Florida Celebrates National and State Midwives Week this October

Florida Friends of Midwives is proud to join the American College of Nurse Midwives, the Midwives Association of Florida, and communities statewide in celebrating National Midwifery Week and Florida Licensed Midwives Week during the first week in October.

Midwifery Week is a chance for midwives and the women they serve to reflect on their experiences and midwifery's contributions to women's health care, including attending births and providing well-woman care. Throughout Florida, regional groups of Florida Friends of Midwives are celebrating with awareness events, social gatherings and local Mayor's proclamations.

One such proclamation will be read at the Sarasota City Commission meeting October 3rd. “Midwives make a strong contribution to the health and well-being of mothers and babies through proper care and treatment in all phases of childbirth," says Sarasota Mayor Suzanne Atwell. “I look forward to welcoming all those involved in this important effort.”

Midwives have a long and valued history in Florida. The state first passed legislation to license direct-entry midwives in 1931, and the first Certified Nurse Midwife was licensed in Florida in 1970. Florida’s 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.

Florida Friends of Midwives celebrates midwives in Florida and throughout the world during this special week. For more information about midwifery in Florida, please visit flmidwifery.org.

ABOUT FLORIDA FRIENDS OF MIDWIVES (FFOM): Florida Friends of Midwives (FFOM) is a nonprofit 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. FFOM members are consumers and birth advocates committed to organizing the community to support midwives and to assure the continued availability of midwifery care in the State of Florida. For more information, please visit flmidwifery.org.

SPOTLIGHT: Samantha McCormick of Baby Love Birth Center

Midwifery is about education and empowerment to me. Sadly, far too many women blindly follow whatever their OB/GYN tells them to do. Facebook and other online resources have significantly increased the opportunities for people to learn about alternatives to "traditional" care, but the responsibility still rests on the individual to choose to educate themselves. Popular media, movies, and TV shows continue to show birth as scary and horribly painful which serves to reinforce misconceptions about birth. It prevents many people from believing how empowering and peaceful birth can be for a prepared and educated woman. Skepticism and fear still prevent many people from considering natural childbirth.

It seems to me that interest in out-of-hospital birth is increasing, and I think the internet has a huge role in that. The old adages "a picture is worth a thousand words" and "seeing is believing" are totally true. Before the ease of viewing videos on YouTube and Facebook or Netflix, one might have read books about natural birth, but there were few options to watch a natural birth. Now anyone can find literally thousands of examples of peaceful natural births - these videos can serve to counter the negative fear-based birth images on TV and in movies.

Ricki Lake's the Business of Being Born has played a huge role in opening people's eyes to alternatives from using an OBGYN and giving birth in the hospital. We often hear from new clients that watching that film helped convince them to come to the birth center.

When a woman chooses an out-of-hospital birth, many times her friends and family are skeptical and concerned for her and the baby's safety. Showing concerned friends and families videos can often overcome their skepticism.

I have been practicing for 15 years. When I first started in a Birth Center in New Jersey, it was pretty much unheard of for the client's mom to have had a natural or out-of-hospital birth. In the past 5 years, we hear more and more that a new client's motivation was that her mom had a natural birth or wished that she had. We lost a whole generation of experience with natural childbirth when birth moved into the hospital in earnest in the 1950's.

The "hippie" movement of the late 1960's and 70's created a call for alternatives. I think we all owe pioneers Ina May Gaskin and Barbara Harper a huge debt of gratitude for rescuing the natural birth movement. They (and others I do not mean to overlook) not only learned and practiced midwifery, but they wrote about it and publicized it. For the longest time, the best way we could show natural birth was Barbara Harper's Gentle Birth Choices film. Ina May also filmed births and promoted her safe techniques for resolving shoulder dystocia, tight cord around baby's neck and breech birth, neatly countering the common concern "but what if something goes wrong?"

I also credit Michel Odent with bringing waterbirth to the US. Although water labor/birth is not for everyone, in my experience water in some form (shower/tub) makes natural birth achievable. He also promoted the idea that attendants and family should leave the mom undisturbed, following up on the work of Lamaze and Dick-Read that fear and tension increase pain.

I see midwifery care and out-of-hospital birth increasing in popularity, especially when this generation of moms’ children grow up and have kids of their own. Although there will always be those who claim out-of-hospital birth is dangerous and impossible, the proof is right there on the internet of how wrong they are.

www.waterbirthbaby.com

Building Community: Footsteps for New Moms

During pregnancy and following the birth of a baby, a wide range of emotions are possible. Often there are the expected feelings of excitement and joy, along with feelings of anxiety and worry. Mothers may also feel overwhelmed, uncertain, and frustrated. Being pregnant can be difficult and caring for a newborn is challenging. Regardless of how prepared a woman is or how much she looked forward to her pregnancy and her baby's birth, the perinatal period may include some unexpected "highs" and "lows."

Footsteps for New Moms is a monthly support group sponsored by BirthGirlz, which is offered the second Monday of the month at their Design District Office. The group is facilitated by a trained therapist and operates under a peer support model.

Persistent depression during the perinatal period can have devastating consequences, not only for the women experiencing it but also for the baby, other children and family. Peer support can be a very effective form of treatment for perinatal mood disorders and can serve as the main form of support for mild cases and in combination with therapy, medication or other modalities for severe cases.

Symptoms of postpartum depression

• Changes in sleep patterns, either being unable to sleep or sleeping too much.
• Fatigue or lack of energy.
• Changes in appetite, either eating too little or too much.
• Feeling hopeless, a loss of control or great sadness.
• Crying for no reason.
• Having no feelings or too much concern for the baby.
• Irritability or outbursts of anger.
• Feeling little interest in daily activities.
• Feelings of guilt.
• Anxiety or panic attacks.
• Difficulty making decisions.
• Suicidal thoughts.
• Scary and repetitive thoughts about the safety of the baby

If you or anyone you know has the above symptoms, please encourage them to join the group and benefit from the opportunity to meet with other local women who are dealing with or have recovered from postpartum reactions and mood issues, including depression, anxiety, post traumatic stress (birth trauma) and baby blues. For additional information contact Michelle Fonte of BirthGirlz at 786-704-8328.

CPM Bill Introduced: A Milestone for Mothers and Midwives!

Join the Celebration for HR 1054!

The MAMA Campaign is thrilled to announce that Congresswoman Chellie Pingree (D-ME-1) has introduced HR 1054, the "Access to Certified Professional Midwives Act of 2011" in the U.S. House of Representatives.

"I believe it's important that women are able to have the birth experience they want, regardless of where they live and how much money they make. That is why it's impo
rtant that women with Medicaid coverage have the same access to high quality, safe, and cost-effective services," Congresswoman Pingree said. The Congresswoman is known in Maine and Washington, DC as a sensitive, independent voice for social and health issues that affect families everywhere.

The Midwives and Mothers in Action (MAMA) Campaign expresses sincerest appreciation to Congresswoman Pingree and celebrates this milestone in the history of direct-entry midwifery in the United States. MAMA is also deeply grateful to Rep. Gwen Moore (D-WI-4) and Rep. Jim McDermott (D-WA-7) for their support and leadership in co-sponsoring HR 1054 with Representative Pingree.

Increasing women's access to the care of CPMs will support better outcomes for mothers and babies, reduced disparities in outcomes for vulnerable populations, and provide significant cost savings for Medicaid and the health care system. We are most grateful to Representative Pingree for her vision and support for childbearing women and their families.

This is Your Milestone!
Your support, your letters to members of Congress, meetings with your legislators in Washington, DC and in-district, and all of the dollars that you have contributed to this cause have made possible the introduction of HR 1054. You should be proud of yourselves - the MAMA Campaign Steering Committee thanks you!

Now the Work Begins....
MAMA will be counting on our energy and involvement in the coming weeks and months as this train gains steam and we forge ahead to garner the support of Congress for enacting HR 1054 into law. Read more here.

Keep MAMA Going in 2011!
Help Keep MAMA Going in 2011! Florida Friends of Midwives as an organization has made contributions to the MAMA Campaign on behalf of Florida's Mothers and babies. But MAMA still needs our help! MAMA now needs the support of our grassroots - mothers and fathers, grandparents, midwives, doulas, and other advocates - to keep the momentum going. Please celebrate with MAMA - show Congress you care, too - by making your contribution today. MAMA will put your dollars to work, making a difference for mothers and babies! Together we can move mountains!

We're in need of new Board Members!

We can't believe it either, but it's been more than three years since Florida Friends of Midwives (FFOM) was resurrected. As we move forward with FFOM and begin to craft a future for the group, a crucial step is ensuring we have a full and functioning Board of Directors whose job it will be to guide and shape the organization in the years to come.

First and foremost FFOM is an organization of consumers. We're in need of three new board members, and are seeking board members whose experience and involvement in the birth community has given them the skills and knowledge to play a central role in the important work of FFOM. Members of the board of directors should represent the interests of the membership of FFOM in furtherance of its mission.

Right now we are looking for three industrious and daring women to accept the following positions:

1. Legislative Committee Chair
2. Fundraising Committee Chair
3. Membership Committee Chair

What do these positions do?

• The Legislative Committee Chair gathers and facilitates the flow of information relating to legislation that affects access to midwifery in Florida, and brings those issues to the board and membership for discussion and possible action.
• The Fundraising Committee Chair serves as a resource to our members and Regional Groups on fundraising techniques and programs and manages our annual fundraising campaign.
• The Membership Chair is responsible for the maintenance of a current membership database, renewal of memberships, collection of dues, and initiatives to encourage new membership.

Our Board of Directors meets monthly by phone and twice annually in person.

If you know someone you would recommend or you wish to be considered as a candidate for the Board of Directors, please email us at info@flmidwifery.org.

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.

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

Facebook Page
• 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.

Response to the July AJOG Meta-Analysis Against Homebirth

Florida Friends of Midwives supports and aligns ourselves with the efforts of The Midwives Alliance of North America (MANA) and The Big Push for Midwives. In July's American Journal of Obstetrics and Gynecology, an article denounced homebirth for increased neonatal mortality. This conclusion was based on a study that our allied organizations have proven misleading. Florida Friends of Midwives endorses the following responses to the study from both MANA and The Big Push.

Response from the Midwives Alliance of North America:

A new meta-analysis rushed to on-line publication well before its availability in print, concluded that less medical intervention, which is a characteristic feature of planned home birth, is associated with a tripling of the neonatal mortality rate compared with planned hospital births. In a study published online on July 1, 2010 in the American Journal of Obstetrics and Gynecology (AJOG), researchers at Maine Medical Center in Portland, Maine analyzed the results of multiple studies from around the world. The lead investigator, Joseph R. Wax, MD, Department of Obstetrics and Gynecology, Maine Medical Center, stated, “Our findings raise the question of a link between the increased neonatal mortality among planned home births and the decreased obstetric intervention in this group.”

However, Canadian researchers whose data showing the safety of home birth in a well-organized and regulated system, were used in the meta-analysis, are sharply critical of the study. Dr. Michael C. Klein, a senior scientist at the Child and Family Research Institute in Vancouver and emeritus professor of family practice and pediatrics at the University of British Columbia said the U.S. conclusions did not consider the facts. “A meta-analysis is only as good as the articles entered into the meta-analysis—garbage in, garbage out. Moreover, within the article, Wax et al did their own sub-analysis of the studies in the meta-analysis, after removing out-of-date and low quality studies, and found no difference between home and hospital births for perinatal or neonatal mortality. Yet in the conclusion, they choose to report the results of the flawed total meta-analysis, which showed the increased neonatal mortality rate.” Klein said that this is apparently a “politically motivated study in line with the policy of the American College of Obstetricians and Gynecolgists (ACOG) who is unalterably opposed to homebirth.”

Saraswathi Vedam, a nurse midwife and researcher at the University of British Columbia who is considered to be an expert on assessing the quality of literature related to homebirth, states that the study is deeply flawed for several reasons, particularly, “the authors’ conclusions are not supported by their own statistical analysis.” Vedam states that Dr. Wax et al acknowledges the consistent findings of low perinatal and neonatal mortality in planned home births across the best quality studies they reviewed “but amazingly Wax does not emphasize or even mention this in his sole conclusion.” This begs the question of whether the author’s analysis and reporting of reviewed articles on homebirth do not support his foregone conclusion about the safety of homebirth.

The Midwives Alliance of North America, a professional organization of over 1200 members, believes childbearing women and those involved in maternal and child health policy should be made aware of the flaws and erroneous claims in the Wax et al study. There is a substantial body of evidence-based literature from well-designed studies that establishes the safety of planned homebirth with a skilled birth attendant. The fact that the American College of Obstetricians and Gynecologists maintains its position in opposition to homebirth, despite the evidence of its safety and efficacy, makes one question ACOG’s motive in publishing Wax’s substandard study.

Midwives are the primary care providers in out of hospital settings. Whether their work is studied and scrutinized here in the US or abroad the findings are consistent. Trained midwives are qualified health professionals with the requisite expertise to provide mothers and newborns with outstanding care, using less intervention, resulting in maternal and infant outcomes as good as those in hospital settings under the care of obstetricians.

The American public, particularly women in the childbearing years and those who care for them, have a right to high quality research on childbirth. Research literature should not be used to cause undue alarm or limit a woman’s choice regarding care providers, including skilled midwives, and place of birth.

Response from The Big Push for Midwives Campaign:

As New York and Massachusetts moved to pass pro-midwife bills in the final weeks of their legislative sessions, the American Journal of Obstetrics and Gynecology fast-tracked publicity surrounding the results of an anti-home birth study that is not scheduled for publication until September. Described as unscientific and politically motivated, the study draws conclusions about home birth that stand in direct contradiction to the large body of research establishing the safety of home birth for low-risk women whose babies are delivered by professional midwives.

“Many of the studies from which the author’s conclusions are drawn are poor quality, out-of-date, and based on discredited methodology. Garbage in, garbage out.” said Michael C. Klein, MD, a University of British Columbia emeritus professor and senior scientist at The Child and Family Research Institute. “The conclusion that this study somehow confirms an increased risk for home birth is pure fiction. In fact, the study is so deeply flawed that the only real conclusion to draw is that the motive behind its publication has more to do with politics than with science.”

Advocates working to expand access to out-of-hospital maternity care questioned the timing of AJOG’s public relations efforts on behalf of a study that won’t be published until next fall.

“Given the fact that New York just passed a bill providing autonomous practice for all licensed midwives working in all settings, while Massachusetts is poised to do the same, the timing of this study could not be better for the physician groups that have been fighting so hard to defeat pro-midwife bills there and in other states,” said Susan M. Jenkins, Legal Counsel for The Big Push for Midwives Campaign. “Clearly the intent is to fuel fear-based myths about the safety of professional midwifery care in out-of-hospital settings. Their ultimate goal is obviously to defeat legislation that would both increase access to out-of-hospital maternity care for women and their families and increase competition for obstetricians.”

The United States recognizes two categories of midwives: Certified Nurse-Midwives, who are trained to practice in hospital settings and who also provide primary and well-woman care, and Certified Professional Midwives, who undergo specialized clinical training to provide maternity care in out-of-hospital settings. Research consistently shows that midwife outcomes in all settings are equivalent to those of physicians, but with far fewer costly and preventable interventions, including a significant reduction in pre-term and low birth weight births, and as much as a five-fold decrease in cesarean surgeries.

The Big Push for Midwives Campaign represents thousands of grassroots advocates in the United States who support expanding access to Certified Professional Midwives and out-of-hospital maternity care. The mission of The Big Push for Midwives includes educating state and national policymakers about the reduced costs and improved outcomes associated with births managed by CPMs in private homes and freestanding birth centers.

Bumi Sehat Haiti Needs Midwives

Bumi Sehat Haiti is currently looking for Midwives skilled and willing to volunteer their time in Haiti. They especially need volunteers during July through September 2010.

They are a village based clinic, established in response to the earthquake in January 2010. Their primary focus is maternal and infant needs in Jacmel, Haiti. Bumi Sehat Haiti is helping to provide access to high quality health services to Haiti’s women—a population that has faced a disproportionate burden of disease well before the January earthquake. Maternal mortality rates are shockingly high—670 deaths per 100,000 births. In comparison, the U.S. maternal mortality rate is 11 deaths per 100,000 births, according to World Health Organization statistics. BSH's clinic in Jacmel, is active and busy, with hundreds of women seeking prenatal, birth and postpartum care. Women from surrounding tent camps and shelter's are encouraged to come for free health care.

The need is great and the people are hopeful. Please find us at www.bumisehatbali.org and follow the links for further information on volunteering.

Items for On-Line Auction-Need for Financial Support for Haiti

It has been five months to the date that the earthquake happened in Haiti that devastated 60-80% of Jacmel where the Bumi Sehat birth clinic is located. Thanks to supporters, the clinic is up and running and is steadily busy with births and prenatals as well as educational classes for mothers. The clinic is in need of funds to support the women of Jacmel.

Bumi Sehat is holding an on-line auction to raise funds for a few projects at the clinic site in Haiti. They are looking for artwork, jewelry, gift certificates (preferably nationally recognized stores as the auction will be available to anyone in the US), airline tickets, etc. to be donated for this auction. Please contact Heather Maurer at embracethegoddess@yahoo.com if you have an item to donate.

Purchase a Bumi Box

Bumi Boxes are still available for purchase to support birthing mothers and will need to be bought on a continuous basis to support new birthing mothers. They contain all the supplies for each birthing woman and her new born baby.

To make an online donation please visit:
http://www.sakthifoundation.org/haiti

State of Florida Celebrates International Day of the Midwife

April 30, 2010 (Florida) -- May 5th is the International Day of the Midwife, a day set aside in 1991 by the International Confederation of Midwives and observed in over 50 nations worldwide. In 1992, Florida Governor Lawton Chiles joined in this celebration by adding Florida to the growing list of states and countries that observe this day.

The World Health Organization states: “On the International Day of the Midwife, we pay tribute to the work of the midwives who are key healthcare providers in facilities and communities. They provide the high‐quality and cost‐effective package of care desperately needed by millions of women around the world. The World Health Organization recognizes the contribution of midwives to the reduction of maternal and newborn mortality and renews its support to quality midwifery!”

Special Events Throughout Florida

In honor of this day, Florida Friends of Midwives, a non-profit consumer organization dedicated to promoting and supporting the practice of midwifery in Florida, will host events throughout the state, and support those hosted by sister organizations. On May 5th, The Florida School of Traditional Midwifery will host their annual celebration of the day in Gainesville, featuring special guests Jill Sonke and Cindy Nelly of the University of Florida Center for the Arts in Healthcare Research and Education (CAHRE). Sonke and Nelly have spearheaded arts in medicine missions in Rwanda, the Congo, and most recently Haiti. On May 6th in Sarasota, Florida Friends of Midwives will host an exclusive screening of Guerrilla Midwife, a documentary recently showcased at the Sarasota Film Festival. The film follows midwife Robin Lim along the streets of Bali and into the Acehnese refugee camps of the Indonesian Archipelago, where the midwifery model of care is put to the test, at the epicenter of the turmoil following the December 2004 Tsunami. And on May 8th, the Miami Florida Friends of Midwives chapter will show the film Laboring Under an Illusion, an anthropological exploration of media-generated myths about childbirth.

A Florida Midwife’s Perspective of International Midwifery

No stranger to the international disparity in childbirth practice, Orlando Licensed Midwife Jennie Joseph was the first foreign-trained midwife to be licensed under the Midwifery Practice Act in Florida in 1994. “I trained as a midwife in England 31 years ago and graduated in May of 1981 with the knowledge that midwifery was the 'gold standard' of care for women worldwide,” says Joseph. “Imagine my surprise on arriving in the US in 1989, where I quickly discovered a total lack of interest, understanding or even acknowledgment of the importance of midwives for a nations health.”

Ms. Joseph is executive director of The Birth Place, a free-standing birthing facility in Winter Garden, and the developer of The JJ WAY, a Maternal Child Healthcare delivery model for indigent women. “Today, I begin to have hope that American's are opening up to the benefits of midwifery in matters of choice, safety, empowerment and economy; that we realize that the midwifery model of care can be the vehicle that moves us higher up on the list of countries providing exemplary maternity care for it's citizens, and that truly 'a midwife for every mother' is not an impossible dream,” says Joseph. “A heartfelt thank you to all the midwives - past, present and future and Happy International Midwives Day!”

Midwives have a long and valued history in Florida. The state first passed legislation to license direct-entry midwives in 1931, and the first Certified Nurse Midwife was licensed in Florida in 1970. Florida’s 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.

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.

Response to Report on Decline in Maternal Health

This letter was printed in the Sarasota Herald-Tribune on Sunday, April 18th. Laura Gilkey is the Vice President of Florida Friends of Midwives.

I disagree with those who urged The Lancet to delay publicizing the recent decline in global maternal mortality ("Maternal Deaths see surprising decline worldwide," Sarasota Herald-Tribune, April 14, page 1A). It should be a beacon of hope that improved nutrition, access to prenatal care, and the availability of skilled attendants is increasing. In 80% of the world, those skilled attendants are midwives. After witnessing the work of Ibu Robin Lim in the Sarasota Film Festival screening of “Guerilla Midwife,” I am inspired to believe that the resurgence of traditional midwifery worldwide is no small factor in this global shift toward healthier birth.

However, one disturbing trend remains missing from the Lancet findings. In the United States, maternal mortality continues to rise sharply. According to the recently released Amnesty International report "Deadly Delivery," U.S. maternal mortality ratios have doubled from 6.6 deaths per 100,000 live births in 1987 to 13.3 deaths per 100,000 live births in 2006, placing us 41st in the world in this category. The report attributes the increase to inadequate access to family planning, less than optimal health, late or inadequate prenatal care, inadequate or inappropriate care during delivery, and limited access to post-natal care.

The United States spends more on health care than any other nation in the world, yet we are failing our pregnant women. We must prioritize accountability of data collection, increase access to midwifery and to prenatal care, eliminate inappropriate obstetric intervention, and mandate postpartum visitation for new mothers.

Action Alert: VBAC Ban in Florida Birth Centers

On Wednesday, March 24th, the State of Florida's Agency for Health Care Administration will move to permanently ban Vaginal Birth after Cesarean (VBAC) in Florida birth centers. Currently, women who choose to give birth normally after surgery must do so in a hospital that will allow it, which encompasses only half of those in the state, or at home with a Licensed Midwife and physician consult sign-off. VBAC's are currently not permitted in birth centers, but only because of a 'de facto ban' due to outdated language in the regulations. After a request that the language be updated to include legalized VBAC's at birth centers with Licensed Midwives and physician consultation, the State used the opening to move to make VBAC's illegal in state licensed birth facilities.

Allowing the pursuit of VBAC at home or at a state licensed birth center with a Florida Licensed Midwife will keep healthy, safe options open for Florida's families, and will dramatically reduce taxpayers' investment in unnecessary surgery.

For these reasons, I urge you to sign this petition and make your voices heard in support of legalizing VBAC's in Florida's licensed birth centers:

To: Florida Agency Health Care Administration

While we recognize the need to change outdated language in the rule, it is our position that the state consider similar language to that of F.S. 467. Such language would work to insure the patient received competent care from a licensed practitioner and respects the right of the patient to make an informed decision. We ask the State of Florida to remain a regulatory body and not take on the role of medical surrogate. (Sign here)

For more information, please visit http://www.vbacsummit.org/VBACBAN.html.

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.