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Update from the States: Utah

Posted by Midwives Alliance on January 23rd, 2015

Understanding Utah's Out-of-Hospital Vital Statistics Report

Last week, the Utah Department of Health released a report based on a data review of planned out-of-hospital (OOH) births for the period between 2010 and 2012.

As outlined in the report, the out-of-hospital birth rate has doubled since 2007, but at 2.7%, remains a small fraction of the total number of births in Utah. Planned homebirths make up approximately 70% of the total number of OOH births, with the remainder occurring in birth centers around the state.The "average" mother choosing to birth at home or in a birth center is well-educated, older than the average mother choosing a hospital birth and more likely to have already had children.

Utah allows for the practice of midwifery with or without a license. Those midwives who choose to license must follow a nationally accepted course of study, pass a national midwifery certification exam, be certified in CPR and neonatal resuscitation as well as meet additional pharmacology requirements. An informed consent document, signed by the client and detailing the midwife's licensure status and potential risks is required for all licensed midwives.

Unlicensed midwives often follow an identical course of study as the licensed midwives, including passing the midwifery certification exam and becoming a certified professional midwife (CPM). Many unlicensed midwives are trained, educated and highly skilled. National practice guidelines include the use of informed consent documents, which should clearly state the training, level of experience and certifications/licenses of the midwife.

A finding of concern noted in the report was a neonatal mortality rate for out-of-hospital births that appears to be nearly double the rate for in-hospital births. While this finding deserves the attention of the maternity care community, it may be skewed by the relatively small numbers of home and birth center births and the even smaller number of adverse outcomes. Because this is a particularly small cohort, there are problems with extrapolation to the broader pool of all births. Nationally, much larger studies of planned, midwife attended OOH births with healthy low-risk women have shown the infant mortality rates to be comparable to hospital rates.Outlier data reports that are not consistent with the many other studies on homebirth indicate the need for further research.

Midwives welcome the use of reviewed data with an eye to quality assurance and practice assessment. We are interested in and supportive of a deeper dive into the data to ascertain whether or not a neonatal mortality rate of 2.3 per thousand live births is indicative of a potential problem related to site of birth, practice variations in risk assessment, or a result of an unusually small number of occurrences, thereby making the data unreliable. Reviewing Vital Statistics data rarely gives an accurate picture because of the limitations of the information collected on birth certificates. In this review for example there is no way to identify births of women with intent to deliver at home who ultimately delivered in the hospital. In other words, women who planned a homebirth and were transported to a hospital for delivery were included in hospital birth numbers. According to Dr. Melissa Cheney, PhD, Associate Professor at Oregon State University, "When we only track the actual place of birth and not the intended place of birth, we introduce error based on what we call misclassification bias. This is particularly concerning when we are dealing with rare events like death, even one or two misclassified events can result in inaccurate findings and misleading comparisons." She goes on to say, "I want to commend Utah for analyzing data on birth outcomes by delivery site and provider type. This is a very important part of maternity care safety surveillance, particularly as more and more women are choosing to give birth outside the hospital. I recommend that all states evaluate their current birth certificate relative to the state of Oregon's data collection tool. Simple changes have allowed us to more accurately track outcomes from planned home, hospital and birth center births. In addition, I would encourage the midwives of Utah to consider participation in the MANA Statistics Project. Use of a validated tool that controls for provider type and planning status can improve the quality of data we use to inform policy and practice."

In conclusion, while the presentation of the data has been somewhat sensationalized in the media, this report clearly demonstrates some of the many reasons more and more families are choosing out-of-hospital birth. Intervention rates are significantly lower, including inductions, C-Sections and epidurals. Families who want the considerable health benefits to mother and baby of physiologic birth, bonding and breastfeeding often seek midwifery care and home birth or birth center birth to achieve those goals. As more families learn about and choose out-of-hospital birth, the midwifery community continues to strive to make the experience as safe as possible.


About the author

Holly Richardson trained as an RN and LDEM (currently inactive) and oddly enough, is now a political junkie. She has served in the Utah House of Representatives and writes Holly on the Hill, one of the Utah's most popular political blogs. In her spare time, she consumes books voraciously, loves to garden and to sew and play with her 5 grandkids, 3 of whom she delivered.

New report recommendations point to midwifery care as optimal maternity care

Posted by Midwives Alliance on January 14th, 2015

Midwives have long been the guardians of normal physiologic birth, recognizing that labor often does not progress as efficiently and safely when interrupted by routine procedures or unnecessary interventions. Recent maternity care discussions within the professions and in the media have revolved around the benefits for mother and baby of allowing normal labor to progress on its own as safest and most conducive to satisfaction, bonding, breastfeeding and neurological development of the newborn. A new report from Childbirth Connections goes in depth to identify the hormonal processes that are critical not only to reproductive success but to long-term health of mother and baby. Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care provides compelling evidence that unnecessary medical interventions disturb these hormonal processes, reducing the benefits of physiologic pathways and creating new health challenges for mothers and newborns. Author Sarah Buckley describes the science of these innate hormonal systems that promote fetal readiness for birth, encourage safe and effective labor, reduce stress and pain, facilitate newborn and maternal transitions and adaptations, and optimize bonding and breastfeeding, among many effects. She discusses how routine procedures and medical interventions can interrupt and disrupt healthy labor and birth.

The report emphasizes the impact of how maternity care is delivered and makes concrete recommendations for improving care while still maintaining safety. Examining the recommendations closely reveals how appropriately midwives provide care and how support of physiologic birth is inherent to their practice. These recommendations, all components of midwifery care, include:

1. Provide education during pregnancy that builds women's confidence in their ability to labor and give birth without medical intervention that can pose additional risks.

2. Foster physiologic birth and safely limit maternity care interventions

3. Inform women about physiologic birth and involve them in their own care.

4. Limit routine practices and interventions to those that have proven benefits.

5. Provide prenatal care that reduces stress and anxiety

6. Foster privacy and reduce stress and anxiety during labor.

7. Employ non-pharmacological comfort measures for pain relief.

8. Provide continuous support during labor.

9. Facilitate spontaneous vaginal birth and immediate skin-to-skin contact between mother and newborn.

Clearly, all of us can use the revelations in this report to better understand the impacts of our care and as midwives reassess our practices accordingly. Midwives have the knowledge, training and experience to support physiologic birth and have developed care models and practices around providing information, reducing stress, building confidence, allowing nature to take its time, and promoting healthy biologic processes and innate hormonal systems that this report shows are essential elements in the health and well-being of mothers and babies and families. What we now know from Unnatural Causes: "When the Bough Breaks" is that the stress hormones in pregnant women of color caused by the stress of daily engagements with racism may contribute to more complicated pregnancies and births, including prematurity and increased mortality and morbidity. The Buckley report's new information on the hormonal physiology of birth makes an even clearer case for the importance of access to culturally competent midwifery care for women of color as a way to address the disturbing and unacceptable disparity in outcomes for mothers and babies of color. Every woman deserves a midwife.

Take a look at the MANA Homebirth Position Paper that outlines the values that guide the practice of homebirth midwifery.

 


About the author

Jill Breen, CPM, CLC, has been serving women, babies and families for 36 years as a homebirth midwife and natural family health consultant in central Maine. She has 6 children and 8 grandchildren, all born into the hands of midwives including her own. She has served MANA in several capacities, most recently as President , and is currently Communications Chair. She is a member of the Home Birth Summit Collaboration Taskforce.

 

 

 

Social Media for Social Change!

Posted by Midwives Alliance on January 12th, 2015

Elevate your social media know-how while supporting the healthy birth movement.

 

Are you a birth junkie who uses social media to spread positive messages about childbirth options?

Are you a midwife, doula, maternal health advocate or mother looking to take your social media skills to the next level?

Would you like to support a national midwifery organization with a growing social media presence?

Midwives Alliance of North America is seeking applicants for a one year volunteer position as an Online Community Manager (OCM).

As a Midwives Alliance OCM, you will:

  • Receive a 4-6 week training in the comfort of your own home, led by a social media expert.

  • Learn the cutting edge tools and strategies that will help you spread your birth know-how, build your online credibility, enhance online relationships and mobilize people, and deepen your skills as a strategic community builder.

  • Learn to use social media strategically to spread messages about healthy pregnancy, birth, postpartum. breastfeeding, parenting, and midwives.

  • Work on a team with others that love social media and birth as much as you do!

Preferred applicants should:

  • Love social media!

  • Be familiar with and regularly use at least one social media platform (like Facebook, Twitter, Pinterest, YouTube, blogging)

  • Love people!

  • Enjoy working in teams interacting with a diverse pool of online users, can be respectful to others even when there's controversy.

  • Love talking birth!

  • Have been known to "talk placentas" at a dinner party . . . and are familiar with current topics in midwifery, childbirth options and women's health issues.

  • Have time to learn and engage. The online training takes 2 hours a week for 4-6 weeks and will be conducted via interactive online platforms.

  • Have time to volunteer. Each OCM is expected to volunteer 2-3 hours per week on a MANA social media platform, with our startup time (February-March) and 2 other times per year being even more intensive.

  • Make a commitment. Because of this significant free training opportunity, the Midwives Alliance asks each volunteer to commit to being a MANA Online Community Manager for a one year term.

Trainings will be held on Tuesdays from 5:00p - 6:30p (Eastern Time). Participants must be available on those dates for the training sessions. The training will be recorded for birth professionals who miss the sessions due to births or family emergencies.

If you are interested - or know someone else who might be - please visit this link by January 30, 2015. Thank you. We look forward to working with you!

The Face of Birth

Posted by Midwives Alliance on October 19th, 2014

MANA Vice President Sarita Bennett, DO, CPM, recently talked with Gavin Banks, one of the two filmmakers responsible for creating and producing The Face of Birth. MANA is excited to be able to offer the first American screening (of the 54min version) of the film at the annual MANA Convention, "The Spirit of Midwifery", in St. Louis, Missouri, this week. Their conversation, like the film, spanned topics that included the personal and the political.

Sarita: What brought you to your interest in the topics of homebirth and midwifery?

Gavin: Years after experiencing the births of my own two children, I met a midwife who had developed a birth stool to facilitate upright birth. She wanted to produce a film about how to use her stool, but also, more importantly, wanted to impart her philosophy of one-to-one care. While making the film I was staggered to learn the divide between evidence-based practice and what was actually happening (culturally-based practice) in our hospitals. I started looking into how to expose the wrongdoings that result from prioritizing the system's needs above the woman's. Then, in 2008, I met Kate Gorman, another filmmaker, who had returned to Australia from the UK after the home birth of her second baby. She was expecting to find the same availability of birth options in Australia. Because of proposed legislative changes, which would regulate childbirth providers and included a requirement for indemnity – malpractice – insurance, home birth was about to become illegal! What was being made illegal in Australia was being endorsed in the UK. We saw the opportunity for this film and a coming together of our visions.

Sarita: What statements were you hoping to make with the film?

Gavin: We wanted to address the main issues of misinformation around homebirth – and physiologic birth - in general. We wanted to show how wonderful birth could be, without being prescriptive about how women should do it. We were interested in dispelling myths about home birth and talking about what "safety" really means. That a mother intact emotionally, and in a good mental place, is an element of that definition of safety - and not just a live mother and baby, which is, of course, should be a given. In our experience of making and marketing the film, we have seen a stark contrast between women who were well-supported in their births, regardless of how it went, and women who didn't receive that kind of care.

We wanted to stress the importance of informed choice and not just informed consent. The film is deliberate in its construction to reflect different ages and groups and to address major stumbling blocks. The Face of Birth is gentle enough to even be appreciated by women who have had multiple elective c-sections.

We knew these issues were international, so we wanted to make a film that could travel. Until women are put in the center of the discussion, globally, nothing will really change. Everywhere it is a fight to define birth as a normal physiologic event instead of a medical emergency – shouldn't it be the other way around?

Sarita: You have included some eloquent global experts and there are so many words of wisdom woven into the film. How did you choose who to include?

Gavin: We wanted the film to affect people emotionally but with the backing of full scientific fact. Our experts were chosen to address the main issues we had identified as stumbling blocks. Sheila Kitzinger brings an understanding of the psychological impact and potential trauma of failing to respect women's rights or needs in birth. Michael Odent cautions us against unnecessary intervention and encourages us to look to scientific research to understand the implications of current (non evidence-based) medical practice. We interviewed Ina May Gaskin and Robbie Davis Floyd, to understand the impact of US birthing culture on global trends and the implications. And, we included published, Australian experts, aware of the situation in Australia, who were doing research that had global significance. We wanted to emphasize that all around the world we don't really follow evidence-based practice, because if we did, birth would be the same everywhere. What we have, globally, are systems based on professional (culturally-based) preferences.

Sarita: Tell me about the aboriginal midwives that were included in the film.

Gavin: Our trip to the Northern Territory in 2010 was funded by one of the researchers in the film. Because of the relationships formed by some remarkable midwives we were introduced to a number of indigenous elders as well as midwives/educators who worked with indigenous women. While in East Arnhemland, I was privileged to witness (and film) a sacred women's ceremony – something that other men never get to see (but you can now in the movie, with the elders' blessing!) The elder's interviews were just as inspiring.

We then travelled to Utopia in the Red Centre. Communication there is very difficult because it is so remote. We arrived unexpected - the local private health service had gotten the dates of our visit wrong, so nothing was organized! They quickly rallied to our side and introduced us to a local midwife with some connection with the community. We drove to an indigenous women's camp where the midwife introduced us to the traditional midwives and the interview began. The interview was over when the women said "That's enough – you can go now". Life out there is so different; the people's generosity is astounding - the poverty unbearable.

Sarita: What drew you to work with MANA?

Gavin: We are trying to get the film out to as many people as possible and appreciate MANA's mission and vision. Our focus is affecting change and we love midwives and doulas. The childbirth culture won't change until women (and those who care for them) stand up and make noise together. When a finding against natural birth comes out, it is immediately taken as gospel by the media. But when something positive comes out, it's justified away: "that applies to a different people than us, and is not relevant in our case". As a man, I understand that men have had so much negative influence on birth; I want to stand up for change –not to be telling women what they should do – instead, to be highlighting the need to support and respect a woman's right to choose how, where and with whom she gives birth.

Sarita: Tell us about the two videos that are accompaniments to The Face of Birth and about any plans for sequels or future work.

Gavin: In making The Face of Birth, we accumulated many hours of interviews, with both our global experts and the women we filmed. Much amazing content couldn't be used in the film (or it would run too long!). We cut these extra, in-depth interviews into two DVDs/ downloads. One features 3.5 hours of expert interviews, which can be selected by topic, and is called "Meet the Experts". We also made another DVD called "Birth Stories" which is made up of nine short films focusing on the extended stories of nine women, including the women seen in The Face of Birth. The trilogy of the three films has significant educational and emotional value, and allows you to explore the issues more fully.

If there is a sequel, I'd like to go into traditional cultures and talk to indigenous midwives from around the world about the how / what / why of what they do. I'd then find scientists who can explain the physiology of why it works. There is an example of this in The Face of Birth (that is more fully explained in the Birth Stories DVD) - the reeds used in the indigenous 'baby smoking ceremony' actually have an antiseptic property, so the ceremony provides a cleansing for the baby and mom and heals infection.

I'm also interested in episodic TV. Once you have an audience, you can continue to build it. One idea would be to base a series around a modern-day midwifery clinic.

Sarita: Is there anything you want to tell women?

Gavin: Some people think only strong women give birth at home. I believe, as Noni Hazlehurst from the movie states, "All women are strong".

All my life I have been surrounded by strong women - whom I love and respect. Supported well in birth, these women have empowering births. Poorly supported, they, their babies and families suffer unnecessary pain.

Childbirth reform isn't a women's issue, it's a human rights issue. Childbirth culture can change but it will take women (and men) around the world to stand up and demand it together. Please use The Face of Birth to spread the word - to get people excited about what birth can be if (and hopefully when) we support women to birth how, where and with whom they choose.

Learn more about the author, Sarita Bennett, here.

Learn more about the Face of Birth here.

Q & A With Sherry Payne, MSN, RN, CNE, IBCLC

Posted by Midwives Alliance on September 3rd, 2014

Are you following Sherry Payne's Walk for Black Infant Mortality Awareness? She's walking across the state of Missouri to "bring attention to the invisible epidemic of African-American infant mortality - babies dying prior to their first birthday." We connected with Sherry before the walk began to learn more about her path to midwifery, her projects at Uzazi Village, and how we can all support the walk. You can also hear her speak at the upcoming MANA convention.

Q: You have had a complex journey on your path towards midwifery. Can you tell us about it? 

I spent many years trying to decide which pathway would be appropriate for me.  I hope to eventually have both a CNM and a CPM credential. I have started working with my CPM preceptor and have applied to CNM schools and am waiting to hear back. My path has been like many others. I started 20 years ago as a homebirth mother, then became a doula, then went to nursing school. I had a career as a labor and delivery nurse, then returned to school to get a masters in nursing education. I taught for a few years and then decided the time was right to pursue my midwifery education now that my youngest is now seven years old.

Q: This has not been a simple path for you. Why is becoming a midwife so important to you?

My passion is perinatal health, and my mission is decreasing perinatal health inequities, so midwifery care is an important component of that. I believe the midwifery model of care is appropriate for my community, even though the women of my community are the least likely to have access to a midwife. Becoming a midwife is important to me and my community to demonstrate what is possible when midwifery care is applied in a culturally congruent manner.

Q: Do you think there are challenges common to women of color who are working towards being a midwife?  

I think there are tremendous challenges to becoming a midwife for women of color. Chief among them are the tensions associated with working with dominant culture preceptors and their dominant culture clients. Will your preceptor understand your cultural context? Will the clients accept you as a care provider? I once had a client barely speak to me or answer my questions. When the midwife later entered the room, the client had nonstop questions. Afterward the midwife asked me why I hadn’t answered the client’s questions. I told her the client barely spoke to me even when I asked repeatedly if she had questions. I was in an awkward position: either look incompetent to my preceptor or present her client as not wanting to work with me. It was a very uncomfortable situation. Taking on a woman of color as a student will be fraught with such landmines. A lot of preceptors even unconsciously decide they don’t want to take this on. It can pit them against their own clients if their client is uncomfortable having a woman of color touch them. Some midwives don’t want to discover this about their clients or maybe even about themselves. All across the country I hear midwife students of color say what a difficult time they have finding preceptors.

Q: Tell us about your work at Uzazi Village.

Uzazi Village is a community-based nonprofit devoted to improving perinatal health in the urban core. We provide culturally congruent education for childbearing families, doula and breastfeeding support services. We also work with providers, offering continuing education on culturally congruent care and other perinatal topics. Finally we offer training and support for candidates of color pursuing perinatal careers.

Q: Can this model be replicated in other communities?

We have several replicable programs intended to be duplicated in other communities of color. The Chocolate Milk Cafe is a mother-to-mother support group model specifically for African-American women to support them in their breastfeeding journeys. Our Sister Doula Program™ pairs specially trained doulas with pregnant women on Medicaid. Finally, our Lactation Consultant Mentorship Program places IBLCE candidates in our free walk-in clinic, paired with qualified mentors to achieve mentorship hours required toward the credential. This program is designed to increase the number of IBCLCs of color.

Q: Tell us what you are speaking about at the MANA conference this year.

My two breakout session topics in October will be: “Saving Ourselves - Black Midwives and Doulas Impacting Inequities” and “What You Don’t Know Hurts Us: Racism, White Privilege, and Perinatal Health Inequities”. These two sessions will showcase what doulas and midwives of color are doing around the country to positively impact their communities and show how allies can assist in these efforts. It is always difficult to hear the structural racism and white privilege talk. Midwives, especially those who work with women of color and in communities of color, want to believe that they are doing good works. Having to confront structural racism in organizations and institutions they love and are committed to can be very challenging. I hope in my presentations at MANA to challenge midwives to really look at their own privilege, whom they do and don’t serve, the structural cultures of their organizations, and what work they need to do to move into a more aware space that would make room for students, apprentices, and clients of color. Not just having them there, but making them feel welcome and wanted.

Q: Tell us about the Black Infant Mortality Awareness Walk.

I plan to walk across the state of Missouri from September 1-10, 2014.  My goal is to raise money for Uzazi Village Sister Doulas Program™, bring awareness to Black Infant Mortality, and engage my state in conversations about solutions to the problem of perinatal health inequities in my community. I have a support team that will accompany me. I plan to stop in towns and cities along the way and speak to churches, and universities, and hospitals. My first stop will be to legislators in the Missouri state capital to engage them on problems with Medicaid and to ask for Medicaid expansion. I have been planning this walk for months and training to get myself in condition. I’m hoping it will be a catalyst for others around the country to take on similar projects. Black infant mortality is a complex, multifaceted issue that needs to be addressed on many levels.  

Q: How can readers support your work?

  • Go to our fundraising website and make a donation.
  • Get pledges, track my walk, and collect donations based on the number of miles I walk
  • Go to our website and learn more about our organization and our programs www.uzazivillage.com
  • Make a donation to Uzazi Village on its donation page
  • If you are local to Kansas City, volunteer for one of our groundbreaking programs
  • Knit or crochet Boobie Hats for our mothers for gifts
  • Donate new and used babywearing gear for our Babywearing Fashion Shows
  • Schedule a talk or presentation with Sherry for your group or organization
  • Schedule a visit to Uzazi Village to learn more about what we do
  • Attend one or both of my sessions at MANA to learn more about health inequities
  • Track my daily progress on my walk
  • Join me on my walk for a day or two
  • Tell other’s about my work and mission
  • Tell me about others doing similar work
  • Friend me on Facebook, or like my Walk for Infant Mortality page or Uzazi Village page
  • Drop me a line, I can be reached at sherry@uzazivillage.com 913-638-0716

 

Sherry L. PayneSherry L. Payne has a bachelors of nursing and a masters in nursing education. She is pursing midwifery education and works part-time as a seminar presenter and nurse educator. She is a lactation consultant and a certified nurse educator. Upon completion of her midwifery studies, she plans to open an urban prenatal clinic and birth center. Ms. Payne founded Uzazi Village, a nonprofit dedicated to decreasing health disparites in the urban core. She owns Perinatal ReSource an education, training and consulting firm. She is an editor for Clinical Lactation Journal, and sits on the board of CIMS, Coalition to Improve Maternity Services. She also sits on her local FIMR Board (fetal infant mortality review). She presents nationally on perinatal and nursing education issues. Her career goals include increasing the number of midwives of color and improving lactation rates in the African American community through published investigative research and application of evidence based clinical practice and innovation in healthcare delivery models.

 

Jeanette McCulloch, IBCLCSherry was interviewed by Jeanette McCulloch, IBCLC, editor of the MANA blog and co-founder of BirthSwell. She has been using strategic communications and messaging to change policy, spread new ideas, and build thriving businesses for more than 20 years. Jeanette is honored to be working with local, national, and international birth and breastfeeding organizations and advocates ensuring that women have access to high-quality care and information.

Top Ten Reasons To Become A MANA Member

Posted by Midwives Alliance on August 26th, 2014

Topics  

1) Help families find you! All midwife members of MANA are eligible to be listed at Mothers Naturally "Find a Midwife."

2) Continuing education. Being a member also means discounted access to the MANA conference, which provides continuing education focused specifically on home birth and birth center practices.

3) Keep up-to-date on the latest research and practice guidelines. Our website, blog, and social media sites provide up-to-the-minute news and research.

4) Find your midwifery community. At the conference, on our social media sites, and our emails, MANA connects you to the midwives and birth professionals in your community.

5) Track your outcomes. Your MANA membership supports the MANAstats project. If you become a MANAstats contributor, you’ll get data you can use to track and compare your practice’s outcomes to nationwide benchmarks.

6) Support groundbreaking home birth research. MANAstats data is available to researchers worldwide, a critical tool in understanding what home birth practices lead to positive outcomes for families.

7) Get the tools you need to run your practice. At the MANA conference, in our email blasts, and on our blog and website, you’ll learn about the latest research, meet the people with groundbreaking models for care, and connect with others who are solving the same challenges you are.

8) Support your profession. MANA provides key education and advocacy for preserving the art and science of midwifery, advocating for maternity care policy reform, supporting and unifying midwives, endorsing a woman-centered maternity care model and preserving normal birth practices. Without your membership support, none of this work is possible.

9) Educate families about the value of midwifery. MANA creates tools you can use to educate families about midwifery care, including the I am a Midwife series, blog content tailored to educating families, and other visuals and content. We encourage all MANA members to use our content on your websites, Facebook pages, and other promotional materials.

10) Get your midwifery gear. The MANA marketplace offers books, t-shirts, and bumper stickers you can use to show your pride in midwifery.

But most importantly . . . because you care about your profession!

MANA is making it easy to take advantage of the many benefits of membership! Join now during the August membership special: $100 for one year.

Help us spread the word *and* win some MANA swag. Share this article *anywhere* where midwives are online. Leave a comment below with where you shared. We’ll pick one of you to win a MANA tshirt! Thank you!

Preview: Lancet Special Series On Midwifery

Posted by Midwives Alliance on June 20th, 2014

"Women should be at the heart of planning maternity services."
— Mary Renfrew, on the findings of the upcoming
Lancet Special Series on Midwifery

Midwives know from lived experience the value midwifery care has for birthing families, their communities, and the world. Next week, the evidence base for the impact of midwifery care will be significantly expanded.

At the recent International Confederation of Midwives meeting in Prague, upcoming publication of the Lancet Special Series on Midwifery was announced. What is this research about and why is this release so important?

The Lancet, considered to be one of the world's leading medical journals, is devoting an entire series to bringing together all of the available information about midwifery care in one place. It comes at a critical time when policy crafters are making decisions in the U.S. and worldwide about how to fill the growing gaps in the maternal health care system.

According to the series coordinator, Petra ten Hoope-Bender, the series will include six papers (read her full description of each paper here).

  • Midwifery and Quality of Care
  • Impact of Scaling Up Midwifery
  • Deploying Midwives in High Burden Maternal Mortality Countries
  • Improving Maternal and Newborn Health through Midwifery
  • Human Rights and Midwifery
  • the Research Agenda

According to the Healthy Newborn Network, the series will "Go a long way to helping make the case that investment in midwifery is a highly effective way of improving a nation's health, as well as just the right thing to do from a woman's perspective."

The series will also be multidisciplinary: ". . . It unites midwives with statisticians, epidemiologists, economists, and other disciplines," according to the Maternal Health Task Force.

The rollout will run Monday June 23rd through September and will be free and available online at the Lancet. Watch here and on Facebook and Twitter for updates, and be sure to join the conversation at #LancetMidwifery.

Nine Tips To Help Midwives and Doulas Work Together

Posted by Midwives Alliance on May 21st, 2014

Guest Post by Sharon Muza, BS, CD(DONA), BDT(DONA), LCCE, FACCE

Editor's Note: Tech issues as we updated the MANA site meant this post couldn't run during the month of May. However, this content remains relevant year round, not just during International Doula Month! 

International Doula Month, celebrated every year in May, is a great time to examine the issue of doulas and midwives working together to support birthing families. While the roles of both birth doulas and home birth midwives are clearly defined, it is not hard to imagine that along with the desire to offer the best professional service to a family, the professionals serving in these capacities might find themselves feeling a bit awkward with each other. There even may be some "jockeying" for position as the midwife and the doula strive to best serve the client and the client's family. Remember that not all home births have a doula presence, so the doula's presence may require some adaptations.

According to DONA International, birth doulas are trained to provide emotional, physical and informational support during labor, birth and the immediate postpartum period. The word "doula" comes from the Greek language and means "woman who serves," though there are both men and women serving in the doula role today. The typical birth doula will meet with his/her client once or twice prenatally to understand their preferences for labor and birth and how the doula can best support them and their family. They also explore any worries or concerns that the pregnant person may have. The doula will attend the birth and then close the professional relationship with a final postpartum meeting or two. The doula is a source of information for the family from the time of hire through the first weeks postpartum. (Postpartum doulas can be hired to provide services after the birth, including newborn care, meal preparation, light housekeeping, and family support.)

The midwife is a trained health care professional who provides clinical care along with information and emotional support during the pregnancy through six weeks postpartum. The term "midwife" means "with woman." Over the course of the pregnancy, a person will see their midwife 15-20 times for pre- and postnatal appointments, where the midwife will assess the client and baby and share information, along with benefits, risks and alternative of procedures, tests and assessments.

Here are nine tips for making the most of what doulas and midwives have to offer while working together:

1. Midwives support healthy, low risk birth and doulas help improve birth outcomes

Midwives are appropriate health care providers for healthy, low risk pregnancy. They are well suited to providing a safe and satisfying birth experience for their clients. Evidence shows that outcomes are good and families are very satisfied with the care they receive.

There is ample research on the benefits of doulas at births. (Hodnett, 2013) When the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) released their groundbreaking "Safe Prevention of the Primary Cesarean Delivery" Obstetric Care Consensus Statement in February 2014, one of their key recommendations to reduce the primary cesarean rate in the USA was the continuous presence of a doula at a birth. (Caughey, 2014)

By working with a midwife/doula team, families reap the benefits of both models of care.

2. Doulas work within their scope of practice

When doulas stay within the scope of their practice, they best serve their clients and are more likely to be a welcomed member of the birth team. Many doulas may be pursuing the path to midwifery. Some doulas may also be a trained midwife or birth assistant, working in that capacity with other clients. But in the doula role, emotional support, physical support and helping a client and the family to find their voice is key.

3. Respect pre-existing relationships

The midwife has an emotional relationship with the client, developed over time. The midwife has also been trained in providing physical support and promoting a normal labor. The midwife is the only one responsible for providing clinical assessments and providing medical advice. The client can make optimal use of both their doula and their midwife. Everyone at the birth has the same goal - healthy family and a healthy birth.

The midwife shares the responsibility of emotionally supporting the client with the birth doula, and recognizes the value of the doula-client relationship. Having a birth doula in attendance allows the midwife to take care of clinical tasks and documentation, and also rest to conserve her energy for the actual birth, when s/he needs to be on the top of their game and ready to respond to unexpected situations. The client views the two professionals differently, but relies on support from both of them. Midwives and doulas are both experts in providing emotional support and physical comfort measures at births.

4. Support in early labor

Often times, a doula will support a client prior to the arrival of the midwife. This early labor support helps the client to gain confidence in their coping abilities, feel supported and promote normal, physiological birth staying hydrated, nourished and changing into positions that promote progress. Sometimes, they arrive together and the midwife can feel confident that the client is supported emotionally while the midwife clinically assesses the situation and sets up birth equipment.

5. Two heads are better than one to promote progress

Having a doula present at a home birth often means that two heads are better than one when it comes to suggesting coping strategies and offering comfort techniques that allow the labor to progress. I always learn something from every midwife I work with; a new position, a different coping strategy. Frequently, the midwife may learn something from me. As a birth doula, I have the chance to work with a wide variety of midwives (and doctors and nurses) and I bring those diverse experiences to all my births.

6. Transfer support

One of the midwife's responsibilities is to provide medical information and assessments and make recommendations for care, prenatally, intrapartum and after birth. The midwife and client make the decision when it becomes necessary to transfer. The doula can help the client to receive all the information that is needed in order for the client to feel comfortable with their choices. The client may choose to transfer and the doula can help the client's voice to be heard.

If a transfer becomes necessary, the doula will stay with the client at the hospital until after the baby is born. Some midwives stay as well, after transferring care to the hospital health care provider. If the midwife leaves, the client will still have continuous support from the doula.

7. Twice as many postpartum visits

Both doulas and midwives have scheduled postpartum visits with the new family. Having separate visits from both professionals means more support for the family on breastfeeding and adapting to caring for and parenting a newborn.

8. Celebrate the different roles

Midwives and doulas serve different but valuable roles during the pregnancy, labor, birth and postpartum period. Working with a midwife should not preclude the benefits of working with a doula and having a doula attend the birth should not interfere with or minimize the trusting working relationship that the midwife has with his/her clients.

9. Collaboration is key

Working together, midwives and doulas are able to create a win-win situation that clearly supports healthy births, healthy parents and healthy babies. When doulas and midwives collaborate, the families reap the benefits. Unfortunately though, subtle (or not so subtle?) areas of conflict can arise, between midwives and doulas, as both strive to serve their clients in the best way possible. When all the professionals attending a birth work together and avoid conflict, the end result is exponentially more positive for all.

Summary

Doulas and midwives should recognize that each professional brings different skills to the birth, along with some overlapping, but not competing abilities. Working together, respectful of the boundaries of the other, will benefit the client and their experience, create a collaborative situation that builds on everyone's strengths and supports the best outcomes for parents and baby. There is no reason to feel territorial or defensive. Open communication between midwives and doulas, mutual respect and a clear definition of each other's scopes of practice create the optimum circumstances to welcome a new human being into the world.

Photo credit: ©2014 Patti Ramos Photography
www.pattiramos.com

References
  • Caughey, A. B., Cahill, A. G., Guise, J. M., & Rouse, D. J. (2014). Safe prevention of the primary cesarean delivery. American journal of obstetrics and gynecology, 210(3), 179-193.
  • Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD003766. DOI: 10.1002/14651858.CD003766.pub5.

About the author

Sharon Muza, BS, CD(DONA), BDT(DONA), LCCE, FACCE is a birth doula and teaches independent Lamaze childbirth classes in the Seattle area, including "VBAC YOUR Way", "Cesarean YOUR Way" and "Labor YOUR Way" classes along with a home birth series for Penny Simkin. Sharon is a birth doula trainer on the faculty at the Simkin Center at Bastyr University. She is the Community Manager for Lamaze International's Science & Sensibility blog for birth professionals and serves as a co-leader of the Seattle Chapter of the International Cesarean Awareness Network. Sharon has served on the board of several local birth organizations and frequently speaks at international conferences. Visit Sharon's website to contact her or learn more.

Rewriting Your Birth Story

Posted by Midwives Alliance on May 13th, 2014

There are many defining moments in a woman's life, but few carry more weight than the day she is born into motherhood. Seeing her child for the first time after the nine months the baby has grown inside her body is elating, and it changes her- whether she's experiencing it for the first time or the seventh time. No birth story is ever the same, and each is unique and compelling.

There are times, however, when the expectations of what labor and birth should have been like, do not come close to what actually happened. This can be at the very least disappointing, and worse, emotionally and physically traumatic. Perhaps it was a natural birth that ended up in unwanted or unnecessary interventions, a complicated c-section, or lack of concern toward the laboring mom's frame of mind. It could be one person, one word, one action that changes everything for that mother, and finding emotional healing is not always easy.

We invite you to listen to The Longest Shortest Time's podcast, "Rewriting Your Birth Story," as Hillary Frank, writer and radio producer, explores the trauma she felt in her own birth story. With her are the midwife who participated in the birth of her baby daughter, as well as maternal care researcher Saraswathi Vedam.

We welcome your thoughts on how we can help mothers who are feeling trapped by negative emotions surrounding their birth stories find their road towards emotional healing. Please share your insights with us.

Stepping Down & Stepping into a New Adventure

Posted by Midwives Alliance on April 29th, 2014

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Embracing my lifelong career in midwifery began not as a conscious intention, but rather, as Destiny. In 1976, I was a twenty-something back-to-the-land hippie in rural northern Michigan when I caught my first baby for a first-time mother. I was also pregnant with my own first child. I wasn't doing it for the money. I was doing it for "the movement" to take birth back. I figured I'd be catching babies long enough to help my girlfriends have their births the way they wanted them, and for me to have mine. After that, I'd move on to my "real job."

Thirty-eight years later, it turns out catching babies was not only my real job, but moving midwifery forward in the United States was my real calling in life. For nearly four decades I have answered my calling fully and wholeheartedly. My midwifery journey has taken me to assorted destinations from community-based homebirth, to clinic-based healthcare for underserved populations, to co-founding a freestanding birth center with a team of DEMs and CNMs. I have caught babies at home, in birth centers and in hospitals. Even in sailboats and under apple trees. I have been educated through multiple pathways including self-taught lay midwifery, competency-based direct-entry midwifery (DEM), and university-based nurse-midwifery (CNM) with an accompanying Master's degree. Each pathway contributed to my expertise in a unique and valuable way. But my early homebirth roots—when our nurslings and toddlers accompanied us and stood wide-eyed and open-mouthed as they witnessed everyday miracles in the birth bed—laid the unflappable foundation for it all.

In the 1970s in my local neighborhood, I blazed a trail for a liberated and personalized way to give birth. In my state in the 1980s, I joined with likeminded peers to organize and co-found a vibrant professional midwifery organization that thrives to this day. In the mid-1990s, after specializing in normal physiological home birth for almost two decades, I went back to school and became a nurse-midwife so I could serve a broader range of women and their families.

It has been a gift and a pleasure to work for two populations different from my own. First I served Hispanic migrant farmworkers who traveled from Texas, Mexico and Central America to harvest fruits and vegetables in Northern Michigan, and then, numerous Tribal communities in the Upper Midwest. It has been a privilege to learn about traditions, health practices, languages, and beliefs unlike mine. For it is only through being immersed in a culture distinctly different from one's own that we learn to think outside of our narrow lens on the world. It is then that the doors of true compassion and understanding can open wider. When I moved into the realm of national midwifery leadership, advocacy to affect U.S. maternity care policies, and international midwifery initiatives, I was able to bring the numerous lessons I'd learned from people, cultures and politics. I became fiercely dedicated to issues of access, equity and respect for women's self-determination and for their right to make decisions about their health and that of their unborn and newborn infants.

In the late 1990s I made a transition from MANA member-at-large to a member of the MANA leadership team. For more than 15 years I have been deeply embedded in that team, first in three different roles on the Board of Directors, including President for two terms, and more recently as MANA's first Executive Director. Throughout those years, it has been my pleasure and privilege to work with many talented, passionate, and dedicated people, very few of whom are paid, and most of whom volunteer their precious time and energy to MANA and the midwifery movement. Gratitude, gratitude to each of you.

As I stand on the cusp of this transition, it is stunning how swiftly all of the years have flown by. During those times when I patiently waited for a breech baby to be born or feverishly worked to get a stuck baby out, the moments were inordinately slow. In fact, at those moments, time stood still. But earlier this month, as I worked amongst colleagues at the historic national meeting of the US MERA Work Group, it was odd to hear these words coming out of my mouth..."I am retiring."  A voice inside me whispered, "Already, really?"

But indeed, I am retiring. I heard my calling. I answered it with a lifetime of service. And now, I am entering into a period of rest and renewal.

As many of you know, after more than 20 years of living as a single, self-employed midwife and mother of three kids, seven months ago I married Fred, my old friend and lover. And as many of you also know—life is short! I intend to jump deeply and fully into this new adventure. Fred has a sailboat, and who knows what destination you might be hearing from me next.

A new and intriguing era for MANA has begun...and I wish you many blessings. May you be confident that MANA is in good hands with the next generation of leaders that are taking the helm and with the generation of Founding Mothers standing side-by-side to guide them. May you be generous in supporting the vision for the future articulated by your new and inspiring President, Marinah Farrell. May you be patient with the leadership team as MANA makes its next evolutionary leap into unchartered territory. And may you find a comfortable and welcoming home in MANA and a satisfying place just right for you to contribute your unique talents to the U.S. midwifery movement.

I leave you all with my spirit-arms wrapped steadfastly around you in camaraderie. Thank you for the honor of serving you all these years, for the many extraordinary and memorable adventures, and for the love you have shown me.

In gratitude,

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