Midwife Robin Lim honored with 2011 CNN Hero Award

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I hadn’t followed this competition, but was excited to learn that the winner of this award, which comes with $300,000 for her cause.

About Robin:

Robin Lim, an American woman who has helped thousands of poor Indonesian women have a healthy pregnancy and birth, was named the 2011 CNN Hero of the Year on Sunday night.

Through her Yayasan Bumi Sehat health clinics, “Mother Robin,” or “Ibu Robin” as she is called by the locals, offers free prenatal care, birthing services and medical aid in Indonesia, where many families cannot afford care.

After reading about Robin and her work, I realized that her clinic sounded familiar. They are listed on my Volunteer Doula Program page! A friend of the clinics posted in comments a few years ago about their work, suggesting I add them to my list.

So glad to see their impact is being honored, and on such a mainstream platform. It’s also lovely to see a birth activist and woman of color honored for her work.

Learn more about her clinic here. They even have a birth doula workshop for interested doulas in Indonesia!

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Vermont mandates insurance coverage for licensed midwives

Great news from Vermont:

“One of the things that’s extremely important to our families is to be able to have a choice about the way we bring Vermonters into this world,” said Gov. Peter Shumlin, D-Vermont.

Shumlin signed a bill into law Wednesday requiring Vermont insurance companies to pay for the prenatal care, deliveries and aftercare that licensed midwives provide.

Insurance coverage for midwifery is a win-win situation. It saves insurers and the state money, and parents get the care they want.

Victory for midwives in Colorado

For the last few months I’ve been watching the situation in Colorado, where the bill allowing direct-entry midwives to practice was set to expire.

Indra Lusero and a group of consumer advocates were working hard to improve the new version of the law. They wanted to make sure that midwives were given the best opportunity to practice their trade, supported by the law.

This is a legislative situation we don’t hear much about. A lot of the news focuses on states trying to get these licensing laws established in the first place (there are currently 23 states without them on the books). But all of these laws do “sunset” at some point, and have to be renewed. It presents an opportunity to change things for the better, which is what these folks were able to do.

Indra and I spoke on the phone during the campaign. Indra became a midwifery advocate after her own home birth. This is what she had to say about why they began the campaign:

Midwives were frustrated with the current state of the law which was inacted in 1993 and hadn’t been improved in 17 years. Some of those initial compromises that had been made in that fraught time were really limiting. Some of the language was explicitly opposed to midwifery—”we’re going to regulate you but we don’t feel good about it.” Some of the scope of practice things: not being able to carry anti-hemorrhagics. Rogam, Vitamin K. And one of the bigs one that we’re fighting over this session is suturing—the ability to repair minor tears at home.

In political environments that are often very midwife unfriendly, these battles can be particularly challenging. Midwives are afraid if they push to hard, they might lose altogether and no longer be able to practice in the state. So often what results is compromise laws that can severely limit the midwives ability to practice as they are trained to do.

Indra’s group though, presented a different advocacy effort–that of consumers, not the midwives themselves. Their stake in the fight is different, and can be received by elected officials in new ways.

In the end it was a big success, and the new version of the bill has passed through the State Legislature with little opposition, to be signed into law by the Governor soon. They weren’t able to secure suturing privileges, but there is a possibility that could be allowed through other mechanisms.

Here are a few of the changes they were able to achieve:

  • Registered CPMs can now be simultaneously licensed as nurses (and vice versa). This was prohibited in the original law.
  • Registered CPMs can now obtain and use these drugs: Vitamin K, Rogam, antihemorrhagic drugs, and eye prohylaxis.
  • The language that spoke negatively of midwifery was removed.

Those are just a few highlights! You can read all the nitty gritty details here. A big congrats to the folks in Colorado who worked on this bill.

Interview with Ina May Gaskin about women of color and birth

I had the unique pleasure of interviewing midwife and birth activist Ina May Gaskin (via email) for my latest Colorlines feature.

Ina May graciously allowed me to post the full text of our interview since only a few snippets made it into the Colorlines piece. She had a lot of wisdom about this issue (not surprisingly!). It really is worth the read–Ina May displays a really comprehensive understanding of the issues facing women of color when it comes to out-of-hospital birth care.

Here’s Ina May:

RD: You mention briefly in Birth Matters that when obstetricians were trying to bring birth to the hospital (and learn how to care for birth), one doctor in Chicago paid immigrant women to give birth there. I’ve also understood that initially, particularly black women weren’t allowed access to hospital birth because of segregation/racism and class issues as well.

IM: That’s true. In general, low-income women in urban areas were initially brought into hospitals so that doctors in training could practice on them. That how they “paid” for their care.

RD: Can you tell me a little more about the history of particularly women of color in the US when it came to birthing in the hospital? Did they have a different experience than white women in terms of when they made the transition from home birth to hospital birth?

IM: Yes. For the most part, women of color who lived in the rural south didn’t go into the hospital until the 1970s and 80s. Alabama, Mississippi, Arkansas, Florida, and Georgia still had midwives who assisted women giving birth at home right through the 1970s. When doctors could count on Medicaid reimbursement for the first time, that situation quickly changed, and the midwives who were so needed before were forced to retire. Farther north, the pattern was somewhat different, because midwifery was outlawed in many states. Everyone was pushed into the hospital when this happened, regardless of the color of their skin. Women of color and poor white women were both used as teaching material in the teaching hospitals throughout the country. For this reason, the shift from home birth to hospital birth took place much earlier among urban women of color than it did for those in rural areas of the south.

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Maternal mortality is on the rise in the US. What can we do about it?

My latest article is up at Colorlines, about the issue of maternal mortality in the United States, particularly for women of color.

The United States spending more money per capita than any other country in the world on health care, but we rank behind 40 other countries when it comes to maternal mortality. Ina May Gaskin, in her new book (review to come!) says that women today are two times more likely to die from childbirth than their mothers were.

A report recently released by the New York City Department of Health examining maternal mortality in the city between 2001 and 2005 found striking disparities for women like Eady: black, non-Hispanic women were more than seven times more likely to die from pregnancy-related causes than white, non-Hispanic women. Such disparities recur nationally. In a March 2010 report entitled “Deadly Deliveries,” Amnesty International explained, “African-American women are nearly four times more likely to die of pregnancy-related complications than white women. These rates and disparities have not improved in more than 20 years.”

But as Rita Henley Jensen explains, the New York report also points to something more than the usual indicators for maternal mortality—poverty, lack of prenatal care and preexisting conditions. Maternal mortality is not just restricted to women of color; we’re actually seeing a rise in maternal and fetal mortality rates overall. California has reported a near tripling of their maternal mortality rate in just the 10 years between 1996 and 2006. The U.S. ranks behind 40 other countries in terms of maternal mortality rates, despite spending the most money per capita on health care.

So how have we created the world’s most expensive maternity care system while still putting women and babies at risk? The answer lies in two of our culture’s biggest influences: money and technology. And now, even as Republican legislators aim to gut the Medicaid program that millions of women depend upon, a movement is growing to make maternity care both cheaper and safer by giving poor women greater access to home births.

I have to say I didn’t like the title of the piece (determined by the editors) because it isn’t just about home birth–it’s about normalizing midwifery care, and particularly expanding access to out of hospital birth, which includes birth centers as well as hospitals. It also includes midwife-provided prenatal care, even if women eventually birth in hospitals.

Home birth is still a dirty word in this country. It’s considered backwards, it’s considered unsafe, it’s considered what someone does when they have no option. This ideology is part of a calculated campaign on behalf of doctors to convince women to give birth with them in the hospital, something that actually killed more women than home births in the initial decades of hospital birth.

Home birth isn’t the problem, and never has been. The problem is making sure all women have access to skilled attendants who know how to care for pregnant women, know how to detect problems, know when to transport to a hospital or when someone might need an obstetrician–someone who is trained specifically to deal with the minority of cases that need specialized medical attention.

Women in the United States are dying in spite of having access to hospital-based maternity care (98%).

That means that women in the US are dying because of hospital-based maternity care.

Either that care is inadequate (like Akira Eady, who I wrote about in the piece, who died from a complication after being released from the hospital postpartum ), or it’s simply too reliant on interventions and surgeries that are harmful. A 33% c-section rate is simply too high. Mothers are dying because they are getting too many surgeries, too many interventions, too many inductions.

We know clearly what isn’t working. The status quo. The 98% hospital birth, the only 9% midwifery care. My article tries to explain how we got here, and what might just help us go in a different direction–back toward patient-centered care that minimizes the use of technology rather than emphasizing it. That only employs tools like c-section when they are really necessary, not just when they are convenient or used to preemptively prevent litigation.

I can’t say definitively that a move back to midwifery care (or home birth) would eliminate disparities. It probably wouldn’t–because racism and classism still exist and still effect our health outcomes. But out-of-hospital midwifery care has some pretty amazing successes both in the US and abroad in terms of reducing maternal mortality. Let’s give it a shot–see if we might not be able to improve these statistics instead of seeing them get worse and worse and worse.

Why midwives would make great abortion providers

It’s the National Day of Appreciation for Abortion Providers. I think we can all understand in this current climate how difficult a job that is to hold. Not many other doctors have legislators meddling in their medical practice, determining what they can do, what they can say, who they can serve. Not to mention the extremists who want to murder providers, and target them with violence.

We all know that we need more providers. There aren’t enough people willing to do this work, and there is a lot of need. We often hear the statistic that 86% of all counties in the US have no abortion provider. I want a world where folks don’t have to go to a special clinic, or a special provider, for abortion care. I want a world where abortion care isn’t segregated from the rest of medical care that a person needs. Where family practice doctors perform procedures (this used to be much more common).

You know who would make great abortion providers?

Midwives.

Talk about full-spectrum care. Midwives already provide care across the spectrum of a woman’s reproductive life–from well-woman care, to pap smears and yearly exams, to prenatal care and childbirth. Abortion would be a logical addition to their scope of practice.

Unfortunately the politics of abortion in this country, and the politics of the medical establishment mean that this is a far-fetched goal. Anti-choice advocates would surely fight any attempt to broaden who is allowed to perform an abortion and doctors (or at least the professional associations that represent their interests) would surely fight any thing that would mean they lose their monopoly on a medical service.

The UK considered a move to allow nurses and midwives to perform the service in 2007, but to my knowledge it didn’t go anywhere.

Historically, midwives were the abortion providers. Before our more advanced medical procedures were invented, midwives were the ones who counseled women on what herbs to use, what other techniques they might have for regulating their menstruation and their fertility. Before women’s health was even considered as part of medical practice, midwives were there providing compassionate care to women and their reproductive lives.

I want midwives to take this back.

A person can dream right?

UPDATE:

Thanks to J at Ipas for pointing out their work training midwives internationally in abortion care:

In many areas around the globe, such as South Africa and Ethiopia, midwives are authorized to perform uterine evacuation or medication abortion. In fact, a national training program in South Africa for midwives has helped to reduce the number of abortion-related deaths.

“Every year, more than 67,000 women die from complications from unsafe abortion — largely because they don’t have access to safe reproductive health care. Midwives, who often live in the communities where women are, can play a key role in providing critical reproductive health services to women if they are trained and empowered,” says Ramatu Daroda, senior training and services advisor for Ipas and trained midwife.

Since 2001, Ipas has trained more than 10,000 midwives in abortion and postabortion care. Ipas strongly believes that midwives are an integral part of reproductive health service delivery; and supports midwifery training and incentives, so that midwives can continue to improve maternal health.

Awesome.

Live in Illinois? The home birth act needs your help this AM

Via the Big Push:

ATTENTION ILLINOIS RESIDENTS & ANYONE WITH FAMILY/FRIENDS IN ILLINOIS.

It is VITAL that everyone re-call your state reps in Springfield ASAP and try to find at least a few friends/family members who will call between 9 and 11 a.m. on Wednesday, November 17. We need to FLOOD the capitol with calls during that time.

  • If your state rep already support the Home Birth Safety Act, please thank them for their past support and ask them to remain strong with us.
  • If your state rep is iffy or unknown, ask them how they will vote and send a text report to the phone number below.

People who live in Illinois can find their reps here.

Please call Springfield as soon as you see this PushAlert, and then call as many people in Illinois as you can to remind them to call right away between 9 and 11 a.m. PST on Wednesday, November 17!

The Home Birth Safety Act would allow the licensing and regulation of Certified Professional Midwives in Illinois. CPMs are not currently allowed to practice legally in IL. More background here.

Midwifery Modernization Act signed by NY Governor

Final piece of good news for midwives in New York State. Governor Patterson on Saturday signed the Midwifery Modernization Act, which will mean a vast improvement in access to midwifery services in NY State. The legislation was pushed through by the amazing organizing and activism that rallied after the closing of St. Vincent’s almost put home birth midwives out of business.

Massachusetts Midwifery Bill needs your help

Our friends over at the Big Push for Midwives sent an action alert about a midwifery bill that is close to passing in Massachusetts. The details are below, and if you are in MA, lend a hand by calling your representatives today. The session ends tomorrow!

Good news!!! We are steps away from getting the midwifery bill—that so many of us have worked on for so long—passed this legislative session, which ends THIS SATURDAY, 31 July.

Even if you have already done so, please call and/or email your OWN Mass Rep. today, tomorrow, or any day you can this week, asking them to reach out to Speaker DeLeo to bring the bill to the House floor for a vote and to help pass the bill THIS SESSION.

Please note the bill, is now known as House 4810: An Act Relative to Certified Professional Midwives and Enhancing the Practice of Nurse-Midwives.

Who’s your rep? You can find them at the following link: http://www.wheredoivotema.com/bal/myelectioninfo.php

Text of the bill can be found at the following link: http://www.mass.gov/legis/bills/house/186/ht04/ht04810.htm

Thank you again to the whole coalition for all of your excellent work. We could not have come this far without everyone’s expertise, experience, passion, and all the good work you are already doing to address this critical issue.

Keep the pressure on!!!
Ann Sweeney
President, Mass Friends of Midwives (MFOM)
www.mfom.org
617-901-2777

Take action today!

Big victory for midwifery in New York State

Baby smiling with words "a midwife helped me out"I have been writing about the dire situation for home birth midwives in New York City, prompted by the closing of St. Vincent’s Hospital, one of the only midwife and birth friendly hospitals in NYC.

Because of a piece of NY State law that required all home birth midwives to have the signature of an OB at a hospital in order to practice, when St. Vincent’s closed due to debt problems, the midwives were out of luck. This move pretty much eliminated home birth as an option in New York City, and the law had made it hard for midwives around the state to practice.

Well, we finally won one! It’s incredible and in many ways unexpected, but a bill was introduced by some amazing and fierce activists in New York State called the Midwifery Modernization Act. This act would remove the requirement for a Written Practice Agreement between midwives in New York State and obstetricians, the contract that was keeping many midwives from practicing because doctors and hospitals did not want to sign them.

Thanks to some amazing lobbying on behalf of birth activists and advocates (and an incredible number of phone calls from folks like YOU) the MMA has passed both the NY State Assembly and Senate.

Hopefully within a short time (as long as Governor Patterson signs the bill) this will mean that midwives across New York State can practice without being beholden to the signature of one OB or hospital.

This doesn’t mean that the midwives won’t be using hospitals to transfer when necessary, but this one signature won’t be the determining factor for their practice.

Congrats to everyone who worked on this important legislation!

More information at Free Our Midwives.