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Midwifery Advocacy and Statistics

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See also:

Subsections on this page:

Major Campaigns

The Big Push for Midwives

. . . 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 Ricki Lake says and check out her new movie, The Business of Being Born.

Report calls 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. 

Call 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.

Midwife Mania? More U.S. Babies than Ever Are Delivered by Midwives [6/25/12] - More and more American women are choosing to give birth with the help of a midwife; in 2009, midwives attended 8.1% of births overall and 12.1% of vaginal births.  As specialists in normal birth, midwives don't do c-section.  When you start care with a midwife, you drastically reduce your risk of ending up with a c-section.

It Takes a Professional Village! A Study Looks At Collaborative Interdisciplinary Maternity Care Programs on Perinatal Outcomes [September 19th, 2012] by Sharon Muza - examines how a team approach to maternity care might improve maternal and neonatal outcomes.

Births Attended by Midwives Safe, Need Fewer Interventions [Medscape, 1/13/12] - A review of 21 studies comparing births attended by certified nurse midwives or physicians found no difference in infant outcomes between the 2 groups, and less use of interventions such as labor induction, episiotomy, and epidurals by the nurses.

Midwife Collaborations Continue to Evolve by Sarah Bruyn Jone [9/25/13] - As collaborations between certified nurse midwives and physicians continue to grow, professional groups for both are working to outline best practices for meeting the health care needs of women.

[Ed: This article is really about CNMs, but we can hope that MDs will come to appreciate the different skills of LMs and CPMs in the years to come.]

9 Things That Need to Change for Women Giving Birth in the U.S.

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, an OB who works with midwives:
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

ACNM responds to producers of The Today Show.

Normal Care for Normal Birth by 2020 ~ Rehabilitating our National Maternity Care policy by the year 2020 by Faith Gibson, LM CPM

Challenging 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.

Cost Issues

  • See also: Medical Necessity of Care for "False Labor"
  • See also: Medical Necessity of Care in the Immediate Postpartum
  • See also: Medical Necessity of In-Home Maternal Followup and Continuity of Care
  • See also: Medical Necessity of In-Home Newborn Followup

  • 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 increased breastfeeding.

    Atul Gawande on the Super-Utilizers

    Participate in Midwifery Research Studies

    Using the AABC Uniform Data Set (UDS), the American Association of Birth Centers is launching the AABC National 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.

    Setting up a Table at a Local Festival

    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 offerings.

    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!

    Library display 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.

    MANA offers Free Materials to Promote the Midwives Model of Care!

    Planning an education event?  Need professional looking presentation folders for state legislators or the local press?  The following items are available to midwives and midwifery advocates free of charge.  (Display boards are on loan and are shipped with return mailers.) Interested parties should contact Pam Maurath, 1-866-439-4837 (toll free) to make arrangements.  Please allow 1-2 weeks for shipping.

    Your state midwifery association may also offer materials for loan.

    Quilt honors mothers who died giving birth - BY HOLLY TKACZYK - about The Safe Motherhood Quilt Project

    Talks in Schools

    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.

    Inaccurate News Stories about Midwifery

    Please send reports about inaccurate or misleading news stories to the MANA Press Officer at http://www.mana.org or

    General Persuasion and Advocacy

    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

    YouTube - 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,

    Keys 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 Curse 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 Leadership".]

    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."

    From Making Sense 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 homebirth.

    General Advocacy Tools from the ACLU

    Steve's Primer of Practical Persuasion and Influence

    How to Get Free Publicity

    Suggestions and sample Web pages for online Activism

    ICAN President's Letter to California Medical Board about VBAC - from Tonya Jamois, 4/20/05

    Compassionate 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

    1. Choose Learn vs. Protect/Attack
    2. Operational Trust Requires open information flow.
    3. Openness depends on a balance of candor and receptivity.
    4. Organize your presentation Using
    5. Use open, clean questions as the basis for getting information.  Ask for more than "Yes" or "No" answers.
    6. Use Triplet Questioning Technique to get complete information.

    Midwifery Publicity

    Baby T's makes infant t-shirts personalized with your practice name or logo.

    Bumper Stickers and Bank Checks with Midwife-Positive Messages

    Peace on earth begins with birth. Support midwives bumper sticker

    Midwifery and Breastfeeding Bumper Stickers - Texas Sticker Company & Label Exchange

    Bumper Stickers: (purple and white)

    $4 each or $0.75 for 20+
    Send order and check to current Region 1 Rep.  Make payable to CAM

    Bumper Stickers for Sale!
    Support CAM and Region IV
    Choose from

    All have CAM contact info at the bottom
    $2 apiece (purple and white)
    Please send orders and checks to:
    Sarah Salisbury
    1198 Oakdale
    Chico, CA  95928

    "Midwives Market - All the bumper stickers, buttons and needlepoint kits that a midwife could dream of. Laingsburg, Michigan kipkoz@sprynet.com."

    There are some nice breastfeeding checks available:

    You could always order some of those inspirational checks from Current- I especially like the Flavia designs.  Then, you can add a phrase of your own, and I'm thinking of plagiarizing something from a bumper sticker, like Midwives:  Experts in normal birth.  Or A midwife for every mother.  Or Home, hospital, or birth center--Choose a midwife.  Or Midwives: The future passes through our hands.  Or Midwifery is a Labor of Love.  [I like the slogan, "Midwives help people out."]

    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 Gets".

    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 1-800-checks.

    You can get Anne Geddes checks (8 scenes or 4 scenes) from Checks In The Mail.

    pregnancy.8k.com - Great T-shirts about midwives, homebirth and natural childbirth.

    General Midwifery Advocacy

    Libertarians support midwifery

    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]

    Main results
    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).

    Authors' conclusions
    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]

    Improving Maternal 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 Based 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 explored."

    MANA's Page on Midwifery Advocacy

    National Organization 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.)


    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.



    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.

    "Midwifery in the Industrialized World by Marsden Wagner MD, MSPH.

    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 of Nurse Advocates for Childbirth Solutions  - WWW.ANACS.Org - Please come and join our community of nurses working together to find solutions to maternity nursing challenges.

    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

    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

    The Fall of Midwifery and the Ascendancy of Medicalized Childbirth

     Charting a Course for the 21st Century: The Future of Midwifery -  a new report by The Pew Health Professions Commission and the UCSF Center for Health Professions Task force on Midwifery urges inclusion of midwifery in managed care plans -- April 19, 1999.
    . . . 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

    Summary of 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 Publications

    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."

    Midwives Under Fire by Katie Allison Graju

    The Childbirth Monopoly - Why the medical industry is dragging its feet when it comes to midwives (by Laurel Druley)
    June 2, 1998

    Henci Goer Supporting Midwifery

    As someone whose specialty is evaluating and synthesizing the research in order to determine what constitutes safe and effective maternity care, I take issue with the repeated statements by your sources that women choosing midwifery care compromise safety. In point of fact, the research literature consistently shows that midwives achieve equally good or better outcomes with much less use of obstetric intervention. How could it be otherwise? All obstetric intervention into the normal process carry harms as well as benefits. If you expose women and unborn babies to them unnecessarily, then you are exposing them to potential harm with no counterbalancing benefit. To cite the preeminent example, take cesarean surgery. The list of serious complications of this surgery that threaten the life and health of mothers and babies and their lives in subsequent pregnancies is as long as your arm. Nationally, our cesarean surgery rate is approaching one in three. As of several years ago, the rate in low-risk first-time mothers was one in four. No objective person could believe that this many women require a major abdominal operation in order to be healthy women giving birth to healthy babies, and, in fact, numerous studies show that cesarean rates overall can safely be one-third what they currently are, and rates in low-risk first-time mothers can safely be one in ten. Studies show that midwives--at least those who practice from the midwifery model of care--have cesarean rates much lower than obstetricians managing similar populations.

    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.

    Henci Goer

    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.

    Certified Nurse Midwives Safer Than Obstetricians for Matched Risk Groups

    If certified Nurse midwives were to claim:
    1. 19% lower infant death risk
    2. 33% lower neonatal mortality risk
    3. 31% lower risk of low birth weight
    compared to physician delivered births (for births with the same degree of risk), some people would not be impressed.  However, the study that has just reported this has much prestige behind it:
    1. One of the two authors (Marian F MacDorman) is with Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Vital Statistics, Hyattsville, Maryland, USA
    2. The journal that published it (Journal of Epidemiology and Community Health) is associated with the very prestigious British Medical Association Group.
    Was this a small study of a few hundred births?  No, the database was all U.S. births in the year 1991.

    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.

    Positive emotional 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."

    Perineal Injury 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

    The Trials 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

    Midwives: An Untapped Resource
    Editorial Comment by Ina May Gaskin (1994)

    Insurance Industry Kills Health Care Reform
    Editorial Comment by Ina May Gaskin (1994)

    Editorial by Marsden Wagner on "A global witch-hunt"

    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
    Signer, Declaration of Independence

    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. 

    WHO recommendations on appropriate technology for birth
    Conference at Fortaleza, Brazil, 22-26 April 1985

    WHO recommendations for appropriate technology following birth
    Trieste, 7-11 October 1986

    WHO (World Health Organization) - appropriate technology for birth revisited British Journal of Obstetrics and Gynaecology, September 1992, Vol. 99, pp. 709 - 710

    Midwifery care and out-of-hospital birth settings: how do they reduce unnecessary cesarean section births?
    Sakala C
    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.

    Motherstuff - Midwifery Organizations by Country [in advocacy]

    Birth Practices 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.

    The Case 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 process.  (Jodi Kluchar is a major activist in awareness about PTSD after childbirth.)

    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

    Baby 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 hospitals

    Florida Governor Supports Midwives

    Midwifery Today - Online Birth Center

    Technocratic Model of Birth vs. Holistic Model of Birth (from Birth as an American Rite of Passage by Robbie Davis-Floyd.

    Comparison between 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 Interview

    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!

    Early Discharge, Untimely Follow-Up Seen Among Many Newborns [Medscape registration is free]

    Physicians Dedicated to Optimal Health Care

    American Public Health Assn

    Physicians for Midwifery or contact Pat Burch at pburch2881@aol.com or at 318-232-5580

    Universal Health Care Action Network: 216-566-8100

    History of Medical Conspiracy to Malign Midwives

    A Short History of Midwifery in America

    AMA Statements about Independent Midwives

    Effects of Technology on Perinatal Mortality

    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


    About CNMs and the ACNM

    About Midwives as Primary Care Providers

    How DEMs can Supplement CNM Praise That Slams Them

    Notes from Sheila Kitzinger Talk - "Crisis in the Perinatal Period".

    If Obstetricians Were Bus Drivers

    Guidelines for Legal Quoting

    I work as an editor for an on-line and in-print periodical part-time, and as a technical writer for a software firm full-time. It is legal to quote sources at any time as long as you are not receiving payment or passing the words off as your own or distributing the item to such an extent as to make the selling of it impossible. When they talk about electronic storage and retrieval units, they are referring to a number of things, including websites, but mostly they refer to imaging systems, which allow you to take a text and make an electronic copy and store it on CD's. Most letter-quality imaging systems cost upwards of $70,000 and can cost much more. These are going to get cheaper, so the publishing industry is trying to protect itself.

    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 quoting.

    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 circulating, BookCrossing might be the answer.

    Continuity of Care

    Maternity Care: Building Relationships Really Does Save Lives - This course presents the research showing that the continuity of care typical of midwifery care isn't just preferred by mothers; it actually saves lives.

    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)

    Continuation of Care Model aids midwives in managing diverse birthing expectations [8/9/17] by Nicole Madigan - “Post birth conversations to ‘de-brief’ and explore why events occurred as they did is the only process available that may help women through the process.” [Ed: Yes, continuity of care should continue all the way through the debriefing, which I typically broach at six weeks, possibly again at three months, sometimes very shortly after the birth if birth memories are consuming her thoughts.]

    Does continuity 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 care."

    A 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 infant.


    United States Maternity Care Facts and Figures, December 2009 from childbirthconnection.org

    California Cesarean Rates 2011

    What is practice variation in obstetrics and why should I care?
    by Adriana Arcia, PhD, RN - So, why should you care about practice variation?  Because, "…one of the most fundamental principles in quality assessment and control is that unwarranted variation in a product or process generally equates to poor quality.  Conversely, as quality improves, variation will diminish"

    CDC has just released their preliminary report on 2008 births in the US - c-section rate increases for the 12 consecutive year to 32.3%

    Birth by 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, 2010
    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://www.cdc.gov/nchs/about/major/dvs/Vitalstatsonline.htm.

    2005 Natality Public Use File - The 2005 natality public use micro-data file is now available for download at: http://www.cdc.gov/nchs/about/major/dvs/Vitalstatsonline.htm. 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 http://www.cdc.gov/nchs/VitalStats.htm 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://www.cdc.gov/nchs/about/major/dvs/NCHS_DataRelease.htm

    Stats (Data) Resources from the California Maternal Quality Care Collaborative (CMQCC)

    Births: Preliminary Data for 2005

    The CDC's National Center for Health Statistics

    Listening to 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.

    CDC's 2005 Reports On Women's Health

    Abortion Surveillance - United States, 2002,

    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.,

    Cesarean Delivery 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.

    Trends in 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 http://onlineqda.hud.ac.uk. 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.

    The ABCD 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.

    "INTO 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 hmbirthhm@yahoo.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/

    Birth-Related Statistics Sources

    The World Factbook.  2001.- Infant mortality rate


    Infant Mortality

    Prenatal Care

    Unintended Pregnancy

    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 worldwide."

    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.

  • Dr. Foster's Good Birth Guide has lots of interesting statistics about birth in the UK.

    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 Information

    Britain's Patients Charter - Maternity Care Section

    Isle of Man Study Shows Medical Interventions Causes Problems

    CNM Statistics

    While almost one-fourth of U.S. babies are born by C-section, the rate was less than 12 percent for those births attended by nurse-midwives in hospitals.

    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!

    Graph of Average Length of Hospital* Stay, by Diagnostic Category† --- United States, 2003 - the average length of stay for "delivery" is 2.6 days.

    Lower Cesarean Rates

    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 our butts."

    Sutter Davis birthing center boasts lowest c-section rate in state [7/10/16] -
    The Sutter Davis Birthing Center boasts the lowest c-section rate in California at just 12 percent of all births.  Midwives, doulas, waterbirth and deepwater tubs for labor make the difference!

    Out-Of-Hospital Midwifery Care: Much Lower Rates of Cesarean Sections for Low-Risk Women

    Outcomes of 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)

    Birth Safety - Maternal Mortality

    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.

    Maternal 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.

    Faith Gibson's response to the poorly written ABC article on the rising rate of maternal mortality in California.

    Why are American women dying in childbirth? [3/8/14] - Maternal mortality rates are falling in every industrialised nation - except for the United States.

    Statewide Review Assesses Preventability of Pregnancy-Related Deaths

    Preventability of 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.

    Maternal Morbidity and Mortality - Annotated Lists of Organizations on Key Topics in Maternal and Child Health from the Maternal and Child Health Library

    Underreporting of 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

    Underreporting of 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.

    United Nations Statistics Division - Millennium Indicators has maternal mortality.

    Worldwide Maternal Mortality Statistics

    United Nations Report on Maternal Mortality

    WHO Statistics on Maternal Mortality - 1995

    Maternal Mortality in the United States: Where Are the Doctors? (Illinois Midwives Page)

    Notes from Marsden Wagner on Maternal Mortality

    NHS maternity statistics, England: 2003-04

    Maternal mortality in the past and its relevance to developing countries today
    Irvine Loudon
    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 whole."

    Birth Safety - Infant Mortality

    See also: Lower Cesarean Rates

    Infant and Neonatal Mortality for Primary Cesarean and Vaginal Births to Women with "No Indicated Risk," United States, 1998-2001 Birth Cohorts.
    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).

    U.S. has second worst newborn death rate in modern world, report says [5/10/06

    The World Fact Book - rank order of countries for infant mortality.

    The State of Infant Health: Is There Trouble Ahead? - Discussion of the 2003 ranking of the US as 28th in infant mortality rate.

    International Comparisons 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.

    Midwifery Unity - The Bridge Club

    Do you believe in Midwifery Solidarity?

    Join the Bridgeclub
    This is where midwives have unity and are able to work together for the good of midwifery - all midwives.

    ACNM's letter to members of Congress re: CPMs as healthcare providers

    Bridge Club's Letter to ACOG re: Improper Term "Lay Midwife" [March, 2006]

    About Midwives - Different Types of Midwives

    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 or whatever.

    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 being professional.

    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.

    About Midwivesfrom MidwifeInfo.com

    Naturally Occurring Midwives

    Types of 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 midwives.

    Different Types of Midwives

    Lay Midwifery: A Feminist Perspective by Martha J. Blizzard White, April 1997

    The Dutch Midwifery System by Beatrijs Smulders

    Public Citizen Study on CNM Outcomes - Nov 1995

    Study Shows 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

    Interspecialty differences 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 use.

    Unnecessary Cesarean Sections: The Nurse-Midwifery Solution

    CNM Compares and Contrasts Homebirth and Hospital Birth

    A Direct-Entry Midwife Explains Her Training

    The Decline 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

    Original Version

    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.

    Corrected Version

    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.

    Specific Country and State Midwifery Groups and Associations

    See also: Midwifery Organizations from motherstuff.com

    See also: Professional Organizations Online

    International Midwifery Links - A summary of Midwifery links from around the world

    Home Midwifery Association (QLD) in Australia

    Association of Radical Midwives - they also have their own UK Midwifery Archives

    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.

    Home births 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, ngould@belfasttelegraph.co.uk]

    Home Birth Association of Ireland

    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 families.

    National Certified Professional Midwives Guild, Office and Professional Employees International Union , Local 54, AFL-CIO-CLC

    New Zealand Midwifery Council

    New Zealand College of Midwives

    Citizens for Midwifery lists many state-level organizations

    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.

    Colorado Midwives Association

    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

    Indiana Midwifery Taskforce

    Iowans for Birth Options

    Kentucky Alliance for the Advancement of Midwifery

    Kentucky-based Midwifery

    MANA Southeast Region

    Maryland Friends of Midwives

    Maryland Families for Safe Birth

    Maryland Legalizes Home Births With Midwives

    Massachusetts Friends of Midwives

    Michigan Midwives Association

    Friends of Michigan Midwives

    Missouri Midwives Association

    Friends of Missouri Midwives (FOMM)

    Ohio Friends of Midwives

    Tennessee Midwives' Association

    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 Site
    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"

    Midwives Alliance of West Virginia

    Wisconsin's Rules Regulating Midwives and Legislation

    Midwifery History

    History of Midwifery Discussions on the Internet

    The First Midwife

    Midwifery and The Bible by Larry Overton

    Witches, Midwives, and Nurses - A History of Women Healers a 46-page booklet by Barbara Ehrenreich and Deirdre English

    Historian uncovers 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.

    A 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 and 1939

    Motherwit - An Alabama Midwife's Story by Onnie Lee Logan as told by Katherine Clark

    Read more at answers.com and from African American Studies Center

    We've Come a Long Way, Babies - a history of childbirth from Mothering Magazine

    The 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 Series - International Journal of Domiciliary Midwifery

    Misconceptions Surrounding 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.

    The Struggle for Midwifery in Ontario by Ivy Lynn Bourgeault - An account and analysis of the first attempt to professionalize midwifery in Canada.

    Labor Among 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.

    Eur J 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.

    African American 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.

    1610-1914 a 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

    Biography of Ina May Gaskin from Salon

    Women and Obstetrics - The Loss of Childbirth to Male Physicians by Shira Happlin

    The Best Means of Combating Infant Mortality - by Abraham Jacobi, M.D., President of the American Medical Association, New York
    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.

    The History of Midwifery in America by Beth Overton ~ May 23, 1996 (revised June 10, 1998)

    A midwife's private practice in Israel

    Judy Slome Cohain
    British Journal of Midwifery 10(4):224-229 · March 2002
    DOI: 10.12968/bjom.2002.10.4.10336

    Childbirth in History - Mail-Order Resources

    Witches, Puritans, and Sexuality by Sasha Haarhoff, RN - This includes history relevant to the role of midwives and birthing women in the Colonial United States.

    Literary References to Midwives

    One of the more notorious references, from Charles Dickens' Martin Chuzzlewit regarding Mrs. Sairey Gamp, a nurse and midwife fond of a tipple which she kept in her teapot. Her staff of office was a large black 'Gamp' (or Umbrella).  She is introduced in Chapter 19.

    Apparently, Dickens didn't have a great opinion of midwives, as another tippling midwife appears in Oliver Twist. In this introduction to Oliver Twist, Mrs. Sairey Gamp is described as a "dirty, drunken old midwife and nurse".

    Gynecology in the Ancient World

    Classic Papers in Neonatal Medicine, Classic Books in Neonatal/Perinatal Medicine and Other Interesting Historical Sites

    Midwifery Historian

    Estelle Cohen, who may still be reachable through the University of Minnesota (try the Center for Advanced Feminist Studies) or I think I heard she was at Harvard at some point (History of Science) -- I'm not sure where she's located these days but she's worked with midwifery treatises (she has a piece in Osiris 1997)

    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.

    Midwifery Theory

    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.

    Midwifery Politics

    Why HMOs Don't Snap Up Midwives

     I am very familiar with the literature on CNM care....multiple, multiple papers indicating its safety, cost effectiveness, consumer satisfaction, outcome statistics equal to or surpassing care by MDs.

    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! 

    Non-Nurse Midwives
    This is exactly my problem with ACNM, being "good girls" will get us nowhere, or will get us exactly where we are in New York City. 10% of hospital births in NYC are done by midwives (impressive, no doubt), but I can tell you from personal experience that you can count on one hand the midwives in this area who are actually practicing "midwifery", because of the politics of trying to "get along" with the OBs and the hospital administration, the few who are fighting the "good fight" (and I emphasize few) are facing an up-hill battle, not only because of recalcitrant OBs and OB nurses, but also because of sister midwives who refuse to "rock the boat".

    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

    Midwife Jokes

    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.

    Homebirth Humor - Birth Cartoons

    Sometimes midwives work with clients who decline even the mildest interventions because they put their faith in God, or because they 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 Tight Budget

    Midwife Literature - Fiction, Biography, Autobiography, Quotes

    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! Margot 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 attendance.

    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.

    Should a CPM be Required for Legal Midwifery Practice?

    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.

    The Midwifery Partnership - Relationship Between Midwives and Clients

    The Midwifery 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.


    Medical Approach Undermines Woman's Confidence

    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???

    Lack of Evidence-Based Medicine in Obstetrics

    Study: Two-Thirds of OB-GYN Clinical Guidelines Have No Basis in Science
    Majority of ACOG Recommendations for Patient Care Found to Be Based on Opinion and Inconsistent Evidence

    Scientific Evidence Underlying the American College of Obstetricians and Gynecologists' Practice Bulletins
    Wright, Jason D. MD; Pawar, Neha MD; Gonzalez, Julie S. R. MD; Lewin, Sharyn N. MD; Burke, William M. MD; Simpson, Lynn L. MD; Charles, Abigail S. MS; D'Alton, Mary E. MD; Herzog, Thomas J. MD
    Published Ahead-of-Print

    CONCLUSION: One third of the recommendations put forth by the College in its practice bulletins are based on good and consistent scientific evidence.

    The need for evidence-based obstetrics - A discussion of the gap between scientific evidence and the practice of obstetrics, written by and for obstetricians but of immense interest to birthing parents.

    "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 Much Medicine.

    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:

    Meta-analysis of the safety of home birth.
    Olsen O
    Birth 1997 Mar;24(1):4-13; discussion 14-6

    From: C-upi@clari.net (UPI)

    Subject: Health Today [Sep 3]

    Organization: Copyright 1997 by United Press International

    Date: Wed, 3 Sep 1997 0:51:08 PDT
    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.

    Obstetric Prenatal Care may be Worthless

    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.

    Midwifery as a Career

    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.

    EXPLORING THE EMOTION. WORK OF MIDWIVES - a powerpoint presentation by Dr. Hunter.

    “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.

    Midwives Around the World

    This partnership model can help to retain empathy for birthing women.

    Midwifery in 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 with 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 vhaddock@sfchronicle.com.

    Midwives as Disaster Preparedness Resource

    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.

    Global Midwifery Charities and Service Organizations

    Midwives on Missions of Service - Healthier birth worldwide through education and service

    Starting a Birth Center

    Birth Centers Online

    Baby Health Mirai  - A Japanese birth center

    Service 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 page.

    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.

    The 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.

    Homebirth in the Hospital

    Some bold midwives have been able to change hospital policy to reduce some of the worst aspects of institutionalized care:

    Homestyle Midwifery - "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 [2007]

    Medline Abstracts on Social Support and Childbirth Classes

    Anti-Intervention Philosophy

    Doctors Are The Third Leading Cause of Death in the US, Causing 250,000 Deaths Every Year

    Doctors Increase Maternal Mortality

    There was an interesting report in the Lancet last year, which speculates that docs were responsible for increasing maternal mortality as they took over from midwives:
    Isle of Man Study Shows Medical Interventions Causes Problems

    WHO on Expected Cesarean Rates

    The World Health Organization estimates that a major medical center that gets all the complicated cases still shouldn't have a rate of cesareans over 15%. A community or just plain vanilla hospital should have a rate of 5-10%. Marsden Wagner (he was the person at WHO who was mostly responsible for these estimates) says that at less than a 5% rate, you tip the balance towards losing moms and babies unnecessarily, and with more than the above rates you run into unnecessary cesarean sections. 17% for a major referral hospital does not sound outrageous.

    If you've ever suspected that a lot of standard medical birthing practices are wrong, you'll find proof in Henci Goer's essential book, Obstetric Myths Versus Research Realities. The website includes the entire chapter on episiotomy.

    Dutch Doulas

    A few days ago, someone asked about how long the nurses in Holland stay. It depends a little, but mostly it is 64-72 hours spread over 7-8 days. A typical routine is: come in at 8, serve the family breakfast in bed, talk with the mother how the night has been, take care of older children. When the mother takes a shower, she will do the bedroom, putting clean sheets on the bed etc. Clean the bathroom afterwards, start the washing machine, help the mother breastfeed. At 10 bathe the baby, make coffee for visitors, receive visitors, put flowers in vases etc. See the visitors out when mum has to breastfeed. Take care of lunch, vacuum the living room. Make mother comfy for an afternoon nap, take older children for shopping, wake up mother, make tea, receive visitors prepare a meal and leave at 6 p.m. We don't have babyshowers before the baby is born. You can visit the new family afterwards and preferably in the first week, when the nurse is in charge. If they have a nurse for two visits a day a mother, sister or good friend will take care of the rest. But it is a good system. When you rise from lying-in you know what you have to know about the baby, you are well rested, your house is clean and your fridge is well-stocked. The nurse also makes a daily report for the midwife, taking temperatures, checking the uterus, the stitches, stools etc.

    The midwife removes the stitches and takes care of the PKU test.

    Hospital Economics Undermine Midwifery Approach

    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."

    Obstetric Atrocities

    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

    Patients' trail 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 // Probe - Doctor facing Medical 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."

    Baby dies in fall to floor during delivery - [12/15/11] - The University of Colorado Hospital is investigating the death of a newborn who fell to the floor during delivery and died.

    And here are some examples of situations that we've never even heard of happening with midwives!

    Sexual Abuses

    Doctor agrees to stop work [4/22/06] The Texas Medical Board this month suspended the license of Dr. Randolph W. Rountree, a San Angelo obstetrician accused of sexually assaulting or having inappropriate contact with four patients.


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