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New Waterbirth Practice Template Adds to Growing Body of Waterbirth Resources

Posted by Midwives Alliance on December 1st, 2016

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Water Birth Practice Template

A new resource providing guidance on hydrotherapy in labor and birth is now available, thanks to a consensus of maternity care experts, including Midwives Alliance of North America. The resource, A Model Practice Template for Hydrotherapy in Labor and Birth, is a part of a growing body of resources for providers working with families considering hydrotherapy.

Tools and Resources:
A Model Practice Template for Hydrotherapy in Labor and Birth.

This guidance template uses “the most current information and best practices available to outline various roles and responsibilities when caring for [those who] labor and/or give birth in water.” The resource was jointly assembled by the American College of Nurse-Midwives (ACNM), the American Association of Birth Centers (AABC), Midwives Alliance of North America (MANA) and National Association of Certified Professional Midwives (NACPM). You can find the tool here.

Largest-ever research study in the US on waterbirth.

In a sample of more than 6,500 babies born in water, researchers found that being born underwater did not confer any excess risk to the baby. Babies born underwater were no more likely than those not born in water to have a low five-minute Apgar score, or require hospitalization or neonatal intensive care (NICU) admission. The research also found no evidence that waterbirth is associated with neonatal death. This indicates that, for low-risk mothers whose labors proceed normally, water immersion is generally a safe pain management option. Find the peer-reviewed research online here and a blog post with the authors here.

Position Statement on Waterbirth.

This position statement, co-authored by Midwives Alliance of North America and Citizens for Midwifery, brings together peer reviewed evidence and the clinical experience of midwives who provide waterbirth. It provides tools for childbirth educators, doulas, midwives and midwifery educators who need to answer consumer questions, and the most current information to help families decide what is best for them. Find the position statement here.

Tools for integrating waterbirth research into practice.

Learn how to use an evidence-informed practice (EIP) framework to understand the potential care implications of the waterbirth research with tools in this blog post here. From Courtney L. Everson PhD, Medical Anthropologist, Dean of Graduate Studies at the Midwives College of Utah, and the Director of Research Education for the Midwives Alliance of North America (MANA) Division of Research (DOR).

Honoring Ellen Harris-Braun

Posted by Midwives Alliance on November 9th, 2016

The entire community of the Midwives Alliance of North America is mourning the loss of Ellen Harris-Braun, CPM, and the Director of Database Development for the Midwives Alliance Division of Research. You can learn more about her life and her contributions to her friends, family, and the profession at her obituary here. We asked some of her colleagues at MANA to share with us recollections of time with Ellen, as a way to honor her and share with you our love for her.

If you have stories of Ellen’s life and her contributions that you would like to share, please do so in the comments. We will pass them along to her family.

Ellen Harris-Braun

Bruce Ackerman, Data Collection Director, Division of Research

Ellen became a dear, dear friend, collaborator and teacher since our very first meeting, at the 2003 MANA conference. At that time Ellen attended the Statistics Committee meeting – knowing her now I would totally expect this, because she was intensely curious and passionate about birth and research, planning to progress from being a doula to entering midwifery. We both volunteered to look into a possible web site for data collection, and met after the meeting, when she immediately set about asking everyone who passed in the hallway what they would like to see in such a site. Ellen got right to it, and loved to hear others’ thoughts.

During these thirteen years Ellen, and her partner Eric, wrote the software code for the MANA Stats site, not once but twice as Eric decided to rewrite and improve it. During the same years, this amazing couple founded an intentional Quaker Community, buying land and building all their houses and common building, learning post-and-beam and straw-bale construction on the way. They raised two amazing children. Ellen indeed progressed into midwifery, despite the requirement in New York that she get a master’s – and used her master’s studies to create the first research module on the MANA Stats form. She maintained other web sites, including a writer’s workshop used by hundreds.

Within MANA and the DOR, Ellen became far more than our programmer, serving on the Coordinating Council where she expertly and gently facilitated difficult meetings. Her skill at writing and succinctly explaining things has shown through in everything we have done together, starting with the beautiful web site design itself. Ellen told me early on that she wanted to meet the leaders of the midwifery movement, and indeed she has become one of those leaders.

These thirteen years of working with Ellen are defined for me in a profound way. As I met Ellen, I was receiving word of my mother’s suddenly taking ill, and the next day my mother passed. After some months I found myself with an “opening”, having expected to spend the year with my mother but now spending it in intensely creative work with Ellen and Eric. Like everything I have seen Ellen’s family and community do, Ellen’s care and passing has been a beacon to us all: sensitive to all their many friends, navigating this sadness and suffering with the most profound self-awareness, and leaving a powerful blog that has been and will always be a resource for others in so many ways.

Ellen has left far more than a legacy for midwifery, far more than a guide to consciously dealing with cancer, far more even than a lovely community and extended family. Ellen has lived one of those lives that deeply touches more people than anyone can know, showing us all a life of humor, curiosity, sparkling intelligence, passion, and bringing the very best of herself to every moment. May our lives be worthy of the lessons offered by knowing her.

Melissa Cheyney, PhD, CPM, LDM, Chair, Division of Research

I first met Ellen in 2007 when I got recruited by Peggy Garland to be involved in the MANA Division of Research.  Ellen and others had just completed a process called the “deep review” where they had studied other data collection tools and created what became known as the 3.0 form.  Peggy brought me on board.

I had the pleasure of working with Ellen for the next nine years on many exciting research initiatives.  Ellen is by far the most brilliant person I’ve ever met.  When I think of her there are three things that come to mind.  The first is our early frustration with each other.  That frustration was motivated, at least on my part, by a  part of Ellen that we laughingly came to call “quizzical resting face.”  Ellen was constantly taking information in about the world around her, thinking it through, repackaging it, and expressing it more clearly than anyone else.  One day she explained to me that her furrowed brow  meant that she was listening and synthesizing and not thinking “you are a moron.”  This was a breakthrough in our relationship.  We went on to collaborate with joy and humor on her length of pregnancy study and it is my deepest wish that we see this through to publication posthumously in her name.  The members of the DOR, I am certain, are of like mind; we will make her critical research available to the midwifery community.

The second thing is something I am grateful for.  In 2014 at the St. Louis MANA Conference several members of the Division of Research were unable to attend and Ellen and I were able to room together.  Some of my most cherished memories of Ellen occurred over that long weekend.  I remember joking with her that she was the healthiest sick person that I’d ever met.  She was up early every morning to run, had cut all sugar from her diet, and was so vibrant.  We spent lots of time in our room scrolling through decades of pictures that she had on her laptop.  She also brought a math project from elementary school to show me – a bar graph.  Geeky research humor.  Ellen and I had a respectful professional relationship prior to the conference but left it as close friends, and for that I will always be grateful.

The third thing is a life lesson that Ellen taught me in April of last year.  I was in New York for a speaking engagement and got to spend a day with Ellen in her home and community.  It was not a convenient time to have me and there was a lot going on there.  However, it enabled me to see the incredible love that Ellen had for her children, for Eric, and her community.  Ellen was a fighter.  To me it seems she fought not out of fear of death, but out of her love for her family and community.  I think it was this love that also drove her to becoming a midwife.  I am sure everyone that knows Ellen has similar stories of how profoundly she touched their lives.  For me, she spurred a true existential moment that led me to reevaluate my own life priorities and to find a better balance between work, family, and community.  The MANA Stats is an amazing legacy, but not nearly as important as what she has taught us all about love and community.

I will miss her and yet I do not feel like she is truly gone.  I work on MANA Stats in some form everyday and see her fingerprints and hear her voice there.  She continues to inspire me every day.

As I wrote this, my husband was making pancakes from Eric’s and Ellen’s famed recipe.  Another gift from that weekend spent with them in New York.  Goodbye Ellen and thank you for all that you have done for midwifery and for me and my family (I imagine you are somewhere listening and correcting the grammar of this remembrance.)

 Ellen and her partner Eric

Courtney L. Everson, PhD, Director of Research Education, Division of Research

Ellen: a name that means so much, a spirit that embodies so much.

I have known Ellen since 2008, when I was first introduced to the work of the Division of Research (DOR) and became involved. Since 2010, I had the opportunity to work closely with Ellen as a Coordinating Council member of the Division of Research, and I feel forever blessed for the friendship and collegiality she has extended to me over the years. My life—like the lives of so many—has been deeply touched by Ellen. Her spirit is one of brilliance, kindness, wit, and humor! Also, she is a great editor! I have always admired Ellen’s ability to see the details and the big picture; to balance life, work, and family; to operate from a position of integrity and love.

It is difficult to put into words just how Ellen has changed my life; the ways she has impacted my life are felt, and no words can fully represent those feelings. What I can say is that I am a better person because of Ellen, and I know her contributions to this world will be forever cherished and appreciated.

With a heart full of love and admiration for the incredible Ellen Harris-Braun.

Marit Bovbjerg, PhD, MS, Director of Data Quality, Division of Research

Ellen, as you all know, was a computer programmer and a midwife.  Think about that for a minute--a computer programmer AND a midwife.  These are not things that often go together.  As more of a computer and math-minded person, who finds herself working among a sea of midwives, I valued Ellen's collaboration more than I can say. She was able to walk in both worlds, and for those of us in only one or the other, she was able to communicate effectively, compassionately, and enthusiastically, happily helping to interpret and translate what might otherwise seem strange. I will miss working with her, bouncing ideas off her, walking with her. I will never, though, forget knowing her.

#MANA16 Sage Femme & Sapling Award Winners

Posted by Midwives Alliance on October 25th, 2016

Each year MANA presents the Sage Femme award to honor a Grand Midwife, past or present, who has practiced the art of midwifery over many years and whose wisdom, perseverance and dedication serves as an inspiration to all midwives now and into the future. The Sapling award is presented each year to a new midwife who has shown exceptional passion and leadership as she continues her journey of learning and service to families and birth.

Carol Nelson, Sage Femme 2016Carol Nelson is our MANA 2016 Sage Femme award recipient. She was chosen by the MANA Board of Directors and the Advisory Council of Elders in recognition of the work she has done over the last four decades for mothers, babies and midwives and her tireless efforts to bring midwifery into the light, to teach and to quietly lead a movement to illuminate the dignity and power of birth.

Carol currently lives on the Farm in Summertown, Tennessee and has attended approximately 2000 births. She was an LPN when she joined The Farm Community in the early 1970’s and began attending births at the Farm Midwifery Center. She was licensed as a midwife by the State of Florida Department of Health in 1982 and became the co-founder of, and director, instructor and preceptor for the South Florida School of Midwifery. She achieved the credential of Certified Professional Midwife (CPM) in 1995. She has served on the Board and as Director of Applications and Treasurer of the North American Registry of Midwives (NARM) and is a NARM delegate to US MERA. She wrote and lobbied for the CPM law in Tennessee, which passed in 2000.

For many years Carol has been the Chair of the Midwifery Education and Advocacy Committee for the Midwives Alliance of North America (MANA) and has represented the profession of midwifery on the Governing Council of the American Public Health Association, holding the space for normal births. In addition to births at The Farm Community and Farm Midwifery Center, Carol has also served mothers in Wisconsin, New York, Florida, Michigan, Canada, and as a midwife for the Amish community near her home.

Carol is passionate about direct assessment education for midwives. Her most recent ground-breaking accomplishment is co-founding and opening the College of Traditional Midwifery in 2016. Carol is widely regarded with respect and admiration by all who have had the honor of working with her, professionals, leaders and colleagues alike - when she speaks everyone listens as they know that she speaks with truth, humility and wisdom. Beloved by midwives, her students, and her birthing families, Carol embodies what it means to be a Sage Femme.

Jamarah Amani, Sapling 2016Jamarah Amani is our MANA 2016 Sapling honoree. Jamarah was born in Wisconsin and raised in the Bay Area of California and is a continuous student of life. She has studied Africana Studies, Women’s Studies and Midwifery at centers of learning such as University of Pennsylvania, Clark Atlanta University and most recently International School of Midwifery. Jamarah’s life path merges many facets of maternity care and social justice (specifically reproductive justice) and has led her to midwifery. Jamarah offers midwifery care, breastfeeding consultations and childbirth education to families across the state of Florida. Her midwifery service "Open Hands" is named after Georgia midwife Biddy Mason, who said "If you hold your hands closed nothing good can come in. The Open Hand is blessed for it gives in abundance as it receives."

Jamarah Amani is a community midwife (licensed in the state of Florida) who believes in the power of birth and that every baby has a human right to be breastfed/chestfed. Her mission is to do her part to build a movement for Birth Justice locally, nationally and globally. Jamarah has said "Birth Justice is a parent's right to ensure the well being of herself and her baby; it intersects with all aspects of our lives – social, political, economic, spiritual and emotional. When parents are empowered, a community is transformed. If we bring our babies into the world with justice, in the natural way, without anyone telling us how to do it, then it nurtures our innate power as mothers to create a free world for our children to play and learn and grow. Birth Justice includes access to holistic, humanistic and culturally centered prenatal, birth and postpartum care (the midwifery model of care), the right to choose when, where, how and with whom to birth as well as the right to breastfeeding support. The complete range of pregnancy, labor and birth options should be available to everyone as an integral part of reproductive justice. These are our rights as parents."

Jamarah has been a community organizer since age sixteen and has worked with several organizations across the United States, the Caribbean and in Africa on various public health issues, including HIV prevention, infant mortality risk reduction, access to emergency contraception and access to midwifery care. She is director of Southern Birth Justice Network, a 501(c)3 non-profit organization working to end shackling of incarcerated women who labor and birth in chains and who are not able to hold and breastfeed their babies because their bodies are locked down. Her organization also offers childbirth education and doula services to high school students in her community. This is the role she creates as a community midwife. In addition to her career in activism and as a community midwife, she is raising four lively children!

Congratulations Jamarah!

Your Birth Photos Featured On the MANA Website!

Posted by Midwives Alliance on September 7th, 2016

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MANA's getting a new look, and we'd love your pictures to be a part of it. Read on to learn how to share your images with the MANA website.

The MANA website is getting a makeover, and we would love to feature your birth images! The MANA website receives thousands of views each month, and we hope your images will be a part of it. Sharing your photos is one way that you can support midwifery.

We are seeking photos that show the many sides of birth, including different settings (home, birth center, and hospital) and a variety of families (we are especially seeking images that depict families of color and LGBTQIA pictures). Photos can be taken during any stage of care, from prenatal care to labor and birth to postpartum visits. We are hoping to include midwives themselves in as many pictures as possible, but we'll consider your amazing birth picture where the midwife is not in the shot!

Guidelines:

  • Keep the Photo Simple: Focus on the subject while limiting background items and distractions.
  • High Resolution and Size: Photos must meet the MINIMUM specifications of being a jpeg file, 300DPI; and at least 8″ wide. Please do not send photos of lesser size and resolution. They cannot be used for print publication. Photos which do not meet these specifications can not be considered.
  • Keep Cropping in Mind: All of the images on our website are horizontal (landscape). Please either submit your photos in this manner or be aware of how this cropping could impact your photo.
  • Photo Consent: If a recognizable person is in the photo (e.g., the face of a parent/baby/midwife), you must be able to provide a photo consent form. If your photo is selected, we will provide you with a specific release form for use.
  • No Watermarking. Photo credit and, if requested, a link to the photographer's website will be provided on the MANA website. However, we are unable to use watermarked images.

Please submit your photos to Marie. If your photo is under consideration, MANA will contact you to request a photo release form and discuss other next steps. Please consider sharing with photographers and families you know who would like to share their pictures and support midwifery care!

New CPM Legislation: Good For Maine? Guest Opinion by Jill Breen, CPM, CLC

Posted by Midwives Alliance on May 4th, 2016

Editor's note: While many are celebrating the recent passage of CPM legislation in Maine, others have shared with MANA leadership their concerns about the specifics of the legislation and the particular legislative process. While MANA fully supports licensure in all 50 states, we also believe that, as more states engage in the process, we need to hear from all voices in the debate. We asked Jill Breen, CPM, CLC of Maine to take off her official MANA communications chair hat and share with us her personal perspective on the changes in her state. What follows is Jill's personal response. Like all guest posts at MANA, this post represents her experiences in Maine and should not be construed as MANA's position.

While some midwives in Maine are celebrating the fruits of their labors, others are grieving for their beautiful state. It is a sad time for Maine families who will not in the future be able to use the midwife of their choice. A bill to license certified midwives cleared its final hurdle on April 29, 2016 when the legislature, after intense lobbying from medical influences, voted to override the Governor's veto and pass it into enactment, in spite of hundreds of calls urging them to sustain the veto. As of Jan 1, 2020 only licensed midwives will be legal to practice, only MEAC accredited CPMs may be licensed, unless the current PEP CPMs have completed a "Bridge" to accreditation by that date. After that date no new PEP CPMs will be able to "bridge" to licensure, as per US MERA language. The statute itself states that no licensed midwives may attend breeches, twins or VBACs in an out-of-hospital setting. Although that restriction has an expiration date in a few years the decisions about scope of practice rules and regs, including lifting the ban on VBACs will be made by The Complementary Medicine Board composed of several naturopaths and accupuncturists, a consumer, and now 2 certified midwives and 2 physicians. The Board of Medicine also has joint rulemaking rights until 2021. With the appalling C-section rates, the lack of access to hospital VBAC, the lack of training for physicians in vaginal birth for breeches and twins, and the hospital liability insurance restrictions, the birthing population of Maine will be under the gun, or should I say knife, for the foreseeable future.

For 230 years, since the time of Martha Moore Ballard and the settling of Maine, midwives have been free to practice and families have been free to choose how, where and with whom to birth their babies.This is the founding principle of both MANA and Midwives of Maine, the 2 organizations I have been devoted to and who, for over 33 years, have worked to ensure competency and accountability while protecting these rights to care and be cared for. Unfortunately this new Maine law does not meet that standard. Crafted in collaboration with the Maine Medical Association and other medical practitioners including CNMs, OB nurses, ACOG and several others, along with 6 CPMs, compromises were made in an effort to reach an understanding and gain support for the bill. The position of the Governor and the Commissioner of the Department of Professional Regulation have consistently asserted to the legislature and the public that there is no need to regulate midwives who already have a national credential, have a good track record and pose no threat to public safety. The Governor is absolutely correct when he says in his veto letter that licensure leads to "economic protectionism" - allowing some midwives to practice and not others, and "over-regulation" - allowing midwives to serve some people but not others. He said he was contacted by "many midwives" and dozens of Maine people urging him to veto this bill. The autonomous practice of midwifery includes risk assessment, informed consent and refusal, peer review, and ethical behavior. These are the tools of self-regulation and protection, in my opinion not needing legislation to achieve.

There has never been an illegal midwife in Maine. Now, thanks to this law, there will be. It is a shame that this happened in a state where midwives are already legal, are recognized by the state in statute, and have good relations with state agencies. I believe some midwives will "go underground", some will retire, and many others will go through the mechanism and expense of licensure. More layers, more cost, more restrictions. I sincerely hope that Maine families benefit more from the advantages of licensure than suffer from the disadvantages. People should always be able to choose their midwife and their midwife be able to choose them. With a heavy heart, I raise my glass of cider to Maine, the way life used to be.

About the Author

Jill BreeenJill Breen CPM, CLC has been serving women, babies and families for 37 years as a homebirth midwife and natural family health consultant, and for 20 years as a CPM. A MANA member since 1984, Jill has served on the Board of Directors in several positions including President, as well as on several working committees, and currently is Communications Chair. She is a founding member of Midwives of Maine, a statewide, inclusive association of midwives since 1981. Jill is a Home Birth Summit delegate active on the Collaboration Task Force. She was an appointee to the Maine Governor’s Advisory Committee on Rulemaking regarding certified midwives and was a member of the Maine CDC Inter-professional Work Group addressing flow of care across birth settings. Jill writes, speaks, and mentors including as a guest lecturer at University of Maine. She is the mother of 6 children, all born at home, and has 9 grandchildren, all born into the hands of midwives, including her own.