Legislative Alert from AABC

Passing along a legislative alert from the American Association of Birth Centers:

Women and Children Lose in Budget Cuts: We need your help!

It always is a shock to me that Women and Children's Programs are at the top of Federal and State budget cuts. Republicans in the U.S. House of Representatives have passed large cuts in health services to women, infants, and children (H.R.1):

Hundreds of millions from WIC (Women, Infants, and Children):
WIC provides Federal grants to States for supplemental food, health care referrals, and nutrition education for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children up to age five who are found to be at nutritional risk.

Hundreds of millions from Maternal and Child Health Block Grants:
This Block Grant referred to as Title V is a public health program that reaches across economic lines to improve the health of all mothers and children, train providers and support services for children with special healthcare needs, offers newborn screening and genetic services, lead poisoning and injury prevention, and health and safety promotion in child care settings.

More than a billion from Community Health Centers:
Community Health Centers are key partners for many Birth Centers. They exist to fill the void in underserved communities and vulnerable populations by assuring access to comprehensive, culturally competent, quality primary care services.

This federal quandary is shared by many states: Demand for health services is growing and states are cutting Medicaid budgets for the poor and disabled. Medicaid accounts for approximately 25 percent of state spending when federal matching dollars are included according to the National Association of State Budget Officers.

PLEASE DO NOT SIT BACK AND DO NOTHING. WOMAN AND CHILDREN NEED OUR HELP NOW. This is not a Republican, Democrat, or Independent position. This is the moral and ethical action to take now.
ACTION STEPS
1. Call your U.S. Senators -( U.S. Capitol Switchboard: 202-224-3121).
Ask to speak to your Senator's health legislative aide.
2. Call your State Governor, Senators and Representatives
3. Tell them you are NOT in support of cuts to women and children's health! The deficit can be reduced by cutting waste in other areas.
4. Please let Karen Fennell (AABC's lobbyist) know of your contacts with legislators.
Tell her who you talked with and any comments or additional information requested. Call Karen at 301-830-3910; Send email to fennell.karen.s@gmail.com

Suggested Talking Points

WIC Program: This is one of the most efficient programs to improve child nutrition. The program gives expectant mothers with very small children important education on how to eat healthy during their pregnancy and how to feed their children healthy meals. And it provides them with coupons to incentivize them to purchase the best foods for their children. Research shows that without this intervention the nutritional intake of these children would be higher in fats, salts and sugars, according to a recent U.S. Food and Nutrition Services study. Instead if spending $1,400 a month in extra medical care for an obese child, for just $41 per month this program shifts these mothers and children into healthy eating patterns, says the Centers for Disease Control and Prevention. Clearly, the WIC approach is a useful and relatively cheap way to stem the rising tide of childhood obesity and a healthy pregnancy.

Maternal and Child Health Block Program: The program has been cut by 30%. This program is the safety-net care for women and children. The block grant pays for child immunizations and prenatal care for tens of thousands women and children. It is obvious that without access to immunizations more dollars will have to be spent to care for kids sick with easily preventable illnesses. Reducing access to prenatal care is both life-threatening and costly. A preemie baby's health costs are 10 times higher than a full-term, healthy-weight child, according to the March of Dimes. It makes no sense to cut a program that has a proven track record of delivering health to babies and driving down America's health care costs.

Community Health Centers: Funding for community health centers will be cut in half. Senator Orrin Hatch (R-UT), who was a cosponsor of the legislation responding to President George W. Bush's call to expand funding for these centers in 2008, says that "since 2001, additional funding has allowed health centers in more than 750 communities nationwide to provide care to about four million new patients. These centers provide affordable and quality care to at-risk Americans who otherwise might have to might have to do without." As state by the Center for American Progress, "No health care costs will be avoided by cutting this $1 billion out of the budget because the absence of care doesn't stop you from getting sick. It simply means you get sicker and you turn up at the emergency room or hospitals when your illness has progressed to the point that you care needs are exorbitantly expensive.

State Medicaid Cuts: Most States have budget proposals to cut funding for Medicaid. Talk to staff about what you know best - health and costs implications of a lack of prenatal and newborn care. A useful resource is the article Ten Myths About Medicaid published by The Kaiser Commission on Medicaid and the Uninsured.
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Jill Alliman, CNM, MSN

Chair, Legislative Committee

American Association of Birth Centers

Snow Baby

Guest article by Katie Tonarely

When Kara Kay started feeling crampy contractions on a Tuesday, she didn’t call a hospital or obstetrician. She didn’t have one. Instead, around 11 a.m. on Tuesday, February 1, Kara called her husband, Mike Benedict, and her Certified Professional Midwife, Deborah Smithey. Then, she sat back, enjoying the early feelings that she knew would eventually bring her her baby. While she waited comfortably inside, the worst blizzard in 100 years raged outside, and Deborah and Mike worked to make their way to Kara.

Choosing a Midwife
A hospital birth was never an option for Kara. “I’ve never been really comfortable with a hospital,” she says. “I never imagined I would have a birth in a hospital.” Mike agrees. After typical hospital experiences with his first two children, he was ready for a change. “It allows the father to be much more involved,” he says of his home birth experience.

A Certified Professional Midwife provides more in-depth care, Deborah says. Prenatal visits usually last an hour or more, and whatever is on the mom’s mind is up for discussion. Of course the CPM also checks how the mother is doing physically: blood pressure, pulse, fetal heart rate and growth. Midwives also focus on a lot on nutrition and overall health during pregnancy.

For Kara and Mike, the safety of home birth was a big factor for them, too. “I feel it’s safer overall, because there aren’t any doctors to force you to take unnecessary drugs or inventions that tend to cause more problems that solve them,” Mike says. Deborah cites a 2009 study that confirms these claims. The study, “Outcomes of Planned Home Births with Certified Professional Midwives: Large Prospective Study in North America” by Kenneth C Johnson and Betty-Anne Daviss, found that birth at home is safer, has better outcomes and fewer interventions.

Getting There
Mike knew the storm was coming and was planning to come home from work early anyway, but when he got the call from Kara, he left so he could get home to be with his wife. Getting there, though, proved to be a challenge, as the snow fell and cars and trucks slid into ditches on either side of the highway. “It was just white; you couldn’t see anything,” he said. After his own car ended up in a ditch, someone picked him up, but that car ended up in a ditch, too. Not really sure what he should do next, Mike started walking and running the mile-and-a-half home. “When I saw the tow-trucks and 18-wheelers stuck in the snow, I started to panic. That’s when I started to get anxious.” The couple of mile journey too him over an hour. “By that time, I was pretty nervous. I was ready to get home,” he says.

The midwife’s journey took even longer. She and her husband left Stockton at about 1 p.m. Normally, her drive to Carthage takes about an hour. They drove a four-wheel-drive truck to maneuver through the 13 inches of snow, with more falling by the minute. In the back seat of the truck, she had her midwifery supplies packed. “The roads became more and more treacherous as we went,” she says. “At one point, we couldn’t see the road at all.” To break through the snow drifts, they had to drive fast, but were also sure to go slow enough, so as not to lose control.

When they finally made it to the highway, they expected to it be clear. Normally, highway 71 is a four-lane highway, but only one lane was moving. “Semi-trucks and pick-ups were stranded on both sides of the road, and some were even stopped in the road,” Deborah says. “I have never seen anything like it.”

Deborah and her husband made it to Kara at 4:30 p.m. The one-hour journey took three hours.

Labor Land
Pregnant with her first, Kara expected a longer labor. Though the world outside was urgent with worries of weather and time, Kara sat comfortably in her home, not worried at all. “I just didn’t realize how bad the weather was,” she says. “I wasn’t concerned.”

As labor progressed through the afternoon and night, Kara used what she had learned in her Bradley Method class. She worked on breathing slowly and had visualizations and mantras ready to help her get through the tough times. “I’m just in labor land; I’m just passing through, “she repeated.

When it was finally time to push the next morning, February 2, Kara worked hard. She says, though, that she never felt the head descend. She counted on Mike and Deborah’s encouraging words. “I didn’t feel like I was getting anywhere,” she says.

Once the baby’s head came out, the midwife helped deliver the baby’s stuck shoulders. Called shoulder dystocia, this complication can be rather painful, yet Kara didn’t know it was happening until later. She continued to rely on her midwife’s encouragement. “Deborah reached up; it wasn’t invasive at all,” Mike says. “At that point, I was really glad that Deborah braved the storm.”

Snow Baby
Mike caught his daughter, Kaliyah Winter, at 7:49 a.m.. She weighed 9 pounds, 12 ounces. “I don’t think this experience will ever leave my mind,” he says.

For her post-partum care, Kara stayed put and was able to enjoy time with Kaliyah. “The midwife came to us,” Mike says. “I didn’t have to lug my baby out in the cold and snow.”

After she realized the snow’s devastation, Kara couldn’t help but be grateful for the midwifery model of care. “This just shows the dedication, loyalty and passion of midwives,” she says. “I’m totally thankful to Deborah and her husband.”


When there’s a natural disaster, Deborah asserts that midwives are best to handle birth. She asserts that it would be ideal for every Missouri county to have a Certified Professional Midwife ready to handle births in an emergency. “Common sense tells us that it would be far safer for a midwife to travel to a birthing mother then have a mother risk delivering along the side of the road in horrible conditions,” she says. In addition, CPMs are trained to handle common complications, such as cord entanglement, shoulder dystocia and post-partum hemorrhage.

For Mike and Kara, the intensity of the storm outside was nothing to compare to the positive feelings associated with bringing a new baby peacefully into the world. “It’s just a miracle, and I’m thankful everything turned out,” Kara says.

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In addition to being a wife and mother to two boys with another due in May, Katie Tonarely spends her time writing for several publications, including Springfield, Missouri's "News-Leader" and "Moms Like Me." She also does web content writing for Demand Media Studios.

For more about homebirth and midwifery in Missouri see:
http://www.friendsofmomidwives.org

"Birth Witnesses" Guest Post

I very much enjoy maintaining the Citizens for Midwifery Facebook page. I share relevant quotes there almost every day and really appreciate the dynamic, vibrant responses I get from the various "likers" present on the page. Recently, I shared this quote:

“Please, choose your birth attendant and place of birth carefully. Search hard for the attendant that you connect well with. You and your baby deserve to be treated with utmost respect and dignity. There are attendants who believe in the sacredness and sanctity of birth. You may, however, need to act as a detective to find them.” –Janice Marsh-Prelesnik (The Roots of Natural Mothering)

This quote resonated with me because of the final line—I am very familiar with that feeling of needing to be a “detective” in order to unearth the kind of care needed/desired/deserved by my family. The quote then prompted some great comments about the value of inviting women (other than formal birth attendants) to witness our birth experiences—sisters, friends, nieces. A commenter named Bonnie shared her ideas that one of the very best ways for young women to learn what birth is really like is to be invited to witness a real birth. And, that this may be one of our most transformative keys to making true and lasting changes in our current birth culture. I was fascinated with her ideas and invited her to write a guest blog post about them. She graciously agreed and her wonderful article on the subject is now available to read here.

Enjoy!

--

Molly

CfM Blogger

Happy Holidays!

As you gather with your family for the 2010 Holiday Season, we wish you love, joy, and memories to last a lifetime, and we thank you for your support of Citizens for Midwifery. As we greet 2011, we hope every day brings new wonders and a promise of a more peaceful world for birthing women, babies, and families around the world.

Warmest Wishes!

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Molly
CfM Blogger

CfM e-newsletter & FREE membership!

Citizens for Midwifery is pleased to have launched our new e-newsletter! You can read the newsletter online here. A printable version is available here. You can also subscribe to the newsletter via Facebook by going to the CfM Facebook page and clicking on the tab that says Email Signup.

An especially important announcement from this first edition is that membership in Citizens for Midwifery is now FREE! Here are the details:

Anyone who signs up with CfM either on our signup page, on Facebook, or CfM’s “Grassroots News” yahoo group will now all be considered members of CfM and will receive the free CfM e-news. In this day and age of social networking the concept of CfM membership needed to evolve to include all the ways people communicate and participate in CfM’s activities. We hope you will be excited by this open membership structure and will encourage all your friends, clients, Facebook friends and associates to sign up for a free membership with CfM today.

Membership is now free, but CfM still needs your financial support. Please donate today! We are so grateful to all the individuals and midwifery practices who have been paid members with CfM over the years. Many of you have been faithful members for years. Your support has made all our work on behalf of consumers, midwifery, and the Midwives Model of Care possible. We hope you will continue to support CfM with an annual donation. If you are a midwife who has been giving “Gift Memberships” to your clients we hope you will continue to make a donation to CfM in honor of each of your clients and encourage your clients to sign up for free with CfM. Donations of any amount are greatly appreciated!

Your donations are fully tax deductible. Donate at our suggested giving levels, or in any amount you can. Donate today on the CfM website or by mail Thank you for your support.

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

Dear Friends,

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

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

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

NOTE: The deadline for comments is December 29!

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

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

Sincerely,

Susan Hodges, “gatekeeper”
For CfM

Grassroots Network: Premature birth rate down

Hello Friends,

We hope you all enjoyed a wonderful Thanksgiving holiday!

This grassroots news message contains good news! According to March of Dimes analysis of 2008 birth data, the United States rate of premature births, or babies born before 37 weeks gestation, has declined for the second year in a row. This two-year decline comes after a 30-year increase in the rate of premature births. In 2006, the rate was 12.8% and in 2008, the rate fell to 12.3%.

Below is a link to a report from USA today that offers a more detailed description of the decline. We also include the link to the March of Dimes news source that not only notes the decline in premature births for 2008, but also includes an update on the state of births in 2010 as well as information on efforts to further decrease the number of babies born prematurely in the US. As you'll see in both articles, the decline is largely attributed to policy changes that prevent cesarean sections and labor inductions before 39 weeks gestation.

USA Today: http://www.usatoday.com/yourlife/parenting-family/babies/2010-11-18-premature18_ST_N.htm

March of Dimes: http://www.marchofdimes.com/nov17_2010.html

We hope you all continue to send us information that you wish to share with the group. We can be reached at info@cfmidwifery.org.

Sincerely,
Stephanie Hucker for Citizens for Midwifery

Grassroots Network: CPM BILL TO BE INTRODUCED IN CONGRESS THIS WEEK!

Dear Friends,

If you are not getting the MAMA Campaign e-news messages, here is the latest!

The e-blast begins:

“The Midwives And Mothers In Action (MAMA) Campaign is very pleased to announce that a bill to amend the Social Security Act to mandate reimbursement for all CPM services for women insured by Medicaid will be introduced in the House of Representatives this week!”

This is the bill that, when passed, will mean that licensed Certified Professional Midwives will be reimbursed for services provided to women on Medicaid. Medicaid reimbursement will make CPMs more attractive to state governments (where they are not already licensed), plus the health insurance industry pays attention to what is covered by Medicaid.

Read details about this bill and more in the rest of the MAMA e-blast at: http://mamacampaign.squarespace.com/grapevine/2010/11/30/cpm-bill-to-be-introduced-in-congress-this-week.html

You can easily sign up to receive the MAMA e-mails directly at the same url -- see the sign up link on the right.

Citizens for Midwifery is a member of the Campaign coalition and actively supports this work, and we encourage you to support it too! Donations of any size are needed and greatly appreciated by the Campaign!

Sincerely,
Susan Hodges, for CfM

Grassroots Network: Help PUSH for CPMs in Illinois!

Dear Friends,

Please read the Big Push Alert notice below, and if you live in Illinois, or know anyone there, please make calls ASAP!

Sincerely,
Susan Hodges, "gatekeeper"

A PUSH ALERT from the Big Push For Midwives

http://www.thebigpushformidwives.org/index.cfm?fuseaction=enews.signup

NOV 15, 2010 -- There is amazing pushing afoot! It is URGENT that we all push together to help Illinois fill the terrible shortage of home birth providers. Together, we can do it!!

The Home Birth Safety Act (SB 3712) to license CPMs in Illinois is being voted on in the House of Representatives this week, even as early as Wednesday, Nov. 16!

We need everyone in Illinois to call their Representatives and to forward this message to their family and friends in Illinois TODAY.

Here is the message that every Representative in Illinois needs to hear:

"I want to let the Representative know that Speaker Madigan has just reviewed the Home Birth Safety Act and improved the bill with an amendment. The bill is definitely going to be called this week. Will the Representative vote Yes for the bill on the House Floor?"

If anyone tells you "this is not the right act," tell them the Home Birth text is in House amendment 001.

• Legislators can be looked up (Legislator Lookup) here: http://www.elections.il.gov/DistrictLocator/DistrictOfficialSearchByAddress.aspx
• If you can call Monday, please call the Representative's district office, and if Tuesday is better, call his/her Springfield office.

The Illinois State Medical Society has been spreading misinformation saying the bill will not be voted on. NOT TRUE. House leadership has assured us a vote, but we need the grassroots to bring it home.

So make the call today and spread the word to everyone you know in Illinois!

After you make your calls, please send a text to report the results to me at the phone number below. Otherwise, please send an email to the email address.

Thank you from all of us Pushers in Illinois!

Rachel Dolan Wickersham, CD(DONA), LCCE
President, Coalition for Illinois Midwifery
Vice President, Illinois Council of Certified Professional Midwives
Jiandra@aol.com
630-750-9444

P.S. Again, please spread this far and wide - to your friends, family, and to all other lists! Even to folks outside of the birthing community. We look forward to keeping you informed of our progress thanks to your support!

Guest Post: American Childbirth Culture

I am pleased to have a guest post today from blogger and activist, Anna Guthrie. (I am accepting guest posts for this blog while I'm on maternity leave--feel free to email me with your ideas!)

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American Childbirth Culture

A couple of months ago, Molly posted some great thoughts about “why” all of this (childbirth/midwifery education) is so important, especially considering that so many people don’t seem to want to change the way things are. That’s the number one question I’ve pondered in all my years of “activism” for normal, natural, or “physiological” birth (as I’ve heard it called most recently).

The next most interesting question I’ve heard is one that has been asked me by many women: “What is so wrong with the [medically dominated] way I gave birth?” The first couple of times, it took me by surprise since I had never said that nor was meaning to be offensive at all in expressing my opinion. I also had no good answer-I’d think, what’s wrong with what’s considered “normal” childbirth in our country? Everything! Where should I start?! But, then I realized that these women were not just asking a question, they were on the defensive…immediately, without even hearing a word I said and they were the ones who had asked me. They had initiated the conversation about birth with a sincere desire to know what I had to say, but couldn’t get beyond their own births. That’s when it hit me…

This is all about our American childbirth culture-it goes deeper than all the statistics and conferences and symposiums. (Although I realize that those things are essential, and thank goodness there are so many people out there doing their part to create a change). I realized I’m interested in the psychological aspect of a woman’s relationship to birth, how the dynamics of our cultural history has shaped that, and how that can be changed.

The medical world that dominates childbirth in this country as well as the social and cultural environment we are born into teaches us from a young age to trust it without question. I just saw a billboard on the side of the freeway in Emeryville, CA (the first of many similar ones now being used by different hospitals). It features a picture of a happy, carefree woman, dressed in a flowing blouse, half-reclined in the grass so that her pregnant belly is obvious, and smiling at her little toddler on her lap. It reads, "Kaiser Permanente...DELIVERS". I couldn’t believe it-anyway, I thought MOTHERS delivered babies J-it’s almost as if they are purposely launching a counter-attack on any recent progress in childbirth education, natural birth, home birth, and midwifery! This is the hold the medical world has on our society. There is so much damage to undo here that it's hard to know where to start.

A woman’s birth is so personal to her and that’s one thing that drives many women to question and reject the status quo; but, it also works against those efforts. So many women give birth without ever hearing anything about this and they never have the opportunity to make a different choice. So that personal relationship to their birth is so sensitive-even more than they comprehend-that they don’t want to know what they are missing, or missed. So, we need to come full circle: instead of girls growing up within this false belief system of “medicalized” childbirth and then trying to shift their paradigm as adults, we need to work to change our culture from the ground up. Girls (and boys) should grow up understanding birth from the healthy perspective of natural, physiological birth being the ideal and medical intervention as merely the benefit of living in the 21st century and out of necessity or personal choice. So, that brings us back to the ultimate question, “why?”… So that the joy of childbirth can be fully experienced by everyone in our society because it is naturally woven into the fabric of our culture.

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Anna Guthrie is a mother of three, homemaker, artist, and childbirth education activist. http://americanchildbirthculture.blogspot.com/

Domestic Violence Resources

As I have noted several times, my first professional interest was in domestic violence. Domestic violence during pregnancy is unfortunately very common (though often overlooked during screenings) and, indeed, often the first incidence of intimate partner violence in a relationship occurs during the woman's pregnancy. In 2003, I wrote a short book about talking to battered women (nothing specifically about pregnancy) and it is available as a free e-book version here.

I think all birthworkers have a professional responsibility to be informed about intimate partner violence and its incidence during pregnancy. (I've also previously written about violence and birth, as it is sanctioned by the American medical care system.) Several helpful free DV resources for professionals came to my attention recently and I decided it was time for another post on the subject!

From an email list, I received this announcement:

Power and Control: Domestic Violence in America is a comprehensive and timely exploration of the shocking persistence of domestic violence in our society. The complex issues around domestic abuse are refracted through the story of Kim, a mother of three in Duluth, MN. Kim's journey takes her from a domestic violence shelter, to a promising fresh start, and then through a disturbing final twist.

The film also tells the story of the leaders who created the hugely influential "Duluth Model," the set of domestic violence policies that have been widely adopted around the world. Today the Duluth approach faces a challenge from increasingly vocal outside critics. At the same time the leaders of the battered women's movement are struggling to maintain the spirit of sisterhood that has
propelled the movement for 30 years.

For more about the film, including 40 interview excerpts with survivors, advocates, police, health care providers, batterers and founders of the battered women's movement, visit: http://www.powerandcontrolfilm.com/

For your free screening (good for 2 days for each user), visit: http://bit.ly/PowerAndControl

Additionally, the Family Violence Prevention Fund has a serious of free webinars about domestic violence available here.

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Molly
CfM Blogger