Grassroots News: $40 Million Going Towards Early Inductive Election, Prematurity

Hello Friends,

The US Department of Health and Human Services (HHS) has launched a campaign called the “Strong Start Initiative,” which is designed to decrease the number of preterm births occurring every year. Babies born prematurely are more likely than babies born at full term to experience a vast array of medical complications both in infancy and across the lifespan. In order to reverse a 20 year trend of increasing rates of prematurity, the HHS has announced the availability of $40 million in grant money for programs that are exploring ways to reduce prematurity through improved prenatal care.

The “Strong Start Initiative” will focus on reducing early elective inductions, which are labors that are induced prior to 39 weeks and without any medical indication. The rate of early elective inductions has increased dramatically over the past decade and is associated with poorer outcomes for babies and increased obstetrical interventions, including cesarean section. Reversing this trend can improve the health of babies and reduce unnecessary medical intervention in birth.

In addition to creating conditions for healthier births and babies, the Strong Start Initiative has the potential to save considerable health care costs that are typically associated with preterm births. The HHS will partner with the March of Dimes, the American Congress of Obstetricians and Gynecologists, and other organizations to implement this campaign.

To learn more about current research on early elective inductions, see the recent Citizens for Midwifery article.
To learn more about the “Strong Start Initiative,” read the full press release.

Warmly,

Lauren Korfine & The CfM Team

GRN: Home Birth Rate Up 20% in Four Years

Hello Friends,

Mothers are clearly calling for a variety of birth options: According to newly released data from the CDC, home birth rates have risen 20% in a four year period (2004-2008). This substantial increase has caught the interest of health care practitioners and policy makers, as well as the mainstream media.

MSNBC and USA Today covered the news and Today Moms, the online parenting network of The Today Show, featured an article called "Why Women Shouldn't Fear Home Birth" by celebrity, Mayim Bialik, who birthed at home.

We are very happy to see this conversation reaching a wider audience and as always, we will continue to work towards ensuring women have access to well-trained midwives in the setting of their choice. You can help by using the CfM Tool Kit: Stand Up for Healthy Birth and Home Birth in your own local community. Please share your efforts with us and the Citizens for Midwifery community on our facebook page.

This clear demand for midwives in various settings is yet another reason why the federal legislation -- "Access to Certified Professional Midwives Act of 2011" (HR 1054) -- is an integral part of creating optimal health outcomes for mothers by securing better access to the high quality care of well-trained midwives.

If you have not already please join the MAMA campaign.


Sincerely,

Hillary Boucher, CfM

P.S. Citizens for Midwifery relies on your generous donations. Please consider supporting us--Click Here to Donate Today!

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

Grassroots News: Good News for Kansas CPMs!

Dear friends,

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

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

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

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

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

The language specifically designating CPMs as providers is:

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

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

Way to go, Kansas!

Sincerely,
Stephanie Hucker and Willa Powell
Citizens for Midwifery

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

Book Review: Get Me Out

Book Review: Get Me Out: A History of Childbirth From the Garden of Eden to the Sperm Bank
By Randi Hutter Epstein, MD
W.W. Norton & Company, 2010
ISBN 978-0-393-06458-2
302 pages, hardback, $24.95
http://www.randihutterepstein.com/

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

Since it shares a subtitle about the history of childbirth, I expected the new book Get Me Out to be very similar in content to the recent book Birth Day by Mark Sloan or to the book Birth by Tina Cassidy. I wondered how much more could possibly be reported about the history of childbirth. It turns out there is plenty more and I was delighted to discover that Get Me Out stands alone as a unique and interesting contribution to books of this genre.

Written by a physician and mother of four, Get Me Out focuses on some very recent elements of birth history including assisted reproductive technologies (ART), ultrasound, and freebirth, subjects not addressed in the books referenced above. Aside from familiar content about things like the Chamberlen brothers and the Twilight Sleep movement, the remainder of the text was fresh and engaging. Part one included an interesting and disturbing chapter about Marion Sims and his research and experiments with fistula repair on enslaved women. A later chapter explores Sims’ research with artificial insemination (this time with middle class white women). In fact, the latter half of the book contains an extensive historical look at artificial insemination, moving into present day history including an exploration of sperm banking and cryo-preservation of eggs.

Unique among birth history books is Epstein’s chapter on freebirth (more commonly known as “unassisted childbirth”) followed with a chapter about ultrasound including content about 4D and “novelty” ultrasounds. There is also a chapter exploring DES and its effects on reproduction.

Also different than Birth Day and Birth, is the total absence of memoir or personal reflective content. Epstein is a medical journalist and Get Me Out is written in that voice. There is a light, personal tone to the text, but nothing personal aside from occasional descriptions, observations, or quotes from interviews with sperm bank mangers (for example). I found myself feeling a little curious about her personal history of childbirth, an element freely interspersed throughout the texts of other recent birth history books.

As the author says, “…the way we give birth is a story about our deepest desires and our fundamental concerns about life, death, and sex.” Get Me Out is a fascinating tale focusing on our collective, cultural story about birth in the late nineteenth and twentieth centuries, as well as dip into the story that continues being written today.

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

Grassroots Network: Numbers of Out-of-Hospital Births Have Increased

Dear friends,

Exciting news about out-of-hospital birth! A just-released report from the Centers for Disease Control (the CDC) showed that the number of out-of-hospital births increased by 5% from 2004 to 2005 and stayed up in 2006 (the numbers had been gradually decreasing over the previous 14 years). In fact, in nine states, out-of-hospital births rose by 15% or more!

This report confirms what has been sensed in the out-of-hospital birthing community for awhile: the amount of demand, interest and births in out-of-hospital settings and the midwives who assist in them are on the rise, and the increase has to do with families wanting births that feel safe, private, affordable and in keeping with their cultural and religious practices. The report goes on to show that out-of-hospital births have better outcomes: fewer pre-term and low-birth weight babies. One theory about these outcomes is that they can be attributed in part to the high-quality, personalized, preventative prenatal care offered by out-of-hospital midwives (including CPMs, Certified Professional Midwives).

On a side note, this report also shows that women have been increasingly seeking out-of-hospital births several years before the release of Abby Epstein and Ricki Lake's popular film The Business of Being Born (2008), proving that this film and other media interest in out-of-hospital birth reflect, not lead, the desires and actions of American families.

To download the full CDC report, go to http://www.cdc. gov/nchs/ data/nvsr/ nvsr58/nvsr58_ 11.pdf.

Sincerely,
Arielle Greenberg Bywater
"sidekick"

Childbirth Connection Tribute to Susan Hodges

How delightful to see a nice tribute to CfM's Susan Hodges in the most recent issue of the Childbirth Connection eNews! This is a great e-newsletter overall and I suggest checking it out by scrolling down to the bottom of the Childbirth Connection homepage.

I am reprinting the tribute below.

--
Molly
CfM Blogger

A Tribute to Susan Hodges
Susan Hodges, co-founder of Citizens for Midwifery, has just stepped down after serving as the group’s president for 13 years.

We salute Susan for her many contributions to support the Midwives Model of Care, which includes:

• Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle
• Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
• Minimizing technological interventions
• Identifying and referring women who require obstetrical attention.

Under Susan’s leadership, Citizens for Midwifery has supported such care by working collaboratively with like-minded organizations, maintaining a website, producing the Midwives Model of Care brochure, sending Grassroots Network email messages, publishing a newsletter, using social media, and many other means. We wish Susan and her family and Citizens for Midwifery well!

New Blog: First the Egg

I've mentioned here before that one of the birth blogs I really enjoy is the Feminist Childbirth Studies blog. The author (another Molly, so she must be great ;-D) let me know recently that she has a brand new website and will be continuing her blog there. Called First the Egg, her tagline is "a feminist resource on pregnancy, birth, and parenting." Her explanation of "why feminist?" is great.

I recognize that women are drawn to birthwork for a wide variety of reasons and many birthworkers do not self-identify as "feminist" (though I think that many of them would actually fall into the category of "cutural feminists"--a branch of feminism that celebrates the female essence and the natural, complementary differences between women and men). For me personally, I was a feminist first, and my interest in birth is a natural outgrowth of my overarching interest in "women's issues." I love learning about what originally drew other women to work with birth. When I trace the thread back in my own life, I see that it extends all the way back to about age 12.

--
Molly
CfM Blogger

Grassroots Network: Citizens for Midwifery Starts Our Next Stage

Dear Friends,

Well, “the time has come” as the walrus said! Here is the official notice (see below): I have “retired” from being President of Citizens for Midwifery. It is time for me to start attending to some other things, and for others to step up!

Don’t worry, I’m not going to just disappear. But you will begin to see other people doing some of the tasks I have been responsible for in the past.

I hope many of you will consider giving some of your time and expertise to continue and expand CfM’s work in the future!

Sincerely,
Susan Hodges, “gatekeeper”

----------------

Citizens for Midwifery Starts Our Next Stage

As we go into our fourteenth year, Citizens for Midwifery is entering a new stage of life: our beloved and long-standing President and Co-founder, Susan Hodges, has stepped down from being President and will retire from the CfM Board by the end of 2010. (See message from Susan below.) Effective January 1, 2010, board member Willa Powell is our new President. Willa has been a member of the CfM board and Treasurer since 1999. (If you have found CfM on Facebook, you may have heard from Willa recently!) Willa is a mother of four (one Cesarean section, one hospital VBAC, and two homebirths after Cesarean) and has served as a citywide elected school board member in Rochester, New York since 1997.

In addition, current board members Carolyn Keefe, Nasima Pfaffl and Arielle Greenberg Bywater are also continuing to serve, bringing their expertise, dedication, and passions­ ranging from research, writing and technological skills to interest in homebirth, VBAC and midwifery legislation­ to CfM.

Citizens for Midwifery has had many successes over the years, including:
§ our highly respected website, newsletter, Midwives Model of Care brochure and other literature widely used to support advocacy and activist work;
§ our Grassroots News Messages, which go out to over a thousand advocates on a regular basis to keep them updated on the latest maternity care news;
§ our Facebook presence, with over 2000 Group members and Fans and over 5000 Cause members; and
§ our current, instrumental role in the MAMA Campaign to impact national legislation to recognize and provide Medicaid coverage for Certified Professional Midwives.

Citizens for Midwifery is run by an all-volunteer board made up of regular citizens: consumers who care about the maternal wellness, childbirth and infant health issues that have always been vital to our mission. The board members serve from all over the country, coming together by phone and in person to write articles, fact sheets, and other documents for consumers, policymakers and birth professionals; support and unite with allied midwifery and other birth organizations; conduct outreach to other engaged consumers; and anything else we can do to promote the Midwives Model of Care. We work collaboratively, we work hard, we change the world­ and we have a lot of fun doing it!

We are currently in the exciting stage of refocusing our efforts and figuring out how best to move forward as an even stronger, higher impact organization. At this year’s annual board meeting, we determined that in order to keep our work vital, enjoyable and sustainable, we must expand our board and our volunteer base. We are looking for a few good women and men to join us in our fight for better access to the high-quality Midwives Model of Care for mothers and babies. We welcome anyone passionate about our mission to contact us to get involved: while people with expertise would be wonderful, we have a wide variety of ways to participate, from discrete tasks to larger roles and positions on our board. We’d love to have wider geographic and racial and ethnic diversity, and consumers of all ages are encouraged to apply. Volunteering for CfM is a great way to learn new things, keep your skills sharp, and connect with a great group of supportive, dynamic activists.

We are especially in need of folks with interest or experience in
· graphic design
· bookkeeping
· web design and content
· online social networking

We are also in search of two new Board officers: a Treasurer (responsible for our finances, sales, and other monetary issues) and a Secretary (responsible for preparing, documenting and archiving our minutes, agendas, and other aspects of our ongoing group history).

And we want to hear your ideas about how CfM can be even more effective. This year, for the first time, we’ll be hosting our Annual Membership meeting as a Webinar, an online seminar you can participate in from anywhere. The meeting will take place on Thursday, March 25, 2010 at 8 pm EST. Visit https://www2.gotomeeting.com/register/222148410 to register to attend. We will also soon be setting up an online survey to gauge your interest in various issues and topics and better target our work, so please look for that announcement and link!

Please contact us with any questions, ideas or comments, or to volunteer, at arielle@cfmidwifery.org .


Farewell from Susan Hodges:

I have been President of Citizens for Midwifery since its beginning (13 years!). I am really proud of all that Citizens for Midwifery has accomplished over the years, but the time has come for me to move on. I have stepped down from being President as of the end of 2009. Our board is embracing this change as a terrific opportunity for CfM’s development. This is a chance for us to reflect on who we are, what we’ve been doing, and what changes we might make so we can grow stronger and be an effective advocate for midwifery in the years to come. This is a chance to let go, and welcome new people, new ideas, new ways to accomplish our goals. I have absolute confidence that the result will be a better-than-ever Citizens for Midwifery!

Hello from new president Willa Powell:

Dear Friends,

I’ve been on the Citizens for Midwifery Board since 1999. Not as long as former president Susan Hodges, but pretty long! I had thought about being President of the Board someday, and assumed that when that day came, I would feel ready. Well, guess what? That day came, and even with more than a year of forewarning, I don’t feel ready!

Susan Hodges is an amazing person and all of us on the Board relied on Susan’s years of experience and personal dedication, as she led us through the necessary relationship building that has made us a respected partner in the midwifery community. In addition, Susan had and has the gift of being able to recognize opportunity when it presents itself, and that is a skill that is not easily learned.

I recently participated in a Webinar on board recruitment when a board member said, “I shouldn’t be on this board; my boss’s boss should be.” That was a profound example of honest assessment that resonated with me. So, while I delight in stepping into Susan’s shoes, I realize this organization needs more than a caretaker. It needs a transformational leader ­ many transformational leaders. The current board is, of necessity, the transition team, and our job is to find those transformational leaders who can take our organization beyond our small but respected present to a future where we will be heard and respected in every policy setting body in the country.

Do you know a transformational leader? Please share the name of that person with us, so we can explore new territory with them. Are you that transformational leader? Most people are too modest to see themselves that way, but you may be one just the same. Perhaps you are like me, and feel much more comfortable with discrete tasks than with visionary stuff. That’s great! We need you too! So if you’ve ever said to yourself, “there must be something I can do” to support midwifery, please reach out to us. If there is a change agent in your circle of friends, who has a passion for midwifery, please share her/his name with us!

Looking forward to hearing from you,
Willa Powell

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

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!!

Sincerely,
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.

-----
FOR IMMEDIATE RELEASE
January 28, 2010
Contact: Kat Song - katsong@childbirthconnection.org

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:
http://www.sciencedirect.com/science/issue/5192-2010-999799998.8998-1591119

To learn more about the Transforming Maternity Care project, please visit:
http://www.childbirthconnection.org/tmc/

For a fact sheet on maternity care in the United States, go to:
http://www.childbirth connection.org/article.asp?ck=10621

About Childbirth Connection
Founded in 1918, Childbirth Connection ( www.ChildbirthConnection.org) 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.

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Kat Song
Director of Public Affairs
www. ChildbirthConnection .org

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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!

Sincerely,
Susan Hodges, “gatekeeper”

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?

--
Molly
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.

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: http://consensus.nih.gov/2010/vbac.htm. 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.

Sincerely,

Susan Hodges, “gatekeeper”

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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
http://www.consensus.nih.gov

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: http://consensus.nih.gov | 1-888-644-2667

Can't attend?
Webcast registration: http://consensus.nih.gov/vbacvideocast.htm -- there will be the ability to ask questions online.
Pre-order statement: http://consensus.nih.gov/vbacstmt.htm

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

Grassroots Network: Childbirth Connection e-News

Dear Friends,

I just received an e-news post from Childbirth Connection. Among other items of interest, it announces a useful new document:

"Know your facts when you discuss maternity care in the US. We have compiled a brief, new resource document called 'United States Maternity Care Facts and Figures.' It details current statistics including the number of births, proportion of hospital care that is devoted to the care of pregnant women and babies, maternity outcomes such as preterm birth and low birthweight rates, as well as statistics about paying for maternity care."

You can find that document here.

The e-news included information about some recent maternity care research, as well as several other useful links.

Anyone can sign up to receive Childbirth Connection e-news. Go here to do so.

Sincerely,
Susan Hodges, "gatekeeper"