The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA
An interactive resource for moms on easy steps they can take to reduce exposure to chemical toxins during pregnancy.
Other excellent resources about avoiding toxins during pregnancy
These are easy to read and understand and are beautifully presented.
. . . was launched Jan. 24, 2008. It's a nationally coordinated campaign to advocate for regulation and licensure of Certified Professional Midwives (CPMs) in all 50 states, the District of Columbia and Puerto Rico, and to push back against the attempts of the American Medical Association Scope of Practice Partnership to deny American families access to legal midwifery care.
You can read what
Lake says and check out her new movie, The Business of
for increased role for midwives in Australia - ABC
News - 2/21/09
Where's my midwife? is
a grassroots organization seeking to increase access to midwives
in hospitals, free-standing birth centers and at home through
education and advocacy.
Reducing Infant Mortality and Improving the Health of Babies - this is a 15-minute, landmark video seminar about improving maternity care in the United States.
"You do not need somebody with the skills of a board-certified
OB/GYN to do a normal, vaginal birth The United States is the only
industrialized country in the world that uses surgeons to attend
normal childbirth. And then we look at those other countries, and
we see that their healthcare costs are lower, their perinatal and
neonatal outcomes are better. the midwives do generally a better
job with the average patient of getting her to delivery without
interventions and without complications."
Happy International Midwives Day - a nice notice to celebrate the day - May 5.
the Midwife [6/12/15] - Why a growing number of U.S. mothers
are turning to midwives, rather than physicians, for prenatal
care, labor, and delivery.
Virtual International Day of the Midwife 2009
Here are the recordings of the live sessions:
And here are a few reflections about the day, if anyone is interested:
From Stuart Fischbein,
OB who works with midwives:
I BELIEVE IN BASIC HUMAN RIGHTS
I am a obstetrician who collaborates with midwives.
I believe strongly in the midwifery model of care and the right of a woman to true informed consent and refusal in the birth process.
His web pages have lots of advocacy information for midwives.
TODAY show in bed with ACOG from Citizens for Midwifery
TODAY Show displays ignorance . . . in bed with ACOG. They selected a single anecdote of a baby death at a birth attended by an ACNM. They chose to avoid stories about deaths at births attended by obstetricians caused by:
1) Babies being decapitated with vacuum extractors:
2) Mothers and babies dying from Cytotec overdoses
3) Fatal infectious outbreaks in newborn nurseries
responds to producers of The Today Show.
for Normal Birth by 2020 ~ Rehabilitating our National
Maternity Care policy by the year 2020 by Faith Gibson, LM CPM
Chokepoint Medicine - For those of you who are most
interested in maternity care, midwifery and PHB, i think this
material will help you understand that the real root of these
problems -- the prejudice against physiological management and
midwives, the political issue of obstetrical supervision, the
escalating medicalization of normal birth through induction and
elective Cesarean -- comes from the same place and is a symptom of
basic problems with health care writ large.
How a group of pregnant women helped Providence cut costs by 15% by Rivkela Brodsky [4/10/15] - Care is primarily provided by a certified nurse midwife as part of this “pregnancy care package.”
Lowering Medical Costs By Providing Better Care - Listen to the Story
The beauty of applying these principles to midwifery care is that
we're helping the mother to become a more effective mother and
helping the baby to get off to the healthiest possible start in
life. Midwifery care increases rates of vaginal births,
which increases respiratory health and all the benefits of
on the Super-Utilizers
Using the AABC Uniform Data Set (UDS), the American Association
of Birth Centers is launching the AABC
Study of Optimal Birth. We are seeking birth centers and
midwifery practices (all settings) to enroll in this research
project. By including all maternity care providers in all settings
we will have comprehensive data on both the process and outcomes
of the midwifery model of care.
It's important to do a good job with publicizing these events -
consider an events promotion service such as fullcalendar.com
One of the best ways to educate your community about midwifery is
to staff a table at local festivals - there are often areas set
aside for "free speech", where non-profits and other organizations
can set up a table and offer educational material. You could
include information from DONA and ICAN to round out your
Years ago I made a wonderful presentation. Here are some
suggestions: Make words or 2-5 word statements about birth that
people will see that triggers their interest. ie, safe birth,
trust, bonding, satisfying, reduce C/sections, waterbirths,
breastfeeding support, in-home personalized care, In- home birth
center, family connection, etc. I printed these on the computer as
large as an 8 1/2x 11 paper could hold. Then I trimmed them and
mounted them on bright( pink, yellow, green, blue all different,
like a rainbow) heavy gauge card stock. You could laminate
them for durability. I made a main poster that just had my
business name and a logo and framed it with color. I put these us
behind me and arranged all the words which were about 8 or so
around the main poster. You can also make a flip chart for quick
teaching when people come up. I laid out a good table with
cloth, brochure holders and card holders so they could be seen
upright. I brought the baby in the pelvis and some books. I had a
sign in sheet for people to be on an email newsletter list. I
would also add a certificate for a 1 hour complimentary
consultation with no obligation. Make it pretty. It is mostly
women that are attracted to these topics. So try again and keep
educating. But the most important thing is to make it eye
appealing and stimulate someone to want to know more. Have fun!
educates public on natural childbirth and midwifery - April
and Ed Coburn were so satisfied with their experience delivering
their son Rainer naturally, with the aid of midwives, that they
decided to do what they could to educate the public about natural
childbirth. The result is "With the Aid of Midwives," a display
they put together at the Oxford Public Library.
Your state midwifery association may also offer materials for
mothers who died giving birth - BY HOLLY TKACZYK - about The Safe Motherhood
While an individual midwife may not accomplish it on a state, city or even district wide basis... everyone of us has the means to create a lasting relationship with at least one institution. In my case, the most natural candidate was my own children's school.
This talk was given to 5th graders. I met in advance with the teacher, the parents' association president and the director of middle school. A note was sent home describing a bit of my presentation so that a parent or child had the option to exempt participation. Only one child in three classrooms did and as it happens, I am still in touch with this young woman today. At this age the most fascinating part of my discussion was my resin pelvis. Most of the kids are in some way active...sports, ballet, dance, PE at the very least! I wanted to give them a lasting reminder of how movement affects change in the pelvic cavity. The most common reason given in Mexico for cesarean (and vaya! We have institutions with a 90% rate) is that the woman is "estrecha" or too narrow. Start showing young girls and boys the idiocy of this statement while they can wrap their minds and hearts around the idea that their bodies are fluid and adaptable.
I did show a birth but in those days didn't have a collection of ones I had attended. Instead I showed one made by my own Dutch midwives (Beatrijs Smulders and Astrid Lindberg). Under Her Own Steam. To this day (and this birth was in the early 80's) it is a timeless and fabulous film. Since the mom has no clothes and has long hair without "styling" it doesn't look "dated" at all. Since they are in the privacy of their own home and all we see is a sofa softly lit by the airy window there is no sense of when it was filmed. The only problem with a video from another culture is that it can give rise to the idea that this only happens "elsewhere." Yes, it can inspire families but not everyone is prepared to reclaim what birth should be and prefer to find it already available locally! To this end, I now use videos that occur in their city, with caregivers locally available in order to underline the message that this is happening HERE and NOW!
Consequences? In 1996 the science teacher who hosted my visit had her baby with me! The kids are now in their second year of college and there have been no babies yet.
My contrast, when I gave my presentation to my older daughter's high school biology class circa 1997, two students were pregnant. One began to take childbirth classes with me and although she needed her baby to be born in the US in order to maintain US nationality for her baby (mom was a minor living out of the US for too many years to qualify automatically) we got busy on the phone to find a compatible caregiver in Texas. She birthed without episiotomy and nursed her baby the entire first year while she homeschooled. She returned to High School and graduated in the Nat'l Honor Society the following year. The other classmate (whose MD parents were scheduling her cesarean) advocated for labor and vaginal birth instead. She dedicated her entire page in the senior yearbook (2 years later) to her child!! She didn't contact me after the talk and frankly although she was in my daughters "year" I had never seen her before but she did have a very trusting relationship with the biology teacher (female) and the info got channeled through her. I don't know the details of her birth other than to know it wasn't surgical. I gave her a lift to a shopping center nearby my home once and she proudly told me about her breastfeeding which she continued for nearly a year while continuing to attend high school.
For the past three years I am a fixture on the "Career Day" talks. The high school students sign up for 3 forty five minutes classroom discussions about the realities of a particular career. And YES, I have had boys in every group. Last year, the senior guy who attended did so because his older sister was pregnant and he wanted to know more about the natural birth option. Another guy attended because his girlfriend did and they wanted to use this afternoon free of classes to be together! Someday he IS going to be some woman's partner and some baby's father...why not plant seeds now?
This May I will attend the birth of my son's high school honors English teacher. Also a young woman who graduated the school in 1994 who remembered there being "somebody" who talked about natural birth. She called the school and found out who that person was. To date I have attended both births of the Early Education Director, both births of the High School Director, two births of the school's accountant, both births of my daughter's high school Spanish teacher, both births of the Maternal class teacher, and the birth of the 5th grade teacher I mentioned before.
My older daughter's friends are now 23 and 24. They call me when the have presentations to make at the University. "What do you have on the benefits for the baby for my early child education class? I have a talk to give for my Psych class and thought I'd talk about how the laboring woman. I remember you talked about endorphins in birth...I am doing a project for my biology class..." One of them just graduated from Harvard and he asked if I still served homemade bread at my talks. So yes, sometimes we appeal to their stomachs as much as their intellect or their hearts! LOL
Long story short...get out there and tell these kids about the magic and the wonder that is waiting for them and that there is no free lunch. They will sweat, work hard and reap the rewards. Keep the awe in your voice and sit WITH them rather than in front of them in presenter style. Bring your photo album and SHARE the births rather than lecture to them.
Please send reports about inaccurate or misleading news stories
to the MANA Press Officer at http:
This book review summarizes some important concepts from The Political Mind: Why You Can't Understand 21st-Century American Politics with an 18th-Century Brain by George Lakoff
George Lakoff on The Political Mind
Linguist and professor George Lakoff, author of The Political Mind: Why You Can't Understand 21st-Century American Politics with an 18th-Century Brain,
to the Art of Persuasion by Susan Hodges at Citizens for Midwifery
from Susan Hodges, a birth advocate for 20 years. Susan is a co-founder and current President of Citizens for Midwifery - www.cfmidwifery.org. [a personal communication, published with her permission]
From my own experience, I have concluded that for most of us, having an institution that we have assumed or trusted in suddenly shown to be not trustworthy is very disturbing. I think that is why women we might otherwise expect to do the research and find all this out and make good choices (like find a midwife!) surprise us by just trusting their OB. Once one is pregnant, it is many times as difficult emotionally to change our thinking. I know -- I did lots of research when I got pregnant for the first time, and we switched from a hospital-based CNM to a home birth CNM when I was 7 1/2 months along. To discover that I could not trust the medical system or even the CNMs within it was deeply disturbing, made me question all societal institutions, etc. (are you surprised that I homeschooled my kids!). So, though I don't have any proof that this helps, I have often prefaced my remarks with come comments about how we tend to make such assumptions and put trust in our society's institutions, and that what I am going to talk about may undermine your trust and may make you uncomfortable, even disturbed, and that is OK -- that is our natural response to this kind of info. This lets people know what is coming a little. If someone is in a place where they cannot deal with this kind of info, they are forewarned and can leave. For others, it may prepare them and help them take it in. During a presentation I may also interject a comment (as appropriate) about how some of this may sound unbelievable, that I also thought it unbelievable, but after research, talking with others, etc., etc. I realized that this really is going on. These kinds of comments serve to create some sense of emotional alignment -- that you the speaker are actually also one of the audience, instead of you the speaker know all this stuff but don't understand how your audience may be reacting. I have also often pointed out to people that we actually live at a time and in a society that is pretty hostile toward to pregnant women and infants, with inaccurate information masquerading as truth and a lack of readily available choices in general. The best we can do is research and make the best choices we can from what is available to us, and hopefully work to make better choices available to our daughters, friends, etc. I hope that this helps! Also, some of the fact sheets in the Resources section of the CfM website might be useful -- for example the one about Out-of-hospital vs hospital c-section rates, at least for those who know they want to avoid an unnecessary cesarean section.
I also like to point out how we treat our pets when they are
going into labor -- they go off to the back of some closet or
other hidden nook or cranny, and the smart pet owner will leave
them alone. Zoo keepers to not disturb the gorillas r zebras or
other mammals when they go into labor, and they won't let the
public look either. Humans are mammals. When we feel afraid,
anxious, violated, etc. (when we lose our privacy or autonomy, or
are threatened...) we secrete adrenaline, the fight or flight
hormone. Surprise! adrenaline counteracts the hormones that make
the uterus contract! (i.e., labor often slows or stops when
women leave home for hospital when in labor). There are many
common practices in the hospital, in addition to recognizable
"interventions" that can cause a laboring woman to feel anxious or
threatened (and then secrete adrenaline) --I have made an informal
list (attached) that you are welcome to use or adapt -- I know you
know all of this, but this is one way to present it. Most women
have not let themselves think about how they actually feel when
placed in a hospital and told to stay in bed, hooked up to a
monitor. They are not asked "if" or given informed consent -- they
are told "you need to do..." or "we need to do this to you..." --
even though all of these things carry risks because they can
disturb and prolong the normal progress of labor. Most people will
react with "I never thought about that". Then you can point
out the most OBs have NEVER seen any labor except labor
disturbed by hospital procedures; so OB assessments of dangers and
what is or is not "safe" are terribly skewed when it comes to
normal birth - not because the OBs are "bad" (though in many cases
they may be) -- they are just ignorant and not trained to attend
normal undisturbed birth. Hoping this is useful too!
ChangingMinds.org - All
about the art of persuasion
Issues around birth can become very polarizing, and I think we
all benefit by learning to communicate compassionately as well as
effectively: The Center for Nonviolent
Communication - A global organization helping people connect
compassionately with themselves and one another through Nonviolent
Communication language, created by Marshall B. Rosenberg, Ph.D.
Made to Stick: Why Some Ideas Survive and Others Die by Chip Heath & Dan Heath - You can listen to their CD or the 40-minute conversation between Chip Heath and Moira Gunn on NPR's Tech Nation, or read this excellent review and summary of the book.
They have also written another book, The
of Knowledge, which helps experts understand how to
communicate better with non-experts.
On the art of Persuasion:
"The way to convince another is to state your case moderately and
accurately. Then scratch your head, or shake it a little, and say
that is the way it seems to you, but that of course you may be
mistaken about it; which causes your listener to receive what you
have to say, and as like as not, turn about and try to convince
you of it, since you are in doubt. But if you go at him (or her)
in a tone of positiveness and arrogance you only make an opponent
of him (her)." -Benjamin Franklin
[T]he motivation underlying our activism for social change must
be transformed from anger and despair to compassion and love. This
is a major challenge for the environmental movement, for example.
It is not to deny the legitimacy of noble anger or outrage at
injustice of any kind. Rather, we seek to work for love, rather
than against evil. We need to adopt compassion and love as our
foundational intention, and do whatever inner work is required to
implement this intention. Even if our outward actions remain the
same, there is a major difference in results if our underlying
intention supports love rather than defeating evil. The Dalai Lama
says, “A positive future can never emerge from the mind of anger
and despair.” [Adapted from a presentation given by Will Keepin
at Schumacher College, Totnes, England, July 17, 1997, from an
article "Twelve Principles of Spiritual
Howard Gardner's book, Changing
Minds, can be very enlightening.
When interacting with those trained in the standard U.S. medical model, it is important to remember that many of them have internalized the notion that hospitals are temples of safety . . . that somehow there is a magic about the place that removes all risk from medical procedures and renders doctors as divine magicians. Talking with them about the superior statistics for homebirth safety may trigger a situation where their cognitive dissonance makes it impossible for them to hear what you're saying. They're not just being stubborn . . . they may actually not be able, literally, to hear the words you are saying. It's worth keeping this in mind.
"Several classic studies from social psychological research investigating processes of self-justification and the theory of cognitive dissonance (see Aronson, 1980, chapter 4; Aronson, 1969) can point to explanations for such seemingly irrational behavior.
"According to dissonance theory, when a person commits an act or holds a cognition that is psychologically inconsistent with his or her self-concept, the inconsistency arouses an unpleasant state of tension. The individual tries to reduce this "dissonance," usually by altering his or her attitudes to bring them more into line with the previously discrepant action or belief. . . . people seek to justify their choices and commitments."
of the Nonsensical: An Analysis of Jonestown by Neal Osherow,
a useful introduction to a variety of psychological factors that
affect the medical establishment's attitudes towards midwifery and
Advocacy Tools from the ACLU
Primer of Practical Persuasion and Influence
to Get Free Publicity
sample Web pages for online Activism
ICAN President's Letter to
California Medical Board about VBAC - from Tonya Jamois,
Communication by Marshall Rosenberg
I took a training course recently called, "The Art of Inquiry". We got a nifty little card to carry around & use when we are trying to get information.
Giving and Getting Good Quality Information
Baby T's makes infant
t-shirts personalized with your practice name or logo.
Midwifery and Breastfeeding Bumper Stickers - Texas Sticker Company & Label Exchange
Bumper Stickers: (purple and white)
Bumper Stickers for Sale!
Support CAM and Region IV
"Midwives Market - All the bumper stickers, buttons and
needlepoint kits that a midwife could dream of. Laingsburg,
There are some nice breastfeeding checks available:
Current has some nice
checks - they also have an option of adding a couple of lines of
text above the signature line! I had some checks once with "Home
Birth is Safe Birth" and also "Birth Is As Safe As Life
Artistic Checks also
will also put a line of text above the signature. Mine says "Honor
labor, call a midwife". You can also phone them at
You can get Anne Geddes checks (8 scenes
scenes) from Checks
In The Mail.
pregnancy.8k.com - Great
T-shirts about midwives, homebirth and natural childbirth.
Where's the Birth Plan? by Jennifer Block - Midwifery-style care saves money and provides excellence for the new family--a great two for one proposal! She clearly points out how the more humane style of care provided by midwives not only saves money, but also saves lives.
A new economic analysis forecasts savings of $9.1 billion per year if 10 percent of women planned to deliver out of hospital with midwives.
The writer of this blog, Jennifer Block, will be presenting
at the international birth conference organized by Amayal in
Monterrey this October 9-11.
Cochrane Collaboration: Midwife-led versus other models of care for childbearing women [4/15/09]
We included 11trials (12,276 women). Women who had midwife-led models of care were less likely to experience antenatal hospitalisation, risk ratio (RR) 0.90, 95% confidence interval (CI) 0.81 to 0.99), the use of regional analgesia (RR 0.81, 95% CI 0.73 to 0.91), episiotomy (RR 0.82, 95% CI 0.77 to 0.88), and instrumental delivery (RR 0.86, 95% CI 0.78 to 0.96) and were more likely to experience no intrapartum analgesia/anaesthesia (RR 1.16, 95% CI 1.05 to 1.29), spontaneous vaginal birth (RR 1.04, 95% CI 1.02 to 1.06), to feel in control during labour and childbirth (RR 1.74, 95% CI 1.32 to 2.30), attendance at birth by a known midwife (RR 7.84, 95% CI 4.15 to 14.81) and initiate breastfeeding (RR 1.35, 95% CI 1.03 to 1.76). In addition, women who were randomised to receive midwife-led care were less likely to experience fetal loss before 24 weeks' gestation (RR 0.79, 95% CI 0.65 to 0.97), and their babies were more likely to have a shorter length of hospital stay (mean difference -2.00, 95% CI -2.15 to -1.85). There were no statistically significant differences between groups for overall fetal loss/neonatal death (RR 0.83, 95% CI 0.70 to 1.00), or fetal loss/neonatal death of at least 24 weeks (RR 1.01, 95% CI 0.67 to 1.53).
All women should be offered midwife-led models of care and women should be encouraged to ask for this option.
Midwives Versus Doctors: The Gloves Are Still Off by Cate Nelson [5/20/09]
. . . [T]here is an increasing gap between the traditional Western medical community and that of midwife-delivered, woman-based care.
Doctors Versus Midwives: The Birth Wars Rage On by Jeffrey Kluger [5/16/09]
and Infant Health Care by Dr. Melissa Cheyney
The Birth Ecology Project
advocates for midwifery, doula care, natural birth, conscious
parenting, and sustainable living. The Birth Ecology Journal
publishes articles and essays of quality on topics of interest to
parents, birth professionals, and birth advocates on the website.
Workshops for parents and professionals are also in the
works. This site also has a great collection of articles -
follow the link!
Premature birth is now the most common, serious, and costly
infant health problem facing our nation. - Midwifery is a terrific
preventive measure, reducing low birthweight by 31%.
The Florence Nightingale
School of Nursing and Midwifery hosted a study day on Community
Caseload Midwifery in October, 2005; the speakers were
Maggie Thomson, a consultant midwife at Whittington Hospital NHS
Trust involved in introducing Sure Start caseload practices in
London and Becky Reed is a midwife with the Albany Midwifery Practice in London.
The Landscape of Caring for Women: A Narrative Study of Midwifery Practice [Medscape registration is free.]
"It is critical that the immediate and long-term effects of
midwifery practice be recognized. We are facing monumental
challenges in health care today. Our current health care system is
struggling to balance rising costs with an ever-increasing
reliance on, and demand for, technological innovation. Midwifery
care has been demonstrated over and over to be excellent and
associated with positive maternal-infant outcomes. This prompts
the troubling question: if midwives have such good outcomes, why
then are they not the primary provider of women's health care in
the United States? The answers are likely complex but must be
MANA's Page on
for Women Expands Definition of Reproductive Freedom to Include
Midwifery Model of Care
A Report on The NOW National Conference Committee on Health and Reproductive Rights, July 3, 1999 (You may have to search for this piece.)
THE NATIONAL ORGANIZATION FOR WOMEN'S RESOLUTION SUPPORTS CHOICES IN CHILDBIRTH AND ENDORSES MIDWIFERY CARE
In July, 1999, the largest and most important women's organization in the country, The National Organization for Women (NOW.), expands the definition of "Reproductive Freedom" to include Choices in Childbirth and Endorses Midwifery Care.
EXPANSION OF REPRODUCTIVE FREEDOM TO INCLUDE THE MIDWIFERY MODEL OF CARE
Midwifery is about choices.
It's about a woman's choice to be touched only by other women of her own choosing.
Midwifery is about a woman's choice to retain control over her own body, even when her choices aren't in line with a liability-driven medical establishment.
Midwifery is about a woman's right to choose where and with whom to give birth.
You can support women's choices by supporting midwifery.
The resolution, "Increasing Access to Out-of-Hospital Maternity
Care Services Through State-Regulated and Nationally Certified
Direct-Entry Midwives" was formally adopted by the Governing
Council of the American Public Health Association (APHA) October
24, 2001. "Recognizing the evidence that births to healthy mothers . . .
can occur safely in various settings, including out-of-hospital
birth centers and homes" The Midwives Model
of Care is based on the fact that pregnancy and birth are
normal life events. Great collection of midwifery links from BirthLove [Ed:
birthlove.com is not available at this time.] Association
Nurse Advocates for Childbirth Solutions -
WWW.ANACS.Org - Please come and join our community of nurses
working together to find solutions to maternity nursing
Informed Birth Choices(IBC) website. - news, information and resources supporting birth attendants' and parents' right to choice. This site is related to legal case - O’CONNER VS. STATE OF WASHINGTON
The resolution, "Increasing Access to Out-of-Hospital Maternity Care Services Through State-Regulated and Nationally Certified Direct-Entry Midwives" was formally adopted by the Governing Council of the American Public Health Association (APHA) October 24, 2001.
"Recognizing the evidence that births to healthy mothers . . .
can occur safely in various settings, including out-of-hospital
birth centers and homes"
The Midwives Model
of Care is based on the fact that pregnancy and birth are
normal life events.
Great collection of midwifery links from BirthLove [Ed:
birthlove.com is not available at this time.]
Nurse Advocates for Childbirth Solutions -
WWW.ANACS.Org - Please come and join our community of nurses
working together to find solutions to maternity nursing
Faith Gibson's site has the best online information about midwifery advocacy.
The Official Plan to Eliminate the Midwife: 1900 -- 1930 - Faith Gibson's collection of source documents
of Midwifery and the Ascendancy of Medicalized Childbirth
. . . the midwifery model of care is an essential element of comprehensive health care for women and their families that should be embraced by and incorporated into, the health care system and made available to all women
Critical Points from "Safety of Alternative Approaches to
Childbirth" by Peter F. Schlenzka - A doctoral thesis
comparing safety and costs of natural, out-of-hospital birth with
in-hospital obstetric births. He finds out-of-hospital
births to be slightly safer and significantly superior in terms of
economic costs ($13 billion annually) and social costs (reduced
incidence of birth trauma and bonding disorders).
Hospital costs driven by heart, pregnancy [9/25/06] - "By payer, pregnancies and delivery made up the biggest cost for private insurance and Medicaid, costing hospitals about $41 billion in 2004, the report said."
"It is always surprising for people to realize how much hospital care goes to mothers and newborns," said Roxanne Andrews, author of the report. "Most think of hospitals as places where only the sick go."
U.S. Agency for Healthcare
Research and Quality runs a Healthcare Cost &
Utilization Project (HCUP). They offer other New Findings and
I found this fun slide
presentation about healthcare costs from AcademyHealth.
C-section most common US hospital procedure [8/2/05 - Reuters]
WASHINGTON (Reuters) - The most common U.S. hospital procedure is the Caesarean section, with 1.2 million of the operations done each year, according to a government report issued on Tuesday.
Caesarean sections cost $14.6 billion in total charges in 2003, the report from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project found.
"There are 4 million babies born every year. Twenty percent or more of them are done by C-section. That is a lot of babies," Elixhauser said in a telephone interview.
"Nearly a quarter of all (U.S) hospital stays are related to
pregnancy and childbirth. Most people don't realize what a big
chunk of hospital care that is."
Fire by Katie Allison Graju
Monopoly - Why the medical industry is dragging its feet
when it comes to midwives (by Laurel Druley)
June 2, 1998
In support of my assertion, I refer you to "Evidence Basis for the Ten Steps of Mother-Friendly Care," a recently published review of the literature on many topics, including midwifery care ("Step 1") and cesarean surgery ("Step 6"). It can be downloaded gratis.
I would be happy to help you with it if you had any questions. If any doubts remain on your part, I suggest that you ask the sources who impugned midwifery care to show you the medical research that backs their statements.
I hope that you and your newspaper will see fit to correct the serious misinformation about the safety of midwifery care for which your sources have made you an unwitting conduit.
P.S. Not wanting to muddy the water with more than one topic in
the body of my letter, I would also like to point out that the
only national data on "maternal request" cesarean that comes from
asking women themselves reported that less than 1% of women
surveyed requested a cesarean with no medical indication. By
contrast, studies substantiate substantial rates of "obstetrician
request" cesareans. I would be happy to discuss this further with
you or your editors as well.
Midwifery care, social and medical risk factors, and birth
outcomes in the USA,
J Epi & Community Health, MacDorman M, Singh G, 1998;52:310-317
Midwives tend to make people happier, and happy people are healthier - Happiness and other positive emotions play an even more important role in health than previously thought, according to a study published in the journal Psychosomatic Medicine by Carnegie Mellon University Psychology Professor Sheldon Cohen.
style predicts resistance to illness after experimental exposure
to rhinovirus or influenza a virus.
Cohen S, Alper CM, Doyle WJ, Treanor JJ, Turner RB.
Psychosom Med. 2006 Nov-Dec;68(6):809-15. Epub 2006 Nov 13.
This recent study confirms the results of a landmark 2004 paper
in which Cohen and his colleagues found that people who are happy,
lively, calm or exhibit other positive emotions are less likely to
become ill when they are exposed to a cold virus than those who
report few of these emotions."
in Nulliparous Women Giving Birth at a Community Hospital:
Reduced Risk in Births Attended by Certified Nurse-Midwives
Browne M, Jacobs M, Lahiff M, Miller S
J Midwifery Womens Health. 2010;55:243-249
of the Midwife
by Katie Granju - From Minnesota Parent, October 1997
A must-read article for anyone trying to understand why the healthcare system in the U.S. continues to snub the midwifery model, despite reduced Cesareans, proven safety, and lower costs.
Midwifery Bibliography - Books and
Resources About the Profession of Midwifery
Tips on Writing Letters of Advocacy
How to Advocate for Midwifery
An Untapped Resource
Editorial Comment by Ina May Gaskin (1994)
Industry Kills Health Care Reform
Editorial Comment by Ina May Gaskin (1994)
Editorial by Marsden Wagner on "A global
The medical Journal The Lancet in its October 14 issue, pp 1020-22, has an article on what they call "Midwife Witch-Hunt" which is about a global "dirty-tricks" campaign to prevent midwives from taking part in home births. The title of this is also interesting in that historically there has been a (real and imagined) association between witchcraft and midwifery. This article is by Marsden Wagner, and identifies some of the ways midwives have been persecuted and put out of work around the world. It is very supportive of midwifery and promoting the profession.
Unless we put medical freedom into the constitution, the time will come when medicine will organize itself into an undercover dictatorship...denying equal privileges. All such laws are unAmerican and despotic...- Benjamin Rush, Physician
Pursuing the Birth Machine - The search for appropriate birth technology" by Marsden Wagner. A brief blurb follows:
Increasingly, physicians in industrialised countries manage birth with sophisticated and expensive technology. In this book, Marsden Wagner provides a history and survey of these technologies, showing how the availability of high-tech interventions has spurred both use and demand. Pointing to the high costs and potentially dangerous side-effects of many interventions, he argues for rational reassessment of what is both affordable and safe for mothers and babies. At the heart of the book is a description of the efforts of participants in a series of World Health Organisation consensus conferences to identify the best ways to influence change in health policies in both industrialised and developing nations. These conferences resulted in the landmark WHO recommendations on appropriate technologies for birth and after birth.This is a timely book --- provocative, instructive, thought-provoking and visionary.
on appropriate technology for birth
Conference at Fortaleza, Brazil, 22-26 April 1985
for appropriate technology following birth
Trieste, 7-11 October 1986
Health Organization) - appropriate technology for birth
revisited British Journal of Obstetrics and Gynaecology,
September 1992, Vol. 99, pp. 709 - 710
and out-of-hospital birth settings: how do they reduce
unnecessary cesarean section births?
Soc Sci Med 1993 Nov;37(10):1233-50
U.S. women beginning labor with midwives and/or in out-of-hospital settings have attained cesarean section rates that are considerably lower than similar women using prevailing forms of care--physicians in hospitals.
Midwifery Organizations by Country [in advocacy]
Committee Holds Inaugural Meeting at CIMS Tenth Anniversary
Meeting in Boston [founded February 25, 2006] - The mission
of the multidisciplinary group is to encourage, conduct, evaluate
and disseminate research related to the best practices in birth
care for childbearing women and their families in the United
States and its territories.
for Midwifery by Jodi Kluchar - Births attended by midwives
have proven to be safer, and less traumatic than births attended
by obstetricians because midwives are trained in the natural birth
Kluchar is a major activist in awareness about PTSD after
Citizens for Midwifery
California Citizens for
Health Freedom, in co-operation with National
Citizens for Health
Mother Friendly Childbirth Initiative
INTRODUCTION from CfM News, October 1996
A consensus group called the Coalition for the Improvement of Maternity Services (CIMS) met in California last March to ratify a document called the "Mother Friendly Childbirth Initiative." Three years in development, this outstanding document is a powerful new tool in the effort to bring sane and healthy childbirth practices to the mainstream United States. Modeled on the World Health Organization's Baby Friendly Initiative that has been so successful in eastern Europe in promoting breastfeeding and maternal bonding, the plan in the U.S is to enroll hospitals and birth centers as endorsers of the MFCI, thus permitting them to advertise themselves as "mother-friendly" while raising the standards for maternity and neonatal care in the United States.
AIMS - Association for
Improvements in the Maternity Services - Supporting Parents
and Professionals in the UK and Ireland
Friendly Hospital Initiative
What's the Baby Friendly Hospital Initiative?
Baby Friendly Hospital Initiative (BFHI) -- The BFHI, sponsored by the World Health Organization and UNICEF, is a world-wide effort to improve breastfeeding rates. Based on the ten steps to successful breastfeeding, the initiative encourages hospitals to examine their practices, make the appropriate changes and then apply for recognition as a Baby Friendly Hospital.
The Baby Friendly
Hospital Initiative- USA, including a list of approved
Florida Governor Supports Midwives
- Online Birth Center
of Birth vs. Holistic Model of Birth (from Birth as an
American Rite of Passage by Robbie Davis-Floyd.
the Midwifery Model of Birth and the Medical Model of Birth
Study Shows: Women Prefer Midwives
Health Administrator Supports Midwifery
About Advocacy and Presenting New Ideas
How to Conduct an Effective Media
How A Doula Got TV Coverage
Stepping Up to the Speaker's Stand
N-NET - Lists the name, address, and phone number of United
States newspapers in an easy-to-use format. It is the largest,
most comprehensive service of this kind on the web.
Midwives could fill in the gap!
Untimely Follow-Up Seen Among Many Newborns [Medscape
registration is free]
Physicians for Midwifery or contact Pat Burch at firstname.lastname@example.org or at 318-232-5580
Universal Health Care Action Network: 216-566-8100
History of Medical Conspiracy to Malign
A Short History
of Midwifery in America
AMA Statements about Independent Midwives
Effects of Technology on Perinatal
I have just read a VERY interesting article in the June 1996 Midirs. The title of the article "Birth: medical emergency or engineering miracle?" does not do the content justice. This is one of the best accounts of the mechanisms of labour that I have read. It is great ammunition for those who are adamant about allowing women freedom of movement and choice of posture for birth. For example, contrary to so much of the literature out there (promoting the curved back), the author says that instinctive back arching by the woman in late second stage is a way to make enough room to allow the baby's head to be born without traumatizing the pelvic floor and allows the shoulders to enter the pelvis.
One of the most amazing things about the article is the observation that, contrary to reports in earlier texts, most babies in (multigravidas) enter the pelvis at term in an ROL (or ROT) position. The reason I found this so validating is that I have always doubted my palpation skills because I seem to ALWAYS find babies in this position at term. I thought they were supposed to be in an LOA position which is what the texts always said (Varney says most common position at labour is LOT (which may be correct for primigravidas)). So, maybe my experience has been more normal than what the texts say.
There are lots more gems in this article.
Various CNM Statistics and Studies
JOINT STATEMENT OF PRACTICE RELATIONS
BETWEEN OBSTETRICIAN/GYNECOLOGISTS AND CERTIFIED
About CNMs and the ACNM
About Midwives as Primary Care Providers
How DEMs can Supplement CNM Praise That
Notes from Sheila Kitzinger Talk - "Crisis
in the Perinatal Period".
If Obstetricians Were Bus Drivers
Medical and research texts are quoted often. Most writers will
allow you to quote with their permission if you are writing a text
for publication, because you are actually promoting their work. In
normal speech, letters and emails, mailing lists, etc. it is
perfectly fine to quote sources. You should feel comfortable
You have got to read an article in the March 97 Lancet
entitled "Pregnancy in the 21st Century". From Britain
(obviously), this is looking at the future of maternity care. Some
of the things the author points out as already-known facts are
quite interesting, such as stating that "it is now clear that many
of these procedures [obstetric interventions such as AROM, EFM,
epis, making moms NPO or ice chips only, etc.} are of value only
in specific circumstances, if at all". Oooh! I like this guy!
Another fact: "in low-risk women, the place of birth has little
effect on the outcome of labour, in terms of safety". He goes on
to say that we do not, as a society, force the population to
travel by rail rather than by car, just because safety statistics
are marginally better. Restricting choice as to place of birth on
similar grounds would be illogical. He also talks about how the
"doula" help interrupt the "intervention cascade". He does foresee
that all breeches and twins will be C-secs in the future, but
maintains that the bulk of prenatal, antepartum and postpartum
care will be provided by midwives, and that the "surgeons" will
still be needed, but on a greatly restricted basis.
10 Big Myths
about copyright explained
You are assisting at someone else's birth. Do good without show or fuss. Facilitate what is happening rather than what you think ought to be happening. If you must take the lead, LEAD SO THE MOTHER IS HELPED, YET STILL FREE AND IN CHARGE. When the baby is born, the mother will rightly say: We did it ourselves!From the Tao Te Ching, Lao Tsu (450 BC)
The State vs.
Midwives: A Battle for Body and Soul by Carolyne Pion
As hokey as it sounds we walked in the local parade this last Saturday w/ a 10 ft. banner that read - MIDWIVES - We had nurse midwives, licensed, CPM's, and lay midwives walking. Our clients ranging from an anesthesiologist to my 26yo very pg daughter and her 2yo son. Another 50 or so feet after - we walked w/ another 10' banner that said HOMEBIRTH. One of my clients that had all six chillens underwater had all kinds of creative waterbirth signs that her darling children carried about like "glug, glug, born in a tub!" Stats on safety of HB on a sandwich board carried by a woman that birthed twins vaginally. Had many other folks like a NICU nurse that had a sign that read Homebirth RN on and on.... We used a classic '53 Ford truck and decorated it w/ Happy Birthday and Happy Mothers Day balloons etc.
The last time I did this some yrs back I got a beautiful draft
horse carriage to pull us - The sign I made read: "Midwives
Yesterday, Today and Tomorrow!"
BookCrossing is a concept of "releasing" a book into the big wide world so that others can read it and pass it along. The hope is that they will also record something about when/where they found the book and what they thought of it. It's a fun way to appreciate the way objects move around in the world and to share your interests.
Well . . . it occurs to me that this would be a fun thing to do
with a variety of books that are directly or tangentially about
birth and midwifery, such as BabyCatcher or some fun parenting
books or some of the Joseph Chilton Pearce or APPPAH/bonding
books. Kind of a way of bringing birth more into the public
consciousness as a topic of general concern instead of leaving it
in the medical section. There are a lot of people who might
not go out of their way to read a book like this, but there's
something more interesting about a book that you serendipitously
find in your path. If you've got some books that are
otherwise languishing on your shelves and want to get them
might be the answer.
Your Baby Your Body Your Midwife - a campaign for one-to-one midwifery care in Scotland from Glasgow Birth Choices
This campaign cites the Cochrane Collaboration as the authority for these benefits:
We know that the midwifery model of care is better & safer -
the Cochrane Database (an independent international organisation)
now lists eleven controlled trials that demonstrate
statistically-proven better outcomes for mothers & their
babies. The care of ONE midwife who provides you with all of your
antenatal checks, attends you in labour & continues her
support in the postnatal period has the following benefits for
mothers & babies:
1. Shorter, less painful labours (something every woman would support)
2. Less use of pharmaceutical (drug) pain relief(which can have harmful effects on both mother & baby)
3. Less likelihood of operative vaginal delivery (such as forceps & ventouse)
4. Better APGAR scores for babies at 5 minutes (the test used to determine the condition of babies at birth)
5. Less likelihood of caesarean section (major abdominal surgery which can also have serious side effects)
of care by well-trained breastfeeding counselors improve a
mother's perception of support?
Ekstrom A, Widstrom AM, Nissen E.
Birth. 2006 Jun;33(2):123-30.
" . . . the mothers were more satisfied with emotional and
informative support during the first 9 months postpartum. The
results lend support to family classes incorporating continuity of
Mother's Feelings for Her Infant Are Strengthened by Excellent
Breastfeeding Counseling and Continuity of Care
Anette Ekström, PhD, RNM and Eva Nissen, PhD, RNMTD
PEDIATRICS Vol. 118 No. 2 August 2006, pp. e309-e314 (doi:10.1542/peds.2005-2064)
CONCLUSION. . . . guaranteed continuity of care strengthened the
maternal relationship with the infant and the feelings for the
Maternity Care Facts and Figures, December 2009 from childbirthconnection.org
California Cesarean Rates 2011
CDC has just released
on 2008 births in the US - c-section rate increases for the
12 consecutive year to 32.3%
the Numbers by Professor Eugene DeClercq - a great video!
It explains, among other things, how the c/sec rate has risen in all the subgroups of people on whom the cesarean rate is being blamed. That means it isn't about the women; it is about changes in practice.
National Vital Statistics Reports - Volume 58, Number 11 March 3,
Trends and Characteristics of Home and Other Out-of-Hospital Births in the United States, 1990–2006
by Marian F. MacDorman, Ph.D., and Fay Menacker, Dr. P.H., C.P.N.P., Division of Vital Statistics
Eugene Declercq, Ph.D., Boston University School of Public Health
These are great statistics to have on hand.
United States Birth Statistics Compiled by Marsden Wagner, MD, Consultant for World Health Organization 2001
1. Percent of countries providing universal prenatal care that
have lower infant mortality rates than the US: 100%
2. Percent of US births attended by midwives: 4%
3. Percent of European births attended by midwives: 75% 4. Number of European countries (Great Britain, France, Germany, Netherlands, Belgium, Denmark, Sweden Norway, and Finland – all with over 75% of midwife-attended births) with higher perinatal mortality rates than the US: 0
5. Average cost of a midwife-attended birth in the US: $1200
6. Average cost of physician-attended birth in the US: $4200
7. Health care cost savings if midwifery care were utilized for 75% of US births: $8.5/billion/ year.
8. Health care cost savings by bringing US cesarean section rate into compliance with WHO recommendations: $1.5 billion/year.
9. Health care cost savings by extending midwifery care and demedicalizing births in the US: $13-20 billion/year United States Birth
Linked Birth/Infant Death Data Sets - DVSs entire collection of linked birth/infant death micro-data sets, together with User's Guides, are now available for download from the NCHS Internet. Period linked files are available for 1995-2004. Birth cohort linked files are available for 1983-1991 and 1995-2002. The vital statistics data file download page is available at: http:
2005 Natality Public Use File - The 2005 natality public use
micro-data file is now available for download at: http:
The 2005 file joins natality public use files for earlier years
(1968-2004) already on this site. Consistent with the latest
agreements between NCHS and NAPHSIS, beginning with the 2005 data
year, US public use micro-data files excludes all geographic
detail (state, county, and city). Users requiring state and county
information are directed to our online data access tool VitalStats
where they can create custom tables based on state and county of
mother<92>s residence. The current policy for release and
access to vital statistics is available at: http:
Resources from the California Maternal Quality Care
Births: Preliminary Data for 2005
The CDC's National Center for
Mothers II Survey Report - a 2005 national survey of women
giving birth in U.S. hospitals by Childbirth Connection.
They found that 33% of first-time mothers had cesarean surgery.
2003 Assisted Reproductive Technology Success Rates Report,
Breast and Cervical Cancer Program Highlights,
Diabetes and Pregnancy Frequently Asked Questions,
Fertility, Family Planning, and Reproductive Health of U.S.,
on Maternal Request - 2003 Data from the National Vital
Statistics reports, Vol 54, Number 2, (116 pdf pages)
In 2003, the latest year statistics are available, there were 4,089,950 births.
Cesarean Rates for First Births and Repeat Cesarean Rates for
Low-Risk Women: United States, 1990-2003
[12/13/05] - We are pleased to announce the launch of the website
This is a free resource developed for those needing support with
qualitative data analysis (QDA) and those learning to use a
Computer Assisted Qualitative Data AnalysiS (CAQDAS) package. The
website is aimed principally at researchers and postgraduates, but
will also be suitable for some undergraduates.
Reading Room is designed to provide state policymakers with
easy access to research and resources related to early childhood
health and development. The reading room is not meant to
provide a complete list of all resources currently available on a
given topic. Rather, it includes material that has proved of
particular interest to state officials as they have worked to
improve the quality of health and developmental services provided
to young children. We welcome suggestions for addtions
to these pages.
MY HANDS- A birth record book for midwives" by Patricia
Edmonds and Heather McCullough.
With cover illustration by Rhonda Baker.
This record book was designed for midwives by midwives who share the desire to have an accurate record of personal birth experiences. We created this book to honor the midwifery tradition of remembering and keeping the tales of the women and babies we are called to serve. This book also assists midwives to easily compile statistics while remembering the heart of birth by retelling the birth story. Contact Pat Edmonds at 503-359-4109, or e-mail her at: Nibs26@aol.com or email@example.com
First Breath Productionsnto My Hands Midwifery, 3839 Pacific Ave, Suite 189, Forest Grove, OR 97116
The Office on Women's Health (OWH) and the National Women's
Health Information Center (NWHIC) is proud to announce the launch
of our new and comprehensive National Women's Health Indicators
Database (NWHID). This is a FREE online tool, which can be
accessed at www.healthstatus2020.com/owh/select_variables.aspx
or through the NWHIC site at www.womenshealth.gov/
CDC Data and Statistics
The Alan Guttmacher
Institute - "for the latest information and analysis on
sexual and reproductive health and rights in the United States and
From Giving Birth - A Journey into the World of Mothers and Midwives by Catherine Taylor:
Did you know? Midwife-attended births in the United States have doubled in the past ten years. Midwives have a 19% lower rate of infant deaths and a 33% lower rate of neonatal mortality (infant death in the first month) than doctors attending comparable births. Midwives who attend hospital births have a cesarean rate that is half the national average. The dutch have the lowest percentage of babies and mothers who die or are injured during childbirth. they also have the lowest rate of medical intervention at birth. 70% of their births are with midwives and 1 in 3 births take place at home.
So does BirthChoice
- This website gives maternity statistics for most NHS hospitals
in the UK
March of Dimes Birth-Related Statistics
Israel Gale's Homebirth Safety
Charter - Maternity Care Section
Isle of Man Study Shows Medical
Interventions Causes Problems
With midwives' help, two in three mothers who had previous C-sections successfully delivered without surgery, the survey indicated. Nationally, only 25 percent of mothers avoid repeat C-sections.
The nation's more than 4,000 practicing nurse-midwives attended 185,000 births in the United States in 1992, or almost 5 percent of the total. Of the 185,000 births, 95 percent were in hospitals.
Those caring for predominantly high-risk patients had an average
Caesarean rate only slightly higher than 12 percent, according to
the survey of 419 hospital-based nurse-midwives and 39
free-standing birth centers.
Graph of reasons for hospital admissions - this helps me to understand why doctors are so opposed to homebirth!
Average Length of Hospital* Stay, by Diagnostic Category†
--- United States, 2003 - the average length of stay for
"delivery" is 2.6 days.
Lessons at Indian Hospital About Births - NYTimes [3/6/10]
Midwives attend most of the births in which the babies are born
vaginally and staff the labor ward around the clock. One of the
OBs is quoted "midwives are better at being there for labor than
doctors are. Midwives are trained for it. It's what they want to
do!" I can imagine the collection whoop of joy I'll hear when many
of you read another doctor's quote "Doctors in Tuba City are free
to "think about what's best for the patient and not what covers
Care: Much Lower Rates of Cesarean Sections for Low-Risk Women
Planned Hospital Birth Attended by Midwives Compared with
Physicians in British Columbia
Patricia A. Janssen PhD, Elizabeth M. Ryan RM, BScN, Duncan J. Etches MD, CCFP, FCFP, Michael C. Klein MD, CCFP, FCFP, FCPS, Birgit Reime DScMPH (2007)
Birth 34 (2), 140–147.
Results: Adjusted odds ratios for women planning hospital birth attended by a midwife versus a physician were significantly reduced for exposure to cesarean section (OR 0.58, 95% CI 0.39–0.86), narcotic analgesia (OR 0.26, 95% CI 0.18–0.37), electronic fetal monitoring (OR 0.22, 95% CI 0.16–0.30), amniotomy (OR 0.74, 95% CI 0.56–0.98), and episiotomy (OR 0.62, 95% CI 0.42–0.93). The odds of adverse neonatal outcomes were not different between groups, with the exception of reduced use of drugs for resuscitation at birth (OR 0.19, 95% CI 0.04–0.83) in the midwifery group.
Conclusions: A shift toward greater proportions of
midwife-attended births in hospitals could result in reduced rates
of obstetric interventions, with similar rates of neonatal
morbidity. (BIRTH 34:2 June 2007)
Maternal Mortality Ratio Has Doubled in 23 Years [12/9/14] - The US pregnancy-related mortality ratio has continued to increase, rising to 16.0 deaths per 100,000 live births. The latest epidemiologic data from 2006 to 2010 suggest that cardiovascular conditions and infection contributed to the increase in pregnancy-related mortality.
Deaths Are on the Rise in the United States [5/12/14] -
Maternal deaths are on the rise in the United States, making the
country one of just eight in the world to experience the increase.
In a report published this month in The Lancet, researchers at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in Seattle reported that between 2003 and 2013, Afghanistan, Belize, El Salvador, Guinea-Bissau, Greece, Seychelles, South Sudan, and the United States were the only countries to have had increases in maternal mortality rates.
Assesses Preventability of Pregnancy-Related Deaths
Pregnancy-Related Deaths: Results of a State-Wide Review.
Berg CJ, Harper MA, Atkinson SM, Bell EA, Brown HL, Hage ML, Mitra AG, Moise KJ Jr, Callaghan WM.
Obstet Gynecol. 2005 Dec;106(6):1228-1234.
CONCLUSION: Despite the decline in pregnancy-related mortality
rates, almost one half of these deaths could potentially be
prevented, mainly through improved quality of medical care.
In-depth review of pregnancy-related deaths can help determine
strategies needed to continue making pregnancy safer.
and Mortality - Annotated Lists of Organizations on Key
Topics in Maternal and Child Health from the Maternal and Child
pregnancy-related mortality in the United States and Europe.
Deneux-Tharaux C, Berg C, Bouvier-Colle MH, Gissler M, Harper M, Nannini A, Alexander S, Wildman K, Breart G, Buekens P.
Obstet Gynecol. 2005 Oct;106(4):684-92.
Pregnancy-Related Death Underreported
Pregnancy-Related Mortality in the United States and Europe.
Deneux-Tharaux C, Berg C, Bouvier-Colle MH, Gissler M, Harper M, Nannini A, Alexander S, Wildman K, Breart G, Buekens P.
Obstet Gynecol. 2005 Oct;106(4):684-692.
CONCLUSION: This study shows the limitations of maternal
mortality statistics based on International Classification of
Diseases cause-of-death codes alone. Linkage of births and deaths
registers should routinely be used in the ascertainment of
pregnancy-related deaths. In addition, extension of the definition
of a maternal death should be considered. Beyond pregnancy-related
mortality ratios, considering the specific distribution of
causes-of-death is important to define prevention strategies.
Statistics Division - Millennium Indicators has maternal
Worldwide Maternal Mortality Statistics
United Nations Report on Maternal
WHO Statistics on Maternal Mortality -
in the United States: Where Are the Doctors? (Illinois
Notes from Marsden Wagner on Maternal
statistics, England: 2003-04
mortality in the past and its relevance to developing countries
American Journal of Clinical Nutrition, Vol. 72, No. 1, 241S-246s, July 2000
"Midwives in the Kentucky Frontier Nursing Service traveled on
horseback to assist with deliveries, which were all at home in a
poor rural farming community with low living standards. Despite
the poverty, maternal mortality rates were 10 times lower than
those in the nearby city of Lexington and the United States as a
See also: Lower Cesarean Rates
Neonatal Mortality for Primary Cesarean and Vaginal Births to
Women with "No Indicated Risk," United States, 1998-2001 Birth
Macdorman MF, Declercq E, Menacker F, Malloy MH.
Birth. 2006 Sep;33(3):175-182.
Results: Neonatal mortality rates were higher among infants
delivered by cesarean section (1.77 per 1,000 live births)
than for those delivered vaginally (0.62).
second worst newborn death rate in modern world, report says
Fact Book - rank order of countries for infant mortality.
of Infant Health: Is There Trouble Ahead? - Discussion of
the 2003 ranking of the US as 28th in infant mortality rate.
of Infant Mortality Rates, 1994 from the March of Dimes
From the 1994 Population Reference Bureau, Inc, the Infant Mortality Rate for the US is: 8.3, and Canada is 6.8. The world IMR is 63, Africa is 92. This means Infant Deaths per 1000 live births. The "World Population Data Sheet" can be obtained from the PRB at :202:483-1100. It lists every country in the US, but does not tell us where we are in comparison. Africa hits over 100. Western Europe is the lowest with an overall rate of 6/1000. Japan is 4.4/1000. Ranking is 24th.
Do you believe in Midwifery Solidarity?
This is where midwives have unity and are able to work together for the good of midwifery - all midwives.
to members of Congress re: CPMs as healthcare providers
Bridge Club's Letter to
ACOG re: Improper Term "Lay Midwife" [March, 2006]
See also: Midwife/Doula
Pheromones Reduce Labor Pain
There are many different types of midwives, and each state may
create its own midwife designation. In a number of states,
their state licensing program uses the same standards as the
NARM CPM . . . in those states, a Licensed Midwife is
functionally equivalent to a CPM.
I sometimes see direct-entry midwives described as "midwives who do not have a formal nursing education". I'm troubled by this negative description. I'd much rather see a description of direct-entry midwives as "midwives trained specifically in the midwifery/non-medical model of care" or "midwives who learn relevant nursing skills in a process integrated with their midwifery education" or "independent midwives" or "autonomous midwives" or anything with a more positive ring to it.
I think it's important to emphasize that the model of specializing directly in midwifery rather than taking a detour through nursing is the model followed in most of the world. I think it helps also to explain that midwifery as an autonomous profession was largely eliminated in the United States in the first half of the twentieth century through the specific actions of obstetricians, and that it reappeared as an offshoot of nursing, which is how we come to have nurse-midwives. Yes, there is lots of overlap between nursing and midwifery, especially among homebirth midwives, who end up providing the nursing care in addition to midwifery care, but it's important to avoid the implication that direct-entry midwives have no nursing skills.
Corollary: I'm amused that people imagine that you can't provide
competent midwifery care without being a nurse first. Do
they worry that OB's can't be competent birth attendants because
they didn't train as nurses first? I'm waiting for a new
class of birth attendants . . . nurse-OBs!
Midwifery is a seperate profession to nursing and is certainly not a specialist branch of it. It is like saying that nursing is a specialist branch of medicine.
Many Midwives have never trained as nurses, and most now enter the profession through a Midwifery degree at university.
Midwives are autonomous practitioners and are the primary carer for the vast majority of women during their pregnancy. Provided a pregnancy is progressing normally a woman need never see a doctor.
Midwives are Midwives, not specialist nurses, and it is insulting
to them & misleading to the public to say otherwise.
A family practice doc's article refers to "professional
midwives". I think this is a great alternative to CNM or DEM
What is the meaning of "professional midwife" and how is it
different than "midwife"? aren't midwives professional, and
don't need a designation telling us so? I can't think of any
other profession that gets this, other than sports, and there are
plenty of people who are not professional sports players, so the
designation means something. I myself am a little annoyed at
the implication that "midwife" alone doesn't indicate a level of
training and professionalism.
Actually I appreciate the use of it, as opposed to him having specified "Certified Nurse Midwives" or something more specific than that.
I see it as an opposition to those who continue to use the term 'lay midwife'. We need to get away from that, as its been hijacked to make people think 'unqualified'. Yes, I think midwife by itself SHOULD be enough, but for most people its a 'huh?' moment.
Using Professional Midwife, in my opinion, is inclusive of all midwives, regardless of route of education. If I had to define it, I could probably only justify it to mean CPM's, LM's, CNM's, CM's... in other words, those who are recognized by some professional agency or government. Yes this might exclude those who were educated by a preceptor model, and then never took the NARM exam or sought some other recognition. There are WONDERFUL, EXPERIENCED midwives out there I've just described, but professional DOES mean there are standards. If midwifery wants to be a profession- recognized, respected, reimbursed, etc. then there should be professional standards. NARM is a perfect example.
I don't think those midwives should stop practicing... they've
got years and reputation under their belt. But I do think
new midwives should seek recognition. We will never be able
to fight the push for Academic education (and more and more of it)
without a recognition of alternative routes of education also
For over 100 years the AMA and other medical groups in the USA (to say nothing of European witch burnings in the middle ages) have sought to portray midwives as ignorant, uneducated, dangerous, quacks, witches, herbalists, satanic....and so we midwives have to prove to the American public, health care policy makers and insurance reimbursers that we are credible, safe professionals, not simply because we are midwives but because we have some authoritative agency (NARM, ACNM, a state licensing board) credentialing us as such. We have worked long and hard, donating our time and resources for years, to create those agencies and mechanisms to be able to demonstrate to state legislatures, the medical, public health and insurance communities, in ways they respect, that we are professionals.
Some midwives are philosophically and/or spiritually opposed to credentialing. In an ideal world midwives would be able to practice without state licensing if they so choose, and at the same time all direct-entry midwives in all 50 states would be able to meet reasonable (not excessively burdensome) qualifications to earn a state license, and the consumer would exercise informed choice to pick the midwife that best meets her needs. I had a conversation with Kitty Ernst several years ago about the ACNM's movement toward ever increasing their length and advanced academic degrees required for mandatory midwifery education. I said and still do that ultimately the criteria for a midwife is and should be: does she have safe outcomes and do her clients return to her for care in their next pregnancy. But sadly we live in a country where midwifery is not respected and is under-utilized, and as Ina May says, with "a health care industry, not a health care system" and the results are unacceptable rates of cesareans, VBACs, neonatal, infant and maternal morbidity and mortality that break our hearts. We are caught in this uniquely American system where politics and power trump evidence-based practice and so we all struggle with how to best promote midwifery as an option for women in all birth settings, given the increasingly hostile birthing climate that exists in the US today.
We need to find a way for all the branches of midwifery in the US
to work together instead of against one another, if we are ever
going to get it done.
Naturally Occurring Midwives
Midwives - a description of Licensed Midwives in New
Mexico, which probably applies equally well to California,
Washington, Florida and other states that license direct-entry
Midwifery: A Feminist Perspective by Martha J. Blizzard
White, April 1997
Midwifery System by Beatrijs Smulders
Public Citizen Study on CNM Outcomes - Nov 1995
Nurse-Midwives a Better Option for most Pregnant Women
News Release-Public Citizen Health Research Group, August 31, 1997
Women with low-risk pregnancies receive fewer obstetrical interventions when cared for by midwives, compared to women attended by physicians
in the obstetric care of low-risk women.
Rosenblatt RA, Dobie SA, Hart LG, Schneeweiss R, Gould D, Raine TR, Benedetti TJ, Pirani MJ, Perrin EB.
Am J Public Health. 1997 Mar;87(3):344-51.
CONCLUSIONS: The low-risk patients of certified
nurse-midwives in Washington State received fewer obstetrical
interventions than similar patients cared for by
obstetrician-gynecologists or family physicians. These differences
are associated with lower cesarean section rates and less resource
Cesarean Sections: The Nurse-Midwifery Solution
CNM Compares and Contrasts Homebirth and
A Direct-Entry Midwife Explains Her
of the African-American Midwife
A German midwife has recently written the following to me in a letter explaining midwifery culture in Germany. I love it.
"And a good thing is that still a law is valid which says that a
midwife has to be called to every birth. That means a doctor is
not allowed to accompany a birth, without trying to get a midwife
there. On the other hand, midwives only have to call a doctor if
there are complications. "
Preparing for Birth
1st baby: You practice your breathing regularly.
2nd baby: You don't bother practising because you remember that last time, breathing didn't do a thing.
3rd baby: You ask for an epidural in the 8th month.
1st baby: You practice your breathing regularly.
2nd baby: You change doctors/hospital because the first birth was "taken away" from you and your choices were not honored. You use lots of alternative methods for coping with pain and spend time in the shower and tub; you birth without drugs.
3rd baby: You use a midwife as your primary caregiver and finally have the birth you wanted in the first place.
See also: Midwifery Organizations from motherstuff.com
See also: Professional
Links - A summary of Midwifery links from around the world
Home Midwifery Association
(QLD) in Australia
of Radical Midwives - they also have their own UK Midwifery
England - Big
shake-up for maternity care - The government has promised
mothers choice by 2009 [2/6/07]
Some English hospitals should be stripped of doctor-led maternity care and specialist children's services, a government adviser says.
Hospitals that lose maternity units may get midwife-led services and more support for home births will be provided to give women greater choice.
in Hungary - Agnes Gereb, the pioneer of home births in
Hungary faces jail [3/11/10]
Midwives to take lead role in stand-alone Northern Ireland maternity units. [Belfast Telegraph - 29 July 2004 - By Nigel Gould, firstname.lastname@example.org]
Home Birth Association of
International Guild of
Traditional Midwives - "Preserving the Values of an Honored
Profession" - IGTM has been founded as a cooperative effort to
serve the needs of traditional midwifery practitioners. We offer
resources and fellowship formidwives who define their practice as
community or traditionally based care.
The Midwives Alliance of North
America (MANA) is an organization of North American midwives
and their advocates. MANA's central mission is to promote
midwifery as a quality health care option for North American
Certified Professional Midwives Guild, Office and
Professional Employees International Union , Local 54, AFL-CIO-CLC
New Zealand Midwifery Council
New Zealand College of
Citizens for Midwifery
lists many state-level
Alabama Birth offers this
fabulous video on You Tube - Alabama
Mothers Deserve Midwives
Californians Advocating Licensed Midwifery - This group was organized by LMs to advocate for positive legislation.
California College of Domiciliary Midwives - Representing the Legal & Legislative Issues of California Licensed Midwives.
California Citizens for
Health Freedom - Frank Cuny has a lot of experience with
California law, and CCHF has been active in supporting Licensed
Midwifery in California.
Florida Friends of Midwifery is a consumer awareness group with information on citizen action, parenting links, and a "Find A Midwife" section.
Midwives Association of Florida
Georgia Friends of Midwives
Indiana Midwives Association
Iowans for Birth Options
Kentucky Alliance for the Advancement of Midwifery
Maryland Friends of Midwives
Families for Safe Birth
Legalizes Home Births With Midwives
Massachusetts Friends of Midwives
Michigan Midwives Association
Missouri Midwives Association
Friends of Missouri Midwives (FOMM)
Ohio Friends of Midwives
Association of Texas Midwives
Texas - HANSA -
Homebirth Awareness Network of San Antonio
Virginia Birthing Freedom, Inc.
Citizens for Midwifery - Midwifery in Virginia
Birth Matters - Virginia
Midwives' Association of Washington State (MAWS)
ACNM - Washington Chapters Web
On February 21, 2000, the Washington State House of Representatives adopted a resolution (House Resolution No. 2000-4753) "That the House of Representatives recognize and honor the many significant contributions midwives have made to the health and well-being of our citizens"
of West Virginia
Regulating Midwives and Legislation
History of Midwifery Discussions on the
The First Midwife
and The Bible by Larry Overton
midwife's diaries from a century ago - Annie Hanson
Christensen, an immigrant from Denmark, attended the births of 406
babies in and around Eastport, Maryland, between August 1898 and
August 1908. Historian Ginger Doyel found her diaries.
Midwife’s Tale: The Life of Martha Ballard, Based on Her Diary,
1785–1812 by Laurel Thatcher Ulrich from Midwifery Today
Mountain of a
midwife - Orlean Puckett lost 24 babies but gained a
thousand children. Orlean Puckett lived in the Blue Ridge
mountains of Virginia, and attended over 1000 births between 1890
Read more at answers.com and from African American Studies Center
a Long Way, Babies - a history of childbirth from Mothering
History of Midwifery and Childbirth in America: A Time Line,
Prepared by Adrian E. Feldhusen, Traditional Midwife
Faith Gibson's letter of Sept. 11, 2004, contains a masterful summary of "The History of Obstetrics" about halfway down the page. Really, her whole site is of inestimable value to historians. Read Overview of historical situation -- official plan to eliminate midwives.
She has a set of web pages about midwifery history - Historical
- International Journal of Domiciliary Midwifery
the Safety of Home Birth and Hospital Birth by Misty Dawn
Richard - a dissertation containing an excellent summary of
midwifery history and current issues.
All about Martha Ballard
- Maine midwife who kept a diary from 1785 to 1812.
Struggle for Midwifery in Ontario by Ivy Lynn Bourgeault -
An account and analysis of the first attempt to professionalize
midwifery in Canada.
Primitive Peoples by George J. Engelmann, 1884
Obstetrics and gynecology in ancient Egypt - this is really about midwifery in Egypt . . . there is no mention of operative delivery in the abstract.
Obstet Gynecol Reprod Biol. 2005 Nov 1;123(1):3-8.
Reproduction concepts and practices in ancient Egypt mirrored by modern medicine.
Haimov-Kochman R, Sciaky-Tamir Y, Hurwitz A.
midwife in central georgia...Miss Mary Coley. The film was
used to train illiterate midwives in the US, then adopted by
Unicef. It's been restored and now avail on DVD.
Digital Library - National Library of Medicine - a digital
library project providing scanned historical American medical
books in pdf and as searchable text files
1659 Midwifery TextBooks Description
MedHist - The guide
to history of medicine resources on the Internet
Ina May Gaskin from Salon
and Obstetrics - The Loss of Childbirth to Male Physicians
by Shira Happlin
Best Means of Combating Infant Mortality - by Abraham
Jacobi, M.D., President of the American Medical Association, New
President's address before the American Medical Association, at the Sixty-Third Annual Session, at Atlantic City, June, 1912.
Includes comments about the training of midwives.
History of Midwifery in America by Beth Overton ~ May 23,
1996 (revised June 10, 1998)
History - Mail-Order Resources
and Sexuality by Sasha Haarhoff, RN - This includes history
relevant to the role of midwives and birthing women in the
Colonial United States.
Apparently, Dickens didn't have a great opinion of midwives, as
another tippling midwife appears in Oliver
introduction to Oliver Twist, Mrs. Sairey Gamp is described
as a "dirty, drunken old midwife and nurse".
Gynecology in the Ancient World
Papers in Neonatal Medicine, Classic Books in Neonatal/Perinatal
Medicine and Other Interesting Historical Sites
From The Dark Side of Modern Medicine - An interview with John
Robbins. Includes discussion of how poorly the medical
establishment "treats" cancer, schoolchildren, and birthing women.
It includes mention of the trial of the twentieth century:
[The BirthLove site is by subscription only - it's well worth the
$10 membership fee; you can get a "sampler" by reading BirthLove's
Top Twenty- For Free!.] [Ed: birthlove.com is not available
at this time.]
"In the early 80s, a group of chiropractors in Chicago...sued the
AMA for conspiring to destroy and eliminate the chiropractic
profession...the AMA was found guilty of intentionally conspiring
to destroy their competition, and the verdict was upheld by the
U.S. Supreme Court. During this lengthy and hard-fought case, the
AMA spent over $20 million in legal fees to defend itself, and
still lost. Nearly 1 million pages of documentation entered the
public record, and many of those documents were from the AMA's
internal files. It was revealed quite clearly that, for many
years, the AMA had deliberately and systematically conspired to
destroy not only chiropractic, but midwifery, homeopathy,
naturopathy, and herbalism. The whole collection of what we call
wholistic and alternative medicine had been the AMA's target for
destruction." -John Robbins
The radio game show, "Says You", had a "guess the definition"
segment for the word nidget: the person sent to fetch the midwife.
Deborah Davis has used feminist postmodern theories to explore case-loading midwifery practice in New Zealand. She focuses on the obstetric setting and describe the way that midwives "make space" for childbirth. Here is a brief abstract from a conference presentation:
"Making Space for Birth - In their daily work case-loading midwives traverse space. They visit childbearing women or attend childbirth in their homes, they may spend time in clinics or a variety of hospitals; smaller primary birthing units or larger obstetric hospitals. They spend their days engaging with childbearing women, their family or supporters and with obstetric or midwifery colleagues. As they move across space and between people, they traverse a variety of physical and discursive spaces.
Midwives journey into the intimate space of the childbearing woman attempting to understand their subjective experience and the way that this pregnancy and childbirth is situated within the landscape of their life world. They travel with this understanding as they negotiate other spaces; the biomedical space of the maternity context and obstetric hospital and the spaces of their own constructions of childbirth. Ultimately they work to create a space for birthing that is perhaps unique to each midwife, woman pairing. The obstetric hospital setting provides midwives with particular challenges as they work to create, maintain and protect the birthing space of the women in their care. Midwives engage in a variety of strategies to this end and these will be explored in this presentation.
This work is based on Deborah’s PhD study that explores the
discursive construction of case-loading midwifery in New
Zealand. The practice of case-loading midwives within the
obstetric hospital provides a focus, surfacing the contested
nature of maternity care and illustrating the way that midwives
negotiate this contested terrain.
So why aren't HMOs beating down the doors of midwifery practices?
It took me a long time to understand this, and (of course) it's not as simple as it seems. I have a Master's in Health Services Administration, and when I was in graduate school and asked the same question, this is what I was taught:
1) Payors (for example HMO's, but also other insurance companies) do not see midwives as a cost savings, but as an additive cost. Since the supply of physicians is not decreasing, they figure that if they add midwifery services as a covered benefit them their costs will just be higher in the long run because physicians will charge more, as they will not tolerate a substantial drop in income.
2) All of the plans are owned and/or controlled by physician
groups. They don't want the competition. Plain & simple.
The flaw in this thinking is that fees are set by the HMOs. Doesn't matter one iota what the physicians charge....the HMO reimburses what *it* wants. The HMOs we contract with send contracts yearly saying "We have cut your fees 25%, take it or leave it." The HMOs set the fees, not the providers. So, since midwives can deliver babies more safely and more cheaply, it behooves the HMOs to use MWs as providers. The MDs cannot, by virtue of the HMO contracts, increase their fees to *catch up*.
>2) All of the plans are owned and/or controlled by physician
groups. They >don't want the competition. Plain & simple.
I'm not sure this is true, although I do not have the stats to back up this claim. I know the docs in my practice are really pissed re the HMOs, and the control of our practice by bean counting insurance types. Some of the IPAs with which the HMOs contract may be MD controlled, but I do not think the HMOs themselves are.
They may not be "controlled" by MD’s, but look frequently who the CEO is for instance. I find the issue of power really interesting. I was part of a practice in a hospital that had the history of being the "country" hospital. That is, their typical clientele consisted of women of color, poor, immigrant, non-English speaking, adolescents, you get the picture. Our practice loved working with these women. THEN, an HMO bought the hospital because it also was debt free. 4 years later: the midwife service is down 3 people secondary to layoffs done because of budget decisions. The HMO clearly has made it their priority to get the white yuppies in from the suburbs to this hospital. To do this, money has been spent changing the name, painting everything, building a parking ramp and putting in valet parking. So, yes, everybody KNOWS that midwives do well with women defined as "high risk" due to social conditions, BUT, what is see is that FPs are seen as the salvation because they are cheaper than OB's, but are really drs, so can do more. In my book in a major metropolitan city, it seems to me that in women's care, they need to consult for most of the same things I have to. Our midwives had a 8% c/sec rate and the FP's had a 15% rate. Needless to say, the HMO is supportive of MD's and not of the midwives who they define by using words like "mid-levels" and "physician extenders" . This has nothing to do with CPMs or DEMs not getting along as other posters here have said. This is about people in an ivory tower ignoring the good research out there about what we do and trying to provide care as cheaply as they think they can. So, the administrators give MA contracts to the FP's that the CNM's can accept and they cut 3 midwives, expecting the remaining 10 to do the same amount of work. I for one am so burnt on the system that I have fantasies about another career. I hope the pendulum swings back soon before we have destroyed anything good in this system or the midwives have all gone crazy or retired!
The most shocking thing about ACNM convention last year was the fear evidenced by so many midwives from around the country. When the issue of "letting" non-nurse graduates of the new SUNY program into the college was discussed, the biggest response was along the lines of "What will ACOG think? Will this "confuse" the public"?" almost as though we had to ask permission to do something so bold as to re-define our very own profession.
In saying all of this, I by no means want to discount the difficulties of the previous generation of midwives who felt the correct course, when faced with strong opposition, was to be accommodating and non-threatening, so that the OBs would let us "play". But I draw my evidence from not only being a second generation feminist (and seeing the "mistakes" made in that movement), but also a working knowledge of the history of revolutionary struggles.
Paradigm shifts are not brought about incrementally. I think the early midwives are to be commended for their efforts, but their strategy of getting in and THEN bringing about change was fundamentally flawed. Naturally, the majority forces more changes on the minority, than the other way around.
I think it was naive to suppose that once midwives got into all of the hospitals and were integrated into the staff, that everyone would "get religion" and "allow" midwifery principles into practice. What I observed, during my training, and as I meet midwives who work in hospital settings, is that they try to win "acceptance" from the medical and nursing staff by being better docs than the docs. Most of them have no knowledge of the underpinnings of "midwifery", because they NEVER GET TO SEE midwifery practiced, so their medical training is reinforced day after day. And over time, they have too much fear and too little confidence to stand up to the powers that be, despite the fact that their conscience still nags at them. They shrug their shoulders and get on with the work of abusing women.
I know that I had to work hard to learn to trust in birth, because I never got to see the outcome of non-intervention or "midwifery tricks" in the hospitals where I worked as an RN and trained to be a CNM. I had tremendous fear of (for example) intermittent monitoring. Hopefully you will all laugh along with me as I recall the first women I monitored intermittently, during my IP clinicals. I was so used to continual monitoring, that I had a hard time believing the baby was still OK, when I wasn't listening (kinda like the tree in the forest problem). I followed the protocol for a 20 minute strip every hour, but in between I would get nervous, and do a real quick check (5 seconds or so) every 15 minutes, just to reassure myself the baby was still there.
When I started my training in Cooperstown, I had to restrain my urge to examine women who were struggling through transition and offer them an epidural. Intellectually, I knew they were OK, but I HAD NEVER SEEN AN UNMEDICATED LABOR (or at least not a very long one). My CNM training encouraged the application of midwifery principles, but none of our clinical sites actually applied them, so it all seemed theoretical.
I spoke with one midwife who works in a big city hospital; she had applied for a job in a private practice and spent a day doing office hours. Much to her disappointment, she was completely unprepared for the task. Women asked her about herbal remedies and alternative treatments, and she had NO IDEA what they were talking about.
For me to overcome my RN experience and my CNM clinicals, I had several things going for me: 1) I am a rebel at heart and don't take no s--t from anybody, although I think I am pretty good at being diplomatic about it. 2) I had the brave example of midwives on this list to guide me. I think about the OOH midwives who face imprisonment or worse to provide competent, woman-centered care and cannot disappoint them by colluding with the enemy. 3) I was aggressive in requesting the most "midwifery-friendly" clinical sites, Cooperstown being the best of the bunch. 4) I took on additional training, at my own expense, spending my "vacation" interning, seeing hundreds of women labor and birth under more or less "natural" conditions (by which I mean no "active management of labor"; the scene there is anything but natural, I would call it "neglected labor", as in, we ignore you until you tell us the baby is ready to come out. 5) I refused to accept a job, for my all important first CNM work experience, at which "medwifery" was practiced, knowing how greatly my first job would influence my practice.
In achieving all of this, I worked hard, and I was lucky along
the way, but I also kept reminding myself that abandoning the
principles of my chosen profession meant letting down all the
women and babies who deserve better. I am sure that all of the
CNMs face this struggle every day, especially those unfortunates
in big city hospital based practice. To them I want to say "No one
will ever give you permission to practice like a midwife, you
simply must demand it". No more good girls!!!
Midwives Talk About Homebirth
Response to ACNM's Issue Brief on
Direct-Entry Midwifery and the CPM Credential
Heard any good
midwife jokes lately? Well, after reading about the
politics, I figure you'd need some humor.
A woman in labor started shouting, "Didn't, Can't, Couldn't,
Wouldn't, Shouldn't", and the midwife just nodded happily and
said, "It looks as if she's having lots of strong
contractions." Ha, Ha.
Humor - Birth Cartoons
Sometimes midwives work with clients who decline even the mildest
interventions because they put their faith in God, or because the
trust in birth, or because they want to believe in their ability
to manifest a perfect birth without any outside assistance.
(Sometimes one wonders why they hired a midwife in the first
place?!?) Here's the helicopter
joke that midwives like to tell in these circumstances.
Holiday Gift Idea for Midwives on a
Lady's Hands, Lion's
Heart is the telling of Carol Leonard's journey as New
Hampshire's first modern midwife.
What better way to reach the masses than through romance novels!
Early is a Harlequin Superromance author who is working on a
continuing series of novels, THE MIDWIVES, which was inspired by
her experience giving birth to her son at home with a midwife in
BABY CATCHER: Chronicles of
a Modern Midwife presents both home births and hospital
births in a way meant to avoid alienating those on
either side of what too often degenerates into a heated argument about place of birth.
"A midwife should have a lady's hands, a hawk's eyes and a lion's
heart" - Aristotle
The Birth House by Ami McKay.
Monique and the Mango Rains; Two Years with a Midwife in Mali by Kris Holloway
She Births; A Modern Woman’s Guidebook for an Ancient Rite of Passage by Marci Macari.
8 pages of the current Compleat Mother (Summer 2006 Number 82)
are dedicated to articles, poetry and excerpts from both titles.
My feelings about CPM are directly parallel to my feelings about
CPAs (Certified Public Accountants). I'm glad that certification
is available, I'm glad one can still hire non-CPAs to keep the
books, and I'm glad anybody can still ask their sister to balance
their checkbook or do it themselves.
Partnership: A Model for Practice by Karen Guilliland &
Sally Pairman - A monograph presenting a descriptive model of
midwifery as a partnership between women and midwives, derived
from the authors' research in practice and personal experiences as
midwives in NZ. Includes discussions on midwifery and
professionalism, feminism, and nursing.
I have begun wondering something that often comes back to my thoughts: Why is prenatal care depicted as being so extremely important in early pregnancy? I just don't get it. What on earth can doctors (and even midwives) do at that stage to guarantee a healthy baby? I don't understand why it is so important that "studies show..." that women who receive early prenatal care have healthier babies than women who don't. And this is why I wonder:
I realize that diet is extremely important. Ideally, the caregiver would discuss and possibly educate the mother about good diet while pregnant, and if pertinent would also discuss smoking and drug use. But beyond that, the pregnancy test, the vaginal exam, the ultrasound, the AFP, the other blood tests, and usually the blood-glucose tests do absolutely nothing to improve the condition of the fetus. What some of these tests can do is help a mother decide if she wants to abort, which of course would improve the outcome statistics, but I see no positive effect they would have on fetuses.
So just what DO all these tests do to mum? They subliminally tell many moms that, while pregnant, good health is precarious, and can only be declared by a medical caregiver. The message is that mom needs medical attention in order to insure a healthy pregnancy. But is this true? Usually not, IMO. Only true high risk pregnancies really need medical care.
I guess my point is, the issue of how normally a birth will go usually starts long before mom goes into labor. Our whole healthcare system treats pregnant mothers from the negative side with an attitude of "you and your baby are only healthy after we determine you are not unhealthy." Guilty until proven innocent.
Also, as far as the studies supposedly showing that early prenatal care is associated with healthier babies, could this possibly because most women who are in decent health and care about themselves and their babies will seek early care, whereas among the group who do not seek early care you will find many who are poor and/or uneducated and/or don't eat well and/or use drugs and don't want to be caught or lectured by a doctor? Would early prenatal care matter if they didn't intend to change their lifestyles?
And my other point is, how the mother feels is so often treated
as unimportant data. If she feels great, well, she still needs
tests to determine if she really is healthy. And if she's feeling
rotten and needs more rest, well tough, she can't take time off
from work because she's "only" pregnant. Now tell me, does this
kind of prenatal care make for healthier babies???
"Of all medical specialties it is in obstetrics and gynaecology in which clinical practice is least likely to be supported by scientific evidence."
"By professing the ability to improve the health outcomes for
already healthy women and their babies, obstetricians have a
special responsibility to ensure that their practices are based on
solid evidence that they do more good than harm."
"Archie Cochrane [originator of the Cochrane
Collaboration] wondered which bits of medicine deserved the
gold medal for being the most scientifically based and which
deserved the wooden spoon for being the least scientific. . . .
eventually he decided that it was the obstetricians that deserved
the wooden spoon for being the least scientific doctors on the
planet." from a page about Too
Archie Cochrane awarded "the wooden spoon" to obstetrics, partly because "The specialty missed its first opportunity in the sixties to randomise the confinement of low risk pregnant women at home and in hospital". from a reference in the Cochrane 1996 Colloquium Abstracts - Papers:
the safety of home birth.
Birth 1997 Mar;24(1):4-13; discussion 14-6
From: Cemail@example.com (UPI)DOCTORS NOT SO GOOD WITH A STETHOSCOPE: Young doctors may be able to hold a stethoscope to their patients' chests, but a new study shows they'll understand only one out of every five sounds they hear. Researchers at Philadelphia's Allegheny University of the Health Sciences tested stethoscope skills in more than 450 internal medicine and family medicine residents and nearly 90 medical students. The doctors and students were asked to identify 12 noises linked to heart abnormalities. Dr. Salvatore Mangione, a lead author of the study, says overall, the doctors were accurate 20 percent of the time. Doctors who could play a music instrument were the most accurate. Mangione says bedside diagnostic skills have been waning, abandoned in the rush to high-tech diagnostic tests and machines that are making patients ``peripheral.'' The researchers released the findings in the Journal of the American Medical Association.
Subject: Health Today [Sep 3]
Organization: Copyright 1997 by United Press International
Date: Wed, 3 Sep 1997 0:51:08 PDT
Expecting Trouble: The Myth of Prenatal Care in America - Book Review
"Much of what passes for prenatal care in this country is unduly expensive, unnecessarily high-tech, and serves no beneficial purpose, consisting of little more than a string of pointless, largely ceremonial clinic visits, which infrequently avert the conditions we want our babies to avoid."
" . . . he concludes that the benefits of prenatal care as currently provided are overstated for the majority of mothers and that the system persists because of the economic and political benefits it affords its supporters.
"He makes a strong case for the use of nurse-midwives for
uncomplicated pregnancies and questions whether the United States
needs both specialists in maternal-fetal medicine and general
obstetricians. He believes that general obstetricians now prefer,
for financial and other reasons, to care for women with low-risk
pregnancies and consequently are "over-trained for low-risk care
and underexperienced for the difficult cases they relinquish to
maternal-fetal specialists." Moreover, he claims that most
obstetricians are not interested in, and do not ask about or try
to affect, the health behavior or social conditions that can
adversely affect pregnancy. Attention to these problems is among
the strengths of nurse-midwives, who spend more time with their
patients and appear to communicate with them more effectively. "
Wasn't there a Harvard symposium in which researchers concluded
that prenatal care was basically not efficacious?
I think we are falling prey to an overly medicalized definition of prenatal care. I'm familiar with the opinions of the skeptics who say it makes no difference. They refer mostly to the kind of prenatal care that none of you do. Things like 5 minute office visits, over-reliance on ultrasound, interventions like triple screening with no good scientific basis, and on and on...
The kind of prenatal care that we do, characterized by conservatism and relationship building, education, empowerment, etc., makes a difference. And since intrapartum is by definition prenatal, the fact that we actually ATTEND deliveries instead of farming labor out to nurses and coming in only at the last moment to "make the catch" makes a difference as well.
I almost never do a delivery without the nurses commenting something to the effect that I am so lucky that all my patients are so sweet and self-controlled---in a way it's flattery but it kind of makes me mad---how do they think I got to be so lucky?? It's because I spend so much TIME, for crying out loud.
So I stand by my original assertion that prenatal care is one of
the crowning glories of the healing arts, and one of the most
effective prototypes of preventive care.
I tell my pregnant women that prenatal care is the care they give themselves during their pregnancies, not what I do to or for them for an hour a month. My role is to give them the information and resources so that they can give themselves the best prenatal care available. I usually break this down so they can understand what I mean.
The average length of pregnancy is 266 days times 24 equals a
total of 6384 hours, and I will see them for an average of 10
times for an average of 1 hour each time which equals 10. That
leaves 6374 hours during their pregnancies when I'm not giving
them "prenatal care". If what they do during those 6000+ hours is
"good" then they are giving themselves good prenatal care. Just
showing up to my office once a month doesn't cast a magical
"low-risk" pregnancy spell on them.
In my posting haste the other day I should have mentioned that I
most certainly do not agree with the Harvard assertion that
prenatal care is ineffective. I suspect they are talking about the
"cattle car care" that typifies many prenatal appointments in this
country. I know one woman who clocked her OB at 45 seconds for a
"prenatal visit" from the time he entered the room till the time
he went out the door! This is worse than no prenatal care because
it is the illusion of prenatal care!
Sometimes I think obstetricians are all suffering from Munchausen
Syndrome by Proxy. They muck around, leave for a while, then swoop
back in to save the day. Seen *that* many times before.
When I was expecting my first baby I had appalling care. I was
told by both midwife and GP that they don't do home births
anymore. I was automatically referred to consultant care (with no
indications), had antenatal screening bloods taken without knowing
what they were for. I ended up not attending most of my antenatal
care (but still had 7 scans). I had no trust in who cared for me.
I decided to refuse everything and was convinced my baby was going
to die. I got a few baby clothes etc. ready but was sure I would
not be bringing a baby home. We didn't bond, it took me 2 years to
get over the pregnancy and birth and I had severe PND. All because
of the "care" I received. I would have been better off having no
antenatal care and an unassisted birth.
Labour of Love - University helps promote international conference - 10/11/2005 - Some of the central themes featured infertility and emotion; professional and emotional coping around birth; professional and personal experiences of traumatic events; emotions and education and breastfeeding and emotion work.
Dr Billie Hunter (School of Health Science, Swansea University) said: 'The significance of the 'emotion work' carried out in the workplace has been increasingly acknowledged over recent years. Emotion work is the work done in managing personal emotions and those of others, and is particularly important in public service work. Within midwifery, the sources of emotion work and the strategies that midwives use to manage their emotions have only recently begun to be analysed, debated and explored.'
Swansea University plans to host the next international emotion work and midwifery conference in 2007.
EMOTION. WORK OF MIDWIVES - a powerpoint presentation by Dr.
“Être là”: étude du phénomène de la pratique sage-femme au Québec dans les années 1970-1980 by Céline Lemay, the First midwife PhD in Québec
This study explores the meaning of the phenomenon of midwifery practice in Québec. After legalization of midwifery in 1999, it was acknowledged that the midwifery practice was, in spite of available information, misunderstood. There was a need to explore the world of midwives to reveal its meanings and to understand what it is like to practice midwifery. The question that was asked was: How can we understand midwifery practice from the lived experience of midwives who were practicing before legalization in Quebec? A qualitative approach was chosen to fully answer the research question. Heidegger’s hermeneutical phenomenology and Ricoeur’s philosophy as well as the methodology of M. van Manen were used to explore the internal meaning structures within the world of midwives. The lived experience of 15 midwives, who practiced before the 1999 legalization of midwifery in Quebec, was collected through in-depth semi-structured interviews. The analysis was done through writing and re-writing.
Themes were like “clearings” so as to “see” the structures of meaning underlying the lived experience of practicing midwives. Some of the themes that were discovered were: being called, being there for each woman, taking time… and space, being there to welcome the newborn, knowing how to help by doing nothing, “be ready”, learning and understanding together, develop complicity, and building a midwife presence in Québec. A very important theme was: “holding the space”, meaning that being a midwife is “being a guardian of the possibilities”, “being a guardian of the mystery”, and “being a guardian of the passage”. Finally, the essential structure of the experience of midwifery practice was: “being there”.
Hermeneutic does not pretend to generate theories but it is
essentially a practical philosophy where knowledge is given a
direction. In a context dominated by medical, technoscientific and
evidence based practice, the findings of this study were
considered as an invitation to explore new possibilities for
midwives. First, we will propose maïeutic, a dialogic
approach to knowledge and understanding wich develop analytical
skill to examine life, cope with diversity and complexity and
flourish amidst it. Secondly, we will propose phronesis or
practical wisdom, an hermeneutical enterprise, a way to mediate
between the universal and the particular. Phronesis involves
deliberation and decision in relation to a singular situation,
leading to ethical choices. In the conclusion, all the potential
for emancipation for midwives will be presented.
MIDWIFE GENIUS ABROAD - Around the age of 17, students in Denmark
take a standardized test that determines their educational fate
and, ultimately, their career path. In an article in *National
Geographic,* raconteur Garrison Keillor noted that Danish teens
who earn a little less than the highest scores are eligible to
become physicists, chemists, and theologians. The very smartest
kids become doctors, psychologists, and midwives.
This partnership model can help to retain empathy for birthing women.
New Zealand - The New Zealand Experience by Karen Guilliland
I'm intrigued by the issue of how power affects one's empathy . . . I've seen otherwise very nice people who seemed to lose their empathy for the birthing woman when they served in the role of primary midwife. Some researchers have examined this issue:
This issue was investigated on KQED's radio show Forum
Michael Krasny, Mon, Dec 11, 2006 -- 10:00 AM
The Psychology of Power
Cameron Anderson, professor of organizational behavior and
industrial relations at UC Berkeley's Haas School of Business
Dacher Keltner, professor in the psychology department at UC Berkeley
Deborah Gruenfeld, professor of organizational behavior and social psychologist at Stanford University's Graduate School of Business
Here are excerpts from a newspaper article about these researchers:
Power is not only an aphrodisiac, it does weird things to some of us by Vicki Haddock [11/19/06]
Why is it said that power corrupts, and absolute power corrupts
absolutely? What is it about the psychology of power that leads
people to behave differently -- and too often, badly?
. . .
Research documents the following characteristics of people with power: They tend to be more oblivious to what others think, more likely to pursue the satisfaction of their own appetites, poorer judges of other people's reactions, more likely to hold stereotypes, overly optimistic and more likely to take risks.
. . .
LBJ biographer Robert Caro observed that power doesn't corrupt; it reveals. Research by UC Berkeley psychology Professor Serena Chen suggests that people who are naturally selfish grow even more selfish if they attain power, while people who are naturally selfless and giving become more so with power.
. . .
The point, Kramer would argue, is not just that power reveals but also that it changes people. Such transformation explains why so many powerful people, imbued with talent, luck and leadership skills, tumble in flames like Icarus. The only way to truly harness power is first to understand what it does to you -- in other words, the consequences of lowered inhibitions.
. . .
Other power seekers relish the psychological satisfaction suggested by novelist Amy Tan's definition of power: "holding someone else's fear in your hand and showing it to them." The abuses at Iraq's Abu Ghraib prison and other atrocities demonstrate a power effect documented three decades ago in Stanford psychology Professor Philip Zimbardo's simulated jail scenario: Students placed in authority grew increasingly repressive and abusive over their "subjects."
. . .
Another symptom of power is reduced awareness of the way you are perceived by others. Again, research shows that powerful people are less able to accurately read the verbal and facial cues of those around them, and thus more likely to misjudge how they are coming off. Instead of focusing outward, they tend to see others as merely orbiting around them.
. . .
Another axiom of the powerful is that they take risks more than others. Such risk-taking is often richly rewarded, but at some point overconfidence can be disastrous.
. . .
So what is required to remain uncorrupted -- to handle power with grace?
The experts say that to remain grounded, it takes a deliberate effort, a sense of humor about yourself and a willingness to become more, not less, reflective.
E-mail Vicki Haddock at firstname.lastname@example.org.
Consider getting involved in local disaster preparedness meetings
to educate public health officials and staff about midwives (CNMs
and LMs) and out-of-hospital birth. These nurse-midwives are
advocating that people be prepared for safe childbearing at home
and other out-of-hospital locations.
Disaster plans for childbirth - Nurse-midwives say women in labor could be turned away from hospitals in an emergency.
The businesswomen are members of the newly formed Disaster
Preparedness Committee of the American College of Nurse-Midwives.
Midwives on Missions of
Service - Healthier birth worldwide through education and
Birth Centers Online
Mirai - A Japanese birth center
Directors Network (SDN) is an organization composed of
Certified Nurse-Midwives (CNMs) and Certified Midwives (CMs) who
administer nurse-midwifery practices across the United States and
who are active members of the American College of Nurse-Midwives
(ACNM). They have a great links
As someone who helped start a birthcenter, and am now doing it again I have a few tips.
I incorporated. I called my state dept of commerce and asked them to send me info. I also picked up an incorporation kit at my local office depot and did all the paperwork myself following the instructions in the kit. I ended up paying $16 for the kit and $135 to the state (I wanted the certificate and an extra copy of the filed papers, that cost extra.....I could have done it not gotten that stuff and paid only $80). Doing it myself saved a lot of money as a lawyer would have charged $300-$400.
I also called the IRS and asked them to send me the form to apply for an employer identification number (EIN). You will need this to start a business account. IRS sent the papers within a week, and I applied via fax after I got my incorporation finished by the state. Doing it by fax was much swifter than by mail.
Most banks will not let you open a "business account" unless you give them incorporation papers, an EIN, a county or city occupational license. If you are in an illegal state you can always get the occupational license as a CBE or some related occupation. Make sure that if you don't have an office, you have zoning to work out of your home, otherwise you won't get the license. Some banks also want a corporate seal. You can order them from an office supply store for less than $20 if you don't want anything too fancy.
Next step is to get an accountant. You don't want to get in trouble with the IRS if you can help it. They can be mean.
I have been advised to pay myself a small wage, and pay the IRS
quarterly for taxes and social security on this sum. You want to
keep this sum as small as possible. You can also pay yourself
dividends over and above your salary.....you will need to pay
income tax on this amount, but not social security.
Boots at the Door
Editorial Comment by Ina May Gaskin (1994) about the arrests of Lynn Amin, CNM, Beverley Thorpe, CNM, and Lorri Walker, RNP for their work at their Natural Birthing Services birth center in Southern California.
Some bold midwives have been able to change hospital policy to reduce some of the worst aspects of institutionalized care:
- "Soul-Satisfying Care for the Childbearing Family" at St. Luke's
Hospital in San Francisco, CA.
Marsden Wagner Responds to AWHONN's
Statement on CPMs 
Medline Abstracts on Social Support and
The Third Leading Cause of Death in the US, Causing 250,000
Deaths Every Year
If you've ever suspected that a lot of standard medical birthing
practices are wrong, you'll find proof in Henci Goer's essential
Myths Versus Research Realities. The website includes
the entire chapter on episiotomy.
The midwife removes the stitches and takes care of the PKU test.
There are hospitals around the country that are doing away with
their midwives. Why? Well, I believe, it is because
there are better outcomes and fewer interventions. The
hospital makes less money if they "allow" their women to birth
without epidurals, episiotomies, AROM, induction, cesareans.
I think it's a money issue, but in a different way. Time equals money. Normal birth takes TIME. Normal births occur over many hours and many shifts of workers/nurses/docs. Births would be fast, the docs could even do the OR on an assembly line. Moms could be in their recovery rooms a few hours after they arrive at the hospital. Cleanup would be quick and easy, and the hospital could close down the maternity ward at night.
In our practice we were providing both the time and the care giver. Basically, we were just borrowing a room under the hospital's roof. Since we stayed in the room for labor, birth and postpartum we didn't require a "maternity ward's" participation in any way, shape or form.
Even so we were told that there was nothing in it for the hospital if we attended births this way! No income from IV's, epidurals, episiotomies, OR use (where all births take place whether vaginal or surgical), drugs, or use of the nursery. If we didn't generate additional costs then they weren't interested in renting us a room.
We finally found a hospital that just charged us a slightly higher price for the use of the room and left us alone. Even the time I caught the baby in the hallway with the resident doctor looking on. We were charged similarly. They said that to do otherwise was a losing business proposition for them since there were simply no costs attached to our style of attending a mother.
Now that we are "official" within this one little hospital
with our own set of 4 rooms, the only task for the nurses is to
bring the sterile instruments and the materials for the baby when
we arrive. We close the door and never see them again unless we
have reason to request they make a special trip over to our wing.
If for some reason we do need to utilize the services of the
hospital then the couple pays for each "a la carte."
This section is here to provide some balance when midwifery opponents bring up cases where a midwife had a bad outcome. Most often, these cases are about unavoidable problems, such as shoulder dystocia, DIC (Disseminated Intravascular Coagulation) or precipitous birth with a preterm baby.
Yes, every once in a while, a midwife truly violates midwifery ethics and does something really stupid, such as using a vacuum extractor at a homebirth. But does anyone think that the medico-legal establishment would review such a case and then allow the midwife to continue practicing? No way!
Here are some examples of the egregious cases of bad outcomes
under the care of obstetricians.
Kaiser Doc Severs Baby's Spinal
Cord with Vacuum Extractor
of pain - List of lawsuits against Dr. Rutland far exceeds
the norm, and the litigation tells a sad tale.
April 7, 2002
Anaheim obstetrician ends battle
Board inquiry agrees to surrender his license.
September 25, 2002, The Orange County Register - archived story ID 58367998 or search for "Anaheim obstetrician ends battle"
[Ed: Don't bother purchasing the article - there's not much more about this than the free intro.]
An Anaheim obstetrician- gynecologist accused of a string of errors in surgeries and deliveries will surrender his license Oct. 24. ..Dr. Andrew Rutland signed an agreement with the Medical Board of California on Aug. 25, ending a two-year state investigation. The board's inquiry began a year after Rutland delivered a baby girl with a torn spinal cord -- and it grew to include allegations regarding 17 patients.
This doctor is alleged to have caused the deaths or permanent disabilities of three babies, in addition to a number of gynecological catastrophies. Perhaps the most egregious of the cases was the use of forceps which tore the baby's spinal column, resulting in the baby's death. The Medical Board did not file charges against the doctor until two years after this tragedy was reported to them.
"An Orange County Register investigation in April found Rutland's
case has been symptomatic of a Medical Board system that worked
too slowly and often disciplined doctors lightly."
And here are some examples of situations that we've never even
heard of happening with midwives!
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