SPOTLIGHT: Commonsense Childbirth School of Midwifery

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

For more information contact:

• Commonsense Childbirth School of Midwifery (CCSM)

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

407-654-8140.

CCSMidwifery@gmail.com

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

Midwives for Haiti

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

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

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

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

Response to the July AJOG Meta-Analysis Against Homebirth

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

Response from the Midwives Alliance of North America:

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

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

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

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

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

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

Response from The Big Push for Midwives Campaign:

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

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

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

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

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

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

Bumi Sehat Haiti Needs Midwives

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

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

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

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

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

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

Purchase a Bumi Box

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

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

State of Florida Celebrates International Day of the Midwife

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

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

Special Events Throughout Florida

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

A Florida Midwife’s Perspective of International Midwifery

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

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

Midwives have a long and valued history in Florida. The state first passed legislation to license direct-entry midwives in 1931, and the first Certified Nurse Midwife was licensed in Florida in 1970. Florida’s midwives have continued to tirelessly serve the families of Florida and to ensure the continued availability of safe, evidence-based birthing options for Florida’s families.

About Florida Friends of Midwives: Florida Friends of Midwives is a non-profit grassroots organization dedicated to promoting the Midwives Model of Care and supporting the practice of midwifery in Florida. Florida Friends of Midwives was formed to support midwives who offer safe, cost-effective, evidence based care to Florida's families. For more information, please visit www.flmidwifery.org.

Response to Report on Decline in Maternal Health

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

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

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

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

Action Alert: VBAC Ban in Florida Birth Centers

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

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

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

To: Florida Agency Health Care Administration

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

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