I am a Midwife Campaign

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


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

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

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Molly
CfM Blogger

Why I Care

Some time ago I wrote a post about medical control as acceptable, in which I pondered the question of why do we care about birth, if many birthing women themselves don't really seem to care? Why do we make it any of our business what other women choose to do with their births?

Well, I've been doing some thinking and here is my list of why I care:

• Because women are suffering--birth trauma is real--see organizations like Solace for Mothers--and postpartum mood disorders are very common.
• Because babies are suffering--late pre-term births are increasingly common, many babies experience at least some post-birth separation from their mothers (which is not their biological expectation), and many babies spend time in the NICU. Infant mortality rates, especially for minority babies, are higher than in other industrialized countries.
• Because breastfeeding is suffering and thus public health is suffering (see my previous article on the birth-breastfeeding continuum)
• Because the physical costs of our current birth model are high--morality and morbidity rates are higher than necessary due to high volume of cesareans and many physicians and hospitals do not practice evidence-based care--continuing to deny laboring women food and drink and continuing to use Cytotec for inductions for example.
• Because the financial costs of our current birth model to society are high--birth is a multi-billion dollar a year industry. Some maternity care facts from CfM:
  • Over four million births in the US each year (26.4 births per 1000 women aged 15-44 years in 2004).
  • Second most common reason for hospitalization of women.
  • Care for mothers and babies combined rank 4^th for hospital expenses.
  • Hospital costs for deliveries mounted to more than $30 billion in 2004. More than 30% of births by cesarean section. ranking seventh highest total on the "national bill" for procedures (over $17 billion per year).
  • Of all births, 99% take place in hospitals, 90% are attended by obstetricians.
  • Over 6 million obstetric procedures are performed – the most common category of surgical procedures.

"The percentage of births paid for by Medicaid varies from state to state but can be as high as 50% or more in some states. Coverage by all insurers (Federal government, Medicaid, private, HMOs, etc.) varies; many will not reimburse for OOH births, and when midwives are covered, the reimbursement rate is only a percentage of the rate for physicians. We all pay for births, including unnecessary interventions and preventable complications and injuries, through our taxes, health insurance withholding, and individual policies."

• Because women's birth memories last a lifetime (see Simkin, Not just another day in a woman's life).
• Because women deserve better.
• Because I know in my heart that birth matters for women, for babies, for families, for culture, for society, and for the world.

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Molly
CfM Blogger

Maternal and Infant Mortality

Last month, I wrote a brief post about the Preconception Educators program sponsored by the US office of Minority Health. Since then, several other things have come to my attention that are related to either maternal or infant mortality. The Unnecesarean blog pointed out that there is an excellent video about infant mortality in the African-American population available from the Minority Health office. In fact, The Unnecesarean is also hosting a blog carnival about this video! (to run July 4th.)

The video is called Crisis in the Crib and emphasizes this fact: "The rate of death for black babies before their first birthday is twice the rate of white babies and greatly outpaces the national average."

Then, a friend sent me a link to an article about childbirth deaths focusing on the "350,000 women lose their lives each year giving birth or through complications of childbearing."

And, in the summer issue of Midwifery Today I read about the new report from Amnesty International called "Deadly Delivery" about the maternal health crisis in the US: "Mothers die not because the United States can't provide good care, but because it lacks the political will to make sure good care is available to all women." Bringing it full circle back to the Crisis in the Crib, I think we could amend that sentence to read, "mothers and babies die...because it lacks the political will to make sure good care is available to all women and their children."

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Molly

CfM Blogger

Preconception Educators

“People can feel especially fragile about giving birth because they hate to think they ‘did it wrong.’ We may defend one way of doing it because it is too threatening to think that there might have been a better alternative to the way we gave birth…go gently, and avoid the impulse to polarize or convert. Encourage each person to speak of her own experience in ‘I’ statements…” --Sacred Circles

I shared this quote in another blog post some time ago. It reminds me that perhaps the best avenue for birth advocacy is to back up and start talking to young women in high school or college, and not in trying to “preach” to other adult women who in all likelihood have very complicated reasons for making the choices they are making (and not being “enlightened” as to the “empowering way!” is usually not one of those reasons). If birth advocates are actually going to make meaningful changes (instead of enemies, or at least making women feel “unheard,” unacknowledged, dismissed, or misunderstood) they/we probably need to reach women before they are in that “fragile” or defensive state with regard to their own experiences.

Then, I received a notice about the federal Preconception Peer Educators Program (A Healthy Baby Begins with You), which trains college students as peer educators. A training is being held in Chicago in September to coincide with Infant Mortality Awareness Month and the program is seeking: 500 students/advisors from 20 states and the breakdown is as follows:

• 20 states
• 5 universities per state
• 4 students and 1 advisor per university

They are also encouraging each school to send at least one male student, which I think is good.

The emphasis of the training and program seems to be on reducing infant mortality, which of course is an important goal, but also one that is inextricably linked to optimal care of the mother (i.e. the kind of care offered by the Midwives Model of Care). So, I would hope to see more content within the program about maternity care, midwifery care, and birth rights in general, but I think it sounds like a very interesting, important, and useful program!

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Molly
CfM Blogger

Articles of Interest

I have a lot of projects going on lately that are taking precedence over blogging here in a frequent or creative way (I am pregnant with my third baby and recently started teaching college classes. I also teach birth classes on a regular basis, homeschool my two boys, etc., etc., etc.). Bear with me and in January I should have more blog-time again!

So, this week I wanted to share some links to articles I read recently:

Three Minute Interview with Ginger Garner (yoga therapist) from the National Association of Mothers' Centers focusing on "Childbirth in America: Why it Needs to Change."

A quote I enjoyed from the article: "Birth is valuable. It gives rise to our entire future. There is power in our ability to give birth to the future of our planet. We need to reclaim that power."

Pregnant Prisoners article. In one residential parenting program mentioned in the article, "Another perk for pregnant women at the prison is access to a volunteer doula program. A non-profit group called The Birth Attendants offers monthly prenatal care, labor and delivery assistance, postpartum services, and family planning education courses."

Also getting a lot of attention in birth activism blogs are the new international infant mortality rankings.

Available at: http://www.cdc.gov/nchs/

Or directly from: http://www.cdc.gov/nchs/data/databriefs/db23.htm

Key findings

Infant mortality rates for preterm (less than 37 weeks of gestation) infants are lower in the United States than in most European countries; however, infant mortality rates for infants born at 37 weeks of gestation or more are higher in the United States than in most European countries.

One in 8 births in the United States were born preterm, compared with 1 in 18 births in Ireland and Finland.

If the United States had Sweden’s distribution of births by gestational age, nearly 8,000 infant deaths would be averted each year and the U.S. infant mortality rate would be one-third lower.

The main cause of the United States’ high infant mortality rate when compared with Europe is the very high percentage of preterm births in the United States.

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Molly
CfM Blogger

Grassroots Network: Infant Mortality Awareness Campaign!

Dear Friends,

The International Center for Traditional Childbearing (ICTC) is observing September National Infant Mortality Awareness Month (September) with the Heads Up on Infant Mortality Campaign. Citizens for Midwifery is supporting this public awareness effort with our sponsorship.

The goals of Infant Mortality Awareness Month are to increase national awareness of contributing factors to infant mortality, and to urge community leaders to assist in efforts to reduce the rate of infant mortality in this country by 2010. The US ranks 30^th in the world for infant mortality, and African American babies are twice as likely to die during the first year, with a mortality rate of 13.5 per 1,000 live births compared to 5.7 per 1,000 live births for whites and Hispanics, according to CDC data.

While many factors affect infant mortality, midwifery care is part of the solution, since midwives provide the kind of holistic prenatal and birth care that results in healthier mothers and babies.

The Heads Up on Infant Mortality Campaign seeks to raise awareness about the tragedy of infant mortality by asking people to knit or crochet baby hats, one for each of the 27,000 babies lost in 2008. All hats received by September 15 will be displayed in ICTC's Infant Mortality Awareness Rally in Washington, DC on September 26. The more hats, the more attention will be raised at the rally (and afterward the hats will be donated for premature babies). So get out the yarn and start knitting or crocheting! Find several quick patterns on the ICTC website!

For more information:

Flier: http://www.blackmidwives.org/headsupflyer.pdf

Press release: http://www.blackmidwives.org/natlheadsuppressrelease.pdf

Quick knitting & crochet patterns: http://www.blackmidwives.org/component/content/article/85

Sincerely,
Susan Hodges, "gatekeeper"

Note from Molly: A local mother's group that I belong to is getting together for a "Knit Night" to knit/crochet hats for this Campaign. While we're at it, we're going to view/discuss the new film Laboring Under an Illusion.

Reducing Infant Mortality Film

In June I posted about a new film called Reducing Infant Mortality. Yesterday, the film was released and is available to watch for free!

Reducing Infant Mortality from Debby Takikawa on Vimeo.

Reducing Infant Mortality Film

A trailer is now available for Reducing Infant Mortality, a FREE film being made "about how our health care system is failing babies and mothers and what we can do about it." Here are some more details from the filmmakers:

The film will be out July 26th. It will be 10-12 minutes long, and is made for everyone one who wants to, to send to their representatives and senators. Our idea is that if people send the link to the film and the politicians receive many of them along with our personal messages about what kind of Health Care Reforms we want to see, we can help move toward a more humane way of bringing our babies into the world -- creating a model that includes an emphasis on skin to skin contact, bonding and breast feeding -- a model that supports the family and family connections.

The film is a carefully crafted proposal for a shift in the way we approach maternal infant medical care. Included in our proposal is the economic component, as well as the unnecessary cost of life and health. We go on to explain how the inclusion of midwives in the model makes sense on every level. It is all voiced by MDs with substantial degrees and positions, no one on the fringe, all with impeccable credentials. I believe that it helps our case to hear the words coming from people who are currently considered by the mainstream to be the experts on birth. It is, after all, the mainstream that we wish to influence. I did everything I could to make it totally credible for the fight that is happening in congress. All statistics have been researched. The March of Dimes gave us permission to use their graphics.

There are definitely a lot of experts interviewed for this film. It sounds like there are exciting plans for it to reach a wide audience.

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Molly
CfM Blogger

Grassroots Network: New Infant Mortality Stats & Comparisons, and C-section death in Boston

Dear Friends,

A maternal death resulting from a cesarean section was reported in Boston, a very sad event. You can read a report here.

This event and the report are a reminder that women are 4 times as likely to die in connection with a cesarean compared to the risk of death with a vaginal birth. Another reason the work for changes in maternity care.

The CDC has just issued a new report: “Recent Trends in Infant Mortality in the United States” which you can find here. The report includes many bar graphs, and includes international comparisons, demonstrating the US’s poor standing. You can also read the excellent New York Times article on this report.

After reading these, all I can think about is how widespread use of the Midwives Model of Care would result in more healthy, living mothers and more healthy, full term, full weight living infants…

Sincerely,
Susan Hodges “gatekeeper”

Mother-Friendly Childbirth Forum

As I write, three CfM Board members are at the Coalition for Improving Maternity Care Services (CIMS) Forum in Florida. Today was the opening day of the Forum and I'm sure there is lots of great stuff going on!

Watch for an update on the Forum after the Board members return! They are definitely going to be busy this weekend. They are each co-presenting sessions at this event. Carolyn is presenting during the session, “Learn to Gather Intervention Statistics and Market The Birth Survey.” Susan will help present “Using the Evidence Basis for the Ten Steps of Mother-Friendly Care in Your Community,” and is participating in a plenary discussion on “Making Mother-Friendly Care a Reality.” She will also be on the panel discussion following a screening of The Business of Being Born. Nasima, who is also a leader on the CIMS Grassroots Advocates Committee (GAC) and worked on the Planning Team, has perhaps been the busiest preparing for the Forum. She and the other GAC leaders are presenting a plenary session on “CIMS Grassroots Advocates Committee (GAC): Transparency in Maternity Care Pilot Site Results and National Launch.” Nasima is also presenting a workshop on “Creating Birth Change: Grassroots Advocacy Effective Resources and Tools.”

You can read more about each of their presentations in follow-up articles in the fall issue of CfM News. These Board members are working so hard on behalf of Citizens for Midwifery as well as for women everywhere who are seeking access to mother-friendly, maternity care!

From the Forum press release:

"The United States spends more on healthcare than any country in the world, $79 billion in 2005. Pregnancy and delivery and newborn care are 2nd and 3rd most expensive conditions treated in U.S. hospitals and the two most expensive conditions billed to Medicaid and private insurance. Despite these burdensome costs fewer newborns die in countries like Lithuania, Slovenia, Israel, Greece, and Portugal. One in 4,800 women in the U.S. are likely to die from pregnancy-related causes compared to 1 in 9,600 in Kuwait, 1 in 17,800 in Denmark, and 1 in 47,600 in Ireland. The CDC estimates the true level of U.S. maternal deaths may be 1.3 to 3 times higher than the reported rate. At the 2008 Mother-Friendly Childbirth Forum hosted by the Coalition for Improving Maternity Services (CIMS), March 6-8 in Kissimmee, Florida, expert speakers will address this issue and explore solutions for what can be done to reduce the maternal and infant mortality rate while enhancing care for the nation's most vulnerable populations - mothers and babies."