Wednesday, January 28, 2009

Midwives on the AP wire

Home-birth advocates press pro-midwife campaign

NEW YORK (AP) — With health care costs high on the national agenda, advocates of home births are challenging the medical and political establishments to give midwives a larger role in maternity care and to ease the state laws that limit their out-of-hospital practice.

Pending bills to further this goal have significant backing in several states, which home-birth supporters want to add to the 25 states that already have taken such steps.

Nationally, a group called the Big Push for Midwives marked President Barack Obama's inauguration with an e-mail campaign urging him to ensure that midwives who specialize in home births are included in deliberations on federal health care reform.

"We're at a tipping point now," said Katherine Prown, the Big Push campaign manager. "Home births are still only a small part of the total, but it's poised for growth."

The campaign seeks to emphasize that in this time of economic crisis, home births can be a safe, satisfying and moneysaving option for many women. But it runs into adamant opposition from the American Medical Association and the American College of Obstetricians and Gynecologists.

"Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause celebre," the obstetricians' policy statement says. "Despite the rosy picture painted by home birth advocates, a seemingly normal labor and delivery can quickly become life-threatening for both the mother and baby."

According to the latest federal data, there were only about 25,000 home births nationally in 2006 — most of them assisted by midwives — out of nearly 4.3 million total births.

Midwife-attended home births increased by 27 percent between 1996 and 2006. Home-birth advocates believe the numbers will rise as more states amend their laws to accommodate the practice, which they contend is at least as safe as hospital births for healthy women with low-risk pregnancies.

One of the strengths of the state-by-state campaign is its diversity, Prown said.

"We're one of the few movements that's succeeded in bringing together pro-life and pro-choice activists, liberal feminists and Christian conservatives," she said. "In every state we manage to recruit Republican and Democratic co-sponsors who normally would never be on the same bill together."

The states are now evenly split on legal recognition of certified professional midwives (CPMs) — those who lack nursing degrees and who account for most midwife-assisted home births.

Half the states have procedures allowing CPMs to practice legally — including five which have taken such steps since 2005. The other 25 states lack such procedures and CPMs are subject to prosecution for practicing medicine without a license.

Depending on legislative decisions, the balance could shift this year. Among the battlegrounds:

_In North Carolina, a House study committee recommended in December that the legislature develop licensing standards for CPMs. The committee said the current system doesn't meet the needs of women who chose non-hospital births because of the "extremely limited supply" of obstetricians and nurse-midwives offering to handle such births.

_In Idaho, advocates who failed previously to get a voluntary licensing bill through the legislature are back with a mandatory licensing bill. State Rep. Janice McGeachin, R-Idaho Falls, says the changes helped persuade the state boards of nursing and pharmacy to drop their opposition. The Idaho Medical Association, which fought the earlier version, has expressed respect for the changes in the bill and is deliberating on whether further changes might produce a version it could accept.

_In Illinois, advocates also are back with a new version of a licensing bill that failed in 2007. Rep. Julie Hamos, D-Evanston, says it toughens qualification standards for CPMs — changes that prompted the Illinois Nurses Association to drop its opposition. The Illinois State Medical Society remains opposed.

"There are many in the legislature who feel a need to have this option — they need to be educated," said Dr. Shastri Swaminathan, the society's president. "We're in strong opposition to licensing midwives who don't have the medical training to provide safe home births."

Cost is a major element in the debate. A routine hospital birth often can cost $8,000 to $10,000, with higher bills for cesarean section deliveries that now account for 31 percent of U.S. births.

Midwives' fees for home births are often less than a third of the hospital cost, in part because the mothers generally don't receive epidural anesthesia or various other medical interventions at home.

For pregnant women, insurance coverage can be a decisive factor in their choice. Many insurers cover care by nurse-midwives in hospitals; coverage is less common for midwives who aren't nurses or who assist with home births.

Many obstetricians acknowledge that the spiraling cost of maternity care and high rate of C-sections are problems.

"But the answer is not to have births at home," said Dr. Erin Tracy, an obstetrician at Massachusetts General Hospital in Boston. "We obviously support women's empowerment, but the No. 1 guiding principle has to be the health and safety of the mother and baby."

The national physicians' groups do support births assisted in hospitals and birthing centers by midwives who've completed nursing school or an equivalent postgraduate program.

The American College of Nurse-Midwives, which represents these midwives, says it differs from the AMA in considering home births a legitimate option for pregnant women. But the college says only nurse-midwives or others with comparable training should be allowed to assist.

"We don't believe it's safe without being integrated into the full health care system," said Melissa Avery, the college's president.

The education standards endorsed by the college would exclude many of the estimated 1,400 certified professional midwives, who often acquire training through apprenticeships.

Jane Peterson of Iola, Wis., is an example. She began a midwife apprenticeship in 1980 and has attended more than 1,330 births since then, many of them before she and her counterparts were legally authorized to practice under a 2005 state law.

Peterson, 56, said she strives to develop collaborative relations with local doctors so that transfers to hospitals go smoothly if risk factors develop. She believes such cooperation should be encouraged nationwide, so more women can feel comfortable about choosing home births.

"People will tell you that you changed their lives," said Peterson, reflecting on the rewards of her job.

"It's hard work — getting up on a cold winter night, going out one more time through the snow. What keeps you going is the recognition women feel — as though they are a different kind of mother when they've been able to give birth their way."

Tuesday, January 27, 2009

. . . TWICE!

Apparently my LTE made it in today's paper as well.

A choice Alabama mothers deserve:

I am writing regarding the article "Risks found in early C-sections" (The News, Jan. 8) on a new study led by researchers at UAB, which concludes "thousands of infants each year are put at increased risk of serious health complications by elective Caesarean deliveries performed before 39 weeks pregnancy." The status of our maternity care system baffles me. The World Health Organization recommends a Caesarean rate of 10 percent to 15 percent, yet Alabama's rate for 2006 was a whopping 34 percent.

While studying public health, I came to fully understand the concept of primary prevention: Prevent the disease or condition before it happens. I also became a firm believer in the practice of evidence-based medicine, which means physicians should base their practices on the latest scientific evidence. Why, then, do Caesareans continue to be offered electively?

Midwives provide options. A 2005 study published in the British Medical Journal found the Caesarean rate for mothers who utilized a certified professional midwife was 3.7 percent. Sadly, this option is unavailable to Alabama mothers. I urge Alabama's legislators to practice evidence-based lawmaking and legalize certified professional midwives.

Jennifer I. Crook Moore

Birmingham

Midwives in the Birmingham News

Our very own Susan Petrus had a Letter to the Editor published in today's Birmingham News. Thanks to Susan for taking the time and initiative to write on behalf of the Midwives Model of Care!
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The Alabama Birth Coalition is not surprised to discover scientific evidence proves elective Caesarean sections before 39 weeks put infants at increased risks of serious health complications. A recent spate of studies, including the Millbank Report's "Evidence-Based Maternity Care," concluded health care providers are ignoring practices that have been shown to improve maternity care and instead are continuing to rely on procedures that are not only unnecessary, but can be harmful for infants and mothers.

Birth outcomes are best when the mother begins labor on her own and is supported through the physiological birth process with minimal interference. Midwife-led maternity care follows best-evidence practices.

Midwives provide superior prenatal care and counseling, which encourages and enables more women to stay healthy and complete full-term pregnancies. Midwives stay with their clients throughout labor, assisting them in achieving normal birth whenever possible. In the absence of this woman-centered personal care, birth becomes overly technological, inhumane and, not surprisingly, more risky for babies and mothers.

Susan Petrus
Board member
Alabama Birth Coalition
Hoover

Monday, January 12, 2009

WAY TO BE NC!

Visit the North Carolina Friends of Midwives and see what's happening!

Wednesday, January 7, 2009

Nurses and Midwives Rock!



If you care at all about the status of our health care system, you'll appreciate this article from the B'ham News about the value of care provided by nurses and midwives.

Tuesday, January 6, 2009

Midwives Deliver

Author Jennifer Block penned a stellar Op-Ed piece in the L.A. Times on Christmas Eve. Read it here.

Monday, January 5, 2009

Birth Right

Our beautiful short documentary created by UAB Ethnographic Filmmaking students Emily Jackson and Neeta Kirpalani is finally live on YouTube. Please, take the time to watch this beautiful short, bookmark it, and share it with all you know.