Homebirth Summit Seeks to Build Consensus

Fewer than 1% of families in the United States choose planned home birth, yet the subject of birthing at home has been the subject of intense and polarizing debate. Elsewhere in the world (e.g., Canada and the United Kingdom), the majority of babies are delivered by midwives and collaborative efforts across professions seek to expand access to integrated home birth services. Last month, the Transforming Birth Foundation awarded a grant to the American College of Nurse Midwives intended to underwrite a U.S. Home Birth Consensus Summit.

Already three years in the making this much anticipated meeting will be facilitated by the Future Search Network, a nonprofit organization that is internationally known for brokering lasting agreements and shared initiatives in highly volatile and polarized settings, around issues related to poverty, health care access, regional and ethnic conflict, and education.

The Home Birth Consensus Summit will be a two- to three-day multidisciplinary summit with the goal of developing areas of consensus on the provision of home birth services in the United States. Invited participants will include representatives from a variety of stakeholder sectors in positions to inform and influence a change process, and/or commit to measurable steps, including consumers and consumer advocates, home birth midwives, maternal/child health collaborating providers (including pediatrics and nursing), obstetricians (including at least one family practice obstetrician and one resident), hospital systems and administration, health plans and liability insurers, health policymakers, legislators and regulators, and public health, epidemiology, and research professionals.

The successful grant proposal was submitted under the leadership of ACNM Home Birth Section Chair Saraswathi Vedam, RM, CNM, MSN, Sci D (h.c.), Associate Professor and Director, Division of Midwifery, University of British Columbia. Joining ACNM as co-applicants of the grant were Midwives Alliance of North America (MANA), American College of Obstetricians and Gynecologists (ACOG), American Pediatric Association (APA), National Association of Certified Professional Midwives (NACPM), International Center for Traditional Childbearing (ICTC), Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), Lamaze, and American Association of Birth Centers (AABC).

According to a statement from the American College of Nurse-Midwives, “Invited participants will include representatives from a variety of stakeholder sectors in positions to inform and influence a change process, and/or commit to measurable steps, including consumers and consumer advocates, home birth midwives, maternal/child health collaborating providers (including pediatrics and nursing), obstetricians (including at least one family practice obstetrician and one resident), hospital systems and administration, health plans and liability insurers, health policymakers, legislators and regulators, and public health, epidemiology, and research professionals.”

ACNM will provide additional information about the Home Birth Consensus Summit when the dates are established as well as following the meeting. For details visit their website www.midwife.org

Afghanistan Midwives on NPR

by Jim Wildman

Midwife Farangis Sultani tells the story of a woman who was in a great deal of pain last winter. The woman was in labor — and her family had brought her to the Shatak village clinic after a three-hour walk on the back of a donkey.

Farangis delivered the woman's baby, but quickly determined there was a twin baby still inside the womb. "It was horizontal," she says. "If she delivered a baby that was horizontal, she was going to die."

The young midwife did what she could — and "with God's hand" — the second baby was born successfully. Mother and twin children were healthy — defying the statistics in Afghanistan's Badakhshan Province, where pregnant mothers and newborns die too often because villagers live too far from health care.

"These women are like guardian angels for infants and mothers," says Zafaran Natiqi, head of women's affairs in Badakhshan.

It's a career path that has the backing of elders in the province, even though Afghanistan's culture doesn't normally allow young and married women to work outside the home. Village councils actually vote to select the midwife candidates from their own community.

"I come from a very religious family," says Mawlawi Zabihulla Atiq, the leader of the provincial council. "I realize this is a necessity. It's how we can protect our pregnant women and daughters."

Farangis Sultani has recorded each delivery she's performed in a giant log book. She points an entry that describes what happened last winter:

When I helped that woman, I felt proud. It's an honor for me, for the people who trained me, and for my family.

Jim Wildman is a senior producer of Morning Edition, traveling with NPR's Renee Montagne on her reporting trip to Afghanistan.

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.

Letter to ACOG President Dr. Richard Waldman

Florida Friends of Midwives has added our organization's name to a list of endorsers to the following letter from the Coalition for Improving Maternity Services. We encourage all who are in support of this letter to endorse it here.

Richard N. Waldman, MD

American College of Obstetricians and Gynecologists

PO Box 96920

Washington, DC 20090-6920

Dear Dr. Waldman:

The Coalition for Improving Maternity Services (CIMS) supports the March 2010 National Institutes of Health (NIH) Consensus Statement on VBAC (vaginal birth after cesarean) and welcomes the American College of Obstetricians and Gynecologists' (ACOG) revised guidelines, Vaginal Birth After Previous Cesarean Delivery (August 2010) aimed at providing women increased access to VBAC and clearly emphasizing women's autonomy and their right to make informed decisions about how they choose to give birth. However, CIMS is concerned that ACOG's unrevised recommendation that trial of labor after cesarean (TOLAC) should take place in hospitals where resources for emergency cesarean are "immediately available" will continue to deter providers and hospitals from supporting this option.

The NIH found that this "immediately available" recommendation was based on consensus and expert opinion rather than strong support from high-quality evidence. The NIH also reported that this recommendation has influenced about one-third of hospitals and one-half of physicians to no longer provide care for women who want a VBAC. All women in labor face unpredictable risks that may require an emergency cesarean, not just women laboring for a VBAC. This recommendation selectively applies a higher standard of safety for women who choose a trial of labor.

CIMS urges ACOG to reassess this specific guideline and remove the current barrier to women's access to VBAC.

In addition to respecting women's autonomy, the current guidelines emphasize the need for physicians to discuss the benefits and risks of both trial of labor and elective repeat cesarean early on in the pregnancy. This is a recommendation that CIMS strongly supports. The NIH identified the importance of evidence-based processes that incorporate women's values and preferences to help women with a previous cesarean make informed choices about mode of birth. Similarly, a key recommendation identified in the multi-stakeholder consensus report, Blueprint for Action: Steps Toward a High-Quality, High-Value, Maternity Care System is expanding the opportunities and capacity for a shared decision-making process and developing tools and resources to facilitate informed choices in maternity care.

In the light of these recommendations, CIMS urges ACOG to revise its patient education publications and on-line consumer resources to include comprehensive information on the benefits and risks of cesarean section and VBAC.

CIMS, whose mission is to promote the Mother-Friendly Childbirth Initiative, an evidence-based wellness model of maternity care that will improve outcomes and reduce costs, urges ACOG to reconsider the "immediately available" recommendation and update its decision-making consumer resources. We believe that ACOG can make an even greater impact on increasing VBAC, reducing cesareans, and ultimately avoiding unnecessary harms to mothers and infants.

Sincerely,

Michelle Kendell, MBA, AAHCC

Chair, Coalition for Improving Maternity Services (CIMS)

On behalf of CIMS and the following organizational members of the Coalition for Improving Maternity Services (CIMS)

Co-Signed By:

Academy of Certified Birth Educators

American Association of Birth Centers

American College of Nurse-Midwives

The Big Push for Midwives

Birth Matters Virginia

Birth Network National

Birth Network of Santa Cruz

Choices in Childbirth

DONA International

International Childbirth Education Association (ICEA)

Lamaze International

Midwives Alliance of North America

North American Registry of Midwives

Our Bodies Ourselves

Perinatal Education Associates

Tatia Oden French Memorial Foundation

toLabor: The Organization of Labor Assistants for Birth Options and Resources

Where's My Midwife?

City of Sarasota, State of Florida Proclaim October 4-8 Licensed Midwives Week

At next week’s City Commission meeting (Monday, October 4, 6:00pm), Sarasota Mayor Kelly Kirschner will proclaim October 4th through 8th as Sarasota Licensed Midwives Week. Mayor Kirschner’s recognition will pay tribute to the skilled, individualized care that Sarasota’s licensed midwives offer women and their families throughout the childbearing cycle. It will signify the strong contribution licensed midwives make to the health and well-being of our community's mothers and babies through appropriate care and treatment in all phases of childbirth.

The week has also been proclaimed Florida Licensed Midwives Week by the office of Florida Governor Charlie Crist, coinciding with National Midwifery Week, a time to recognize the contributions of Certified Nurse Midwives (CNMs), Certified Midwives (CMs) and Certified Professional Midwives (CPMs) nationwide. The American College of Nurse Midwives (ACNM) publicly announces the week with an introduction to midwifery. "The heart of midwifery care for women and newborns lies more in the nature of that care than in its specific components. Midwifery practice has a firm foundation in the critical thought process and is focused on the prevention of disease and the promotion of health, taking the best from the disciplines of midwifery, nursing, public health and medicine to provide safe, holistic care."

HISTORY OF MIDWIFERY IN FLORIDA: Midwives have a long and valued history in Florida. The state first passed legislation to license direct-entry midwives in 1931. In the 79 years since, Florida’s licensed midwives have continued to tirelessly serve the families of Florida and to ensure the continued availability of safe, evidence-based birthing options for Florida’s families. In 1992, Governor Lawton Chiles declared the first-ever Licensed Midwives Week. More women than ever before are seeking out licensed midwives for maternity care.

ABOUT MIDWIFERY IN FLORIDA: In Florida, two types of midwives are allowed to practice: Certified Nurse-Midwives and Licensed Midwives (a Florida state licensure), also known as direct-entry midwives. Throughout the state, about 11.2 percent of births are estimated to be managed by midwives, rather than by OB-GYNs. Many birth centers and midwives have reported a significant increase in business in the past year. This increase is believed to be a result of various factors, primarily a greater number of women seeking alternative birthing choices due to an unhealthy increase in caesarean sections and other unnecessary interventions that frequently occur in hospital settings. In a 2006 report on Florida Licensed Midwives, midwives had a caesarean section rate of 6.3 percent compared to a 36.64 percent statewide average in hospitals the same year.

In honor of this week, Florida Friends of Midwives (FFOM), a non-profit grassroots organization dedicated to promoting and supporting the practice of midwifery in Florida, will be hosting various community events throughout the state this week and during October to celebrate the more than 110 currently practicing licensed midwives. For more information of midwifery in Florida, please visit www.flmidwifery.org.

“We are humbled by the dedication of the mothers who worked so hard to have this week declared licensed midwifery week,” says licensed midwife Miriam Pearson-Martinez. “We hope that the events happening all over the state this week serve to raise awareness regarding the benefits of midwifery care.”

The proclamation in Sarasota will be read by Mayor Kirschner at the beginning of the City Commission meeting, Monday, October 4th, at 6:00 pm in Sarasota’s City Hall. Florida Friends of Midwives encourages all families who have benefited from the care of licensed midwives to attend this special recognition.

About Florida Friends of Midwives: Florida Friends of Midwives 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. For more information, please visit www.flmidwifery.org.

SPOTLIGHT: Commonsense Childbirth School of Midwifery

Commonsense Childbirth School of Midwifery (CCSM) was established in January 2009 to provide education and training in the art of out-of-hospital birth to individuals seeking to become Florida Licensed Midwives. Our goal at CCSM is to educate andprepare students to become skilled, caring midwives to serve women and families in their communities.“I am excited to be able to direct a midwifery school (for the second time) and look forward to bringing a unique approach to midwifery education,” said owner and Executive Director Jennie Joseph, LM, CPM. “My focus will be on the clinical aspects of midwifery training and I will apply my international and individual experiences to a very strong and clinically sound format.”

A British trained midwife, Jennie Joseph comes from the European perspective where midwifery is a trusted, respected and necessary profession. When she emigrated to Florida,Jennie encountered American professional, racial, ethnic and gender prejudice. Motivated to make a change in her adopted community, she started the Hand-In-Hand Women and Family Support Services, providing private, group and volunteer childbirth education, breastfeeding counseling and doula/labor support services.

As a Florida Licensed Midwife, Jennie opened The Birth Place, a full-service midwifery clinic with home and birth center delivery including waterbirth. She served as Director for the School of Complementary Medicine’s Midwifery Program in Oviedo and became active in a number of community organizations such as ICTC, the Florida Black Women's Health Organizations, the March of Dimes "Sisters/Companeras" Program, and founded Commonsense Childbirth Inc. a Florida non-profit corporation dedicated to providing prenatal, birth and postpartum services to indigent teens and women who might otherwise not receive care.

In 2003 Jennie developed The JJ Way™ a unique MCH model of care to address the difficulties and inequities in health care service and delivery which have negatively impacted perinatal health outcomes, especially for minorities. The model consists of clinical, outreach and training components. The Easy Access Clinic model, replicated in several communities, uses The JJ Way® Model of Maternity Care to help close the gap in Black infant health disparities. Astudy in 2007 of birth outcomes for The JJ Way® program serving at-risk minority women showed NO low birth weight or premature babies among African American or Hispanic patients at The Birth Place.

“I am fighting for access, connections, knowledge and empowerment within our communities,” explains Jennie, “truly 'getting to the heart of the matter' because we believe in A midwife for EVERY mother.”

Jennie has published a photo journal “Beautiful! Pregnancy Perfected The JJ Way” which depicts the impact of her maternal child healthcare system on positive pregnancy outcomes. A portion of proceeds from the sale of this book goes to support Commonsense Childbirth.

A much sought-after speaker, in any given week Jennie may be found advocating for maternal and child health in a variety of venues: in Washington, DC speaking to a congressional committee, being recognized at the Tribeca Film Festival in Manhattan, presenting her model at a national conference, and still running her full-service midwifery practice, teaching and precepting her CCSM students. Most recently the Foundation for the Advancement of Midwifery awarded a 2010 technical assistance grant to Commonsense Childbirth, providing consultation in the areas of finance, fundraising, and strategic planning.

In all her works, Jennie seeks to create excellence. CCSM is committed to providing the finest educational program throughout the national and international direct-entry midwiferycommunity for individuals with a desire to provide a high standard of care for childbearing women and their families. The student is taught to differentiate between low-risk and high-risk pregnancies, work within midwifery legal scope of practice, collaborate with other medical professionals, and to organize and operate as a professional midwife after licensing.

CCSM believes that midwives should be based in their communities where they are able toprovide culturally competent maternity care, education, guidance and social support to women and their families. Recognizing the rich cultural diversity in Florida and the increasingly diverse populations in our communities, CCSM seeks to recruit a student population that is culturally and ethnically reflective of our communities to prepare students to provide effective midwifery services responsive to the needs of Florida consumers.

As CCSM Academic Director, Justine Clegg, LM, CPM, brings her midwifery education experience from Miami Dade College (1993-2008) and the South Florida School of Midwifery. A Florida Licensed Midwife for 24 years, she is also a Licensed Mental Health Counselor, Certified Lactation Counselor, and has served as Chair of the Council of Licensed Midwifery, on the MEAC and NACPM Board of Directors, chaired the Dade County Fetal and Infant Mortality Review team for 5 years and helped develop the NARM certification process. She is a “founding mother” and Continuing Education Coordinator for the Midwives Association of Florida (MAF). She is currently on the Board of Directors of the Association of Midwifery Educators (AME).

CCSM meets academic and clinical requirements for the North American Registry of Midwives (NARM) and the Florida midwifery practice act, F.S. 467, including the Core Competenciesof the Midwives Alliance of North America (MANA) and the American College of Nurse Midwives (ACNM). Core Competencies identify the essential knowledge base required of an entry-level midwife. The curriculum is also consistent with the Curriculum Framework developed by the Florida Department of Education and the requirements of Florida law.

Graduates will receive a Diploma from CCSM and will be eligible to sit for the North American Registry of Midwives (NARM) national certification examination. The NARM is the Florida licensing exam for the Midwifery profession. Students must pass the NARM exam and be licensed by the Council of Licensed Midwifery to work as a Midwife in the State of Florida. Upon graduation the student will have compiled a notebook of materials and practice protocols to be prepared to practice as a Florida Licensed Midwife.

The academic environment at CCSM is geared to the adult learning style. A cadre of credentialed faculty and preceptors supports a strong educational program in this fledgling school. Teaching methodologies use a variety of strategies to engage all learning levels, to develop clinical skills, critical thinking and problem solving abilities. Classes are interactive and student participation is required. Programs are varied in format. Research is facilitated and encouraged.

An education based on the art of traditional midwifery and knowledge of medical science must be strong clinically as well as academically. Students start clinical placement in their first semester. CCSM provides clinical experience concurrent with academic coursework, giving relevance to classroom material. Preceptors who work with our students include Licensed Midwives, Certified Nurse Midwives and Medical Doctors who are licensed in Florida. We believe it is important that students rotate through various types of clinical settings to learn valuable skills and be prepared for all venues of practice. Programs are designed to help students develop and refine clinical, communication and decision-making skills essential to safe, compassionate midwifery practice. It is imperative that midwives regard the dignity and rights of clients and families, communicate effectively, be able to differentiate between low-risk and high-risk maternity clients and to make arrangements for collaboration or referral.

CCSM students care about their community. Our program includes a volunteer requirement each semester. One student volunteered in Haiti after the recent earthquake. Last semester students drove to Tallahassee to participate in Midwifery Capitol Day event April 21, 2010 with Justine Clegg and MAF lobbyist Dawn Steward, to educate Florida legislators about midwifery practice.

Classes are held on Fridays in Winter Garden. Tuition for the Three-year Program is $19,320 and $5,250 for the Four month program. In addition to the three year and four monthdirect-entry midwifery education programs, CCSM offers Doula training, Childbirth Education and Lactation Counseling certification courses. CCSM is an approved CEU provider for Florida licensed midwives through CEBroker. Orientation for the next midwifery class starting in January 2011 will be announced in the fall. Email ccsmidwifery@gmail.com to be added to our mailing list.

Commonsense Childbirth School of Midwifery is owned and operated by Commonsense Childbirth, Inc, a non profit Florida corporation. The Advisory Committee consists of community leaders, midwives and other healthcare professionals interested in CCSM’s efforts to provide the finest program of study within the international midwifery community. CCSM is approved by the Florida Council of Licensed Midwifery and licensed by Florida Department of Education Commission for Independent Education. CCSM is a member of the Association of Midwifery Educators (AME) and will be seeking accreditation through the Midwifery Education Accreditation Council (MEAC).

For more information contact:

• Commonsense Childbirth School of Midwifery (CCSM)

1150 E Plant Street Suite F, Winter Garden, FL 34787

407-654-8140.

CCSMidwifery@gmail.com

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• NARM
• Council of Licensed Midwifery
• MEAC
• The JJ Way
• Association of Midwifery Educators
• Midwives Association of Florida

Midwives for Haiti

Midwives for Haiti is a non-profit organization that was founded by Nadene Brunk, Certified Nurse Midwife. This Virginia based 501c3 organization was founded in 2004. Since its inception, Midwives for Haiti has provided Haitian women with the proper education and tools to keep women and babies safe during the birthing process.

Lack of proper prenatal care and skilled birth attendants makes Haiti the most dangerous place in the western hemisphere to have a baby. In Haiti 48 of 1,000 infants die during birth and 520 of 100,000 women die during labor. These statistics are detrimental to the social development and well-being of so many families in Haiti.

Midwives and Clinicians from all around the world come together through Midwives for Haiti and teach Haitian women proper prenatal care and teach the skill of being a proper birth attendant.

Midwives for Haiti depends on volunteers and donations to continue to help so many in that part of the western hemisphere. If you’d like to contribute in any way, please visit www.MidwivesforHaiti.org, or follow them on Facebook.