Midwifery infighting

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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.

Inspiring birth story from reader

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A reader also named Miriam sent me a lovely email with her birth stories, and agreed to let me share them here. It’s always lovely to me to hear from parents who had second birth experiences that fulfilled their dreams and expectations. Enjoy!

Hello Miriam-

I wanted to thank you for all your wonderful posts about reproductive freedom.  While I’ve always been pro-choice, until I had children myself, I didn’t think of it has having anything to do with birth choices.

My first child was born in the hospital four years ago and it was horrific. It was the classic medically unnecessary c-section after a tidal wave of interventions that I was unprepared to deal with.  I’d wanted as natural a birth as possible and I was basically denied and undermined in every way in working towards this goal. I was never really given informed consent about the Pictocin they put me on right away, even though I was already in labor. As you can imagine, one thing lead to another and another until I had a c-section. The really truly stupid thing about it was that the reason they officially gave “failure to progress” was based on the fact that some 7 different people had checked my dilation and everyone had a different number, 4, 8, 3, 5… it was crazy!

After that, we had four months of breastfeeding misery…which did have a happy ending, we were successful with breastfeeding and my son weaned a little bit after he turned three.

I now think that so many women have postpartum depression because they internalize and blame themselves for painful birth experiences. We are made to feel like failures, were the system is what failed. I didn’t get depressed at all, as it happens. I got wicked insane angry. It took a couple of years of talking to people, doing a lot of reading and such but I finally put all the pieces of the puzzle together and figured out what really happened to me and my baby and why.

Seven weeks ago I had my second child, a girl, at home. It was the exact opposite of my hospital birth experience. It was wonderful, peaceful and loving. (and I got to eat!) My midwife supported me and took the time to listen to me and discuss options. It was so different from being told what to do without any discussion!  We had a birth pool, which felt amazing. And in the end, I have to say, it wasn’t as painful as everyone seems to think childbirth is. Maybe because we get scared and have mentally been indoctrinated to think that child birth is super painful and everyone absolutely needs to have drugs? I don’t know. The recovery was a cake-walk compared to the recovery from the c-section and we haven’t had any problems whatsoever with breastfeeding.

Anyway, sorry for the long rambling message. Your posts about being pro-choice and the homebirth/midwife movement were a part of my mental space as I got ready for this birth and it meant a lot to me. Thank you.

Sincerely,

Miriam

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

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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.

Radical doula on Twitter

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I joined the Twitter-mania a few months ago. I find it to be a great way to learn about breaking news and share links with other like-minded people.

You can follow me at http://twitter.com/miriamzperez

If you’re on twitter, send me a message!

Great article on the practice of shackling incarcerated women

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Anna Clark has a great piece up at RH Reality Check about the practice of shackling incarcerated women. She delves into both the realities of the practice (horrific) and the amazing activist response that has arisen to organize against this practice (and has been successful!). Here is an excerpt:

The 2008 federal policy against shackling cued renewed hope among advocates for the humane treatment of incarcerated women. Beyond lawsuits and advocacy with individual departments, legislative campaigns to restrict shackling are finding unprecedented success-after years of falling on deaf ears.

New Mexico is the most recent state to bar shackling through a bill signed by Governor Bill Richardson this spring. New York and Texas currently have bills backed by legislative support that await the word of their governors before they become law. “For us, it’s not enough to change regulations (on shackling in particular prisons),” Saada Saar said. “To do this campaign through the legislature gives us a way to respond to violations of the policy. Through state statutes, mothers’ rights are better protected.”

“A lot of states do have corrections policies that restrict shackling, but (the policies) aren’t commonly known or understood,” Sussman said. “A law allows us to go to court; it makes it hard for others to say they didn’t know (that shackling is restricted).

“We have a strong case in Illinois because of the law there, for example. We need to bring cases to ensure enforcement,” Sussman added. “It’s a dual strategy.”

It’s a strategy that inspires diverse support. Broad coalitions are signing on to legislative and legal campaigns to transform the experience of giving birth in prisons, jails, and detention centers.

Among those backing the New York Anti-Shackling Bill are women’s health advocates, prison rights organizations, medical and public health groups, and “even fellowships and ministries that aren’t our frequent allies,” Sussman said.

Read the rest here and more from Anna Clark here.

Latino’s born to midwives will no longer be denied passports

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An update to this story from almost a year ago. It was reported by the NY Times that Latinos born near the border to midwives were having their citizenship challenged.

Well some good news for us on this front from the ACLU:

Pending court approval, DOS will train its staff on how to fairly weigh all the evidence provided in passport applications and how to avoid improperly subjecting people whose births were assisted by midwives in Texas and along the U.S.-Mexico border to heightened scrutiny in reviewing their passport applications.

All denials will be automatically reviewed by a three-member panel comprised of experienced DOS staff members, and if that panel also denies an application, DOS must communicate the specific reasons for the denial to the applicant. The applicant can then challenge the denial and ask DOS to reconsider its decision.

Additionally, anyone birthed by a midwife who has filed an application for a passport between April 2003 and September 15, 2008 and, with a few exceptions, whose application was not expressly “denied,” can re-apply for free. DOS will be setting up mobile units across the border on specific dates to assist those reapplying.

Via Latina Lista

Home birth in Australia may soon be illegal

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New legislation in Australia that requires all midwives to be insured may make home birth illegal and inaccessible.

From News.Com.Au:

Under the draft Health Practitioner Regulation National Law, released last week, a midwife cannot be registered unless she has insurance.

But with insurance companies and the Government so far refusing to include homebirths in the indemnity scheme, midwives will face being de-registered if they attend a homebirth.

Via Citizens for Midwifery.

This is really terrible and this insurance squeeze often effectively makes midwifery illegal/inaccessible in the US too.

Great segment on doulas in the mainstream media

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This is unusual, but refreshing! A great segment on the benefits of doulas on the Today show.

The only feedback, as usual, was the lack of racial diversity in the segment. But they only talked to one doula and one family.

Thanks to Tanya for the link!

(Note: I removed the embedded video because it was not functioning, but go here to watch the video.)

Have you miscarried? A research opportunity

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From Lisa Rosenzweig, a doctoral candidate in Clinical Psychology:

Research Opportunity for Women who have Miscarried

Everyone has a unique experience with miscarriage and unfortunately, little is known about women’s experiences of support and how this may affect responses to miscarriage, and so I invite you to participate in my dissertation research study examining women’s experiences following a miscarriage. Although there is no direct benefit to you, survey results may help healthcare providers better understand and meet the needs of women following miscarriage. This online survey takes approximately 15-20 minutes and is open to women who have miscarried a wanted pregnancy in the previous 6 months who are 18 years of age or older, living in the United States, and involved in a relationship with a significant other. Participants are eligible for a raffle for a $50 American Express gift certificate. For more information, please don’t hesitate to contact me.

Lisa Rosenzweig
Teachers College
lsr2106@columbia.edu

Link to the survey here!

Immigrant woman’s baby taken away because she couldn’t communicate with hospital staff

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Thanks to Indra Lusero for posting this on facebook, from RaceWire:

In Pascagoula, Mississippi, in November 2008, Cirila Baltazar Cruz gave birth to a baby girl. Soon after, her daughter was taken away from her because she could not communicate with the hospital attendants.

Far away from her native Oaxaca, Mexico, she did not understand the Puerto Rican interpreter assigned to her. Cirila speaks Chatino, an indigenous Mexican language spoken by about 50,000 people. A social worker called in by hospital authorities deemed the new mother negligent and unfit to raise the baby, stating as reasons that she was an “illegal immigrant” and that she did not speak English.

…

Baltazar Cruz is up for deportation, while her daughter is reported to be with an affluent Ocean Springs couple.

The way immigrant women are abused in this country is incredible and so saddening. Not being able to communicate with the hospital staff is the HOSPITAL’s issue, not the mother’s.