California pregnancy-related deaths triple in the last decade

A new investigative report released by California Watch reports that maternal mortality rates in California have seen a spike in recent years, almost tripling in the last ten years.

To me, there is one clear cause of this kind of increase, and that’s the c-section rate, which according to California Watch have increased 50% in the same decade in CA.

The World Health Organization recommends a c-section rate of about 10%. We currently have a national average of 30%. In some hospitals it’s as high as 90%.

C-sections are major abdominal surgery. There are risks involved, and with so many c-sections, you’re going to start having deaths as a result.

We need less c-sections. Period.

The other thing this report revealed was that there was significant increase in maternal mortality among non-Hispanic whites, a group traditionally excluded from maternal mortality and low infant birth weights. Well again, this is probably because of the c-section rates, which might even be higher among this group than women of color.

The idea that increases in technology use could actually harm women, rather than help them, is impossible to believe for the OB-GYN community:

When researchers unveiled their initial findings to a conference of the American College of Obstetricians and Gynecologists in 2007, there were gasps from the audience, according to participants at the San Diego event. The idea that California was moving backward even in an era of high-tech birthing was implausible to some.

This is exactly the point. Overusing technology it’s just as harmful as under-utilizing it. The bottom line is that OB-GYNs are trained as surgeons, and their dominance of maternity care is proof of that–they are performing more and more surgeries than ever.

We need practitioners who are trained to care for women birthing without technology, namely midwives. Technology has a role, but it should be the exception not the rule. And let’s be clear here. It’s not just c-sections that are to blame. It’s also increasing induction rates, epidurals and other medical interventions that disrupt the process and are more likely to cause interventions.

“For every maternal death, there are 10 near misses; for every near miss, there are 10 severe morbidity cases (such as hysterectomy, hemorrhage, or infection), and for every severe morbidity case, there is another 10 morbidity cases related to childbirth,” Camacho wrote in an e-mail.

Are you a French-speaking midwife or doula?

Lynn Paltrow, Executive Director of National Advocates for Pregnant Women, is looking for US based progressive and French-speaking midwives or doulas. She has a colleague working on a project called Middle Africa Network for Women’s Reproductive Rights: Gabon, Cameroon, Equatorial Guinea.

If you are this midwife, or know of someone, you can email Lynn at lmp@advocatesforpregnantwomen.org.

Lynn just informed me that a doula would work as well, so if you’re a French-speaking doula, contact Lynn!

Grit.tv takes on birth politics

There is a great segment on Grit.tv about childbirth in the US, featuring Debra Pascali-Bonaro (my doula trainer!) of the Orgasmic Birth documentary.

“The Bellevue Hospital Natural Birth center in Manhattan, one of the few centers that cater not to the wealthy but to poor women, closed this month amid controversy. With the ongoing debate about health care reform and costs, decisions about childbirth are getting lost in the shuffle. We discuss the closing of the birth center and the medicalization of childbirth with Katherine Abelson, midwife at the Brooklyn Birthing Center, Elan McAllister, doula and president and founder of Choices in Childbirth, and Debra Pascali-Bonaro, doula and director and producer of Orgasmic Birth.”

Full video after the jump!

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Oprah.com article on alternative birth practices

I was interviewed for this Oprah.com article about alternative birth practices. It’s a pretty good overview of the standard aspects of alternative birth practices: midwives, doulas, out of hospital births, techniques like water. I seem to be the only source the author quotes, so here is a round-up of my contributions. While I’m flattered to be used as a resources I wish he had also talked to some other experts on the issue!

Also of note is that what seems to have drawn the author to the subject was his wife’s own delivery with a midwife in a birth center wing of a hospital just three months ago. He told me this during the interview, it wasn’t in the actual article. It’s so often that awareness about childbirth only comes when a person or their partner go through it themselves.

Read the whole piece here and see my quotes after the jump.

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Want Certified Professional Midwives in health care reform? Today is your chance.

I haven’t been following the play by play on health care reform, but I know there are some important opportunities at stake and recognition of CPMs is one of them. If you care, see below for instructions to take action today.

From the Big Push for Midwives:

We are down to the wire days left before the final deadline for including Certified Professional Midwives in the Senate health reform bill!

We need everyone to CALL or FAX your TWO U.S. SENATORS today!

Please ask them to take the lead in sponsoring an amendment to the Senate health bill to provide Medicaid payment of Certified Professional Midwife services.

To find your Senators and their contact information, go here.

Call the U.S. Capitol Switchboard at 202-224-3121 and ask for your Senator or Representative’s office.

Keep trying if you don’t get through. We MUST make our voices heard and there are LOTS of groups calling about health care reform — support for Certified Professional Midwives and out-of-hospital maternity care needs to get heard through all the noise!

Ask to speak with your Senator’s legislative health assistant. Be sure to get his/her name. This is critical information for us to follow-up with the staff.

Please note that emails and messages left with receptionists are not effective!

Ask that your Senator take the lead in sponsoring an amendment to provide Medicaid payment for the services of Certified Professional Midwives, who are the only type of midwife in the U.S. with specialized training in out-of-hospital maternity care.

Call or email Karen Fennell and tell her who you talked with and any comments or additional information requested so she can follow up with offices. Call 301-830-3910 or send an email to karenfennell50@yahoo.com.

Some background information and talking points to add if you wish after the jump.

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New midwifery school opening in Florida this winter

I’m really excited to share the news that Jennie Joseph’s new midwifery school, Commonsense Childbirth School of Midwifery, is opening this Winter in Central Florida, near Orlando.

I got the chance to meet Jennie Joseph recently and she is really fantastic. She has a down-to-earth no nonsense approach to birth care, with an important focus on low-income women and women of color. What she does works–it really has transformed outcomes in her community.

We need more midwives, and that means we need more midwifery schools. Yay!

Know any pro-choice midwives in San Diego, CA?

A reader emailed me recently to ask about finding pro-choice midwives and birth centers in San Diego after she had this not-so-pleasant experience:

I just visited The Best Start Birth Center in San Diego for an annual exam and introduction to their pre-natal and birthing facilities. After taking my medical history, the midwife asked me about my “grieving process” for a past abortion, and then referred me to Rachel’s Vineyard, a pro-life Catholic ministry that offers workshops to “heal the trauma of abortion.”  I was startled, angered, and disappointed. I realized that I could not comfortably receive care in this facility, even though it’s the only midwife-run birth center in my area.

It is not uncommon for the silence of the midwifery community on abortion to hide the beliefs of some who are patently anti-choice. Since most women who have abortions are also mothers at some point in their lives, this reader’s experience may not be so uncommon.

So Radical Doula readers, anyone know of pro-choice midwives in San Diego that we can refer her to? How I wish there was a directory somewhere online with this information. Leave any suggestions you might have in comments!

Midwifery infighting

I was really upset to see the news that the American College of Nurse Midwives (ACNM) had come out against the Certified Professional Midwives (CPMs) attempts at getting recognized in the health care reform process. You can read the ACNM letter to their members here.

It all just makes me sad, reading this letter, wishing I understood exactly why those dialogues between the CPM groups and the CNM groups broke down. If your read this letter in response to ACNM’s actions, Geradine Simkins, CNM, MSN, MANA Board President explains that it was actually just one phone call where ACNM refused to concede anything.

It is disingenuous of ACNM to state in its Special Alert to ACNM Members on July 15, 2009, “ACNM’s decision to oppose this initiative followed unsuccessful attempts by ACNM and MAMA Campaign leaders to reach a compromise that both organizations could support…” There was no formal process or interaction, no negotiations, and no attempt at collaboration between ACNM leaders and MAMA Campaign leaders. There was one phone conversation in which the ACNM representative stated there was only one concession they would accept: federal recognition only for gradates of MEAC-accredited programs; this is not a compromise. The MAMA Campaign, of course, is promoting all CPMs to receive federal recognition as Medicaid providers, not just some CPMs.

I’m a big fan of CPMs, and while I think CNMs have done a lot to bring the midwifery model of care to the hospital setting, women need more options. I like that there is a midwifery model out there that doesn’t start with nursing school, or rotations in the labor and delivery wards of hospitals. I like that some midwives are just trained to do home births, or birth center births. We need that, just like we need OBs to do c-sections (when necessary) and CNMs to do births in hospital.

ACNMs main issue with CPMs seems to be the fact that apprenticeship model’s of education are recognized alongside traditional brick and mortar education. I don’t want to throw apprenticeship out the window. I want it to be a valid way of learning. This is how midwifery started! These are our roots. We can’t abandon them completely. They’ve served us.

Why can’t we all just get along?

Well, because everyone has their own professional interests in mind.

I can’t pretend I understand what is behind ACNM’s opposition to CPMs.

Maybe ACNM is afraid of their reputation. Maybe they are afraid if these other midwives get acknowledged as providers by the federal government, it will tarnish the name of midwives. Maybe they are afraid of losing business to a new group of midwives. I don’t really know, but it’s just typical for those on the margins to end up fighting each other over little scraps when the big players (doctors) end up with all the power and gains.

I know not all CNMs are supportive of this decision by ACNM. Read this letter from a group of CNMs, even in leadership of other organizations, for a great breakdown of why this was a terrible move on the part of ACNM, why it’s wrong, bad for midwifery and ignores the evidence (does this sound familiar?).

Sigh.

You can sign this petition in response to ACNMs campaign.

What’s the connection between health care reform and midwifery care?

My first article is up at The American Prospect, about Certified Professional Midwives and health care reform. I talked to some amazing advocates in reporting for the piece, including Michelle Bartlett, an Idaho midwife who helped push through licensing legislation in her state.

Michelle Bartlett is not the typical Washington high-stakes health-care player. She’s probably not on the radar of anyone in Congress or the Obama administration. Bartlett is a midwife in Idaho, but in the last few years, she’s been trying her hand at lobbying. This came after a night spent in jail for using medication during a home birth she attended in 2000. Bartlett was the second midwife to be charged for this type of practice in Idaho, and thanks to her efforts, she will be the last in her state. “I’ve done a lot of hard things in my life, and giving birth was one of them,” Bartlett says. “But giving birth to a law was really hard.”

On April 1, Gov. C.L. “Butch” Otter of Idaho signed legislation allowing certified professional midwives (CPMs) like Bartlett to administer medication during births. Unlike certified nurse midwives who are able to practice in all 50 states and generally work in hospital settings alongside obstetricians, midwives like Bartlett are referred to as “direct entry” midwives, and practice exclusively outside of hospitals, mostly in homes or birth centers. These CPMs spend three to five years training and meet the standards for certification set by the North American Registry of Midwives.

State licensing fights may be the first step for these midwives, but it’s not their last. Now they’re turning their attention to the federal health-care reform debate, and a look at the maternity-related health-care costs quickly explains why. Childbirth is among the top five causes for hospitalization, and the No. 1 cause for women. According to Childbirth Connection, Cesarean section is the most common operating-room procedure, and in 2009 the C-section rate hit an all-time high according to the Centers for Disease Control and Prevention, at 31.8 percent of all births. These rates account, in part, for the increasing cost of maternity care in the U.S. Maternal and newborn charges totaled $86 billion in 2006, 45 percent of which was paid for by Medicaid. The federal government is already footing a huge portion of the U.S.’ maternity-care bill, and these midwives think they can help reduce costs significantly, and not just for low-income women.

Check out the rest of the article here.

If you want to join the advocacy efforts mentioned in the article, check out The Big Push for Midwives and The MAMA Campaign.