care, and, due to recent federal legislation, all maternity care is fully subsidized and/or covered by insurance, and the government has launched a comprehensive effort to encourage lower-cost out-of-hospital and non-medicalized birth.

--All midwifery licensing is now federally recognized, and the government's recent reports on the vast benefits of midwifery care are encouraging more and more women to seek out midwifery services.

--Due to the above, new Cesarean rates are starting to come in, and the percentage is down to about 15% of all births.

--Also due to the above, new Epidural rates are starting to come in, and the percentage is down to about 20% of all births.

--All American hospitals have recently adopted the Mother-Friendly Childbirth Initiative and have replaced standard L&D wards with 90%+ birthing rooms fully equipped with tubs, birthing stools, and free doula services.

--Due to the new across-the-board Baby-Friendly Hospital standards that have come out of the Mother-Friendly Childbirth Initiative, 95% of all American women are now breastfeeding for at least a year.

--The World Health Organization is now promoting the American model of maternity and midwifery care, what with its excellent outcomes and evidence-based policies, as the gold standard in the world.

In light of all of this, Citizens for Midwifery has decided to disband its board, but only after we use our remaining funds for one last annual board meeting at an all-inclusive Caribbean resort.

Happy April 1st, everyone! May it one day not be such a joke!

--Arielle Greenberg (CfM Board)