Book Reaction: Cut, Stapled, and Mended

To be honest, I wasn't sure what to expect from Roanna Rosewood's memoir, Cut, Stapled, and Mended. After it arrived I actually wondered if I should have agreed to review it, because I have so many things to read, things to think about, and interests that are calling me---do I really need to read a memoir about someone's cesareans? I've already read so many books about birth, do I really want to read another one? Well...the answer was YES, I did need to read it. After I finished the book, I felt almost speechless at how deeply it had touched me. This book was a surprise all the way through, from the opening Orgasmic Amazon Queen sex scene, to a session with a psychic healer who tapped in to Roanna's past life abdominal wound, to her dogged quest to open herself to her own feminine wisdom, to her birth experiences---all soul-shattering in their own way---this book touched me profoundly. I was shocked to find myself with tears in my eyes at many different points and eventually truly unable to put it down.

Orgasmic Amazon Queen notwithstanding, Roanna comes across as a practical and down-to-earth narrator, who in her quest to understand herself, her body, her inner wisdom, and her birth experiences, makes a decidedly not down-to-earth personal journey through a variety of healing modalities and nontraditional experiences and perspectives. I really loved the balance she struck between the spiritual and metaphysical experiences she describes and the nitty-gritty reality of doing this thing, giving birth. In a perfect example of what I mean, she writes:

You think I would run out of poop but I don't. It's endless poop. 

My ego, having (literally) had enough of this shit, quits. It gets up and walks right out the door. What is left of me poops in the tub. Looking down, I say, 'ewwwww.' I say it as if it wasn't me who just shat in the tub. I say it as if I just happened to come across poop in my bath one day. 'Ewwww' or not, I'm never getting out of the tub ever again. If this tub were full of nothing but shit mud, I would still stay right here (p. 144).

And, just a few pages later, the experience I already quoted in a prior post:

Only then does the Divine come, taking my body as her own. I am no longer alone. There is no fear…I experience completeness. I find religion. Infinity is tangible. Generations of children, their dreams, passions, defeats and glories—they all pass through me, converging here, between my thighs… (p. 146-147).

via Thesis Tidbits: Cut, Stapled, and Mended | Talk Birth

Despite planning homebirths, Roanna experiences two cesareans and her journey towards VBAC is an arduous one:

Deep inside, I feel the screams of birth echoing off the sides of my skull. Softer and softer they fade, becoming a faint whisper, then disappearing completely.

I open my mouth. 'Please,' I whisper-scream-beg-cry, 'please come back.'

She does not.

I am, once again, mortal. (p. 155)

While I would likely proceed with some degree of caution if reading this memoir as a pregnant first-time mom, there is much to be learned from Roanna's experiences. Her narrative is rich, deep, compelling, scary, dramatic, poignant, and powerful. I highly recommend it!

--

Disclosure: I received a complimentary copy of this book for review purposes. Crossposted at Talk Birth.

Grassroots Network: Effective Health Care Program Update: New Draft Key Questions and a Draft Review Are Now Available for Comment

Dear Friends,

The federal Agency for Healthcare Research and Quality (AHRQ) is preparing a review document about “interventions” that are effective in reducing cesarean sections, and all of us have a chance to give input!

ARHQ has drafted 4 key questions for members of the public to answer on-line, plus you can also upload a document. Go to: < http://www.effectivehealthcare.ahrq.gov/index.cfm/research-available-for-comment/comment-key-questions/?pageaction=displayquestions&topicid=263&questionset=147 >.

Scroll down below the questions to read the draft review (not too long). This will help you to see where they are starting from. For example, the word “intervention” is really used to denote any action (or non-action) that is being studied for its effect on reducing cesarean rates, even if you don’t normally think of it as an intervention. Also, it is apparent that routine hospital practices (that we know can interfere with labor) aren’t really mentioned in the list of “interventions”…

NOTE: The deadline for comments is December 29!

Wonderful that AHRQ is looking seriously at the topic of how to reduce the cesarean section rate, and that they are inviting comments from the public! I would encourage you to be respectful and informative in your comments, so that they are helpful and useful for the purpose of this review.

Please feel free to pass this on to other relevant lists you may be on!

Sincerely,

Susan Hodges, “gatekeeper”
For CfM

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

Cesarean Awareness

Some time ago, I connected online with a new Lamaze childbirth educator named Kelli Haywood. Recently, she notified me about her cesarean awareness radio piece that aired on Mountain News and World Report. The piece is 30 minutes long and contains a lot of information about cesareans, necessary cesareans, informed consent, and so forth. As well as the childbirth educator speaking and sharing her personal story of her first birth by cesarean, she interviewed an obstetrician, CNM, and a CPM for the piece. And, a local mother shares her story of necessary cesarean.

As Kelli noted, "While the piece is particular to Kentucky and the mountain region, however, it also applies on the broader nationwide scope." I agree! It was definitely worth the listen and I enjoyed all of the perspectives shared. I was interested by some statements made by the OB that epidurals are perfectly safe and in some studies "lower the cesarean rate" (!?)--he then notes that this is, "probably because the patients are more compliant." (emphasis mine). Ah ha! This epidural information was followed up with additional information and resources from the CBE and CNM questioning the widespread use of epidural anesthesia.

The story is called Cesarean Birth and the Women of the KY Mountains and Nationwide.

There is also a companion article with additional resources available on Kelli's blog, Birth True.

--
Molly
CfM Blogger

Cesarean Awareness Month!

I wanted to pass along a letter from ICAN about Cesarean Awareness Month (April). ICAN (International Cesarean Awareness Network) is a wonderful organization and I am so thankful for the wonderful work it does. I am also completely psyched that the ICAN conference is going to be in St. Louis next year--St. Louis is only about two hours drive for me and I am SO THERE for this conference! I have been an ICAN member for about two years now and I have really enjoyed several of their webinars.

When I think about Cesarean Awareness Month, I think of all the cesareans that don't happen when women receive the Midwives Model of Care. I also think about the rising cesarean rate--preliminary data is out and the rate as increased again to 32.3%.

Anyway, below is the letter from ICAN!

--
Molly
CfM Blogger
---
Dear friend of ICAN,

Thank you for your continued support of ICAN's mission! In honor of Cesarean Awareness Month, I invite you to do something concrete to show your commitment to moms and babies everywhere. I encourage you to become an ICAN subscriber or renew your subscription by visiting the ICAN Bookstore or contacting your local chapter today.

Cesarean Awareness Month is the perfect time to subscribe to ICAN. In addition to reduced subscription rates, we will be offering three fantastic webinars, all of which are free to ICAN subscribers:

• Cesarean Scar Care in the Post-Partum Period: Sunday, April 11 at 7 pm EDT.
• ICAN Birth Class: Cesarean Prevention: Tuesday, April 20 at 9 pm EDT
• ICAN Birth Class: Journey to VBAC, date TBA

We also encourage you to join us for an ICAN meeting live, online on Thursday, April 15 at 9 pm EDT.

As always, ICAN subscribers also receive the Clarion, ICAN's quarterly print newsletter and discounts to the ICAN Bookstore and the ICAN Conference. Professional subscribers enjoy a free listing on ICAN's Professional Subscriber Network, and Childbearing Years and Lifetime subscribers will receive a special mention in the next Clarion. Subscribers who participate in our online forums also receive public recognition by means of special ribbons every time they post.

ICAN is an all-volunteer organization working tirelessly to improve maternal-child health. Through the financial support of our subscribers, we have been able to:Provide support through over 130 chapters in the US, Canada and around the world, through our 1-800 number and through our online forums

• Provide evidence-based information through our website
• Increase awareness of cesarean and VBAC issues through our blog and social networking sites.
• Offer live, interactive online webinars to educate health care consumers and professionals
• Send ICAN representatives to our nation's capital to bring light to insurance discrimination due to cesarean as a "pre-existing condition"
• Send ICAN representatives to conferences around the US to raise awareness of cesarean and VBAC issues

Thank you again for your support. Please let us know how you will be honoring Cesarean Awareness Month by sending an email to feedback@ican-online.org.

Warmly,

Desirre Andrews
ICAN President
www.ican-online.org

Grassroots Network: NIH Consensus Development Conference on VBAC

Dear Friends,

As most of you know by now, the National Institutes of Health (NIH) convened a Consensus Development Conference on VBAC (vaginal birth after cesarean) in Bethesda, MD on March 8-10, 2010. I felt privileged to represented CfM and be one of the voices for consumers, trying to keep the focus on what is best for women and babies rather than the concerns and pressures that hospitals experience.

It was clear that many of the presenters really understood the problem of VBAC bans, especially Rita Rubin who gave a powerful presentation of women's stories. There was plenty of frustration, too, especially near the end when the panel ethicist refused to acknowledge a pregnant woman's right to refuse surgery, even when she has appropriately weighed the risks to herself and her baby.

All in all, I think the conference really moved the VBAC conversation in the context of other problems in maternity care. It remains to be seen just how much medical practice - and culture - will change as a result of the panel recommendations.

This Grassroots Message includes CfM's response to the NIH Consensus Report on VBAC. At the bottom, I've included links to the NIH conference documents, media coverage. Happy reading! Citizens for Midwifery on the 2010 NIH Consensus Development Conference on VBAC

Our overall assessment of the NIH report can be found below and links to much of the media coverage below that. A full analysis can be found here.

The NIH panel recommendations urge two courses of action that, if implemented, would go a long way toward improving the situation for women with prior cesareans. They state that their goal is to "support pregnant women with a prior transverse uterine incision to make informed decisions about TOL [trial of labor] and ERCD [elective repeat cesarean delivery]". To do that, they (1) urge evidence-based practice, and they (2) urge ACOG to reconsider "ACOG #5". CfM agrees. We would also like to see the following actions:

* All hospitals and OBs should start supporting VBACs, not just "offering" and "encouraging". CfM believes the Midwives Model of Care represents that support of physiologically normal birth.

* ACOG should rescind "ACOG #5" immediately. In doing so, insurance companies would no longer have a basis for dropping or threatening to drop malpractice insurance or raising insurance rates on practitioners and hospitals that offer VBAC, as those individuals and institutions will merely be responding to both the evidence and the guidelines. By rescinding "ACOG #5", ACOG and its members would be taking a step toward earning back the trust and confidence of the women they serve.

* Informed consent must be based on an honest risk assessment, including information about provider outcomes, provider bias and conflicts of interest, as well as the research evidence, in order to support all women, not just VBACing women, to have healthy births.

Willa Powell

CfM President

---
The NIH documents can all be reached from their press release, including the full report, the full evidence report, and recorded webcasts of the conference:

http://www.nih.gov/news/health/mar2010/od-10.htm

There has been a great deal of news coverage, including:

http://www.nytimes.com/2010/03/11/health/11birth.html

http://www.npr.org/templates/story/story.php?storyId=124542025

http://www.msmagazine.com/news/uswirestory.asp?ID=12295

Many organizations are developing press releases and responses including ICAN and Lamaze:

http://ican-online.org/print/node

Lamaze

A running blog discussion from the conference can be found at

http://thefeministbreeder.com/once-a-cesarean-rarely-a-choice

http://thefeministbreeder.com/nihvbac

and several blog postings with ongoing discussion can be found here:

http://www.theunnecesarean.com/blog/2010/3/10/nih-vbac-consensus-development-conference-gift-horse-or-troj.html

This article anticipated the NIH conference and very much supports CfM's philosophy:

http://www.nytimes.com/2010/03/07/health/07birth.html?partner=rss&emc=rss

A fairly comprehensive list of articles on this conference is available at:

http://birthaction.org/Blogs/tabid/66/EntryId/64/Articles-and-blogs-on-the-NIH-VBAC-Consensus-Panel.aspx

There's even a petition: http://www.petitiononline.com/VBAC2010/petition.html

NIH VBAC Conference

The NIH Conference on VBAC is currently in progress. Citizens for Midwifery's new president, Willa, is attending the conference and has been able to pose questions about VBAC bans and also to make a statement about the lack of feasibility of conducting double-blind trials in VBAC study as well as to encourage the inclusion of a homebirth cohort as a control group in studies.

If you haven’t been able to watch the conference, here some some other resources:

Abstracts PDF

Live Twitter coverage on Feminist Breeder

Those will at least give you a flavor for how things are going!

--

Molly

CfM Blogger

Grassroots Network: Opportunity for VBAC Feedback at Upcoming NIH Conference

Dear Friends,

I am the new president of Citizens for Midwifery, and I will be attending the Vaginal Birth After Cesarean (VBAC) Consensus Development conference sponsored by the National Institute of Health (NIH) in Washington DC on March 8-10, 2010. This conference will examine the research around VBAC and may impact birth, especially VBAC, for the next decade.

We know from our experience with the NIH's so-called patient choice cesarean conference that our presence, pressure and input can make a difference. On the issue of VBAC, we want to make it clear that hospital bans on VBAC violate our right to informed consent/informed refusal. Curiously, there is no speaker specifically addressing this Patients Rights point. We need to hammer it home at every opportunity...with evidence of the overuse of C/S in the first place...with evidence of the safety of VBAC and the risks associated with repeat C/S...and armed with our Constitutional right to bodily integrity: with or without evidence.

Even if you can't get to DC, you can watch the conference and participate online. You can also sign up to receive the resulting statement and watch the video archive afterward. Indeed, I'm asking everyone to sign up to receive the statement that will be the result of this conference: go here and find the Pre-order Statement button at the top of the page. Signing up to receive the statement - all by itself - communicates to the NIH that there is tremendous interest and public involvement on this issue.

At the same website, you will see an outline of the speakers list and agenda and sign up for the live webcast or there are several ways in, via calendar, for example: here or here. If you are at all able to view all or part of the live webcast I urge you to do so.

There is generally an opportunity for the audience to ask questions or redirect attention after each presentation. If you can watch, and want to ask a question, email me at willa@cfmidwifery.org, post on the wall of our Facebook Fan page, or text me at 585.729.5161, and I'll do my best to make your points live and in person. If I can't, there is an opportunity to submit written feedback on-site. It may also be possible for webcast viewers to leave feedback in real time, and you can post comments on the draft document on Wednesday morning.

Please plan to watch and weigh in.

Willa Powell, President

Citizens for Midwifery

willa@cfmidwifery.org

Note from Molly: I'm not sure if all the links are working correctly--the calendar link doesn't work for me, but I think maybe I am missing something.

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

Journal abstract

Response to Boston Radio Program About CPMs

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

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

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

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

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

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

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

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

Susan Hodges

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

Grassroots Network: Maternity care insurance problem stories needed!

Dear Friends,

Please read the "Urgent request for stories" message from ICAN below. They are looking for documented accounts where women have had problems with insurance coverage related to pregnancy, particularly regarding discriminatory insurance practices based on a previous cesarean section. Read below for more details and what you can do.

Sincerely,
Susan Hodges, "gatekeeper"

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

From: Gretchen Humphries
Subject: Urgent request for stories

I have sent you this request because of your connections within the Birth Community. I hope that you will see if there is any way you can assist ICAN with this request.

We have made this request before but now the stakes are really high. Peggy Robertson is a woman from CO who testified yesterday before the HELP committee (the Senate Health Education Labor and Pensions Committee) about being denied coverage because of a previous cesarean, unless she could prove she had been sterilized. (We managed to work in a couple of comments about VBAC bans too! Which got some response from a couple of Senators!) Senator Mikulski, who chaired that hearing, has asked for more stories similar to Peggy Robertson's. Please distribute this request as widely as you can

-ICAN needs stories about discriminatory insurance practices based on a previous cesarean. This can include but is not limited to demands for sterilization, restrictions on how soon you can have another pregnancy and be covered, higher premiums, restrictions on the total amount of benefits they will pay, excessively high deductibles for maternity care. Even if all you have is your name, state, contact information (email is fine) and a description of the circumstances (with the name of the relevant insurance company(ies) if possible) we can use it. If you have written documentation, that would be pure gold.

There is interest about this at the highest levels of the Federal Govt. and we will use this to open the discussion on other areas of discrimination (like VBAC bans, lack of transparency, etc)....so please, take a moment and get the information to ICAN. You can email me at advocacy@ican-online.org or you can snail mail to ICAN of Ann Arbor, PO Box 48, Stockbridge, MI 49285.

Your story could make a difference that would improve the care available for millions of women and their babies.

Gretchen Humphries
Advocacy Director, ICAN
advocacy@ican-online.org
(517) 745-7297

Florida Celebrates National Licensed Midwives Week!

STATE OF FLORIDA CELEBRATES LICENSED MIDWIVES WEEK OCTOBER 5 - 9

Governor Charlie Crist Signs Proclamation Heralding Midwives for Dedicated Care

SARASOTA, FL (October 5, 2009)
– Governor Charlie Crist signed a proclamation today observing October 5 through the 9 as Licensed Midwives Week in the State of Florida, upholding midwives for being “dedicated to the care of pregnancy and childbirth and treat[ing] each woman’s pregnancy according to her unique physical and personal needs.” Governor Crist’s proclamation also recognized midwives for their role in the need to “improve birth outcomes in the State of Florida and ensure that women are given proper care and treatment in all phases of childbirth.”

In honor of this week, Florida Friends of Midwives (FFOM), a non-profit grassroots organization dedicated to promoting and supporting the practice of midwifery in Florida, will be hosting various community events throughout the state this month to celebrate the more than 110 Licensed Midwives in the Sunshine State.

Florida Licensed Midwives Week coincides with National Midwifery Week, a time to recognize
the contributions of Certified Nurse Midwives (CNMs), Certified Midwives (CMs) and Certified Professional Midwives (CPMs) nationwide. The American College of Nurse Midwives (ACNM)
publicly announced the week with an introduction to midwifery. “The heart of midwifery care for women and newborns lies more in the nature of that care than in its specific components. Midwifery practice has a firm foundation in the critical thought process and is focused on the prevention of disease and the promotion of health, taking the best from the disciplines of midwifery, nursing, public health and medicine to provide safe, holistic care.”

Midwives have a long and valued history in Florida. The state first passed legislation to license direct-entry midwives in 1931. In the 77 years since, Florida’s licensed midwives have continued to tirelessly serve the families of Florida and to ensure the continued availability of safe, evidence-based birthing options for Florida’s families. In 1992, Governor Lawton Chiles declared the first-ever Licensed Midwives Week. More women than ever before are seeking out licensed midwives for maternity care. According to the latest data from the Florida Council of Licensed Midwifery, births managed by Licensed Midwives in the state grew by about 5.5% from 2005 to 2006.

“We are honored every day to serve Florida’s mothers, babies, and families,” says Sarasota Licensed Midwife Alina Vogelhut, LM. “It means so much for our profession to be honored by Governor Charlie Crist and the State of Florida.”

Midwifery in Florida

In Florida, two types of midwives are allowed to practice: Certified Nurse-Midwives and Licensed Midwives (a Florida state licensure), also known as direct-entry midwives. Throughout the state, about 11.2 percent of births are estimated to be managed by midwives, rather than by OB-GYNs. Many birth centers and midwives have reported a significant increase in business in the past year. This increase is believed to be a result of various factors, primarily a greater number of women seeking alternative birthing choices due to an unhealthy increase in cesarean sections and other unnecessary interventions that frequently occur in hospital
settings. In a 2006 report on Florida Licensed Midwives, midwives had a cesarean section rate of 6.3 percent compared to a 36.64 percent statewide average in hospitals the same year.

For more information of midwifery in Florida, please visit www.flmidwifery.org.

Fighting VBAC bans on a busy schedule: mother-sized activism

From ICAN: "Currently, 28% of US hospitals have in place official bans on vaginal birth after cesarean. An additional 21% have de facto bans, where there is no official policy but no doctors will support VBAC. Want to do something about it but think you're too busy to do much? Check out ICAN's new feature, Mother-Sized Activism."

What a great idea! La Leche League frequently refers to "mother-sized" roles within the organization and I like seeing the same concept applied to birth activism.

--
Molly
CfM Blogger

ICAN Blog

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).

--
Molly
CfM Blogger

Big Push Thank You Video

I recently posted about the launch of BigPushTube. There is a nice "thank you" video up right now that encourages the activism spirit!

Canadian Birth Changes

The Society of Obstetricians and Gynaecologists of Canada has recently changed their position on breech birth to one of support for the option of vaginal breech birth. You can read more about in an article in The Vancouver Sun. There is some discussion about this on Uncecessarean as well as a comprehensive look at the flip-flop from Science and Sensibility.

--
Molly
CfM Blogger

Grassroots Network: ICAN responds to AMA’s latest outrageous move

Dear Friends,

The American Medical Association is out-doing itself. The organization is opposing key parts of Obama’s health care reform plans, for which they are being roundly criticized even by physicians (letters to the editor in the New York Times). They are, of course, working on anti-CPM and anti-home birth “model” legislation to put into place their resolutions from last year.

But to top off their display of arrogance, the objective of a new proposed resolution seeks to punish patients who are not “compliant” with the idea that doctors should not have to put up with patients who seek to assert their right to make the final decisions on their own medical care.
International Cesarean Awareness Network (ICAN) has posted an excellent press release on this latest outrage, which I have also pasted below.

Sincerely,
Susan Hodges, “gatekeeper”



From ICAN:

AMA Resolution Would Seek to Label “Ungrateful” Patients

Redondo Beach, CA, June 11, 2009 - At the American Medical Association’s (AMA) Annual Meeting next week, delegates will vote on a resolution which proposes to develop CPT (billing) codes to identify and label “non-compliant” patients (1) [2]

The resolution complains:

“The stress of dealing with ungrateful patients is adding to the stress of physicians leading to decreased physician satisfaction.”

“This resolution is alarming in its arrogance and its failure to recognize, or even pay lip service to, patient autonomy,” said Desirre Andrews, the newly elected president of the International Cesarean Awareness Network (ICAN).

If approved, the resolution could hold implications for women receiving maternity care. For pregnant women seeking quality care and good outcomes, “non-compliance” is often their only alternative to accepting sub-standard care. Physicians routinely order interventions like induction, episiotomy, or cesarean section unnecessarily.

Liz Dutzy, a mother from Olathe, Kansas, delivered her first two babies by cesarean and was told by her obstetrician that she needed another surgical delivery. “My doctor told me that I needed to have a cesarean delivery at 39 weeks, or my uterus would rupture and my baby would die.” She sought out another care provider and had a healthy and safe intervention-free {home} birth at 41 weeks and 3 days gestation.

A recent report by Childbirth Connection and The Milbank Memorial Fund, called “Evidence-Based Maternity Care: What It Is and What It Can Achieve ,” (2) [3] shows that the state of maternity care in the U.S. is worrisome, driven largely by a failure of care providers to heed evidence-based care practices. For most women in the U.S., care practices that have been proven to make childbirth easier and safer are underused, and interventions that may increase risks to mothers and babies are routinely overused. The authors of the report point to the “perinatal paradox” of doing more, but accomplishing less.

The resolution proposed by the Michigan delegation of the AMA could threaten patient care and patient autonomy for several reasons:

• Billing codes that would categorize any disagreement and exercise of autonomy on the part of the patient as “non-compliance” “abuse” or “hostility” could create a pathway for insurance companies to deny coverage to patients
• Use of these labels fails to recognize patients as competent partners with physicians in their own care
• Tagging patients as “non-compliant” fails to recognize that there is not a “one size fits all” approach to care, that different opinions among physicians abound, and that patients are entitled to these very same differences of opinion
• Labeling patients as “non-compliant” may, in fact, be punitive, jeopardizing a patient’s ability to seek out other care providers

The resolution also fails to address how it would implicate patients navigating controversial issues in medical care, like vaginal birth after cesarean (VBAC). While a substantive body of medical research demonstrates that VBAC is reasonably safe, if not safer, than repeat cesareans, most physicians and hospitals refuse to support VBAC. (3) [4] The language in the resolution suggests that patients who assert their right to opt for VBAC could be tagged as non-compliant, even though their choice would be consistent with the medical research.

“The reality is that the balance of power in the physician-patient relationship is decidedly tipped towards physicians. The least patients should have is the right to disagree with their doctors and not be labeled a ‘naughty’ patient,” said Andrews.

About Cesareans: When a cesarean is medically necessary, it can be a lifesaving technique for both mother and baby, and worth the risks involved. Potential risks to babies from cesareans include: low birth weight, prematurity, respiratory problems, and lacerations. Potential risks to women include [5]: hemorrhage, infection, hysterectomy, surgical mistakes, re-hospitalization, dangerous placental abnormalities in future pregnancies, unexplained stillbirth in future pregnancies and increased percentage of maternal death.

Mission statement: ICAN is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery and promoting vaginal birth after cesarean. ICAN has 110 chapters in North America and Europe, which hold educational and support meetings for people interested in cesarean prevention and recovery.



(1) Resolution 710 “Identifying Abusive, Hostile or Non-Compliant Patients” [6]

(2) Evidence-Based Maternity Care: What It Is and What It Can Achieve [7]

(3) http://www.ican-online.org/ican-in-the-news/trouble-repeat-cesareans [8]

New Jersey Cesarean Refusal Case

Though it happened some time ago, I only recently learned about a frightening case in New Jersey in which a woman in labor refused to sign the hospital's blanket consent form for a cesarean (the woman did not need a cesarean, it was a "just in case" thing). The end result was that she had her baby taken away and her parental rights terminated. There is more discussion about it in this blog post.

Cases like this are why I appreciate the legal services offered by National Advocates for Pregnant Women.

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Molly
CfM Blogger

Happy Earth Day!

Peace on Earth Begins with Birth.

This phrase keeps turning around in my head today as I spent Earth Day outside with my two children and our friends. I wanted to share some quotes from the Midwifery Today book The Heart & Science of Homebirth (in the article "Remembering Why We are Midwives" by Judy Edmunds):

"...I believe in the beauty and dignity inherent in all women. I am awed by their strength and power and am fortunate to be able to attend births where these qualities are so clearly displayed. Having a share in drawing out that power, respecting that dignity and nurturing the spirit of courage is being privy to a bit of creation itself. It is an incredible privilege."

"Midwives try to convey these simple truths: Birth is not a clinical exercise. It is not a medical procedure. In nearly every instance, it should not be major surgery. Nor should it even routinely include minor surgery. Rather than being a time of weakness with beds, shots, fasting, IVs and wheelchairs, it is time of energy and strength. Raw power. Mightiness. Courage."

This is a beautiful summation. If more women and babies began their journeys together with this attitude towards birth behind them, perhaps we really would have peace on earth!

I also wanted to link to two great blog posts I read today. First, at Stand & Deliver, a review of the book Policing Pregnancy that includes a thought-provoking analysis of using the term "obstetric conflict" instead of "maternal-fetal conflict." Second, at The Unnecesarean a discussion about a new British study "Maternal Request Not Reason for Rising Cesarean Rate."

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Molly
CfM Blogger

Vitamin D and Cesareans

Several people have sent me a link to news articles about a recent study linking Vitamin D Deficiency to Increased C-Section Rate.

Amy Romano, blogging as a guest on the Giving Birth with Confidence blog, has a really fabulous analysis of the study: Rotating Theories of the Increasing C-section Rate: Vitamin D Edition

Her conclusion is particularly astute:

"Another red flag for bias? One of the study’s four authors is a paid consultant to none other than Quest Diagnostics, the company that made me listen to an ad for vitamin D blood testing while I was on hold.

Debunking this study doesn’t mean that vitamin D deficiency is harmless or that there aren’t other potential public health benefits to preventing and treating vitamin D deficiency in pregnant women. But we need a lot more information before we start blaming the increasing cesarean rate on vitamin D. It’s tempting in the face of a cesarean epidemic to assume that women’s bodies are deficient in something or another, or to just assume that women are asking for it. These theories direct attention away from the systemic problems that keep the cesarean rate marching higher and higher."

Speaking of the Giving Birth with Confidence blog, Amy also has an in-depth post there looking at the new homebirth study from the Netherlands that concluded giving birth at home is at least as safe as giving birth in the hospital. Rixa at Stand and Deliver also has a good post about this homebirth study, including lots of links to the difference media coverage of it. Make sure to check these out!

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Molly
CfM Blogger