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.

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.

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.

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

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.

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.

Action Alert: Birth Center Reimbursement

Medicaid Birth Center Reimbursement Act Introduced in the Senate

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

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

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

IMPERATIVE ACTIONS

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

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

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

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

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

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

Sincerely,

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

Fight Florida's Ban on VBACs in Birthing Centers!

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

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


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

PUSH BACK for VBAC's.

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

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