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Update from the States: Massachusetts

Posted by Midwives Alliance on April 9th, 2015

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Guest Author: Sarah Whedon, Ph.D

Here in Massachusetts, midwifery supporters have been working for many years to pass a bill that would license Certified Professional Midwives (CPMs). We believe we now have a real shot at passing the bill into law in the current legislative session.

This January we re-filed the bill, An Act Relative To Certified Professional Midwives (SB 1825/HB 2941), sponsored by Representative Kay Khan and Senator Anne Gobi. If passed into law, the legislation would:

  • require all midwives practicing out-of-hospital to be CPMs;
  • create state licensing requirements for CPMs;
  • establish a Committee on Midwifery to issue CPM licenses and regulate CPM practice.

Currently, Massachusetts regulates only Certified Nurse Midwives (CNMs), who do not attend homebirths here. There is no state oversight of CPMs, who provide out-of-hospital care to approximately 500 women and their families across the state each year, a number that is growing annually.

Representative Khan, the House sponsor of the bill has said, "It is critical for the future of maternal health care that we establish oversight for the homebirth midwives practicing in the Commonwealth. Not only will it ensure accountability and offer families secure options for choosing to deliver their child at home, but it will reduce medical costs, promote collaboration among healthcare professionals, and improve public safety for consumers."

Although the bill was originally drafted in 1998 by supporters of Massachusetts CPMs, they quickly formed a coalition with CNMs to advocate for the midwifery legislation. That coalition operated for more than a decade until, for both administrative and policy reasons, the formal coalition was dissolved in 2010 and the bill was cleaved into two, one that would regulate the practice of CPMs and the other which expanded the scope of practice for CNMs. The CNM bill passed in 2012, freeing CNMs from a requirement to work under a supervising physician and allowing them to both write prescriptions and order tests.

The CPM bill has been reintroduced into the Massachusetts legislature multiple times, working its way through various committees. During this time, it has the gained the support of powerful consumer organizations like the Massachusetts ACLU, Amnesty International, Massachusetts NOW, Mass Friends of Midwives, Massachusetts League of Women Voters, Our Bodies Ourselves, and the Massachusetts' Women's Bar Association. However, due to pressure from powerful medical organizations, the bill has been stalled each time.

Judy Norsigian, who for many years was executive director of Our Bodies, Ourselves, wrote to debunk myths about the midwifery bill perpetrated by medical dissenters. She asserted that, "failure to license CPMs will make the several hundred home births that occur in Massachusetts every year less safe by failing to create an integrated maternal health care system with enhanced collaboration among all care providers. This bill would affirm that all Massachusetts maternal health care providers are committed to practicing with state oversight and public accountability."

Massachusetts Midwives Alliance and Massachusetts Friends of Midwives continue to collaborate on advocating for the bill. We recently received the good news that Rep. Jeffrey Sanchez will now be the House Chair of the Health Care Financing Committee and Rep. Kate Hogan will be the new House Chair of the Public Health Committee. Both have been supporters of the midwifery bill during prior sessions and have indicated an ongoing commitment to advance this legislation. We congratulate Reps. Sanchez and Hogan in their new leadership roles and look forward to working with them on An Act Relative To Certified Professional Midwifery.

We are hopeful that this session will be the one in which Massachusetts formally recognizes the vital role of Certified Professional Midwives in providing broader birth options for low-risk birthing families.

For more information and to get involved please contact:

Audra Karp, Mass. Midwives Alliance, 617-522-8383

Ann Sweeney, Mass. Friends of Midwives, 617-254-6175/617-901-2777

Follow along with the bill's progress on Facebook and Twitter.

The history of this bill is drawn from an unpublished paper by Molly J. Lawney, "Massachusetts: 'An Act Relative To Certified Professional Midwives'" March 18, 2013.

 

About the author

Sarah Whedon, Ph.D, is a homebirth mom who serves as co-director of the Boston Doula Project and managing editor of Pagan Families.

Update from the States: California

Posted by Midwives Alliance on March 24th, 2015

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California midwives are going to the legislature with three midwifery bills this session. California Association of Midwives (CAM) and California Nurse Midwives Association (CNMA) have each sponsored legislation that will increase access to midwifery care for the families of California.

New California Legislation: Expanding Access To Midwifery Care Through Medi-Cal

California Senate Bill 407 will, if passed, authorize California Department of Health Care Services to recognize licensed midwives as providers in the Comprehensive Perinatal Services Program (CPSP). This is a critical step towards Medi-Cal coverage for licensed midwives in California. SB 407, sponsored by CAM, will add licensed midwives to the list of qualified Comprehensive Perinatal Service Program providers under Medi-Cal, further expanding access to community-based midwifery care in all settings for all women and families in California. The Comprehensive Perinatal Services Program (CPSP) provides educational, nutritional, and psychosocial support to pregnant women, as well as childbirth and breastfeeding education, services already provided within the scope of LM practice and fully in line with the midwifery model of care.

The Comprehensive Perinatal Services Program became a Medi-Cal benefit in 1987. Licensed midwives are not currently, but should be, recognized as eligible providers of these benefits, which fall squarely within their scope of practice. The passage of this bill would allow licensed midwives who work in clinics providing CPSP services to bill Medi- Cal.

This bill is a part of a larger legislative strategy spearheaded by the California Association of Midwives (CAM). "All women in California deserve to be able to choose midwifery care," said Sarah Davis, LM "Our goal is to expand the option of midwifery care to all women in California by making care with licensed midwives Medi-Cal eligible."

If passed SB 408 will expand midwifery care – particularly in rural and other underserved areas – by allowing 'midwife assistants' to legally assist licensed midwives at out-of-hospital births. Typically, two providers attend each birth, but licensed midwives are scarce in some areas of the state. This bill would allow a specially trained 'midwife assistant' to legally assist a licensed midwife, expanding the reach of existing providers.

California Assembly Bill 1306 removes physician supervision from the law governing CNM practice. It also authorizes a certified nurse-midwife to manage a full range of primary health care services for women from adolescence beyond menopause in all settings, including, but not limited to, a home, without direct supervision of a physician. The bill, sponsored by CNMA, would provide for consultation, collaboration, or referral as indicated by the health status of the client and the resources of the medical personnel available in the setting of care, and would provide that the practice of nurse-midwifery emphasizes informed consent, preventive care and early detection and referral of complications to a physician and surgeon. This bill would authorize a certified nurse-midwife to provide peripartum care in an out-of-hospital setting to low-risk women with uncomplicated singleton-term pregnancies who are expected to have uncomplicated birth. It would also allow nurse- midwives to furnish medications and devices within the scope of her practice, and to make repairs of the perineum for 1st and 2 degree lacerations.

Regulatory Process Still Underway

Physician supervision is no longer required for licensed midwives, thanks to the passage of California bill AB1308 in 2013. That bill also called for a number of changes to be determined through regulation (as opposed to legislation). CAM, alongside the consumer group California Families for Access to Midwifery (CFAM) have been participating in the regulatory process.

The new regulations dictate a physician referral for preexisting maternal diseases or conditions likely to affect a pregnancy and significant diseases arising from pregnancy. At issue is the complete list of those conditions. The regulation has been the source of some confusion (it calls for exams, not a required transfer of care to a physician). It has also sparked concern, particularly from consumers concerned that a physician may be unwilling to address their desire for a home birth with a licensed midwife.

"Consumers of California want the option of using a midwife, either at home for birth or in clinics, birth centers and hospitals. California Families for Access to Midwifery is very excited to support the three midwifery bills introduced to our legislators! We were a part of the process from the passage of AB1308 (the removal of physician supervison for LMs), to the regulatory process, and now we are supporting SB 407 and 408 and again supporting the removal of physician supervision from the nurse midwives of California AB 1306. " -Tanya Smith-Johnson President CFAM

To keep up-to-date with changes in California, visit CAM's website here and CFAM's website here.

About the author

Sarah Davis, LM, IBCLC, is the Policy Chair of California Association of Midwives and a midwifery advocate in San Diego, California. She has practiced in home, birth center, and clinic settings and is the mother of an amazing 2 1/2 year old.

Our Treasurer Midwifes MANA

Posted by Midwives Alliance on March 23rd, 2015

MANA Treasurer Vicki Hedley shares her background and her passion for The Midwives Alliance, our mission, health and growth

I live in Montvale, NJ and have a busy homebirth practice. I have five children ranging in age from 32 down to 13. I also have two grandchildren, whom I had the privilege to receive into my hands in October of 2012 and October of 2014. I have been attending births since 1996, first as a doula, doula trainer, and childbirth educator, and since 2008 as a CPM when I graduated from the National College of Midwifery. In 2010 I also became a CM. My learning occurred through the apprenticeship model in many different settings with beautiful and wise midwives who taught the art of midwifery through their example. I continue the tradition of mentoring others through study groups and apprenticeship. Midwifery is the most difficult and the most rewarding work I have ever done, and I am honored to have the title "midwife".

Before becoming a midwife I had a private accounting practice for sixteen years. I feel as if I midwifed my clients through the stresses of finances and taxes. I have been a member of MANA since 1999, many years before becoming a midwife. MANA has been the home for all midwives for over 30 years, the mother of the CPM and NARM, and an organization with integrity that I have great respect for. I have served on the Board of Directors as treasurer for nearly two years. I have a feeling there aren't too many midwife/accountants out there, so it seems that I am a good fit for the job. It is a challenge working with a small budget, but we spend our money wisely, always thinking of our membership and how you would benefit most from the available dollars.

I see my role as treasurer as more than just a number cruncher. There is certainly importance in the day-to-day bookkeeping that is required to run our operation; but the treasurer is involved in virtually every aspect of the organization. I oversee conference finances, create budgets, work closely with the Division of Research helping them with their finances, assist in writing grants, and work very hard to strategize ways of increasing our income. Our membership is our most valuable asset. It is you, the members of MANA who keep the operation going. Grants are not used for operations, so we count on your membership dollars to pay for all things operations such as upkeep on our websites, our wonderful conference coordinator, our amazing membership support staff, communications, and more. Without you we could not do the important work that we do.

With your help we can achieve our goals:

  • To engage midwives in dialog and to encourage solidarity across North America
  • To recognize the diversity among midwives and to foster inclusive community building
  • To build an identity as a cohesive organization representing the profession as well as the tradition of midwifery at regional, national and international levels
  • To position midwives as acknowledged authorities, working to improve perinatal health in collaboration with other professionals
  • To collect and disseminate high quality research about midwifery care
  • To promote excellence in midwifery practice
  • To sponsor continuing education opportunities for midwives
  • To increase access to midwives in all settings
  • To endorse the Midwives Model of Care™ as the gold standard for childbirth
  • To affirm the rights of pregnant women to give birth where and with whom they choose

The Midwives Alliance promotes professional development and continuing education of midwives so all women and babies will have access to practitioners who can provide excellent prenatal care, safe and empowering births, comprehensive postpartum care, and privacy during the critically important bonding period of mother-infant attachment.

Thank you for the privilege of serving on your Board of Directors. I look forward to seeing you in Albuquerque in October for our annual conference. Contact me at treasurer@mana.org.

About the author

Vicki Hedley, CPM, CM, is a mother, grandmother and midwife in Montvale, NJ.

Update from the States: Wisconsin

Posted by Midwives Alliance on March 10th, 2015

As a part of our new "Update from the States" series, we asked Marijke van Roojen, president of the Wisconsin Guild of Midwives, to catch us up on the current activities of the midwifery community in this progressive midwestern state. Read on to learn about their current initiatives:

Wisconsin Guild of Midwives Current Initiatives (WGOM)

WGOM has once again had a busy year. Our vibrant membership of midwives and student midwives meet 5 times a year and in addition to sustaining private midwifery practices across the state, we are engaged in various public health efforts in collaboration with community, state and university partners.

The Wisconsin Guild of Midwives Doula Project

In November 2014, with support from the March of Dimes and many community partners, WGOM hosted the ICTC Full Circle Doula training in Milwaukee, offering full and partial scholarships to 18 women of color from our state. These women are now in the process of forming 2 regional doula collectives to serve Milwaukee and Dane Counties. The project is designed to build mother mentorship networks and to increase access to culturally concordant and relevant birth services in order to reduce adverse birth outcomes in the African American communities in our state. This training and the empowerment of women exposed to this model of care introduces families to alternatives in childbirth and parenting, teaches self and community advocacy to reduce unnecessary interventions in birth, promotes earlier entry into services including midwifery care, builds provider-client trust, and profoundly impacts the life course of these women and their children. WGOM also intends to use this training to establish a culturally-accessible, low-cost route of entry to a midwifery model of birth work, laying the groundwork for women of color to consider midwifery as a profession and to be fully supported in that choice.

MEAC Accreditation

The direct-entry midwifery program at South West Technical College in Fennimore WI, under the able leadership of Ms. Sherry DeVries, CPM, LM, CNM, MSN, became MEAC accredited in September 2014. There are two tracks - one for the student midwife and the other for the CPM seeking a degree in Direct Entry Midwifery. The CPM bridge program is an abbreviated program and the candidate receives advanced standing for work accomplished because of the previously earned CPM credential. Congratulations to Ms. DeVries, program coordinator and instructor, and SWTC!!

Newborn Screening Program

Gretchen Spicer, LM, CPM has been hired by the State of Wisconsin to provide Newborn Screening education and services to the OOH population in our state. She writes:

"Thanks to a wonderful collaboration built by many people over the last 12 years, Wisconsin has one of the highest rates of newborn screening in out of hospital deliveries in the nation. Nearly all the babies delivered by Licensed Midwives in Wisconsin get blood and heart screening in the first 24 to 48 hours of life and hearing screening within the first month of life. Wisconsin Sound Beginnings (WSB) provided grant funding for the purchase of 11 OAE hearing screeners that are shared by midwives in each geographic area. The Wisconsin SHINE (Screening Hearts in Newborns) project included Licensed Midwives in their pilot project for screening newborns for Critical Congenital Heart Disease (CCHD). The SHINE project has placed 80 pulse oximeters in OOH practice settings and has provided extensive training and support for midwives as they began pulse oximeter screening."

About the author

Marijke van Roojen, LM, CPM, MPH, President, Wisconsin Guild of Midwives, has dedicated her professional life to two disciplines: maternal child health with an emphasis on the social determinants of health, and community-based mediation, restorative justice and the field of Alternative Dispute Resolution. She currently resides near Green Bay, Wisconsin with her family, is an AAP/AHA Neonatal Resuscitation Instructor and is semi-retired as a midwife in private practice with BirthWise Health and Birth Center. As an MPH in Maternal Child Health and a License Midwife with 28 years of experience in private midwifery practice, Ms. van Roojen has served on numerous oversight committees, advocacy organizations and boards, representing direct-entry midwifery at the local, state, national and international levels.

Connect With MANA: Vice President's Address

Posted by Midwives Alliance on February 18th, 2015

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MANA Vice President Sarita Bennett, DO, CPM, shares with us her role on the board of the Midwives Alliance, her priorities for 2015, and ways to deepen your involvement at MANA.

As the vice president, my job is often very fluid and calls for being willing to do whatever needs done. I strive to keep an eye on the general board work and have at least some understanding of the many projects that are in process. At the same time I look for opportunities to hear what members and midwives are saying "on the ground." Through the last 3+ years on the board, my phone contact list has filled with what looks like a huge family – all with the last name MANA!

Have a question about MANA? Contact me!

I receive all of the emails to info@mana.org including communications from midwives, students, potential students and consumers. My goal: respond within 24-48 hours. Consumers are usually looking for midwifery services and I refer them immediately to the "Find a Midwife" feature on our consumer site, www.mothersnaturally.org. MANA members: be sure to opt in to this excellent benefit by making sure your membership is current and your information is accurate.

Mother's Naturally: What Would You Like Changed?

In 2015, I will be working with a team to update this website so that midwives can feel confident recommending it to their clients. It has the potential to be a great resource and just needs a little TLC. Please take a moment to look at the current website and give us feedback for what you would like to see. I'm the one who receives the info@mothersnaturally.org emails, too!

Tap into the resources the MANA website has to offer!

Have you looked at the MANA website (www.mana.org) lately? I am amazed at the vast amount of information and resources contained there. I encourage each of you to take some time to look through it and get a sense of the family of volunteers and staff that keep this organization on track and of the tremendous amount of work that has been done through the years to define and support the midwifery profession. As you explore, think about what could be updated or added to make the website an even stronger benefit to members. Some ideas we are looking at include a members only "classified ads" page where not only books and equipment can be advertised but also opportunities for apprenticeships and employment. Again, let me know what would serve you and ways you might be willing to get involved.

Deepen your connection to MANA

Did I say "willing to get involved"? One of the MANA Board's most important responsibilities in 2015 is looking for innovative – and fun! - ways to raise funds to support the Division of Research. The work of the DOR benefits us all as the MANA Statistics Project produces the evidence needed to support the wisdom of physiologic birth and midwifery care. These benefits range from the ability to provide improved care to the ability to affect policy. This dedicated team of professionals has worked for many years on a shoestring budget and now are standing on the edge of the potential for huge growth. But the DOR can't grow without funds. If you are willing to help, please contact me asap at vp@mana.org. We need you!

Free Membership For New Midwives

If you are a newly credentialed midwife or soon-to-be-credentialed midwife, don't forget to sign up for MANA's free one year membership honoring you and the hard work you have put in to achieve your goals. You are the future of the profession and we want you to know that you matter to MANA.

Thanks to Face of Birth

I want to take this opportunity to thank the producers of the amazing new video "The Face of Birth" for their generosity in supporting MANA. If you haven't had a chance to watch it, please do. Please visit and Like their Facebook page, too. To get a deeper feel for the passion behind the film, you can check out the blog on the MANA website that features an interview I did with one of the producers, Gavin Banks. The film was screened on the first night of our conference in St. Louis last fall, and shown again later in the weekend in response to many requests.

Join Us In Albuquerque!

Even though October seems far away during this long winter, the MANA 2015 conference is already taking shape. Abstracts are coming in and ideas are brewing. Make sure you find a way to join us in New Mexico!

Thank you for your midwifery passion and your dedication to families. And, thank you for your support of MANA - where all midwives matter. Feel free to contact me - in person at the conference, or by email vp@mana.org - with your ideas and visions for MANA.

 

About the author

Sarita Bennett, DO, CPM, grew up in a rural mountain culture that valued self-reliance and in which home birth was the norm. In the early 1980’s, she joined with other young midwives in her state to support one another and find sisterhood as they developed standards of care, risk factor guidelines and a well-honed peer review process. In 1994, Sarita found herself answering another calling and began her Osteopathic education at the West Virginia School of Osteopathic Medicine. In 2001, she returned to her rural home town, providing home birth and general family practice until 2013, when she relocated to begin a new adventure. Along with her passion for midwifery, she discovered her gift for mentoring and is actively involved in educating future midwives through The Academy of Experiential Midwifery Education. Sarita served as secretary for the MANA Board of Directors from October 2011 until being elected as vice president in 2014.

Midwives Alliance: Celebrating What YOU Bring To Midwifery

Posted by Midwives Alliance on February 10th, 2015

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Midwives Alliance: Celebrating What YOU Bring To Midwifery

 

 

Midwives are NOT all the same, and MANA celebrates their difference. 

This drives our strategic priorities for 2015:

  • Support for midwives who wish to continue their fight for autonomous practice

  • Legalization of the CPM in all states

  • Access to training for all midwives to meet the unique needs of their communities

  • Equity in the profession and calling that is birth work.

We are proud that our volunteer board is composed of: CPMs, LMs, CNMs, a CM, and a DO, midwives from every educational pathway. We are working hard in a consensus model to help midwives have a stronger national voice and presence. 

Here’s how we want to work with you and for you in 2015.

Deeper connections to our membership.

We are planning many new ways for members to stay connected to MANA’s work in 2015!

  • Online workshops and webinars with CEUs,

  • Virtual Town Hall meetings to talk about issues of concern to midwives and to hear the voices of our members

  • Division of Research updates to share the exciting work of the DOR and to encourage everyone to learn about and contribute to data collection.

  • Ongoing improvements in our website to better reflect your interest in technology and social media as a tool for sharing information

  • Updating our essential documents and preparing more position papers on topics and issues of interest to midwives and clients, including waterbirth.

Representing YOUR voice at the national level.

The Midwives Alliance amplifies YOUR voice at national midwifery and public health conferences and in coalitions that bring partner midwifery organizations together such as US MERA and the Allied Midwifery Organization. To better represent you, I want to hear what matters to you! I personally would love to travel to your state and visit with your local organization and hear your concerns as we move into this year – the more we form a communication web the better we can address the hard repercussions of midwives in states where they are on the ground working for change.

Bringing together midwives from across the nation: MANA15!

Where else do ALL midwives come for nourishment, knowledge, skills and new perspectives? Please join us for YOUR midwifery gathering in Albuquerque October 15-18th, 2015: exciting speakers, gathering of indigenous midwives, free pre-conference skills workshops for students, trips in the glorious New Mexico landscape, fabulous merchants, and so much more! 

We have a dedicated local crew working hard to help make this year an enriching and memorable experience. In this time of ever expanding internet conferences and virtual meetings, MANA wants to remain a welcome place for midwives, birth workers, consumers and activists to come together and share their voices in person. We hope you will always think of the Midwives Alliance as your home, so we are working diligently to make sure you have a lovely fall gathering this year.

Welcoming YOU, your voice, and your skills to MANA.

I invite you to join the Midwives Alliance as a volunteer and as a member. It may seem impossibly daunting to work within a national organization, but I want to assure you that NEW voices are what we are looking for in 2015. MANA cannot be your voice unless you participate and we are dedicated to helping new voices become strong voices, so consider joining us as we hold the ground for "all midwives."

Tell me what matters most to you.

I hope you will feel free to contact me, any time, at president@mana.org. I want to hear from you and care deeply about your rights, as does the entire board of MANA. We need greater autonomy and justice within the profession, and as we move into 2015, The Midwives Alliance wants to continue to be the progressive organization that has always defended the rights of midwives to be distinct and autonomous practitioners. Midwives are THE solution to our maternity care crises in the United States and the world.

Thank you and Happy New Year!!

Marinah V. Farrell, CPM

President, Midwives Alliance of North America


Marinah FarrellAbout the author

Marinah Farrell is a CPM in Phoenix Arizona working in homebirth and birth center practices. She is recognized for her work in public health issues, is a founding member of Phoenix Allies for Community Health, a free clinic in downtown Phoenix., and participates as a human rights activist both in the U.S and internationally. Marinah is in her first term as MANA President.

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.

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