Grassroots News: Good News for Kansas CPMs!

Dear friends,

Good news from Kansas! CPM's were officially recognized as legal practitioners in Kansas birth centers. Congrats, Kansas! Below is more information on the history of CPM's in Kansas, and the specificities of their recognition. As always, if you have any news items that you would like to share, please e-mail info@cfmidwifery.org.

History: a 1996 Kansas Supreme Court ruling stated that in the case presented against a direct-entry midwife, she was not violating the Medical Practices Act because midwifery was not the practice of medicine and she was working in conjunction with a supervising physician. This led many to interpret the law as meaning that direct entry midwives were legal but unregulated in Kansas. Others disagreed with the broadness of that interpretation, with concern that it applied only in that case and that it was contingent on working with physician back-up. Nevertheless, midwives have not been harassed in Kansas and have worked openly.

Previous regulations for birth centers in Kansas required that the center be owned and operated by a physician or CNM, and be staffed with physicians and CNMs. One unique and brilliant CNM, Cathy Gordon, and her compatriot, Debbie Perry, CPM, have worked tirelessly for over two years to revise the birth center regulations to officially allow CPMs to work in them. These regulations just passed! Now, CPMs are legal practitioners in Kansas birth centers. Though not addressing home birth, these regulations provide a definite legal status for CPMs in Kansas. Since regulations hold the power of law, this is one more state where CPMs are recognized as legal providers of care.

Additionally, the language added by MAMA Campaign efforts to the birth center provision in the new healthcare law requires states to provide Medicaid reimbursement to any healthcare provider recognized by state law who is providing services in a licensed birth center. The CPMs in Kansas now fall under that definition!

The full text will not be on the web until July 9. If anyone wants the whole document as a pdf, should contact Ida Darragh at ivd@aol.com.

The language specifically designating CPMs as providers is:

Page 1024:
(f) ''Certified professional midwife'' means an individual who is educated in the discipline of midwifery and who is currently certified by the North American registry of midwives.
(g) ''Clinical director'' means an individual who is appointed by the licensee and is responsible for the direction and oversight of clinical services at a birth center as specified in K.A.R. 28-4-1305.
(h) ''Clinical staff member'' means an individual employed by or serving as a consultant to the birth center who is one of the following:
(1) The clinical director or acting clinical director;
(2) a licensed physician;
(3) a certified nurse-midwife;
(4) a certified professional midwife;
(5) a certified midwife; or
(6) a registered professional nurse.

Page 1029:
(m) Each patient shall be admitted for labor and delivery by a physician, a certified nurse-midwife, a certified professional midwife, or a certified midwife.

Way to go, Kansas!

Sincerely,
Stephanie Hucker and Willa Powell
Citizens for Midwifery

Maternal and Infant Mortality

Last month, I wrote a brief post about the Preconception Educators program sponsored by the US office of Minority Health. Since then, several other things have come to my attention that are related to either maternal or infant mortality. The Unnecesarean blog pointed out that there is an excellent video about infant mortality in the African-American population available from the Minority Health office. In fact, The Unnecesarean is also hosting a blog carnival about this video! (to run July 4th.)

The video is called Crisis in the Crib and emphasizes this fact: "The rate of death for black babies before their first birthday is twice the rate of white babies and greatly outpaces the national average."

Then, a friend sent me a link to an article about childbirth deaths focusing on the "350,000 women lose their lives each year giving birth or through complications of childbearing."

And, in the summer issue of Midwifery Today I read about the new report from Amnesty International called "Deadly Delivery" about the maternal health crisis in the US: "Mothers die not because the United States can't provide good care, but because it lacks the political will to make sure good care is available to all women." Bringing it full circle back to the Crisis in the Crib, I think we could amend that sentence to read, "mothers and babies die...because it lacks the political will to make sure good care is available to all women and their children."

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Molly

CfM Blogger

Grassroots Network: Survey for Patients/Consumers on Overtreatment

Survey for Patients/Consumers on Overtreatment

Dear Friends,

Hope you all are enjoying the start of summer!

First of all, we at CfM apologize that our Grassroots News Messages have been so sparse lately. Much has been going on in all of our lives, and unfortunately our news messages have taken a back seat. In the coming months, we promise to refocus our energy and use this network to spread the news about maternity care. If you have anything that you are interested in sharing, we encourage you to contact us at info@cfmidwifery.org. Additionally, if you would be interested in helping regularly with the Grassroots Network messages, we’d love to hear from you.

Below is information regarding a survey from TreatmentTrap.org and Consumer Union's Safe Patient Project dealing with overtreatment. While the site doesn't specifically mention childbirth, overtreatment, unnecessary treatment and other errors are frequent in maternal health care in the U.S. We encourage you to share your experiences with these incidents, especially as they relate to childbirth. The survey reflects the beginning of attention to overtreatment in general, and an awareness of related issues such as a lack of informed consent and being given misleading medical information. This is a chance for all of us to draw the attention of the sponsoring organizations to the severe and costly problem of unnecessary and overtreatment in maternity care in particular. Through raising these issues, we can actively support a woman's right to the childbirth she sees fit, and her right to be treated honestly and respectfully by her care providers, both of which are essential for improving the state of maternal health care in the US.

Please read the information below and participate in the Survey!

Sincerely,
Stephanie Hucker and Susan Hodges of Citizens for Midwifery

New Survey Launched to Query Patients/Consumers on Overtreatment

A new survey is being launched to enable patients to share their experience of overtreatment, an emerging quality and patient safety issue in health care today.

The survey is a partnership between TreatmentTrap.

org and Consumer Union's Safe Patient Project. While not a scientific survey, it aims to elicit patient experiences of overtreatment to raise public awareness. Patient experiences of overtreatment can be useful to health care leaders and policy makers as they establish priorities to reduce overuse.

The survey can be found by going to: www.treatmenttrap.org. Click on "Share Your Story" and you will be directed to the CU Safe Patient Project survey.

The "Share Your Story" survey asks two questions: "Have you had medical care you thought was unnecessary?" and "Have you declined medical care you thought was unnecessary and obtained a medically appropriate alternative?"

The survey prompts respondents to share experiences of overuse including those identified as overused by the National Quality Forum's National Priorities Partnership. These procedures include: spine surgery, heart bypass surgery, hysterectomy and prostatectomy.

For further information, contact Rosemary Gibson at rosemarygibson100@gmail.com

Book Review: Breastfeeding Facts for Fathers

Since Father's Day is this weekend, I thought this was a perfect book review to share!

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

Since partner support of a breastfeeding mother is one of the most important factors in breastfeeding success, the short book Breastfeeding Facts for Fathers is a valuable book indeed. Written in a clear, straightforward format, brief one-page sections address topics like, “why you want your baby breastfed,” “is formula really so bad,” “a happier, healthier mom,” “sex and the breastfeeding woman,” and “when breastfeeding is not advised.” There is also a brief segment about safe co-sleeping. These sections are followed by a brief FAQ addressing topics such as how often mom should breastfeed, how to know baby is getting enough milk, how long to breastfeed, nipple piercing, breast implants, alcohol, and breastfeeding in public.

As a quote in the book states, “Having a father is critical to the healthy development of a child. Being a father is critical to the healthy development of a man.” Providing breastfeeding information specific to fathers, Breastfeeding Facts for Fathers supports this healthy development of father, mother, and baby.

A Spanish edition, a low-literacy (abridged) version, an ebook edition, and a hospital edition (co-sleeping information omitted) of Breastfeeding Facts for Fathers are all available at various affordable prices from Platypus Media.

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

Book Review: The Littlest Sister

Book Review: The Littlest Sister

By Leigh Schilling Edwards

Strategic Book Publishing, 2008
ISBN 978-1-60693-041-0
14 pages, softcover, $12.00
http://www.facebook.com/pages/The-Littlest-Sister/317995643791

Reviewed by Molly Remer, MSW, CCCE

http://talkbirth.wordpress.com

Written from the perspective of a family’s middle child—the big sister of a hospitalized baby—The Littlest Sister is designed for siblings of a baby in the Neonatal Intensive Care Unit (NICU). It would also be a good book for a child who was formerly a preemie themselves. There is an older brother in the story as well, which enables readers of either gender can easily identify with the children.

Color snapshots of a real family grace each page and make the book very genuine and true-to-life. The baby in the book was born at 30 weeks and has Down Syndrome and a mild heart defect. The pictures and text contain a lot of details children will identify with—there is a picture of the big brother touching the baby in her isolette, pictures of the baby sister with a tube in her nose and monitors attached, and so forth. Bottle feeding is mentioned briefly and I wish breastfeeding had been mentioned as well

I have a special interest in the subject area because I worked for the Ronald McDonald House for four years. Written in a warm, personal tone, using easy to understand language and simple descriptions, The Littlest Sister would be a great addition to the lending library resources of Ronald McDonald Houses or NICU facilities.

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

Maternal-Fetal Conflict?

Mamatoto is a Swahili word meaning "motherbaby"--reflecting the concept that mother and infant are not two separate people, but an interrelated dyad. What impacts one impacts the other and what is good for one is good for the other. The midwifery and birth communities have used this concept for quite some time and more recently some maternal health researchers have also referenced the idea of the "maternal nest"--that even following birth, the mother is the baby's "habitat."

The Science and Sensibility blog is hosting their sixth blog carnival around the theme of mother-baby togetherness after birth, based on Lamaze's Healthy Birth Practice #6: Keep Mother and Baby Together – It’s Best for Mother, Baby, and Breastfeeding.

This carnival topic prompted me to revisit a post I made some time ago about maternal-fetal conflict:

Critiques of homebirth sometimes rest on a (flawed) assumption of maternal-fetal conflict (which is also invoked to describe situations with substance abuse or other risky behavior). In the Fall 2007 issue of CfM News, now President Willa Powell wrote about maternal-fetal conflict in response to an ABC segment on unassisted birth. She wrote:

[quoting the expert physician interviewed for the segment] "The few hours of labor are the most dangerous time during the entire lifetime of that soon to be born child. Because of this, I would argue, all soon to be born children have a right to access to immediate cesarean delivery, and women who insist on denying this right are irresponsible."

This was the only professional opinion in the program on unassisted birth, and he set up a typical expression of an obstetric community belief: the “maternal-fetal conflict.” The notion is that there are two “patients”, where the mother’s desires are sometimes in conflict with the well-being of the baby, and that the obstetrician has a moral/professional obligation to abandon the mother in favor of the baby.

I have to remind myself that Dr. Chervenak is setting up a false choice. In fact, this scenario is a “doctor-patient conflict”. The mother wants what’s best for herself and her child, but she disagrees with her doctor about what is, in fact, best. Women are making choices they believe are best for themselves and best for their babies, but those choices are often at odds with what doctors consider best for both, and certainly at odds with what is best for the obstetrician!

In the book Birth Tides, the author discusses maternal-fetal conflict:

According to obstetricians, the infant's need to be born in what they have defined as a safe environment, i.e. an obstetric unit, takes precedence over the mother's desire to give birth in what doctors have described as the comfort of her own home. It is a perspective that pits the baby's needs against those of the mother, setting 'overriding' physical needs against 'mere' psychological ones. It is rooted in the perception that the baby is a passenger in the carriage of its mother's body--the 'hard and soft passages,' as they are called. It is also rooted in the notion of the mind-body split, in the idea that the two are separate and function, somehow, independently of each other, just like the passenger and the passages. While women may speak about 'carrying' babies, they do not see themselves as 'carriers,' any more than they regard their babies as 'parasites' in the 'maternal environment.' If you see your baby as a part of you, there can be no conflicts on interests between you.

I previously linked to a book review that explores this concept of the more aptly described "obstetric conflict" in even more depth.

As we consider healthy birth practice six, I think it is fitting to remember that mother and baby dyads are NOT independent of each other. I have written before about the concept of mamatoto--or, motherbaby--the idea that mother and baby are a single psychobiological organism whose needs are in harmony (what's good for one is good for the other).

As Willa concluded in her CfM News article, "...we must reject the language that portrays a mother as hostile to her baby, just because she disagrees with her doctor."

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Molly
CfM Blogger