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.

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.

News from the MAMA Campaign

Florida Friends of Midwives endorses the MAMA Campaign. Please read this update, including an incredible list of accomplishments in just a few short months.

What a summer this has been for Midwives and Mothers in Washington, DC! Now, as the health care bills pick up speed in Congress this fall, we need your support and your dollars more than ever. Billy Wynne, our lobbyist, wrote to us this past week: “You should feel very good about the massive education campaign you’ve undertaken and the broad support you’ve gained …now it’s crunch time!”

Just since May, the MAMA Campaign has accomplished a lot by acting quickly and effectively.
We have:

• Drafted an amendment to recognize and reimburse CPMs in Medicaid
• Hired a national health policy and lobbying firm to guide our advocacy work in DC
• Held a “fly-in” of more than twenty MAMA activists to Washington, DC, in June who met with over 30 key congress members
• Traveled to DC nearly every week since then and followed up with supporters to keep the pressure up
• Prepared a cost-analysis based on Medicaid data from a health policy study in Washington State that was submitted to the Congressional Budget Office on our behalf by Chairman Waxman’s office
• Met with 8 top Medicaid officials in Baltimore in July, an unusual opportunity for a provider group new to Capitol Hill
• Monitored and adjusted our strategy weekly as the proposed legislation twists and turns through Congress
• Secured the support of important national groups: Childbirth Connection, the National Women’s Law Center, the National Women’s Health Network, Raising Women’s Voices, Our Bodies Ourselves, the Coalition for Improving Maternity Services, American Association of Birth Centers, and state midwifery and consumer groups

And we have continued to manage the campaign using the pro-bono skills and expertise of top leadership in six national midwifery and citizen organizations as well as activated superb grassroots support across the country.

Over these next weeks we will continue to have opportunities to include Certified Professional Midwives in the health care bills. However, the time is growing short and we really need your help. As Billy says, it’s crunch time!

Every step of the way you have stood behind us. Thank you! Together we have raised $100,000 for the Campaign this summer – 2/3 of our goal and a truly stunning fundraising coup for our movement! We are so grateful to you!!

Now we need your help to get across the finish line!
Will you give $10, $25, $50 or even $100 to continue our work for federal recognition of CPMs? Just click to donate.

Will you help us identify potential major donors? Write to president@nacpm.org with ideas.

And of course, be sure to keep the letters to your legislators coming – we need that “dull roar” from the states and districts to move our provision over the top! Constituents are the ones that legislators are listening to. That’s you! Find letter templates and instructions on our website.

Thank you so much! We look for to hearing from you!

Mary Lawlor, CPM
President, NACPM
National Co-Chair, MAMA Campaign

Susan Hodges
President, Citizens for Midwifery
National Co-Chair, MAMA Campaign

Florida Celebrates Licensed Midwives Week October 5-9

Governor Charlie Crist has signed a proclamation observing October 5 through the 9 as Licensed Midwives Week in the State of Florida, upholding midwives for being “dedicated to the care of pregnancy and childbirth and treat[ing] each woman’s pregnancy according to her unique physical and personal needs.” Governor Crist’s proclamation also recognized midwives for their role in the need to “improve birth outcomes in the State of Florida and ensure that women are given proper care and treatment in all phases of childbirth.”

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 month to celebrate the more than 110 Licensed Midwives in the Sunshine State.

Florida Licensed Midwives Week coincides 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 announced 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.”

Midwives have a long and valued history in Florida. The state first passed legislation to license direct-entry midwives in 1931. In the 77 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. According to the latest data from the Florida Council of Licensed Midwifery, births managed by Licensed Midwives in the state grew by about 5.5% from 2005 to 2006.

“We are honored every day to serve Florida’s mothers, babies, and families,” says Sarasota Licensed Midwife Alina Vogelhut, LM. “It means so much for our profession to be honored by Governor Charlie Crist and the State of Florida.”

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.

For more information of midwifery in Florida, please visit www.flmidwifery.org.

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.

Announcing: Commonsense Childbirth School of Midwifery

(from Executive Director Jennie Joseph, LM, CPM)

Thank you for your interest in Florida's newly licensed direct-entry midwifery program. I am proud to offer the Three-year Midwifery Program and the Four Month Pre-licensure Program for foreign-trained midwives only (midwives licensed/certified in another country).

Both programs will lead to a Diploma in Midwifery and, after passing the NARM (North American Registry of Midwives) exam, an opportunity to become a Florida Licensed Midwife (LM) affording practice in Florida under Chapter 467 FS and the ability to provide prenatal. labor and delivery and postpartum services for Florida families. Candidates may also apply for the nationally accredited credential Certified Professional Midwife (CPM) after passing the NARM.

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.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.

I welcome the renowned Justine Clegg MS, LM, CPM as our Academic Director. Justine is a Florida Licensed Midwife and Licensed Mental Health Counselor. Involved in maternal and child health since 1973 as a La Leche League leader, childbirth educator, founding member of the Midwives Association of Florida, homebirth midwife and political activist, she earned her M.S. in counseling in 1991 and has served as Director of the Midwifery Program at Miami Dade College since 1994. She was a founding Board member of MEAC (Midwifery Education Accreditation Council) and helped develop the NARM (North American Registry of Midwives) certification process, as well as being the current Board Secretary of the Association of Midwifery Educators. She will join me in presenting an academic program crafted to produce confident, accomplished midwives, ready and able to serve their community with heart and passion.

As we begin classes in January 2010 we will be operating under the initial Provisional License # 4052 as issued by Florida Department of Education. Please note: we have been informed that we cannot start the 'distance learning' component of our program until we have completed the first year. At that time we will need to re-apply to the state of Florida for the ability to add 'distance learning'. After one year the state will issue our 'full' license. To that end we will proceed in January 2010 with an ON-SITE PROGRAM only.

Classes will be held on Fridays at 1150 E. Plant St. Winter Garden. I will only be seating a very small class initially with a view to expanding the following year. Tuition for the Three-year Program is $19,320 and $5,250 for the Four Month Program. Our upcoming Orientation is scheduled for October 9, 2009 at The Birth Place, Winter Garden. Please email docsophie@gmail.com for more details or to rsvp.

Thank you!

Jennie Joseph LM, CPM
Executive Director

FFOM Wants to Hear Your Birth Story

Due to the volume of quick responses, the ACOG website survey on homebirth was password protected after 18 hours. The effort to flood them with positive birth stories was an immediate success. Visit the Citizens for Midwifery Grassroots Network and The Big Push for Midwives campaign for more information. Thanks for your support!

The ACOG survey demonstrates that the opposition to home birth is powerful and organized. Midwives and consumers of midwifery care need to stay informed, and be ready to support midwives politically. Stay connected to events and actions in Florida by joining Florida Friends of Midwives. There is an e-group, forums, and a newsletter to keep you informed of important events.

We still want to hear your positive birth story! To tell your birth story to support midwives, please submit it to the Florida Friends of Midwives website. Follow the instructions below, and email birth stories to stories@flmidwifery.org.

How to Submit Your Birth Story:

If you would like to submit of your birth with a Florida midwife, here is what to do:

1. Submit your story in a .txt or .doc format. All stories should be accompanied by photographs in .jpeg, .jpg, .eps format.

2. Include your name and a title for the story.

3. Stories should be ¾ page to 1 ½ pages. Try to separate your story in to several paragraphs.

Please spell check your story before you send to us! It sounds very basic, but it is important and helps us get the stories up sooner. We will make corrections if necessary, but you will help us out greatly if you spend some time checking your story for accurate spelling and grammar.

We will notify you if your story is used and provide you with a link to view it on the website. Again, please be aware that we may edit your story for grammar, punctuation, spelling and length if necessary. It may take us up to a month to post your story, if it's used. Try to be patient with us.

VERY IMPORTANT! You MUST include a statement with your story that you give FFOM permission to print your story. We cannot publish it to the web without this statement!

Waterbirth Workshop with Barbara Harper

ONE DAY COURSE IN GAINESVILLE SEPTEMBER 9TH

Learn all the specific physiologic reasons why water immersion and waterbirth work the way they do. Discuss "delivery" or birth techniques and tricks, like using pictures on the bottom of the tub to determine blood loss; reevaluate 2nd stage moves and maneuvers; shoulder dystocia in the tub; keeping water warm - why or why not; protocols, etc. Lots and lots of information, videos and studies from 25 years of research, experience and collecting data. Worth every penny!!

This workshop is taught by Barbara Harper, whose expertise in waterbirth and gentle, undisturbed birth is widely sought in all areas of the globe. She has lectured in 43 countries, including many medical schools, nursing schools, midwifery programs and university women’s studies departments. Barbara has been interviewed by hundreds of newspapers and magazines and has appeared on dozens of radio and TV shows to talk about her work with waterbirth and gentle birth.

The class is $255 for providers, $125 for nurses, doulas, and childbirth educators, and $75 for pregnant moms or couples. It will be held on Wednesday, September 9, 2009, from 9:00am - 4:30pm at the United Church of Gainesville, 1624 NW Fifth Ave.

For more information, please call (954) 821-9125, or email Barbara Harper at barbara@waterbirth.org.

FFOM Welcomes Ina May Gaskin to Sarasota

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

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

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

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

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

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

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

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

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

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

ABOUT THE PANELISTS:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Fight Florida's Ban on VBACs in Birthing Centers!

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

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


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

PUSH BACK for VBAC's.

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

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

ACTION ALERT: Health Care Reform

Dear Midwifery Supporters,

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

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

Thank you,
Board of Directors
Florida Friends of Midwives
_____________________________________________________________________________________

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Transparency Needed as C-Section Rates Rise

CIMS, the Coalition for Improving Maternity Services, a group working toward transparency in maternity care, announced last week that the 2007 US birth statistics, just released, show that 31.8% of births are via cesarean section. The percentage of cesarean deliveries has increased by 50% since 1996 and is more than double the World Health Organization’s recommended rate of 15%.

Currently, cesarean rates vary widely across the US. The 2007 birth data highlight this variation; for instance, a woman giving birth in New Jersey has a 73% higher chance of having a cesarean than a woman in Utah.

This strong variation in rates isn’t only geographic; it is also seen among individual hospitals in a community. For example, in 2006, New York City, one of the few places facility-level rates are available, St. Vincent’s Staten Island Hospital had a rate of 44.5% compared to 17.2% at North Central Bronx Hospital. Many believe that this variation is due to high risk sicker mothers and babies that these hospitals serve; however, that is only part of the story. Extensive research has shown that these huge variations are strongly linked to the practices and policies of individual hospitals and providers not just the health status of mothers and babies.

“Most women believe that they will only have a cesarean section if they experience complications in pregnancy or labor. But research tells us that most of the factors affecting a woman’s risk of a cesarean have nothing to do with her health or that of her baby. One of the most effective strategies for avoiding a preventable cesarean is choosing a provider and birth setting with a low cesarean rate. In the United States, we are seeing increased public reporting of outcomes and procedure rates for facilities in surgical and cardiac care, but, access to maternity care data remains almost non-existent,” says Amy Romano, MSN, CNM, a transparency expert for CIMS.

C-section can be a life-saving procedure, but it is a major surgery that carries extensive risks for both mother and baby, risks that are not present in a vaginal birth. Research conducted by the World Health Organization shows that these risks of cesarean outweigh the benefits when the c-section rate exceeds 15%. Currently, women have no way of knowing if their local hospitals exceed this recommended rate.

“Women can unknowingly increase their risk of unnecessary surgery based on their selection of where and with whom to birth. To enable women to make informed choices, maternity care data must be available at the facility level. Whether requiring a c-section or planning a natural birth, women need data in order to choose the facility that most closely matches their needs,” said Elan McAllister, Founder of New York’s Choices in Childbirth and Co-chair of the Transparency in Maternity Care Project.

Transparency empowers consumers, and studies have shown that public reporting of intervention rates and outcomes leads to better healthcare. New York and Massachusetts are the only states with legal mandates to require release of facility-level maternity care obstetrical intervention statistics such as cesarean sections. Unfortunately, such information remains unavailable in most parts of the country, but a CIMS project is working to change this fact.

To help expectant parents to make informed health care decisions about where and with whom to birth, CIMS developed the Transparency in Maternity Care Project: The Birth Survey. CIMS has trained local level ambassadors across the US to interface with their state departments of health to work to make facility-level intervention rates available to the public. As intervention rates are obtained, including the rate for c-sections, they will be included in publicly accessible free reports.

Transparency of health care information is increasing across the US and maternity care must be included in this movement. Otherwise, women are choosing their place of birth blindfolded and potentially increasing their chances of having an unnecessary cesarean section as rates across the country continue to rise above recommended levels.

C-sections increasing infant mortality

In the June entry, we examined how c-sections could be increasing maternal mortality in the United States. Now let’s examine the other half of the equation – the baby. As of 2006 our infant mortality rates fall all the way to the second worst in the modern world, according to reports published in an article by CNN (www.cnn.co m/2006/HEALTH/parenting/05/08/mothers.index./). Most of the European nations rank better, and several studies and reports have noted that the United States offers inferior health care regardless seemingly better supply of medical resources. It is also noted that those same countries regularly employ midwives as care providers while our society seems to shun these women – treating them as nothing more than relics. However, midwives are excellent assets to good prenatal care and have lower rates of c-sections.

Studies have shown that c-section babies have poorer outcomes than their vaginally born peers. One such study published in Birth looked at a group of babies born in uncomplicated vaginal births and a group of babies born by planned, uncomplicated c-section births (www3.interscience.wiley.com/cgi-bin/fulltext/118622106/HTMLSTART). When the two groups were compared, it was found that babies born via c-section had higher mortality rates. Another such study published in BMJ also concluded that infants in the occipital anterior position faired better during vaginal delivery than a c-section – either planned or not (www.reuters.com/article/healthNews/idUSSAT17412420071031). Why would this be? As previously discussed, there are risks involved with a c-section, such as a potential for injury to the baby during the incision process. Also, babies born via c-section do not have the benefit of passing through the birth canal where some of the fluid in their lungs is pushed out, leading to higher rates of respiratory distress. Of course, there are many more risks involved, but these are just two examples of what could go wrong during a c-section.

Another factor in this epidemic would be the number of elective c-sections being performed prior to 40 weeks. Because each baby is different, we run the risk of extracting a baby from=2 0the womb before s/he is fully developed and ready to be born. The March of Dimes discusses the risks associated with being born prematurely as difficulties in breathing, feeding, temperature regulation, and jaundice (www.marchofdimes.com/pnhec/240_19673.asp). With the increase of non-medically needed, elective c-sections comes the increase of babies being born prematurely. Prematurity increases mortality. The CDC lists prematurity as being the second leading cause of death in infants (www.cdc.gov/MMWR/preview/mmwrhtml/mm5642a8.htm). A study published in Pediatrics also found that preterm births account for a little over one third of infant deaths. This is alarming in a country where we seem to have so many neonatal intensive care units.

So what should we do to decrease the infant mortality rate? First of all, we should look to our peers in Europe and Japan to see what type of care they provide. As previously stated, those countries tend to treat midwives more like competent care providers and trust the thousands of years of collective experience midwives have accumulated throughout the history of humankind. Secondly, we should seek to increase educational outlets for women aspiring to become midwives and teach our doctors, doctoral students, patients, and others involved in patient care about the risks involved with ro utine medical interventions. We want healthy families – that means both healthy mothers AND healthy babies!

Response to AMA Resolution 205

Recently, the American Medical Association (AMA) released a resolution in favor of lobbying for legislation stating that hospitals are the safest place to birth:

RESOLVED, That our AMA develop model legislation in support of the concept that the safest setting for labor, delivery, and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex, that meets standards jointly outlined by the AAP and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers.” (Directive to Take Action) (http://www.ama-assn.org/ama1/pub/upload/mm/471/205.doc)

While this does not blatantly state the AMA will seek to outlaw home birth, one can imagine that legislation dictating that women should give birth in a hospital or birthing center within a hospital would imply women will forfeit the right to give birth at home. The AMA makes this resolution based upon issues of safety. However, safety may not be the true issue behind this resolution.

According to a study published in the British Medical Journal by Kenneth C. Johnson and Betty-Anne Davis, home birth is just as safe as giving birth in the hospital and associated with lower instances of intervention in low-risk pregnancies (http://www.bmj.com/cgi/content/full/330/7505/1416?ehom). In fact, the ratio of women undergoing continuous electronic fetal monitoring (EFM) is remarkably lower at home than in the hospital.. From my personal experience, the belts for the EFM were uncomfortable and easily moved by my unborn children. Isn’t it obvious that you wouldn’t receive accurate readings of the baby’s vital signs if s/he kicks it away? Moreover, a study published in The Journal of Perinatal Education shows that routine interventions do not improve maternal and infant outcomes (http://www.lamaze.org/Default.aspx?tabid=461, http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1905822). In fact, these routine interventions – which are more often than not performed in hospitals20– cause more harm than good in low-risk pregnancies and lead to unnecessary c-sections. The World Health Organization (WHO) actually recommends the midwifery model of care for the majority of pregnancies and seeks to lower the number of unnecessary c-sections being performed (www.who.int/entity/making_pregnancy_safer/documents/newsletter/mps_newsletter_issue5.pdf). It would seem the medical model of care in this country is currently failing us in that c-section rates have sky-rocketed, along with the rates of interventions.

I suggest instead of lobbying for legislation stating what setting is best for childbirth we review the United States Constitution, the Bill of Rights, and the Patients’ Bill of Rights. Passing any legislation that would define where a woman could give birth is a blatant violation of our rights as citizens of this country. We should also review studies from all ends of the spectrum to make informed choices.

Choosing A Care Provider

When choosing a primary care provider, we don't ordinarily rush to hire a surgeon to handle our every need. A sneeze does not indicate a necessity for rhinoplasty, nor does a headache always require brain surgery. So why then is it that women are rushing into the arms of surgeons to give birth? Obstetricians are surgeons who go to medical school to specialize in surgical techniques for labors and deliveries gone wrong. It wasn't until the late 19th century that the practice of routine intervention became commonplace, more than likely due to the advent of antiseptics, antibiotics, and anesthesia. Before the popularization of obstetrics, midwives cared for most pregnant women during labor and delivery. Thousands of years of history and experience refined their skills and abilities into what we now know as modern midwifery. The scope of midwifery covers much of the natural processes of pregnancy and childbirth, yielding only to complications in which medical intervention becomes necessary and life saving. Midwives are trained to minimize interventions and respect the natural birth process, which yields better outcomes for mothers and babies.

Midwives practice evidence-based care. "Evidence-based" means using results of the best research about the safety and effectiveness of specific tests, treatments, and other interventions to help guide maternity care decisions. You may be surprised to learn that most maternity care in the United States is NOT evidence-based. Midwives receive training in labor and delivery just as an obstetrician does; however, the midwife is more akin to your primary care physician who refers to a specialist – for complications outside of the general practice scope. In some states, including Florida, midwives receive licensure as well. While we are more likely to hear about cases in which bad outcome are associated with midwife-attended births, those situations most certainly do not represent the majority of such births. The National Birth Center Study (Rooks et al., 1989) found that birth centers were a safe alternative to hospitals for women at low-risk of birth outcomes, and used fewer resources than hospitals did. A systematic review of midwife-led birth centers reached the same conclusion (Walsh & Downe, 2004). Similarly, a recent study of more than 5000 women intending to birth at home attended by Certified Professional Midwives found a similar rate of intrapartum and neonatal mortality rates as in low risk hospital births, but with lower medical intervention rates (Johnson & Daviss, 2005).

Midwife means "with woman." Midwives provide personalized care that respects individual and cultural differences. With a midwife, you become an active partner in your care working with your midwife to decide the course of your pregnancy and birth. Whether you are a first-time mom or a fifth-time mom, a new baby will change your life in wonderful and unpredictable ways. The outcome of a birth is more than a healthy mom and baby – it’s a family. Midwives treat you as a whole person while addressing your physical, emotional, psychological, and spiritual needs throughout pregnancy, birth, and the postpartum period. Remember midwives when you think of pregnancy and childbirth. Healthy, low-risk women have the option of hiring a midwife to care for them during pregnancy. Women have the right to choose what type of practitioner will provide their prenatal care.