Mother-Friendly Evidence Based Fact Sheet

I've referenced this fact sheet several times on the blog already, but I wanted to call attention to it in its very own post :)

In Sept. 2007, Citizens for Midwifery published a useful new fact sheet summarizing the evidence basis for the 10 Steps for Mother-Friendly Care. The fact sheet is two sided and packed with information. The Coalition for Improving Maternity Services (CIMS) has a mission “to promote a wellness model of maternity care that will improve birth outcomes and substantially reduce costs.” To this end, they created the evidence based
Mother-Friendly Childbirth Initiative (MFCI). This Initiative “provides guidelines for identifying and designating “mother-friendly” birth sites including hospitals, birth centers and home-birth services.” There are ten steps for mother-friendly care and ample evidence supporting each step.

CIMS also has a very useful consumer handout–”Having a Baby: 10 Questions to Ask“–that helps expectant couples ask questions of their health care providers to determine if the care they are receiving is the evidence based, mother friendly care all pregnant women deserve.

An award!

The Enjoy Birth blog just awarded CfM an "Excellent Blog Award." Thank you!

Also, Robin Elise Weiss (the pregnancy and childbirth guide at About.com) listed the CfM blog as one of the "Top 10 Blogs You Should be Reading." There are a lot of other great blogs on her list, so make sure to check it out! I already loyally read several of them, but some were new to me also.

Note added on 2/19, I just saw today that House of Harris also awarded CfM an "Excellent Blog Award" on 1/28. She says it was awarded "for helping to educate the general public about what they can do to give midwifery a voice in this country!"

Sexual Abuse & Birth

Approximately one out of three girls and one out of five boys experience sexual abuse during their childhoods. Why does this matter for birth? As social worker and co-founder of DONA International, Phyllis Klaus notes, "Abuse memories can be activated at significant developmental periods or at stressful life events. Pregnant and becoming a parent are times of vulnerability, perhaps due to uncontrollable factors such as rapid changes in the woman's body, uncertainty and labor pain, stretching of the birth canal as the baby descends...Survivors of abuse may be affected by numerous invasive procedures as well as coping with medical professionals who are strangers with authority and power."

Care providers skilled in the Midwives Model of Care may be more able to provide an atmosphere of safety and respect for abuse survivors and are much less likely to use invasive procedures that can lead survivors to feel further victimized.

Midwifery Today is hosting a conference in May specifically about sexual abuse. The conference is designed both for "Survivor Moms" and also for midwifery and mental health care professionals.

Grassroots Network: PushDay News

From CfM President Susan Hodges:

I have just returned home from the Big Push for Midwives campaign launch in Chicago! The organizers of the campaign did a fantastic and very professional job! While not many media people actually showed up in person, the campaign contacted many many people in both local and national press, and the more the Big Push does, the more the media will pay attention. Also, all of you who blog, the more discussions there are on blogs, any blogs, about maternity care, CPMs and especially the Big Push for Midwives Campaign, the more likely the press is to pay attention.

The Big Push website is now live! It includes the contents of the Press Packet prepared for the launch yesterday, and just in, a wonderful statement by Ricki Lake supporting the Big Push campaign! More is being added to the website each day, so keep checking back. There will be reports (and photos!) of the various Rallies and other Push Day events that were held in quite a few states. Keep checking back!

Media coverage has varied. The good news is that The Big Push for Midwives launch was featured in the Chicago Tribune! The bad news is that the reporter mistakenly characterized CPMs as lay midwives. You can read the article here.

Katie Prown, Campaign Manager for The Big Push for Midwives 2008 wrote in an e-mail: Please, please, please flood the comments section with corrections. "Lay" means untrained. CPMs are not lay midwives, they're professional midwives. They're not lay practitioners, they're healthcare professionals. To refer to a CPM as a lay midwife is an oxymoron, just as it would be to refer to a Certified Nurse Midwife as a lay midwife. We need to hammer away at these points because the last thing we want is to fall into ACOG's trap of accusing us of promoting the licensure of "lay" providers.

So, COMMENTS and LETTERS to the editor are NEEDED as soon as possible! A link to post a comment is found at the end of the article.

At the same time, the Jan. 28 edition of NEWSWEEK has a great article: “Birth the American Way.”It focuses especially on the Business of Being Born but includes a quote from Jennifer Block and other good points. Don’t hesitate to write a letter to the editor of Newsweek!!! You can write a comment at the end of the article. I just checked, and there are A LOT of comments already, many defending cesarean sections! So, here is another opportunity to comment positively about normal, undisturbed birth with midwives, and correct misinformation. You don’t have to read all the comments the most recent ones will give you a sense of the conversation, and are likely to be the ones current viewers are reading. You can also write a letter to the editor (see a print copy of Newsweek for information on how to send in a letter).

Sincerely,
Susan Hodges, “gatekeeper”

Neonatal Mortality Rankings

Unicef just published new statistics ranking countries on the state of children.

The United States is tied for 33rd (through 41st) in neonatal mortality (at 5) with these countries: Belarus, Croatia, Lithuania, Malaysia, Malta, Qatar, Slovakia, United Arab Emirates, United States.

Thanks to Jessica in MO for the update!

Malpractice Insurance & Midwives

Midwifery advocates working on legislation are often met with the question/response, "but what about malpractice insurance? Families need to have some recourse in the event of problems during birth." This is often a close-the-door pseudo-question asked with an air of finality--as in, "now, that settles that. We're all finished here."

Reading the current issue of Midwifery Today finally helped me respond to that question and also to discern what I have always felt that questions of legislation and legalization of midwifery should not involve a need for, or a requirement of, malpractice insurance. It also helps explain why bringing up malpractice insurance need not be an avenue for closing discussion.

From author Judy Slome Cohain: "Mandatory malpractice insurance does not enable a person to sue for malpractice. Any midwife or citizen can be sued at present--insurance or no insurance. Mandatory malpractice insurance can only do one thing: increase the profitability of lawsuits."

When looking through this lens, it becomes clear that lawyers and insurance companies have more to gain from legislation mandating insurance policies for midwives than do birthing women and their families.

The article in Midwifery Today is called "Mandatory Malpractice Insurance: Increases CS Rate & Profitability of Litigation, Decreased Planned Homebirths."

Grassroots Network: Missouri Articles Need Responses

Thanks to Mary Ueland of MO and Friends of MO Midwives for sending this information. For background about current efforts to have legal CPMs in MO, see Grassroots Network Message 706014 (if you are a GRN subscriber, you can find all messages under Messages in the yahoogroup)

Mary wrote:

"As many of you know, the St. Louis Post-Dispatch has just featured two prominent articles on Missouri's midwifery situation and, today, a story on the birth center in Columbia.

Most importantly, please leave a comment here as soon as possible. [Note: there are now five pages of comments compared with the three comments noted when Mary sent her email]

Most of the legislators will be checking this out, and we have a chance to influence their opinions through these comments!"

Sincerely,
Susan Hodges, gatekeeper

St. Louis Post Dispatch Features Homebirth Slideshow

The media continues to draw attention to midwifery and homebirth! Today, the St. Louis Post Dispatch website features a moving slideshow presentation of a midwife attended homebirth. You can view the slideshow here.

Grassroots Network: Big Push Campaign!

Some of you may have already heard of this effort being developed during the last few months. Midwifery advocates/activists especially from midwestern states have been working together to form a campaign to get CPMs licensed in all 50 states. Citizens for Midwifery supports this campaign, as well as many national and state organizations. The official launch will take place next Thursday in Chicago!

The text of the Media Alert is below.

You probably already know if folks in your state are planning any events associated with the Big Push, and they will also have access to additional materials.

I will be in Chicago for the Big Push launch, so watch for a first hand account posted as soon as possible after the event!

Sincerely,
Susan Hodges “gatekeeper”



PushNews from The Big Push for Midwives Campaign

CONTACT: Steff Hedenkamp, (816) 506-4630, RedQuill@kc.rr.com
FOR IMMEDIATE RELEASE: Friday, January 18, 2008

MEDIA ALERT
National “Big Push for Midwives” Campaign to Launch
20 states already signed up for nationally coordinated advocacy campaign for regulation and licensure of Certified Professional Midwives (CPMs)

WHAT:

The Big Push for Midwives Campaign will launch next week in Chicago on “PushDay” to advocate for regulation and licensure of Certified Professional Midwives (CPMs) in all 50 states and the District of Columbia. The Big Push Campaign is also pushing back against the attempts by the American Medical Association to deny American families access to legal midwifery care.

Following the PushDay news conference about the national campaign launch, there will be several activities, including a book signing by author and journalist Jennifer Block for her book “Pushed,” a film screening of the Ricki Lake and Abby Epstein documentary, “The Business of Being Born,” and a viewing of The Safe Motherhood Quilt Project created by midwife pioneer Ina May Gaskin.

WHY:

Currently, Certified Nurse-Midwives (CNMs), who work predominantly in hospital settings, are licensed and legal in all 50 states. Certified Professional Midwives (CPMs), who specialize in out-of-hospital delivery, are licensed and legal in fewer than half of our states. CPMs:

Are specifically trained to provide out-of-hospital maternity care for healthy women experiencing normal pregnancies.

Offer a family-centered model of care, which is associated with reducing the incidence of c-section, birth injury and trauma, as well as significantly reducing the cost of maternity care.

Play a vital role in reducing the two most preventable risk factors for infant mortality: low-birth weight and premature birth: babies born too small or too soon.

– Serve a disproportionate percentage of underserved populations, including low-income, rural, inner-city, immigrant, and uninsured families, as well as those Americans who choose out-of-hospital birth for deeply held cultural and philosophical reasons.

WHEN AND WHERE:

Thursday, JANUARY 24 at Courtyard by Marriott, 30 East Hubbard Street, Chicago

· 1 p.m. “PushDay” News Conference

· 1:30 p.m. “Pushed” book signing by author and journalist Jennifer Block

Viewing of The Safe Motherhood Quilt Project by Ina May Gaskin

· 2:30 p.m. Film screening of documentary “The Business of Being Born”

In addition, multiple states will have PushRallies and PushParties to kickoff the Big Push Campaign, such as Alabama, Idaho, Indiana, Missouri, North Carolina, Pennsylvania and South Dakota.

WHO:

The Big Push for Midwives Campaign is the first initiative of the National Birth Policy Coalition (NBPC), which was established in 2007 and is focused on increasing access to the Midwives Model of Care in all settings, as well as supporting legislative initiatives that promote the autonomous practice of Certified Professional Midwives and Certified Nurse-Midwives. So far, the NBPC has been endorsed by more than 20 organizations, including national and state midwifery organizations, as well as state consumer organizations.

CONTACT:

Media inquiries about the news conference, book signing, film event, or participating states PushEvents should be directed to Steff Hedenkamp (816) 506-4630, RedQuill@kc.rr.com.

Grassroots Network: Home Births to be covered by insurance in NH!

Both the House and the Senate in New Hampshire have passed bills that mandate insurance companies to cover home births! The two bills were slightly different, so not quite ready for the Governor's signature, but the bills passed by big margins. This is a terrific development for home birth and perhaps and example that will be useful for other states.

Read more about this news here.

Sincerely,
Susan Hodges, gatekeeper

Birth Book again

I received my personal copy of Birth Book today and I'm so delighted! I wanted to share the cover image here and will post an additional review when I have read the book. The book is the actual shape of the image shown--the white space is the remainder of the cover. So, it is an unusual size for a book.

So far, I have really enjoyed flipping through and admiring the gorgeous photos!

Orangutan Cesarean

I recently read a news article about Como Park Zoo and Conservatory where on Dec. 13 an orangutan had a cesarean section to deliver her baby.

The article goes on to share the following:

"When orangutan Markisa's labor began it became apparent that something was not right and that keepers and vets had to intervene. Fortunately, a birth management plan was prepared in advance which outlined steps to take for such a crisis. Markisa was transferred to the Veterinary Medical Center at the University of Minnesota where a cesarean section was performed on the orangutan by vets and medical staff from both the Veterinary Medical Center
and University of Minnesota Children's Hospital, Fairview."

Of course, this not only makes me reflect on the experiences of human mothers and babies every day, but also on the impact of human interference with the birth process regardless of the species involved. What impact did it have on this orangutan mother to have keepers and vets watching her labor with their "birth management plan...outlining crisis steps" in hand? It is well documented that animals do not labor well when they are watched. Primates, and human mothers too, need to labor in an environment where they feel safe and secure--usually one with lots of privacy. I wonder how the expectation and plan for crisis impacted the outcome of this orangutan mother's labor. As Michel Odent, MD, notes: "Our understanding of birth physiology is based on the simple fact that adrenaline (the emergency hormone mammals release when they are scared, when they are cold or when they feel observed [emphasis mine] and oxytocin are antagonistic. In other words, when human beings release adrenaline, they cannot release oxytocin."

Oxytocin is the hormone that facilitates labor. A synthetic form of oxytocin, know as Pitocin, is frequently given to mothers giving birth in hospitals.

And tellingly the news article concludes by noting...."The male baby orangutan was in critical condition the first few hours after delivery and the mother was transferred back to Como Zoo to recuperate." I suspect the critical condition of this baby resulted because all mammal babies are meant to immediately be placed on the "maternal nest"--i.e. their mother's chest with immediate access to the breast.

How many mothers labor each day in conditions similar to this primate mother? Under the watchful eyes of many people holding emergency management plans and expecting a crisis right around the corner....

Gentle Birth Choices & Waterbirth

Laboring in a pool of warm water has sometimes been referred to as the "midwife's epidural." Many women experience profound benefits of laboring in water, including a reduction in sensation of pain as well as an increase in feelings of peace and relaxation. Advocates feel it is a very gentle way to birth and to welcome a new baby. One of the pioneers of the use of hydrotherapy during labor is Barbara Harper, the author of the classic book Gentle Birth Choices. One of the extra cool things about this book is that it comes with a DVD of the video Gentle Birth Choices. This video is a favorite of childbirth educators and pregnant women. The video has a lot of interview clips and information about different birth issues and less actual birth content than some may like, but it is a good resource and also makes a good video for use in an educational presentation. I like good bargains, so I love getting extra value for my dollar and getting both a book and DVD for the price of one!

This book is an empowering resource for women who want to take the "reins" of their birth experiences and make their own, informed decisions.

Other good books about waterbirth include The Waterbirth Book by Janet Balaskas, reviewed here previously and the older, but still useful and interesting, Water Birth by Susanna Napierala.

We've long valued the work of Waterbirth International and the support and resources it has offered to families planning waterbirths. Now, the organization is facing financial hardship that threatens imminent closure. For more information about making a donation to keep Waterbirth International alive for the women and babies who need click here.

More media coverage of birth!

The stream of television programs addressing birth continues! In addition to the information from Susan below, I recently learned that the prenatal bellydance instructor interviewed recently on Good Morning America has had offers from two more news programs. I am hopeful that this new tide of positive birth coverage will have wide ranging effects on women's attitudes toward birth and what it can be.

------------------------------------------------------------
Grassroots Network: Ricki Lake on NBC.

Dear Friends,

This certainly has been a busy week for the Grassroots Network!

This morning, Ricki Lake was interviewed on The Today Show on NBC News about her film The Business of Being Born.

There is also the opportunity to comment there are already quite a few excellent comments, and you can add more! Scroll down the article to find a link for comments.

If you haven't seen the film yet, it is definitely worth viewing. Many people and organizations across the country are holding screenings. You can find out more here, but do note that the website does not list all screenings.

Sincerely,
Susan Hodges, gatekeeper

Grassroots News: Remembering Paula Mandell

Dear Friends,

In November (GNM 711025) I mentioned that Paula Mandell was very ill and no longer able to post the messages. She was at home in hospice care. I am sad to inform you that Paula passed away last Friday, at home with her family. She is survived by her best friend and husband, Steve Christensen, and her three daughters Lauren, Tess and Abby.

Paula gave generously of her time, talents and wisdom to CfM since 1996, and was a member of the Board from 2000 to 2005.

Please read more about her here (scroll to bottom). The Citizens for Midwifery Board will truly miss her, along with all who knew and loved her.

Sincerely,
Susan Hodges, gatekeeper

Grassroots News: Birth Segment on Good Morning America

From CfM President Susan Hodges:

The segment with Jennifer Block aired a little after 8 a.m. eastern time this morning Jan. 8.

You can read the whole story at on the Good Morning America website. If you scroll down to the end, you can read comments (over 400 at last check!) and add your own.

I thought the segment was remarkably even-handed for ABC News on such a controversial topic. Of course, they also had the representative doctor sharing his opinion that unassisted birth is dangerous and irresponsible etc., etc.

Sincerely,
Susan Hodges

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

The prenatal bellydancing segment that aired on Good Morning America on January 1 can also have comments contributed. I had a chance to view a tape of this segment this afternoon and it was presented positively overall. They spoke with a midwife in Missouri (the prenatal bellydance instructor) and also with a family physician who attends home births and birth center births--speaking as "an expert in natural birth." They showed some clips of one of the bellydancing class participants at home in labor preparing for a homebirth. I think it is exciting and encouraging to see topics like this on popular television programs and though the presentation or comments from the program hosts may not always be ideal (with negative or incorrect information), the fact that they bring birth to public attention is something to be excited about!

Molly :)

Motherbaby International Film Festival

Posting about the Business of Being Born made me think about an article I read this month in the January/February issue of Mothering magazine called Birth Film Revolution. The article is an overview of the films shown at the premiere launch of the new Motherbaby International Film Festival in September 2007. The article briefly summarizes 23 films about birth, midwifery, or breastfeeding. I have seen several of the films, but others were new to me.

"The Motherbaby International Film Festival (MIFF) is here to improve the images of birth, to empower women and inspire social change. A midwife once said, 'It's when we try to take control, that things get out of hand.' This Festival pictures birth in the respectful hands of the Mother."

One film I enjoy that was not on the list is Birth Joy & Raspberry Leaves, which is available from Compleat Mother magazine. This film is not as professional of quality as some of the more recently made films, but it shows five lovely waterbirths and is a really enjoyable video.

The Business of Being Born

This month marks the theatrical release of the dynamic new birth film The Business of Being Born produced by Ricki Lake and directed by Abby Epstein.

Here is a modified except of my review of this film from the fall issue of CfM News:

This film explores the culture of birth in the United States. Clips of current media portrayals of “typical” births--such as Maternity Ward—are contrasted with shadowing a homebirth midwife visiting with pregnant women and their partners in their homes. Interview clips are also interspersed throughout the film—interviews with doctors who are vocally and unpleasantly opposed to homebirth and midwifery as well as physicians expressing their support and enthusiasm. Clips with other experts are also shared, including one with CfM’s very own Susan Hodges.

The film includes footage of the homebirths of several of the couples interviewed prenatally. The births are gorgeous and lovingly portrayed. The film also shares intimate footage of Ricki Lake’s own homebirth in her bathtub. The birth was very beautiful and touching and it is stunning to see brash, confident Ricki in such a trusting and vulnerable state.

While I do have some lingering reservations about the way the filmmakers chose to close the film, my conclusion is that this was a very moving, engaging, and emotional film. I laughed, cried (at least three times!), and alternately felt outrage, triumph, disappointment, joy, shock, and excitement.

Action Alerts--Grassroots Network

From Susan Hodges on the Grassroots Network:

1. Medscape is running an Instant Poll regarding the legal ban on lay midwives (actually, all midwives except CNMs are illegal in Missouri). Click on the link below and you can voice your opinion! The poll runs through January 8.

Ban on Lay Midwifery Poll

In Missouri, lay midwives who oversee deliveries can be prosecuted for committing a class C felony. Although legislation had been passed to let lay midwives practice freely, it was recently overturned by a ruling in a lawsuit filed by opponents. Do you agree or disagree with the ban on lay midwifery? To vote or view results of the poll, click on the title above.

2. Jennifer Block is scheduled to appear on Good Morning America some time in the next couple of days (tentatively on Tuesday). The show airs on ABC from 7am-9am EST (check for other time zones). ABC will also be posting an excerpt of Pushed on their web site, and I imagine there will be room for comments, so be sure to leave your 2 cents if you have it to spare!

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

Good Morning America also recently aired a segment about belly dancing and childbirth featuring a midwife from Missouri!

More about Birth Book

I forgot to mention that the Birth Book copies sold by CfM are autographed by Raven Lang! The books are exact reprints except for a different cover image and the addition of page numbers (which according to many people is a very good addition). This is an extremely limited reprinting and CfM is very excited to offer these for sale! We will add a cover image soon.

Happy New Year! Here's to access to midwifery care throughout the country! And to beautiful births for families around the world!