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Peggy O'Mara

A Quiet Place

Michel Odent Conference in Hawaii

March 29th, 2012

If you saw The Business of Being Born, you will well remember the charming French physician, Michel Odent, who spoke eloquently of the connection between our capacity to love and our earliest imprinting. Odent originally became known for his pioneering work at the Pithiviers hospital in France. (1962-1985). He authored the first article in the medical literature about the use of birthing pools. (The Lancet, 1983) and introduced the idea of birthing pools and home-like birthing rooms to maternity units.

Odent is the author of 12 books in 22 languages, including Birth Reborn, The Caesarean, The Functions of the Orgasms, and Childbirth in the Age of Plastics and co-author of five academic texts. He reminds us that, like all animals, we want privacy during birth: a birthing women needs to feel safe and free from dogma. For more of Odent’s writing, see his website Womb Ecology and search the Primal Health Research Databank that he created.

Ina May Gaskin

This fall, Odent is hosting a conference in Hawaii. The Mid-Pacific Conference on Birth and Primal Health Research will be held at the Honolulu Convention Center October 26-28, 2012.; Odent calls this conference The Honolulu Great Wake-Up Call. It follows the 2010 Mid-Atlantic Conference, which attracted 1250 participants from 39 countries. The purpose of this conference is to present an overview of current technical and scientific advances in childbirth and, in response, to ask new questions about its future.

The conference program will bring together an impressive group of speakers, including Michael Stark, MD, considered to be one the most influential surgeons of our time and “father” of a simplified cesarean technique; Kirstin Uvnas-Moberg, MD, professor of physiology at the Karolinska Institute in Stockholm, and author of The Oxytocin Factor; and Susan Wickham, RM, PhD, founder  of Midwives Information and Resource Center (MIDRS) and editor of Essentially MIDRS, a monthly midwifery journal.

Sarah Buckley

Several Mothering contributors and experts will also be presenting: Robbie Davis-Floyd on Birth Across Cultures; Ina May Gaskin (and Michel Odent) on Unusual Routes to Midwifery and Obstetrics; Cathy Daub and Elizabeth Davis on Transcendant Emotional States in Childbirth.

I will participate in a roundtable on Writing about Mothering with Jan Tritten from Midwifery Today and  Sarah Buckley, Australian obstetrician and author of Gentle Birth, Gentle Mothering.

The conference is $220. It would be great to see you there.

 

 

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We Need More Midwives

March 21st, 2012

 

Our beloved Ina May Gaskin, midwifery pioneer, was interviewed by Amy Goodman on Democracy Now Monday, March 19th. Ina May is alarmed about the rising rate of maternal and infant mortality in the US. According to the Centers for Disease and Prevention ( CDC ) US infant and maternal mortality failed to improve between 2000 to 2005. This plateau represents the first time since the 1950s that infant mortality has seen no improvement. Ina May started The Safe Motherhood Quilt Project to commemorate the US mothers who have died in childbirth.

WHAT IS A MIDWIFE?

The word midwife comes from the Old English “mit wif,” which literally means with women. A midwife is a health professional who provides care to low-risk women during pregnancy, childbirth and postpartum. Many midwives also provide primary “well-woman” care. Though they are specialists in low-risk pregnancy and childbirth, midwives are trained to both identify and address high risk situations.

HOW MANY MIDWIVES ARE THERE?

In the US approximately 10,000 midwives attend just 10% of births, or 430,000 a year. If midwives attended 75% of births in the US, as they do in New Zealand—a country with better infant mortality than the US—we would need 75,000 more midwives.

Scientific evidence suggests that women with normal pregnancies should be cared for by midwives. On a global scale, a lack of midwives is a healthcare emergency. According to WHO, UNICEF and other groups, maternal mortality is the “highest health inequity in the world.”

WHAT ARE THE TYPES OF US MIDWIVES?

Certified Nurse Midwife (CNM): A registered nurse with two years postgraduate work in caring for pregnant and birthing women in a certified CNM program. Certified by the American Midwifery Certification Board (AMCB). Most practice in hospital setting.

Certified Midwife (CM): A midwife whose education is through apprenticeship and/or midwifery schools. Certified by the American Midwifery Certification Board (AMCB). Most practice in hospital setting

Certified Professional Midwife (CPM): A midwife whose education is usually through apprenticeship, midwifery school, training programs, and out of hospital experience. Certified by the North American Registry of Midwives (NARM). Most practice in home or birth center setting.

State Licensed Midwives: Twenty-six states in the US license, certify, register or grant permits to midwives. In these states, CPMs must have a state license in addition to their national credential.

ARE MIDWIVES COVERED BY INSURANCE?

Insurers are required by law to cover the services of CNMs and most cover CPMs as well. Most major health insurers contract with birth centers for reimbursement. In addition, midwifery practices and birth centers often offer sliding scales for those who are uninsured or not covered by Medicaid.

A 1998 study at San Diego Birth Center showed that midwife/birth center collaborative care saved parents 21 percent as compared with hospital birth. A study published in 1999 in the Journal of Nurse-Midwifery on the cost effectiveness of home birth revealed that the average, uncompicated vaginal birth costs 68 percent less in a home than in a hospital.

WHAT ARE THE LAWS?

Effectively, one can practice midwifery legally in 39 states; in 12 states one cannot. Twenty-six states license or certify midwives. In nine states, midwifery is legal by judicial interpretation. An additional four states do not regulate, but also do not prohibit midwifery. Nine states plus the District of Columbia actually prohibit midwifery and in another two, midwifery is legal but there is no certification process. The Midwives Alliance of North America (MANA) keeps active statistics on the legal status of midwives.

HOW CAN I BECOME A MIDWIFE?

Here are some resources for those who are considering midwifery as a profession:

For an aspiring midwife FAQ, see Midwifery Education Accreditation Council.

For information on Certified Professional Midwives, see The National Association of Certified Professional Midwives.

For information on Certified Midwives and Certified Nurse Midwives, see The American College of Nurse Midwives.

See if your community college offers midwifery education. Southwest Tech in Fennimore, Wisconsin is a model community college midwifery program.

Midwives are the health professional of the future. We need more now!

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Questions To Ask About Homebirth

March 5th, 2012

 

 

Homebirth is safe and on the increase. You’ve probably all heard about the January report from the Centers for Disease Control and Prevention (CDC) that shows that homebirth increased 29% between 2004 and 2009. Homebirths increased 36% during this same time period among non-Hispanic white women: 1 in every 90 non-Hispanic white women has a homebirth, according to the CDC.

The percentage of homebirths was higher in the northwest than the southeast and more common among older married women with several children. Most homebirths are attended by midwives. Homebirths have a lower risk profile than hospital births suggesting that midwives are selecting low-risk women as candidates

The increase in homebirths is certainly fueled by the soaring rate of medical interventions at hospital births, particularly cesarean surgery, and the success of Ricki Lake’s film, The Business of Being Born. While the American College of Obstetricians and Gynecologists (ACOG) and other naysayers challenge the safety of homebirth, in fact, its safety is well documented. Critics lump unplanned homebirths together with planned homebirths, but planned homebirths by low-risk, well nourished women who receive good prenatal care have always been found to be safe. In fact, birth is safe in any setting.

For most of us, it’s getting comfortable with the fact that birth is safe that is our most important preparation for birth. What helps us get comfortable with this fact is being around others who already believe it. If you are interested in a homebirth, find the homebirth community and get involved. Read the literature on the safety of homebirth and understand the politics. Find a birth attendant who you really like and in whom you can put your trust. Don’t expect yourself to know everything, but find someone who does.

QUESTIONS TO ASK YOUR MIDWIFE

Here are some questions to ask your prospective birth attendant. Add your own.

What is your midwifery education and experience? What certifications or licenses do you have?

How long have you been practicing? How many births have you attended?

Who is your midwifery back-up? Who is your medical back-up?

How often will I see you during my pregnancy? How long will prenatal visits last?

How will my partner (and children) be involved in prenatal visits, during labor and at the birth?

Will you provide me with nutritional guidelines?

What is your philosophy about prenatal testing?

Do you offer childbirth education classes?

Will you suggest non-drug soothers, and different positions during labor?

How long after birth is the umbilical cord cut?

How long will you stay at my home after the birth?

What emergency equipment do you carry?

What back-up hospital do you use? Under what circumstances do you transport? What is your rate of hospital transport?

SURROUND YOURSELF WITH THE POSITIVE

In addition to asking the right questions, surround yourself with positive images of and stories about birth. Look at cross-cultural art that depicts the classic image of Madonna and Child. Read homebirth stories. You can find these stories in Ina May Gaskin’s books, Spiritual Midwifery, Birth Matters and Ina May’s Guide to Childbirth.

Watch The Business of Being Born.

Read the 2200 threads of birth stories in the Mothering community.

Read more birth stories on Mothering.com.

Birth is normal. Trust yourself. Trust the process. Trust the outcome.

 

 

 

 

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US Infant and Maternal Mortality: A National Disgrace

October 18th, 2010

According to the Centers for Disease and Prevention ( CDC ) US infant and maternal mortality failed to improve between 2000 to 2005. This plateau represents the first time since the 1950s that infant mortality has seen no improvement. The US spends more than any other country in the world on health care and yet is only 33rd in the world in infant mortality. A baby born in Cuba, Slovenia, the Czech Republic or South Korea has a greater chance of living for the first year than a baby born in the US. In fact, a baby born in Singapore has twice the survival rate of a US baby.

The infant mortality among non-Hispanic black women is 2.4 times what it is among non-Hispanic white women. One of the chief contributing factors to infant mortality is premature birth. In 2005, 36.5 percent of all infant deaths in the US were due to preterm-related causes; among the non-Hispanic black community nearly half (46%) of infant deaths were related to prematurity.

Global health care worker, Oya Kali, MPH, presented compelling research on the underlying causes of prematurity and infant mortality at the 7th International Black Midwives and Healers Conference. Her research at the University of California at Berkeley focused on the effect poverty has had on generations of African American families and how the trauma of generational poverty becomes biologically embedded in African American women.

To illustrate this embedding, Kali cited the concept of “weathering” as defined by Arline T. Geronimus, Sc.D, professor and senior researcher at the University of Michigan School of Pubic Health. The concept “weathering” suggests that the health of African Americans is subject to early deterioration as a consequence of social exclusion. In fact, as a race, African Americans suffer prematurely from poor health outcomes.

Kali talked of the cumulative health impact of socioeconomic disparity, cultural marginalization, and chronic psychological and biological stress. Since the 1990s we have had new tools to measure the high cortisol levels that indicate chronic stress. Many studies support the link between maternal stress and preterm labor. The baby’s hormones respond to the mother’s stress hormones and trigger early birth. According to Kali, fifty to 100 percent of women who birthed early describe themselves as being stressed.

Examples of the chronic stress caused by institutional racism were reported by both Kali and by Eleanor Hinton-Hoytt, president of the Black Women’s Health Imperative. Kali said, “My people accept the fact that the doctor does not want to touch you.” Hinton-Hoytt told of black women who reported that their white doctor would not touch them or look them in the eye.

Infant mortality for white college educated women is 4 in 1000; for black college educated women it is 12 in1000, worse than for white women who have not graduated high school.

Overall, 32 percent of mothers live in poverty; 40 percent for African American moms. Poverty affects where you live, your access to food, your social support and the health care available to you. It affects whether or not you feel safe walking down the street with your newborn baby. Social isolation further adds to the stress of poverty. Kali suggests that one solution is increasing social support to pregnant women and new moms; she calls this “sisters supporting sisters.”

When it comes to saving our babies, we are all sisters.

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Diversity in Birth and Parenting Organizations

October 16th, 2010

When I called Shafia Monroe, president of the International Center for Traditional Childbearing (ICTC), to talk about coming to the 7th International Black Midwives and Healers Conference, she commented on the lack of diversity among the leadership of birth and parenting organizations in the US, a lack that I too have observed. In response, Monroe put together a diverse panel of presidents of major US health organizations.

Monroe sees ICTC as a midwifery building organization. She said that there are not enough women of color who want midwives or who want to become midwives. ICTC has created a fast track to midwifery and has already graduated 300 midwives. The organization also offers doula training.

ICTC conducted a pilot study of 300 black women regarding how they were treated by their care providers during pregnancy. There is some evidence that birth outcomes are worse if a black woman is not cared for by a midwife of color. Ninety percent of the women in the study reported being alone during birth and none were offered a doula. ICTC intends to follow up their pilot study with a national survey. Monroe concludes that most pregnant black women do not feel supported within their community.

Jocelyn V. Sargent, program officer of the W.K.Kellogg Foundation, Loretta Ross, president of SisterSong and Kathryn Hall-Trujillo, president of Birthing Project, USA.

Loretta Ross is the president of SisterSong, an organization that has created a framework for reproductive justice, and that, with the Black Women Health’s Imperative, is working to create a national coalition of organizations of women of color. According to Ross, reproductive justice is a human right: the right to birth and parent your child in the way that you want and the right to decide whether or not to have children. SisterSong views midwifery also as a human right and gives $100,000 a year in scholarships to SisterSong member midwives.

Kathi Barber, president of AABA and Eleanor Hinton Hoytt, president of the National Black Women's Health Imperative.

The National Black Women’s Health Imperative, originally the National Black Women’s Health Project, is a 140,000 member organization founded by Ms. Byllyee Avery at the first black women’s health conference at Spelman College in 1983. The mission of President and CEO, Eleanor Hinton Hoytt, is to raise the voices of black women as they relate to health and to “get rid of restrictions that limit who we are and what we can do.” She wants to see power back in the hands of women.

The Black Women’s Health Imperative is working for an increased minimum wage and for paid sick leave. Without paid sick leave, women cannot leave work to take care of sick children or go to prenatal visits. The median income for black women is $26,796.

Kathryn Hill-Trujillo, president of Birthing Project, USA talking to Shafia Monroe, president of ICTC.

Kathryn Hall-Trujillo is the president of Birthing Project USA, an organization that also works for reproductive justice for women of color. She wants to help women have permission to sister one another and believes that the pain of being separated from one another is an underlying cause of infant mortality. Birthing Project USA supports women in Haiti, New Orleans and all over the world.

Shafia Monroe, president of ICTC, left, and Kathi Barber, president of AABA.

Kathi Barber is the founder and president of the African American Breastfeeding Alliance (AABA) . Her organization works to un-teach about infant formula because she says that black women tend to believe that formula is the same or better than breastmilk. She also educates about the self interests of the $3 billion a year formula industry.

AABA promotes breastfeeding as a woman’s right and stresses the particular advantages of breastfeeding for black mothers. Breastfeeding can reduce infant mortality by 20%, and is particularly needed in Newborn Intensive Care Units (NICU). Breastfeeding helps contract a mother’s uterus after birth, thus reducing bleeding, which is especially helpful in situations where she is not well cared for and finally, breastfeeding reduces postpartum depression.

Barber bemoaned the fact that there are not enough black lactation consultants in the US. She reported that at a recent national lactation conference, out of 1000 attendees, there were only nine black attendees and of these, just four were lactation consultants.

Michelle-Nicholle Calaresco, director of DONA

Michelle-Nicholle Calaresco is the first multi-cultural director of the Doulas of North America (DONA). Up until recently, the number of doulas of color has not been tracked by DONA and Calaresco hopes to grow the numbers in a culturally sensitive way.

DONA offers fellowships to doulas of color and this year graduated five fellows, the fist of whom is Pat Barella. Barella has created The International Doula Registry of Professional Services (TINDROPS) to maintain standards of practice, lobby for the professional doula and educate the public. Barela was the first to seek approval from the National Uniform Claim Committee for a code for doulas. DONA wants doulas to be available to all women and hopes to encourage and train doulas to be successful at both and service and the business of being a doula.

DONA Fellow, Pat Barella, left, and Peggy O’Mara, right.

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More Midwives

October 14th, 2010

We need more midwives. On a global scale, a lack of midwives is a healthcare emergency. According to WHO, UNICEF and other groups, maternal mortality is the “highest health inequity in the world.” Ninety-nine percent of women who die in childbirth do so in the developing world; 50% of these deaths occur in sub-Saharan Africa. WHO estimates that we need 350,000 more midwives worldwide to meet this crisis. According to the International Confederation of Midwives there are currently about 250,000 licensed midwives, 13,000 in sub-Saharan Africa.

We also need more midwives in the US where approximately 10,000 midwives attend just 10% of births, or 430,000 a year. If midwives attended 75% of births in the US, as they do in New Zealand—a country with better infant mortality than the US—we would need 75,000 more midwives. Scientific evidence suggests that women with normal pregnancies should be cared for by midwives

The International Center for Traditional Childbearing (ICTC) has graduated 300 midwives, but many more are needed, especially in the African American community as evidence suggests that women of color birth best with midwives of color. In fact, one of the criteria for a mother friendly birth is that a birthing mother receive culturally competent care.

We often see midwives as a good choice, but seldom do we realize how life saving their model of care really is. If we are to decrease our rates of medical interventions during birth in the US and improve our poor rates of infant and maternal mortality, we will need more midwives. Let us encourage young women in our communities to see midwifery as a viable and powerful career choice.

Boston midwife, Makeda Kamara, CNM, and myself at the ICTC conference in Long Beach, California.

ICTC conference.

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At The Black Midwives and Healers Conference

October 8th, 2010

Mothering’s art director, Laura Egley-Taylor, and I are in Long Beach, California attending the 7th International Black Midwives and Healers Conference. The conference is sponsored by the International Center for Traditional Childbearing (ICTC), the seminal organization founded by Mothering’s Living Treasure, Shafia Monroe, CM. (Below at the opening luncheon)

I spoke to Martha Drohobyczer, CNM (below) this morning about the importance of objective and standardized criteria for preceptors of student midwives. One of the obstacles to increasing the number of black midwives is the lack of preceptors in general and of preceptors of color in particular. Drohobyczer suggests that preceptors be credentialed, perhaps by an organization such as the North American Registry of Midwifes (NARM), which already has an approval process in place for preceptors.

Later in the morning, Darynee Blount, LM, CPM (left) and Jennifer Joseph, LM, CPM (right) talked about routes to midwifery. Midwives deliver approximately 10 percent of births or 430,000 births a year. In other countries with better infant and maternal mortality than the US, midwives deliver the majority of babies. We need more midwives in the US.

It takes a very determined and multi-dimensional woman to become a midwife because she has to receive her education, find a preceptor, start a business and figure out how to earn money while she does all this. We need to support our midwives, to create scholarships and grants for midwifery education; form friends of midwives organizations in our cities and states; and help to educate the public, especially young people, about the superiority of midwifery care as documented in Judith Pence Rooks classic book Midwifery and Childbirth in America.

One of the most exciting models of direct entry midwifery education discussed at this panel is at Southwest Tech in Fennimore, Wisconsin, where one can earn an associate degree in direct entry midwifery that combines classroom instruction with the apprenticeship model. A program of this nature is accessible to many students because it offers tuition assistance, affordable housing and liaison with preceptors. Kudos to Sherry Devries and her colleagues for creating this exemplary program.

Here are some resources for those who are considering midwifery as a profession:

For an aspiring midwife FAQ, see Midwifery Education Accreditation Council.

For information on Certified Professional Midwives. see The National Association of Certified Professional Midwives.

For information on Certified Midwives and Certified Nurse Midwives see The American College of Nurse Midwives.

To find a preceptor, contact the midwifery organization in your state.

Please share other helpful resources you know about.

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