Tuesday, September 29, 2009

Birth Plan Item #1: Leave My Cervix Inside My Body!

Last night I finished reading several articles in Midwifery Today about birth in the Ukraine. Apparently, it is a routine practice immediately postpartum to use two "shoe horn" shaped devices to pull the cervix out of the woman's body to examine. Yes, I think that warrants repeating--manually pulling out the cervix to look at! (no pain medications). This is so patently horrible and unnecessary that I had a visceral response to reading about it--my uterus hurt.

However, as I reflected on my reaction, I began to wonder if the practice is any more strange or disturbing that some U.S. maternity care routines? I still feel like cervix-pulling-out ranks pretty high on the horrible factor, but I also recognize that is is filtered through my cultural lens of what I'm used to--"normal" (i.e. culturally acceptable) birth practices in the U.S. (such as Pitocin injection immediately following most normal births regardless of indication and so on and so forth). We have any number of questionnable medical care practices in this country too, but because I'm used to them they register as "normal." Of course, this doesn't mean I approve of them or fail to notice that they are not evidence-based, but I accept them as possible occurrences and I'm certainly not surprised to read about them over and over again.

One of the articles was about birth in a Ukrainian "birth house" and the other was a composite of observations about birth in the Ukraine in general. Sometimes there is a tendency amongst midwifery supporters to romanticize birth and midwifery care in other countries and to vilify the U.S.--if you are a Ukrainian woman, this is clearly misplaced!

My first thought when reading the essays was, "Wow! The U.S. system isn't so terrible after all!" But then, I tried to imagine the U.S. birth culture seen through completely fresh eyes, as I had just viewed the cervix-pulling technique. How would facets of hospital birth care in the U.S. appear to me if I was just hearing about them for the first time? As gross human rights violations?

Though I cannot make it have the same raw emotional and physical shock to me as cervix-pulling-out, I can only imagine how an episiotomy might sound to my imaginary fresh eyes: "then the doctor took some scissors and cut through the skin and muscles at the base of the woman's vagina." Or, the same with the not uncommon addition of, "as she begged 'please don't cut me! No!'"

I also read with sadness and dismay about the emotional maltreatment of Ukrainian women in labor and how (in hospitals) they are frequently denied the companionship of their husbands. Is this really more awful than women being coerced into unnecessary cesareans or even more basic, being denied food and drink throughout their labors? No, not really, just less familiar.

While it is nice to recognize that there are things that women birthing in U.S. hospitals can be very grateful for, there is not an official continuum or hierarchy of "better" bad things to happen to birthing women regardless of country of residence. Humanized care is humanized care. Women worldwide deserve a safe environment, a respectful caregiver, continuous emotional support, physically responsive care, evidence-based medicine, and to have their cervixes and uteruses left inside their bodies.

CfM Blogger

P.S. In case anyone is interested, "cervices" or "cervixes" and "uteri" or "uteruses" are both acceptable plurals ;-)

Friday, September 25, 2009

Varying Opinions on Midwifery Licensure

As an organization, Citizens for Midwifery supports the Big Push campaign and is also a partner in the MAMA campaign. However, I think it important to acknowledge that there are strong differences of opinion within the "birth world" about legislative "solutions" in midwifery. I frequently post updates and alerts from various campaigns to this blog. However, there are women who caution that licensing and legislation have unforeseen consequences and I think it is both fair and important to listen to their voices too.

Carla Hartley and Gloria Lemay are women that I admire and respect and both of them have recently voiced their concerns via their blogs about licensing midwives.

Gloria made a thoughtful post titled Licensing, registering and certifying midwives–at what cost?

And Carla has made a couple of quick posts about licensing and also re: malpractice insurance.

My personal feelings about midwifery legislation were deeply shaped by the experiences of living in Missouri for my entire life, in which until last year, the practice of midwifery was a felony. A felony is a serious thing and our intense legislative efforts in Missouri were able to remove that obstacle. There are those who expressed concern about taking a legislative approach, feeling that it was better to leave things as they were and cautioning that legislation has its own risks. I think it certainly is important to be mindful of risks, but I also feel (and felt) very strongly that leaving midwifery a felony was the worst possible tactic to take. I take an, "anything is better than midwives being FELONS!" perspective. Additionally, I felt strongly that it was unethical, impractical, and illogical to assume and trust that another woman would be willing to break the law for me and my family by attending my births--that is a LOT to expect from another woman and from her family, who is by extension also put at significant risk. I couldn't ethically continue to expect that. I do not claim to know for certain if pushing for licensure is the correct answer for every state, however, and I find it important to listen to both sides of the issue. There are a lot of very informed people working on legislative campaigns and I place a great deal of trust in their wisdom and expertise! I also believe that they have the best interests of the consumer at heart.

CfM Blogger

CIMS Letter to The Today Show

Citizens for Midwifery was pleased to join with many other birth organizations as a signer of the well-crafted and intelligent letter composed by CIMS in response to The Today Show "Perils of Midwifery segment recently aired. You can read this "One Voice" response as a pdf file here. The letter is also reprinted below:

Sept. 22, 2009

Dear Producers of The Today Show,

The Coalition for Improving Maternity Services (CIMS) and the undersigned organizations are disappointed with The Today Show’s misrepresentation of midwives and home birth that aired on Sept. 11, in a segment titled “The Perils of Midwifery,” later changed to “The Perils of Home Birth.” This biased and sensational segment inaccurately implied that hospitals are the safest place to give birth even for low-risk women and mischaracterized women who choose a home birth with a midwife as "hedonistic," going so far as to suggest that these women are putting their birth experiences above the safety of their babies. Neither could be further from the truth.

Unfortunately, The Today Show did not do its homework on the evidence regarding the safety of home birth and midwifery care. The segment featured an obstetrician who presented only the American College of Obstetricians and Gynecologists’ (ACOG) position in opposition to home birth, but it did not make any attempt to present the different viewpoints held by the many organizations that are committed to improving the quality of maternity care in the US. We are deeply saddened that the show did not take the opportunity to note that both CIMS and The National Perinatal Association respect the rights of women to choose home births and midwifery care, and that the respected Cochrane Collaboration recommends midwifery care because it results in excellent outcomes.

There is no evidence to support the ACOG position that hospital birth for low-risk women is safer than giving birth with midwives at home. What the research does show is that the routine use of medical interventions in childbirth without medical necessity can cause more harm than good, while also inflating the cost of childbirth. However, the current health system design offers little incentive for physicians and hospitals to improve access to maternity care practices that have been proven to maximize maternal and infant health.

“Birth is safest when midwives and doctors work together respectfully, communicate well, and when a transfer from home to hospital is needed, it is appropriately handled,” says Ruth Wilf, CNM, PhD, a member of the CIMS Leadership Team.

That is why the national health services of countries such as Britain, Ireland, Canada, and the Netherlands support home birth. In those countries, midwives are respected and integrated into the maternity care system. They work collaboratively with physicians in or out of the hospital, and they are not the target of modern day witch hunts. These countries have better outcomes for mothers and babies than the US.

Childbirth is the leading reason for admission to US hospitals, and hospitalization is the most costly health care component. Combined hospital charges for birthing women and newborns ($75,187,000,000 in 2004) far exceed charges for any other condition. In 2004, fully 27% of hospital charges to Medicaid and 16% of charges to private insurance were for birthing women and newborns, the most expensive conditions for both payers. The burden on public budgets, taxpayers and employers is considerable.

As US birth outcomes continue to worsen, it should come as no surprise to The Today Show that childbearing women are seeking alternatives to standard maternity care. After all, American women and babies are paying the highest price of all—their health—for these unnecessary interventions, which include increasing rates of elective inductions of labor and cesarean sections without medical indication.

To the detriment of childbearing families, the segment “The Perils of Midwifery” totally disregarded the evidence. Although the reporters acknowledged that research shows home birth for low-risk women is safe, that message was overshadowed by many negative messages, leaving viewers with a biased perception of midwifery care and home birth. CIMS makes these points not to promote the interests of any particular profession, but rather to raise a strong voice in support of maternity care practices that promote the health and well-being of mothers and babies.

One of the ten Institute of Medicine recommendations for improving health care is to provide consumers with evidence-based information in order to help them make informed decisions. The Institute recommends that decisions be made by consumers, not solely by health care providers. The Institute maintains that transparency and true choice are essential to improving health care. We remain hopeful that the medical community will soon recognize the rights of childbearing women when it comes to their choices in childbirth and will respect and support these choices in the interest of the best possible continuity and coordination of care for all.

We urge The Today Show to provide childbearing women with fair and accurate coverage of this important issue by giving equal time to midwives, public health professionals, researchers of evidence- based maternity care, and especially to parents who have made choices about different models of care and places of birth.

Coalition for Improving Maternity Services
Academy of Certified Birth Educators
Alaska Birth Network
Alaska Family Health and Birth Center
American Association of Birth Centers
American College of Community Midwives
American College of Nurse-Midwives
Bay Area Birth Information
Birth Network of Santa Cruz County
Birth Works International
Birthing From Within, LLC
BirthNetwork National
BirthNetwork of Idaho Falls
BirthNetwork of NW Arkansas
Choices in Childbirth
Citizens for Midwifery
DONA International
Doulas Association of Southern California
Evansville BirthNetwork
Harmony Birth & Family
Idaho Midwifery Council
Idahoans for Midwives
InJoy Birth and Parenting Education
International Childbirth Education Association
International MotherBaby Childbirth Organization
Lamaze International
Madison Birth Center
Midwives Alliance of North America
Motherbaby International Film Festival
Nashville BirthNetwork
National Association of Certified Professional Midwives
North American Registry of Midwives
Oklahoma BirthNetwork
Perinatal Education Associates, Inc.
Reading Birth & Women's Center
Rochester Area Birth Network
Sage Femme
The Big Push for Midwives Campaign
The Tatia Oden French Memorial Foundation
Triangle Birth Network
Truckee Meadows BirthNetwork

About Us
The Coalition for Improving Maternity Services (CIMS) is a coalition of individuals and national organizations with concern for the care and wellbeing 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. The CIMS Mother-Friendly Childbirth Initiative is an evidence-based mother-, baby-, and family- friendly model of care which focuses on prevention and wellness as the alternatives to high-cost screening, diagnosis, and treatment programs.

1. The Perils of Home Births, http://www.msnbc.msn.com/id/21134540/vp/32795933#32795933
2. Birth Can Safely Take Place at Home and in Birthing Centers,
3. Offers All Birthing Mothers Unrestricted Access to Birth Companions, Labor Support, Professional Midwifery Care, http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2409134&blobtype=pdf
4. ACOG Place of Birth Policies Limit Women's Choices Without Justification and Contrary to the Evidence, http://childbirthconnection.com/article.aspClickedLink=790&ck=10465&area=27
5. Ratifiers and Endorsers of The Mother-Friendly Childbirth Initiative,
6. Choice of Birth Setting, http://www.nationalperinatal.org/advocacy/pdf/Choice-of-Birth-Setting.pdf
7. Position Statement on Midwifery, http://www.nationalperinatal.org/advocacy/pdf/Midwifery.pdf
8. Midwife-led versus other models of care for childbearing women,
9. Evidence-Based Maternity Care: What It Is And What It Can Achieve,
10. Lamaze Healthy Birth Practices,
11. Millennium Development Goals Indicators, United Nations, http://mdgs.un.org/unsd/mdg/Data.aspx
12. National Vital Statistics System, Birth Data, http://www.cdc.gov/nchs/births.htm
13. Induction By Request, http://www.marchofdimes.com/prematurity/21239_20203.asp
14. Cesarean Birth By Request, http://www.marchofdimes.com/prematurity/21239_19673.asp
15. Crossing the Quality Chasm: A New Health System for the 21st Century,
16. The Mother-Friendly Childbirth Initiative, http://www.motherfriendly.org/mfci.php

Coalition for Improving Maternity Services
1500 Sunday Drive, Suite 102
Raleigh, NC 27607

Tel: 919-863-9482
Fax: 919-787-4916


Making Mother-Friendly Care A Reality
CIMS is a not-for-profit organization recognized as tax-exempt under Internal Revenue Code section 501(c)(3). Our mission is to promote a wellness model of maternity care that will improve birth outcomes and substantially reduce costs.

Thursday, September 24, 2009

Media & Birth Petition

I'm not sure exactly how I personally feel about this approach, but I wanted to share this announcement from Choices in Childbirth about accuracy in media reporting about birth:

"Two weeks ago, NBC's The Today Show ran a deeply biased and poorly-researched report entitled "The Perils of Midwifery," which depicted midwife-assisted home birth as a dangerous celebrity-driven fad. At Choices in Childbirth and the New Space for Women's Health, we know better, and we know that it's never been more important to support midwives and the other members of New York City's birth community.

Pleas sign our petition to demand accurate reporting on all available childbirth options. We'll be delivering it in person to The Today Show on October 9, but before then, we're aiming for 5000 signatures. Make sure yours is one of them!

Here's the link."

It's Crunch Time--News from the MAMA Campaign


Congress is ready to move on health care reform. But will they make
Certified Professional Midwives (CPMs) part of that reform? We still hope
so, and we know you do, too. You have been working hard with us for months on this campaign to give CPMs federal recognition. You’ve written your letters and you’ve told your friends. You’ve helped us along the way. But now we need a little more.

-At Long Last, the Senate Has a Bill-
Last Wednesday, the powerful Senator Max Baucus of Montana introduced his long-awaited America’s Healthy Future Act. This bill will be the crux of the health care reform debate for the next few weeks. Read a summary of Baucus’s bill on his website.

The bill is large and complicated, with provisions that will affect
insurance companies, Medicare, and even Native American tribes.

But it is silent on the important issue of Medicaid patients’ access to

We have been pounding the pavement in Washington, D.C., letting legislators know in person about the health benefits and cost savings that CPMs can provide. The legislators are interested. Because of our persistent outreach, all of the key offices are aware of Certified Professional Midwives and that CPMs can be part of the health care reform solution. They are sympathetic to our cause. But they need to hear from you, their constituents, in order for that sympathy to be translated into legislative action. To legislators hearing form constituents is the most important thing!

-Use Your Voice!-
We’ve asked you to contact your legislators, and you’ve delivered! Already, thanks to your letters, dozens of legislators have expressed support for our amendment, several in writing, and including several members of the committee that are writing the health care bills.

But we need more. Congress only pays attention if you tell them over and over. Please write your legislator today and ask them to support the inclusion of CPMs in Medicaid! Did you already write a letter? Write again! Go to http://mamacampaign.squarespace.com/contact-your-legislator for instructions on writing and sending your legislators a letter. THANK YOU to all of you who have already written.

-The Today Show Insults Midwives-
Last week the Today show ran a startling piece of yellow journalism titled,
"[1]The Perils of Homebirth". We did not like it, and if you saw it, we bet
you did not like it either: it quoted the American College of Obstetricians
and Gynecologists (ACOG) as comparing home birth to a “spa treatment.” But despite its obvious bias, the piece did drive home some important facts:
1. http://today.msnbc.msn.com/id/26184891/vp/32795933#32795933

1. Home birth is on the rise in the U.S. and our efforts are gaining the
attention of the mainstream. The insulting attacks on home birth by ACOG in the piece are a sure sign that they feel threatened by the growing preference in the U.S. for midwives, home birth, and choices in maternity care. They try to make us afraid, but we know the truth: the latest published study on home birth reveals it to be [2]safer than hospital birth for low risk women, even in cases of vaginal birth after caesarean (VBAC)!
2. http://www.cfpc.ca/local/user/files/%7B7A4B29B5-2599-4374-81FF-D061F23496BB%7D/Home%20birth%20cmaj.081869v1.pdf

2. Mothers and Midwives do not take kindly to cheap shots. Viewer comments flooded the Today Show and were overwhelmingly [3]pro-midwife. We feel confident that the producers of the show now know that we will not be cowed by scare tactics and sensational stories.
3. http://www.newsvine.com/_question/2009/09/11/3252633-is-choosing-a-home-birth-with-a-midwife-worth-the-potential-risk

We know that YOU are going to help us STAND AND DELIVER the kind of choices that you, your children, and their children deserve in maternity care.

-MAMA Is Blogging Health Care Reform.-
You can follow the health care reform debate with MAMA! Read the latest post on our blog, The Grapevine.

Donate Your Resources! Visit http://www.nacpmcommunity.org/content.aspx?page_id=301&club_id=962241

This is a historic moment for midwives! The MAMA Campaign was launched in May, just four short months ago, and we have already garnered the attention of top Congressional leaders and federal agencies. MAMA has been busy! Of particular significance are the many less obvious but equally important gains made by the MAMA Campaign. In support of our common goal, our six partner organizations entered into a formal relationship for the first time! While our short-term goal of federal recognition is clear and focused, the long-range impact of bringing national attention to CPMs and their potential contributions to health policy is immeasurable in its importance.

To date, MAMA has received nearly $100,000 in individual contributions and organizational support! Now, we need at least an additional $50,000 in order to maintain our presence in Washington, DC through this Congressional debate over healthcare reform. We have come so far, and we can’t stop now.

Please consider making a contribution today to help carry us over the
top! Invest in the future of midwifery in the United States!

Please donate at http://www.nacpmcommunity.org/content.aspx?page_id=301&club_id=962241

With hope for a future that holds a Midwife for every Mother!
-The MAMA Campaign www.mamacampaign.org

Friday, September 18, 2009

Massachusetts Friends of Midwives Video

A nice video tribute to Massachusetts Midwives (hat tip to Bellies and Babies for the link):

CfM Blogger

Ohio Homebirth Case

It has taken me a little while to post about this, but I wanted to share this post from the Ohio Families for Safe Birth blog about a homebirth family who was charged with child endangerment after having their second child at home (they called 911 several hours after the birth because of a concern about the mother--the baby is, and was, fine).

Situations like this are one reason while activists in Ohio are working midwifery licensure--"If this family’s choice of care provider and location for birth were legally recognized, I don’t think they would be in this situation."

This case hasn't gotten much attention that I'm aware of (a google search didn't turn up anything much more than the blog post referenced above).

CfM Blogger

Friday, September 11, 2009

Grassroots Network: TODAY show in bed with ACOG

Dear Friends,

Friday morning’s TODAY show included a segment about the “perils of home birth.” The show included a sad home birth (with a nurse-midwife) where the baby died of a cord accident, without mentioning that such deaths can happen in the hospital also, or addressing the US’s high perinatal mortality rate. Representatives of ACOG described home birth as “the equivalent of a spa treatment”! Definitely not even-handed reporting, but looks like ACOG is out to get media for their biased beliefs.

You can watch the segment at http://today.msnbc.msn.com/id/26184891/vp/32795933#32795933

You can read comments about the show (and add your own) at: http://www.newsvine.com/_question/2009/09/11/3252633-is-choosing-a-home-birth-with-a-midwife-worth-the-potential-risk. Almost all of the comments are pro-midwife.

And if you want to e-mail the Today show and let them know the real reasons more women are choosing home birth, or that you’d like to see an HONEST segment on home birth, you can write to them at Today@NBCUNI.com.

Finally, true to form, the Big Push has fired off an eloquent Push Alert (see previous post).

As the saying goes, any attention is good attention, or at least a great opportunity for getting more and better attention!

Thank you to the several individuals who brought this to my attention, including the links.


Susan Hodges, “gatekeeper”

The Big Push Press Release: Physicians Take Anti-Midwife Smear Campaign to the Airwaves

I was getting ready to write about this myself--thinking of calling it, "ACOG Makes a New Friend"--but the indomitable Big Push Campaign beat me to it and their release is so pointed that I have nothing more to add!

If you have difficulty viewing this message, please visit the PushNewsroom.

Home Birth Mothers, Celebrities, Insulted on National TV


WASHINGTON, D.C. (September 11, 2009) – Referring to women who choose to give birth in out-of-hospital settings as "hedonistic" and likening childbirth to a "spa treatment," members of the American College of Obstetricians and Gynecologists, a trade group representing the professional and financial interests of OB/GYNs, took their anti-midwife campaign to the airwaves in a Today Show segment rife with insults, stereotypes, and misinformation, using one family's tragedy as a platform for the organization's well-funded assault against choices in childbirth.

"About the only thing ACOG has right is that women are choosing out-of-hospital deliveries in record numbers," said Steff Hedenkamp of The Big Push for Midwives Campaign. "What Erin Tracy and other apologists for the group's anti-midwife position fail to see is that one of the forces driving women to seek out-of-hospital care is the paternalistic, profit-driven model of maternity care that far too many of its own members provide."

During the segment ACOG reiterated its claim, which has been thoroughly debunked by a large and growing body of medical literature, that out-of-hospital delivery is unsafe. Describing women who choose to give birth in private homes and freestanding birth centers as "hedonistic" mothers who knowingly put the lives of their babies at risk for the sake of an "experience" they believe will be like a "spa treatment," members of the group echoed last year's position statement claiming that women who choose out-of-hospital deliveries base their decisions on what's "fashionable" or "trendy."

"ACOG clings to this ridiculous fantasy that women choose to deliver their babies outside of the hospital because they want to be like Ricki Lake, Demi Moore or Meryl Streep and that if women would only watch enough fear-mongering stories on morning television they'll be brainwashed back into hospitals," said Katherine Prown, Campaign Manager of The Big Push for Midwives. "Insulting our intelligence and promoting policies that deny us choices in maternity care are not exactly winning strategies for stemming the tide of women seeking alternatives to standard OB care."

Earlier this year, a New York City couple lost their baby during a planned home birth under the care of a Certified Nurse-Midwife. Licensed and regulated in all 50 states, Certified Nurse-Midwives are trained to provide hospital-based maternity care. By contrast, Certified Professional Midwives, who undergo specialized clinical training in out-of-hospital birth, are legally authorized to provide care in 26 states, although outdated regulations effectively prevent them qualifying for licensure in the state of New York.

Legislation to license and regulate Certified Professional Midwives is currently pending in an additional 18 states, despite staunch opposition from the American Medical Association, which has joined with ACOG in adopting position statements that would deny families who choose out-of-hospital maternity care legal access to nationally credentialed midwives with specialized training to provide it.

The Big Push for Midwives Campaign represents thousands of grassroots advocates in the United States who support expanding access to Certified Professional Midwives and out-of-hospital maternity care. The mission of The Big Push includes educating national policymakers about the reduced costs and improved outcomes associated with out-of-hospital birth and advocating for including the services of Certified Professional Midwives in health care reform. Media inquiries: Katherine Prown (414) 550-8025, katie@thebigpushformidwives.org


The Big Push for Midwives Campaign | 2300 M Street, N.W., Suite 800
Washington, D.C. 20037-1434 | TheBigPushforMidwives.org


I only recently learned that the International Cesarean Awareness Network (ICAN) has a blog. I'll definitely be checking in regularly! One of the recent posts addressed an article published in The PregnancyZone about the "benefits of cesarean section delivery" with a rebuttal titled, Benefits of Cesarean? Think Again.

Speaking of ICAN, two weeks ago I was thrilled to finally see a production of the play BIRTH, as part of a BOLD event in St. Louis. The event was co-sponsored by ICAN of St. Louis. It was a really wonderful production and I'm so glad I finally got to see the play in real life (I've read the book version).

CfM Blogger

Worst to First Campaign

I received an email from an activist in Connecticut regarding the "Worst to First" Campaign: "...in the attempt to make the Worst To First Maternity care program national. The goal of our campaign is to meet with all statewide hospitals in attempt of challenging them to lower their cesarean rates, lowering the episiotomy rates, and offer alternative birthing positions besides the lithotomy position which we all know is less than ideal."

You can read more about the campaign on the website. It seems like this program pairs nicely with The Birth Survey's effort to increase transparency in maternity care.

CfM Blogger

AABC Legislative Alert

Tell Your Legislators - Congressional Budget Office says Birth Center Bill will SAVE $47 million!

We have Good News for Healthcare Reform. The Congressional Budget Office has evaluated the Birth Center Medicaid Reimbursement Act (HR 2358 and S1423) and says:

It will SAVE at least $47 million over the next 10 Years!

If your Representatives and Senators are not co-sponsors of the Bill, you need to ACT NOW.

1) Meet or call the staff at your legislators' district offices. Invite them to your birth center.

2) Call their Washington, DC offies and ask to speak with their Health Legislative Assistant.

3) Tell them about our bill to add the birth center to Medicaid services. Let them know if they will co-sponsor and help pass this bill, that it will Save Healthcare Dollars!!

4) Make sure that the staff will commit to calling you back with an answer. If they will not co-sponsor-find out why.

This is a nonpartisan issue about the health of mothers and babies, access to care, and saving federal dollars. Let's add as many co-sponsors as we can this month!

We are asking you to make your calls today!!

Learn more about how you can make a difference at www.birthcenters.org.


Jill Alliman, CNM, MSN
Chair, Legislative Committee
American Association of Birth Centers

News from the MAMA Campaign: THE TIME IS NOW


With those words on Wednesday night, President Obama urged Congress and all of us to work together to reform the U.S. health care system. And as the President noted, committees of Congress are already hard at work writing health care reform bills. _This means that now is also the time to stand up for Certified Professional Midwives (CPMs) as part of health care reform._

In his speech to the Joint Session of Congress, President Obama restated the basic components of his plan for health care reform, and addressed some of the controversies and misinformation that have been in the headlines. View the speech at http://www.npr.org/templates/story/story.php?storyId=112695048

Based on the responses of Representatives and Senators from both sides of the aisle, there was strong agreement that the health care system has major problems and needs to be fixed, and that health insurance needs reform. While not everyone agrees on the best way to accomplish these goals, adding CPMs to the list of Medicaid providers is a no-brainer -- it would add a high quality, low cost choice for maternity care for women on Medicaid, and eventually for women on most insurance plans.

While details of reform are still being worked out, President Obama
mentioned that there is already agreement on about 80% of what is in the various draft bills. While the "public option" remains a contentious topic, it is only one possible part of the package. The MAMA Campaign goal to have Certified Professional Midwives added to the list of Medicaid providers does NOT depend on a public option being part of the health care reform plan.

President Obama stated: "_One of the unique and wonderful things about America has always been our self-reliance, our rugged individualism, our fierce defense of freedom and our healthy skepticism of government. And figuring out the appropriate size and role of government has always been a source of rigorous and sometimes angry debate_." The work of Certified Professional Midwives exemplifies these valuable characteristics, but making it possible for all women to have access to the choice of midwifery care in out-of-hospital settings is one appropriate place for federal government to play a role- just as it has successfully done in states across the country. _Adding Certified Professional Midwives to the federal list of Medicaid providers is a simple step to make this possible, and is why it should be part of any health care bill that comes out of Congress!_

Let's make sure CPM recognition is part of any health care bill that comes
out of Congress! Support MAMA today, donate at http://www.nacpmcommunity.org/content.aspx?page_id=301&club_id=962241

To read more about President Obama’s speech, visit
1. http://www.nationaljournal.com/congressdaily/hca_20090910_4249.php
2. http://www.kaiserhealthnews.org/Stories/2009/September/10/obama-speech-expert-panel.aspx

All summer long, and especially during the August recess, members of
Congress have been busy responding to questions about health care from their constituents. At town hall meetings across the country, people have been asking their legislators about pre-existing conditions, insurance costs, and the public option.

_But did you know that Americans nationwide were also asking about midwives?_

We do. We’ve seen the results of it. _Thanks to your letters and emails
and our weekly visits to Washington DC, legislators’ support is growing to
extend Medicaid coverage to include CPMs._ They are now considering our provision. With your help we can get them to include CPMs as a priority and put our amendment into the bills.

Congress is likely to act on health care reform this month. The more
legislators learn about Certified Professional Midwives, the more support
they show for an amendment that would reimburse CPM’s services through Medicaid. But legislators are cautious. They will not distinguish our amendment from the many proposed amendments unless they know that there is something special about it. They need to hear that their constituents want to be able to choose CPMs for their maternity care providers. There are still opportunities to insert our amendment into the House and Senate health care bills.

Ask them to support federal recognition for Certified Professional Midwives as Medicaid providers.

If you signed up to help at www.mamacampaign.org and you live in a key
state [ http://finance.senate.gov/sitepages/committee.htm] or district [http://energycommerce.house.gov], chances are that you have already heard directly from us over the last month asking you to call or write your Senator[http://www.senate.gov] or
Representative [http://www.house.gov] at their local or district offices. Thank you to all of you who have contacted your legislators in these key states and districts.

As the president puts pressure on congress to make reform happen, we need more letters from supporters across the country. Please write a letter to your own Congress members! Go to [http://mamacampaign.squarespace.com/contact-your-legislator] for instructions on writing and sending your legislators a letter. THANK YOU to all of you who have already written.

You can follow the health care reform debate with MAMA! Read the latest post on our blog, The Grapevine at http://www.mamacampaign.org/grapevine

Your donations keep this campaign going. And we thank you for your
support. If you haven’t donated yet, please donate today! Your gift of $25, $50, or even $100 will ensure that legislators continue to hear about the importance of federal recognition for Certified Professional Midwives.Visit http://www.nacpmcommunity.org/content.aspx?page_id=301&club_id=962241 to make a donation today. MAMA is working for you!

Please help your MAMA!

Wednesday, September 9, 2009

The Big Push & Ina May

From The Big Push Campaign:

Guess Who's Coming to Dinner? ......


Donate $25 or more to The Big Push for Midwives Campaign before 6:00 a.m. Monday, September 14 and you could have dinner with Ina May Gaskin!

All you need to do is make a
donation of at least $25 via the website and share a word or phrase that describes what having access to out-of-hospital birth options with CPMs means to you. See directions at the end for where to enter your word or phrase.

If you are selected, Ina May will come to your home to break bread with you. She will also make herself available for a public event while she is in town to raise funds for your work on behalf of CPMs and out-of-hospital maternity care.

While you tell all of your friends what you're doing to win dinner with Ina May Gaskin, The Big Push for Midwives team will be
putting your donation to good use to keep ACOG on the defensive by:

  • Reframing the debate around homebirth in major media outlets by continuing to develop compelling talking points and cultivating relationships with key reporters and bloggers
  • Applying consistent pressure to legislators to make sure that Certified Professional Midwives are incorporated into healthcare reform at the state and federal levels
  • Providing assistance to leaders in states who are pushing back against the well-financed and coordinated opposition to licensure legislation across the country.

You have until 6:00 a.m. on Monday, September 14 to make a minimum
donation of $25 and share a word or phrase that describes what having access to out-of-hospital birth options with CPMs means to you. The winner will be announced on Tuesday. If you have any questions, please contact Katherine Prown, Campaign Manager for The Big Push for Midwives Campaign.

Secure online donations can be made through the
Big Push for Midwives Contribute page as well as through Paypal by clicking on the Donate button on the home page.

On the secure donation page, add your word or phrase where it says "Please send acknowledgment of this gift to:" If contributing through Paypal on the homepage, put your word or phrase in the "Special Instructions to Seller" box.

Thank you for your support of mothers, babies and families!

The Push Team

Tuesday, September 8, 2009

Where's My Midwife?

"The only midwifery program in Wilmington NC was dissolved last month leaving women days or weeks from their due dates without their chosen care provider. Members of Where's My Midwife illustrate their anger at having fewer maternity care options with a flashmob protest at the farmer's market Saturday. Visit www.wheresmymidwife.org for more details."

CfM Blogger

Monday, September 7, 2009

Labor Day Videos

Since it is Labor Day, I want to share links to two videos. The first is from a homebirth rally in Canberra, Australia (read more about the situation in Australia in my previous posts. Hat tip to Gloria Lemay's blog for the video link).

The second clip is a documentary with scenes from various BOLD events. BOLD is an acronym for "Birth on Labor Day." As part of this "global movement to make maternity care mother-friendly," birth activists across the country put on performances of Birth, a play by Karen Brody, during August and September (hat tip to Woman to Woman CBE for this video link). I was extremely excited to attend a performance of Birth in St. Louis last weekend. I've wanted to see the play since I first heard about it several years ago and it didn't disappoint! The play was followed by a birth art activity and a BOLD Red Tent (birth story sharing circle).

CfM Blogger

Friday, September 4, 2009

Book Review: The Father's Home Birth Handbook

The Father’s Home Birth Handbook
By Leah Hazard
Victoria Park Press, 2008
Softcover, 208 pages
ISBN: 978-0-9560711-0-1

Reviewed by Molly Remer, MSW, ICCE

The Father's Home Birth Handbook is a succinct and easy to read little guide for fathers and adds to the growing library of birth resources specifically geared towards fathers-to-be. The book is written by a woman, but contains ample quotes from fathers which lend a male perspective. It also includes a number of good birth stories interspersed throughout, which were all written by men.

The target audience for the handbook is easily summed up in the prologue: “…I’ve met far more men who have responded to their partners’ home birth wishes with a mixture of shock, cynicism, and fear…Far from being domineering ogres who just want to see wifey tucked ‘safely’ away a hospital, these loving fathers have simply had very little access to accurate, impartial information about the safety and logistics of home births versus hospital births.”

The first chapter addresses “Risk & Responsibility,” because that is one of the very first issues of concern for most people new to the idea of homebirth. It moves on to a chapter called “Think Positive,” followed by “Choosing the Guest List” and then one titled “Pleasure and Pain” This chapter covers comfort measures and what to do while the woman you love is giving birth: “…away from the intravenous drip and ticking clocks, you can support your partner in experiencing labour in all of its awesome, challenging power.”

Chapter five—“Birth: Normal and Extraordinary” covers Labor 101 topics, including what to do with the placenta. This is followed by “Challenges & Complications” which covers some common issues of concern such as premature labor, being overdue, prolonged labor, distressed baby, cord around the neck, tearing, and blood loss. Each of these is followed by a “what can I do to help?” section.

The final chapter—“Now What?”—concludes with a nice segment called “how can I carry the lessons I’ve learned from my homebirth with me into the rest of my life as a father?”

Published in Scotland, the handbook has a UK perspective—it assumes participation in the NHS and a “booked” midwife and homebirth. There is no “how to choose a midwife” type of section (because there is no choice of midwives). For US readers, this leaves a set of issues unaddressed—such as varying legal statuses, etc. UK specific issues also arise based on the possibility of caregivers who are not thrilled about homebirth, but who have to come to the birth since it is a government supported option. It comes across that in Scotland homebirth may seem readily okay on paper, but in reality is more difficult to pull off.

The book does briefly discuss the birth climate in the US and soundly critiques ACOG’s position on homebirth.

The book has an index and a resources section.

The Father’s Home Birth Handbook is a friendly, practical, matter-of-fact, helpful little guide that neatly addresses common questions and concerns many fathers-to-be have about planning a homebirth.


Associated amusing anecdote: my three year old noticed me reading this book, looked at the cover and said, "The dad is trying to grab him, but that little baby is floating away!

CfM Blogger

Wednesday, September 2, 2009

Grassroots Network: Infant Mortality Awareness Campaign!

Dear Friends,

The International Center for Traditional Childbearing (ICTC) is observing September National Infant Mortality Awareness Month (September) with the Heads Up on Infant Mortality Campaign. Citizens for Midwifery is supporting this public awareness effort with our sponsorship.

The goals of Infant Mortality Awareness Month are to increase national awareness of contributing factors to infant mortality, and to urge community leaders to assist in efforts to reduce the rate of infant mortality in this country by 2010. The US ranks 30th in the world for infant mortality, and African American babies are twice as likely to die during the first year, with a mortality rate of 13.5 per 1,000 live births compared to 5.7 per 1,000 live births for whites and Hispanics, according to CDC data.

While many factors affect infant mortality, midwifery care is part of the solution, since midwives provide the kind of holistic prenatal and birth care that results in healthier mothers and babies.

The Heads Up on Infant Mortality Campaign seeks to raise awareness about the tragedy of infant mortality by asking people to knit or crochet baby hats, one for each of the 27,000 babies lost in 2008. All hats received by September 15 will be displayed in ICTC's Infant Mortality Awareness Rally in Washington, DC on September 26. The more hats, the more attention will be raised at the rally (and afterward the hats will be donated for premature babies). So get out the yarn and start knitting or crocheting! Find several quick patterns on the ICTC website!

For more information:

Flier: http://www.blackmidwives.org/headsupflyer.pdf

Press release: http://www.blackmidwives.org/natlheadsuppressrelease.pdf

Quick knitting & crochet patterns: http://www.blackmidwives.org/component/content/article/85

Susan Hodges, "gatekeeper"

Note from Molly: A local mother's group that I belong to is getting together for a "Knit Night" to knit/crochet hats for this Campaign. While we're at it, we're going to view/discuss the new film Laboring Under an Illusion.

Grassroots Network: NEW Canadian Study shows safety of home birth!

Dear Friends,

Yet another large study, just published in the Canadian Medical Association Journal, demonstrates the safety of planned, midwife-attended home birth!

In the abstract, the authors conclude:

“Planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician.”

The new Canadian study compares outcomes for planned midwife-attended home births, planned midwife-attended hospital births (with the same cohort of midwives), and planned physician-attended hospital births. The women in all three groups all met the requirements to be eligible for a home birth, so the study groups are as comparable as possible.

The study used data from one health region in British Columbia. Canadian midwives practice in both home and hospital settings, which allowed a comparison of midwife-attended home and midwife attended hospital birth where ONLY the setting was different.

There are many interesting facts, data and observations in this study which is well worth reading!

You can read the abstract and the complete article (the early-release version) at:
http://www.cmaj.ca/cgi/rapidpdf/cmaj.081869. I have pasted the abstract below.

Susan Hodges, “gatekeeper”

Note from Molly: The ever-informative and intelligent Science and Sensibility blog took an in-depth look at this study in this post. A particularly good point that Amy made about the new study was "3. The researchers isolated the effect of the birth setting itself by comparing midwife-attended home birth with midwife-attended hospital birth. In fact, the same group of midwives cared for women in both settings, so differences are likely to be related to the setting and its protocols and technological accoutrements (or lack thereof) rather than differences in the providers who actually provide the care."


Early release, published at www.cmaj.ca on August 31, 2009. Subject to revision.

Outcomes of planned home birth with registered midwife
versus planned hospital birth with midwife or physician
Patricia A. Janssen PhD, Lee Saxell MA, Lesley A. Page PhD, Michael C. Klein MD,
Robert M. Liston MD, Shoo K. Lee MBBS PhD

Studies of planned home births attended by
registered midwives have been limited by incomplete
data, nonrepresentative sampling, inadequate statistical
power and the inability to exclude unplanned home
births. We compared the outcomes of planned home
births attended by midwives with those of planned hospital
births attended by midwives or physicians.
Methods: We included all planned home births attended
by registered midwives from Jan. 1, 2000, to Dec. 31, 2004,
in British Columbia, Canada (n = 2889), and all planned
hospital births meeting the eligibility requirements for
home birth that were attended by the same cohort of midwives
(n = 4752). We also included a matched sample of
physician-attended planned hospital births (n = 5331). The
primary outcome measure was perinatal mortality; secondary
outcomes were obstetric interventions and adverse
maternal and neonatal outcomes.
Results: The rate of perinatal death per 1000 births was
0.35 (95% confidence interval [CI] 0.00–1.03) in the group
of planned home births; the rate in the group of planned
hospital births was 0.57 (95% CI 0.00–1.43) among women
attended by a midwife and 0.64 (95% CI 0.00–1.56) among
those attended by a physician. Wo men in the planned
home-birth group were significantly less likely than those
who planned a midwife-attended hospital birth to have
obstetric interventions (e.g., electronic fetal monitoring,
relative risk [RR] 0.32, 95% CI 0.29–0.36; assisted vaginal
delivery, RR 0.41, 95% 0.33–0.52) or adverse maternal outcomes
(e.g., third- or fourth-degree perineal tear, RR 0.41,
95% CI 0.28–0.59; postpartum hemorrhage, RR 0.62, 95%
CI 0.49–0.77). The findings were similar in the comparison
with physician-assisted hospital births. Newborns in the
home-birth group were less likely than those in the midwife-
attended hospital-birth group to require resuscitation
at birth (RR 0.23, 95% CI 0.14–0.37) or oxygen therapy
beyond 24 hours (RR 0.37, 95% CI 0.24–0.59). The findings
were similar in the comparison with newborns in the
physician-assisted hospital births; in addition, newborns in
the home-birth group were less likely to have meconium
aspiration (RR 0.45, 95% CI 0.21–0.93) and more likely to
Abstract be admitted to hospital or readmitted if born in hospital
(RR 1.39, 95% CI 1.09–1.85).
Interpretation: Planned home birth attended by a registered
midwife was associated with very low and comparable
rates of perinatal death and reduced rates of obstetric
interventions and other adverse perinatal outcomes compared
with planned hospital birth attended by a midwife
or physician.