Saturday, January 30, 2010

Grassroots Network: MAMA Campaign Update

Dear Friends,

Just in case some of you haven’t signed up with the MAMA Campaign, below is the latest e-mail update. Regardless of your opinions about the existing Health Care (Insurance) Reform bills, they include some things that are good for mothers and midwives. What Congress will do with health care reform is still up in the air, but we can all communicate to our Congress people that maternity care is still an urgent issue that should not be ignored in the midst of the political hoopla. We still need real care, access to midwives, and birth practices that are based on evidence, not legal fears or economics.

Susan Hodges, “gatekeeper”


A Call to Arms for Women and Families!

Now is the time to call and write to your legislators for women and families!

The political landscape of health care reform changed dramatically last week with the election of Scott Brown to fill Ted Kennedy’s seat in the Senate, but women’s needs for maternity care reform did not!

  • Women in the many counties across the nation with no maternity care provider at all need access to care for their births
  • Women whose previous cesarean section is deemed a pre-existing condition by insurance companies need access to reimbursement for their birth
  • Women being pressured to have an induction at 40 weeks or to undergo other unnecessary interventions need access to evidence-based care
  • Women who are part of the 32% cesarean section rate in the US need access to VBAC
  • Women need access to normal birth options, increasingly rare in the US
  • Women insured by Medicaid need access to birth centers
  • And women need access to the care of CPMs if maternity care is to be reformed in the US!
With health care reform in jeopardy, the hard-won provisions that benefit childbearing women in the bills are in jeopardy, including:
  • Senator Cantwell’s provision that would effectively require the payment of the provider fee for CPM births in birth centers
  • The mandate for Medicaid to reimburse the facility fee for birth centers
  • Childbirth Connection’s provision requiring the implementation of maternity care performance measures – a crucial step towards evidence-based maternity care
  • Equitable reimbursement for Certified Nurse Midwives
Whatever your politics, please call your House Members and Senators today! If you are in favor of health care reform, let your legislators know today! Even if you are not in favor of the health care bill, tell your legislators to provide for the needs of childbearing women by preserving the above provisions in legislation!

Where is MAMA now?
MAMA is determined to look for every opportunity to see that the needs of childbearing women for improved quality and access to care are addressed by Congress.
MAMA representatives were on the Hill to the last possible moment advocating for CPMs in the current health care reform legislation. As our lobbyist, Billy Wynne, told us, CPMs made more progress on the Hill in these last eight months than most provider groups new to the Hill make in 3-4 years! MAMA is extremely pleased with the extraordinary support gained from key Congressional leaders – thanks to all of your calls and letters to your legislators! And MAMA is especially grateful to Senator Cantwell for her determination to find a way to “get the ball rolling” for CPMs and for her provision in the Senate bill that would have the effect of requiring reimbursement of the provider fee for CPM births in birth centers. MAMA is grateful for these accomplishments and is determined and well-positioned for the next steps as we move forward into 2010.

Now is the time to regroup, evaluate and plan for success in 2010 for Federal recognition for CPMs. And MAMA is doing just that. The Campaign Steering Committee will soon:
  • Meet in Washington, D.C. to capture all that we have learned so far and to solidify a strategy for 2010
  • Hold a webinar for supporters about the progress of the campaign to date and to engage you in next steps for CPMs and mothers

Your Dollars for MAMA Make a Difference!
We are so close to our fundraising goal to finish out this phase of the campaign for Federal recognition for CPMs. We are so grateful for your support! Midwives and mothers, parents and grandparents, state midwifery associations and state consumer advocacy groups, have made possible this historic fundraising success! We need to raise just a few thousand dollars to reach our goal. Can you help? Any amount will make a difference. Please donate today. Thank you!

How to be Social With MAMA
In order to tell more people about our efforts, MAMA has been exploring the world of social networking! We not only have an active MAMA Campaign Group on Facebook, but we also have a MAMA Campaign Cause (sponsored by our non-profit fiscal agent, Foundation for the Advancement of Midwifery.) We want all of you to join the Facebook MAMA Campaign Cause and then let your friends know about it as well! It will only take a few minutes and we promise it will only hurt a little.

Easy Step-by-Step Instructions for joining Facebook and the MAMA Campaign Cause:
  1. Get a cup of tea, a piece of chocolate...whatever relaxes you.
  2. Turn on your computer...which is already on if you are reading this so go back to step one and then skip to step 3.
  3. Go to your Internet search engine and type in "facebook"... if you are already a member of facebook then skip to step 6.
  4. Join facebook by filling out the form clicking the button that says "sign up"
  5. Get distracted for a little while trying to set up your profile (this is the painful part).
  6. Type in and hit enter.
  7. "Bookmark" this cause so that you can find it again
  8. Click the button to “Join the Cause.”
Congratulations! Now, invite your Facebook Friends to the Cause:
  1. Now that you are a member of one of the most elite causes on the Internet (just kidding), you can invite a select group of your friends to join as well (actually, invite all of them).
  2. When you first sign up, Facebook will prompt you to invite your friends; or as a member of this cause you can scroll down on the home page and see two incredibly important green buttons. One says "donate" (self-explanatory) the other says "Tell Friends"
  3. Click on "Tell Friends" and you get an opportunity to post to your profile.
  4. You can select up to 60 of your friends (popular people will have to do this over again for a few days) and then send them a message asking them to join the cause. Here is a sample message that you can use: “The Midwives and Mothers in Action (MAMA) Campaign now has a Cause page (sponsored by the Foundation for the Advancement of Midwifery) at I’ve joined the Cause because… (insert your own personal reason). So please spread the word and tell your friends. Help support federal recognition of Certified Professional Midwives.”
  5. Now don’t forget to click on the “Donate” button on the Cause. The MAMA Campaign is within a few thousand dollars of our campaign fundraising goal. Here is your opportunity to help MAMA over the top! Any amount, $10, $20, $50 will make a big difference to the Campaign. Go ahead and give a little…
  6. You're done. Now get off the computer and do something in the real world for awhile. Thanks for your time and attention.
MAMA Is Blogging Health Care Reform, visit our blog the Grapevine.

If you have any questions, concerns or comments please contact the campaign at

Cesarean Article

Cesarean section linked to increased risk for maternal death, serious complications
By Ingrid Grasmo
25 January 2010
Lancet 2010; Advance online publication

MedWire News: The risk for maternal death and serious complications is high for women undergoing cesarean section and should therefore be done only when medically indicated, show findings from the third phase of World Health Organization (WHO) global survey on maternal and perinatal health.

For the survey, Metin Gulmezoglu (WHO, Switzerland) and co-authors analyzed 107,950 deliveries reported in 122 facilities from nine Asian countries.

The overall rate of cesarean section was 27.3 percent, while that of operative vaginal delivery was 3.2 percent. Facilities in China, Sri Lanka, Vietnam, and Thailand had higher rates of cesarean section than did those in Cambodia, India, Japan, Nepal, and the Philippines.

Women undergoing operative vaginal delivery had a 2.1-fold increased risk for maternal mortality and morbidity index (at least one of: maternal mortality, admission to intensive care unit [ICU], blood transfusion, hysterectomy, or internal iliac artery ligation) compared with women delivering spontaneously.

An increased risk was also seen for all types of cesarean section, with respective odds ratios (ORs) of 2.7, 10.6, 14.2, and 14.5 for antepartum delivery without indication, antepartum delivery with indication, intrapartum without indication, and intrapartum with indication, respectively.

However, cesarean section was associated with improved perinatal outcomes for breech presentation (OR = 0.2 antepartum and 0.3 intrapartum), but also with an increased risk for stay in neonatal ICU (2.0, and 2.1, respectively).

The researchers conclude: “Cesarean section should be done only when there is a medical indication to improve the outcome for the mother or the baby.”

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

Journal abstract

Friday, January 29, 2010

Book Review: Lady Hands, Lion's Heart

I cannot believe that I have never posted my review of this book--it was published in CfM News, but I never re-posted here. For shame, since it is one of my all-time favorite midwifery memoirs!

The author has a new book too called The Beauty Girls. I'll bet it is a treat as well!

Lady's Hands, Lion's Heart ~ A Midwife's Saga
by Carol Leonard, 2008
ISBN: 978-0-615-19550-6
Bad Beaver Publishing, $15.00, 363 pages, soft cover

Reviewed by Molly Remer, MSW, ICCE,

This new book by experienced New Hampshire midwife, Carol Leonard, is a wonderful read. It is funny, compelling, exciting, and sad. I think it is the best midwife’s memoir I’ve ever read.

Spanning 13 years (1975-1987), the book represents not just her personal experiences and birth stories, but also chronicles the development of independent midwifery in New Hampshire and the birth of MANA and its emergence as an international presence.

Leonard is an engaging writer with a flair for the dramatic. The style of the book is present tense, so you get a sense of actually “being there” and the book reads with the pace of a novel.

The many birth stories in the book are riveting. She has her share of close calls and complications, as well as tons of strong, inspirational births. Her love of the work and of the women she serves shines throughout and I got a strong sense of the author as a deeply passionate and committed woman.

The book opens with her own birth story in a hospital in 1975, her only child, and chronicles her development into a midwife (a fascinating sub-story in the book is of the changes her local hospital goes through to make their maternity unit more mother-friendly). Be prepared for a sad ending.

The birth stories shared each represent an event or lesson learned. Leonard is a busy midwife (you get a sense in the book that she doesn’t have much time to take care of herself!) and she attends many births in her years of service. The births detailed here are carefully chosen for impact and purpose. (Side note: as an LLL Leader, I was saddened that her one experience with LLL [in the book] is a bad one).

More than a collection of birth stories or midwifery musings, Lady’s Hands, Lion’s Heart, is a personal journey, as well as a spirited account of a larger journey occurring in the midwifery profession.

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

Laboring Under an Illusion update

In October, I posted my review of the film Laboring Under an Illusion by filmmaker and anthropologist Vicki Elson. I really enjoyed this film and my birth class students love it too--it is one of the most frequently checked out videos from my lending library and they all say the same things after watching it, "it was funny" and "it really brought home some good points." Humor should not be underestimated as an important teaching tool. It can really help important messages sink in and "stick" in a way that other mediums may not. I'm a fan!

Anyway, I wanted to post that I'd received an update from the filmmaker and to increase access she's lowered the price. So now, $39.95 is for ANY use (except broadcast): personal, public screening, classroom, etc. And, an order of 5 or more DVD's is $19.95 each.

Check it out here!

CfM Blogger

Thursday, January 28, 2010

Grassroots Network: Childbirth Connection “2020 Vision” reports released!

Dear Friends,

This is just in from Childbirth Connection! I have not had time to read the reports yet, but I expect they will prove to be extremely valuable resources and powerful support for maternity care reforms that include evidence-based care and midwives!!

Susan Hodges, “gatekeeper”


RELEASE: Landmark Maternity Care Reports Issued; Consumers, Providers Hammer Out Recommendations

Please read below about two new reports developed over the past two years through a multi-stakeholder collaborative process: “2020 Vision for a High-Quality, High-Value Maternity Care System” and “Blueprint for Action.” These reports incorporate the thinking of over 100 maternity care leaders representing every industry stakeholder – from hospitals and health plans to consumers and providers. The recommendations in these reports are expected to have major impact on health care reform and on the future of birth in the US. They include specific proposals to overhaul the payment system, improve the liability system, and steps to reduce harm, improve quality and women’s experiences of care.

January 28, 2010
Contact: Kat Song -

Childbirth Connection Releases Landmark Reports For Revamping U.S. Maternity Care System
That Point To Rapid Gains in Quality and Value

Consumers, Providers and Other Groups Hammer Out System-Wide Recommendations and Action Steps

Washington DC - Childbirth Connection today released two landmark reports that create a framework for revamping maternity care in the US and advancing health care reform: “2020 Vision for a High Quality, High Value Maternity Care System” and “Blueprint for Action.” The reports were developed through an extensive multi-year collaboration with more than 100 maternity care leaders representing industry stakeholders – from hospitals and health plans to consumers and providers. These reports and related papers have just been published in a special supplement of Women’s Health Issues.

"Recognizing that rapid gains in the quality, value and outcomes of maternity care are well within reach, Childbirth Connection launched its Transforming Maternity Care project several years ago,” said Maureen Corry, executive director, Childbirth Connection. Although a wealth of high-quality evidence and experiences of high-performing segments of the maternity care system were readily available to improve maternity care, these resources were not impacting most women and newborns. “It was time to act and we called upon key leaders across the health care system to develop a long-term vision for the future of maternity care in the United States. This vision served as a starting point for a collaborative process to develop action steps for broad-based maternity care system improvement,” said Corry.

Maternity care is the runaway leader in hospital charges and is the number one reason for hospitalization in the country. Maternal and newborn hospital charges alone exceeded $86 billion in 2007, with employers and private insurers paying for 50% of all births and Medicaid paying for 42%. While most childbearing women and their babies are healthy and at low risk, the current style of maternity care is technology-intensive. Costly childbirth procedures that entail risk are overused and wasteful, while proven ones that are generally safer and less expensive are underutilized. Marked disparities in access, quality and outcomes persist, with many maternal and newborn health indicators moving in the wrong direction. The return on investment for our significant expenditure in this important sector is poor.

"The good news is that every challenge is an opportunity for improvement that can benefit millions of mothers and babies annually. The ‘2020 Vision’ developed by a multi-disciplinary, multi-stakeholder team, puts forth the values, principles and attributes of an optimal maternity care system and describes fundamental goals for a system meeting those criteria,” said Rima Jolivet, Transforming Maternity Care Project Director, Childbirth Connection. “With the ‘2020 Vision’ in hand, five stakeholder workgroups collaborated to develop reports with recommendations and action steps for moving toward the vision,” said Jolivet.

Stakeholder workgroup chairs presented their reports and recommendations at an invitational policy symposium commemorating Childbirth Connection’s 90th anniversary. Transforming Maternity Care: A High Value Proposition was held at Georgetown University, Washington DC, in April 2009. Invited discussants, moderators and the audience provided comments to strengthen the reports and recommendations. The Transforming Maternity Care Steering Committee then synthesized the workgroup reports and additional feedback into the direction-setting report, “Blueprint for Action: Steps Toward a High-Quality, High-Value Maternity Care System.” The Blueprint answers the question “Who needs to do what, to, with and for whom to improve the quality of maternity care over the next five years?” Actionable strategies to improve maternity care quality and value are centered on eleven critical focus areas for change:

- Performance measurement and leveraging of results
- Payment reform to align incentives with quality
- Disparities in access and outcomes of maternity care
- Improved functioning of the liability system
- Scope of covered maternity care services
- Coordination of care across time, settings and disciplines
- Clinical controversies
- Decision-making and consumer choice
- Scope, content and availability of health professions education
- Workforce composition and distribution
- Development and use of health information technology

"A great achievement of the project is the remarkable level of consensus that was reached by the workgroups through an in-depth, collaborative process to arrive at negotiated agreements and sound proposals for tackling complex issues,” said Ned Calonge, Chief Medical Officer, Colorado Department of Public Health and Environment who served as Chair of the workgroup for Maternity Care Clinicians and Health Professions Educators.

The Blueprint for Action is the first step in a long-term initiative to undertake collaborative national, regional, and local endeavors to improve maternity care quality and value. At the briefing, Corry announced the establishment of a public-private Transforming Maternity Care Partnership to carry out the next phase of the project and implement Blueprint steps to accelerate health system change.

"We welcome all maternity care stakeholders to identify relevant Blueprint steps and join this effort to attain rapid achievable gains in maternity care quality and value on behalf of childbearing women and newborns,” said Donna Lynne, President of Kaiser Permanente Health Plan of Colorado and Transforming Maternity Care Steering Committee member.

The "2020 Vision" and "Blueprint for Action" reports are freely available on the Women's Health Issues website at:

To learn more about the Transforming Maternity Care project, please visit:

For a fact sheet on maternity care in the United States, go to:

About Childbirth Connection
Founded in 1918, Childbirth Connection ( is a not-for-profit organization working to improve the quality of maternity care through research, education, advocacy and policy. As a voice for the needs and interests of over 4.3 million women who give birth annually, Childbirth Connection uses best research evidence and the results of its periodic national Listening to Mothers surveys to inform policy, practice, education and research.

# # #

Kat Song
Director of Public Affairs
www. ChildbirthConnection .org

Sign up for eNews (occasional news and alerts) at

Join the Maternity Quality Matters Campaign for women and babies!

Tuesday, January 26, 2010

Grassroots Network: Australian home birth study

Dear Friends,

A new home birth study based on data from South Australia has just been published. Of course, an editorial on the topic in the same issue of the journal, penned by the President of the Australian Medical Association ("which is opposed to home birth in Australia") helped to "spin" the findings to show that home birth is much more dangerous than hospital birth, even though the actual data show no such thing.

You can read the whole article here: "Planned home and hospital births in South Australia, 1991-2006: differences in outcomes" (Robyn Kennare, Marc Keirse, Graeme Tucker and Annabelle Chan, MJA 192(2), 18 January 2009).

You can also find some great analysis of what the study actually tells us. If you are interested in reading research critically and understanding how data and results can be twisted (on purpose or by not thinking about what they mean), these analyses are worth your time:

"That Homebirth Study in South Australia"
by Lauredhel on January 16, 2010

More critique of the homebirth study and its reporting by the media"
January 20, 2010 – 7:58 pm, by Croakey

You can be sure that US medical organizations, especially ACOG, are well aware of this study, and the chances are we’ll see and hear references to it in the weeks and months ahead; we can be prepared!

Susan Hodges, “gatekeeper”

Friday, January 22, 2010

Cochrane Review about Eating During Labor

Most you are probably already aware of the recent Cochrane review about eating during labor--concluding that there is no justification to support fasting during labor. Of course, midwives have known this for a long time...

As the background statement notes, restricting fluids and foods during labor is common practice in many hospitals with some women only being allowed sips of water or ice chips. This restriction is unpleasant for lots of women and may have a variety of negative impacts on their births. I don't know if people in different geographic areas are starting to see changes in their local hospitals' fasting-during-labor guidelines, but I have yet to notice any loosening of restrictions in my own community.

The conclusion of the review is as follows:

"Since the evidence shows no benefits or harms, there is no justification for the restriction of fluids and food in labour for women at low risk of complications. No studies looked specifically at women at increased risk of complications, hence there is no evidence to support restrictions in this group of women. Conflicting evidence on carbohydrate solutions means further studies are needed and it is critical in any future studies to assess women's views.

The full Cochrane review is here. And there is a podcast available about it here.

There is a Reuters Health article about it here.

I noticed that less well-circulated amongst the birth community is the Cochrane review that was released the same day about Doppler use during high-risk pregnancies reducing risk in high-risk groups. I'd like to be mindful of the tendency to NOT share information that perhaps does not support our own views--isn't this what the medical community frequently does with evidence about the healthy birth practices we support so strongly?

CfM Blogger
P.S. I saw lots of general news articles about this doppler review and received an update directly from the Cochrane Library explaining it, but then did not find the actual review on the Cochrane site...Here is a link to an article from Science Daily about it.

Free Webinar About Uterine Fibroids

I just received an email today about a free webinar about uterine fibroids during pregnancy.

It is on Saturday, January 23rd, at 10 am Pacific in case anyone is interested in checking it out. You can register here.

I did not poke around the website enough to figure out if the webinar has commercial ties, I suspect it might, but I still thought I'd share the info in case anyone is interested in looking into it further!

CfM Blogger

Wednesday, January 20, 2010

Grassroots Network: NIH VBAC Consensus Conference Information

Dear Friends,

The National Institutes of Health are holding a “consensus development conference” on the issue of VBAC in early March. You can attend in person but there is also the option of registering for the Webcast, where registrants will also be able to submit questions on-line.

The announcement below includes brief background, but you can find more extensive background, plus a listing of the entire program, at: There is also detailed information about the venue, transportation, etc.

On the web page above, there is a menu choice of “get involved”. The very last item is “contact us with questions or comments”. Given our experience with the consensus conference on “maternal choice cesarean section” a few years ago, the NIH definitely needs to hear from many people, from both inside and outside the hospital walls, for there to be any chance of a fair or meaningful “consensus” to be reached.

It is worth reading through the program topics and who is speaking on them. Almost all of the speakers are OBs. It is interesting that no mention is made of the use of drugs to stimulate or augment labor as an issue in the safety of VBAC –hopefully that will be addressed… There appears to be virtually no consideration about the manner in which VBAC is undertaken (support? Use of drugs? Attitude of provider? Type of provider? Etc.) which seems like a pretty important topic related to frequency, success and risks. There is a section for “mothers’ stories” – by a USA Today medical reporter, the next to last speaker on the program. Does anyone know her? And, of course, there is no listed topic addressing the high and increasing rate of cesarean section, an underlying factor.

We know consumers and others made a difference by attending, commenting and speaking up at the “maternal choice cesarean” NIH conference. So, let’s make use of this opportunity to make our voices heard in whatever way we can regarding VBAC.


Susan Hodges, “gatekeeper”


Join the National Institutes of Health's Consensus Development Conference on Vaginal Birth After Cesarean: New Insights

March 8-10, 2010
Natcher Conference Center | NIH Campus | Bethesda, Maryland

For most of the 20th century, clinicians believed that once a woman had undergone a cesarean, all of her future pregnancies required delivery by that procedure as well. In the 1980s, vaginal birth after cesarean (VBAC) also began to be considered a viable option for these women. Since 1996, however, VBAC rates in the United States have consistently declined, while cesarean delivery rates have been steadily rising.

What accounts for these changing practice patterns? Frequently cited concerns about VBAC include the possibility of uterine rupture during labor, infection, and other complications. However, repeat cesarean delivery carries risks for both mother and baby, and may impact future pregnancies.

Be part of pivotal discussions that will help answer critical questions related to vaginal birth after cesarean. The conference is free and open to the public. Your input is valuable. Please join us!

Information and Registration: | 1-888-644-2667

Can't attend?
Webcast registration: -- there will be the ability to ask questions online.
Pre-order statement:

Continuing Education for this activity is pending. Please see the final announcement for details.

Friday, January 15, 2010

Birth Space, Safe Place Book Giveaway!

I usually post my book reviews on this blog, but this week I am doing something different because I have a book giveaway to do in addition to my review!

I recently finished reading the book Birth Space, Safe Place: Emotional Well-Being through Pregnancy and Birth by Adela Stockton. The book is a slim little volume that covers a lot of ground in its page. I enjoyed the specific focus on emotional well-being, as I have never read a birth book specifically devoted to the subject before. It was also the source of some good opening quotes for the CfM Facebook page. The review and giveaway are posted on my Talk Birth blog.

"We must attempt to tell the whole truth about birth, the truth that includes transformation, mastery, satisfaction, personal power, and the difference between pain and suffering."
--Cheri Van Hoover

CfM Blogger

Thursday, January 14, 2010

Grassroots Network: MAMA Campaign goes into the “Home Stretch”

Dear Friends,

Here’s hoping you all had a terrific holiday season!

As you know from the news, the health care reform legislation is not yet finished. Here is the latest from the MAMA Campaign, which is still actively working for Certified Professional Midwives, because it isn’t over till it’s over!

For more about the MAMA Campaign, visit

Susan Hodges “gatekeeper”


From the MAMA Campaign:

Happy New Year From the MAMA Campaign!

We at the MAMA Campaign wish you a Happy New Year and hope you had an excellent holiday season! We enjoyed our time off with our families, and are now back to work for Certified Professional Midwives (CPMs) on Capitol Hill! We want to give you an update about our goals and plans for the next month, which is the critical “home stretch” as the House and Senate make preparations for their final vote on the health care reform bill.

MAMA is Back on the Hill for Midwives and Mothers
Your Senators and Congress Members returned to Washington this week and are back in action to produce a health care bill for President Obama to sign early in the New Year. And MAMA is right there too!

During these next few weeks, the House and the Senate will be working together in an informal “conference process” to reconcile the differences in the health care bills passed by each chamber late last year. Our MAMA lobbyist, Billy Wynne, informed us that high level negotiations began last Thursday among the staff of the Senate and House leadership and key committees to hammer out a bill that both chambers can pass. These staff members have cleared their calendars into the future for this work and held a 15 hour work session on Saturday. While the negotiations are already proving contentious, it is expected that a deal will in fact be reached and that a final bill will be sent to the President sometime in February.

The conference process offers a fresh opportunity for the Campaign to leverage the strong support that MAMA enjoys among members of the Senate Finance and the House Energy and Commerce Committees to raise the profile of Certified Professional Midwives in the final health care bill. MAMA leadership, along with MAMA constituents from key states and Health Policy Source, our intrepid lobbyists, are at work over these next weeks of the conference process to include language in the final bill that will specifically reference Certified Professional Midwives.

And we continue to be grateful to Senator Cantwell and Finance Committee leadership for Senator Cantwell’s provision that will have the effect of requiring payment of the provider fee for CPMs offering services in licensed birth centers – and for securing Senator Reid’s commitment to keep this provision in the bill throughout the conference process.
And remember: it is your support that has produced such important gains in Congress over these last months for Midwives and Mothers! So keep your letters and dollars flowing as MAMA moves into the New Year with fresh energy for Midwives and Mothers!

MAMA Is Ready To Start the Year Strong!
Individual contributions from people like you give MAMA life. Thanks to every one of our 500 donors, MAMA is alive and well! With just a few more weeks to go, we need just a few more dollars. Can you help us now by making a contribution of $50, $100, $500 or more? Every dollar will be well-spent as we wrap-up this phase of our campaign to achieve federal recognition of Certified Professional Midwives!
Any amount will make a difference!

Donate to MAMA at .

Keep Those Letters Coming!

As your legislators make crucial decisions about what will be included in health care reform, it is important that they hear from you and that they know that MAMA is watching! Write to your members of Congress today to ask them to include Certified Professional Midwives in any health care reform legislation! If you have not written yet, now is the time! If you have written previously, write again! Your Senators and Representatives need to hear from YOU on behalf of Certified Professional Midwives and Mothers, regardless of their position on health care reform. Visit for help and sample letters you can use to contact your legislators.

MAMA Is Blogging Health Care Reform
Also back online after the holiday break is the Grapevine - MAMA’s source for keeping you up-to-date on health care reform. Come see our take on the latest happenings on Capitol Hill! Visit the Grapevine at .

If you have any questions, concerns or comments please contact the campaign at

Monday, January 11, 2010

Multimedia Review: Baby’s First Gift

Multimedia Review: Baby’s First Gift
Casscom Media, 2009
2 CD & DVD Set

Reviewed by Molly Remer, MSW, ICCE

For parents who are drawn to the idea of “prenatal education,” the set Baby’s First Gift is a good resource. Containing two CDs and one DVD packaged together, the program is designed to help parents in “forming a positive, loving, teaching relationship with your child before birth.” The information provided is developed specifically for the purposes for prenatal stimulation and communication. There is a Christian overtone to the packaging, but it is very slight and unlikely to make other faith traditions feel uncomfortable.

The first CD in the Baby’s First Gift program consists of instrumental music that would be good for use in birth classes, for relaxation, and for baby-parent bonding. The second CD explains the concept of prenatal education and includes explanations of several different games/exercises to do with baby prenatally—kick game, xylophone game (with three musical notes), and simple words. It also suggests creating your own special song or melody to share with your baby in-utero (great idea for dads). This CD also includes a section about preparing for birth and has a guided relaxation exercise. The DVD presentation is of a pregnant couple demonstrating the prenatal education exercises explained on the CD. Like the first CD, the second half of the DVD is "Prenatal Music for Life," this time set to accompanying waterfall images.

Be aware that both the CD and DVD refer frequently to the book The Prenatal Classroom which is not included as part of the program. The informational CD and DVD are narrated by men with pleasant, soothing, calm voices. The pregnant couple demonstrating exercises on the DVD are also pleasant and contemporary.

My initial reaction to a program like this was a bit of skepticism and that feeling remains after reviewing the program. As I watched the DVD, the games felt stilted and somewhat artificial—my own prenatal experiences are that bonding with, connecting to, and communicating with the baby are spontaneous, intuitive, and arise frequently without need for planned out exercises or games. However, I feel like the program may be an especially good tool to introduce to families at high-risk of child abuse. For the average couple, I think this kind of prenatal connection tends to occurs naturally without training or lessons.

From a mother’s perspective, as the one who carries the baby and is in constant contact and awareness of the baby, the idea of formal “prenatal communication” seems redundant. For fathers-to-be who are perhaps feeling distant or disconnected from the baby and the experience of pregnancy or for high-risk families, Baby’s First Gift could be a helpful tool.

Disclosure: I received a complimentary copy of the program for review purposes.

Friday, January 8, 2010

Favorite Midwifery & Birth Books of 2009

On New Year's Eve on the new CfM fan page on Facebook, I posed the question, "what was your favorite birth or midwifery book in 2009?" I got a variety of responses and I'd like to share them all in one post.

Selene recommended Cara Mulhahan's book Labor of Love (see book review posted yesterday).

Amanda suggested The Birthkeepers: Reclaiming an Ancient Tradition and added that she wants to read Simply Give Birth. I hadn't heard of The Birthkeepers before, so I look forward to learning more about it and possibly sharing a review!

Another fan suggested the very useful When Survivors Give Birth saying that it, "was very insightful and I know will prove to be invaluable in the years to come...This year I plan to conquer...Varney's Midwifery."

I thought I had heard of just about every birth book ever written, but Hillary mentioned her favorite, Sacred Birthing by Sunni Karll, and that was another book with which I am unfamiliar, but would like to read.

Summer mentioned that her, "favorite was definitely The Power of Women by Sister MorningStar. I found it inspiring, insightful, and very fitting for the title," while Cristina found Marcie Macari's She Births , "gave me a lot to think about and I loved it."

Adventures in Natural Childbirth by Janet Schwegel was referenced by Jennifer as an all time favorite: "Tales from women on the joys, fears, pleasures, and pains of giving birth naturally with the support of midwives, doulas and 'enlightened' physicians." (Another book of empowering birth stories that I really enjoy is Journey Into Motherhood.) She also shared that she is considering reading "Don't Just Stand There for dads by Elissa Stein in the new year."

Pushed by Jennifer Block received a couple of hearty recommendations, with another Jennifer adding that, "Ina May's Guide to Childbirth was really great, too."

I re-read Pushed this year also and agree that it is a gem.

Another activism-stirring book, Birth as an American Rite of Passage, by Robbie Davis-Floyd, was enthusiastically recommended by Jenny saying, "Pretty heavy, but probably the single strongest influence on both my personal outlook and my childbirth classees."

Jeanne Ohm suggested Pathways magazine Issue #24--all about birth. I'd like to order a box of this issue to hand out to my birth class clients!

Beth shared that she, "loved Birth Models That Work. It's a MUST read...And Half the Sky. It's not all about midwifery but it's about women's issues across cultures and it highlights a lot of birth needs for women in developing countries."

My book club plans to read Half the Sky at some point this year. I don't think I can talk them into Birth Models that Work, but I could try! ;)

Lara shared that she "liked Ina May's Spiritual Midwifery, and the new waterbirth book by Lakshmi Bertram. I've heard that next year there might be a newly updated Obstetrical Myths Versus Research Realities by Henci Goer, and I'd really like to read that one."

Kendra loved Carol Leonard's, Lady's Hands, Lion's Heart from Bad Beaver Publishing. She "laughed and cried and loved every page." Anyone who has read my review of Leonard's book in CfM News knows that I share Kendra's sentiments! It is wonderful.

Another midwifery memoir receiving a recommendation was Baby Catcher by Peggy Vincent. Sierra also added that "Permission to Mother by Denise Punger is also an amazing read."

Another book I'm unfamiliar with was recommended by Sarah, who said, "I loved a recently translated Dutch book called Pregnant with Heart and Soul by Riet Van Rooji." She also added that "Jenny West's The Complete Idiots Guide to Natural Childbirth is brilliant too, great to get such a good midwife writing for the mainstream."

(I do have to add that I reviewed the Idiot's Guide book for LLLI and was very dismayed by the pervasive bottle imagery throughout the book--as the "midwife tip" icon no less! :( )

A doula named Laurie shared some good information about another book I'd like to look into further, saying, "A book I just started that is really informative and interesting is The Female Pelvis. I know it sounds extremely boring, however it is filled with great exercises for pregnant moms, to help protect against injury. The pictures are great, there are at least 2-4 per page and I think they will help the moms be able to visualize a lot more what they are trying to protect and why. It is written by Blandine Calais-Germain."

On a similar subject, I'm currently reading and very much enjoying Wild Feminine, which is primarily about "holistic pelvic care." It is really interesting and I recommend it.

I was delighted to receive all of these wonderful suggestions from all over the country (and even internationally). How fun!
Personally, I read so many great books in 2009 that it is hard for me to choose a favorite, but I think I'll have to go with The Power of Women as my favorite birth read for 2009 (review here). It is followed closely by Simply Give Birth (review here). I've read both of those recently though, so it is possible that I'm forgetting some other treasures that I discovered earlier in 2009!

CfM Blogger

Thursday, January 7, 2010

Book Review: Labor of Love

Labor of Love: A Midwife’s Memoir
by Cara Muhlhahn, CNM
Kaplan Publishing, 2009
Softcover, 232 pages

Reviewed by Molly Remer, MSW, ICCE,

Labor of Love is a spirited account of urban midwifery written by the CNM who was featured in the documentary The Business of Being Born, Cara Muhlhahn. This book would be particularly interesting to midwifery students and midwives who plan to practice in urban areas. Anyone who is expects midwifery memoirs to be full of empowering birth stories and life on the commune will find a different flavor in this tale.

This memoir was much more autobiographical than many other books in this genre--there were lots of details about Cara’s personal life, past, and family (details which are nearly absent in some other midwifery memoirs). There were also fewer birth stories than I had expected and the birth stories themselves were not very detailed. In general, Labor of Love was a multifaceted picture of a midwife’s life, her path to midwifery, her thoughts about her career, and her varied work experiences.

A strong thread of self-satisfaction—and almost smugness—runs throughout the book and it can be distracting, but then again, perhaps a gutsy midwife deserves some self-congratulation! The book feels more relevant to midwifery students than it is to childbirth educators, doulas, or other general birth activists. If you are looking for a picture of contemporary, modern, urban midwifery and how a woman’s life expands to incorporate it, you may enjoy Cara’s story.

This is a revised version of a review previously published in CfM News.

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

Friday, January 1, 2010

DVD Review: It’s My Body, My Baby, My Birth: A film About Natural Childbirth

DVD Review: It’s My Body, My Baby, My Birth: A Film About Natural Childbirth

Wisewoman Childbirth Traditions, 2007, or
27 minutes

Reviewed by Molly Remer, MSW, ICCE

“It was ecstasy” and “I could do that again, and again, and again…” These are two of the first things you hear as the film It’s My Body, My Baby, My Birth opens. The film features a very multicultural group of seven families sharing their experiences with natural childbirth. Most of their experiences are homebirths with midwifery care, but also included are a mother speaking about her natural hospital birth, one with a birthing center birth, and one having a home VBAC. Also interspersed through the film are interview clips with a hospital based obstetrician, a homebirth CPM, a hospital based CNM, and a childbirth educator. The mothers and fathers both talk and share their experiences and feelings.

The primary focus of this film is answering the question, “why natural childbirth?” It is not a birth movie per se. There is no actual birth footage, though there are several clips of the women in labor (naked) and of newly born babies. In this way, the film is a good introduction to the beauty and power of birth, without overwhelming a novice viewer with intense crowning sequences. The film would be a great one to have on hand for a husband who perhaps does not want to see other women giving birth, but who wants to understand why his own wife wants this. The film is very reasonably priced, making it a perfect addition to anyone's film library.

The CPM and filmmaker, Maria Iorillo, speaks candidly at one point about her own birth experience and also shown is a snippet from a prenatal visit with her voiceover explaining that most prenatal visits last an hour—“forty-five minutes of talking and fifteen minutes hands-on.” This scene is a good example of midwifery care in action, as is further commentary that the midwife remains with the family at least three hours postpartum and returns at one day, three days, five days, ten days, and six weeks (how many women can say they get this kind of care from an obstetrician?!). One of the mothers shares that she wanted a midwife because, “I wanted that relationship.”

I have a long-standing interest in language and the power of words. The language in this film is breathtaking. The CNM talks about women being discouraged from having natural births and says, “[the woman’s feeling of] I am that powerful, that brilliant, that strong—they are robbed of the experience of knowing that.” One of the mothers speaks of her “incredible elation and sense of this enormous power. Enormous power.” When speaking of the support around her during her VBAC, another mother says, “There was a lot of honor in it.” Another couples shares how “completely blissed out” they were—“it was the most profound rite of passage we’ve ever experienced…we did it together…it was powerful.” The OB says that “labor is a primal experience; it is what our bodies were crafted to do. Natural childbirth allows that to happen” (she also notes in the film that more space needs to be made in hospitals for the “experience.”)

I believe this film has great potential to help people understand why a woman would want to experience natural birth, what is at stake, and why birth matters. It matters profoundly.