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MANA13

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.

Understanding MANA Stats: a Q & A with Missy Cheyney

Posted by Midwives Alliance on October 24th, 2013

Melissa Cheyney, PhD, CPM, LDM, will again be presenting at the Midwives Alliance of North America conference this year, providing membership with an update on the MANA Stats Project. This year at the conference, she will also be announcing the upcoming release of two research articles that examine outcomes from MANA Stats 2004-2009. I sat down to talk with Missy about her presentation at MANA, her hopes for MANA Stats in the future, and how this critical research project can be a tool for expectant parents. Missy is the Chair of the Midwives Alliance Division of Research and an Associate Professor of Medical Anthropology and Reproductive Biology in the Department of Anthropology at Oregon State University (OSU). Learn more about her here. You can learn more about MANAstats here.

Jeanette: So first of all, tell me the basics. What is MANA Stats?

Missy: The MANA Statistics Project (known as MANA Stats) is a web-based data collection tool that has been gathering data about maternity care and birth outcomes since 2004. There have been three main data collection form versions since the project’s inception: the 2.0, 3.0 and 4.0 versions. Overall, more than 60,000 courses of care now comprise the MANA Stats data registry, with more than a 1,000 new records submitted monthly. The majority of records are for planned home births.

Midwives' participation in the MANA Stats registry is voluntary, except in Oregon and Vermont. Midwives log clients into the system early in care before the outcome of care is known. The system then prompts midwives to complete records for all clients who are logged. Once the data is entered, they go through a rigorous review process to make sure the data are as accurate and reliable as possible.

J: And what’s the news about your upcoming research articles?

M: I’m excited to report that a group of researchers and I have two papers on the MANA Stats 2.0 dataset coming out in the Jan/Feb 2014 issue of the Journal of Midwifery and Women’s Health.

J: Before we talk more about the upcoming articles, let’s discuss the basics of the work of the Division of Research. What are the goals of MANA Stats?

M: MANA Stats is designed to serve three purposes.

The first is that it provides contributing midwives with a tool to track outcomes for her or his own practice. The MANA Stats system auto-calculates midwives’ practice outcomes instantly so they can keep close track of their own outcomes. Ideally, as a midwife sits down with a prospective client who’s asking questions, he or she can provide up-to-the-minute information about transport rates, neonatal mortality rates, or whatever data are relevant to the questions the client is asking. This is an important part of shared decision making.

Second, once the sample size is large enough to allow for analysis, researchers on the MANA Division of Research calculate outcomes that midwives can use to compare to their own practice statistics. These larger analyses are communicated to contributors at the annual MANA meetings and via direct contributor communications. They allow midwives to perform quality assurance and quality improvement in their own practices.

The third thing we do is to maintain datasets for researchers. We export our data from the online format it is collected in and respond to requests for data access. Although fewer researchers have requested data than we initially anticipated, all requests to date have been granted. We welcome all data access applications for research projects that have IRB approval from the primary investigator’s home institution and that have research questions that can be addressed with our dataset. Researchers can ask innumerable questions related to place of birth, normal physiologic birth, midwife-led birth, and many other interesting research questions.

J: At the MANA conference you provide midwives with benchmarking statistics based on the MANA Stats data set. Why is this important? Can’t midwives just look at vital statistics (birth certificate) data for their states?

M: Midwives cannot go to Vital Records to ask how they’re doing because Vital Records – except in a few states – does not evaluate outcomes based on intended place of birth. When you are looking at your own outcomes and asking, “how am I doing?” you want to make sure you are comparing apples to apples. We want to compare our outcomes to all women who went into labor intending to deliver at home (or in a birth center), regardless of where they actually delivered.

If you were to look at national statistics—which includes high-risk women who give birth in the hospital—it would not be appropriate, for example, to compare your c-section rate to Vital Records data on c-section rates. We would expect there to be a higher c-section rate in the hospital because, presumably, more higher-risk women are giving birth in the hospital.

Without MANA Stats or the American Association of Birth Centers’ Perinatal Data Registry, it is difficult to find an appropriate benchmark. How would midwives know if their transfer rates were approximately what other midwives are getting? Or whether it is uncommonly high or low, if there isn’t a benchmark by which to compare it?

That’s the goal of these conference presentations: to provide contributing midwives with those benchmarks. We’ve been providing them to membership in some form annually since 2007. Our ability to provide them, however, is tied to sample size. We have been able to talk about demographics for years and even c-section rate because something like a c-section is not a rare event as it occurs in around 6% of cases. It has only been quite recently that we have had enough data to evaluate rare events like deaths with any degree of reliability. In the upcoming article on the 2.0 dataset, even waiting until we reached a sample of size of close to 17,000, there is still much that we could not evaluate because the power of our tests was too low. We need to keep collecting data, and we need all midwives to participate.

J: And why doesn’t MANA make those benchmarking numbers open to the public?

M: It has always been our goal to publish them in a peer reviewed journal, to provide the public with the highest level of accountability.

J: Explain why the peer review process is so important to you and to MANA.

M: I think it is very important that research papers that come from the MANA Stats Project’s datasets go through the process of rigorous peer review required for publication in an academic journal.

The debate around homebirth is very polarized in our country. Many of us hold very deep convictions about it. I am a midwife who attends homebirth. Like most midwives, I feel homebirth is an excellent option for low risk women who hope to avoid unnecessary interventions and to support the processes of physiologic birth. Physicians who only receive our transfers and so only witness the times when mothers need interventions only available in the hospital, like epidural or pitocin augmentation, may feel very differently. How do we remove these biases from our research? The answer is that we cannot completely. What we can do is allow our work to be reviewed critically by others before it goes to press. Our reviewers may see things we have missed or see alternative interpretations of our data.

In a peer-reviewed publication process, outside researchers, who don’t know who you are, look at your work. They look very closely at your methods, and they critically evaluate the tests you have run and the interpretations you have made. They hold you to a very high standard. This can serve as an important corrective to researcher bias.

In the absence of rigorous peer-review, really you can say anything that you want to.  And with a controversial topic like home birth, we want that added measure of protection to have as many eyes as possible on it. We want to make sure that we haven’t made any mistakes, that we’ve been really transparent in how we’ve calculated our numbers, and that it meets the standard of rigorous peer-review for an academic journal.

Otherwise there’s nothing to keep anyone from making claims to safety just by going on the Internet and saying "it is safe; here are our rates." We want that level of scrutiny on our work and peer review is the way to achieve that.

J: We see the CDC release their numbers each year, and we see some states release their numbers each year. Why doesn’t MANA release their data every year?

M: A CDC-style report every year that takes MANA stats and reports on safety has been a vision of mine for some time. We would love to do that, and I received a grant from FAM to study the feasibility of doing just that.

To have meaningful data on rare events like infant death, we need to increase the sample size by increasing the number of participating midwives. Only about one percent of people in the U.S. choose a home birth. In addition, not every midwife in the U.S. uses MANA Stats to track their data, although participation has grown each year. It has taken six years to get a large enough sample size to allow for this first set of publications. It takes time for a project like MANA Stats to build a sufficient sample size to have credibility with a peer reviewed journal.

The good news is that our contributor base is expanding, and the number of homebirth and birth center births are on the rise in the U.S. We now have more than 400 participating midwives. In 2012, we collected data on around 10,000 courses of care. I will be presenting some preliminary findings from this dataset at the conference, and it will be one of the next articles that I work on.

Also, MANA does not have the organizational capacity of the CDC. MANA is a largely volunteer-driven organization, and MANA Stats has a very small budget. The CDC and the various states releasing annual data have paid staffs—some quite large—devoted to this effort. We welcome any and all funding opportunities that would allow us to engage in similar efforts to the CDC and other reporting bodies.

In my life as a researcher at Oregon State, I really cannot imagine a project as large as MANA stats running on volunteer time and such a miniscule budget. It would be a multi-million dollar endeavor in that world. I am so grateful for the committed staff on the coordinating council of the DOR who work tirelessly to support contributors, review data, export data, and analyze findings fueled only by a desire to know more about midwife-led births at home and in birth centers. All of this is done under almost constant criticism. Their work is herculean, and I am proud to be a part of it.

J: Please tell us more about the research that is on the horizon.

M: We’ve had seven researchers or sets of researchers apply to use our data set, all of whom have received access, and now some of the publications from those requests are starting to either go to press or are under review. Some are students who have used the data for a Master’s thesis but may not have the intention to publish the findings. Four articles have emerged that are either in press or under review, including the two that I mentioned, on the MANA Stats 2.0 dataset coming out in the Jan/Feb 2014 issue of the Journal of Midwifery and Women’s Health.

J: One of those two articles looks at the outcomes of the MANA Stats 2.0 dataset. What can we expect to learn?

M: This article looks at the demographics of the MANA Stats data set 2004-2009, including the intended place of birth and the type of midwife in attendance (we have mostly CPMs but also some CNMs, naturopathic midwives, doctors of osteopathy, or midwives who identify as un-credentialed or traditional midwives who utilize the data set).

It also looks at standard maternal-child health outcomes and home birth indicators, like transfer rates, i.e. intrapartum transfer, neonatal transfer, maternal postpartum transfer, and it looks at reasons for those transfers. It also examines cesarean section rates and spontaneous vaginal birth rates. It also examines intrapartum, early neonatal, and late neonatal mortality. Finally, it explores rates and type of tearing, hemorrhage, and NICU admissions.

J: How can the outcomes research inform consumers?

M: I think many consumers are asking themselves: "What are the trade-offs for the place of birth that I am choosing?" There’s no perfect place to give birth, and there’s no place to give birth that will have a mortality rate of zero.

So what a woman is actually doing is negotiating her own individual risk profile, as well as her own personal and family values as she chooses a place to give birth. An informed consumer needs access to information on all of the potential birth options: home, birth center, and hospital, as well as by provider type: CPM, CNM, OB, etc.

Women are often forced to make difficult decisions that involve trade-offs around rates of intervention, the likelihood they will be able to know who will attend them when they go into labor, cost, and access to medical back-up should a complication arise. If you are in the hospital, you may have significantly more intervention than you might at home. But then the question might be, at what cost? What's the impact of interventions when they are unnecessary? Do they increase morbidity? Those are questions you cannot ask if you do not track outcomes by intended and actual place of delivery.

Consumers today have to piece together information from studies that are often conducted outside of the U.S. So they are also making inferences about safety and benefits across different medical systems. There’s not a perfect place to get information about place of birth and provider type. But MANA Stats is bringing something to that discussion. Our sample size is getting large enough to start to look at things like rare events that will figure in for a woman trying to decide where she wants to give birth and with whom. What is her risk of having a c-section? What’s her risk of having an unnecessary c-section? What’s the risk of the baby having problems? Those are all questions a woman might want to ask, and there’s not one place that she can go to get this information right now. I think that's a problem, and I am excited to see all that has been happening in the research world over the last few years—the National Birth Center Study II, the Home Birth Consensus Summit, and the Institutes of Medicine Birth Settings Workshop. What an exciting time!

J: And what is your hope for MANA stats long term?

M: My hope is that someday we will not need MANA Stats for tracking safety. My hope is that the system of national surveillance will eventually accurately take into account provider type and intended place of birth, because many of our discussions right now are around safety; those are the most fundamental questions that people are asking.

However MANA Stats will still need to collect data because, from a researcher’s perspective, safety questions aren’t the only questions one could ask. I’m really interested in the process of care. How does a particular style of care lead to different outcomes? What components of midwife-led care lead to lower rates of unnecessary interventions? How can normal physiologic birth best be supported? How does midwifery care improve outcomes for communities of color who have a higher risk of mortality under standard medical maternity care? There are still some questions about process of care that are best evaluated by a more nuanced data collection tool like MANA Stats or AABC's PDR that are designed for home and birth center settings.

I am also excited about the future of data sharing. What if ACNM, AABC, and MANA could share data between our systems or bring it all together so data could be collapsed into one large data set across provider type and across intended place of birth? That would really be ideal.

J: I know one goal is to expand the number of researchers accessing the data. How can a researcher apply?

M: Interested applicants should go to the website. Interested researchers can read through our handbook and contact me with any questions. We are also committed to ensuring that midwives and student midwives have access to the data. If someone is interested but doesn’t have access to an Institutional Review Board (IRB) for example, we can help match students and midwives without formal research experience or institutional affiliations with expert researchers through a program called Connect Me. Midwives and students midwives can serve as content experts and learn the processes of research design and analysis as they collaborate with more experienced researchers. Two student midwives have successfully used the Connect Me program to date, and they will be presenting their findings at this MANA meeting.

J: Why is Institutional Review Board (IRB) approval so important?

M: IRB or ethics boards exist at institutions to ensure the rights of human research participants are protected. Unfortunately this process had to be created to prevent future atrocities like the Tuskegee experiments or some of the experimentation on human beings done in concentration camps in Nazi Germany.

To prevent the exploitation or coercion of research participants, universities and other organizations conducting or sponsoring research require that all researchers who intend to use data collected from human subjects be familiar with national and state-level guidelines for working with human subjects data. Institutional Review Boards are also usually inter-disciplinary, and they review research proposals to make sure that if there are any places where special protection of participants needs to be in place, that that is done.

There are two reasons why this is important to us. First, we want to make sure the privacy of participants is respected and protected. For example, in MANA Stats there are such a small number of early neonatal deaths that it wouldn’t be impossible for a researcher to figure out who some of the mothers and babies are in the sample. By combining the date of birth and the location where the birth occurred, a Google search could potentially give you the name of a participant.

Our second reason is very practical: The code of federal regulations # 21 part 56 requires it, and researchers cannot submit findings for publication unless they have gone through appropriate procedures to access data. You must have IRB clearance before you analyze data for publication.

J: Any final thoughts?

M: Yes two things. First, I encourage all those engaged in the place of birth debate to remain open, curious, and critical about what the flurry of research coming out now can tell us. It is difficult to move science forward when pro- and anti- sides of a debate become entrenched. The answer to the question of where women should give birth is very likely more complicated than simply answering yes or no to whether one thinks homebirth should be an option. I don’t think every woman is a good candidate for home birth, but I am also very frustrated with its wholesale dismissal by some as an option ever. We need a more nuanced research agenda that examines questions of safety, benefit, risk, cost, and access to care for multiple subsamples of women with various risk profiles. Secondly, no matter where a woman chooses to give birth or where we as providers feel the safest choice might lie, we have a duty to work together across difference to support and care for our nation’s mothers and babies.

Jeanette McCulloch, IBCLC, has been combining communications work and women’s health advocacy for more than 20 years. She is a co-founder of BirthSwell, which is working to improve infant and maternal health—and the way we talk about birth and breastfeeding—by making social media accessible for birth and breastfeeding professionals. She is a board member of Citizens for Midwifery and is active in local, statewide, and national birth and breastfeeding advocacy projects.

Photo credit: Scott Kemp


Updated 10-29: The URL of this post was changed due to technical issues. All comments submitted with a full name and valid email address have been moved to the new, correct, URL.

Addressing Diversity: Contemporary Midwives’ Perceptions of Organizational Diversity Initiatives

Posted by MANA Community Manager on October 18th, 2013

Last week, I had the pleasure of talking with Keisha Goode, PhDc, who is unfortunately unable to present her dissertation findings at the upcoming 31st annual Midwives Alliance Conference on Birthing Social Change due to a last minute family emergency. Luckily, I got to talk with her extensively about her work, and you can view her slides here. Her presentation “In Their Own Words: Experiences of Contemporary Black Midwives in the United States,” addresses experiences of race and how perceptions of race impacts how we address creating social change, equal access and providing quality health care for all women.

Kate Dimpfl: Let’s start off by talking about how you came to this work. What drew you to talking about race and racism in midwifery?

Keisha Goode: I started as a literacy teacher and when I thought about doctoral education, I first thought about connecting maternal education and literacy amongst black students. However, something about it didn’t move me.

Then I started to explore black motherhood in general and then as it relates birth, I noticed the historical midwifery literature for black midwives focused primarily on granny midwifes. Out of my own curiosity, I started to look at what was happening with black midwives now.

I was fascinated by how relatively few, black midwives currently are operating in the US, especially in terms of history, and I wanted to figure out why.

KD: How do you think our current system of midwifery training and education impacts entry into the field for black women?

KG: I was surprised to discover that regardless of age, [black women’s] perceptions of midwifery education and access to education were pretty similar.

I think that a lot of progress has been made, but one thing that strikes me is that issues of “belongingness” are still present. The feeling of trust or care or respect for black students in education is a consistent issue.

If a goal is to diversify the core of midwives, there has to be a space and acknowledgement that racial diversity is a real issue, and then how do you navigate that head-on in midwifery programs? That looks like having people of color teaching and working inside of midwifery programs, even online. People have to see someone who looks like them. Race can’t be the introductory class, but needs to be deeply imbedded throughout the curriculum. This means having difficult but essential conversations about race.

But to move beyond diversity initiatives to become more substantive, it needs to starts with acknowledgment that there is an issue and putting more structural things in place to address it, like addressing race throughout the curriculum, scholarships and funding for midwives of color, access to mentors or preceptorships.

KD: Let’s explore some of the research outcomes you wanted to highlight in your presentation. How do black midwives experience the current healthcare crisis?

KG: I think [perceptions of the health care crisis in the US] are similar to other racial groups, but the main point I wanted to make in that part of the findings, is similar to how black midwives also interpret the high black maternal and infant mortality rates.

Simply put, race is so deeply imbedded in every aspect of our society and social institutions. Access to health care and quality of health care are so deeply connected to race and has real outcomes. Being black and pregnant is very different than being in another racial group.

I was fascinated by stories from the midwives of how the everyday living as a black pregnant woman impacts her health, her baby and the birthing moment. Issues of mortality and morbidity are related to social interactions as well as other maternal health issues.

(Here is a good clip from Michael Lu, MD that also illustrates this point).

KD: How can we support black women to overcome real racial challenges in her pregnancy and her ability to access midwifery care?

KG: It is hard to implement “eliminating racism” as a tangible policy change, and while policy helps with access to care, that isn’t the full issue.

We see [how midwifery care positively impacts] black women and their babies. And while this wasn’t a major research question, I saw that impact of media on black women’s perception of black midwives, in that they either don’t exist or are somehow “less than.”

There is an opportunity to shift the framework of how black women see black midwives and to encourage black women to see it as an option for safe, quality care. It is truly a lack of awareness that midwifery care is an option. Positive images in the media help.

Diversifying the cultural imagination of black women perpetuated in the media-reifying tropes of the mammy, “angry black woman” and the like-do little create space for counter-narratives, i.e. the level of experience, education and professionalism that is midwifery.

KD: You shared some ways to counteract institutional racism in midwifery education. Would you apply any of those techniques to shifting these larger cultural perceptions of black midwives?

KG: When women are pregnant they need to see images of black midwives. There is a huge absence of these images in shows like The Baby Story or even in stock photos. At first I thought this point seemed small, but we see so many images in a day. To see images of black women birthing with black midwives inside or outside the hospital is powerful.

We also need a prominent spokesperson for women of color and midwives of color, much like Erykah Badu is doing for the International Center for Traditional Childbearing, or like Ricki Lake is doing for homebirth. Also the researchers or policy makers who are invested in talking about race- and they don’t have to be black- need to address how to counter those messages in the media. We need more research like this, and more policy makers who are putting race as one of the pieces amongst other issues.

KD: What are some of the biggest surprises that you have experienced in your research?

KG: I was surprised that there wasn’t more cohesion among the various types of midwives, which creates tensions. I was surprised and saddened by the politics of the perceptions of the different types of midwifery, which can take away from access to and quality of care for women and girls. This speaks to a need for more clarity and collaboration to eliminate those tensions that prevent everyone from reaching common goals. This must first begin at the level of professional midwifery organizations.

Another surprise was the overall feeling from the black midwives I talked to that the larger organizational conferences weren’t addressing things that were applicable in their own communities, so willingness to participate was less. There is decline in participation in these larger groups because their needs were not met, but they are missing the benefit to being a part of the larger organizations.

One way to address this is to make sure that disparities are touched upon in a very real way throughout the conference, and it was good to see that the 2013 MANA conference seems to reflect that.

KD: What do you want everyone to understand when it comes to black midwives experience in midwifery education?

KG: Midwifery education, midwifery organizations, and research/policy would be my top agenda items. First, in terms of education, don’t make the mistake of advertising for black midwives or underserved groups without insuring that there are structural things in place: funding, scholarships, mentorship, faculty of color and race woven into the curriculum.

For the midwifery organizations, it is kind of the same thing in terms of planning a conference: ensuring that what you are saying about addressing racial disparities-in policy documents, websites etc.- is translated clearly through the conference. That might look like diverse board representation, scholarships for black midwives, and making sure that conferences are safe and welcoming spaces to address race in a meaningful, substantive way.

Lastly, in terms of research and policy, midwifery should have the goal of being more cohesive as a community to create legislative and policy changes as well as creating more opportunities for midwifery research. I see evidence of this happening and am very hopeful.

KD: What do individuals at the conference need to have in their awareness so they are able to create better outcomes for black women in their own community?

KG: Good question. I think the main thing is to understand the ways in which race and power are so deeply entrenched into midwifery and birth. The idea that midwifery is colorblind is an illusion. Acknowledging race isn’t being racist. Race has real impacts on black women and birth outcomes.

The experience of black women working with a black midwife is going to be different- not better or worse – but different than working with a white midwife. I would also say that continuing to do the work of educating - that midwifery is safe, high quality, cost effective and that ground level teaching is important for everyone, but particularly for black women.

Meet Keisha:

Keisha Goode, PhDc, is a doctoral candidate in Sociology at the City University of New
York Graduate Center. With the advisement of Barbara Katz Rothman, she is completing her dissertation entitled “Contemporary Black Midwives in the United States: Experiences and Perceptions” which explores the impact of race and racism in midwifery education programs, organizations, and birth outcomes. She is a lecturer in Sociology and Women’s Studies at Lehman College. She earned a Master of Arts in Women’s Studies from the George Washington University and a Bachelor of Arts in English from the University of Maryland, College Park. Email Keisha for further information about the study.

Author Bio:

Kate Dimpfl, CCE, CD, runs Holistic Childbirth and works as a childbirth educator and doula in Ithaca, NY. When not talking about birth she is walking about town with her family. To learn more about Kate, visit: www.holisticchildbirth.org.

Photo credit: bitsybaby.com

Birthing Social Change FREE Pre-Conference Session Oct 24

Posted by MANA Community Manager on October 7th, 2013

As a part of the Birthing Social Change: MANA 2013 Annual Conference, MANA is offering a free pre-conference session, designed to help us all work towards a more inclusive profession and greater equity in maternal and infant health. The following post was written by the session leaders (including Annie Menzel CPM, PhC; Wendy Gordon CPM, LM, MPH; Gretchen Spicer CPM, LM; Laura McNeill Groundwork Antiracism Collective Trainer;  Elizabeth Bruno, Groundwork Antiracism Collective Trainer; Marijke van Roojen, LM, CPM) to help us learn more about what to expect. To register, please click hereCEUS have been applied for with ACNM and MEAC.

The 2013 Midwives’ Alliance Conference website says that at “the heart of MANA’s goals” is the mission of “supporting equal access to high quality maternity care for all women and their families.” We can all get behind this aspiration. But how exactly do we translate it into practice? This full-day pre-conference workshop will help to equip midwives to understand three crucial themes that will help lay the groundwork for moving from aspiration to action:

1) the current racial and economic inequalities in access to good care, reflected in worse maternal and infant health among communities of color

Midwives are already working hard to care for many women who are not well served by the system of mainstream maternity care—women in rural areas, women in plain communities, low-income women, young women and older moms.

Many midwives put themselves at legal risk to provide this care, and to keep the crucial option of homebirth open. As we well know, the system of maternity care in the United States is far from ideal across the board. But as a group, white women, especially middle-class and affluent white women, tend to have the most and best options, including midwives from their own communities. 

In contrast, women of color, especially low-income African American, Native, Southeast Asian, and Latina women, have the fewest options for quality maternity care—including very few (if any) midwives from their own communities. The workshop will highlight the connections between these inequalities of access to midwifery education and care and the broader systems of racial and economic injustice in this country.

Using activities incorporating movement and breath; listening and response; and audiovisual resources,we will also demonstrate the ways that these large systems of inequity come to harm the individual lives and health of moms, babies, and families of color, while tending to benefit the lives and health of white moms, babies, and families.

2) the history of how these inequalities came about, and the role that US midwifery has played

Understanding the current state of inequality in access to and outcomes of maternity care will help us move toward change. Through a participatory timeline exercise, we will trace this history.

We will situate the history of midwifery within the broader history of reproductive inequality and violence, from experimentation on enslaved African American women to the sterilization of women of color and institutionalized and incarcerated women, as well as strategies of survival and resilience within communities of color.

We will track the ways that midwifery has been both a history of healing and a history of racial injustice, from Native American midwifery to enslaved African American healers; from the work of Black, Mexican-American, Asian-American, and European-American community midwives to the medical and state campaigns to eliminate them; from the re-emergence of white midwives in the 1970s, which failed to acknowledge much of this history, to present-day barriers to access to midwifery education, care, and professional inclusion for practitioners of color. We will also learn about ways that midwives and birth workers of color have challenged these barriers.

3) what “supporting equal access” would really mean and require for individual midwives, our professional organizations, and our educational institutions.

Together, we will look forward and learn how to make changes in our practices and our day-to-day lives, including small steps you can take right away.

Using role-playing exercises that draw upon participants’ real life experiences, we will practice recognizing and responding to racist speech and situations. We will also think together about how white midwives can apply existing models of antiracist collective action and accountability to midwifery. We will learn about exciting projects for equity in maternal and infant health led by community midwives of color. Brainstorming with others from our regions, we will identify steps toward long-term plans for supporting these projects and dismantling barriers to education and professional inclusion.

In order to build on the learning that we gain, the momentum that we generate, and the connections that we make through this workshop, the facilitators also plan to hold follow-up discussions during the conference, time and locations TBA.

Please join us! Everyone is welcome. Working together to understand ways that whiteness shapes midwifery practices will give us crucial tools for “birthing social change” toward equity in maternity care and real inclusivity in our profession.

While we welcome and encourage everyone to attend the full conference, all birth professionals and student birth professionals are welcome. The session is free and registration is required. Please click here for signup information.

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NEW EVENT!

We will be viewing Cracking the Codes, a new film that asks America to talk about the causes and consequences of systemic inequity. Cracking the Codes: The System of Racial Inequityfeatures moving stories from racial justice leaders including Amer Ahmed, Michael Benitez, Barbie-Danielle DeCarlo, Joy DeGruy, Ericka Huggins, Humaira Jackson, Yuko Kodama, Peggy McIntosh, Rinku Sen, Tilman Smith and Tim Wise.

When: Friday 7 pm

Location: TBA at conference

Who: Anyone attending the MANA conference is welcome - you do not need to have attended the full-day workshop to participate.

Honoring Grand Midwife Umm Salaamah “Sondra” Abdullah-Zaimah

Posted by MANA Community Manager on October 2nd, 2013

“Every community should have their own midwife. Someone who understands their culture, who they already trust, who is a part of their community, who they’ve known since they were children.” ~ Umm Salaamah “Sondra” Abdullah-Zaimah, MN, CNM, CPM

Umm Salaamah “Sondra” Abdullah-Zaimah will be turning 70 this month and has been practicing midwifery for nearly 35 years. She will be honored this year at the upcoming MANA conference with the Sage Femme Award. MANA volunteer Nermari Broderick recently interviewed Umm Salaamah so we could all learn more about her and her work.

Umm Salaamah’s career began when she was seeking maternity care options for her daughter and goddaughter, both teenage mothers-to-be with a high distrust of the health care system.

“I found a group of midwives working with a doctor at a free clinic in the Bronx, but by the time I found them, she was five months pregnant, so they wouldn’t take her on,” said Umm Salaamah. “I had been through the emergency childbirth training that they gave police officers. Both of those babies were born at home, during a snow storm that shut everything down. Only the national guard was out in New York City.” Both mothers and babies were healthy and as Umm Salaamah describes it, “I was dumb and lucky. Blessed, really.”

Umm Salaamah was studying to become a nurse with the goal of becoming a nurse midwife when her daughter became pregnant again. This time, Umm Salaamah reached out to Ina May Gaskin and the Farm community for training. Recalling an initial training at the Farm, Umm Salaamah says, “I fell in love with how they did things at the Farm. I came home, I quit my job, I bought a van and wrote a letter and told Ina May I was on my way.”

Umm Salaamah spent two years on the Farm, and then returned home to her family in Brooklyn to work with her community. She went on to also become a certified nurse midwife and has worked with communities across the country and the world, including Georgia, Florida, Texas, Kentucky, Mississippi, Tennessee, Honduras, Ghana and many others. She has helped to launch or support a number of international projects, including a maternal health clinic in Senegal. Sharing her insights with others working internationally: “If you go in with an attitude of respect and love, you see other people - as if they are your sister, your daughter, your mother. If you don’t see the outside of a person, but you see that they love their children, want the best for their children, they want the same things you want, if you love them and respect them and are willing to share, rather than coming to tell people what to do, you have a much, much better relationship and you are in a position to learn. It has to be a sharing, compassionate, loving relationship.”

She is particularly focused on ensuring that her knowledge - and the knowledge of other elder midwives - gets shared with the next generation of midwives. “The more I can train women to recognize when they need to transport, to recognize problems, and pass those on, the more I am sharing good practices among women. There’s an African proverb that says if you teach a man, you teach an individual. If you teach a woman, you teach a nation. She is going to share with her community.”

Umm Salaamah has devoted significant time and energy to the midwifery community, including serving on the MANA board, chairing the committee that became the North American Registry of Midwives (NARM) and serving on the NARM board.

Umm Salaamah provides critical support to a number of organizations, including serving as the midwifery director for Birthing Project USA, an international organization and resource center for improving birth outcomes for women of color. She is a founding member and director of midwifery education of the International Center for Traditional Childbearing. The organization was created to promote the health of women and their families and to train Black women aspiring to become midwives.

She is also a founder of Midwives On the Move (MOM). MOM is a committed group of midwives, aspiring midwives, doulas, nurses, birth activists, consumers and volunteers working together in the U.S. and Ghana, West Africa, to exchange midwifery skills, knowledge and ideas.

Today, one of her goals is to ensure that all women have access to community-based midwifery. “I think that every community should have their own midwife, someone who understands their culture who they already trust, someone who is a part of their community, who has known them since they are children. I don’t think it is good for a people to have to take their most most vulnerable members - their pregnant women and brand new babies - off to another culture, that is not always respecting their rituals or their culture.”

One midwife is chosen each year to be the recipient of The Sage Femme award. It honors a grand midwife, past or present, who has practiced the art of midwifery over many years. One whose work, perseverance and dedication will serve as an inspiration to midwives future and present. Learn more about the Sage Femme award and MANA’S 2013 conference, Birthing Social Change.

Nermarí Faría Broderick is one of MANA’s volunteer online community managers. A mother of three (soon to be four), she is very passionate about birth and midwifery since she became pregnant with her first over seven years ago. In her day job, she does public relations. You can find her on twitter at @justNermari

[eds. note - new photo added 10/8, provided by Aima Bey]

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