Documentary: The Mama Sherpas

A CfM Facebook fan recently posted to share some information about an interesting sounding new documentary about Nurse-Midwives:

The Mama Sherpas follows nurse midwives, the doctors they work with, and their patients, in the DC area over the course of two years. The documentary will provide a personal glimpse into what midwives can bring into the birthing process in the hospital system.

Maher focuses on four “collaborative care” practices where doctors and midwives manage women’s care together. Although there is few collaborative care efforts in the United States, research proves that this method provides better outcomes for mother and baby as well as lowers the C-section rate, which has skyrocketed in recent years.

The documentary’s subject is one that explores two of the most heated debates - Women’s Issues and Health Care. This will be an important contribution to women’s films as a genre because knowledge about medical options has often been withheld from women. Additionally, this film will serve as an educational tool to inform women about their own health and bodies.

For information on partnership or sponsoring visit www.themamasherpas.com. Also, visit http://www.facebook.com/TheMamaSherpas for photos, videos, and updates.

Here are a few ways you can help with our outreach:
1. Add a logo of our film to your website
2. Blog about our film
3. Suggest participants
4. Tweet, Link to our website, and share our Fb page
5. Watch and share the scenes (clips are on the FB page)
6. Suggest possible stories to follow! For instance, “I’d like to see how dad’s prepare for labor.” We’ll add it to our story queue!
7. Host a fundraiser in your community
8. Host an Discussion Group about the film and film scenes centered on a topic area
9. Connect us with a community organization in your area
10. And...

• Check us out on Facebook and Pinterest
• View our channels on Vimeo and YouTube
• Follow us on Tumblr and Twitter
• Join our Email list for updates

AJOG editorial rejects the ethic that autonomy is a fundamental human right

Read it for yourself:  Planned Homebirth: the professional responsibility response

This article represents a serious attack on home birth and on patient centered care in the United States.  The attack is based on poor research and runs roughshod over established rights to bodily integrity.

This article was “Presented at European Congress of Perinatal Medicine, Paris, France, June 13, 2012.”  So not only does the article attack home birth, it also represents an attempt to “export” to the rest of the world a position that the obstetric profession, not mothers, should have the final decision on birth, at a time when that isn’t even legally defensible here in the United States.

The primary author, a Fellow of ACOG, faculty member at Cornell University Department of Obstetrics and Gynecology, should be aware of American jurisprudence supporting patient autonomy and right to informed consent.  We can also assume that he is aware that systems of midwife attended homebirth are well established and integrated into the health delivery systems of many European countries.  And yet, it is the decision of the 2010 European Court of Human Rights case that seems to have prompted this “critical evaluation”.  This was a case where obstetrician, Agnes Gereb, was imprisoned for attending home births in Hungary.  Her story is told in the movie “Freedom for Birth”, produced by One World Birth.

The authors’ conclusion is the height of hubris: “We urge obstetricians, other concerned physicians, midwives and other obstetric providers, and their professional associations to eschew rights-based reductionism in the ethics of planned home birth and replace rights-based reductionism with an ethics based on professional responsibility.”  In other words, reject the ethic that autonomy is a fundamental human right.

Who decides what is reasonable?

Fiduciary responsibility is, by definition, putting the needs of the patient first.  If fiduciary responsibility was the same as professional responsibility, this would not be an either/or proposition.  The author defines professional responsibility as a model of decision making where “the patient has the right to select from medically reasonable alternatives”.  Who gets to decide what is reasonable?  Why, the obstetrician, of course.  And if the patient opts for an alternative the obstetrician has not deemed reasonable, then the obstetrician is justified in placing the “rights of the fetus” ahead of the rights of the first patient (the mother), although what is actually being asserted is the obstetrician’s own agenda over the rights of his/her patient.

Buried in this article, and lost in the conclusion, is one very true statement: “The first professional responsibility of obstetricians is to ensure that hospital delivery is safe, respectful, and compassionate.” The author goes on to describe what that needs to look like, and in an easily overlooked fashion concedes that hospitals aren’t always safe places either.  In fact, both infant and maternal mortality are on the rise in the United States, at a time when hospitals have a near monopoly on birth.  This failing falls squarely at the feet of ACOG and the collective actions of its Fellows, which calls to mind this quote:

“ACOG no longer has the moral authority to set standards in maternity care…. It has made too many self-aggrandizing and self-protective recommendations (e.g. against home birth, videotaping birth, and VBAC) that limit the freedom of American women and families.” (M. Wagner, Born In The USA, 2006, University of California Press, p. 32)

Overlooking this reality completely, the author also overlooks the most reliable research on the safety of home birth, while noting that ACOG “accepts the findings of Wax et al”, a thoroughly discredited piece of published research that does not stand as prima fascia evidence against the safety of home birth.  Even Amy Tuteur (no friend to home birth) says this AJOG article is “poorly researched, relies on bad studies and is woefully paternalistic”.

One contradiction stands out as the authors call for “safe, respectful, and compassionate” hospital delivery.  No hospital birth can be truly respectful if the birth is happening in the hospital because the physician disrespects the woman’s right to an alternative and has rigged the system to eliminate access to all legal alternatives.

Illinois Friends of Midwives also responds to this article, calling it “paternalistic and misogynistic."
Wendy Gordon, LM, CPM, MPH, Midwives Alliance Division of Research, published an in-depth response on Science and Sensibility.

Another resource in any discussion on the safety of birth, and home birth in particular, can be found on Citizens for Midwifery website.

Yours in safe and respectful maternity care,
Willa Powell & the CfM Team

-----

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Book Review: Pushing for Midwives

Book Review: Pushing for Midwives: Homebirth Mothers and the Reproductive Rights Movement
by Christa Craven
Paperback: 232 pages
Publisher: Temple University Press; 1 edition (October 28, 2010)
ISBN-13: 978-1439902202

Reviewed by Molly Remer, Talk Birth

Mainstream feminist groups have been slow to recognize the right to reproduce along with the right to be free from reproducing. A focus of the second-wave women’s movement was shaking off motherhood as what solely defined womanhood. So perhaps there has been a reluctance to watch over the process that makes women mothers. –Jennifer Block quoted in Pushing for Midwives

Framed as a health policy concern, Pushing for Midwives assesses the homebirth movement and midwifery activism in the context of the reproductive rights movement. The focus of the book is on legislation in Virginia, but is still of relevance and interest to activists from other states. Craven also tackles complicated topics that are often ignored in homebirth and midwifery texts, addressing issues of race, privilege, and socioeconomic status and the impact on access to care. She also takes a solid look at issues of political and religious diversity within the homebirth activist community.

Written in a densely academic style evocative of a dissertation, Pushing for Midwives, became tedious and dry in places and took a long time to finish reading. The very narrow focus on Virginia, while still applicable to other states, became tiresome by the final chapters.

I particularly enjoyed Craven’s exploration of the history of consumer activism in midwifery as well as the consideration of homebirth in the larger context of women’s health activism. I appreciated her exploration of the feminist movement and how it has historically neglected issues of birth advocacy and reform, while also looking the current relationship between feminism and midwifery activism, particularly how birth advocates choose to self-identify. Women’s health activists and midwifery advocates will likely find a lot of food for thought in the pages of Pushing for Midwives.

–
Disclosures: I received a complimentary copy of this book for review purposes.
Amazon affiliate links included in book title and image.

I am a Midwife Campaign

MANA has a great educational campaign going on right now called I am a Midwife. The campaign involves a series of short videos released once a week about a variety of topics. More than just a general education campaign, each video includes a variety of different women--midwives, mothers, public health activists, maternity care activists, authors---speaking out on important topics in maternity care. Each woman also identifies, "I am a Midwife." This week's video is about health disparities in maternity care, which is a very important and too-often ignored topic. It raises the concern that African American women and their babies are more likely to die than their Caucasian counterparts even when other variables are equalized (i.e. same socioeconomic status, same education, etc.) and moves into wider discussions about racism and the treatment of minority group members. It then focuses on the value and role of midwifery care in addressing these concerns.


As MANA states in relationship to this campaign: "For midwives, sharing is daring. We dare to challenge the status quo. We dare to speak up for women's innate wisdom in pregnancy and birth. We dare to assert that there is a better way for our babies to be born. And we dare to insist that birth belongs to families."

Absolutely! The I am a Midwife public education campaign is extremely powerful. I have to confess that when it originally launched, I didn't personally make time to watch the videos right away, somehow assuming that they were "generic" videos with a "rah, midwives!" type of message. Don't make the same mistake I did. These are quality videos with important messages, powerful voices, and essential education and information. You will definitely learn something from watching them!

--
Molly
CfM Blogger

Answer Ina May's Call: This Mother's Day, Support A Woman's Birth Choices

“{I am calling] for greater involvement of women in the formulation of maternity care policy and in the education of young women and men about birth. Women who are fully informed about the capacities of women’s bodies should lead the way, and all women 
who care about social justice and human rights should be involved.”
– Ina May Gaskin, Birth Matters: A Midwife’s Manifesta




Happy Mother's Day!

Here at Citizens for Midwifery, we have been heeding Ina May’s call for more than 16 years, providing women with evidence-based information about pregnancy and birth, and supporting state and national efforts to secure access to midwifery care for all women.

And we need your help! We can’t do it alone!

US Birth statistics and maternity care present many challenges:

One in three US babies are born by cesarean section, a rate more than twice that recommended by the WHO, a rate that results in harm to mothers and babies.

Racial disparities in birth outcomes remain a tremendous problem. For example, African American infants are 2.4 more times likely to die in their first year than white infants, and African American women are more likely to have cesarean sections, and nearly twice as likely to experience preterm labor or give birth to a low birthweight baby. Midwives providing individualized care have been successful in reducing these disparities.

In countries with lower c-section rates and better maternal and infant outcomes than ours, midwives provide primary care for all healthy pregnancies and births.

Access to midwives and the Midwives Model of Care in the US is limited. CPMs are licensed or legally recognized in just 27 states, and CNMs are restricted in the care they may give by practice agreements and supervision requirements in 23 states.

In the US in 2009, only 8.1 % of births in all settings were attended by midwives.

Citizens for Midwifery is working to meet those challenges, with information and action.

• Through our website and educational materials, we provide women and birth advocates with high quality, consumer-focused information.  Our website reaches many women every day (over 66,000 every year!), who download materials or find midwives and advocates in their area.

• Citizens for Midwifery represents consumers as essential stakeholders and elevates the importance of the consumer voice in key national forums on the future of midwifery care.  As part of the MAMA Campaign, CfM continues to work actively to achieve federal recognition for CPMs, so that more and more women of all income levels will eventually have access to the Midwives Model of Care.

• CfM has been at the forefront, using the internet and social networking to reach more women and families than ever before with solid information that is helpful when making maternity care choices and for advocating for the Midwives Model of Care. We have one of the most active Facebook pages reaching consumers, with over 5,000 people on our page and lively exchanges occurring on a regular basis.

Now we need YOUR financial support so we can do more and even better! Times and technology are changing, and we need your help to update our infrastructure so we can reach more women even more effectively.

Your donation today will help us to:

• Update our online infrastructure to more effectively communicate with women and activists.
• Launch targeted educational campaigns and materials to meet the diverse needs of women and birth advocates.
• Maintain a consistent consumer presence representing women at critical moments and decision points in the evolution of US midwifery.

With your support we can reach more expectant women and advocates and do more to advance the Midwives Model of Care than ever before!

Please make a donation today!
        
Visit the CfM Fundraising page at www.cfmidwifery.org/Donate. And please share this letter with your friends and family on Facebook, Twitter and email listserves.  Mothers and babies, now and in the future, will love you for it!

Thank you!


Nasima Pfaffl

President

P.S. Your donation, of ANY amount at www.cfmidwifery.org/Donate, will help us answer Ina May Gaskin’s call to equip women with the information and tools to improve maternity care in their communities.

Legislative Alert from AABC

Passing along a legislative alert from the American Association of Birth Centers:

Women and Children Lose in Budget Cuts: We need your help!

It always is a shock to me that Women and Children's Programs are at the top of Federal and State budget cuts. Republicans in the U.S. House of Representatives have passed large cuts in health services to women, infants, and children (H.R.1):

Hundreds of millions from WIC (Women, Infants, and Children):
WIC provides Federal grants to States for supplemental food, health care referrals, and nutrition education for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children up to age five who are found to be at nutritional risk.

Hundreds of millions from Maternal and Child Health Block Grants:
This Block Grant referred to as Title V is a public health program that reaches across economic lines to improve the health of all mothers and children, train providers and support services for children with special healthcare needs, offers newborn screening and genetic services, lead poisoning and injury prevention, and health and safety promotion in child care settings.

More than a billion from Community Health Centers:
Community Health Centers are key partners for many Birth Centers. They exist to fill the void in underserved communities and vulnerable populations by assuring access to comprehensive, culturally competent, quality primary care services.

This federal quandary is shared by many states: Demand for health services is growing and states are cutting Medicaid budgets for the poor and disabled. Medicaid accounts for approximately 25 percent of state spending when federal matching dollars are included according to the National Association of State Budget Officers.

PLEASE DO NOT SIT BACK AND DO NOTHING. WOMAN AND CHILDREN NEED OUR HELP NOW. This is not a Republican, Democrat, or Independent position. This is the moral and ethical action to take now.
ACTION STEPS
1. Call your U.S. Senators -( U.S. Capitol Switchboard: 202-224-3121).
Ask to speak to your Senator's health legislative aide.
2. Call your State Governor, Senators and Representatives
3. Tell them you are NOT in support of cuts to women and children's health! The deficit can be reduced by cutting waste in other areas.
4. Please let Karen Fennell (AABC's lobbyist) know of your contacts with legislators.
Tell her who you talked with and any comments or additional information requested. Call Karen at 301-830-3910; Send email to fennell.karen.s@gmail.com

Suggested Talking Points

WIC Program: This is one of the most efficient programs to improve child nutrition. The program gives expectant mothers with very small children important education on how to eat healthy during their pregnancy and how to feed their children healthy meals. And it provides them with coupons to incentivize them to purchase the best foods for their children. Research shows that without this intervention the nutritional intake of these children would be higher in fats, salts and sugars, according to a recent U.S. Food and Nutrition Services study. Instead if spending $1,400 a month in extra medical care for an obese child, for just $41 per month this program shifts these mothers and children into healthy eating patterns, says the Centers for Disease Control and Prevention. Clearly, the WIC approach is a useful and relatively cheap way to stem the rising tide of childhood obesity and a healthy pregnancy.

Maternal and Child Health Block Program: The program has been cut by 30%. This program is the safety-net care for women and children. The block grant pays for child immunizations and prenatal care for tens of thousands women and children. It is obvious that without access to immunizations more dollars will have to be spent to care for kids sick with easily preventable illnesses. Reducing access to prenatal care is both life-threatening and costly. A preemie baby's health costs are 10 times higher than a full-term, healthy-weight child, according to the March of Dimes. It makes no sense to cut a program that has a proven track record of delivering health to babies and driving down America's health care costs.

Community Health Centers: Funding for community health centers will be cut in half. Senator Orrin Hatch (R-UT), who was a cosponsor of the legislation responding to President George W. Bush's call to expand funding for these centers in 2008, says that "since 2001, additional funding has allowed health centers in more than 750 communities nationwide to provide care to about four million new patients. These centers provide affordable and quality care to at-risk Americans who otherwise might have to might have to do without." As state by the Center for American Progress, "No health care costs will be avoided by cutting this $1 billion out of the budget because the absence of care doesn't stop you from getting sick. It simply means you get sicker and you turn up at the emergency room or hospitals when your illness has progressed to the point that you care needs are exorbitantly expensive.

State Medicaid Cuts: Most States have budget proposals to cut funding for Medicaid. Talk to staff about what you know best - health and costs implications of a lack of prenatal and newborn care. A useful resource is the article Ten Myths About Medicaid published by The Kaiser Commission on Medicaid and the Uninsured.
--

Jill Alliman, CNM, MSN

Chair, Legislative Committee

American Association of Birth Centers

Grassroots Network: Premature birth rate down

Hello Friends,

We hope you all enjoyed a wonderful Thanksgiving holiday!

This grassroots news message contains good news! According to March of Dimes analysis of 2008 birth data, the United States rate of premature births, or babies born before 37 weeks gestation, has declined for the second year in a row. This two-year decline comes after a 30-year increase in the rate of premature births. In 2006, the rate was 12.8% and in 2008, the rate fell to 12.3%.

Below is a link to a report from USA today that offers a more detailed description of the decline. We also include the link to the March of Dimes news source that not only notes the decline in premature births for 2008, but also includes an update on the state of births in 2010 as well as information on efforts to further decrease the number of babies born prematurely in the US. As you'll see in both articles, the decline is largely attributed to policy changes that prevent cesarean sections and labor inductions before 39 weeks gestation.

USA Today: http://www.usatoday.com/yourlife/parenting-family/babies/2010-11-18-premature18_ST_N.htm

March of Dimes: http://www.marchofdimes.com/nov17_2010.html

We hope you all continue to send us information that you wish to share with the group. We can be reached at info@cfmidwifery.org.

Sincerely,
Stephanie Hucker for Citizens for Midwifery