Legislative Update - Capital Testimony

The following is a testimony that was presented jointly by Midwives Association of Florida and Florida Association of Birth Centers last week to the Health Care Appropriations Subcommittee. FFOM endorses this testimony and encourages your support of these allied organizations.

Good Afternoon Chairman Hudson and Members,

In this tough budget year I am glad to have the opportunity to share with you a good investment. Birth Centers are an investment that has a high PE (price per earnings) ratio. - A licensed midwife and a birth center is the perfect combination for a healthy birth outcome. The State of Florida in its wisdom has recognized the need to utilize prenatal funds more efficiently and to increase the limited availability of care providers. Families view midwifery services in a birth center as a quality, cost-effective alternative to traditional physician hospital births.

The Florida Health Finder lists over 20 free standing birth centers that are located th

roughout the state. As you are aware prenatal providers in some counties are scare.

Presently a birth center is reimbursed by Medicaid an average of $2,000 per birth. A hospital birth would cost more than double the cost. At this time Medicaid pays for 10 prenatal visits. Birth Centers promote optimum care – they encourage the pregnant woman to start prenatal care at 10 weeks and goes to 42 weeks of pregnancy. That is a total of 16 visits.

Did you know that Birth center service also offer additional free services to their clients and at no cost to the taxpayer?

• Initial and ongoing diet evaluation and nutrition guidance. We know how important it is for the pregnant mother to be healthy during her pregnancy.
• They offer exercise for pregnancy, birth and postpartum -a birth center offers. This could lower the incidence of post-partum depression.
• Child Birth Classes – not only do they educate the pregnant mother what to expect during her pregnancy. Provide awareness to parents to put their baby to sleep on their back to reduce SIDS.
• Parenting and infant care classes
• Baby Safety Education.
• Breastfeeding support – research shows breastfeeding reduces infant illness; babies are healthier, which saves the Medicaid dollars in visits to the physician.
• Breastfeeding also has long-term health benefits:
• Reduced incidence of diabetes, heart disease, childhood obesity……

And last but not least – importance of family planning and baby spacing.

All of this for $2,000.

Most birth centers use a formula of 1/3 Medicaid, 1/3 self paid and 1/3 private health insurance. Some birth centers have 50% or more Medicaid patients. A proposed 20% reduction of an average of $400.00 per patient would cripple the fiscal health of a birth center. Many would be forced not to see Medicaid patients in order to keep their door open.

We are aware of the budget climate and I hope this information will be valuable you continue to craft the budget. Let us know a good investment when we see one!

Thank you for listening and your dedication to our state and our soon to be born citizens.

TIPS: How to Contact Elected Officials

As we find ourselves in the Spring 2011 Legislative Session, it is a critically important time to contact our elected officials and make our voices for midwives heard. The following will give you some ideas on how to best get your message across to legislators during this busy time.

GETTING STARTED

Identify your legislators and learn about their background, affiliations and voting record. These websites will help get you started, and our FFOM Legislative Committee can help you find more information.

• State House of Representatives: http://www.myfloridahouse.gov
• Florida State Senate: http://www.flsenate.gov

Schedule a meeting with your legislators. Most legislators spend the majority of time in their home districts, as the legislative session is quite short. Take advantage of the opportunity to meet with your representative or senator between sessions to foster a relationship and introduce the concerns of FFOM to him/her.

When meeting with your elected officials, bear in mind that a brief visit is all that is necessary as follow-up phone calls and letter will enhance the impact of your meeting. During your meeting, keep the following in mind:

1. Introduce yourself – as a constituent. Thank the legislator for taking the time to meet with you. Identify yourself as a member of FFOM and share a little about our mission and the people we serve (keep it brief).
2. State your purpose. If appropriate, be clear about what legislation you are supporting or opposing. Mention it by bill number and topic. Focus on one topic per meeting. Let the legislator know your position and why you are asking her/him to vote for that position.
3. Let the legislator and her/his staff members know that you FFOM have information and expertise. Let them know we can be a resource to them on midwifery related issues.
4. Give them a chance to talk about their perspective on your issue.
5. Ask for their vote and try to get a commitment at the meeting.
6. Let them know you plan to stay in touch.

Remember: KEEP IT BRIEF. At most, you can expect 30 minutes of their time. During session or other busy seasons, a 10 minute conversation will be the average. Follow up with a thank you letter right away.

LETTER WRITING TIPS

Writing letters, particularly after an in-person visit, help to keep midwifery issues and related legislation on the table with your representatives. The more often they hear and see information from FFOM about our concerns, the more important the issue will seem. Here are some hints to make your letters well received:

1. Use the correct address and salutation (i.e., Dear Senator name, or Dear Representative name, or Dear Governor name). While the legislature is in session, send letters to Senate or House offices. Between sessions, use the local office in your area.

2. Describe the bill by popular name and by House or Senate file number, or clearly describe the issue.

3. Be brief and clear. Write about one issue per letter, and state the issue and how you want your elected official to vote in your first sentence. Letters should be no longer than one page, however longer letters may be appreciated if you have some new information on the subject.

4. Be specific. If possible, give an example of how the issue affects your district.

5. Be timely. Make sure your legislator will have sufficient time to consider your request.

6. Know your facts. Inaccurate or misleading information will hurt your credibility.

7. Be polite in your requests for support or opposition. Never express anger, make demands, or threaten defeat at the next election. You will want to have future contact with the legislator.

8. Use your own words and stationary rather than form letters or postcards. In addition, write legibly or type – your letter could be discarded if it is not easy to read.

9. Be constructive. Explain an alternative or better solution to the problem and offer to be a resource on the issue.

10. Send a note of appreciation when your elected official supports your issue. When he or she does not support your issue, explain why you think a different decision should have been made. It might make a difference the next time.

PHONE CALLING TIPS

Phone calls can be used to follow-up on letters and meetings, but are often best used for immediate action requests, just prior to votes or new legislative activity. Multiple calls from multiple constituents just prior to a vote can help impress upon the legislator how important this issue is to the people s/he represents. Below are some guidelines for phone calls:

1. State your name, address and indicate that you are a constituent.

2. Give the name and House or Senate File number of the legislation, or clearly explain the issue.

3. State whether you oppose or support the legislation and how you want your legislator to vote. Include a statement on how the issue affects you personally.

4. You will usually be speaking with a secretary or aide who is checking pro or con and the call will last a very short time. Keep the phone call under five minutes unless the aide or legislator prolongs the conversation.

5. Listen to the legislator’s point of view.

6. Take down the name of the aide with whom you spoke so that you will have a contact person in case you need to contact the legislator again.

7. Thank them for their time, both on the telephone and with a note of thanks for the conversation that includes a concise summary of your opinion.

8. Do not call too often and risk becoming a nuisance.

9. Do not lie or try to talk your way around questions to which you do not know the answers. Say that you will get back to the legislator or aide, and then do so.

EMAILING TIPS

Email remains a controversial method of contacting your senators and representatives. Though it seems like a quick and easy way of getting your message to many officials, the use of email generators and other programs have made some offices less likely to respond to email. If you do choose to email your legislators, follow the guidelines under letter writing, and be sure to reference your address and that you are a constituent at the very beginning of your email. Those offices that filter emails often do so based on whether or not the author is a constituent.

Ultimately, FFOM recommends that you use email judiciously, relying more on the “old school” forms of communication to build the relationships that will be critical to forwarding the FFOM agenda in the coming years.

KEEP US POSTED!

Finally, please let us know when you have contacted someone so that our team can follow up with them. Our organization represents many constituents from all over the state and some parts of the country. The more we contact different officials, the more likely we are to find representatives that are willing to lend an ear, or better yet, champion a cause.

FFOM Position Against AHCA 59-A

Florida Friends of Midwives believes that a woman has a right to choose her birth attendant and her place of birth. It has come to our attention that the Agency for Health Care Administration (AHCA) is currently seeking to amend the rules that govern the operation of birth centers in Florida. The proposed rule changes, should they be adopted, will restrict a woman's access to out-of-hospital birth for conditions that are widely accepted by the CDC and other regulatory bodies to be safe and normal factors not worthy of high risk status.

This past March, AHCA held an administrative hearing to review proposed birth center rule changes. Prior to that hearing our understanding was that any changes would serve the purpose of bringing birth center rules into greater symmetry with the rule that govern the practice of licensed midwifery. It was also our understanding that interested parties including state midwifery professional organizations and consumer advocacy groups would be kept apprised of further meetings and decision-making regarding this issue. Unfortunately it is now clear that there have been several meetings held in the last several months and additional language was been incorporated into the proposed rule changes based in large part from internal suggestions by the Board of Nursing. These proposed changes include: eradicating the option for vaginal birth after cesarean (VBAC) in birth centers; increasing mandatory prenatal testing without recourse; limiting access for any woman who has ever tested positive for Group Beta Streptococcus bacteria; removing the ability for licensed midwives in birth center settings to administer lidocaine; eliminating informed consent for multiparous women; and finally, restricting care providers including licensed midwives, certified nurse midwives, family practitioners or obstetricians, from practicing as they would in a hospital or out of hospital setting, including conducting physicals, evaluating risk score criteria or other limitations that bind them beyond their own practice regulations.

These changes were proposed in a way that does not follow the accepted and appropriate method for amending rules as per Florida's Sunshine law. It also effectively keeps the licensed midwives, certified nurse-midwives and obstetricians who own birth centers out of the process, as well as the women and families who utilize their services.

Please visit our website at www.flmidwifery.org for additional information including a copy of the most recent proposed rule changes and a template letter for contacting AHCA staff. Right now it is essential that consumers make our voices heard. Should this rule change be accepted, as many as one half of the women who currently choose to give birth in Florida's birth centers will be unable to do so legally.

FFOM Hosts Maternal Health Weekend in Sarasota

Last weekend, Florida Friends of Midwives sponsored and co-sponsored several events aimed at improving maternal health care locally and throughout the country. Headlining the weekend was Sunday afternoon's panel discussion Maternal Health Care in the 21st Century: Sarasota and Beyond. Present for this and all other events was the world's leading midwife, Ina May Gaskin.

Ms. Gaskin began her visit to Sarasota with a Clinical Conference for the medical staff of Sarasota Memorial Hospital (SMH) on Friday, October 30. Her presentation was entitled "Combining the Best of Modern Obstetrics with Respect for Nature and Traditional Midwifery Approaches." Her objectives were threefold: to explore the knowledge base and skills common to traditional midwifery; to understand the need for both modern obstetrics and (authentic) midwifery; and to build positive relationships between the two professions (especially with regard to home birth midwives). Present at the conference were SMH Director of Maternal-Fetal Medicine Dr. Washington Hill; Sarasota County Health Department OB/GYN Dr. John Abu; Licensed Midwives Christina Holmes and Alina Vogelhut; and several members of the hospital staff and the community, including childbirth educators, nurses and retired physicians. The presentation will be available via podcast on the SMH Continuing Education website.

Friday afternoon found Ina May Gaskin touring both of Sarasota's freestanding birth centers (Birthways Family Birth Center and Rosemary Birthing Home), and having lunch with Sonia Pressman Fuentes, the co-founder of the National Organization for Women (NOW). Two of the most influential women in recent American history, the pair discussed the shift in birth culture in the last half century, the difference between American governmental structure and that of most European countries with better maternal outcomes, and the role of the feminist movement in changing the American perception of birth.

Saturday morning, October 31, Ina May Gaskin presented the Safe Motherhood Quilt Project at the Selby Public Library. Ms. Gaskin spoke to Sarasota's SNN News Channel 6 before the presentation, saying "In 2007, the World Health Organization reported that there are forty other countries that do better at preventing maternal death than the United States." Three panels of the quilt were shown in the library's Geldbart Auditorium, after having been hung from the atrium balcony during the week prior. These three panels contained 58 squares, each representing a woman who has died of pregnancy or childbirth related causes in America since 1982. Ms. Gaskin argues that simple measures such as a unified federal death certificate and an increase in percentage of hospital autopsies would dramatically improve U.S. maternal outcomes. The presentation was followed by a booksigning benefiting the project, as well as Florida Friends of Midwives (FFOM), a non-profit grassroots organization dedicated to promoting and preserving access to midwifery care in Florida. Ms. Gaskin signed copies of her classic Spiritual Midwifery, the gold standard prenatal education book Ina May's Guide to Childbirth, and her newest release, Ina May's Guide to Breastfeeding, said by Dr. Christiane Northrup to be "the best thing ever written on the subject."

Sunday afternoon at 3:00 pm, Ina May Gaskin met in the Hyatt Regency Sarasota Ballroom with Dr. Washington Hill once more, as well as Sarasota Healthy Start Coalition executive director Jennifer Highland and Representative Keith Fitzgerald, for a panel discussion called Maternal Health Care in the 21st Century: Sarasota and Beyond. The discussion was moderated by Sarasota Vice Mayor Kelly Kirschner, who shared his perspective as a City Commissioner that improved maternal health is a formula of community growth.
The panel was a free program which included refreshments and a 28 page Maternal Health Resource Guide, all made possible by the hard work of the sponsoring organizations and the generosity of several business partners. Approximately 250-275 people attended the discussion, including several guests of expertise in the field of maternal health and associated disciplines.
Dr. Washington Hill was the first to speak, pointing to a collaborative model of care as the standard for positive outcomes, and encouraging open communication between the many components of maternal health care and its providers.
Ina May Gaskin followed, discussing maternal death, its possible prevention and ways to move toward accurate recordkeeping, and the importance of prenatal health. She illustrated strategies in other countries with much better outcomes than ours, such as the Netherlands, which provides its new pregnant women with paid postpartum care.
Jennifer Highland, executive director of the Healthy Start Coalition of Sarasota County, then presented a staggering display of statistics illustrating Sarasota's place in Florida and the rest of the country in categories such as infant death, fetal death, smoking during pregnancy, breastfeeding rates and more. Jennifer suggested that Sarasota County's high cesarean section percentage be closely examined and reversed to improve preterm birth rates and NICU admissions, and that prenatal health be a priority of all parties involved.
Finally, Florida House of Representatives Health and Family Services Policy Council member Rep. Keith Fitzgerald gave the audience a history of health insurance, an overview of health care reform issues, and a call to action. When talking about the frequency of special interest groups' appointments with him and his colleagues, Fitzgerald asked: "Where are you?"

Questions were then taken from audience members, who asked about tort reform, individual OB/GYN's c-section rates, and women's intuition--among many other things.

After the panel discsussion, Florida Friends of Midwives (FFOM) hosted the tribute An Evening with Ina May Gaskin in the Boathouse of the Hyatt Regency Sarasota. Guests received keepsake tickets, signed a book of gratitude for Ms. Gaskin, and viewed a tribute DVD of her work and its manifestation through the midwives and midwife-assisted births here in Sarasota. Special thanks to Radio-Free Carmela and the Transmitters and Tanya Radtke for providing music for the evening. Net proceeds of approximately $2500 will help FFOM in their strategy to protect Florida's midwives and their laws, and to improve public awareness of the Midwives Model of Care.

A Letter from the MAMA Campaign

Dear Florida Supporters of Midwifery--

As Florida constituents you all are in a unique and special position to help encourage federal recognition of CPMs by helping The MAMA Campaign.

The MAMA Campaign is an effort by six national organizations to include CPMs as Medicaid providers in the evolving healthcare reform legislation currently under consideration. Visit www.mamacampaign.org for more information about the campaign and to signup for news and alerts.

This week, the MAMA Campaign is trying to get letters from constituents sent to the offices of Senator Nelson and/or Congresswoman Kathy Castor of the 11th district in Florida. Anyone who lives in Florida can write as a constituent to Senator Nelson. We only need people who are constituent’s of Congresswoman Kathy Castor to write to her. To find out if you or someone you know lives in Castor’s Tampa Bay area district, visit http://www.govtrack.us/congress/findyourreps.xpd?state=FL&district=11.

Congresswoman Castor is on the House Energy and Commerce committee and Senator Nelson sits on the Senate Finance Committee. These committees will make decisions about changes to Medicaid in the current health care reform efforts, including whether or not CPMs will be added to the list of approved Medicaid providers. Hence, as Floridians, you are in a special position to help influence these critical legislators. This inclusion of CPMS as federal Medicaid providers would be an important step in increasing access to CPMs across the country.

Both Congresswoman Kathy Castor and Senator Bill Nelson have indicated some support for our amendment. But ours is only one of many potential amendments to the health care bills, all demanding their attention. We need you to write a letter of encouragement to Senator Nelson and/or Congresswoman Castor, telling them to take action on this issue.

Please forward this letter writing request to other Floridians who support midwifery. If you have clients, friends, relatives or ANYONE who is a constituent who will write a letter to Representative Castor and/or Senator Nelson please ask them to do so. It is important to send letters as soon as possible! These personal letters from constituents are critical and make a huge impact. Please write and fax or email a short letter TODAY!

MAMA CAMPAIGN INSTRUCTIONS AND TALKING POINTS FOR E-MAILED OR FAXED LETTERS FROM CONSTITUENTS OF SENATOR NELSON OR REPRESENTATIVE CASTOR

1. Handwritten or typed letters may be faxed to the number provided below.

2. Please fax your letter to the legislator’s Washington, D.C. office. This is the best way to get the letters to them quickly and effectively. If you are unable to send a fax, the next best thing is to send your letter by using the legislator’s web-based e-mail form. If you would like to help but can’t fax a letter, or send an email, a phone call to their Washington, D.C. office, is also helpful.

Rep. Kathy Castor (FL-11th)(Tampa): Visit http://www.govtrack.us/congress/findyourreps.xpd?state=FL&district=11 to see if you are a constituent.

DC Fax: (202)225-5652
DC Phone: 202-225-3376
Web Email Form: https://writerep.house.gov/writerep/welcome.shtml

Sen. Bill Nelson (FL)
DC Fax: 202-228-2183
DC Phone: 202-224-5274
Web Email: http://billnelson.senate.gov/contact/email.cfm

3. Please include the following crucial language in your letter; this is what you are asking your legislator to do:

FOR REP. CASTOR: "I am a constituent and I ask that the Congresswoman support efforts to improve the maternity care system by adding Certified Professional Midwives to the list of providers covered by Medicaid. Will Congresswoman Castor raise this issue with Energy & Commerce Chairman Henry Waxman as a priority for her, to see if we can get this important provision in the final House bill? It’s so crucial that we expand access to maternity care as a component of health reform.”

FOR SEN. NELSON "I am a constituent and I ask that the Senator support efforts to improve the maternity care system by adding Certified Professional Midwives to the list of providers covered by Medicaid. Will Senator Nelson please raise this issue with Finance Committee Chairman Max Baucus as a priority for him, to see if we can get this important provision in the final Senate bill? It’s so crucial that we expand access to maternity care as a component of health reform.”

4. A short letter is sufficient. But, if you wish to write an expanded, more personalized letter, at the end of this document are a list of talking points to help you explain why Senator Nelson or Representative Castor should ask their appropriate chairman to add this amendment to the bill. You do not need to use all the talking points. We encourage you to make this a personal letter from you. We do not want these to look like form letters. We do suggest, because the chairmen are looking for cost-savings wherever they can find them, that you might want to emphasize the second and fourth bulleted points in the list of talking points below.

Note: For clarity’s sake, please be sure to write out “Certified Professional Midwife” rather than “CPM”.

5. Share a brief personal detail if possible and relevant, for example: “Two of my children were born at home attended by Certified Professional Midwives. I believe all women regardless of their income should have access to the safe, high-quality, cost-effective care provided by Certified Professional Midwives.”

6. Sign off with your name, address, and contact information.

7. If Senator Nelson’s or Representative Castor’s office would like more information about our efforts to pursue this important Medicaid improvement, they may contact Mary Lawlor with the National Association of Certified Professional Midwives at president@nacpm.org or on her cell phone at 917-453-6780. She and other Campaign members will be in D.C. during the next few weeks and may be available to meet his/her staff.

8. Please send the MAMA Campaign a copy of your letter. Email it to info@mamacampaign.org or FAX to 802-536-4142.

Again, anyone who lives in Florida can write as a constituent to Senator Nelson. We only need people who live in Congresswoman Kathy Castor’s district to write to her. To find out if you or someone you know lives in Rep. Castor’s district which includes: Tampa and St. Petersburg and parts of Hillsborough, Pinellas and Manatee counties, visit http://www.govtrack.us/congress/findyourreps.xpd?state=FL&district=11. PLEASE forward this writing request to other Floridian’s who support midwifery. These letters are incredibly important.

If you haven’t already, please sign up with the MAMA Campaign at www.mamacampaign.org to get e-alerts and find more information and handouts. Please donate to the campaign at www.mamacampaign.org. Thanks so much for all you are already doing and for all you will do this week!

THANK YOU!

Nasima Pfaffl
Citizens for Midwifery/MAMA Campaign
321-733-6156
nasima@cfmidwifery.org

Talking Points :

CPMs are highly-trained, credentialed clinicians who provide effective, evidence-based maternity care. They are the only maternity care providers specifically trained in attending births outside the hospital and, by assisting in births at home and in birthing centers, offer women an important choice in how their babies are delivered.

I support the basic principal that health reform should make obtaining care MORE AFFORDABLE for all American. Adding Certified Professional Midwives to the Medicaid list would SAVE MONEY by reducing health care costs immediately.

Each mother on Medicaid who chooses an out-of-hospital birth with a Certified Professional Midwife would lower Medicaid costs, since Medicaid would otherwise be paying for a hospital birth at greater cost and with much greater likelihood of an expensive cesarean section.

Research demonstrates that midwives who attend births outside the hospital (at home or in a birth center) have much lower rates of unnecessary and potentially dangerous medical interventions such as inductions and cesarean-sections with at least as good outcomes in terms of maternal and infant mortality, at substantially lower costs.

Because Certified Professional Midwives provide thorough individualized care that promotes healthy pregnancies, the babies are healthier – more are full term and full weight, avoiding costly health problems.

Of the twenty-five states that now provide a path to licensure for Certified Professional Midwives, only 9 include CPMs in their state Medicaid programs, so low-income women on Medicaid have difficulty obtaining services. This falls short of genuine and consistent patient choice and access. Certified Professional Midwives and women who want access to them are seeking federal Medicaid reimbursement for their services as one important step to increase access to this kind of maternity care.

All women deserve to have access to quality, comprehensive maternity care, in the communities where they live, with a choice of qualified provider and services that are fully recognized and reimbursed by both private and public payers.

As the #1 reason for hospitalization, but with declining quality outcomes in the U.S., it is essential for health care reform to include maternity care.

FFOM Welcomes Ina May Gaskin to Sarasota

Sarasota, FL (July 31, 2009) -- On November 1, 2009, Sarasota will host a discussion entitled 'Maternal Health Care in the 21st Century: Sarasota and Beyond.' The program will feature a distinguished panel of internationally recognized speakers. The Sarasota-Manatee Chapter of the National Organization for Women (NOW) is sponsoring the event, along with co-sponsors Florida Friends of Midwives and the Sarasota Commission on the Status of Women. The discussion will take place at the Hyatt Regency Sarasota. The public is welcome to attend at no cost.

The panelists for this discussion are:
--Dr. Washington Hill, MD, FACOG, Labor and Delivery Medical Director and Maternal-Fetal Medicine Director at Sarasota Memorial Hospital;
--Ina May Gaskin, MA, CPM, Founder and Director of The Farm Midwifery Center;
--Rep. Keith Fitzgerald, PhD, Florida House of Representatives, District 69; and
--Jennifer Highland, MPH, Executive Director of the Healthy Start Coalition of Sarasota County.

The discussion will be moderated by Kelly Kirschner, MA, Sarasota City Commissioner and Vice Mayor, and will last approximately an hour and a half. Time will be allotted for audience questions and answers, as well as refreshments following the program.

This panel will review current trends in maternity care in Sarasota within the context of the U.S. and the world and target paths to improving maternity care locally and nationwide. Topics for discussion include:

• maternal mortality,
• obstetric intervention rates and risks,
• legislation,
• legal reform and malpractice concerns,
• insurance coverage,
• community education and awareness,
• the midwifery model of care,
• informed consent and refusal,
• transparency in maternity care,
• the availability of prenatal care (including education, counseling, and doulas), and
• the upcoming expansion of Sarasota Memorial Hospital to include new labor and delivery rooms.

Hosting a panel discussion about maternal health care issues was the brainchild of Sonia Pressman Fuentes, co-founder of the National Organization for Women (NOW). “After spending a lifetime improving the legal status of women and fighting gender discrimination in the US and the world, it is exciting for me to be involved in a field new to me, that of improving maternal health care options for women in Sarasota, the US, and the world,” says Fuentes. Joining her in planning the event is Laura Gilkey, local childbirth advocate and board member of Florida Friends of Midwives. "With a panel representative of obstetrics, midwifery, legislature and public health, perhaps Sarasota can begin a conversation that will pave the way toward becoming a national model of community healthcare reform through improved maternity care," says Gilkey.

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For more information, please contact Laura Gilkey at laura@kangaroopromotions.net / (941) 915-8115. Interviews are available at the request of the press. Planning and agenda updates for the panel will be posted on the website www.borninsarasota.blogspot.com.

About the National Organization for Women (NOW): The National Organization for Women (NOW) is the largest organization of feminist activists in the United States. NOW has 500,000 contributing members and 550 chapters in all 50 states and the District of Columbia. Since its founding in 1966, NOW's goal has been to take action to bring about equality for all women. NOW works to eliminate discrimination and harassment in the workplace, schools, the justice system, and all other sectors of society; secure abortion, birth control and reproductive rights for all women; end all forms of violence against women; eradicate racism, sexism and homophobia; and promote equality and justice in our society.

About Florida Friends of Midwives (FFOM): Florida Friends of Midwives (FFOM) is a non-profit grassroots organization dedicated to promoting the Midwives Model of Care and supporting the practice of midwifery in Florida. Florida Friends of Midwives was formed to support midwives who offer safe, cost-effective, evidence based care to Florida's Families. Our members are consumers and birth advocates with a common goal: to preserve the legal protection afforded to Florida's midwives and birth centers. We are committed to organizing the community to support midwives and to assure the continued availability of midwifery care in the State of Florida.

About the Sarasota Commission on the Status of Women (SCSW): The Sarasota Commission on the Status of Women (SCSW) was re-established in Sarasota County to empower women through education, research, and advocacy.

ABOUT THE PANELISTS:

Dr. Washington Hill, M.D., FACOG
Labor and Delivery Medical Director / Maternal-Fetal Medicine Director, Sarasota Memorial Hospital
B.A., Rutgers University, College of South Jersey, Camden, New Jersey, 1961
M.D., Temple University School of Medicine, 1965
Obstetrics and Gynecology Residency, William Beaumont General Hospital, 1970
Post Graduate, Maternal-Fetal Medicine Fellowship, University of California, San Francisco, 1984
Board Certification, American Board of Obstetrics and Gynecology with Special Competence in Maternal-Fetal Medicine, 1989 with Recertification 1978, 1993 and 1998

Dr. Hill is the Past President of the Medical Staff and Chairman of the Department of Obstetrics and Gynecology at Sarasota Memorial Hospital, Sarasota, Florida. He is currently Director of Maternal-Fetal Medicine. He is also Clinical Professor Department of Obstetrics and Gynecology at University South Florida College of Medicine, Tampa Florida and Clinical Professor Department of Clinical Sciences OB/GYN Clerkship Director-Sarasota Campus Florida State University College of Medicine Tallahassee Florida. After earning his medical degree at Temple University and interning at Walter Reed General Hospital in Washington, D.C., Dr. Hill spent the next nine years as a Medical Officer in the United States Army. During this time, he conducted his residency training in Obstetrics and Gynecology at William Beaumont General Hospital in El Paso, Texas. Upon finishing his residency, he was an Obstetrician and Gynecologist in Germany for three years. After twelve years of private practice in Obstetrics and Gynecology, Dr. Hill completed a fellowship in Maternal-Medicine at the University of California, San Francisco and Children’s Hospital of San Francisco in 1984. While there, he was also a Research Fellow at the Cardiovascular Research Institute. Following completion of his fellowship in Maternal-Fetal Medicine, he has practiced this subspecialty for over 20 years first at the Sutter Perinatal Center and the University of California-Davis School of Medicine, Sacramento, California, and then at Creighton University, School of Medicine, Omaha, Nebraska; Meharry Medical College, and Vanderbilt University School of Medicine, Nashville, Tennessee. He served as Chairman of the Department of Obstetrics and Gynecology at Meharry Medical College, School of Medicine, educating minority medical students and residents from 1990 until 1992, when he took his current position as Director of Maternal-Fetal Medicine and the Perinatal Center of Sarasota Memorial Hospital in Sarasota, Florida. Dr. Hill is a leader in Maternal-Fetal Medicine. He has a strong interest in education, patient care, teaching and clinical practice. He is a regular participant at conferences which teach perinatal healthcare providers management and use of research in caring for high risk pregnancies. He has been a leader in the development of a center of excellence known throughout the nation for the care of high risk pregnant patients. Dr. Hill is a frequently sought after speaker in the community and at medical centers around the nation in high risk pregnancy management. He is Board Certified in Maternal Fetal Medicine and Obstetrics and Gynecology. He also serves around the country as a consultant for maternal-fetal medicine and medical legal issues. In his “spare time,” he likes to travel, especially to Africa on medical missions and will be happy to recruit to go also. He also enjoys sports, music and collecting African artifacts when not engaged in his teaching duties. Dr. Hill is the author of at least 60 articles in refereed journals and the book, “Ambulatory Obstetrics.” He contributes regularly to the medical literature and provider education. A native of Camden, New Jersey, Dr. Hill is married to Pauline Hill.

Ina May Gaskin, M.A., C.P.M.
Founder / Director, The Farm Midwifery Center
State University of Iowa, Iowa City, Iowa, B.A., English, Summa cum laude, Highest honors
Northern Illinois University, DeKalb, Illinois, M.A., English
North American Registry of Midwives
Certified Professional Midwife
Tennessee Licensed Certified Professional Midwife

Ina May Gaskin, MA, CPM, is founder and director of the Farm Midwifery Center, located near Summertown, Tennessee. Founded in 1971, by 1996, the Farm Midwifery Center had handled more than 2200 births, with remarkably good outcomes. Ms. Gaskin herself has attended more than 1200 births. She is author of Spiritual Midwifery, now in its fourth edition. For twenty-two years she published Birth Gazette, a quarterly covering health care, childbirth and midwifery issues. Her most recent book, Ina May’s Guide to Childbirth was released in 2003 by Bantam/Dell, a division of Random House. She has lectured all over the world at midwifery conferences and at medical schools, both to students and to faculty. She was President of Midwives' Alliance of North America from 1996 to 2002. In 1997, she received the ASPO/Lamaze Irwin Chabon Award and the Tennessee Perinatal Association Recognition Award. In 2003 she was chosen as Visiting Fellow of Morse College, Yale University. Ms. Gaskin has lectured widely to midwives and physicians throughout the world. Her promotion of a low-intervention but extremely effective method for dealing with one of the most-feared birth complications, shoulder dystocia, has resulted in that method being adopted by a growing number of practitioners. The Gaskin maneuver is the first obstetrical procedure to be named for a midwife. Her statistics for breech deliveries and her teaching video on the subject have helped to spark a reappraisal of the policy of automatically performing cesarean section for all breech babies. As the occurrence of vaginal breech births has declined over the last 25 years, the knowledge and skill required for such births have come close to extinction. Ms. Gaskin’s center is noted for its low rates of intervention, morbidity and mortality despite the inclusion of many vaginally delivered breeches, twin and grand multiparas. Their statistics were published in “The Safety of Home Birth: The Farm Study,” authored by A. Mark Durand, American Journal of Public Health, March, 1992, Vol. 82, 450-452. Ms. Gaskin was featured in Salon magazine’s feature “Brilliant Careers” in the June 1, 1999 edition. She is the originator and coordinator of The Safe Motherhood Quilt Project, a national effort developed to draw public attention to the current maternal death rates, as well as to the gross underreporting of maternal deaths in the United States, and to honor those women who have died of pregnancy-related causes since 1982. Her newest book, Ina May's Guide to Breastfeeding, will be released October 1st, 2009.

Rep. Keith Fitzgerald, Ph.D.
Florida House of Representatives, District 69
University of Louisville, B.A., 1979
Indiana University, Ph.D., 1987

Representative Keith Fitzgerald was elected to represent State House District 69 in 2006. His district includes the northern part of Sarasota County and a small portion of Manatee County. Representative Fitzgerald was born in Springfield, OH and grew up in Louisville, KY. He holds a B.A. from the University of Louisville, and a Ph.D. from Indiana University. Representative Fitzgerald has lived in Sarasota and taught political science at New College of Florida since 1994. He and his wife, Angela Baker, have nine-year-old twins. Representative Fitzgerald is a lifelong public servant. From the time when he worked in high school and college as a reading tutor for dyslexic children until his present job as a college professor at New College of Florida, he has been an educator. As a Ph.D. in political science, he has studied politics his whole life, taught at colleges and universities and conducted scholarly research. Representative Fitzgerald serves as the Democratic Ranking Member on the Policy Council and as a member of the Finance and Tax Council, Health and Family Services Policy Council, Select Policy Council on Strategic & Economic Planning and the Military and Local Affairs Policy Committee. Representative Fitzgerald also serves as Policy Chair for the House Democratic Caucus. His prior leadership positions include service on the Advisory Council of Faculty Senates, the Board of Trustees at New College of Florida and the Sarasota City Charter Review Board.

Jennifer Highland, M.P.H.
Executive Director, Healthy Start Coalition of Sarasota County
University of South Florida, M.P.H. Public Health, 1995

Jennifer’s passion for helping mothers and infants began, of course, with the birth of her children. Most of her early career in Louisiana, Georgia and Texas was as a registered nurse working in hospital settings, in clinical nursing and staff development. Her education positions allowed her to utilize her graphic art skills in the development of printed educational materials and newsletters for hospital staff and nurses. After she moved to Florida and became a mother, Jennifer volunteered for the Breastfeeding Advocates of Sarasota County and completed her Master of Public Health Degree from USF, graduating in 1995. Jennifer was the Project Coordinator for the first and on-going national breastfeeding promotion campaign, “Loving Support Makes Breastfeeding Work,” through her employment with Best Start, Inc., in Tampa. She then became trained as a Childbirth Educator and taught at Sarasota Memorial Hospital. Her work at Healthy Start began in 2001 as the Contract/Quality Manager. Her role expanded to include professional education. In 2006 she became the Executive Director.

MODERATOR: Kelly Kirschner, M.A.
Sarasota City Commission (District 3 Commissioner / Vice Mayor)
B.S. Foreign Service, Georgetown University
M.A. Latin American Studies, Georgetown University

Kelly is a lifelong Sarasotan. He has served the Sarasota community as President of the Alta Vista Neighborhood Association as well as having been an active member of the Coalition of City Neighborhood Associations. Believing strongly in public service, Kelly has worked for the White House Office of Public Liaison; served as a Peace Corps Volunteer; and led a USAID community conservation project in rural Guatemala. Kelly lives with his wife, Tracy, son, Bodhi, and daughter, Selby, in District 3.

EVENT SPONSOR: Sonia Pressman Fuentes, JD
The National Organization for Women (NOW)
B.A. Cornell University 1950
J.D. University of Miami School of Law 1957

Sonia Pressman Fuentes, who was born in Berlin, Germany, of Polish parents, came to the U.S. with her immediate family in 1934 to escape the Holocaust. She graduated as valedictorian of her high school in Monticello, New York, Phil Beta Kappa from Cornell University, and first in her class at the University of Miami (FL) School of Law. She was an attorney for the U.S. Department of Justice, the National Labor Relations Board, the Equal Employment Opportunity Commission (EEOC), and the U.S. Department of Housing & Urban Development in Washington, D.C. She was the first woman attorney in the Office of the General Counsel at the EEOC and drafted a number of the Commission’s landmark guidelines and decisions. She was a co-founder of NOW, WEAL (the Women’s Equity Action League), and FEW (Federally Employed Women) and a charter member of VFA. She was the longest-serving board member in the history of NWP (National Woman’s Party). She also served as an attorney and executive, respectively, at the headquarters of GTE Service Corporation and TRW Inc., and was the highest-paid woman employee at each of those headquarters. In 1993, she retired from the federal government, thereafter wrote her memoir, Eat First—You Don’t Know What They’ll Give You, The Adventures of an Immigrant Family and Their Feminist Daughter, and embarked on new careers as a writer and public speaker. For further information, see her website.

EVENT COORDINATOR: Laura H. Gilkey, BLA
Florida Friends of Midwives (FFOM)
B.L.A. Landscape Architecture, University of Florida, 2000

Laura Gilkey serves on the Board of Directors for Florida Friends of Midwives, and is the Florida Coordinating Ambassador for The Birth Survey: The Transparency in Maternity Care Project. Laura is an endorser of The Mother-Friendly Childbirth Initiative and a member of the Coalition for Improving Maternity Care Services. She is a project coordinator and quilter for Ina May Gaskin's Safe Motherhood Quilt Project, intended to raise awareness about American maternal mortality. Laura has recently joined the Planning and Evaluation Committee for the Healthy Start Coalition of Sarasota County, whose mission is to improve the health and well-being of Sarasota's pregnant women, infants, and small children. Professionally, she is the marketing manager for Michael A. Gilkey, Inc., landscape architecture studio, and is the owner of Kangaroo Promotions, Inc., a creative marketing firm in Sarasota.

Action Alert: Birth Center Reimbursement

Medicaid Birth Center Reimbursement Act Introduced in the Senate

This has been a very busy week week in Washington, DC! In the Senate, U.S. Senators Barbara Boxer (D-CA) and Mark Begich (D-AK) introduced S.1423 the Medicaid Birth Center Reimbursement Act to ensure Medicaid birth center facility fee payments to states.

In the House, the health care reform bill H.R. 3200 "America's Affordable Health Choices Act of 2009" was introduced. This bill includes the birth center bill language but it does not guarantee that all state Medicaid plans will cover the facility fee.

It is CRITICAL that we have strong co-sponsorship for our bills in the House and the Senate. This means that we need YOU and your colleagues, family members, clients and friends to contact your federal Senators and Representatives RIGHT AWAY.

IMPERATIVE ACTIONS

Continue to work in the House and the Senate to secure co-sponsors for our bills (H.R. 2358 and S.1423).

• Call your U.S. Senators and Representatives. Click here for directions on how to contact your Representatives and Senators and what to say. After you have made your calls, please call or email AABC's lobbyist Karen Fennell and tell her who you talked with and any comments or additional information requested. Call Karen at 301-830-3910; Send email here. This report to Karen is important so that she can follow-up.
• Invite your Senators and Representatives to an Open House at your birth center during the August recess (the entire month of August). Invite the media and your clients to come. This is a win-win. The legislators and the birth center will receive positive press. We will develop an "Open House" packet and post it online in a few days for you to adapt for your community.
• Attend the town hall meetings on health care reform that are being held across the country and make your voice heard at those meetings.
  

We MUST be prepared with strong co-sponsorship to move our legislation. Who is already a co-sponsor?

House Bill H.R. 2358
Sponsor: Susan Davis (CA)
Co-Sponsors: Gus Bilirakis (FL), Lois Capps (CA), Robert Whittman (VA), Tammy Baldwin (WI), Sander Levin (MI), Diana DeGette (CO), Eric Massa (NY), and Janice Schakowsky (IL)

Senate Bill S.1423
Sponsor: Barbara Boxer (CA)
Co-Sponsor: Mark Begich (AK)

We need EVERYONE to take action and ensure that our bill is passed as soon as possible!

Sincerely,

Jill Alliman, CNM, MSN
Chair, Legislative Committee
American Association of Birth Centers

Fight Florida's Ban on VBACs in Birthing Centers!

Join the fight to change the State of Florida's ban on Vaginal Births After Cesarean (VBAC) in birthing centers.

Currently the State of Florida's legislative rule governing birth centers is written in a manner which has now been used to restrict women from choosing VBACs with any licensed practitioner in a free standing birth center.


The Florida Alliance of Birth Centers has retained an attorney to challenge the legislative rule banning a woman from attempting a vaginal birth after c-section in a birth center. With c-section rates in some Florida hospitals topping 70%, women's choices are being limited.

PUSH BACK for VBAC's.

Visit the Birthgirlz website for more details and please donate today.

Until midnight tonight, any donation made to this worthy cause will be matched.

ACTION ALERT: Health Care Reform

Dear Midwifery Supporters,

Florida Friends of Midwives supports The Big Push for Midwives in their current federal legislative efforts. They have been hard at work presenting evidence in Washington that access to Certified Professional Midwives and out-of-hospital maternity care would save billions of US healthcare dollars while simultaneously improving birth outcomes.

Now, it's Florida's turn to show our support. Please read the following ACTION ALERT carefully, and take few moments to let our current administration know that this issue is important to you and your family.

Thank you,
Board of Directors
Florida Friends of Midwives
_____________________________________________________________________________________

As many of you may know, the White House issued a call this week asking citizens from across the country to send emails about what they would like to see in health care reform. Not long afterwards, the server accepting the emails crashed.

Why? Because it got flooded with emails about the President's birth certificate!

Now the press is reporting about it, just as they did when grassroots organizers for the legalization of marijuana set the record for the most number of emails sent during the transition-a mere 6000. We can top that!

It turns out there is another, lesser-known online form for submitting comments about health care reform. Let's use it!

If we top 6000 emails-and I know we can-we will set a new record and get the White House's attention on how strong support for out-of-hospital maternity care and Certified Professional Midwives is.

So please go to the following link and fill out the form with a short, simple message about why you want all women, including those on Medicaid, to have access to out-of-hospital maternity care and Certified Professional Midwives who are specially trained to provide it.

http://www.healthreform.gov/communityreports/comments.html

Pick one or two points to include in your own words: And always use the title, Certified Professional Midwives, spelled out.

Certified Professional Midwives are specially trained as experts in out-of-hospital maternity care and deliver babies in private homes and in freestanding birth centers.

Research consistently shows that low-risk women planning to deliver their babies at home under the care of Certified Professional Midwives experience outcomes equal to low-risk women who deliver in the hospital, but with far fewer costly and preventable interventions, including a five-fold decrease in cesarean section.

Babies delivered under the care of Certified Professional Midwives have significantly reduced rates of prematurity and low-birth weight, two of the leading contributing factors to racial and ethnic disparities in birth outcomes and to the costs associated with long-term care.

David Anderson, Professor of Economics at Center College with a specialization in the costs of out-of-hospital maternity care, calculates that increasing use of Certified Professional Midwives and of out-of-hospital maternity care by less than 10% would result in savings of $9.1 billion annually, while actually improving outcomes.

The state of Washington reports a savings of $3.1 million dollars over a period of two years to the state Medicaid system when women experiencing healthy, low-risk pregnancies give birth with licensed midwives instead of in the hospital.

The recent Milbank Report conservatively estimates savings of $2.5 billion dollars a year if the cesarean surgery rate is brought down to 15% in the U.S.

Certified Professional Midwives are the only providers specially trained in out-of-hospital birth in the event that hospitals become unsafe for healthy pregnant women during a disaster.

Thank you to everyone who is reaching out-it only takes a few minutes but it is so very helpful. We are making amazing progress in DC and now is not the time to let up! So please forward this to family and friends who can help, and thank you for doing your part to get Certified Professional Midwives and out-of-hospital maternity care included in health care reform.

ATTENTION MIDWIVES! Yes, we are shouting at you! Please send this action alert with a personal appeal to your networks of clients-it only takes a few minutes, and people are especially motivated to act when they get a personal request from their midwife.

STATE GROUPS! Please be sure to post this alert to your state lists!

Katherine Prown, PhD
Campaign Manager
TheBigPushForMidwives.org
414.550.8025
Envisioning a safer, less-costly model of maternity care in the United States.

ACTION ALERT: Congressional Briefing this Thursday, 5/21

This Thursday, May 21st, at 8 am, a Congressional briefing will convene at the Sewall-Belmont House, 144 Constitution Ave. N.E., Washington, D.C. The topic of this briefing is the critical role that out-of-hospital maternity care (and the Certified Professional Midwives who are trained to provide it) can play in health care reform by reducing costs and improving outcomes.

Background: A recent study commissioned by the Washington State Department of Health found that Licensed Midwives saved taxpayers and private insurers approximately $2.7 million per year. A similar study conducted for Florida would prove that number much higher. In 2007, we welcomed 239,143 babies into the Sunshine State, as opposed to 88,958 in Washington. Medicaid currently covers about 49.6% of all Florida births (37.2% of which are cesarean sections) vs. 45.6% in Washington (29% c-section rate). Using these statistics, mathematics tells me that Licensed Midwives in Florida save taxpayers and private insurers over $10 million ANNUALLY.

A joint Milbank report released last year conservatively estimates that if the national cesarean section rate were reduced from its current 31.8% to the 15% World Health Organization recommended maximum, we would save at least $2.5 billion dollars per year in government-subsidized health care alone (not including private insurance companies). As currently only 26 states license midwives, this dollar amount will only increase with greater access to midwifery care, resulting in fewer interventions.

Studies show that low-risk women who plan out-of-hospital births with Licensed Midwives have outcomes equal to low-risk women who deliver in the hospital, but with far fewer preventable, costly interventions.

• Do you believe that Licensed and Certified Professional Midwives play an important role in our health care system?
• Do you believe that out-of-hospital births are safe for low-risk, healthy women attended by Licensed Midwives?
• Do you believe that our current cesarean section rates (37.2% in Florida) are too high?
• Do you believe that our government should support an initiative that would simultaneously save taxpayers money and improve birth outcomes?

If you answered yes to any of these questions, please consider taking a moment over the next couple of days to contact our federal legislators (contact links below). Ask them to consider officially co-sponsoring the briefing on Thursday. Suggest that they send a 'Dear Colleague' letter to encourage Congressional attendance. Most importantly, invite them to attend the briefing, as their doing so would represent your interest as their constituent.

Please read this Call to Action from The Big Push for Midwives, including talking points and tips for speaking with legislators. Remember, they work for you. Your voice will be heard.


US Senator Mel Martinez
US Senator Bill Nelson

Bilirakis, Gus M., Florida, 9th (*note:he's the one that co-sponsored the bill for medicaid reimbursement of birth centers)
Boyd, Allen, Florida, 2nd
Brown, Corrine, Florida, 3rd
Brown-Waite, Virginia, Florida, 5th
Buchanan, Vern, Florida, 13th
Crenshaw, Ander, Florida, 4th
Castor, Kathy, Florida, 11th
Diaz-Balart, Lincoln, Florida, 21st
Diaz-Balart, Mario, Florida, 25th
Hastings, Alcee L., Florida, 23rd
Grayson, Alan, Florida, 8th
Klein, Ron , Florida, 22nd
Kosmas, Suzanne M., Florida, 24th
Mack, Connie, Florida, 14th
Meek, Kendrick, Florida, 17th
Mica, John, Florida, 7th
Miller, Jeff, Florida, 1st
Posey, Bill, Florida, 15th
Putnam, Adam, Florida, 12th
Rooney, Tom, Florida, 16th
Ros-Lehtinen, Ileana, Florida, 18th
Stearns, Cliff, Florida, 6th
Wasserman Schultz, Debbie, Florida, 20th
Wexler, Robert, Florida, 19th
Young, C.W. Bill, Florida, 10th