Medical Care is a Consumer Issue

From the book Women and Doctors some good reminders that medical care is a consumer issue (and a business!):

"Keep in mind that health care is a business. Doctors would like to have you see them as thorough professionals, unsullied by such crass considerations as income and market share. Don't believe it! Not only are genuinely unethical and mercenary doctors actively marketing their operations, but well-intentioned doctors are doing it as well. In fact, the health-care system as a whole is actively pursuing you as a patient through the same techniques that everyone with a product is using to get you to be a customer. The danger lies in your failing to understand that. Be a smart and wary consumer, and keep the entire health-care system in the same perspective that you probably already have placed car dealers, insurance salesmen, and makers of food products."

And on a related note, here are some stats from the recent US Maternity Care Facts from Childbirth Connection:

In 2006, combined facility charges billed for "mother's pregnancy and delivery" and "newborn infants" ($86 billion) far exceeded charges for any other hospital condition in the United States.

In 2006, 42% of all maternal childbirth-related hospital stays were billed to Medicaid. The two most common conditions billed to Medicaid as the primary payer in 2007 were pregnancy and childbirth (28%) and newborns (26%), which together comprised 53% of discharges billed to Medicaid.

"Mother's pregnancy and delivery" and "newborn infants" were the first and third most expensive conditions billed to private insurance in 2006, involving 14% of hospital charges to private insurers, or $41 billion.

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Molly
CfM Blogger

Burnout Articles from Midwifery Today

I always enjoy reading my issues of Midwifery Today and in the most recent Winter issue two articles really stood out to me.

The first was:

The Rise and Fall of a Birth Junkie, by Mary Doyle
"A midwife describes both her passion for and addiction to the calling of midwifery, along with her subsequent burnout, and makes the case for prioritizing self-care within the midwifery profession."

Though I'm not a midwife, I found this article particularly interesting in light of conversations I've read in online forums about the appropriateness--or not--of using the term "birth junkie."

A quote that jumped out at me was "'Work more, sleep less, and don't eat--you have no time!' is not advice we'd ever give a client, and yet we do just this in our own lives--and we pay dearly for making those choices."

The second article was:

The Stork and the Phoenix: Birth, Burnout and Rebirth, by Michele Klein
"Author Michele Klein uses the archetypes of the stork and the phoenix to delve into the issues surrounding burnout within the midwifery profession, and provides examples of 'phoenix midwives' who have reinvented themselves and their roles 'with women.'"

I really enjoyed her exploration of "phoenix midwives" who rise from the ashes after burning out with midwifery and continue to serve women in other innovative capacities. I've seen this phenomenon amongst my own contacts in the birth world. I think the idea can apply to activists as well as to actual midwives. (As a side note, in the body of the article, the author cites one of my articles--"Birth Lessons from a Chicken"--and that was kind of fun to see :)

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Molly
CfM Blogger

Happy Holidays!

As you gather with your family for the 2009 Holiday Season, we wish you love, joy, and memories to last a lifetime, and we thank you for your support of Citizens for Midwifery. As we greet 2010, we hope every day brings new wonders and a promise of a more peaceful world for birthing women, babies, and families around the world.

Warmest Wishes!

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Molly
CfM Blogger

Cardiology & Birth Analogy

I'm sorting through my large stacks of books containing pages I've marked with quotes/ideas I'd like to share via various blogs. The pile has become very overwhelming and I've decided I need to pare it down...decide what to post about and what to put back on my shelf. Some time ago, I shared a birth analogy from the book Mother's Intention about health clubs needing to be staffed with cardiologists (just in case one of the patrons had a heart problem while exercising).

Later in the book, the author employs another helpful analogy, again using cardiology as an example to make a point about inappropriately applied maternity care interventions:

What if...

You went to the doctor complaining of chest pain...not bad pain, but bothersome. To rule out a heart problem, the caregiver listens to your heart. He scowls, then excuses himself to make a phone call. He comes back in and tells you that you need to be admitted to the hospital for a test that requires the use of a drug. The drug has a low risk of serious complications, which is why you must be in the hospital, but he feels confident in taking that risk.

You go, and within minutes of having the drug administered, you have a heart attack. You are rushed into emergency open-heart surgery. Complications arise, but they are dealt with. You nearly bleed to death, but with a blood replacement you recover.

The repair doesn't go well, which may mean you will need further surgery later...maybe even a heart transplant. You definitely will need to change your previously active lifestyle.

Later, you discover the call your care provider places wasn't to a specialist, but an HMO lawyer who advised him not to let you walk out the door, just in case the routine examination missed a serious problem. You also learn there were less dangerous ways to determine if there could be a minor problem.

It turns out, you really did have a minor case of heartburn. All you have been through was unavoidable, but "As long as everyone's ok now...that's all that matters"...right?

A comment like that, to a mother who has suffered unnecessarily, when she would have--or could have had--the result of a live, healthy baby without such sacrifice, disregards her feelings of loss.

Parents should be expecting more!

In another book waiting in my pile (Open Season), I was amused to see a quote marked in which OBGYN care is referred to as "gynogadgetry."

And in another book, The Doula Guide to Birth, I marked another quote that feels very relevant to the others above: [a March 2006 study in the American Journal of Obstetrics & Gynecology] "reviewed all fifty-five of ACOG's current practice bulletins, calling these articles 'perhaps the most influential publications for clinicians involved with obstetric and gynecological care.' The study concluded that 'among the 438 recommendations made by ACOG, less than one third [23 percent] are based on good and consistent scientific evidence.'"

Enough said.

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Molly
CfM Blogger

Breastfeeding & Birth Continuing Education Resources

Infant Feeding in Emergencies webinar presented by Dr. Karleen Gribble. Some REALLY good stuff here.

Free online courses from USAID via Global Health e-learning centre
(Lots of courses, not just about breastfeeding, but worldwide information about things like infant sepsis, postpartum care, family planning, etc. Great resource! These are not webinars, but are web-based training--click from page to page to page.)

Violence against Women and the Perinatal Period: The Impact of Lifetime Violence and Abuse on Pregnancy and Postpartum

Breastfeeding after Sexual Abuse

Traumatic Stress Symptoms in Parents of Premature Infants

Hope these are helpful! If you only choose one to click on, I highly recommend the infant feeding in emergencies webinar (it does take about an hour, so if you have less time go with the three article links instead...)

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Molly
CfM Blogger

Response to Boston Radio Program About CPMs

To hear a recent discussion on legislature to create a registry for CMs and CPMs in Massachusetts and read the posted comments, click on this link. Dr Eugene DeClerq did a great job during the interview and our own Susan Hodges posted the following informative comment:

Midwives and midwifery clients and advocates have been working for many years to achieve meaningful regulation for midwives in Massachusetts. The current bill this radio show refers to would create a Board of Registration of Midwifery, which will license and regulate the practice of Certified Nurse Midwives (CNMs), Certified Midwives (CMs), and Certified Professional Midwives (CPMs). The point of having such legislation is both to create a reasonable system of accountability AND to increase access to midwives in all settings.

There is no one type of provider or one birth setting that is best for all pregnant women, because we are all unique individuals. There are always some risks in childbirth, no matter where or with whom you give birth. For most women, pregnancy is a normal process that proceeds on its own unless interfered with, but this process can also be affected by the mother’s beliefs and feelings, and by how she is treated by the people who are with her and their beliefs about birth. Furthermore, a great deal of standard hospital and obstetric practices and interventions applied to women in labor are not based on any evidence at all. Therefore, it is only reasonable that women should have a range of proven options available to them. Passing legislation that enables credentialed midwives to practice legally and with accountability makes sense. No one is going to force any woman to have a home birth, or to have a midwife, but for those of us who would prefer to be attended by a midwife in hospital, birth center or home, such legislation would certainly increase our options.

ACOG is a professional organization accountable only to its members. It does not have evidence to support its anti-home birth stance, it is based purely on belief! See their statement at http://www.acog.org/from_home/publications/press_releases/nr02-06-08-2.cfm . It states: “ACOG believes that the safest setting for labor, delivery, and the immediate postpartum period is in the hospital, or a birthing center …” without citing a single reference to support this “belief”. So much for scientific medicine. In fact, a large collection of studies over many years and in a number of countries has consistently shown that for a woman having a normal pregnancy a planned homebirth with a trained midwife is as safe as the hospital, with far fewer interventions and less morbidity for mothers and babies. (for just one example, see http://www.cfmidwifery.org/pdf/CPM2000.pdf and see more fact sheets and resources on the CfM website).

Obstetricians and hospitals are not accountable for their outcomes. For example, while the cesarean rates have been increasing every year (now over 30%!!) in the absence of any medical justification for such high rates, no one in state or federal government offices has even been asking: Are we having better outcomes for mothers and babies with these rates of cesarean sections? In fact, research has shown that when cesarean rates rise above 10 to 15%, more babies and mothers die than are saved by the surgery. Similarly, no one has been asking about outcomes related to the huge increases in induction, use of drugs to intensify labor, and use of epidurals. In contrast, even the relatively rare instances of a midwife transferring a laboring woman to a hospital for medical care usually are scrutinized critically.

Informed consent in hospital-based maternity care in general is a joke – women are not adequately informed about the pros and cons (including the % risk) for specific interventions and for NOT doing the intervention. Hospitals and obstetricians rarely if ever inform women that there are economic incentives behind each and every “suggested” practice and intervention, ie, conflicts of interest. In contrast, most states that regulate out-of-hospital midwives require extensive disclosure documents that the client must read and sign.

A woman can find out far more information about a used car than she can find out about her obstetrician. In most states, she may be able with some difficulty to find out rates for some interventions (cesarean section, induction) and outcomes (perinatal death, maternal death) for a local hospital, but not for individual obstetricians. For rates of episiotomies and cesarean sections, research has shown enormous variation among individual providers, even within the same hospital, demonstrating the lack of evidence for the high rates of these practices. A midwife is trained to observe and monitor, but not to intervene unless there is clear justification, because her focus is on supporting the normal birth, not getting in the way. For most women choosing a midwife, especially outside the hospital, she can be pretty sure she will not be subjected to any unnecessary interventions.

Nearly 25 years ago, when intervention rates were far lower than today, I was pregnant with my first baby. My husband (a scientist, and from a medical family) and I did extensive research regarding our options and birth practices. Even then, there was plenty of evidence that unless you had a real medical reason to be in a hospital to give birth, you would be better off at home with a midwife. As a result, at 7 ½ months we switched to a home birth midwife (who happened to be one of very few CNMs with a home birth practice at that time). It was one of the best decisions I’ve ever made. Not only did I get outstanding care and support, but my midwife competently, safely and non-intrusively addressed a minor “variation on normal”; had I been in the hospital, standard practice would almost certainly have caused a life-threatening hemorrhage. Glad I was at home with a midwife!

Susan Hodges

Disclosure: I am a founding member of and current president of Citizens for Midwifery, a national non-profit organization providing information about midwives and the Midwives Model of Care.

Book Review: The Power of Women

The Power of Women
By Sister MorningStar
Motherbaby Press, 2009
ISBN 978-1-890446-43-7
201 pages, paperback, $29.95
http://motherbabypress.com/

Reviewed by Molly Remer, MSW, ICCE
http://talkbirth.wordpress.com

Occasionally, a book comes into my life that touches me so deeply that I am at a loss for words. The new book, The Power of Women, by Sister MorningStar, is one of those rare books. A treasure. A gem. A rare jewel. A delight. These are the words that do come to mind. However, superlatives--though true--do little justice to describing the actual book.

The Power of Women is a book of "instinctual" birth stories told through the eyes of a gifted and sensitive midwife. The stories are from her perspective, not the mother's. Each story has either a lesson to share or is a glimpse into that deep inner wisdom and strength found in birthing women that is so easily ignored or dismissed in our modern birth culture. This book is good "word medicine" and the empowering stories within it shine a light to help other women trust their instincts. This light also helps other birth professionals rediscover the magic and mystery and wonder of birth and women.

The Power of Women also touched me in a special way because the author divides her time between my own native Missouri and a birth center in Mexico. Some of the stories shared take place in each location (more from Mexico). I found it delightful to discover the power of my own Missouri midwifery activist friends represented throughout the book. Familiar names and faces graced the pages for me and it was a treat to experience that connection.

The book consists of twelve chapters, each containing 5-9 different stories each. The stories themselves are not long, narrative birth accounts, but are moments captured brilliantly for the glimpse of powerful truth they share. Some are only 1/2 page in length--but the depth in each is great. The chapters are titled things like "Stories of Power" or "Stories of Courage" or "Stories of Community and the tales shared therein are loosely bound together with that common thread.

To be clear, not all of the stories are "happy" or are necessarily "good" birth stories, some are even fairly scary and even depressing. All are powerful.

My only critique of the book, which I hesitate to share because it seems petty in light of such a beautiful and wise book, is that the formatting of the text is odd. The font size is small and the text tightly spaced with very small indents.

If you find yourself in a place where you feel trapped alone in a world where the birth you love so much is becoming a "mythological story," read this book. If you are an aspiring or current midwife, doula, or childbirth educator and wish to deepen your understanding of birth, read this book. If you are a pregnant woman hungering to dig deeply into instinctual birth and the wisdom and power of story, read this book. The Power of Women is a powerful, touching, and magical journey.


--
Disclosure: I received a complimentary copy of this book for review purposes.

Grassroots Network: Childbirth Connection e-News

Dear Friends,

I just received an e-news post from Childbirth Connection. Among other items of interest, it announces a useful new document:

"Know your facts when you discuss maternity care in the US. We have compiled a brief, new resource document called 'United States Maternity Care Facts and Figures.' It details current statistics including the number of births, proportion of hospital care that is devoted to the care of pregnant women and babies, maternity outcomes such as preterm birth and low birthweight rates, as well as statistics about paying for maternity care."

You can find that document here.

The e-news included information about some recent maternity care research, as well as several other useful links.

Anyone can sign up to receive Childbirth Connection e-news. Go here to do so.

Sincerely,
Susan Hodges, "gatekeeper"

Grassroots Network: “2009 – A great year for CPMs and Mothers!”

Dear Friends,

Below is the latest from the MAMA Campaign. Of particular note: a recording of the webinar from December 3 is now available on-line!

Sincerely,
Susan Hodges “gatekeeper”

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

From the MAMA Campaign 12/9/09:
2009 – A great year for CPMs and Mothers!
As the U.S. Congress keeps working on health care reform all the way up to the Christmas holiday, the MAMA Campaign is going to keep working right along with them to get Certified Professional Midwives (CPMs) included in the health care reform bill!

As we keep up the effort to include CPMs, (we’re on the Hill today, the 15th, as we write this to you!), the turn of the year is also a time to take pride in the high points and accomplishments of 2009.

2009: What a Year for CPMs!
Midwives and Mothers in Action (MAMA) was “birthed” by the partner organizations on the International Day of the Midwife in Washington, D.C. in May. Since then, MAMA:

• Hired a national health policy and lobbying firm to guide our advocacy work in DC
• Held a “fly-in” of more than twenty MAMA activists to DC in June to meet with over 30 key congress members
• Traveled to DC nearly every week throughout the summer and fall to build support in the House Energy & Commerce Committee and the Senate Finance Committee, which have jurisdiction over Medicaid issues
• Prepared a cost-analysis based on Medicaid data from a health policy study in Washington State that was submitted to the Congressional Budget Office on our behalf by Chairman Waxman’s office
• Met with 8 top Medicaid officials at the Centers for Medicare and Medicaid (CMS), a very unusual opportunity for a provider group new to Capitol Hill
• Achieved a significant partial victory: Senator Cantwell’s provision in the Senate bill that will have the effect of requiring Medicaid to pay the provider fee, in addition to the facility fee, to CPMs attending births in birth centers
• Has raised over $140,000 towards our goal since mid-July in the most successful fundraising effort for midwives ever!
• Is still on the Hill for CPMs as we move into January, working to include CPMs in the final health care bill that will be signed by the President!

Thanks to all of you MAMA supporters and your letters, faxes, calls and in-district visits to your legislators, all of the key Senate and House offices now are aware of the benefits that CPMs bring to women and families in quality of care and cost-savings to the system! A huge thank-you to all of you! As we head into the New Year for CPMs, we take with us what our lobbyist, Billy Wynne, has told us: that, in just a few short months, we have achieved Congressional attention and support for our cause that often takes 3 to 4 years! Thank you for your dedication and support!


MAMA Was So Happy to See You!
Thanks to all of you who joined us last week for our Campaign Webinar: MAMA Has Good News to Share! We had a great time and, from your comments, so did you! For those of you who were not able to join us live, a recording of the Webinar is now available at: http://www.mamacampaign.org/mama-webinars/?utm_source=MAMA+Campaign+News+and+Alerts&utm_campaign=6229a8f528-Eblast+week+12-16-09&utm_medium=email

Why Including CPMs in Medicaid Will Improve the Lives of Women
As we take stock at the end of this year, we never forget who we’re working for: women who need the choice of a CPM but won’t be able to afford one unless CPMs are included in Medicaid.

We are reminded of the work of CPMs Constance Frey, LM, CPM, and Carolee Hall, LM, CPM. Frey and Hall have a thriving midwifery practice in Olympia, Washington, which attends to 10 20% teenage clients.

Midwifery care, which offers these young women choices and gives them the opportunity to birth unhindered by medication, can allow these girls and young women to be authorities over their own bodies. Direct entry midwifery care provides for one-on-one counseling between midwife and client, and focuses on educating the client, making her a partner in her own healthcare.

“They gain confidence to birth their own babies without pain medication and surrounded by love,” says Frey. “Oftentimes teens are the population that needs more of the individual attention that a midwifery practice can offer them.” Frey and Hall have had great success with teens who come to their clinic with difficult histories, including drug abuse, and who are able to change their lives to become more responsible and healthier. “Many, many of these teens end up having natural, unmedicated childbirth and breastfeeding their babies.”
Like most midwives in Washington State, Frey and Hall’s practice is comprised in large part of women on Medicaid. “We are committed to working as much as possible with those whom we can support as they step into that transition into education and empowerment.”

MAMA Reaches Down Deep to Fund the Campaign!
The end of the year is almost here! Donations continue to flow in, providing MAMA with the fuel she needs to reach the finish line! State midwifery and consumer organizations from New England to California and Michigan to Texas have been stepping up to help. The breadth and commitment of our donors continues to amaze us! Can you help MAMA send out the year with a bang? Help MAMA get a great start on 2010 ... donate today!
Go to http://www.nacpmcommunity.org/content.aspx?page_id=301&club_id=962241 to donate to MAMA!

MAMA Is Blogging Health Care Reform
Tune into the Grapevine at: http://mamacampaign.squarespace.com/grapevine/?utm_source=MAMA+Campaign+News+and+Alerts&utm_campaign=6229a8f528-Eblast+week+12-16-09&utm_medium=email , MAMA’s source for keeping you up-to-date on health care reform. And check in today to hear about the BBC interview with Alena Ciecko, daughter of our own Campaign Steering Committee member, Jo Anne Myers-Ciecko, and her experience of being pregnant in the US.

See You Next Year!
This is the last scheduled MAMA Campaign Eblast of 2009. The MAMA Campaign Eblast-writing crew is taking the holidays off to enjoy with our families. Then, come January, we’ll be back at work to let you know everything that happened over those two weeks…and so much more. Please look for us in the New Year!

If you have any questions, concerns or comments please contact the campaign at info@mamacampaign.org.

Nils Bergman Kangaroo Care Presentation

Via the lovely ladies at Independent Childbirth, I came across this slideshow presentation about skin-to-skin contact, breastfeeding, and perinatal neuroscience by Dr. Nils Bergman. Lots and lots of amazing and useful information!

Super short summary of the 243 slides: babies NEED to be with their mothers following birth in order to develop proper neural connections and ensure healthy brain development and proper brain "organization." Mother's chest is baby's natural post-birth "habitat" and is of vital developmental and survival significance. Breastfeeding = Brain wiring.

It would be nice to see every NICU and hospital have an in-service about this.

I was lucky enough to hear Dr. Bergman present on this subject in person at the La Leche League International conference in 2007. (Indeed, I actually ended up "performing" on stage with him in a mimed play put on immediately prior to his presentation!) He is a dynamic and engaging speaker (with a great accent!) and has so much of value to share. I will never forget hearing his duet with an LLL Leader of the song "Anything Tech Can Do, Mum Can Do Better."

Yes she can, yes she can, yes she CAAAANNNNNN!!

--
Molly
CfM Blogger

New Facebook Fan Page

Citizens for Midwifery has a newly established fan page on Facebook. Feel free to click the new "find us on Facebook" link on the right hand sidebar to become a fan!

This blog feeds directly into the Facebook page, so for those of you who are reading the post via Facebook, thanks for already being a fan!

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Molly
CfM Blogger

Grassroots Network: “MAMA Is Still on the Hill for You!”

Dear Friends,

Below is the latest from the MAMA Campaign. You’ll find more information about Senator Cantwell’s amendment that mandates Medicaid reimbursement for state-recognized midwives (including CPMs) providing services in birth centers.

The MAMA Campaign Steering Committee is continuing to work hard to get CPMs included as Medicaid providers in the health care reform legislation as Congress nears the finish line for that effort. There are still opportunities – it’s not over yet!

So, please continue to fax and e-mail letters to your Senators and Representatives. They really need to hear from you, their constituents! See some short and easy sample letters at: http://mamacampaign.squarespace.com/sample-letter/ and more detailed info at: http://mamacampaign.squarespace.com/contact-your-legislator/. Keep those letters coming – they do make a difference!

And please consider making a donation -- any amount will help!

Sincerely,
Susan Hodges “gatekeeper”


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



From the MAMA Campaign 12/9/09:

MAMA Is Still on the Hill for You!
The US Senate is pushing forward to pass health care reform by Christmas! And MAMA is on the Hill right along with your Congress Members urging that CPMs be included in this bill! This past week we met with several supportive Senator offices in our efforts to accomplish this goal.

MAMA will be working for midwives and mothers on Capitol Hill right up to the final vote on the joint House/Senate bill, expected to take place by the third week in January. The provision to reimburse CPMs in the Federal Medicaid program enjoys wide support in Congress, thanks in large part to your great outreach to your Congress Members. MAMA will continue to leverage this support to take advantage of any and all opportunities to include CPMs in the health care bill throughout the entire process during this congressional session.

MAMA Was So Happy to See You!
Thanks to all of you who joined us last week for our Campaign Webinar: MAMA Has Good News to Share! We had a great time and, from your comments, so did you! Over 50 people participated. The MAMA Campaign Steering Committee shared information about the campaign strategy, infrastructure, accomplishments, and steps forward. Participants were excited to hear details about Senator Maria Cantwell adding language to reimburse CPMs in licensed birth centers into the Senate bill. And we were excited to be joined on the Webinar by our DC lobbyist, Billy Wynne who shared with us his perspective on the Campaign’s progress!

Participants commented:

-“I was able to get a better grasp of the routes which this campaign must navigate- from lobbyist, to the Senate, to the House. I was pleased to hear that great progress is being made.”

-“I am impressed by the continuity of effort put out by everyone and the seriousness it garnered. I thank you immensely.”

-“Congratulations on this tremendous effort!”

-“It is good to know that the MAMA Campaign is run by real people and is alive and well…hearing from each of you was very promising.”

We Especially Enjoyed Answering Your Questions!
Billy and our Steering Committee members were able to answer a number of questions during the Webinar. For those of you who submitted questions that we did not have time to answer during the call, you will be hearing from us soon. And we thought we would answer one of your questions here as well:

Question: “I have read Senator Cantwell’s language regarding the payment of provider fees for birth center birth attendants and I don’t see how this language constitutes a the mandate to pay the provider fee. Can you walk us through this?"

Answer: As you will remember from our last few Eblasts, MAMA has had a terrific victory in the last few weeks: under the Senate version of the health care reform bill, Certified Professional Midwives who deliver in birth centers will have their provider fee reimbursed by Medicaid. The provision included by Senator Cantwell to move the ball forward for CPMs is included in the section of the Senate bill that mandates that the facility fee for birth centers be paid by Medicaid. It reads:

"A State shall provide separate payments to providers administering prenatal labor and delivery or postpartum care in a freestanding birth center…such as nurse midwives and other providers of services such as birth attendants recognized under State law, as determined appropriate by the Secretary."

It is typical that mandates for reimbursement by Medicaid be included in Section 1905 of the Social Security Act, and MAMA’s provision to reimburse CPMs in Medicaid is drafted to be included in the SS Act. However, Congress has the power to establish a mandate for coverage of CPM services anywhere, as it has done here with Senator Cantwell’s provision.

The provision is a mandate because it begins with “shall” rather than a “may.” That is the operative word and the operative distinction. There is no discretion in the language to ignore the directive to make the separate provider payments.

And while “As determined appropriate by the Secretary” might make you worry (after all, what if the Secretary says “no?”), don’t: this is very common language that just makes clear that the Secretary of Health and Human Services has discretion in interpreting legislative text. The second sentence of subparagraph (C), makes very clear who the Secretary needs to include in defining “birth attendant”. This phrase regarding the Secretary does not in any way negate the mandate or leave it to the discretion of the Secretary whether or not to make the separate provider payments. The mandate for payment of provider fees has the force of law with this language. We have researched this language with our lobby office where they have many years of experience in drafting key Medicaid legislation for Congress, and we have no concerns about the effectiveness of this provision.


In answer to another question: the use of the term “birth attendant” in this bill is intended to be inclusive, not diminishing, and will in no way undermine the efforts and accomplishments in the state statutes to use the term “Licensed” for midwives.

MAMA Reaches Down Deep to Fund the Campaign!
MAMA supporters are reaching down deep this month to get MAMA to the finish line! While the Senate is working overtime to find their way through the health care reform debate, we are also finding creative ways to support the work of our volunteers and professional lobbyist.

• State midwifery and consumer groups are spreading the word -- recent gifts have come from Massachusetts, California, and Colorado.
• A local brewpub in Montana hosted a fundraiser for MAMA on the night before Thanksgiving.
• A midwifery school director has challenged students and faculty to match her own contribution.
• A photographer in Maine is taking holiday portraits for midwifery clients and donating 50% of her sales.

Thank you to all of our donors -- we're almost there! Please send a donation today! Click here to donate to MAMA!

If you have any questions, concerns or comments please contact the campaign at info@mamacampaign.org.

Grassroots Network: OB supports delayed cord clamping

Dear Friends,

As we try to change the way childbirth is conducted, the question of when the cord is clamped affects both mothers and babies. While immediate cord clamping is habitual in hospital-based obstetrics, midwives, especially out-of-hospital, typically delay cord clamping at least until the cord has stopped pulsing.

Now Nicholas Fogelson (an OB?) has written an excellent commentary on the need for this OB practice to change, including references:

http://academicobgyn.com/2009/12/03/delayed-cord-clamping-should-be-standard-practice-in-obstetrics/

Delayed Cord Clamping Should Be Standard Practice in Obstetrics
December 3, 2009

For anyone working to achieve this change in practice, this will be a good resource. And there are good comments to which Fogelson has promptly written thoughtful responses.

Yet another instance of midwives being ahead of the game!

Sincerely,
Susan Hodges "gatekeeper"

Book Review: Permission to Mother

Permission to Mother
By Denise Punger, MD, IBCLC
OutskirtsPress 2007
Softcover, 257 pages
ISBN: 978-1-4327-0385-1
www.twofloridadocs.com

Reviewed by Molly Remer, MSW, ICCE
http://talkbirth.wordpress.com

Written by a doctor and mother of three sons, Permission to Mother is a series of short, autobiographical vignettes about various natural mothering topics. The style is both a strength and weakness of the book. The bite-sized stories are perfect for a busy mother to read in between household tasks or while nursing her baby. However, the brevity precludes depth and most topics lacked full exploration. Many of the “chapters” are only one page in length (sometimes only half a page). The longest are 3-4 pages. This is not sufficient space to really examine a topic—instead the sections are more like short anecdotes/snippets from the author’s life and experiences, often ending almost as soon as they began.

The book is organized into four parts. The stories in Part One cover a variety of topics beginning with Dr. Punger’s experiences with birth in medical school, then moving into her own birth experiences, her experiences working with a doula, and homebirth observations. The highlight of the whole book is the birth story of her third son—an undiagnosed double footling breech birth at home.

The second section of the book address “The Breastfeeding Years” and includes a wide variety of stories about nursing during pregnancy, tandem nursing, working and breastfeeding, becoming an IBCLC, breastfeeding through anesthesia, and also segments about the family bed, cloth diapering, homeschooling, and unschooling. A surprising story in this section called “My Spiritual Journey as a Physician, Mother and IBCLC,” is actually a story about her sons’ circumcisions. Depending on your personal feelings about circumcision, this section may sadden or disappoint you or it my provide reassurance about your own decisions.

Part Three addresses “Breastfeeding Medicine” and explores some case examples from the author’s medical practice with nursing mothers. Again, the segments are so brief that they contain little of clinical value to other practitioners.

Part Four is a brief section about “Why I Do the Work I Do” and consists of letters to the author from satisfied clients.

As I read this book, I had the persistent feeling that much of the content had been written for other sources—perhaps a magazine or a blog. There was a choppiness to the writing that conveyed this sense. And, as previously referenced, the extremely short, vignette format lent an unsatisfying incompleteness to many of the stories. I also noted a higher-than-average number of minor errors in the text contributing an amateur quality to the book.

Despite these critiques, it was refreshing to read about natural mothering from a physician’s perspective and I enjoyed her insights about breastfeeding medicine. (Can you imagine how the world might look if more physicians practiced with this background and experience?!) If you are looking for short, personal narrative experiences of natural mothering, you may enjoy the simple style and friendly stories in Permission to Mother.

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Originally published in The CAPPA Quarterly, October 2008.

Disclosure: I received a complimentary copy of this book for review purposes.

Doula Article

Felt the need to post a link to this article about doctors' objecting to doulas in the birth room. The champion opening line was what hooked me:

"Like some ancient wounded creature, the male medical establishment occasionally lashes out in uncomprehending fury at 'patient-led' developments in medical care that threaten to undermine its power."

;-D

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Molly
CfM Blogger