Keepsake Ultrasound Ban

The governor of Connecticut recently signed a ban on "keepsake ultrasounds" (the kind that are performed "for fun" at a store in the mall, for example). The bill "bars anyone from performing ultrasounds on pregnant women unless a doctor orders them for medical or diagnostic purposes."

See: Conn. governor signs keepsake ultrasound ban

I have very mixed feelings about this ban. While I agree that unnecessary ultrasounds should not be performed, legal "bans" make me uneasy--for example, what if a governor decides "banning homebirth" is a good idea or "banning midwifery." When things like this happen, I start to worry about a slippery slope of governmental interference with parental health care decision-making.

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Molly
CfM Blogger

Pit to Distress

There has been a lot of chatter on the internet recently about the "pit to distress" phenomenon apparently practiced in some hospitals. The phrase referred to the administration of Pitocin until the baby goes into distress and a cesarean can be performed. The Unnecesarean blog (as well as others) covered the topic in such depth, I don't have much to add! See this post and this post for her thoughts and quotes from a variety of sources. She quotes Keyboard Revolutionary (who I believe started the whole blog-flurry) as saying, “'OBs, do you still think women are choosing not to birth at your hospitals because Ricki Lake said homebirths are cool? Do you still think we are only out for a 'good experience?'"

Nursing Birth also has an excellent post on the subject.

All these posts and the "pit to distress" subject keeps making me think of the quote that opens Henci Goer's Obstetric Myths vs. Research Realities book: "Facts can be disproved, and theories based on them will yield in time to rational arguments and proof that they don't work. But myth has its own furious, inherent reason-to-be because it is tied to desire. Prove it false a hundred times, and it will still endure because it is true as an expression of feeling...It is illogical--or at least, pre-logical; but from this very fact it gains a certain strength: logic may disprove it, but it will not kill it."

This, to me, explains the essence of why harmful maternity care practices continue to persist in hospital settings.

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Molly

CfM Blogger

ACNM Opposition Letter

On Wednesday, the American College of Nurse Midwives (ACNM) posted a letter to Congress expressing opposition to the proposal to federally recognize Certified Professional Midwives under the Social Security Act (which would make CPMs eligible for Medicaid reimbursement). The letter emphasizes differences in educational preparation for CNMs vs. CPMs. ACNM also sent a letter to the membership regarding the organization's opposition to the MAMA Campaign.

The Midwives Allianace of North America (MANA) has responded to these letters here with an exploration and critique of some of the claims made by ACNM.

Citizens for Midwifery is part of the coalition of organizations behind the MAMA Campaign that supports federal recognition of CPMs.

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Molly
CfM Blogger

Homebirth in the Hospital

I recently finished reading a new book called Homebirth in the Hospital (watch for my full review in the fall issue of CfM News). The book proposes an "integrative" model of childbirth--integrating natural childbirth with modern medicine. Interestingly, immediately after finishing the book I happened to come across the website of an OB practice in New York City called Village Obstetrics. With the tagline "minimally invasive obstetrics," this practice seems to be exactly the sort of integrative practice proposed by Stacey Marie Kerr in her book. I thought it was a neat coincidence. I was especially interested in the practice statistics on the Village OB site--they are excellent! (And it goes to show that when providers are proud of their stats, they have no trouble sharing them. It is a red flag if you ask a practitioner about their stats and they "aren't sure" or an unwilling to reveal them to you.) Without including scheduled cesareans (which appeared to be for legitimate reasons), they have a 6% cesarean rate (+ an additional 15% for various reasons)!

The Homebirth in the Hospital book doesn't address statistics specifically, but I assume physicians following that model would have similar, lower rates of interventions. (Do note that there are other things on the Village OB site, such as encouragement of continuous monitoring, that do not seem consistent with an integrative model.)

I finished the book (and the OB practice's site) feeling like a "homebirth" in a hospital is most definitely not for me (not really enough like homebirth at all!), but also feeling glad and optimistic that there are medical care providers out there who are seeking to practice in integrative ways that respect birth and women. I also am fully aware that the vast majority of American women give birth in hospitals and I think we desperately need other hospital-based healthy birth options to meet those women's needs!

I was also reminded of a section in the book Birthwork that addresses complementary care:

Parents who have quite comfortably given birth naturally and taken responsibility for their health are often perplexed by the zeal with which the medical model is upheld and promoted...Conversely, ardent natural birth activists can similarly perplex and infuriate those who have been grateful for necessary medical help their received when they gave birth in a hospital.

Like all great systems of belief, the revelations and tools of borth modern medical birth and natural birth are there to be embraced by those who choose to embrace them, and to be kindly offered to those who may benefit from them. We need to begin by negotiating the confusion that exists around the availability and right to medical help for a planned natural birth, and the availability and right to birth naturally within a medical setting. Rather than insisting on one right away, we need to appreciate that different systems of care can be complementary and helpful to one another. They can work together.

This section also reminded me of the recent study from the Netherlands about the safety of homebirth and how their maternity care system is is much more cooperative than we see here as it promotes access to midwifery as well as a good transportation and referral system (which necessitates working, egalitarian relationships between care providers).

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Molly
CfM Blogger

Legislative Alert re: Birth Centers

From the American Association of Birth Centers:

Medicaid Birth Center Reimbursement Act

Introduced in the Senate - S.1423

This has been a very busy week week in Washington, DC! In the Senate, U.S. Senators Barbara Boxer (D-CA) and Mark Begich (D-AK) introduced S.1423 the Medicaid Birth Center Reimbursement Act to ensure Medicaid birth center facility fee payments to states. In the House, the health care reform bill H.R. 3200 "America's Affordable Health Choices Act of 2009" was introduced. This bill includes the birth center bill language but it does not guarantee that all state Medicaid plans will cover the facility fee. It is CRITICAL that we have strong co-sponsorship for our bills in the House and the Senate. This means that we need YOU and your colleagues, family members, clients and friends to contact your federal Senators and Representatives RIGHT AWAY.

IMPERATIVE ACTIONS Continue to work in the House and the Senate to secure co-sponsors for our bills (H.R. 2358 and S.1423). 1) Call your U.S. Senators and Representatives. Click here for directions on how to contact your Representatives and Senators and what to say. After you have made your calls, please call or email AABC's lobbyist Karen Fennell and tell her who you talked with and any comments or additional information requested. Call Karen at 301-830-3910; Send email here. This report to Karen is important so that she can follow-up. 2) Invite your Senators and Representatives to an Open House at your birth center during the August recess (the entire month of August). Invite the media and your clients to come. This is a win-win. The legislators and the birth center will receive positive press. We will develop an "Open House" packet and post it online in a few days for you to adapt for your community. 3) Attend the town hall meetings on health care reform that are being held across the country and make your voice heard at those meetings. We MUST be prepared with strong co-sponsorship to move our legislation.

Who is already a co-sponsor? House Bill H.R. 2358 Sponsor: Susan Davis (CA) Co-Sponsors: Gus Bilirakis (FL), Lois Capps (CA), Robert Whittman (VA), Tammy Baldwin (WI), Sander Levin (MI), Diana DeGette (CO), Eric Massa (NY), and Janice Schakowsky (IL) Senate Bill S.1423 Sponsor: Barbara Boxer (CA) Co-Sponsor: Mark Begich (AK)

We need EVERYONE to take action and ensure that our bill is passed as soon as possible! Sincerely,

Jill Alliman, CNM, MSN Chair, Legislative Committee American Association of Birth Centers

Letters Needed to Australia Senate Committee by July 20

Received this message from the Maternity Coalition in Australia:

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You may have heard that women's right to choose homebirth with a midwife in Australia is currently under threat.

Three Bills have been introduced to our Commonwealth Parliament to implement the Government's maternity reform agenda. These Bills give Medicare (government healthcare funding) and subsidised insurance to eligible midwives - a huge breakthrough for Australian women. It means that from November 2010, Australian women will be able to choose a midwife in private practice to provide them with continuity of care through pregnancy, labour and birth.

The problem is that the Government doesn't intend the funding or insurance to cover homebirths, at this stage. And under proposed National Registration rules, midwives will need insurance covering every aspect of their practice, in order to be registered. Effectively this will prevent midwives in private practice attending women birthing at home from 1 July 2010.

A Senate Committee is investigating all the facts relating to insurance for homebirth so our politicians can make an informed decision. This committee is seeking submissions on the issue.

We believe it’s vital that the Senate Review committee receive submissions from internationally-respected organisations and professionals.

Please consider writing a brief submission from your organisation to the Senate Committee telling them that it is essential that women retain the right to choose homebirth, with a midwife in private practice.

http://www.aph.gov.au/Senate/committee/clac_ctte/health_leg_midwives_nurse_practitioners_09/index.htm

PLEASE NOTE: SUBMISSIONS CLOSE 20 JULY

If midwives lose their right to attend homebirths in Australia, other countries’ governments could use our example to enact similar legislation.

Mothers and midwives across Australia are working tirelessly – holding rallies, writing letters to politicians, meeting with them, speaking to bureaucrats, writing submissions, etc.

We implore that you add your international voices to ours.

Please forward this email far and wide amongst your networks.

See attached:
+Maternity Coalition’s fact sheet about the issues as we understand them
+Homebirth Australia’s info sheet on how to make a submission to the Senate Review committee

--
Melissa Fox
Mother of Lily (4) and Mia (1)
Maternity Coalition Inc
Brisbane
AUSTRALIA
Ph: +61 7 3846 4664
Mob: +61 404 88 2716
Web: Maternity Coalition

Articles

A couple of interesting articles caught my eye today:

Delivering Affordable Health Care--this article in American Prospect talks about recent midwifery legislation in Idaho and also raises the point that homebirth and midwifery care are good for the "pocketbooks" of both women AND the government. It was written by doula-blogger Miriam Perez who also writes an interesting and thought-provoking blog called Radical Doula.

Why mothers should put up with pain of childbirth - by a male expert in midwifery was published in the Daily Mail this week. The article is getting a lot of critical comments along the lines of "no uterus, no vote," which I can see the sentiment behind. However, his basic point is a sound one (I think!): "[labor]..should be considered a ‘rite of passage’ and a ‘purposeful, useful thing.’"

Community-Based Doulas: A Good Investment in the Future was published on The Huffington Post last week. Written (surprisingly to me!) by Jane Fonda, she talks about her hope that one day every WIC program in the country will have a community-based doula program. As a matter of fact, in Springfield, MO about two hours from where I live, there is a program similar to what she describes called The Doula Foundation of Mid-America. I'm hopeful the this program will spread closer to my own community within the next several years. A similar article was included in the new book The Doula Guide to Birth that I am presently reading.

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Molly
CfM Blogger

Nice New Resource

Injoy has teamed up with Lamaze to produce a nice little website with pdf handouts and video clips about "how to have a better birth." Titled Mother's Advocate, the site also has a nice 18 page booklet available called Healthy Birth Your Way. The handouts and video clips are based on Lamaze's Six Care Practices (last year CfM developed a handout incorporating these practices called "What Does Good Maternity Care Look Like?").

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Molly
CfM Blogger

Free Domestic Violence Resources

When I was a junior in college, I began volunteering at a shelter for battered women (every Wednesday morning I answered the crisis line and every Saturday night I worked alone as "shelter relief" doing anything that needed to be done). I connected deeply with this work and it was tremendously important to me. I carried my passion for it into graduate school and did my master's "block field placement" at another shelter for battered women. Though it has now been quite a few years since I last set foot in a shelter environment, I will always have a special interest in domestic violence and the needs of battered women. My life's passion has shifted to birthwork and activism for healthy birth options for women, but this passion is firmly rooted in the commitment to women's health and social justice for women that blossomed in me during those many shifts at the shelter in college.

I've written previously about violence against women both medical and domestic and I was excited to learn from a post on the allDoulas forums that there is new FREE Online Training for Health Care Professionals about domestic violence during pregnancy available from Safe Place, a shelter in Austin, TX.

"Domestic Violence & Pregnancy: Effective Screening and Intervention is a 1.5 hour on-line training is intended for staff nurses, advanced practice nurses, physician assistants, social workers, case managers and physicians in the Ob/Gyn and family planning settings. This training will explore the fundamental domestic violence knowledge required to identify, treat, document and, if necessary, report domestic abuse. CNEs (Texas) and CEUs (Texas) are available."

In 2004, I wrote a booklet called Talking to a Battered Woman that I recently decided to make available as a free pdf from my personal site.
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Molly
CfM Blogger

Items of Interest

On the Mindful Mama website this past week I was interested to read an article called Five Things Every Woman Should Know Before Giving Birth.

Written by the author of a fairly new book titled Homebirth in the Hospital, she suggests 6 "C's" for having a "homebirth in the hospital":

• First, take responsibility for your choices.
  

• Expect communication to be open and flowing both ways

• Pay attention to continuity of care

• The confidence you have in your provider and in your birth team is essential.
  

• In any hospital, there must be control of protocols...I can not stress this point strongly enough: Protocols are the most disempowering aspect of modern maternity care, giving the message that our bodies don’t really know how to have babies without someone else managing the process for us.

• Finally, the sixth C to consider, the one that should never be allowed into a birth: conflict. Conflict releases stress hormones that work against the powerful hormones that facilitate birth. Humans are mammals, and no mammal gives birth easily when fearful or in an unsafe situation. If you resolve most issues long before your first contraction, you shouldn’t have to fight for your choices while you are in labor.

The author is also interviewed in a video clip on the site about Finding Your Power in Birth:



Also from Mindful Mama is another short Penny Simkin video called Alternative Ways to Relieve Labor Pain (she teaches a hand massage technique):



Finally, I'm a little behind in mentioning this, but a Letter to the Editor from OBOS director Judy Norsigian regarding Evidence-Based Labor and Delivery Management was published in the American Journal of Obstetrics and Gynecology in May. The conclusion of the letter was: "In the absence of adequate evidence, we believe that the American College of Obstetricians and Gynecologists should retract its strong opposition to home births."

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Molly
CfM Blogger

Australia Homebirth Video

This is a video with images drawn from a rally in Australia to protest the recent legislation that threatens to destroy homebirth midwifery:


~ we love homebirth ~

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Molly
CfM Blogger

Maternal-Fetal Conflict

Critiques of homebirth sometimes rest on a (flawed) assumption of maternal-fetal conflict (which is also invoked to describe situations with substance abuse or other risky behavior). In the Fall 2007 issue of CfM News, Board member Willa Powell wrote about maternal-fetal conflict in response to an ABC segment on unassisted birth. She wrote:

[quoting the expert physician interviewed for the segment] "The few hours of labor are the most dangerous time during the entire lifetime of that soon to be born child. Because of this, I would argue, all soon to be born children have a right to access to immediate cesearean delivery, and women who insist on denying this right are irresponsible."

This was the only professional opinion in the program on unassisted birth, and he set up a typical expression of an obstetric community belief: the “maternal-fetal conflict.” The notion is that there are two “patients”, where the mother’s desires are sometimes in conflict with the well-being of the baby, and that the obstetrician has a moral/professional obligation to abandon the mother in favor of the baby.

I have to remind myself that Dr. Chervenak is setting up a false choice. In fact, this scenario is a “doctor-patient conflict”. The mother wants what’s best for herself and her child, but she disagrees with her doctor about what is, in fact, best. Women are making choices they believe are best for themselves and best for their babies, but those choices are often at odds with what doctors consider best for both, and certainly at odds with what is best for the obstetrician!

In the book Birth Tides, the author discusses maternal-fetal conflict:

According to obstetricians, the infant's need to be born in what they have defined as a safe environment, i.e. an obstetric unit, takes precedence over the mother's desire to give birth in what doctors have described as the comfort of her own home. It is a perspective that pits the baby's needs against those of the mother, setting 'overriding' physical needs against 'mere' psychological ones. It is rooted in the perception that the baby is a passenger in the carriage of its mother's body--the 'hard and soft passages,' as they are called. It is also rooted in the notion of the mind-body split, in the idea that the two are separate and function, somehow, independently of each other, just like the passenger and the passages. While women may speak about 'carrying' babies, they do not see themselves as 'carriers,' any more than they regard their babies as 'parasites' in the 'maternal environment.' If you see your baby as a part of you, there can be no conflicts on interests between you.

I previously linked to a book review that explores this concept of the more aptly described "obstetric conflict" in even more depth.

Tomorrow is Independence Day and I think it is fitting to remember that mother and baby dyads are NOT independent of each other. I have written before about the concept of mamatoto--or, motherbaby--the idea that mother and baby are a single psychobiological organism whose needs are in harmony (what's good for one is good for the other).

As Willa concluded in her CfM News article, "...we must reject the language that portrays a mother as hostile to her baby, just because she disagrees with her doctor."

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Molly
CfM Blogger

Physicians & Birth

A few weeks ago, I read an older book titled Woman-Centered Pregnancy and Birth. I marked the following quote to share because I thought it succinctly summed up one of the primary issues in maternity care:

"The major problem which arose almost as soon as physicians started attending women in birth is the same problem which exists today in obstetrics: physicians use their medical techniques when they are not really necessary and their technology and practices often create more problems than they solve. It is possible to appropriately apply this criticism to nearly every form of technology which has been used by physicians on women in birth from the 1500's to the present."

I also noted an observation from the book Birth Tides: Turning Towards Homebirth: "To these people, it seems as thought the medical system has been reduced to a form of social control. [Another woman] makes the point, however, that controlling women has always been an intrinsic part of antenatal care."

I think the recent AMA resolutions I've posted about and the situation with private midwifery in Australia lend credence to the idea that the medical system is a form of social control!

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Molly
CfM Blogger

Midwifery in Australia

As some of you may already know, legislation passed in Australia that effectively renders homebirth inaccessible and homebirth midwifery illegal. I haven't seen a lot of birth blog coverage of this distressing development, but news stories have been popping up in my Google Alerts like crazy:

Uninsured midwives face home birth ban

Tough new laws to make homebirths illegal

Law to stop midwives working outside hospitals

Fears on mid-wife impact with new birthing regulations

Maternity group slams midwife legislation

A few other international articles came to my attention recently also:

MIDWIFE CRISIS BRINGS MISERY TO THOUSANDS (UK)

Global Shortage of Midwives Deadly: WHO

Finally, I wanted to link to a recent New York Times article by a CNM about her experience during a stillbirth at a hospital: In a Lifeless Birth, a Midwife’s Opened Eyes

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Molly
CfM Blogger

Birth Matters Virginia Video Contest Winners!

Birth Matters Virginia announced the winners of their video contest today. The first place winner was to Ragan Cohen for Prevent Cesarean Surgery:



Second place went to Laura Alvarez for The Nature of Natural Birth:



And Honorable Mention to Becky Carey for Misconception:



You can see the other finalists here.

Congratulations to the winners! What great contributions!

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Molly
CfM Blogger

Grassroots Network: MAMA Letter-Writing Campaign

Dear Friends,

Please join the M.A.M.A. campaign effort to send an outpouring of personal letters to U.S. Senators and Representatives to their local district offices this week.

Sincerely,
Arielle Greenberg Bywater, "gatekeeper sidekick"

In this message:
A. Greetings and Background Information
B. Instructions for Letter Writing
C. Sample Letter

A. Greetings, mothers, midwives and supporters of maternity care choices!

We need all your energy and enthusiasm for our ambitious policy goals on behalf of pregnant women across the nation and the Certified Professional Midwives who can provide services to them. This is the MOMENT for action!

Just last week, the Midwives and Mothers in Action (MAMA) Campaign organized twenty midwives and consumers to visit their Congress members in Washington DC and tell them about midwifery care. This lobbying push is a vital part of the MAMA Campaign mission to increase all women's access to midwives and to quality, affordable maternity care by achieving federal recognition of Certified Professional Midwives (CPMs).

The MAMA Campaign was established by a coalition of six key national midwifery and consumer organizations.

Our immediate goal is to get an amendment into the health care bills currently moving through Congress to mandate federal Medicaid coverage for CPM services. Health care reform is at a pivotal point and we have an unprecedented opportunity to inform Congressional members about the skilled, high quality maternity care provided by CPMs and the cost savings CPMs can achieve. Congressional members are particularly interested in what their constituents are thinking.

So now we need your help …
• Please join the effort to send an outpouring of personal letters to U.S. Senators and Representatives to their local district offices this week. We've learned this is the best way to get their attention on fast-moving urgent policy issues.

• Please read further to see a sample letter you can use, and tips for writing. Your role in the MAMA Campaign is so important. Now is your chance to stand up and be counted!

Thank you for your support!


B. Writing Your Congress Members – Suggestions & Instructions

THANK YOU! Contacting your U.S. Senators and Representatives is important! Please mail your letters to their local district offices.
You'll find a sample letter below these instructions; use or adapt this language for your own personalized letter to your members of Congress. If you have any questions or need assistance please contact Evelyn deFrees, Campaign Manager (info@mamacampaign.org).

Eight points to remember when writing your own letter:

1. Ask: Please be sure to include the specific "ask," underlined in the first and final paragraphs of the sample letter (the "ask" is what you want your Senator or Representative to do).

2. Information: The second paragraph is an important part of the message. Feel free to use other words in paragraphs 3 and 4 to explain why Certified Professional Midwives should be added as Medicaid providers. See handout "Midwives and Mothers in Action: Improve Maternity Care Quality by Expanding Patient Choice"

3. Your story: A sentence or two about your "story" personalizes the letter; describe a birth or birth provider experience you or a family member or friend has had, or why you are passionate about this issue.

4. NOTE: Please ALWAYS write out "Certified Professional Midwife"; do NOT use "CPM" by itself (which is frequently misinterpreted with the more familiar "CNM").

5. CPM Facts: If you want to write about the CPM credential and/or education, please use the CPM FAQ sheet – please stick to that exact language, which has been carefully developed for this purpose.

6. Format: Neat, hand-written letters are the most effective – it shows that someone cared enough about the issue to take their time to personally sit down and write to their congress member. Typed, printed and signed letters are next best. Make sure your name and address with zipcode are on your letters as well as the envelope.

7. District Offices: Please send letters to your U.S. Senator and/or Representative's local district/state office (mail to their Washington office would take several weeks to get to them). For addresses: Visit www.house.gov and www.senate.gov ; once on these homepages, click on the search tool in the upper corners of the pages to find your own U.S. Senator or Representatives, and their websites and addresses for district offices.

8. Tell us you've taken action: Please send us a copy of your letter so we can track what policy-makers are hearing from constituents like you about the urgent need for federal recognition of Certified Professional Midwives. Please send a copy to info@mamacampaign.org or to MAMA Campaign c/o NACPM, 243 Banning Road, Putney VT 05346

C. SAMPLE LETTER for CONGRESS MEMBERS

[Date]
The Honorable [Full Name]
[Street Address]
[City], [State] [Zip]


Dear [Senator/Representative Last Name]:

Congress is now debating comprehensive health reform legislation. I urge you to ensure that the maternity care needs of millions of women and their families are addressed by your support for adding Certified Professional Midwives (CPMs)--who are licensed by their states--to the list of Medicaid-eligible providers recognized at the federal level. Health care reform must address the problems and high costs of maternity care in the U.S and ensure safe, qualified maternity care providers for all pregnant women.

Safe high-quality care: Today in many states across the country women seek safe, high-quality, health-promoting maternity care provided by Certified Professional Midwives who provide excellent childbirth outcomes with a fraction of the medical interventions (including cesarean section). I received my prenatal care and delivered my baby with the assistance of a Certified Professional Midwife and believe all women in our state and country should have this safe, cost-effective choice regardless of their income level.

Cost Effective: Pregnant women on Medicaid deserve access to the full range of maternity care providers including Certified Professional Midwives. The choice of Certified Professional Midwives is often restricted to those with private insurance coverage or the capacity to pay out-of-pocket. Adding Certified Professional Midwives to the Medicaid list would start reducing health care costs immediately.

Choice at lower cost: Childbirth is the number one reason for hospitalization in the US, accounting for $86 billion in annual expenditures in 2006. Much of that spending is driven by costly, overused and unnecessary interventions. Certified Professional Midwives can help Congress deliver on the basic goals of health care reform: preserving a patient's choice of health care provider while simultaneously improving quality and outcomes, at lower cost. Expanding Medicaid coverage to include services provided by Certified Professional Midwives is the equitable thing to do. The tremendous cost and quality advantages make it sound public policy.

Please support this important change to the law governing Medicaid so that Certified Professional Midwives who are licensed by their states are added to the list of Medicaid-eligible providers recognized at the federal level. Thank you for your time.


Sincerely,

[Your name]
[Address]
[Phone number]


Please visit the Midwives and Mothers in Action Campaign online.

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.

--
Molly
CfM Blogger

Fetal Monitoring

I started to write about this in my previous post and then realized it actually belonged in its own post!

The author of Bearing Meaning spends an entire chapter analyzing Williams Obstetrics and the language of birth contained therein. In Williams fetal monitoring is referred to as an "elegant means" of "demonstrating the effect of the forces of labor and delivery on the baby's heart rate." However, as the author of Bearing Meaning (Robbie Kahn) notes, "The tracings don't record labor in a generic sense. They record it under specific conditions--the hospital...Thus, monitor tracings hardly are elegant, if elegant means imparting information at high levels of sophistication. Indeed, the monitor may be simply recording responses characteristic of a woman laboring under the conditions imposed in the hospital rather than imparting sophisticated information about childbirth in general." (emphasis mine).

This observation reminded me of Henci Goer's recent post on the Science and Sensibility blog: The Labor Environment: “Many things that count cannot be counted." In this post, she looks at a recent study published in the June issue of Birth, "gauging the effects of modifying the labor room to encourage mobility, reduce stress and anxiety, and discourage routine medical intervention." The labor environment impacts women's birth experiences in a number of ways (some that cannot be quantified for research studies) and my observation is that fetal monitoring is one of the most significant elements of the labor environment. It creates conditions for laboring women that then alters their normal, physiological, spontaneous responses to labor and thus cannot be seen as accurately reflecting the influence of labor on the baby.

Speaking of fetal monitoring, ACOG just issued new guidelines refining the fetal heart rate monitoring guidelines. The guidelines briefly refer to manual auscultation. Quoted in the release is the following comment: "'Since 1980, the use of EFM has grown dramatically, from being used on 45% of pregnant women in labor to 85% in 2002,' says George A. Macones, MD, who headed the development of the ACOG document. 'Although EFM is the most common obstetric procedure today, unfortunately it hasn't reduced perinatal mortality or the risk of cerebral palsy. In fact, the rate of cerebral palsy has essentially remained the same since World War II despite fetal monitoring and all of our advancements in treatments and interventions.'"

--
Molly
CfM Blogger

Breastfeeding Podcasts

Yesterday I discovered some podcasts on on the Motherwear blog. It is great fun to listen to podcasts while doing other work on the computer and I enjoyed finding some new ones. I listened to a thoughtful one by Penny Simkin called: Podcast: Early sexual abuse and breastfeeding. A point she makes that is that during labor if we suspect that a woman has an abuse history it isn't important to actually know if she does, she can just be treated as if she has an abuse history--and this only means she will be treated with more respect, more caring, more gentleness, and her needs are more likely to be met.

I haven't listened to any of the others yet, but I'm looking forward to all of them (especially the one about breastfeeding in the movies, which reminds me of the new film Laboring Under an Illusion that I'm looking forward to seeing):

• African American moms and breastfeeding, with Kathi Barber
• How do other mammals do it? With Dia Michels
• What's the problem with those formula company bags? With Alison Stuebe
• Starting solid foods, with Ellyn Satter
• Breastfeeding in the movies, with Sarah Rubenstein Gillis
• Low milk supply: Could it be your hormones? With Lisa Marasco
• So, you want to work in breastfeeding support (just me)
  
• Nursing in public and the law, with Jake Marcus
• Making more milk, with Diana West
• Hathor the Cow Goddess, with Heather Cushman-Dowdee
• Postpartum depression and breastfeeding, with Kathleen Kendall-Tackett
• MilkShare, with Kelly Faulkner
• The Milk Memos, with Cate Colburn-Smith

Coincidentally, I just bought The Milk Memos at the LLL of Missouri conference earlier this month. Also in my to-read pile is Diana West's other book Defining Your Own Success. I look forward to having these podcast preview from the authors while I wait to get a chance to read their books! Speaking of books, I just finished reading Bearing Meaning: The Language of Birth and I'm currently reading Sarah Buckley's Gentle Birth, Gentle Mothering.

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Molly
CfM Blogger

Maternal-Child Health Careers Book Survey

A midwife is working a new book to help people interested in careers in maternal child health to find their best path. She is looking for survey responses from physicians, midwives, nurses, doulas, birth educators, lactation consultants, massage therapists, prenatal exercise specialists, chiropractors, naturopaths, and herbalists--anyone who works with women during the childbearing year!

If you are interested in completed her survey, click here.

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Molly
CfM Blogger