The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS,
a homebirth midwife in Mountain View, CA
The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS,
a homebirth midwife in Mountain View, CA
|
Have you given birth in the last three years? If so, take The Birth Survey and provide feedback on your experience, your doctor, midwife, birth center, or hospital at www.TheBirthSurvey.com Women providing women with insight into maternity care practices in their communities. It has been easier to get consumer satisfaction information about a camera than about maternity care services – but no longer. The Coalition for Improving Maternity Services (CIMS) has developed www.TheBirthSurvey.com a consumer feedback website where women provide information about the maternity care they received - with specific doctors, midwives, hospitals, and birth centers. Families choosing where and with whom to birth can utilize this consumer feedback, along with data on hospital and birth center intervention rates and practices, to make informed health care choices. |
. . . was launched Jan. 24, 2008. It's a nationally coordinated campaign to advocate for regulation and licensure of Certified Professional Midwives (CPMs) in all 50 states, the District of Columbia and Puerto Rico, and to push back against the attempts of the American Medical Association Scope of Practice Partnership to deny American families access to legal midwifery care.
You can read what
Ricki Lake says and check out her new movie, The
Business of Being Born.
Using the AABC Uniform Data Set (UDS), the American Association of Birth
Centers is launching the AABC
National Study of Optimal Birth. We are seeking birth centers and midwifery
practices (all settings) to enroll in this research project. By including
all maternity care providers in all settings we will have comprehensive
data on both the process and outcomes of the midwifery model of care.
It's important to do a good job with publicizing these events - consider
an events promotion service such as fullcalendar.com
One of the best ways to educate your community about midwifery is to
staff a table at local festivals - there are often areas set aside for
"free speech", where non-profits and other organizations can set up a table
and offer educational material. You could include information from
DONA and ICAN to round out your offerings.
Years ago I made a wonderful presentation. Here are some suggestions:
Make words or 2-5 word statements about birth that people will see that
triggers their interest. ie, safe birth, trust, bonding, satisfying, reduce
C/sections, waterbirths, breastfeeding support, in-home personalized care,
In- home birth center, family connection, etc. I printed these on the computer
as large as an 8 1/2x 11 paper could hold. Then I trimmed them and mounted
them on bright( pink, yellow, green, blue all different, like a rainbow)
heavy gauge card stock. You could laminate them for durability. I made
a main poster that just had my business name and a logo and framed it with
color. I put these us behind me and arranged all the words which were about
8 or so around the main poster. You can also make a flip chart for quick
teaching when people come up. I laid out a good table with cloth,
brochure holders and card holders so they could be seen upright. I brought
the baby in the pelvis and some books. I had a sign in sheet for people
to be on an email newsletter list. I would also add a certificate for a
1 hour complimentary consultation with no obligation. Make it pretty.
It is mostly women that are attracted to these topics. So try again and
keep educating. But the most important thing is to make it eye appealing
and stimulate someone to want to know more. Have fun!
Library
display educates public on natural childbirth and midwifery - April
and Ed Coburn were so satisfied with their experience delivering their
son Rainer naturally, with the aid of midwives, that they decided to do
what they could to educate the public about natural childbirth. The result
is "With the Aid of Midwives," a display they put together at the Oxford
Public Library.
Your state midwifery association may also offer materials for loan.
Quilt
honors mothers who died giving birth - BY HOLLY TKACZYK - about The
Safe Motherhood Quilt Project
While an individual midwife may not accomplish it on a state, city or even district wide basis... everyone of us has the means to create a lasting relationship with at least one institution. In my case, the most natural candidate was my own children's school.
This talk was given to 5th graders. I met in advance with the teacher, the parents' association president and the director of middle school. A note was sent home describing a bit of my presentation so that a parent or child had the option to exempt participation. Only one child in three classrooms did and as it happens, I am still in touch with this young woman today. At this age the most fascinating part of my discussion was my resin pelvis. Most of the kids are in some way active...sports, ballet, dance, PE at the very least! I wanted to give them a lasting reminder of how movement affects change in the pelvic cavity. The most common reason given in Mexico for cesarean (and vaya! We have institutions with a 90% rate) is that the woman is "estrecha" or too narrow. Start showing young girls and boys the idiocy of this statement while they can wrap their minds and hearts around the idea that their bodies are fluid and adaptable.
I did show a birth but in those days didn't have a collection of ones I had attended. Instead I showed one made by my own Dutch midwives (Beatrijs Smulders and Astrid Lindberg). Under Her Own Steam. To this day (and this birth was in the early 80's) it is a timeless and fabulous film. Since the mom has no clothes and has long hair without "styling" it doesn't look "dated" at all. Since they are in the privacy of their own home and all we see is a sofa softly lit by the airy window there is no sense of when it was filmed. The only problem with a video from another culture is that it can give rise to the idea that this only happens "elsewhere." Yes, it can inspire families but not everyone is prepared to reclaim what birth should be and prefer to find it already available locally! To this end, I now use videos that occur in their city, with caregivers locally available in order to underline the message that this is happening HERE and NOW!
Consequences? In 1996 the science teacher who hosted my visit had her baby with me! The kids are now in their second year of college and there have been no babies yet.
My contrast, when I gave my presentation to my older daughter's high school biology class circa 1997, two students were pregnant. One began to take childbirth classes with me and although she needed her baby to be born in the US in order to maintain US nationality for her baby (mom was a minor living out of the US for too many years to qualify automatically) we got busy on the phone to find a compatible caregiver in Texas. She birthed without episiotomy and nursed her baby the entire first year while she homeschooled. She returned to High School and graduated in the Nat'l Honor Society the following year. The other classmate (whose MD parents were scheduling her cesarean) advocated for labor and vaginal birth instead. She dedicated her entire page in the senior yearbook (2 years later) to her child!! She didn't contact me after the talk and frankly although she was in my daughters "year" I had never seen her before but she did have a very trusting relationship with the biology teacher (female) and the info got channeled through her. I don't know the details of her birth other than to know it wasn't surgical. I gave her a lift to a shopping center nearby my home once and she proudly told me about her breastfeeding which she continued for nearly a year while continuing to attend high school.
For the past three years I am a fixture on the "Career Day" talks. The high school students sign up for 3 forty five minutes classroom discussions about the realities of a particular career. And YES, I have had boys in every group. Last year, the senior guy who attended did so because his older sister was pregnant and he wanted to know more about the natural birth option. Another guy attended because his girlfriend did and they wanted to use this afternoon free of classes to be together! Someday he IS going to be some woman's partner and some baby's father...why not plant seeds now?
This May I will attend the birth of my son's high school honors English teacher. Also a young woman who graduated the school in 1994 who remembered there being "somebody" who talked about natural birth. She called the school and found out who that person was. To date I have attended both births of the Early Education Director, both births of the High School Director, two births of the school's accountant, both births of my daughter's high school Spanish teacher, both births of the Maternal class teacher, and the birth of the 5th grade teacher I mentioned before.
My older daughter's friends are now 23 and 24. They call me when the have presentations to make at the University. "What do you have on the benefits for the baby for my early child education class? I have a talk to give for my Psych class and thought I'd talk about how the laboring woman. I remember you talked about endorphins in birth...I am doing a project for my biology class..." One of them just graduated from Harvard and he asked if I still served homemade bread at my talks. So yes, sometimes we appeal to their stomachs as much as their intellect or their hearts! LOL
Long story short...get out there and tell these kids about the magic and the wonder that is waiting for them and that there is no free lunch. They will sweat, work hard and reap the rewards. Keep the awe in your voice and sit WITH them rather than in front of them in presenter style. Bring your photo album and SHARE the births rather than lecture to them.
Please send reports about inaccurate or misleading news stories to the
MANA Press Officer at http:
or
SMorayCPM@compuserve.com.
Keys to the
Art of Persuasion by Susan Hodges at Citizens
for Midwifery
from Susan Hodges, a birth advocate for 20 years. Susan is a co-founder and current President of Citizens for Midwifery - www.cfmidwifery.org. [a personal communication, published with her permission]
From my own experience, I have concluded that for most of us, having an institution that we have assumed or trusted in suddenly shown to be not trustworthy is very disturbing. I think that is why women we might otherwise expect to do the research and find all this out and make good choices (like find a midwife!) surprise us by just trusting their OB. Once one is pregnant, it is many times as difficult emotionally to change our thinking. I know -- I did lots of research when I got pregnant for the first time, and we switched from a hospital-based CNM to a home birth CNM when I was 7 1/2 months along. To discover that I could not trust the medical system or even the CNMs within it was deeply disturbing, made me question all societal institutions, etc. (are you surprised that I homeschooled my kids!). So, though I don't have any proof that this helps, I have often prefaced my remarks with come comments about how we tend to make such assumptions and put trust in our society's institutions, and that what I am going to talk about may undermine your trust and may make you uncomfortable, even disturbed, and that is OK -- that is our natural response to this kind of info. This lets people know what is coming a little. If someone is in a place where they cannot deal with this kind of info, they are forewarned and can leave. For others, it may prepare them and help them take it in. During a presentation I may also interject a comment (as appropriate) about how some of this may sound unbelievable, that I also thought it unbelievable, but after research, talking with others, etc., etc. I realized that this really is going on. These kinds of comments serve to create some sense of emotional alignment -- that you the speaker are actually also one of the audience, instead of you the speaker know all this stuff but don't understand how your audience may be reacting. I have also often pointed out to people that we actually live at a time and in a society that is pretty hostile toward to pregnant women and infants, with inaccurate information masquerading as truth and a lack of readily available choices in general. The best we can do is research and make the best choices we can from what is available to us, and hopefully work to make better choices available to our daughters, friends, etc. I hope that this helps! Also, some of the fact sheets in the Resources section of the CfM website might be useful -- for example the one about Out-of-hospital vs hospital c-section rates, at least for those who know they want to avoid an unnecessary cesarean section.
I also like to point out how we treat our pets when they are going into
labor -- they go off to the back of some closet or other hidden nook or
cranny, and the smart pet owner will leave them alone. Zoo keepers to not
disturb the gorillas r zebras or other mammals when they go into labor,
and they won't let the public look either. Humans are mammals. When we
feel afraid, anxious, violated, etc. (when we lose our privacy or autonomy,
or are threatened...) we secrete adrenaline, the fight or flight hormone.
Surprise! adrenaline counteracts the hormones that make the uterus contract!
(i.e., labor often slows or stops when women leave home for hospital when
in labor). There are many common practices in the hospital, in addition
to recognizable "interventions" that can cause a laboring woman to feel
anxious or threatened (and then secrete adrenaline) --I have made an informal
list (attached) that you are welcome to use or adapt -- I know you know
all of this, but this is one way to present it. Most women have not let
themselves think about how they actually feel when placed in a hospital
and told to stay in bed, hooked up to a monitor. They are not asked "if"
or given informed consent -- they are told "you need to do..." or "we need
to do this to you..." -- even though all of these things carry risks because
they can disturb and prolong the normal progress of labor. Most people
will react with "I never thought about that". Then you can point
out the most OBs have NEVER seen any labor except labor disturbed
by hospital procedures; so OB assessments of dangers and what is or is
not "safe" are terribly skewed when it comes to normal birth - not because
the OBs are "bad" (though in many cases they may be) -- they are just ignorant
and not trained to attend normal undisturbed birth. Hoping
this is useful too!
Issues around birth can become very polarizing, and I think we all benefit
by learning to communicate compassionately as well as effectively: The
Center for Nonviolent Communication - A global organization helping
people connect compassionately with themselves and one another through
Nonviolent Communication language, created by Marshall B. Rosenberg, Ph.D.
Made to Stick: Why Some Ideas Survive and Others Die by Chip Heath & Dan Heath - You can listen to their CD or the 40-minute conversation between Chip Heath and Moira Gunn on NPR's Tech Nation, or read this excellent review and summary of the book.
They have also written another book, The
Curse of Knowledge, which helps experts understand how to communicate
better with non-experts.
On the art of Persuasion:
"The way to convince another is to state your case moderately and accurately.
Then scratch your head, or shake it a little, and say that is the way it
seems to you, but that of course you may be mistaken about it; which causes
your listener to receive what you have to say, and as like as not, turn
about and try to convince you of it, since you are in doubt. But if you
go at him (or her) in a tone of positiveness and arrogance you only make
an opponent of him (her)." -Benjamin Franklin
[T]he motivation underlying our activism for social change must be transformed
from anger and despair to compassion and love. This is a major challenge
for the environmental movement, for example. It is not to deny the legitimacy
of noble anger or outrage at injustice of any kind. Rather, we seek to
work for love, rather than against evil. We need to adopt compassion and
love as our foundational intention, and do whatever inner work is required
to implement this intention. Even if our outward actions remain the same,
there is a major difference in results if our underlying intention supports
love rather than defeating evil. The Dalai Lama says, “A positive future
can never emerge from the mind of anger and despair.” [Adapted from
a presentation given by Will Keepin at Schumacher College, Totnes, England,
July 17, 1997, from an article "Twelve Principles
of Spiritual Leadership".]
Howard Gardner's book, Changing
Minds, can be very enlightening.
When interacting with those trained in the standard U.S. medical model, it is important to remember that many of them have internalized the notion that hospitals are temples of safety . . . that somehow there is a magic about the place that removes all risk from medical procedures and renders doctors as divine magicians. Talking with them about the superior statistics for homebirth safety may trigger a situation where their cognitive dissonance makes it impossible for them to hear what you're saying. They're not just being stubborn . . . they may actually not be able, literally, to hear the words you are saying. It's worth keeping this in mind.
"Several classic studies from social psychological research investigating processes of self-justification and the theory of cognitive dissonance (see Aronson, 1980, chapter 4; Aronson, 1969) can point to explanations for such seemingly irrational behavior.
"According to dissonance theory, when a person commits an act or holds a cognition that is psychologically inconsistent with his or her self-concept, the inconsistency arouses an unpleasant state of tension. The individual tries to reduce this "dissonance," usually by altering his or her attitudes to bring them more into line with the previously discrepant action or belief. . . . people seek to justify their choices and commitments."
From
General Advocacy
Tools from the ACLU
Steve's Primer
of Practical Persuasion and Influence
Suggestions
and sample Web pages for online Activism
ICAN President's Letter to California
Medical Board about VBAC - from Tonya Jamois, 4/20/05
Compassionate
Communication by Marshall Rosenberg
I took a training course recently called, "The Art of Inquiry".
We got a nifty little card to carry around & use when we are trying
to get information.
Giving and Getting Good Quality Information
Baby T's makes infant t-shirts personalized
with your practice name or logo.
Midwifery Publicity
Bumper Stickers and Bank Checks with Midwife-Positive Messages
Peace on earth begins
with birth. Support midwives bumper sticker
Midwifery and Breastfeeding Bumper Stickers - Texas Sticker Company & Label Exchange
Bumper Stickers: (purple and white)
Bumper Stickers for Sale!
Support CAM and Region IV
Choose from
"Midwives Market - All the bumper stickers, buttons and needlepoint
kits that a midwife could dream of. Laingsburg, Michigan kipkoz@sprynet.com."
There are some nice breastfeeding checks available:
Current has some nice checks
- they also have an option of adding a couple of lines of text above the
signature line! I had some checks once with "Home Birth is Safe
Birth" and also "Birth Is As Safe As Life Gets".
Artistic Checks also will
also put a line of text above the signature. Mine says "Honor labor,
call a midwife". You can also phone them at 1-800-checks.
You can get Anne Geddes checks (8
scenes or 4
scenes) from Checks In The
Mail.
pregnancy.8k.com - Great T-shirts
about midwives, homebirth and natural childbirth.
The Birth Ecology Project
advocates for midwifery, doula care, natural birth, conscious parenting,
and sustainable living. The Birth Ecology Journal publishes articles and
essays of quality on topics of interest to parents, birth professionals,
and birth advocates on the website. Workshops for parents and professionals
are also in the works. This site also has a great collection of articles
- follow the link!
Premature birth is now the most common, serious, and costly infant health
problem facing our nation. - Midwifery is a terrific preventive measure,
reducing low birthweight by 31%.
The Florence Nightingale School
of Nursing and Midwifery hosted a study day on Community
Based Caseload Midwifery in October, 2005; the speakers were Maggie
Thomson, a consultant midwife at Whittington Hospital NHS Trust involved
in introducing Sure Start caseload practices in
London and Becky Reed is a midwife with the Albany Midwifery Practice
in London.
The Landscape of Caring for Women: A Narrative Study of Midwifery Practice [Medscape registration is free.]
"It is critical that the immediate and long-term effects of midwifery
practice be recognized. We are facing monumental challenges in health care
today. Our current health care system is struggling to balance rising costs
with an ever-increasing reliance on, and demand for, technological innovation.
Midwifery care has been demonstrated over and over to be excellent and
associated with positive maternal-infant outcomes. This prompts the troubling
question: if midwives have such good outcomes, why then are they not the
primary provider of women's health care in the United States? The answers
are likely complex but must be explored."
MANA's Page on Midwifery
Advocacy
National
Organization for Women Expands Definition of Reproductive Freedom to Include
Midwifery Model of Care
A Report on The NOW National Conference Committee on Health and Reproductive
Rights, July 3, 1999 (You may have to search for this piece.)
THE NATIONAL ORGANIZATION FOR WOMEN'S RESOLUTION SUPPORTS CHOICES IN CHILDBIRTH AND ENDORSES MIDWIFERY CARE
In July, 1999, the largest and most important women's organization in the country, The National Organization for Women (NOW.), expands the definition of "Reproductive Freedom" to include Choices in Childbirth and Endorses Midwifery Care.
******************
EXPANSION OF REPRODUCTIVE FREEDOM TO INCLUDE THE MIDWIFERY MODEL OF CARE
Midwifery is about choices.
It's about a woman's choice to be touched only by other women of her
own choosing.
Midwifery is about a woman's choice to retain control over her own
body, even when her choices aren't in line with a liability-driven medical
establishment.
Midwifery is about a woman's right to choose where and with whom to
give birth.
You can support women's choices by supporting midwifery.
"
The resolution, "Increasing Access to Out-of-Hospital Maternity Care
Services Through State-Regulated and Nationally Certified Direct-Entry
Midwives" was formally adopted by the Governing Council of the American
Public Health Association (APHA) October 24, 2001.
"Recognizing the evidence that births to healthy mothers . . . can occur
safely in various settings, including out-of-hospital birth centers and
homes"
The Midwives Model of
Care is based on the fact that pregnancy and birth are normal life
events.
Great
collection of midwifery links from BirthLove
Association
of Nurse Advocates for Childbirth Solutions - WWW.ANACS.Org -
Please come and join our community of nurses working together to find solutions
to maternity nursing challenges.
Informed Birth Choices(IBC)
website. - news, information and resources supporting birth attendants'
and parents' right to choice. This site is related to legal case
- O’CONNER
VS. STATE OF WASHINGTON
Faith Gibson's site has the best online information about midwifery advocacy.
The Official Plan to Eliminate the Midwife: 1900 -- 1930 - Faith Gibson's collection of source documents
The
Fall of Midwifery and the Ascendancy of Medicalized Childbirth
. . . the midwifery model of care is an essential element of comprehensive health care for women and their families that should be embraced by and incorporated into, the health care system and made available to all women
Summary
of Critical Points from "Safety of Alternative Approaches to Childbirth"
by Peter F. Schlenzka - A doctoral thesis comparing safety and costs
of natural, out-of-hospital birth with in-hospital obstetric births.
He finds out-of-hospital births to be slightly safer and significantly
superior in terms of economic costs ($13 billion annually) and social costs
(reduced incidence of birth trauma and bonding disorders).
Hospital costs driven by heart, pregnancy [9/25/06] - "By payer, pregnancies and delivery made up the biggest cost for private insurance and Medicaid, costing hospitals about $41 billion in 2004, the report said."
"It is always surprising for people to realize how much hospital care goes to mothers and newborns," said Roxanne Andrews, author of the report. "Most think of hospitals as places where only the sick go."
U.S. Agency for Healthcare Research and
Quality runs a Healthcare
Cost & Utilization Project (HCUP). They offer other New
Findings and Publications
I found this fun slide
presentation about healthcare costs from AcademyHealth.
C-section most common US hospital procedure [8/2/05 - Reuters]
WASHINGTON (Reuters) - The most common U.S. hospital procedure is the Caesarean section, with 1.2 million of the operations done each year, according to a government report issued on Tuesday.
Caesarean sections cost $14.6 billion in total charges in 2003, the report from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project found.
"There are 4 million babies born every year. Twenty percent or more of them are done by C-section. That is a lot of babies," Elixhauser said in a telephone interview.
"Nearly a quarter of all (U.S) hospital stays are related to pregnancy
and childbirth. Most people don't realize what a big chunk of hospital
care that is."
Midwives
Under Fire by Katie Allison Graju
The
Childbirth Monopoly - Why the medical industry is dragging its feet
when it comes to midwives (by Laurel Druley)
June 2, 1998
In support of my assertion, I refer you to "Evidence Basis for the Ten Steps of Mother-Friendly Care," a recently published review of the literature on many topics, including midwifery care ("Step 1") and cesarean surgery ("Step 6"). It can be downloaded gratis.
I would be happy to help you with it if you had any questions. If any doubts remain on your part, I suggest that you ask the sources who impugned midwifery care to show you the medical research that backs their statements.
I hope that you and your newspaper will see fit to correct the serious misinformation about the safety of midwifery care for which your sources have made you an unwitting conduit.
Sincerely,
Henci Goer
P.S. Not wanting to muddy the water with more than one topic in the
body of my letter, I would also like to point out that the only national
data on "maternal request" cesarean that comes from asking women themselves
reported that less than 1% of women surveyed requested a cesarean with
no medical indication. By contrast, studies substantiate substantial rates
of "obstetrician request" cesareans. I would be happy to discuss this further
with you or your editors as well.
Midwifery care, social and medical risk factors, and birth outcomes
in the USA,
J Epi & Community Health, MacDorman M, Singh G, 1998;52:310-317
Midwives tend to make people happier, and happy people are healthier - Happiness and other positive emotions play an even more important role in health than previously thought, according to a study published in the journal Psychosomatic Medicine by Carnegie Mellon University Psychology Professor Sheldon Cohen.
Positive
emotional style predicts resistance to illness after experimental exposure
to rhinovirus or influenza a virus.
Cohen S, Alper CM, Doyle WJ, Treanor JJ, Turner RB.
Psychosom Med. 2006 Nov-Dec;68(6):809-15. Epub 2006 Nov 13.
This recent study confirms the results of a landmark 2004 paper in which
Cohen and his colleagues found that people who are happy, lively, calm
or exhibit other positive emotions are less likely to become ill when they
are exposed to a cold virus than those who report few of these emotions."
Midwifery Bibliography - Books and Resources
About the Profession of Midwifery
Tips on Writing Letters of Advocacy
Midwives: An
Untapped Resource
Editorial Comment by Ina May Gaskin (1994)
Insurance Industry
Kills Health Care Reform
Editorial Comment by Ina May Gaskin (1994)
Editorial by Marsden Wagner on "A global witch-hunt"
The medical Journal The Lancet in its October 14 issue, pp 1020-22, has an article on what they call "Midwife Witch-Hunt" which is about a global "dirty-tricks" campaign to prevent midwives from taking part in home births. The title of this is also interesting in that historically there has been a (real and imagined) association between witchcraft and midwifery. This article is by Marsden Wagner, and identifies some of the ways midwives have been persecuted and put out of work around the world. It is very supportive of midwifery and promoting the profession.
Unless we put medical freedom into the constitution, the time will come when medicine will organize itself into an undercover dictatorship...denying equal privileges. All such laws are unAmerican and despotic...- Benjamin Rush, Physician
Pursuing the Birth Machine - The search for appropriate birth technology" by Marsden Wagner. A brief blurb follows:
Increasingly, physicians in industrialised countries manage birth with sophisticated and expensive technology. In this book, Marsden Wagner provides a history and survey of these technologies, showing how the availability of high-tech interventions has spurred both use and demand. Pointing to the high costs and potentially dangerous side-effects of many interventions, he argues for rational reassessment of what is both affordable and safe for mothers and babies. At the heart of the book is a description of the efforts of participants in a series of World Health Organisation consensus conferences to identify the best ways to influence change in health policies in both industrialised and developing nations. These conferences resulted in the landmark WHO recommendations on appropriate technologies for birth and after birth.This is a timely book --- provocative, instructive, thought-provoking and visionary.
WHO
recommendations for appropriate technology following birth
Trieste, 7-11 October 1986
WHO (World Health
Organization) - appropriate technology for birth revisited British
Journal of Obstetrics and Gynaecology, September 1992, Vol. 99, pp. 709
- 710
Midwifery
care and out-of-hospital birth settings: how do they reduce unnecessary
cesarean section births?
Sakala C
Soc Sci Med 1993 Nov;37(10):1233-50
U.S. women beginning labor with midwives and/or in out-of-hospital settings have attained cesarean section rates that are considerably lower than similar women using prevailing forms of care--physicians in hospitals.
Motherstuff
- Midwifery Organizations by Country [in advocacy]
Birth
Practices Committee Holds Inaugural Meeting at CIMS Tenth Anniversary Meeting
in Boston [founded February 25, 2006] - The mission of the multidisciplinary
group is to encourage, conduct, evaluate and disseminate research related
to the best practices in birth care for childbearing women and their families
in the United States and its territories.
California Citizens for Health
Freedom, in co-operation with National
Citizens for Health
Mother Friendly Childbirth Initiative
INTRODUCTION from CfM News, October 1996
A consensus group called the Coalition for the Improvement of Maternity Services (CIMS) met in California last March to ratify a document called the "Mother Friendly Childbirth Initiative." Three years in development, this outstanding document is a powerful new tool in the effort to bring sane and healthy childbirth practices to the mainstream United States. Modeled on the World Health Organization's Baby Friendly Initiative that has been so successful in eastern Europe in promoting breastfeeding and maternal bonding, the plan in the U.S is to enroll hospitals and birth centers as endorsers of the MFCI, thus permitting them to advertise themselves as "mother-friendly" while raising the standards for maternity and neonatal care in the United States.
AIMS - Association for Improvements
in the Maternity Services - Supporting Parents and Professionals in
the UK and Ireland
Baby Friendly
Hospital Initiative
What's the Baby Friendly Hospital Initiative?
Baby Friendly Hospital Initiative (BFHI) -- The BFHI, sponsored by
the World Health Organization and UNICEF, is a world-wide effort to improve
breastfeeding rates. Based on the ten steps to successful breastfeeding,
the initiative encourages hospitals to examine their practices, make the
appropriate changes and then apply for recognition as a Baby Friendly Hospital.
The Baby Friendly Hospital
Initiative- USA, including a list of approved hospitals
Florida Governor Supports Midwives
Midwifery
Today - Online Birth Center
Technocratic
Model of Birth vs. Holistic Model of Birth (from Birth as an American
Rite of Passage by Robbie Davis-Floyd.
Comparison
between the Midwifery Model of Birth and the Medical Model of Birth
Study Shows: Women Prefer Midwives
Health Administrator Supports Midwifery
About Advocacy and Presenting New Ideas
How to Conduct an Effective Media Interview
Stepping Up to the Speaker's Stand
N-NET - Lists the name, address, and phone number of United States newspapers
in an easy-to-use format. It is the largest, most comprehensive service
of this kind on the web.
Midwives could fill in the gap!
Early
Discharge, Untimely Follow-Up Seen Among Many Newborns [Medscape registration
is free]
Physicians for Midwifery or contact Pat Burch at pburch2881@aol.com or at 318-232-5580
Universal Health Care Action Network: 216-566-8100
History of Medical Conspiracy to Malign Midwives
A Short History of
Midwifery in America
AMA Statements about Independent Midwives
Effects of Technology on Perinatal Mortality
I have just read a VERY interesting article in the June 1996 Midirs. The title of the article "Birth: medical emergency or engineering miracle?" does not do the content justice. This is one of the best accounts of the mechanisms of labour that I have read. It is great ammunition for those who are adamant about allowing women freedom of movement and choice of posture for birth. For example, contrary to so much of the literature out there (promoting the curved back), the author says that instinctive back arching by the woman in late second stage is a way to make enough room to allow the baby's head to be born without traumatizing the pelvic floor and allows the shoulders to enter the pelvis.
One of the most amazing things about the article is the observation that, contrary to reports in earlier texts, most babies in (multigravidas) enter the pelvis at term in an ROL (or ROT) position. The reason I found this so validating is that I have always doubted my palpation skills because I seem to ALWAYS find babies in this position at term. I thought they were supposed to be in an LOA position which is what the texts always said (Varney says most common position at labour is LOT (which may be correct for primigravidas)). So, maybe my experience has been more normal than what the texts say.
There are lots more gems in this article.
Various CNM Statistics and Studies
About Midwives as Primary Care Providers
How DEMs can Supplement CNM Praise That Slams
Them
Notes from Sheila Kitzinger Talk - "Crisis in
the Perinatal Period".
If Obstetricians Were Bus Drivers
Medical and research texts are quoted often. Most writers will allow
you to quote with their permission if you are writing a text for publication,
because you are actually promoting their work. In normal speech, letters
and emails, mailing lists, etc. it is perfectly fine to quote sources.
You should feel comfortable quoting.
You have got to read an article in the March 97 Lancet entitled
"Pregnancy in the 21st Century". From Britain (obviously), this is looking
at the future of maternity care. Some of the things the author points out
as already-known facts are quite interesting, such as stating that "it
is now clear that many of these procedures [obstetric interventions such
as AROM, EFM, epis, making moms NPO or ice chips only, etc.} are of value
only in specific circumstances, if at all". Oooh! I like this guy! Another
fact: "in low-risk women, the place of birth has little effect on the outcome
of labour, in terms of safety". He goes on to say that we do not, as a
society, force the population to travel by rail rather than by car, just
because safety statistics are marginally better. Restricting choice as
to place of birth on similar grounds would be illogical. He also talks
about how the "doula" help interrupt the "intervention cascade". He does
foresee that all breeches and twins will be C-secs in the future, but maintains
that the bulk of prenatal, antepartum and postpartum care will be provided
by midwives, and that the "surgeons" will still be needed, but on a greatly
restricted basis.
10 Big Myths about
copyright explained
You are assisting at someone else's birth. Do good without show or fuss. Facilitate what is happening rather than what you think ought to be happening. If you must take the lead, LEAD SO THE MOTHER IS HELPED, YET STILL FREE AND IN CHARGE. When the baby is born, the mother will rightly say: We did it ourselves!From the Tao Te Ching, Lao Tsu (450 BC)
The State vs. Midwives:
A Battle for Body and Soul by Carolyne Pion
As hokey as it sounds we walked in the local parade this last Saturday w/ a 10 ft. banner that read - MIDWIVES - We had nurse midwives, licensed, CPM's, and lay midwives walking. Our clients ranging from an anesthesiologist to my 26yo very pg daughter and her 2yo son. Another 50 or so feet after - we walked w/ another 10' banner that said HOMEBIRTH. One of my clients that had all six chillens underwater had all kinds of creative waterbirth signs that her darling children carried about like "glug, glug, born in a tub!" Stats on safety of HB on a sandwich board carried by a woman that birthed twins vaginally. Had many other folks like a NICU nurse that had a sign that read Homebirth RN on and on.... We used a classic '53 Ford truck and decorated it w/ Happy Birthday and Happy Mothers Day balloons etc.
The last time I did this some yrs back I got a beautiful draft horse
carriage to pull us - The sign I made read: "Midwives Yesterday, Today
and Tomorrow!"
BookCrossing is a concept of "releasing" a book into the big wide world so that others can read it and pass it along. The hope is that they will also record something about when/where they found the book and what they thought of it. It's a fun way to appreciate the way objects move around in the world and to share your interests.
Well . . . it occurs to me that this would be a fun thing to do with
a variety of books that are directly or tangentially about birth and midwifery,
such as BabyCatcher or some fun parenting books or some of the Joseph Chilton
Pearce or APPPAH/bonding books. Kind of a way of bringing birth more into
the public consciousness as a topic of general concern instead of leaving
it in the medical section. There are a lot of people who might not
go out of their way to read a book like this, but there's something more
interesting about a book that you serendipitously find in your path.
If you've got some books that are otherwise languishing on your shelves
and want to get them circulating, BookCrossing
might be the answer.
Your Baby Your Body Your Midwife - a campaign for one-to-one midwifery care in Scotland from Glasgow Birth Choices
This campaign cites the Cochrane Collaboration as the authority for these benefits:
We know that the midwifery model of care is better & safer - the
Cochrane Database (an independent international organisation) now lists
eleven controlled trials that demonstrate statistically-proven better outcomes
for mothers & their babies. The care of ONE midwife who provides you
with all of your antenatal checks, attends you in labour & continues
her support in the postnatal period has the following benefits for mothers
& babies:
1. Shorter, less painful labours (something every woman would support)
2. Less use of pharmaceutical (drug) pain relief(which can have harmful
effects on both mother & baby)
3. Less likelihood of operative vaginal delivery (such as forceps &
ventouse)
4. Better APGAR scores for babies at 5 minutes (the test used to determine
the condition of babies at birth)
5. Less likelihood of caesarean section (major abdominal surgery which
can also have serious side effects)
Does
continuity of care by well-trained breastfeeding counselors improve a mother's
perception of support?
Ekstrom A, Widstrom AM, Nissen E.
Birth. 2006 Jun;33(2):123-30.
" . . . the mothers were more satisfied with emotional and informative
support during the first 9 months postpartum. The results lend support
to family classes incorporating continuity of care."
A
Mother's Feelings for Her Infant Are Strengthened by Excellent Breastfeeding
Counseling and Continuity of Care
Anette Ekström, PhD, RNM and Eva Nissen, PhD, RNMTD
PEDIATRICS Vol. 118 No. 2 August 2006, pp. e309-e314 (doi:10.1542/peds.2005-2064)
CONCLUSION. . . . guaranteed continuity of care strengthened the maternal
relationship with the infant and the feelings for the infant.
Linked Birth/Infant Death Data Sets - DVSs entire collection of linked
birth/infant death micro-data sets, together with User's Guides, are now
available for download from the NCHS Internet. Period linked files are
available for 1995-2004. Birth cohort linked files are available for 1983-1991
and 1995-2002. The vital statistics data file download page is available
at: http:
2005 Natality Public Use File - The 2005 natality public use micro-data
file is now available for download at: http:
The 2005 file joins natality public use files for earlier years (1968-2004)
already on this site. Consistent with the latest agreements between NCHS
and NAPHSIS, beginning with the 2005 data year, US public use micro-data
files excludes all geographic detail (state, county, and city). Users requiring
state and county information are directed to our online data access tool
VitalStats http:
where they can create custom tables based on state and county of mother<92>s
residence. The current policy for release and access to vital statistics
is available at: http:
Stats (Data) Resources
from the California Maternal Quality Care Collaborative (CMQCC)
Births:
Preliminary Data for 2005
The CDC's National Center for Health
Statistics
Listening
to Mothers II Survey Report - a 2005 national survey of women giving
birth in U.S. hospitals by Childbirth Connection. They found that
33% of first-time mothers had cesarean surgery.
2003 Assisted Reproductive
Technology Success Rates Report,
Breast
and Cervical Cancer Program Highlights,
Diabetes
and Pregnancy Frequently Asked Questions,
Fertility,
Family Planning, and Reproductive Health of U.S.,
Cesarean
Delivery on Maternal Request - 2003 Data from the National Vital Statistics
reports, Vol 54, Number 2, (116 pdf pages)
[12/13/05] - We are pleased to announce the launch of the website http:
This is a free resource developed for those needing support with qualitative
data analysis (QDA) and those learning to use a Computer Assisted Qualitative
Data AnalysiS (CAQDAS) package. The website is aimed principally at researchers
and postgraduates, but will also be suitable for some undergraduates.
The
ABCD Reading Room is designed to provide state policymakers with easy
access to research and resources related to early childhood health and
development. The reading room is not meant to provide a complete
list of all resources currently available on a given topic. Rather,
it includes material that has proved of particular interest to state officials
as they have worked to improve the quality of health and developmental
services provided to young children. We welcome suggestions for
addtions to these pages.
"INTO MY
HANDS- A birth record book for midwives" by Patricia Edmonds and Heather
McCullough.
The Office on Women's Health (OWH) and the National Women's Health Information
Center (NWHIC) is proud to announce the launch of our new and comprehensive
National Women's Health Indicators Database (NWHID). This is a FREE online
tool, which can be accessed at www.4woman.gov/statedata
or through the NWHIC site at www.4woman.gov.
The Alan Guttmacher Institute
- "for the latest information and analysis on sexual and reproductive health
and rights in the United States and worldwide."
From Giving Birth - A Journey
into the World of Mothers and Midwives by Catherine Taylor:
CDC's 2005 Reports On Women's Health
Abortion Surveillance
- United States, 2002,
In 2003, the latest year statistics are available, there were 4,089,950
births.
With cover illustration by Rhonda Baker.
This record book was designed for midwives by midwives who share the
desire to have an accurate record of personal birth experiences. We created
this book to honor the midwifery tradition of remembering and keeping the
tales of the women and babies we are called to serve. This book also assists
midwives to easily compile statistics while remembering the heart of birth
by retelling the birth story. Contact Pat Edmonds at 503-359-4109, or e-mail
her at: Nibs26@aol.com or hmbirthhm@yahoo.com
First Breath Productionsnto My Hands Midwifery, 3839 Pacific Ave, Suite
189, Forest Grove, OR 97116
Birth-Related Statistics Sources
The World Factbook.
2001.- Infant mortality rate
Dr. Foster's Good Birth
Guide has lots of interesting statistics about birth in the UK.
So does BirthChoice
- This website gives maternity statistics for most NHS hospitals in the
UK
March of Dimes Birth-Related Statistics
Israel Gale's Homebirth Safety Information
Britain's
Patients Charter - Maternity Care Section
Isle of Man Study Shows Medical Interventions
Causes Problems
With midwives' help, two in three mothers who had previous C-sections successfully delivered without surgery, the survey indicated. Nationally, only 25 percent of mothers avoid repeat C-sections.
The nation's more than 4,000 practicing nurse-midwives attended 185,000 births in the United States in 1992, or almost 5 percent of the total. Of the 185,000 births, 95 percent were in hospitals.
Those caring for predominantly high-risk patients had an average Caesarean
rate only slightly higher than 12 percent, according to the survey of 419
hospital-based nurse-midwives and 39 free-standing birth centers.
Graph of reasons for hospital admissions - this helps me to understand why doctors are so opposed to homebirth!
Graph
of Average Length of Hospital* Stay, by Diagnostic Category† --- United
States, 2003 - the average length of stay for "delivery" is 2.6 days.
Out-Of-Hospital
Midwifery Care: Much Lower Rates of Cesarean Sections for Low-Risk Women
Outcomes
of Planned Hospital Birth Attended by Midwives Compared with Physicians
in British Columbia
Patricia A. Janssen PhD, Elizabeth M. Ryan RM, BScN, Duncan J. Etches
MD, CCFP, FCFP, Michael C. Klein MD, CCFP, FCFP, FCPS, Birgit Reime DScMPH
(2007)
Birth 34 (2), 140–147.
Results: Adjusted odds ratios for women planning hospital birth attended by a midwife versus a physician were significantly reduced for exposure to cesarean section (OR 0.58, 95% CI 0.39–0.86), narcotic analgesia (OR 0.26, 95% CI 0.18–0.37), electronic fetal monitoring (OR 0.22, 95% CI 0.16–0.30), amniotomy (OR 0.74, 95% CI 0.56–0.98), and episiotomy (OR 0.62, 95% CI 0.42–0.93). The odds of adverse neonatal outcomes were not different between groups, with the exception of reduced use of drugs for resuscitation at birth (OR 0.19, 95% CI 0.04–0.83) in the midwifery group.
Conclusions: A shift toward greater proportions of midwife-attended
births in hospitals could result in reduced rates of obstetric interventions,
with similar rates of neonatal morbidity. (BIRTH 34:2 June 2007)
Statewide
Review Assesses Preventability of Pregnancy-Related Deaths
Preventability
of Pregnancy-Related Deaths: Results of a State-Wide Review.
Berg CJ, Harper MA, Atkinson SM, Bell EA, Brown HL, Hage ML, Mitra
AG, Moise KJ Jr, Callaghan WM.
Obstet Gynecol. 2005 Dec;106(6):1228-1234.
CONCLUSION: Despite the decline in pregnancy-related mortality rates,
almost one half of these deaths could potentially be prevented, mainly
through
improved quality of medical care. In-depth review of pregnancy-related
deaths can help determine strategies needed to continue making pregnancy
safer.
Maternal
Morbidity and Mortality - Annotated Lists of Organizations on Key Topics
in Maternal and Child Health from the Maternal
and Child Health Library
Underreporting
of pregnancy-related mortality in the United States and Europe.
Deneux-Tharaux C, Berg C, Bouvier-Colle MH, Gissler M, Harper M, Nannini
A, Alexander S, Wildman K, Breart G, Buekens P.
Obstet Gynecol. 2005 Oct;106(4):684-92.
Pregnancy-Related Death Underreported
Underreporting
of Pregnancy-Related Mortality in the United States and Europe.
Deneux-Tharaux C, Berg C, Bouvier-Colle MH, Gissler M, Harper M, Nannini
A, Alexander S, Wildman K, Breart G, Buekens P.
Obstet Gynecol. 2005 Oct;106(4):684-692.
CONCLUSION: This study shows the limitations of maternal mortality statistics
based on International Classification of Diseases cause-of-death codes
alone. Linkage of births and deaths registers should routinely be used
in the ascertainment of pregnancy-related deaths. In addition, extension
of the definition of a maternal death should be considered. Beyond pregnancy-related
mortality ratios, considering the specific distribution of causes-of-death
is important to define prevention strategies.
United
Nations Statistics Division - Millennium Indicators has maternal mortality.
Worldwide Maternal Mortality Statistics
United Nations Report on Maternal Mortality
WHO Statistics on Maternal Mortality - 1995
Maternal
Mortality in the United States: Where Are the Doctors? (Illinois Midwives
Page)
Notes from Marsden Wagner on Maternal Mortality
NHS
maternity statistics, England: 2003-04
Maternal mortality
in the past and its relevance to developing countries today
Irvine Loudon
American Journal of Clinical Nutrition, Vol. 72, No. 1, 241S-246s,
July 2000
"Midwives in the Kentucky Frontier Nursing Service traveled on horseback
to assist with deliveries, which were all at home in a poor rural farming
community with low living standards. Despite the poverty, maternal mortality
rates were 10 times lower than those in the nearby city of Lexington and
the United States as a whole."
See also: Lower Cesarean Rates
Infant
and Neonatal Mortality for Primary Cesarean and Vaginal Births to Women
with "No Indicated Risk," United States, 1998-2001 Birth Cohorts.
Macdorman MF, Declercq E, Menacker F, Malloy MH.
Birth. 2006 Sep;33(3):175-182.
Results: Neonatal mortality rates were higher among infants delivered
by cesarean section (1.77 per 1,000 live births) than for those delivered
vaginally (0.62).
U.S.
has second worst newborn death rate in modern world, report says [5/10/06
The
World Fact Book - rank order of countries for infant mortality.
The
State of Infant Health: Is There Trouble Ahead? - Discussion of the
2003 ranking of the US as 28th in infant mortality rate.
International
Comparisons of Infant Mortality Rates, 1994 from the March of Dimes
From the 1994 Population Reference Bureau, Inc, the Infant Mortality
Rate for the US is: 8.3, and Canada is 6.8. The world IMR is 63, Africa
is 92. This means Infant Deaths per 1000 live births. The "World Population
Data Sheet" can be obtained from the PRB at :202:483-1100. It lists every
country in the US, but does not tell us where we are in comparison. Africa
hits over 100. Western Europe is the lowest with an overall rate of 6/1000.
Japan is 4.4/1000. Ranking is 24th.
See also: Midwife/Doula Pheromones
Reduce Labor Pain
Bridge Club's Letter to ACOG
re: Improper Term "Lay Midwife" [March, 2006]
There are many different types of midwives, and each state may create
its own midwife designation. In
a number of states, their state licensing program uses the same standards
as the NARM CPM . . . in those states, a Licensed Midwife is functionally
equivalent to a CPM.
I sometimes see direct-entry midwives described as "midwives who do not have a formal nursing education". I'm troubled by this negative description. I'd much rather see a description of direct-entry midwives as "midwives trained specifically in the midwifery/non-medical model of care" or "midwives who learn relevant nursing skills in a process integrated with their midwifery education" or "independent midwives" or "autonomous midwives" or anything with a more positive ring to it.
I think it's important to emphasize that the model of specializing directly in midwifery rather than taking a detour through nursing is the model followed in most of the world. I think it helps also to explain that midwifery as an autonomous profession was largely eliminated in the United States in the first half of the twentieth century through the specific actions of obstetricians, and that it reappeared as an offshoot of nursing, which is how we come to have nurse-midwives. Yes, there is lots of overlap between nursing and midwifery, especially among homebirth midwives, who end up providing the nursing care in addition to midwifery care, but it's important to avoid the implication that direct-entry midwives have no nursing skills.
Corollary: I'm amused that people imagine that you can't provide competent
midwifery care without being a nurse first. Do they worry that OB's
can't be competent birth attendants because they didn't train as nurses
first? I'm waiting for a new class of birth attendants . . . nurse-OBs!
Midwifery is a seperate profession to nursing and is certainly not a specialist branch of it. It is like saying that nursing is a specialist branch of medicine.
Many Midwives have never trained as nurses, and most now enter the profession through a Midwifery degree at university.
Midwives are autonomous practitioners and are the primary carer for the vast majority of women during their pregnancy. Provided a pregnancy is progressing normally a woman need never see a doctor.
Midwives are Midwives, not specialist nurses, and it is insulting to
them & misleading to the public to say otherwise.
About Midwivesfrom
MidwifeInfo.com
Types
of Midwives - a description of Licensed Midwives in New Mexico,
which probably applies equally well to California, Washington, Florida
and other states that license direct-entry midwives.
Lay Midwifery:
A Feminist Perspective by Martha J. Blizzard White, April 1997
The
Dutch Midwifery System by Beatrijs Smulders
Public Citizen Study on CNM Outcomes - Nov 1995
Study Shows Nurse-Midwives
a Better Option for most Pregnant Women
News Release-Public Citizen Health Research Group, August 31, 1997
Interspecialty
differences in the obstetric care of low-risk women.
Rosenblatt RA, Dobie SA, Hart LG, Schneeweiss R, Gould D, Raine TR,
Benedetti TJ, Pirani MJ, Perrin EB.
Am J Public Health. 1997 Mar;87(3):344-51.
CONCLUSIONS: The low-risk patients of certified nurse-midwives
in Washington State received fewer obstetrical interventions than similar
patients cared for by obstetrician-gynecologists or family physicians.
These differences are associated with lower cesarean section rates and
less resource use.
Unnecessary Cesarean
Sections: The Nurse-Midwifery Solution
CNM Compares and Contrasts Homebirth and Hospital
Birth
A Direct-Entry Midwife Explains Her Training
The Decline of
the African-American Midwife
A German midwife has recently written the following to me in a letter explaining midwifery culture in Germany. I love it.
"And a good thing is that still a law is valid which says that a midwife
has to be called to every birth. That means a doctor is not allowed to
accompany a birth, without trying to get a midwife there. On the other
hand, midwives only have to call a doctor if there are complications. "
Preparing for Birth
Original Version
1st baby: You practice your breathing regularly.
2nd baby: You don't bother practising because you remember that last
time, breathing didn't do a thing.
3rd baby: You ask for an epidural in the 8th month.
Corrected Version
1st baby: You practice your breathing regularly.
2nd baby: You change doctors/hospital because the first birth was "taken
away" from you and your choices were not honored. You use lots of
alternative methods for coping with pain and spend time in the shower
and tub; you birth without drugs.
3rd baby: You use a midwife as your primary caregiver and finally
have the birth you wanted in the first place.
See also: Midwifery Organizations from motherstuff.com
See also: Professional Organizations
Online
International
Midwifery Links - A summary of Midwifery links from around the world
Home Midwifery Association (QLD)
in Australia
Association of
Radical Midwives - they also have their own UK
Midwifery Archives
England - Big
shake-up for maternity care - The government has promised mothers choice
by 2009 [2/6/07]
Some English hospitals should be stripped of doctor-led maternity care
and specialist children's services, a government adviser says.
Hospitals that lose maternity units may get midwife-led services and
more support for home births will be provided to give women greater choice.
Midwives to take lead role in stand-alone Northern Ireland maternity units. [Belfast Telegraph - 29 July 2004 - By Nigel Gould, ngould@belfasttelegraph.co.uk]
Home Birth Association of Ireland
International Guild of Traditional
Midwives - "Preserving the Values of an Honored Profession" - IGTM
has been founded as a cooperative effort to serve the needs of traditional
midwifery practitioners. We offer resources and fellowship formidwives
who define their practice as community or traditionally based care.
The Midwives Alliance of North America
(MANA) is an organization of North American midwives and their advocates.
MANA's central mission is to promote midwifery as a quality health care
option for North American families.
National Certified
Professional Midwives Guild, Office and Professional Employees International
Union , Local 54, AFL-CIO-CLC
New Zealand College of Midwives
Citizens for Midwifery lists
many state-level organizations
Alabama Birth offers this fabulous
video on You Tube - Alabama
Mothers Deserve Midwives
Californians Advocating Licensed Midwifery - This group was organized by LMs to advocate for positive legislation.
California College of Domiciliary Midwives - Representing the Legal & Legislative Issues of California Licensed Midwives.
California Citizens for Health
Freedom - Frank Cuny has a lot of experience with California law, and
CCHF has been active in supporting Licensed Midwifery in California.
Florida Friends of Midwifery is a consumer awareness group with information on citizen action, parenting links, and a "Find A Midwife" section.
Midwives Association of Florida
Kentucky Alliance for the Advancement of Midwifery
Kentucky-based Midwifery
Massachusetts Friends of Midwives
Friends of Missouri Midwives (FOMM)
Tennessee Midwives'
Association
Texas - HANSA
- Homebirth Awareness Network of San Antonio
Virginia Birthing Freedom, Inc.
Citizens for Midwifery - Midwifery in Virginia
Midwives' Association of Washington State (MAWS)
ACNM - Washington Chapters Web Site
On February 21, 2000, the Washington State House of Representatives
adopted a resolution (House Resolution No. 2000-4753) "That the House
of Representatives recognize and honor the many significant contributions
midwives have made to the health and well-being of our citizens"
Midwives
Alliance of West Virginia
Wisconsin's
Rules Regulating Midwives and Legislation
History of Midwifery Discussions on the Internet
Historian
uncovers midwife's diaries from a century ago - Annie Hanson Christensen,
an immigrant from Denmark, attended the births of 406 babies in and around
Eastport, Maryland, between August 1898 and August 1908. Historian Ginger
Doyel found her diaries.
Mountain of a midwife
- Orlean Puckett lost 24 babies but gained a thousand children. Orlean
Puckett lived in the Blue Ridge mountains of Virginia, and attended over
1000 births between 1890 and 1939
We've
Come a Long Way, Babies - a history of childbirth from Mothering Magazine
The History
of Midwifery and Childbirth in America: A Time Line, Prepared by Adrian
E. Feldhusen, Traditional Midwife
Faith Gibson's letter of Sept. 11, 2004, contains a masterful summary of "The History of Obstetrics" about halfway down the page. Really, her whole site is of inestimable value to historians. Read Overview of historical situation -- official plan to eliminate midwives.
She has a set of web pages about midwifery history - Historical
Series - International Journal of Domiciliary Midwifery
Misconceptions
Surrounding the Safety of Home Birth and Hospital Birth by Misty Dawn
Richard - a dissertation containing an excellent summary of midwifery history
and current issues.
All about Martha Ballard - Maine
midwife who kept a diary from 1785 to 1812.
The Struggle
for Midwifery in Ontario by Ivy Lynn Bourgeault - An account and analysis
of the first attempt to professionalize midwifery in Canada.
Labor
Among Primitive Peoples by George J. Engelmann, 1884
Obstetrics and gynecology in ancient Egypt - this is really about midwifery in Egypt . . . there is no mention of operative delivery in the abstract.
Eur
J Obstet Gynecol Reprod Biol. 2005 Nov 1;123(1):3-8.
Reproduction concepts and practices in ancient Egypt mirrored by modern
medicine.
Haimov-Kochman R, Sciaky-Tamir Y, Hurwitz A.
1610-1914
a Digital Library - National Library of Medicine - a digital library
project providing scanned historical American medical books in pdf and
as searchable text files
1659 Midwifery TextBooks Description
MedHist - The guide to
history of medicine resources on the Internet
Biography
of Ina May Gaskin from Salon
Women and
Obstetrics - The Loss of Childbirth to Male Physicians by Shira Happlin
The Best Means
of Combating Infant Mortality - by Abraham Jacobi, M.D., President
of the American Medical Association, New York
President's address before the American Medical Association, at the
Sixty-Third Annual Session, at Atlantic City, June, 1912.
Includes comments about the training of midwives.
The History
of Midwifery in America by Beth Overton ~ May 23, 1996 (revised June
10, 1998)
Childbirth in History
- Mail-Order Resources
Witches,
Puritans, and Sexuality by Sasha Haarhoff, RN - This includes history
relevant to the role of midwives and birthing women in the Colonial United
States.
Apparently, Dickens didn't have a great opinion of midwives, as another
tippling midwife appears in Oliver
Twist. In
this introduction to Oliver Twist, Mrs. Sairey Gamp is described as
a "dirty, drunken old midwife and nurse".
Gynecology in the Ancient World
From The Dark Side of Modern Medicine - An interview with John Robbins. Includes discussion of how poorly the medical establishment "treats" cancer, schoolchildren, and birthing women. It includes mention of the trial of the twentieth century: [The BirthLove site is by subscription only - it's well worth the $10 membership fee; you can get a "sampler" by reading BirthLove's Top Twenty- For Free!.]
"In the early 80s, a group of chiropractors in Chicago...sued the AMA
for conspiring to destroy and eliminate the chiropractic profession...the
AMA was found guilty of intentionally conspiring to destroy their competition,
and the verdict was upheld by the U.S. Supreme Court. During this lengthy
and hard-fought case, the AMA spent over $20 million in legal fees to defend
itself, and still lost. Nearly 1 million pages of documentation entered
the public record, and many of those documents were from the AMA's internal
files. It was revealed quite clearly that, for many years, the AMA had
deliberately and systematically conspired to destroy not only chiropractic,
but midwifery, homeopathy, naturopathy, and herbalism. The whole collection
of what we call wholistic and alternative medicine had been the AMA's target
for destruction." -John Robbins
Deborah Davis has used feminist postmodern theories to explore case-loading midwifery practice in New Zealand. She focuses on the obstetric setting and describe the way that midwives "make space" for childbirth. Here is a brief abstract from a conference presentation:
"Making Space for Birth - In their daily work case-loading midwives traverse space. They visit childbearing women or attend childbirth in their homes, they may spend time in clinics or a variety of hospitals; smaller primary birthing units or larger obstetric hospitals. They spend their days engaging with childbearing women, their family or supporters and with obstetric or midwifery colleagues. As they move across space and between people, they traverse a variety of physical and discursive spaces.
Midwives journey into the intimate space of the childbearing woman attempting to understand their subjective experience and the way that this pregnancy and childbirth is situated within the landscape of their life world. They travel with this understanding as they negotiate other spaces; the biomedical space of the maternity context and obstetric hospital and the spaces of their own constructions of childbirth. Ultimately they work to create a space for birthing that is perhaps unique to each midwife, woman pairing. The obstetric hospital setting provides midwives with particular challenges as they work to create, maintain and protect the birthing space of the women in their care. Midwives engage in a variety of strategies to this end and these will be explored in this presentation.
This work is based on Deborah’s PhD study that explores the discursive
construction of case-loading midwifery in New Zealand. The practice
of case-loading midwives within the obstetric hospital provides a focus,
surfacing the contested nature of maternity care and illustrating the way
that midwives negotiate this contested terrain.
So why aren't HMOs beating down the doors of midwifery practices?
It took me a long time to understand this, and (of course) it's not
as simple as it seems. I have a Master's in Health Services Administration,
and when I was in graduate school and asked the same question, this is
what I was taught:
1) Payors (for example HMO's, but also other insurance companies) do not see midwives as a cost savings, but as an additive cost. Since the supply of physicians is not decreasing, they figure that if they add midwifery services as a covered benefit them their costs will just be higher in the long run because physicians will charge more, as they will not tolerate a substantial drop in income.
2) All of the plans are owned and/or controlled by physician groups.
They don't want the competition. Plain & simple.
The flaw in this thinking is that fees are set by the HMOs. Doesn't matter one iota what the physicians charge....the HMO reimburses what *it* wants. The HMOs we contract with send contracts yearly saying "We have cut your fees 25%, take it or leave it." The HMOs set the fees, not the providers. So, since midwives can deliver babies more safely and more cheaply, it behooves the HMOs to use MWs as providers. The MDs cannot, by virtue of the HMO contracts, increase their fees to *catch up*.
>2) All of the plans are owned and/or controlled by physician groups.
They >don't want the competition. Plain & simple.
I'm not sure this is true, although I do not have the stats to back
up this claim. I know the docs in my practice are really pissed re the
HMOs, and the control of our practice by bean counting insurance types.
Some of the IPAs with which the HMOs contract may be MD controlled, but
I do not think the HMOs themselves are.
They may not be "controlled" by MD’s, but look frequently who the CEO is for instance. I find the issue of power really interesting. I was part of a practice in a hospital that had the history of being the "country" hospital. That is, their typical clientele consisted of women of color, poor, immigrant, non-English speaking, adolescents, you get the picture. Our practice loved working with these women. THEN, an HMO bought the hospital because it also was debt free. 4 years later: the midwife service is down 3 people secondary to layoffs done because of budget decisions. The HMO clearly has made it their priority to get the white yuppies in from the suburbs to this hospital. To do this, money has been spent changing the name, painting everything, building a parking ramp and putting in valet parking. So, yes, everybody KNOWS that midwives do well with women defined as "high risk" due to social conditions, BUT, what is see is that FPs are seen as the salvation because they are cheaper than OB's, but are really drs, so can do more. In my book in a major metropolitan city, it seems to me that in women's care, they need to consult for most of the same things I have to. Our midwives had a 8% c/sec rate and the FP's had a 15% rate. Needless to say, the HMO is supportive of MD's and not of the midwives who they define by using words like "mid-levels" and "physician extenders" . This has nothing to do with CPMs or DEMs not getting along as other posters here have said. This is about people in an ivory tower ignoring the good research out there about what we do and trying to provide care as cheaply as they think they can. So, the administrators give MA contracts to the FP's that the CNM's can accept and they cut 3 midwives, expecting the remaining 10 to do the same amount of work. I for one am so burnt on the system that I have fantasies about another career. I hope the pendulum swings back soon before we have destroyed anything good in this system or the midwives have all gone crazy or retired!
The most shocking thing about ACNM convention last year was the fear evidenced by so many midwives from around the country. When the issue of "letting" non-nurse graduates of the new SUNY program into the college was discussed, the biggest response was along the lines of "What will ACOG think? Will this "confuse" the public"?" almost as though we had to ask permission to do something so bold as to re-define our very own profession.
In saying all of this, I by no means want to discount the difficulties of the previous generation of midwives who felt the correct course, when faced with strong opposition, was to be accommodating and non-threatening, so that the OBs would let us "play". But I draw my evidence from not only being a second generation feminist (and seeing the "mistakes" made in that movement), but also a working knowledge of the history of revolutionary struggles.
Paradigm shifts are not brought about incrementally. I think the early midwives are to be commended for their efforts, but their strategy of getting in and THEN bringing about change was fundamentally flawed. Naturally, the majority forces more changes on the minority, than the other way around.
I think it was naive to suppose that once midwives got into all of the hospitals and were integrated into the staff, that everyone would "get religion" and "allow" midwifery principles into practice. What I observed, during my training, and as I meet midwives who work in hospital settings, is that they try to win "acceptance" from the medical and nursing staff by being better docs than the docs. Most of them have no knowledge of the underpinnings of "midwifery", because they NEVER GET TO SEE midwifery practiced, so their medical training is reinforced day after day. And over time, they have too much fear and too little confidence to stand up to the powers that be, despite the fact that their conscience still nags at them. They shrug their shoulders and get on with the work of abusing women.
I know that I had to work hard to learn to trust in birth, because I never got to see the outcome of non-intervention or "midwifery tricks" in the hospitals where I worked as an RN and trained to be a CNM. I had tremendous fear of (for example) intermittent monitoring. Hopefully you will all laugh along with me as I recall the first women I monitored intermittently, during my IP clinicals. I was so used to continual monitoring, that I had a hard time believing the baby was still OK, when I wasn't listening (kinda like the tree in the forest problem). I followed the protocol for a 20 minute strip every hour, but in between I would get nervous, and do a real quick check (5 seconds or so) every 15 minutes, just to reassure myself the baby was still there.
When I started my training in Cooperstown, I had to restrain my urge to examine women who were struggling through transition and offer them an epidural. Intellectually, I knew they were OK, but I HAD NEVER SEEN AN UNMEDICATED LABOR (or at least not a very long one). My CNM training encouraged the application of midwifery principles, but none of our clinical sites actually applied them, so it all seemed theoretical.
I spoke with one midwife who works in a big city hospital; she had applied for a job in a private practice and spent a day doing office hours. Much to her disappointment, she was completely unprepared for the task. Women asked her about herbal remedies and alternative treatments, and she had NO IDEA what they were talking about.
For me to overcome my RN experience and my CNM clinicals, I had several things going for me: 1) I am a rebel at heart and don't take no s--t from anybody, although I think I am pretty good at being diplomatic about it. 2) I had the brave example of midwives on this list to guide me. I think about the OOH midwives who face imprisonment or worse to provide competent, woman-centered care and cannot disappoint them by colluding with the enemy. 3) I was aggressive in requesting the most "midwifery-friendly" clinical sites, Cooperstown being the best of the bunch. 4) I took on additional training, at my own expense, spending my "vacation" interning, seeing hundreds of women labor and birth under more or less "natural" conditions (by which I mean no "active management of labor"; the scene there is anything but natural, I would call it "neglected labor", as in, we ignore you until you tell us the baby is ready to come out. 5) I refused to accept a job, for my all important first CNM work experience, at which "medwifery" was practiced, knowing how greatly my first job would influence my practice.
In achieving all of this, I worked hard, and I was lucky along the way,
but I also kept reminding myself that abandoning the principles of my chosen
profession meant letting down all the women and babies who deserve better.
I am sure that all of the CNMs face this struggle every day, especially
those unfortunates in big city hospital based practice. To them I want
to say "No one will ever give you permission to practice like a midwife,
you simply must demand it". No more good girls!!!
Response to ACNM's Issue Brief on Direct-Entry
Midwifery and the CPM Credential
Heard any good midwife
jokes lately? Well, after reading about the politics, I figure
you'd need some humor.
A woman in labor started shouting, "Didn't, Can't, Couldn't, Wouldn't,
Shouldn't", and the midwife just nodded happily and said, "It looks as
if she's having lots of strong contractions." Ha, Ha.
Homebirth Humor
- Birth Cartoons
Sometimes midwives work with clients who decline even the mildest interventions
because they put their faith in God, or because the trust in birth, or
because they want to believe in their ability to manifest a perfect birth
without any outside assistance. (Sometimes one wonders why they hired
a midwife in the first place?!?) Here's the helicopter
joke that midwives like to tell in these circumstances.
Holiday Gift Idea for Midwives on a Tight
Budget
Lady's Hands, Lion's Heart
is the telling of Carol Leonard's journey as New Hampshire's first modern
midwife.
What better way to reach the masses than through romance novels! Margot
Early is a Harlequin Superromance author who is working on a continuing
series of novels, THE MIDWIVES, which was inspired by her experience giving
birth to her son at home with a midwife in attendance.
BABY CATCHER: Chronicles of a
Modern Midwife presents both home births and hospital births in a way
meant to avoid alienating those on
either side of what too often degenerates into a heated argument about
place of birth.
"A midwife should have a lady's hands, a hawk's eyes and a lion's heart"
- Aristotle
The Birth House by Ami McKay.
Monique and the Mango Rains; Two Years with a Midwife in Mali by Kris Holloway
She Births; A Modern Woman’s Guidebook for an Ancient Rite of Passage by Marci Macari.
8 pages of the current Compleat Mother (Summer 2006 Number 82) are dedicated
to articles, poetry and excerpts from both titles.
My feelings about CPM are directly parallel to my feelings about CPAs
(Certified Public Accountants). I'm glad that certification is available,
I'm glad one can still hire non-CPAs to keep the books, and I'm glad anybody
can still ask their sister to balance their checkbook or do it themselves.
The
Midwifery Partnership: A Model for Practice by Karen Guilliland &
Sally Pairman - A monograph presenting a descriptive model of midwifery
as a partnership between women and midwives, derived from the authors'
research in practice and personal experiences as midwives in NZ. Includes
discussions on midwifery and professionalism, feminism, and nursing.
I have begun wondering something that often comes back to my thoughts: Why is prenatal care depicted as being so extremely important in early pregnancy? I just don't get it. What on earth can doctors (and even midwives) do at that stage to guarantee a healthy baby? I don't understand why it is so important that "studies show..." that women who receive early prenatal care have healthier babies than women who don't. And this is why I wonder:
I realize that diet is extremely important. Ideally, the caregiver would discuss and possibly educate the mother about good diet while pregnant, and if pertinent would also discuss smoking and drug use. But beyond that, the pregnancy test, the vaginal exam, the ultrasound, the AFP, the other blood tests, and usually the blood-glucose tests do absolutely nothing to improve the condition of the fetus. What some of these tests can do is help a mother decide if she wants to abort, which of course would improve the outcome statistics, but I see no positive effect they would have on fetuses.
So just what DO all these tests do to mum? They subliminally tell many moms that, while pregnant, good health is precarious, and can only be declared by a medical caregiver. The message is that mom needs medical attention in order to insure a healthy pregnancy. But is this true? Usually not, IMO. Only true high risk pregnancies really need medical care.
I guess my point is, the issue of how normally a birth will go usually starts long before mom goes into labor. Our whole healthcare system treats pregnant mothers from the negative side with an attitude of "you and your baby are only healthy after we determine you are not unhealthy." Guilty until proven innocent.
Also, as far as the studies supposedly showing that early prenatal care is associated with healthier babies, could this possibly because most women who are in decent health and care about themselves and their babies will seek early care, whereas among the group who do not seek early care you will find many who are poor and/or uneducated and/or don't eat well and/or use drugs and don't want to be caught or lectured by a doctor? Would early prenatal care matter if they didn't intend to change their lifestyles?
And my other point is, how the mother feels is so often treated as unimportant
data. If she feels great, well, she still needs tests to determine if she
really is healthy. And if she's feeling rotten and needs more rest, well
tough, she can't take time off from work because she's "only" pregnant.
Now tell me, does this kind of prenatal care make for healthier babies???
The need for evidence-based obstetrics - A discussion of the gap between scientific evidence and the practice of obstetrics, written by and for obstetricians but of immense interest to birthing parents.
"Of all medical specialties it is in obstetrics and gynaecology in which clinical practice is least likely to be supported by scientific evidence."
"By professing the ability to improve the health outcomes for already
healthy women and their babies, obstetricians have a special responsibility
to ensure that their practices are based on solid evidence that they do
more good than harm."
"Archie Cochrane [originator of the
Archie Cochrane awarded "the wooden spoon" to obstetrics, partly because
"The specialty missed its first opportunity in the sixties to randomise
the confinement of low risk pregnant women at home and in hospital".
from a reference in the Cochrane
1996 Colloquium Abstracts - Papers:
Meta-analysis
of the safety of home birth.
Expecting
Trouble: The Myth of Prenatal Care in America - Book Review
"Much of what passes for prenatal care in this country is unduly expensive,
unnecessarily high-tech, and serves no beneficial purpose, consisting of
little more than a string of pointless, largely ceremonial clinic visits,
which infrequently avert the conditions we want our babies to avoid."
" . . . he concludes that the benefits of prenatal care as currently
provided are overstated for the majority of mothers and that the system
persists because of the economic and political benefits it affords its
supporters.
"He makes a strong case for the use of nurse-midwives for uncompli
Olsen O
Birth 1997 Mar;24(1):4-13; discussion 14-6
From: C-upi@clari.net (UPI)
Subject: Health Today [Sep 3]
Organization: Copyright 1997 by United Press International
Date: Wed, 3 Sep 1997 0:51:08 PDT
DOCTORS NOT SO GOOD WITH A STETHOSCOPE: Young doctors may be able to hold
a stethoscope to their patients' chests, but a new study shows they'll
understand only one out of every five sounds they hear. Researchers at
Philadelphia's Allegheny University of the Health Sciences tested stethoscope
skills in more than 450 internal medicine and family medicine residents
and nearly 90 medical students. The doctors and students were asked to
identify 12 noises linked to heart abnormalities. Dr. Salvatore Mangione,
a lead author of the study, says overall, the doctors were accurate 20
percent of the time. Doctors who could play a music instrument were the
most accurate. Mangione says bedside diagnostic skills have been waning,
abandoned in the rush to high-tech diagnostic tests and machines that are
making patients ``peripheral.'' The researchers released the findings in
the Journal of the American Medical Association.
Obstetric Prenatal Care may be Worthless