On August 7th, TIME did a piece on homebirth.  

 

"For most pregnant women, a key part of their birth plan involves how they'll get to the hospital. But more and more moms-to-be are skipping that step and planning to deliver at home. Old-school birthing is back in style, with well-read women forsaking obstetricians for midwives and epidurals for warm baths. These women want to give birth in their own bed or tub, with none of the medical interventions that have become staples of modern childbirth, like contraction-inducing medication and C-sections, which now serve as the grand finale in nearly a third of U.S. births. "For a normal, healthy pregnancy, the hospital environment is overkill," says Jessica Reid, 27, a stay-at-home mom in Pasco, Wash.

Reid had her first baby in a hospital but plans to have her second--due in late August--at home. "Interventions that neither the mother nor father wish to occur are more likely when surrounded by people who view pregnancy as an illness or labor as inherently dangerous," she says. "I consider birth sacred and a joy, and I intend to birth my baby in a way that reflects that."

Not since Ina May Gaskin's natural-childbirth advocacy inspired a generation of home birthers in the 1970s has the practice been such a hot topic--or so hotly contested. While home birthing still accounts for less than 1% of U.S. births, there's a movement afoot to license more lay midwives to attend home births. Concerned by this development, the American Medical Association (AMA) is urging lawmakers to curb the home-birthing movement, including having the licensing of so-called direct-entry midwives--who do not have nursing degrees--overseen by a state medical-practitioner board.

One of the biggest champions of home birthing is former talk-show host Ricki Lake, who produced the 2008 documentary The Business of Being Born. Lake and other activists contend that fear of litigation has led to more women in labor being tethered to monitors and forced under the knife. And pro--home birthers are pushing the notion that choosing where and how to give birth should be regarded as a civil rights issue. "Legislating against home birth is totally un-American and unfair," says Joan Bryson, who has worked as a midwife in New York City for 17 years. "We rank 42nd in the world in live births, and we spend more money than anyone else. You can't blame it on home birth."

Most planned home births are assisted by a midwife, although some extremists favor so-called free birthing, with no attendant. Home-birth midwives say they accept only low-risk patients, which excludes women with diabetes, high blood pressure, multiple births or any other risky condition. Most midwives--who typically charge from $1,000 to $5,000 per birth, significantly less than the cost of a hospital delivery--travel with basic emergency medical equipment, including oxygen, resuscitation gear and medication to stop hemorrhaging. And all insist they practice preventively and know when--and how--to get a woman to a hospital.

Take, for example, the case of a prolapsed umbilical cord. In roughly 1 out of every 300 births, the cord slips down into the birth canal before the baby does and risks cutting off the baby's oxygen supply. Kitty Ernst, an expert on midwifery at the Frontier School of Midwifery and Family Nursing in Hyden, Ky., says midwives are trained to push the baby's head back up off the cord and hold it there--the same way an obstetric nurse would--and get Mom to the hospital as an operating room is being prepared for her. "Your hand gets pretty tired," she says of this emergency procedure, which she adds can take as little as five minutes if the hospital is across the street.

But it's those precious minutes that have obstetricians alarmed. "Unless there's ready access to certain emergency personnel and equipment and even surgery, you're potentially endangering babies' and moms' health and lives," says Dr. Erin Tracy, an ob-gyn at Boston's Massachusetts General Hospital who authored two anti-home-birth resolutions approved by the AMA in June. "We've all seen scenarios where mothers came in, after very major blood loss, in a very catastrophic state," she says. "By the time they arrive in the hospital, you're sort of behind the eight ball in trying to resuscitate these patients. The same thing with neonatal outcome."

Doctors argue that what may seem like a low-risk pregnancy can go very wrong at the time of delivery--and that making home birth easier to access could lead to a huge step backward. After birthing moved to hospitals en masse in the 1950s, the maternal mortality rate plummeted, from 376 per 100,000 live births in 1940 to 37.1 per 100,000 in 1960. The most recent statistics show 15.1 deaths per 100,000. Many doctors fear that mortality rates will go up with the rising incidence of home birthing, but there are conflicting data on this. A study published in 2005 in the British Medical Journal found that home birthing had a similar mortality rate to that of low-risk hospital births; other studies have suggested a two- or threefold increase in the incidence of neonatal death.

In the absence of clear data, obstetricians in the U.S. are concerned about the recent push by direct-entry midwives to receive licenses so they can practice their craft without fear of prosecution. This summer, Missouri reversed its 25-year ban on non-nurse midwives. Twenty states have similar legislation they are either introducing or planning.

Meanwhile, many obstetricians are trying to meet women halfway, through hospital-affiliated natural-birth centers. These centers are often located near regular hospitals and boast low episiotomy and C-section rates. The decision about where to give birth "is not black and white," says Lake, who is on the board of a $7 million birthing center set to open in Manhattan in 2010. "It's amazing, the technology we have. But we are losing the value of normal, natural birth." Nationwide, the number of birthing centers is growing by about 5% a year. But what might seem like an ideal solution has run into roadblocks, as a few prominent centers have closed in recent years because of high malpractice-insurance costs--which means many natural-birth seekers will still have to choose between hospital and home.

Copyright (c) 2008 Time Inc. All rights reserved. Reproduction in whole or in part without permission is prohibited."

    In case you were wondering what you missed, here is Brynne Potter's thought-provoking speech,

 

Thank you so much for this recognition and for the opportunity to come together to celebrate our passions for safe and satisfying birth for mothers and babies. And thank you for giving me the opportunity to stand up on a soap box for five minutes and preach to the choir…two of my most guilty pleasures.

 

All of us who share history in the passing of CPM legislation and the subsequent forming of Birth Matters are united as part of a grand staging of an ancient parable of science and philosophy:

 

What happens when an unstoppable force meets an immoveable object? 

 

The object in this play is the institutional status quo. This immoveable and insidious medical authority tells us to be good girls and do as they say and never complain even when our bodies are used as economic stimulus to a dying industry. It maintains it’s position of king of the hill by deriding those who question it as selfish and those who provide alternatives as toothless crones who tend their stills and whelp babies in dirty backwoods cabins. And it consciously works to divide and subjugate to further insure that no one has the strength to pull up it’s deep roots.

 

Enter stage left, or right depending on your political leanings, the unstoppable force…us.

 

 For most of us, our entry into this collective force came through our birth experiences.  For some of you, it was in reaction to hitting the immovable object full-on during your pregnancies and births. For all of us, in your search for something different we found ourselves drawn towards a type of care that held a promise for a potential experience that would not only be safe and satisfying, but would also cause a shift of the lens in our perception that allowed us to see though some of the illusions that keep the power in the hands of the few. And as we found others who had also experienced the shift- we became a part of the force, and the force was with us. J

 

It carried us, at times kicking and screaming, right to the front doors of the immovable object.  And when we stood at the door for many years banging into the brick wall, the force drew more and more of us to this seemingly impossible cause.  And, eventually, what we experienced was the answer to the parable.  When the force is comprised of individuals who share a common passion, who shed their differences and join hands for a singular cause, they become unstoppable.  And when they hit an immovable object that is comprised of institutional, bureaucratic and unhealthy standards…they transform it.  Like waves on stone, we wear it down, smooth it over and make our way to shore.

 

And so here we are, on the tranquil shores of success.  Crystal clear waters, white sand, ripe fruit, and nearly every OB in Virginia falling over themselves to support natural birth and the midwives model.

 

Whoops…too much dreaming? J

 

It would be so nice if we could just close the book on this happy tale of the success of David over Goliath.  But as most of you know, our success has served as the equivalent of waking the sleeping giant. Most of you know about the recent attempts by the VA BOM to restrict the practice of CPMs, as well as the continued loss of practicing CNMs all over the state.  But, in part because of the legislative success of states like VA, Utah, Wisconsin, and Missouri, as well as the unprecedented success of The Business of Being Born, there is movement to try to eradicate our progress and to ensure that we are all put down far enough to keep us from ever trying to challenge authority in the future.

 

In June of this year, the AMA adopted a resolution to introduce legislation in all 50 states outlawing home birth, and potentially making criminals of the mothers who choose it. Citing no scientific evidence for this position, what the AMA proposes is a future where women are forced to have their babies in hospitals whose systems result in the surgical delivery of over 1/3 of all babies.

I have vacillated between two reactions to this development:  the first I call the anger-outrage-grief-despair combo.  I am tired, beaten down, and in disbelief that we actually asked to be part of a system that is so fundamentally flawed and inherently unfixable.

 

The second is the place that I know I learned and created in myself when I was part of the unstoppable force.  I know what it feels like to have the synergy of a thousand voices working together and transforming immoveable objects into allies and friends.  The current flowed in our direction and the tide finally came in and we found ourselves on the shore.  Yes, there is a strong undertow and it is trying to pull us back out to sea.  But this time we are already formed.  We are a united force with resources and wisdom of what it takes to transform obstacles.  This time it might look different.  We might not play this out on a big stage at the General Assembly, perhaps it will be in each of our local communities…we all need to join our local chapters of BirthMatters.  We need to each add our names to the database resource of the VABirthPAC, and all Virginia midwives and midwifery students need to join the Commonwealth Midwives Alliance to stay united and pool our resources of political strength.  If we can each do just this much, we will be unstoppable.

 

I hope that each of you who have stepped up to take a role in this cause can get the gift of bringing that force back into your personal lives and let it work for you to transform any personal obstacles that interfere with your dreams.

 

 

 

 

For information about future Birth Matters Events, click here.

Come on out and March for Babies!  Birth Matters Tidewater will be marching to save premature babies on November 1, 2008.  If you can't be there to march, you can still donate, sponsor a walker or the team, or just post a badge on your website to help us get the word out.     

"The March of Dimes has changed the name of its biggest event to March for Babies. It's a great change because it makes it very clear exactly who I am walking for -- all babies. I am very excited to be a part of the “first” March for Babies; please support my participation.

Although the name of this signature event changed, the mission did not. The March of Dimes champions the needs of moms and babies in our community and across the nation. The money we raise for March for Babies will support lifesaving research, services, education and advocacy that help babies get a healthy start.

The mission of March of Dimes is to improve the health of babies by preventing birth defects, premature birth, and infant mortality."

 

Come on out and join us!

 

 

    

The Birth Survey has been made available to the public!

The Transparency in Maternity Care Project was birthed in February of 2006 by the Grassroots Advocates Committee (GAC) of the Coalition for Improving Maternity Services (CIMS). We are a volunteer group dedicated to ensuring public access to quality of care information specifically related to maternity care providers and institutions. It is our intention to extend the current social trend toward transparency in health care into the virtually overlooked maternity care arena.

The Birth Survey is structured around the Coalition for Improving Maternity Services (CIMS) evidence-based 10 Steps to Mother-Friendly Care and other quality of care indicators. The creation of The Birth Survey has been inspired by Childbirth Connection's Listening to Mothers Survey (Harris Interactive, October 2002) and the A-CAHPS (Ambulatory Consumer Assessment of Healthcare Providers and Systems) program and surveys.

We believe that women of childbearing age must have access to information that will help them choose maternity care providers and institutions that are most compatible with their own philosophies and needs. We hope that the Transparency in Maternity Care Project will provide information that will help women make fully informed maternity care decisions.

We also believe that maternity care practitioners and institutions must have access to feedback from their patients. We hope that doctors, midwives, and hospital administrators will find the information generated through the Transparency in Maternity Care Project useful in quality improvement efforts.

Women need accurate, objective data in order to make fully informed choices about birth settings and providers. Practitioners and hospital administrators also need data to evaluate whether they are delivering quality care. We hope this project will fill a void by providing much needed information that benefits all parties engaged in maternity care.

GOALS

Our goal is to give women a mechanism that can be used to share information about maternity care practices in their community while at the same time providing practitioners and institutions feedback for quality of care improvement efforts.

At the heart of the project is an on-going, online consumer survey, The Birth Survey, that asks women to provide feedback about their birth experience with a particular doctor or midwife and within a specific birth environment. Responses will be made available online to other women in their community who are deciding where and with whom to birth. Paired with this experiential data will be official statistics from state departments of health listing obstetrical intervention rates at the facility level.

FOUR PRIMARY OBJECTIVES

Objective 1 Annually obtain maternity care intervention rates on an institutional level for all fifty states.

Objective 2 Collect feedback about women’s birth experiences using an online, ongoing survey, The Birth Survey.

Objective 3 Present official hospital intervention rates, results of The Birth Survey, and information about the MFCI in an on-line format.

Objective 4 Increase public awareness of differences among maternity care providers and facilities and increase recognition of the MFCI as the gold standard for maternity care.

 

Click on over and take the survey!  Your answers will do a world of good for transparency in maternity care!

 

          The 7th annual awards gathering and fundraising was held this afternoon in Richmond.  There was a fabulous turn out, the silent auctions items were incredible, the key note speaker was awesome, and the awardees were inspirational!

 

Cara Mulhahn, CNM, is the midwife featured in The Business of Being Born.  As the key note speaker, she shared stories about some of her most inspiring mothers and their births.  She talked about unity among CPMs and CNM, and hopefully, midwives and obstetricians.  She is a very dynamic speaker who made us laugh, shudder, and keep thinking about where we'd like to see maternity care end up.  It was an honor and a pelasure to get to meet her!

 

Brynne Potter, CPM of Charlottesville and Therese Hak-Kuhn, midwife assistant, of Richmond were this year's winners of the Birth Matters Annual Award.  The awards are given to people in Virginia who are making positive changes for birth, and are impacting their communities.  They may be doctors, midwives, or other birth activists, male or female, and there are 2 winners.  This year's winners are more than midwives.  Brynne has been the political liason for the Commonwealth Midwives Alliance with the General Assembly.  She's given countless hours to work on legislation concerning midwifery and maternity care.  Therese trains doulas through ALACE, provides labor and post-partum support, and is the facilitator of the Richmond Home Birth Circle.  It was incredible to be in the company of such magnificent women and their supportive families!

 

          Look out for next year's event!   

 

Although the name of this signature event changed, the mission did not. The March of Dimes champions the needs of moms and babies in our community and across the nation. The money we raise for March for Babies will support lifesaving research, services, education and advocacy that help babies get a healthy start.

Please help by donating today!

 

The mission of March of Dimes is to improve the health of babies by preventing birth defects, premature birth, and infant mortality.

Click here for more information on how to donate to our team, get involved in the walk, and more!

 

*Study Indicates Higher Incidence of Childbirth-Related PTSD Than Previously Thought 

Nearly one in 10 U.S. women who have given birth recently meet the formal criteria for post-traumatic stress disorder resulting from childbirth, according to a survey released this week by the not-for-profit maternity care group Childbirth Connection, the Wall Street Journal reports. Some medical experts say that PTSD, most commonly linked to people who have experienced violent events, can also be triggered by a painful or complicated labor and delivery in which a woman believes she or her child might die. PTSD can set in immediately or months after a traumatic event. According to the Journal, the condition often occurs when someone has experienced an event that includes actual or threatened serious injury or death and evokes intense fear or a feeling of helplessness. Symptoms of the condition can include anxiety, flashbacks and a "numbness to daily life," the Journal reports.

For the survey, titled "New Mothers Speak Out," Childbirth Connection commissioned Harris Interactive to screen 900 U.S. mothers using an established PSTD screening tool. Nine percent of the women surveyed screened positive for all the criteria of PTSD outlined in the Diagnostic and Statistical Manual of Mental Disorders, and 18% of participants showed some signs of the condition, according to the report. Researchers noted that most women enrolled in the survey who experienced PTSD and other depression symptoms did not seek professional help. According to the Journal, the rate of PTSD among mothers has not been studied extensively, but separate studies conducted outside the U.S. estimated that between 1.5% and 5.9% of mothers experience the condition. PTSD is thought to be far less common in mothers than postpartum depression, which affects about 15% of mothers, according to the National Institute of Mental Health.

Health care providers believe the increasing number of obstetric procedures used in labor and delivery could be playing a role in PTSD. Cheryl Beck -- a professor at the University of Connecticut School of Nursing, who served as an adviser for the study -- said the mothers reporting signs of PTSD had a higher rate of medical intervention and were more likely to describe feeling helpless in a threatening environment. A history of sexual abuse or other trauma also can increase a woman's risk of experiencing PTSD related to childbirth, the Journal reports.

According to the Journal, the survey's results are "likely to add fuel to a debate about how to better identify and treat maternal mood disorders and whether widespread, systemic screening is warranted." New Jersey in 2006 passed a law requiring women to be screened for risk of depression after being discharged following childbirth, as well as at the first postpartum doctor's visit. Other states, including Illinois and Texas, have passed laws to increase educational awareness of postpartum mental conditions.

Federal legislation (S 1375) that would fund research into postpartum mood disorders and the effects of screening for the conditions failed to reach the Senate floor last month as part of a legislative package (S 3297), but supporters believe the bill could be reconsidered in the fall. Opponents of the measure have said the bill could lead to increased "drugging of mothers." Shari Lusskin, director of reproductive psychiatry at New York University Medical Center, said many aspects of PTSD are not fully understood, especially childbirth-related PTSD. She said, "We don't want to overmedicalize a normal part of human development. Just because you had a traumatic birth, doesn't mean you'll get PTSD" (Zimmerman, Wall Street Journal, 8/5).

 

*From The National Partnership for Women and Families

N.Y.C. Maternal Death Review Struggles for Life

By Malena Amusa

WeNews Correspondent

Eleven major hospitals in New York City do not participate in a state initiative to review maternal deaths, although the city has the highest number of maternal deaths in the nation. The lead manager of the reviews says that could be fatal for the effort.

 

(WOMENSENEWS)--A probing 90-question review promises to unravel the stubborn knot of questions about why as many as 139 women died from pregnancy-related complications in New York state between 2003 and 2005 and why New York City continues to be a leader in maternal mortality.

For more than two years, a voluntary maternal mortality review conducted in the state has been struggling with its own life-and-death problem: the disappearance of New York City hospital participation.

The New York City Health and Hospitals Corporation--a coalition of city-owned care and treatment facilities that represent a large portion of the city's maternal deaths along with the largest population of African American patients--has backed out of the review process.

As a result Donna Montalto, who heads the New York state review, says a report due out in 2009 won't have enough hospitals participating to a make a meaningful analysis of maternal deaths in the state.

The Health and Hospitals Corporation, a public hospital system that includes 11 acute care hospitals and several home care, diagnostic and treatment facilities, withdrew from the review in 2006. Two years before, 13 maternal deaths occurred in its hospitals, representing nearly half of all the maternal deaths in the city that year, state health department data indicate. Three years later in 2007, the number of deaths fell to six.

"We chose not to participate in the Safe Motherhood Initiative simply because we already participate in a number of established monitoring and review processes, measures and collaboratives," Pamela McDonnell, a spokesperson for the Health and Hospitals Corporation, replied via e-mail.

'Damaging' Departure of Data

The fact that the city's hospitals with the largest number of black patients will be missing is especially damaging to the study, says Montalto, director of New York's American College of Obstetricians and Gynecologists, which launched the Safe Motherhood Initiative in 2001 in conjunction with the New York State Department of Health. In addition to conducting the review, the team of medical specialists that run the initiative also train physicians volunteering to study curriculums on averting maternal mortality.

Montalto is now working with the Healthcare Association of New York State, an association of the state's hospitals, to educate and encourage all hospitals to participate. In 2004, black women were nearly four times as likely to die in childbirth as white women nationwide, and had a maternal death rate of 34.7 per 100,000 live births compared to 9.3 deaths per 100,000 live births for white women.

These types of reviews are path-breaking analyses of maternal death causes and recommendations are active in at least nine states, including New York state for now.

Designed to discover and interpret major risk factors, Montalto's State Maternal Mortality Review surveys--among many data--the deceased woman's occupation, primary language, education, insurance coverage, prenatal care, method of delivery and history of sexually transmitted diseases. It asks if the pregnancy was intended or unintended. It might also help explain why African American women represent a disproportionate amount of maternal deaths.

While all hospitals are required to report maternal deaths to state agencies, this voluntary review effort strives to present a detailed account of the life of the woman and her care in the ward and make recommendations on enhancing quality of care in obstetrics and gynecology.

New York Leads Cities in Maternal Deaths

New York City leads all other U.S. cities in the number of maternal mortalities, and between 1989 and 1998, the state had the highest rate of maternal mortalities per 100,000 live births--28.7--in the nation, the Atlanta-based Centers for Disease Control and Prevention reported in 1999.

The Health and Hospitals Corporation represents the inner city population, Montalto says. "They would have a wealth of data considering their hospital demographic, which includes the Harlem Hospital population."

Montalto says the New York-Presbyterian Healthcare System, a major network of private hospitals operating top city facilities, has also backed out.

A spokesperson from New York-Presbyterian said yesterday she could neither confirm nor deny that her organization withdrew from the study without further research.

Unlike studies conducted by the Centers for Disease Control, which de-contextualize a mother's death--erring on the side of numbers instead of in-depth analysis and interpretation of what went wrong--the review report discusses pregnancy outcomes by race and specific risk determinants, such as in-hospital maltreatment and the woman's pre-existing health issues, which are then matched along a roster of social and health conditions associated with maternal deaths.

The first New York Safe Motherhood report came out in 2005 and interpreted 33 deaths between August 2003 and June 2005. A team of specialists conducted on-site reviews of 21 of the deaths, with black women representing the majority, or nearly 60 percent. The team of specialists found that 43 percent of the pregnancies were already at high risk--for example, due to obesity and heart disease--and that mothers could benefit from knowing their risk sooner. A big issue concerning Montalto: less than half of the cases--about 37 percent--received adequate prenatal care.

Probing Black Women's Deaths

But one chart shows that black women with adequate prenatal care died at a rate comparable to that of white women with inadequate prenatal care--which hints at a medical mystery a small field of researchers are trying to explain. While some analysts emphasize a lack of health care and poverty to explain high maternal mortality rates among black women, newer studies have indicated that regardless of a black woman's income and education levels, black women are more likely to die having a baby than white and Latina women.

Now, a network of progressive experts is trying to pinpoint how stress and racism places black mothers and their children at greater harm in the ward. Still, Montalto says most black mothers in the study did not have continuous prenatal care and this is an urgent part of the picture.

Ultimately, the findings she helped co-author were considered tentative, so the second review, slated for 2009, raised hopes of better insights that investigators could use to guide health care facilities and doctors.

Since the initial report, the proportion of hospitals where maternal deaths occurred at all and that reported to the Safe Motherhood Initiative went from half to a third, says Montalto.

Nationwide, an estimated 1,000 U.S. women die of pregnancy-related complications every year, according to a 2006 maternal mortality review summary by government agencies including the Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists.

In the fall, the consortium will release its maternal and fetal statistics online as a part of a transparency initiative, says McDonnell, the Health and Hospital Corporation spokesperson, but the information will not probe causes of death or the identities of the mothers. Officials at the Health and Hospitals Corporation have set a goal of zero maternal deaths, using intervention and management procedures to respond to crisis.

"We also conduct mock codes and drills to ensure consistency with response to obstetric and medical emergencies," says McDonnell.

Montalto says hospital legal teams fear being marked for having a higher risk population and more maternal mortalities so they avoid the review, which they fear may not adequately guard confidentiality.

While New York City's big hospitals must have every maternal death reviewed by state authorities, Montalto says the reviews tend to be inappropriately sympathetic to errors, similar to "having your mom come in and review your homework."

Members of this separate, state review group--the Perinatal Center Team--could not be reached for comment.

Malena Amusa is a journalist living in New York City.

Women's eNews welcomes your comments. E-mail us at editors@womensenews.org.

     In case you missed it, Chalk the Walk 2008 was a great success!  Birth Matters Tidewater's Artists did a wonderful job of getting the word out!  Thanks to our wonderful artists Amy, Jenn, and Brandy for doing such a great job!!

 

 

     Birth Matters Tidewater will be down at the oceanfront this afternoon!  Come on out and check us out at Chalk the Walk.