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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

Topics  

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,

New Best Practice Guidelines For Transfer From Planned Home Birth To Hospital

Posted by Midwives Alliance on April 24th, 2014

As midwives, we all know that the way a woman is received at the hospital during a transfer from a home birth can impact both her physical and emotional safety. Midwives, hospitals, and policy makers have a new tool designed to help create an optimal transfer environment.

The model blueprint, known as the Best Practice Guidelines: Transfer From Planned Home Birth To Hospital was designed as an open source tool that anyone can use in creating policies and procedures for optimal transfer.

The new guidelines are a landmark achievement by the Home Birth Consensus Summit (HBCS) Collaboration Task Force. Chaired by past MANA President Diane Holzer and including past president and current MANA Communications Chair Jill Breen, this is a multi-stakeholder collaboration among physicians, midwives, nurses and consumers who have worked together to support the safety and well-being of families who choose home birth by creating this tool that bridges practitioners and sites of birth.

You can read about the guidelines in Science and Sensibility and at the HBCS website. MANA is a proud endorser of the guidelines. The HBCS delegates are seeking additional endorsements, from both organizations and individuals. You can learn more and sign on here.

What We Know - And What We Can Change - About Cesarean Birth in the U.S.

Posted by Midwives Alliance on April 9th, 2014

When three women in early labor walk into a hospital in the United States, we know that one of them will have her baby by cesarean section. Why is the surgical birth rate so high, and what can we do about it? We know that full term vaginal birth with mother and baby enjoying skin to skin during the first hour, with baby at the breast, and an environment filled with love and familiar voices is what both science and instinct tell us is best for mother, baby, and family. How do we make this a reality for more women in the U.S.? Identifying the issues can help us develop the best solutions through education and implementation of what we learn.

What are some of the challenges women face in achieving normal physiologic birth?

1. Hospital birth procedures. Time limits on stages of labor, interventive or interruptive hospital routines, and lack of support for women with challenging labors and longer labors may all contribute to high c-section rates. Experience shows us that:

  • Each woman's labor has its own rhythm that works well for her and her baby.
  • Even minor interventions,  procedures, and interruptions can distract, slow down or even stop labor and can impact the progress.
  • Fetal heart monitors can restrict a woman's ability to move during labor and distract her and her team from the work at hand.
  • Continuity of care, even having one person such as a doula or midwife stay with a woman throughout her labor and birth can help her cope, decreasing the need for pain medication and increasing her confidence and ability to birth without intervention.

2. Inductions. The increasing rates of inductions may be a contributing factor in the high c-section rate.

  • Inductions with an unripe cervix or undescended fetal presenting part (the baby's head in a vertex presentation if well-flexed and low in the pelvis will work with the contractions to promote efficient labor and dilation of the cervix) may result in cesarean section.
  • The use of pitocin increases the need for pain medication, both of which may not be well tolerated by the baby and may lead to cesarean due to fetal distress - a classic snowball effect of one intervention leading to another. A new study also suggests that term newborns exposed to pitocin in labor have a higher rate of admission to Intensive Care than those who are not.

3. "Normal" pregnancy. Many "variations of normal" that used to be considered reasonable for vaginal delivery, such as breech and twins, are now candidates for routine cesarean section. Physicians may not have the training or skills to adequately assist due to inexperience in these types of vaginal births.

4. Restricted access to Vaginal Birth After Cesarean. Although we no longer believe "once a cesarean, always a cesarean," it has become harder and harder for women to find care providers to help them achieve a vaginal birth after cesarean. Although ACOG has modified its position on limiting VBACs to advanced care centers with 24 hour in-house operating room staff, liability insurance providers have been much slower to reinstate coverage to smaller hospitals who may have had excellent VBAC success rates 10 years ago but were forced to discontinue offering VBACs because of policy. Even large hospitals who have numerous providers in their on-call list may find it unrealistic to offer VBACs when all their providers are not on the same page. A woman may have to travel hours to find a provider and a hospital who will support her goal of normal physiologic birth after a previous C-section.

5. Birth culture. A cultural attitude that does not value normal labor and birth, does not believe in women's abilities to birth, and does not believe in pain as a positive force, does not foster a woman's confidence in herself, her body or her connection to her baby during labor and birth. Just recently, we saw a very public example of the devaluation of physiologic birth when a national sports commentator criticized a major league baseball player for missing the season's opening game in order to be at the birth of his child, and suggested the player and his wife should've opted for a scheduled a C-section.

Paving the Way for Change

We know that cesarean section, now considered "routine" surgery, has risks for both mother and baby, including infection, adhesions, anesthesia complications, unintended damage to mother's organs, unintended damage to baby, and respiratory compromise for baby. Repeated cesarean sections with subsequent pregnancies carry greater risks for mom with each surgical delivery. Also, delayed bonding and breastfeeding are often consequences of operating room and recovery room routines and incapacitation of mom.

Education and the implementation of our learnings are key to decreasing cesarean sections and making the benefits of normal physiologic birth available to more women and babies. Thankfully, more and more resources are available for women to get the information they need for the birth they want, including consumer organizations such as ICAN, Homebirth Cesarean International, and websites like MothersNaturally.org. For mothers who do have a cesarean delivery, they can minimize separation and delayed bonding by requesting support for skin-to-skin with baby in the operating room, breastfeeding with the help of a Certified Lactation Counselor (CLC) or International Board Certified Lactation Consultant (IBCLC) in the recovery room, and having a "mommy" surrogate (partner, family member, or friend) stay with baby for all necessary procedures and when mother is unavailable.

There are many ways we can work to make hospitals and surgical experiences more mommy, baby, and family friendly. Midwifery care in all settings, including birth centers and homebirth, is linked to lower C-section rates. Hospitals that achieve Baby Friendly certification focus on natural birth and breastfeeding. In May 2012, MANA, ACNM, and NACPM released a Joint Statement entitled Supporting Healthy Normal Physiologic Birth to provide guidance for the birth community in how we can change the culture of birth in the U.S. We are now encouraged by the recent Joint Statement for the Safe Prevention of the Primary Cesarean Delivery released last month by the American Congress of Obstetricians and Gynecologists and the Society of Maternal-Fetal Medicine as another impetus for finding solutions to the cesarean epidemic. 

This month is Cesarean Awareness Month. We have been - and will continue to - highlight stories, images, and research about cesarean birth, prevention, and VBAC all month long on Facebook and Twitter. We hope you will join the conversation with us there, and add your comments here on the blog.

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 is working on Best Practices Guidelines with several state and national task forces. She served on the MANA Board, most recently as President, and is currently Communications Chair.

 

Women's History Month – Keeping the Spirit Going!

Posted by Midwives Alliance on March 26th, 2014

Though March is officially Women's History Month, we would like to continue our reflections on the history of midwifery and maternal health care. Will you join us with your Throwback Thursday posts and pictures?

In 1982, the Midwives Alliance of North America was established as a non-profit (501 c 6) professional organization for all midwives. MANA grew out of a grassroots coalition of diverse types of midwives including nurse-midwives, lay midwives, direct-entry midwives, and traditional midwives from across North America. Since 1982, the Midwives Alliance has taken leadership in advocating for a maternity care model that encourages women to take charge of their reproductive health and that ensures optimal outcomes for mothers and babies. The safety and benefits of the midwifery model of care have been proven again and again in countries across the world, including the United States. MANA has a proud history of relentlessly advocating for women's autonomy in their reproductive lives through promoting midwifery as a high quality maternity care option.

Let's continue to celebrate more than 30 years of advocating for Midwifery care. Bring us back to your early days as a midwife, and let us recall those stories during Throwback Thursdays in April. Have an old convention guide? Photos? Tee shirts? Share your images, and memories on Throwback Thursday on one of our social media outlets. Post on Pinterest, Facebook, or Twitter, link to MANA, and use the hashtag #TBT so we can follow along!

Take a moment to honor Women's History by reminding us how far we've come, and how far we intend to go to bring quality, respectful midwifery care to all women.

Informed Consent and Hospital Transfer: A Mother's Perspective

Posted by Midwives Alliance on March 15th, 2014

Roanna Rosewood is an author and was a keynote speaker at MANA 2013 in Portland, OR in October 2013.

Someone else told me about the incident, years after it happened. It was too late to ask questions or involve myself. Too late to find out if I was the reason why my first midwife stopped catching babies, right after my attempted HBAC turned into another cesarean. But I can't help but wonder, if I had been given the opportunity to tell the doctor that staying home for so long was my choice, would it have stopped her from berating my midwife? If I explained that my midwife had recommended transport but I was the decision-maker, would my midwife have been spared the doctor's anger and – I can only speculate – its resulting fear?

I'm not suggesting that my midwife couldn't handle a disagreement. I'm recognizing that the balance of power surrounding birth has become so skewed that belligerent obstetricians are a real threat to midwives. The same outcome that an obstetrician's insurance can write off without question could lead to criminal prosecution and crippling legal fees for a midwife. Does this unjust disturb midwives as much as it does me? Or are you so accustomed to it that you can't tell where fear of persecution ends and your work begins?

I understand that the concept of patient autonomy was so foreign to the doctor that she felt justified in gently soothing me in one room while criticizing my midwife in the other. What I don't accept is that my midwife didn't tell me about it. I hired her to advise and inform me. I trusted her to advise and inform me. That I was out of earshot when doctor let-loose, didn't invalidate her responsibility.

I recognize that my midwife's choice to bear the doctor's wrath alone was a generous and loving act, made to protect the small shreds of sanctity that remained after they tied me down and cut me open. But what she didn't understand, what every midwife who tries to shield her client from our broken maternity care system doesn't understand, is that doing so perpetuates the problem.

Until hospitals are safe and respectful places to transfer to, the attempt to isolate expectant homebirth families in affirmation-filled, "just trust birth" expectation bubbles, isn't only risky for the mothers and babies who might end up needing to transfer to the most dangerous maternity care system in the industrialized world. It is also the abandonment of every midwife who risks her livelihood and freedom to practice without legal protection.

We trust midwives to reveal what we need to know about birth. But this isn't limited to the process of bringing our babies earth-side; we also need to learn that birthing women have not yet established their right to autonomy, informed consent, or to be the decision-makers for their own newborns' care. Homebirth families must be armed with the tools necessary to win the cultural and legal war being waged against physiologic childbirth and stand with the midwives who hold the space for it. At the very least, this includes:

  1. Understanding the manner in which the family, midwife, and records will be received in the case of a hospital transfer.
  2. Awareness of the evidence (or lack of) behind routine hospital interventions and strategies for refusing unwanted ones.
  3. A welcome invitation to join other families around the world who are working to establish human rights in childbirth, by participating in the birth revolution.

Just as mothers must find the courage to face contractions in order to move through them, with midwives on our side, so too will we find the courage to face and heal our maternity care system.

Roanna Rosewood is the bestselling author of Cut, Stapled, & Mended: When One Woman Gave Birth on Her Own Terms After Cesarean, an international birth empowerment speaker, and the managing director of Human Rights in Childbirth.

Introducing MANA's New President: Marinah Valenzuela Farrell

Posted by Midwives Alliance on March 6th, 2014

MANA has begun a new era!

Introduction by Geradine Simkins, DEM, CNM, MSN is MANA's executive director. You can learn more about her here.

Three years ago when I recruited Marinah Farrell to be on the MANA board, little did I know I would be introducing her to you today as your new President. I am thrilled to say that with her Presidency MANA has begun a new era in at least two important ways. First, Marinah is the first President who is not from the "Founding Mother" generation of MANA. She stands on the shoulders of the cadre of seasoned MANA leaders who will work hand in hand with her. And second, Marinah is the first midwife of color to be president of MANA, a milestone of serious significance for MANA. Welcome to your new position, Madame President, the torch has been passed to you. Shine on!

Marinah's Story

by Marinah Valenzuela Farrell

I can never think about my story without invoking the history and spirits of my ancestors. My grandfathers and grandmothers were fiercely elegant even amidst the poverty that surrounded them. I conjure memories of my grandfather's blue eagle-eyed silence as we rode his horse into the mountains of Mexico, an explorer of the wild and lover of herbal medicine. This knowledge he passed down to my mother, who passed it down to me.

My parents met in El Paso Texas, and I grew up in a place between the U.S. and Mexican borders. I grew to awareness that it was important to work for vulnerable populations because both of my parents were devoted to missionary work their entire lives. Much was given, and therefore, I have always felt much was expected. Thus, I work for many non-profit organizations here in Arizona and abroad. Everyday, I give thanks for the gift of midwifery and for the communities who invite me into their lives.

My first MANA convention (doesn't everyone have a story of their first MANA convention?!) was in Arizona. Ina May Gaskin and Marsden Wagner were there, as well as all types of midwives and birth workers and advocates. Being at MANA was a "coming home" and an all-star event of unforgettable individuals. From that time forward, I have loved MANA.

With the advent of technology, the aging of our tireless founding mentors, the explosion of maternal health organizations and the fast American pace of life, our board had to look hard at our grassroots style and wonder how in the world we would be able to keep up. We reject becoming pathologically "corporate," but also realize we need to adhere to business policies and practices in order to meet the accelerating demands of our organization. We want to remain an organization that honors all midwives, can professionally represent our members, can still be groovy and, more importantly, will be compassionately progressive.

Our learning curve became a slope. We prioritized trainings in organizational and cultural humility and how to be more supportive of gender freedoms. We created better systems of communications for the "virtual" demands of social and electronic media. We amplified our voice at International and National meetings because midwives are more supported than ever in some ways and yet more vulnerable to hostility because of it. Our Division of Research, whose Coordinating Council are pioneers each and every one, is an essential contribution we make to the midwifery profession. It facilitates us understanding what the big picture looks like in maternal and child health, and for everyone "out there" to understand the important role midwives play in that picture.

The founders of MANA packed into cars with their babies on a shoestring budget and met in hotel rooms to write bylaws and to be recognized as a profession. MANA was founded on a love of midwives and, ultimately, the families they serve, and this remains our core foundation. Looking towards the next 30 years, MANA is evolving to embrace the "new" tools of technology, social media and research. My vision is for every MANA member to have equal access to the profession and our organization because every community and every woman needs a midwife that best represents their own values and cultures. And, ultimately, MANA wishes to welcome a new generation of leaders into the movement to carry on this always hard, always beautiful, "groovy" work.

Peace, health and love to you, Marinah

To learn more about MANA's recent projects and strategic priorities, visit our new e-zine here.

Black History Month 2014 Is Ending, But Health Disparities Continue

Posted by Midwives Alliance on February 25th, 2014

Opportunities to make change year round

During the month of February, MANA has been highlighting birth workers of color and their role in improving outcomes for mothers and babies.

Although Black History Month ends this week, the impacts of health disparities in the U.S. continue year round.

MANA would like to bring attention to one national effort to create health equity: scholarships for birth workers of color.

The Birth Workers of Color Scholarship "Grand Challenge" is asking every midwifery program in the U.S. to offer one scholarship per year to women of color. As the site says:

"A midwife for every woman. That is our grand ideal. But what if you are a woman of color in America, where is your midwife from your unique culture?"

If you operate a midwifery training organization, please consider adding a scholarship today. For all of us there are many ways to get involved:

  • Raise awareness. Share the site widely and call on the organization that trained you to offer a scholarship.
  • Offer your assistance as a mentor or preceptor.
  • Offer scholarships for workshops or other trainings you provide.

This project is being spearheaded by Claudia Booker, CPM, Jennie Joseph, CPM, LM and Vicki Penwell, CPM, LM. Learn more at the Birth Workers of Color Scholarship site here.

Educate yourself and your community on maternal child health disparity in the U.S.

When the Bough Breaks free viewings extended for 2014.

To honor Black History Month in 2013 MANA created the opportunity for members, friends, and the community at large to have free access to When The Bough Breaks, a groundbreaking documentary that explores why black babies in the U.S. are more than twice as likely to die, be born too soon, or too small.

MANA has extended this opportunity for 2014. To learn more, email socialjustice@mana.org today.

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