International Day of the Midwife T-Shirts!

To kick off our second annual fundraising campaign in high fashion, we have issued an International Day of the Midwife / Florida Friends of Midwives t-shirt! International Day of the Midwife is Tuesday, May 5th, but this t-shirt has an impactful message year-round:

The World Needs Midwives Now More Than Ever.

We have removed the date and year so that these shirts will be timeless and relevant for years to come. Please show your support for Florida Friends of Midwives and for this special observance by ordering your t-shirt today! Shirts are $15 and come in standard sizes S, M, L and XL. Shipping is $4; if you live in Sarasota, please email Laura Gilkey at membership@flmidwifery.org to avoid shipping charges.

Thank you for your continued support of Florida Friends of Midwives!

Choose a size - International Day of the Midwife T-Shirt

Small $15.00 Medium $15.00 Large $15.00 Extra Large $15.00

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.

Jana Borino: A Retrospective

In Memoriam ::
Jana Borino
December 5, 1964 -
February 13, 2009

This biograpohy was reproduced from the program to Jana's memorial service, with permission from the collaborative authors. The service was held at Kanapaha Botanical Gardens in Gainesville, Florida. Guests were encouraged to wear bright colors, children were invited to speak, and the service closed with all present joining in song.

Jana Borino was born on December 5, 1964 to parents Carl and Sue Borino in Belleville, NJ, and was raised in Pompano Beach and Plantation, FL. Jana was an independent spirit who, from an early age, enjoyed music and dancing. Jana grew up along side her brother Carl Borino and her sister Terri Borino-Gordon. At the young age of 11, Jana valiantly braved Hodgkin's disease. During these early years, Jana was greatly influenced by her paternal grandmother, Tessie Borino, who gave her a respect for the birth process and the rearing of a child. At age 18, Jana packed her car and moved to Gainesville, Florida where she met her husband of over 26 years, Keith Gretter. When Jana became pregnant with their first daughter Chelsea, she became a client of the Birth Center of Gainesville, and delivered Chelsea at home with the assistance of a Midwife and some of her closest friends. This personal experience at the age of 19 ignited a passion in Jana for the field of midwifery.

After such an incredible birth herself, Jana knew that she wanted to become a Midwife so that she could be of assistance to other families looking for an alternative to a hospital birth. Jana attempted to enroll in Midwifery school, but her dreams were quickly halted when an amendment was added to the Midwifery bill in the state of Florida. This amendment prohibited any new students from gaining licensure, or allowing them to legally practice Midwifery in the state of Florida. Jana believed strongly in the values that midwives bring to communities and began a crusade to once again legalize the practice of direct-entry midwives. In 1992, the hard work of many individuals across the state, including Jana, paid off when Florida Statue 467, The Midwifery Practice Act, that allowed for the licensing of direct-entry midwives in Florida was once again opened. Jana felt deeply that Gainesville needed a Midwifery school that would allow students to become Licensed Midwives upon completion. Jana's vision came to fruition with community outreach and education, trips to Tallahassee, and many fundraising events. Jana met with numerous state officials to develop a curriculum framework for educational programs under the new law. During this time in Jana's life she also gave birth to their second daughter, Emma. Emma's homebirth assisted by a Midwife only strengthened Jana's commitment to her vision of a Midwifery school in Gainesville. Jana's many roles in her community and in her home were supported directly by the love and compassion of her husband Keith. His continued support allowed Jana to reach each and every goal she set for herself, her community, and her family.

Once the law was passed, Jana brought together a group of strong and intelligent women to form the founding Board of Directors of the Florida School of Traditional Midwifery (FSTM), and soon after these women accepted their first class. Jana was the founding mother and Executive Director of the FSTM for over 13 years. Jana made many contributions to the school with her incredible teaching, fundraising, grant-writing and public-speaking skills. Not only did Jana fight for the advancement of Midwifery in the state of Florida as well as nationally, she attended numerous births as a Midwife's Assistant for over 20 years. Jana also served on many boards and committees of national, state and local midwifery organizations, including as a board member of the Foundation for the Advancement of Midwifery. This foundation recently created a grant called "The Jana Borino Award for Community Development," to honor Jana's numerous contributions to the field of Midwifery.

Almost 13 years ago, during a beautiful homebirth, Jana and Keith brought their third daughter, Tessie into the world. Shortly after that, Jana was diagnosed with breast cancer, which she battled and braved for the past 10 years. After a long and valiant fight, Jana passed away peacefully in her home in Gainesville, FL on February 13, 2009, surrounded by her loving family. Although many of us remember Jana as a pioneer, visionary and powerhouse in the field of Midwifery, Jana herself was most proud of her role as mother to her three beautiful daughters, Chelsea, Emma and Tessie. Even though she was tireless in her work in our community, she always kept the girls close to her heart and encouraged their growth into strong and healthy women.

Jana was passionately committed to her friends. They would all laugh in a heartfelt way when each of them would say they were Jana's best friend...and they were. Jana had the special gift of making each person feel loved, special and worthy. She insisted that each live their dream and find the commitment within themselves to make a difference in our world. Her determination to be a voice for women, children, and families came through time and again in her role as a community leader, mother and friend.

As Jana's spirit leaves her physical body and begins its new journey, we know we will never be the same. Left behind is a legacy of families whose lives have been forever touched by the mission of this extraordinary woman. All of us in Jana's life know that this world is a better place because of her.

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!

Florida Friends of Midwives Responds to the Closure of Miami Dade College's Midwifery Program

Despite strong opposition from the community, Miami Dade College's Midwifery Program to close indefinitely

MIAMI, FL (August 14, 2008) – Florida Friends of Midwives (FFOM), a non-profit grassroots organization dedicated to promoting and supporting the practice of midwifery in Florida is disappointed and concerned with the indefinite closure of Miami Dade College's Midwifery Program, a vital program to the local community and to communities statewide. Despite strong opposition expressed by students, mothers, midwives and concerned members of the community, the College cited tough economic times as the reason for their decision.

On Friday August 8, 2008, the College held a meeting at the Medical Campus to formally announce the closure of the program and return prepaid tuition to currently enrolled students. At that meeting, members of the public showed up to express their disappointment and dissatisfaction with the closure of the program. The College claims tough economic times have caused them to close programs with low enrollment and high costs. However, Midwifery is the first and only one out of over 200 degree-granting programs offered at Miami-Dade College to be eliminated as a result of those cuts.

Students, who had already completed all course requirements to be admitted into the program, were devastated. Some students had relocated to South Florida, and many had already taken out loans to cover tuition costs. "Miami Dade College doesn't understand that we didn't choose to be in this career program just to have any degree – this is our passion," said Melissa Chin Casey, who was set to start the Midwifery Program in the Fall 2008 semester. "It's insulting and cruel for the administrators to say the program was cut because of low enrollment, when we are practically beating down the door for them to let us in. As a public education institution, they have failed this community."

MDC's accredited Direct-Entry Midwifery Program was the first in the country to be offered at a public institution, offering students a more affordable option compared to the programs offered at private colleges and universities. Since it's inception in 1994, over 80 midwives have been trained and graduated the program.

"This community has endured a great loss with the closing of this program," said Tamara Taitt, president for Florida Friends of Midwives. "Many of the women who have graduated from this program have become indispensable to our community by providing quality and personalized pre- and post-natal care."

Obstetrical care in South Florida has come under scrutiny in recent years as the rate of caesarean sections in the state of Florida has increased to an all-time high of 36.6% in 2006 which is well above the World Health Organization and Healthy People 2010's recommendations of 15%. Specifically, Palm Beach County had a cesarean section rate of 39.3%, Broward was 41.2%, and Miami-Dade was 45.5%. According to the Florida Council of Licensed Midwives, Florida Licensed Midwives had a cesarean section rate of 6.3% in 2006. There is also expected to be a significant shortage of Obstetricians in the tri-county area within the next three years.

Miami Dade College is a public institution and has an obligation to the public it serves. FFOM believes it is unjust to close a program that is crucial on a number of levels. To take away this program is to take away one of the only affordable opportunities in this country for women to become Licensed Midwives through an accredited program.

FFOM urges the College to reconsider the closure of the Midwifery Program and also ask for continued support from the community in our efforts to keep this program open.

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.

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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.

Could C-sections Be Increasing Maternal Mortality?

The adage “healthy baby, healthy mother” is touted by people everywhere. One half of that equation – the mother – must provide care for herself and her newborn for at least a couple of decades. However, we have seen a rise in the maternal mortality rates here in this country. In 2003 and 2004, the maternal mortality rates rose to 12 per 100,000 and 13 per 100,000 respectively (http://www.kaisernetwork.org/Daily_Reports/rep.index.cfm?DR_ID=47116). To make that easier to understand, 1 in 7692.31 women will die during childbirth or the six week post-partum period. The United States of America boasts advanced technology, state-of-the-art gadgets, and renowned research facilities. Why then are we experiencing a surge in what was once thought of as a third-world country issue? Perhaps we need to look no further than the rising c-section rates.

The CDC statistics have shown a continued increase in the c-section rates here in this country to the tune of 50% in the last ten years (www.int.com/articles/2008/04/22/opinion/edlanger.php). The truth is that 1 out of every 3 pregnant women will undergo a c-section. A c-section is a major abdominal surgery that carries the same risks as any other abdominal surgery, yet women are increasingly being convinced of all the benefits involved in a c-section. “You won’t have bladder dysfunction.” “You’ll avoid vaginal tearing.” “You can schedule your baby’s birthday!” All of these so-called benefits are given much more emphasis than the risks: injury to intestines or bladder (still think you can avoid that bladder dysfunction?), injury to the baby, post-partum hemorrhage, infertility, death. In fact, women are 3 times more likely to die during a c-section than a vaginal birth according to a large study published in the Lancet (http://www.wddty.com/03363800369784516151/c-section-aftershocks.html, Lancet, 1999; 354: 776). I would like to assert the clear correlation between the rising c-section and maternal mortality rates and make the case women everywhere to be on high alert.

Let’s examine some probable causes as to how the c-section rate is affecting the maternal mortality rate. In the United States, we have seen a rise in obesity, which seemingly sets up pregnant women for a c-section. Speculation and early research claims obese women have weaker contractions due to obesity-related health problems (http://www.medicineonline.com/news/12/8821/Obese-pregnant-women-may-have-weaker-contractions.html). “Fetal distress” may also be cited as a reason for c-section in obese women when, in fact, the monitors are simply not working through the mother’s fat tissues. Another cause of the rising c-section rate is the increasing number of older first-time mothers. It would seem that many women delay having families in order to complete higher education and start careers. Older women are much more likely to end up with a c-section regardless of whether they are high risk or low risk (http://www.webmd.com/baby/news/20070312/older-moms-have-more-c-sections). Furthermore, hemorrhage and sepsis are the leading causes of maternal mortality throughout the world – both of which are risk factors in c-sections (www.who.int/reproductive-health/publications/interagency_manual_on_RH_in_refugee_situations/ch3.pdf). While we could discuss all of these causes in further depth, I trust that my assertation that the rising c-section rate is increasing the maternal mortality rate has been made clear.

I’m a believer in the saying that “prevention is the best medicine,” and I would like to further assert that simple preventative measures can both lower the c-section rates and the maternal mortality rates. First of all, I suggest every single pregnant woman learn as much as she can about the pros and cons of c-sections and other medical interventions. Perhaps with more knowledge, women wouldn’t be so apt to choose an elective c-section. Secondly, eat a healthy, balanced diet and get plenty of exercise. No one can go wrong with that recommendation, whether young, old, male, female, white, black, green, or polka-dotted. Thirdly, seek consultation from a midwife. Midwives have lower rates of c-sections and can provide excellent prenatal care for most pregnant women. Finally, know your rights as a patient and exercise your right to refuse treatments. If no medical indications show a necessity for c-section, simply repeat these words: “I do not consent.” Your doctor may not like hearing those words, but it is his or her responsibility to respect your wishes as his or her patient. You are the boss, you are paying them for their services, and you certainly wouldn’t take insubordination from an employee.