05.Sep.2013 BirthPlace breastfeeding rates — exceptional.

Thanks to all our clients who participated in our annual breastfeeding rates survey. The results are attached to this note. We really want to point out that most women can breastfeed if they get support. Our clients, lovely as they are, are not superwomen. They work. They have other children. They have busy lives. And they succeed in breastfeeding well above the national and regional norms. Second point — check out our c-section rates for first time moms — 7%. 7% is awesome. Imagine how low it could be if we transferred to doctors who also had low c-section rates. 7% — we are very proud. And, again, our data shows that women’s bodies work. Birthing and breastfeeding are not only possible but important. Thanks again to all our clients. Here’s the report.

Breastfeeding Rates with the Birth Place: a Home and Birth Center Midwifery Practice.

Stacey Haugland, CPM

Abstract

August is International Breastfeeding Awareness Month.   In celebration, we prepared a report on our breastfeeding rates since opening our practice here at the Birth Place.  We found that our breastfeeding rates far exceed regional and national averages, and in fact surpass the Healthy People 2020 breastfeeding goals.  Of the 125 women who worked with the Birth Place between its opening August 2009, and the end of May 2013, 99.2% breast fed at some point.  At three months 90% were exclusively breastfeeding, at six months 85% were exclusively breast feeding and 94% were breastfeeding, and at 12 months 83% were breastfeeding.  Montana boasts one of the highest breastfeeding rates in the country.  However, the incidence and duration of breastfeeding at the Birth Place exceeds Montana’s rates.

Birth Place Montana  CDC Report Card Healthy People 2020 Goal
Ever breastfed 99.2% 83.5% 81.9%
3 months exclusive 90% 40.1% 46.2%
6 months 94% 45.4% 60.6%
6 months exclusive 84% 12.5% 25.5%
12 months 83% 27.0% 34.1%

Birth Place is the midwifery practice of Stacey Haugland, Certified Professional Midwife (CPM) and Kattie Jones, CPM.  We attend births in the home and birth center.  Stacey Haugland, CPM, and Kattie Jones, CPM, are also Certified Lactation Counselors.  Breastfeeding education is integrated into the prenatal appointments and supportive home visits are provided at day one, three, and five post-partum. Home visits are followed with post-partum office visits at week one, two, four, and six. Our message to expectant families is that for most women, breastfeeding is easy and pleasurable.  The Birth Place provides additional lactation support throughout the nursing relationship including special visits for Times of Teething, Going Back to Work, and Tandem Nursing.  In addition we offer a weekly breastfeeding support drop-in group staffed by Certified Lactation Counselors.

Midwifery care, with its focus on individual care and physiologic birth, provides a solid foundation for successful breastfeeding. We find the in-home support during the early post-partum period essential to long-term breastfeeding success.

Methods

Objective: To determine the rate and duration of breastfeeding among the clients of the Birth Place who gave birth between August 2009 and May 31, 2013.

Participants: All clients who worked with Stacey Haugland, CPM, Kattie Jones, CPM, and the Birth Place in that time period, regardless of location of actual birth.

Process:  Between August 2009 and May 31, 2013, 125 women gave birth with us at the Birth Place. Each woman was called and asked the same series of questions.  112 women (90%) were reached and agreed to answer the questions.  The script is as follows:

August is International Breastfeeding Awareness Month. We are collecting data on our breastfeeding rates.  Can I ask you a few questions? [all answered “yes”].

At 3 months of age was (baby’s name)

  • Eating breast milk at the breast
  • Eating breast milk at the breast and in a bottle
  • Eating breast milk only in a bottle
  • Eating formula and breast milk
  • Eating formula

At 6 months of age was (baby’s name)

  • Eating breast milk at the breast
  • Eating breast milk at the breast and in a bottle
  • Eating breast milk only in a bottle
  • Eating formula and breast milk
  • Eating formula

And at 12 months of age was (baby’s name)

  • Eating breast milk at the breast
  • Eating breast milk at the breast and in a bottle
  • Eating breast milk only in a bottle
  • Eating formula and breast milk
  • Eating formula

Whenever a woman indicated that a baby was not eating formula but only eating breast milk, she was asked “and was (baby’s name) eating any other foods, cereals, teas, or juices at this age?”

The Data

This report encompasses all clients who birthed with the Birth Place between July 2009 and May 31, 2013, 125 women in all.

Of the targets for the Healthy People 2020 Goals, this set of women surpassed each target marker.

Ever breastfed:  Healthy People 2020 Goal is 81.9%. Birth Place data 124 out of 125, 99%

Breastfeeding at 3 months:  data set n=112, 104 reported breastfeeding at 3 months, 101 were exclusively breast feeding.  Healthy People 2020 Goal is 46.2% for exclusive breastfeeding.  Birth Place data shows 90%

Breastfeeding at 6 months: data set n=101, 94 reported breast feeding at 6 months, 85 exclusive breast feeding. Health People 2020 Goal is 25.5% for exclusive breast feeding at 6 months/60.6% breast feeding at 6 months.  Birth Place data shows 84% exclusive breast feeding at 6 months/93% breastfeeding at 6 months.

Breastfeeding at 12 months: data set n=67, 56 report breastfeeding at 12 months.  Healthy People 2020 Goal is 34.1% breastfeeding at 12 months. Birth Place data reports 83% breastfeeding at 12 months.

General Practice Data

General practice demographics are located in appendix A.

Discussion

The Birth Place provides midwifery care to low risk women and their full term babies. All births are planned to occur out of hospital, either at the Birth Place or at the client’s home.  Stacey Haugland is a Certified Professional Midwife and has been attending births in Southwestern Montana since 1997. She is also a Certified Lactation Counselor. Kattie Jones became a Certified Professional Midwife in 2013. She is also a Certified Lactation Counselor.

All clients birthing with the Birth Place plan on having a physiologic birth, i.e. labor starts on its own, is not made stronger than the body would naturally make it, and no pain medication is utilized.  The majority of women birthing with us choose to labor either in upright position and/or use submersion in water at some point in their labor as a method of relaxation and pain control. Because the babies are full-term and un-medicated, they rarely need assistance with breathing. Consequently, babies are put directly on the mother’s chest and left skin-to-skin until after the first nursing is completed. In general no palate disruption or overstimulation occurs because these un-medicated babies do not need assistance clearing their airways, i.e. bulb syringe or deLee trap.  However, women in this study who transported in labor and birthed either vaginally or by cesarean section in hospital show no difference in breast feeding rates than women who birthed out of hospital with the Birth Place. This lack of difference suggests that the ante-natal education and post-partum breastfeeding support are of essential importance in breastfeeding outcomes.

Limitations: All clients self-select for midwifery care. They may be pre-disposed to breastfeed and to extend breastfeeding beyond the regional and national norms. All responses were self-reported and could not be externally verified. The sample size is small.

Acknowledgements

Many thanks to assistants Christine Clark and Kes Noel for their technological skills and data tabulation.  And our deepest thanks to each client who responded to our calls and agreed to answer these questions.

References

Breastfeeding Report Card, United States 2012: Outcome Indicators, based on the United States National Immunization Survey, 2009 Births, Centers for Disease Control and Prevention, Department of Health and Human Services.

2020 Breastfeeding Goals

http://www.usbreastfeeding.org/LegislationPolicy/FederalPoliciesInitiatives/HealthyPeople2020Breast feedingObjectives/tabid/120/Default.aspx

Health People 2020 http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicid=26

Montana Department of Vital Statistics 2009 report

http://www.dphhs.mt.gov/statisticalinformation/vitalstats/index.shtml

State Health Facts

http://www.statehealthfacts.org/profileind.jsp?ind=501&cat=10&rgn=28

CDC state report cards

http://www.cdc.gov/breastfeeding/data/reportcard2.htm

Appendix A

Practice Demographics

The 125 women who gave birth with the Birth Place between August 2009 and May 31, 2013 have the following demographics. Demographic categories are taken from the Montana Office of Vital Statistics.

Race

White American Indian Other
118 (94%) 2 (2%) 5 (4%)

Parity

The majority of women in this sample were either first or second time mothers.

One Two Three Four Five +
57 (46%) 36 (29%) 20 (16%) 8 (6%) 4 (3%)

Birth Weight

There was one (0.8%) low birth weight babies in this sample

Birth Weight 2500-3999 grams Birth Weight 4000+grams
105 (84%) 19 (15%)

Completed weeks of pregnancy

Midwifery care as practiced by Stacey Haugland, CPM, and Kattie Jones, CPM at the Birth Place is for low risk women. Consequently any labor before 36 ½ weeks is transferred to medical care. In this sample four (3%) of the woman initiated labor prior to 37 weeks. They gave birth in the hospital.

36 Weeks 37-39 Weeks 40-42 Weeks
4 (3%) 61(49%) 60 (48%)

Mother’s Age

20 – 24 25 – 29 30 – 34 35 – 39 40 – 44
10 (8%) 39 (31%) 52 (42%) 18 (14%) 6 (5%)

Cesarean Section

We are happy to be able to document the benefits of midwifery care for first time mothers.  Our c-section rate for primips is 7%.  All three of the multips who had c-sections had only given birth by c-section and needed a repeat surgical delivery (attempted primary VBACs).

Total C-section 12(10%)
Primip 9 (7%) Multip 3 (2%)

16.Feb.2013 Why I support Bozeman Nurses and hope you do too.

On Tuesday, February 19 from 8am to 4pm Bozeman Nurses and their supporters will be picketing the hospital on Highland Blvd.  The nurses have some real concerns about contract negotiations.

Nursing has been and continues to be a predominantly female profession. And predominantly female professions often struggle with issues of fair wage scale, seniority, and benefits. Female professions can also be riddled with vertical and horizontal hostility. Many of our Bozeman Nurses are saying that it is the bullying or hostile work environment, in addition to the other factors, that is propelling them to picket. As someone who believes that all workers should be paid a fair wage and work in a healthy and respectful environment, I support our nurses in their contract negotiations and will be joining them on Tuesday morning.

But it is not just my overriding commitment to fairness or equality that motivates me to join the Bozeman Nurses on their picket line. It is my universe. Consider the world of this midwife. I have spent the last 20 years trying to improve the maternal and newborn experience here in my town, in my county. And honestly, I think I have made a pretty good impact in expanding and elevating the out-of-hospital experience of pregnancy, birth, and lactation for hundreds of women and their families. But I don’t want to improve birth for just those women who work with me or work with another out-of-hospital provider. I want every woman to have better birth options. Most women birth in the hospital.

In the last two decades I have seen real and significant improvements in how women and their babies are treated, in what options are available to them at the hospital. And every single improvement was championed by Bozeman Nurses. Who was sitting at those 6:00 am meeting to develop a breastfeeding coalition? Nurses.  Who voted to use a bequest to the hospital to improve overall breastfeeding education among labor and delivery staff? Nurses. Who is shepherding the Baby Friendly Hospital Initiative through Deaconess?  Nurses. Who just overwhelming voted in favor of couplet care, caring for the mother and baby together instead of keeping babies in the nursery? Nurses.

Of course, your physician or certified nurse midwife is an important influence in your pregnancy and birth. But the nurses you meet for the very first time when you are in labor are the people who most impact your birth. They greet you and guide you and support you — having never met you before your labor. For most women who birth in hospital, the nurses make the experience.

And so in recognition of the amazing job that Bozeman Nurses do every day to support laboring women and their families, and the absolutely strong commitment Bozeman Nurses have and continue to make to improve hospital policy and procedure, and the high level of professionalism I have witnessed among Bozeman Nurses,  I am clear: I support Bozeman Nurses in their contract negotiations and will join them Tuesday on their picket line.

Tueday, February 19 from 8am to 4pm, Bozeman Nurses will be picketing the hospital on Highland Blvd.  Please consider joining them for a stretch of time. They would like an especially strong turn out at 8am, as that is when the press will be covering the event. Drive by. Stop by. Bring the kids. Thank the nurses for all that they do. Tell them that your midwife sent you.

26.Aug.2011 Daemon’s Birth Story

Birth Story: Daemon James

Our day started out as pretty normal, went shopping and had another appointment with Stacey to see how things were going. All was good so we came home to make a belly cast. While preparing and laying on the floor, my back starting hurting so we stopped and I tried to work that out thinking it was just from laying there. Starting having contractions around 7pm and they got stronger and closer. Around 8:30 we called Stacey to let her know that we were 2 minutes apart and about a minute long, she suggested we come down and see her to check and maybe have the baby. We got to the Birth Place at 9pm. Stacey checked us to which we were at 5 centimeters and “Let’s have a baby tonight!” We stayed and labor progressed. We tried didn’t positions and the birthing tub to which that was the best. All was going great, but strong and intense. We started pushing maybe around midnight and at 1:13am Friday the 19th, we pushed out our son. Derrick did a great job catching him and cutting the cord. What an experience, to have a labor that lasted maybe six hours for my first baby was awesome, but for sure really hard work.  Stacey, Katie and Christine were such great help through out the birth with checking on us and encouraging when we needed it. My husband Derrick and my mom Deniece were great coaches and I couldn’t have done this without any of them. 

Thanks to everyone for their help.

11.Aug.2011 International Breastfeeding Awareness Month

For International Breastfeeding Awareness month we did something I’ve always wanted to do. We called all our clients and asked about their breastfeeding duration. Thanks to everyone who responded.
What we learned is that we have great outcomes. We thought we had great outcomes, but now we can document them.
Here’s the study!

Breastfeeding Rates with the Birth Place: a Home and Birth Center Midwifery Practice.
Stacey Haugland, CPM
Abstract
August is International Breastfeeding Awareness Month. In celebration, we prepared a report on our breastfeeding rates since opening our practice here at the Birth Place. We found that our breastfeeding rates far exceed regional and national averages, and in fact surpass the Healthy People 2020 breastfeeding goals. Of the 52 women who worked with the Birth Place between its opening August 2009, and the end of May 2011, 100% breast fed at some point. At three months 91.2% were exclusively breastfeeding, at six months 79.3% were exclusively breast feeding and 96.6 % were breastfeeding, and at 12 months 88.9% were breastfeeding. Montana boasts one of the highest breastfeeding rates in the country. However, the incidence and duration of breastfeeding at the Birth Place exceeds Montana’s rates.
Birth Place Montana CDC Report Card Health People 2020 Goal
Ever breastfed 100% 88.5% 81.9%
3 months exclusive 91.2% 50.8% 46.2%
6 months 96.6% 55.4% 60.6%
6 months exclusive 79.3% 23.0% 25.5%
12 months 88.9% 34.8% 34.1%

Birth Place is the midwifery practice of Stacey Haugland, Certified Professional Midwife and features home and birth center births. Stacey Haugland, CPM, and her assistant Kattie Jones are Certified Lactation Counselors. Breastfeeding education is integrated into the prenatal appointments and supportive home visits are provided at day one, three, and five post-partum. Home visits are followed with post-partum office visits at week one, two, four, and six. Our message to expectant families is that for most women, breastfeeding is easy and pleasurable. The Birth Place provides additional lactation support throughout the nursing relationship including special visits for Times of Teething, Going Back to Work, and Tandem Nursing.
Midwifery care, with its focus on individual care and physiologic birth, provides a solid foundation for successful breastfeeding. We find the in-home support during the early post-partum period essential to long-term breastfeeding success.
Methods
Objective: to determine the rate and duration of breastfeeding among the clients of the Birth Place who gave birth between August 2009 and June 2011.
Participants: All clients who worked with Stacey Haugland, CPM, and the Birth Place in that time period, regardless of location of actual birth.
Process: Between August 2009 and June 2011, 52 women gave birth with Stacey Haugland, CPM, through the Birth Place. Beginning July 2011, each woman was called and asked the same series of questions. 44 women (85%) were reached and agreed to answer the questions. The script is as follows:
August is International Breastfeeding Awareness Month. We are collecting data on our breastfeeding rates. Can I ask you a few questions? [all answered “yes”].
At 3 months of age was (baby’s name)
• Eating breast milk at the breast
• Eating breast milk at the breast and in a bottle
• Eating breast milk only in a bottle
• Eating formula and breast milk
• Eating formula
At 6 months of age was (baby’s name)
• Eating breast milk at the breast
• Eating breast milk at the breast and in a bottle
• Eating breast milk only in a bottle
• Eating formula and breast milk
• Eating formula
And at 12 months of age was (baby’s name)
• Eating breast milk at the breast
• Eating breast milk at the breast and in a bottle
• Eating breast milk only in a bottle
• Eating formula and breast milk
• Eating formula
Whenever a woman indicated that a baby was not eating formula but only eating breast milk, she was asked “and was (baby’s name) eating any other foods, cereals, teas, or juices at this age?”

The Data
This report encompasses all clients who birthed with the Birth Place between July 2009 and June 30, 2011, 52 women in all.
Of the targets for the Health People 2020 Goals, this set of women surpassed each target marker.
Ever breastfed: Healthy People 2020 Goal is 81.9%. Birth Place data 52 out of 52, 100%
Breastfeeding at 3 months: data set n=34, 33 reported breastfeeding at 3 months, 31 were exclusively breast feeding. Healthy People 2020 Goal is 46.2% for exclusive breastfeeding: Birth Place 91.2%
Breastfeeding at 6 months: data set n=29, 28 reported breast feeding at 6 months, 23 exclusive breast feeding. Health People 2020 Goal is 25.5% for exclusive breast feeding at 6 months/60.6% breast feeding at 6 months. Birth Place data shows 79.3% exclusive breast feeding at 6 months/96.6% breastfeeding at 6 months.
Breastfeeding at 12 months: data set n=18, 16 report breastfeeding at 12 months. Healthy People 2020 Goal is 34.1% breastfeeding at 12 months. Birth Place data reports 88.9% breastfeeding at 12 months.

General Practice Data
General practice demographics are located in appendix A.
Discussion
The Birth Place provides midwifery care to low risk women and their full term babies. All births are planned to occur out of hospital, either at the Birth Place or at the client’s home. Stacey Haugland is a Certified Professional Midwife and has been attending births in Southwestern Montana since 1997. She is also a certified lactation counselor.
All clients birthing with the Birth Place plan on having a physiologic birth, i.e. labor starts on its own, is not made stronger than the body would naturally make it, and no pain medication is utilized. The majority of women birthing with Stacey Haugland, CPM, choose to labor either in upright position and/or use submersion in water at some point in their labor as a method of relaxation and pain control. Because the babies are full-term and un-medicated, they rarely need assistance with breathing. Consequently, babies are put directly on their mother’s chests and left skin-to-skin until after the first nursing is completed. In general no palate disruption or overstimulation occurs because these un-medicated babies do not need assistance clearing their airways, i.e. bulb syringe or deLee trap. However, women in this study who transported in labor and birthed either vaginally or by cesarean section in hospital show no difference in breast feeding rates as women who birthed out of hospital with the Birth Place. This lack of difference suggests that the ante-natal education and post-partum breastfeeding support are of essential importance in breastfeeding outcomes.
Limitations: All clients self-select for midwifery care. They may already be pre-disposed to breastfeed and to extend breastfeeding beyond the regional and national norms. All responses were self-reported and could not be externally verified. The sample size is small.
Acknowledgements
Many thanks to assistance Christine Clark for her technological skills and data tabulation. And my deepest thanks to each client who responded to my call and agreed to answer these questions.
References
Health People 2020 http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicid=26
Montana Department of Vital Statistics 2009 report
http://www.dphhs.mt.gov/statisticalinformation/vitalstats/index.shtml
State Health Facts
http://www.statehealthfacts.org/profileind.jsp?ind=501&cat=10&rgn=28
CDC state report cards
http://www.cdc.gov/breastfeeding/data/reportcard2.htm

Appendix A
Practice Demographics
The 52 women who gave birth with the Birth Place between August 2009 and June 2011 have the following demographics. Demographic categories are taken from the Montana Office of Vital Statistics.
Race
White American Indian Other
47 (90.5%) 1 (2.5%) 4 (8%)

Parity
The women in this sample were fairly evenly split between first and second time mothers.
One Two Three Four Five
22 (38.5%) 23 (44.2%) 5 (9.6%) 3 (5.8%) 1 (2.5%

Birth Weight
There were no low birth weight babies in this sample
Birth Weight 2500-3999 grams B irth Weight 4000+grams
41 (79%) 11 (21%)

Completed weeks of pregnancy
Midwifery care as practiced by Stacey Haugland, CPM, at the Birth Place is for low risk women. Consequently any labor before 36 ½ weeks is transferred to medical care. In this sample none of the women initiated labor prior to 37 weeks. Of interest is that the majority of women gave birth after 40 weeks gestation. All out-of-hospital labors were physiological, i.e., none were induced.
37-39 weeks 40-42 weeks
23 (44%) 29 (56%)

Mother’s Age
20 – 24 25 – 29 30 – 34 35 – 39 40 – 44
1 (2.5%) 15 (29%) 22 (42%) 10 (19%) 4 (7.7%)

Location
Of the 52 women in this sample, all but two initiated labor intending to birth out-of-hospital. One woman was transported in her 38th week for pre-eclampsia and one woman was induced for post-dates pregnancy.
Out-of-hospital (home and birth center) Hospital
44 (85%) 8 (15%)

Cesarean Section
The majority of women transported had surgical births, including two women who had had previous cesarean births.
Total C-section 7 (13%)
Primip 5 (9.5%) Multip 2 (4%)

Waterbirths
Of the women who birthed out-of-hospital with the Birth Place, the majority labored and birthed in the water.
Waterbirths 31 (70.5%)

11.Jul.2011 Puppies,Babies, and our ability to love

My Puppy and My Poppa

I had a lovely al fresco breakfast in my backyard. Every other bite of spinach salad was interrupted by my 7 month old puppy. She wanted me to toss her ball, to rub her ears, to play tug-of-war and then she would wander off to eat a peonie or watch the chickens or patrol the fence line or chewchewchew on her stick. We had already spent 45 minutes at the park playing fetch and practising our sit/down/stay/catch/come.  She had had lots exercise. What she needed was attention and reassurance. She’s a puppy. In another 2 years, she will be able to sit quietly while I eat my breakfast. She will grow up. Right now, she’s a baby dog.

It got me thinking. I have a friend in her 50’s who has never had children, has never been around young children, and can not stop complaining about the children she interacts with in public spaces. Really, she is an incredible person. (She wouldn’t be my friend if she weren’t.) I have always thought of her as just missing a component of “humanness”, the ability to nuture.  Children are not little adults. And all adults should, by the time they are adults, understand the needs of children and understand what behaviors are realistic. But many of us don’t learn this. Many. I am sometimes quite surprised even by my clients’ beliefs about children. (That babies eat 3 times/day. That babies can wait 45 minutes until you finish your report,etc). My clients are by and large amazing, intellegent people. But many have grown up without this knowledge. Sitting at my breakfast table,  I started to think about what I knew about my friend’s parents — good, Godly, pillars of the community who raised her and her siblings with a strict, military discipline. She never got softness. She never got attachment. And in my inbox this morning was this: http://www.psychologytoday.com/blog/moral-landscapes/201106/believing-children-are-resilient-may-be-fantasy  How timely.

While eating my salad and playing with my dog, and in that special way we have with our friends, I figured out how to fix her. She needs a puppy. She needs to love some small, fragile being so much that she will gladly bend her needs to meet the needs of another. (I really don’t think it would be fair for her to learn this with an actual child). She needs to feel the absolute joy that comes from caring for another, small being.  Her cats don’t count. Her plants don’t count. She needs someone truly dependent.

I hope you find the article interesting. And I hope it helps in those moments when you hear (inside your own head or out), “You’ll spoil the baby”, “Let him cry it out”, “Oh, she’ll get over it”, “What about your needs?”, or any of the million other immature thoughts that try to keep us from responding to our babies. It really matters that you are responsive to your baby. It matters their whole lives. And it matters for the next generation too.

Now maybe I should call me friend and ask if she managed to figure out how to fix me while she was eating breakfast this morning.

05.May.2011 Happy International Midwives Day!

From the Midwives Alliance of North America:Happy International Midwives Day!
The Road to Durban: Midwives Walking for the Women of the World
Last year Bridget Lynch, President of the International Confederation of Midwives (ICM), called on the midwives of the world to attend the triennial ICM Congress to be held in Durban, South Africa in June 2011. The ICM also called on 99 member associations in 88 countries representing more than 250,000 midwives to organize 5 kilometer walks in cities and towns across the world on International Midwives Day, May 5. On June 18 when the midwives of the world gather for the ICM Congress, they will complete the walk into the city of Durban in celebration of our commitment to improving maternal and newborn health globally. 

This is the first time in the ICM’s history the Congress is being held in sub-Saharan Africa. This is a particularly significant opportunity for the ICM to bring visibility to midwives. The Congress will be taking place in an area of the world with the highest rates of maternal and newborn morbidity and mortality. With only five years left to achieve the United Nations Millennium Development Goals and improve maternal and newborn health globally, now is the time to highlight the central role of midwives in achieving these goals! In locations across the globe today, midwives and midwifery supporters are “Walking the Road to Durban” in solidarity. http://www.midwives2011.org/Congress/TheRoadtoDurban.aspx

Bringing the Message Home in the United States
Women in the U.S. are more likely to die of pregnancy-related complications than in 49 other countries, including nearly all European countries, Canada, and several countries in Asia and the Middle East. Worse yet, the maternal mortality ratio for American Indian/Alaska Native women is four times higher than the Healthy People 2010 goal (the national target set by the government) and eight times higher for African American women. Maternal mortality is the death of a woman during or shortly after a pregnancy (up to 42 days postpartum) and is calculated as the number of maternal deaths per one hundred thousand live births. The U.S. average rate was reported to be 13.3 deaths per 100,000 lives births according to Amnesty International’s 2010 report, “Deadly Delivery: The Maternal Health Care Crisis in the USA.” 
In some places, and among some populations, maternal mortality is much higher. For example, in the state of Georgia the rate is 20.5 deaths per 100,000 births; in Washington, D.C., it is 34.9 deaths per 100,000 births; and in New York City, the ratio for Black women is 83.6 deaths per 100,000 live births, according to Amnesty International’s report. 

More Midwives Mean Better Outcomes  

As the ICM points out, “The world needs midwives now more than ever.” It is becoming increasingly clear that midwifery can be a solution to the outrageous statistics that continue to plague a nation that spends billions of health care dollars on maternity services alone. America also needs midwives now more than ever. MANA’s new strategic directions directly address the state of maternal and infant health care in America. 

This International Midwives Day, MANA members across the nation have organized walks, rallies, and events to bring attention to the midwives’ role in helping decrease maternal mortality.  We want to highlight some of the events members of MANA’s Midwives of Color Section have gone to tremendous lengths to host which highlight the plight of mothers-both nationally and internationally-as we stand in sisterhood and solidarity with all midwives facing tremendous odds. We are ready, we are here; The Walk to Durban begins today
The Road to Durban: Events Across the Country- 

  • Phoenix, AZ. Marinah Farell in conjunction with MIRA (Migrant Inner-city and Rural Aid) and other midwives from the Arizona Association of Midwives are joining a solidarity walk with 100 Physicians participating in a White Coat march at the capital in protest of Arizona’s immigration laws.
  • Chiapas, Mexico. Corinne “Coco” Pierre-Louis and Luna Maya Birth Centerwalking at San Cristobal de las Casas.  www.lunamaya.org 
  • Orlando, FL. Jennie Joseph and The Birth Place are hosting a Rally at Lake Eola Park with City of Orlando Commissioner Ings, Central Florida Friends of Midwives and Central Florida Birth  Network. Nashville, TN.  Carlotta Crawford of  ICTC 
  • Nashville and Harmony Family Health Care is hosting a Meet the Midwives event and Rally at Fannie Mae Dees Park (Dragon Park).
  • Los Angeles, CA. Haize Rosen is hosting a Walk/ Rally with ‘Mamas, Midwives and Celebrities’. Press and radio spots will be present. 
  • Dorchester/ Roxbury, MA. Makeda Kamara is hosting a walk at Franklin Park
  • Washington, DC. Claudia Booker – is celebrating the day with a free, all day “Midwifery and Birth Film Festival” on Saturday, May 7, 2011 from 2:00 PM until 10:00 PM at the ECAC (Emergence Community Arts Collective) 733 Euclid Street NW, Washington DC 20010 www.ecacollective.org 
  • Miami, FL. Jamarah Amani and Birthworkers of Color United, a local collective of midwives, doulas, childbirth educators and breastfeeding counselors, are leading mothers and community in a rally on 33rd Street and Biscayne Boulevard in Miami to mark the International Day of the Midwife. 
  • Espanola, NM. Michelle Peixinho, Tewa Women United and Young Women United are joining together to walk in solidarity with all midwives around the world approximately three miles through Española starting at the Northern New Mexico College and ending at 507 W. Pueblo, the potential site of Española’s future free-standing birth center! 
  • Lansing, MI. A walk/race is scheduled to take place at Hawk Island Park, starts with a pep rally, includes a kids’ 400 meter fun run, awards and a picnic lunch! In mid-day a Council of Midwives will be convened. The day ends with a concert at the Gone Wired Café.  

We Are All in This Together
We must make certain women in the U.S. have access to the best care that protects their physical and emotional integrity, ensuring not just survival, but providing experiences that are conscious, informed, satisfying, and memorable. It takes all of us, moms, babies, families and communities are depending on us. 
Join together on International Midwives Day!

Jennie Joseph, Midwives of Color Section Chair

Geradine Simkins, President and Interim Executive Director

MANA Board of Directors 

14.Feb.2011 Nurse-IN in Nation’s Capital Has Bozeman Connection

Kudos to Amber and Mark and their beautiful daughter for their part in the successful Nurse-IN at the Smithsonian.  I was lucky to be their midwife and attend their amazing birth. I am thrilled to know that they are such great agents of change for families and babies.

Here’s a Washington Post article about the Nurse-In.  A woman was approached by a security guard and asked to nurse in the women’s restroom. When she found there was no actual seating in the restroom,  she was advised to sit on the toilet to nurse. The incident is a great example of barriers to nursing and how far we, as a culture, have moved away from natural parenting. The security guard was, no doubt, well intentioned but needed to be educated about nursing. The Nurse-In was a great way to bring attention to the issue.

Alas, I cannot get the photos to load. Mark is wearing a great shirt that says “real men support breastfeeding.”  Check out the article. Way to go Mark and Amber!

31.Jan.2011 Let’s Reframe the Debate Already

FOR IMMEDIATE RELEASE: January 26, 2011It is Time to Reframe the Homebirth Conversation:Focus on Optimal Maternity Care and the Practitioners Who Can Provide It
In their recently released “Committee Opinion” on homebirth, the American College of Obstetricians and Gynecologists (ACOG) affirms the role of informed disclosure by saying, “…we have an obligation to provide families with information about the risks,
benefits, limitations, and advantages concerning the different maternity care providers and settings.” Midwives and other maternity professionals, therefore, are surprised that ACOG relies on the widely criticized Wax publications on homebirth, when there are more credible and carefully designed investigations that assess the relative risks of birth sites. Further, members of the Midwives Alliance – an organization representing the profession of midwifery since 1982 – are concerned that this ACOG Committee Opinion was apparently not subjected to review by experts who understand how to evaluate the quality of scientific studies on homebirth.

We believe it is time to re-frame this conversation. Midwives and obstetricians have been debating the safety of homebirth for far too long. In North America today planned homebirth for healthy women, attended by skilled providers, with access to medical consultation when necessary, is a safe option. Midwives as primary maternity providers, across settings and nations, have been identified as contributing to improved health outcomes. In the U.S. this includes care by Certified Nurse-Midwives, Certified Professional Midwives, and Certified Midwives. Moving beyond this debate over place of birth will allow obstetricians and midwives to focus on the goals we have in common.

There are critical issues facing all maternity providers today. First, we must understand the bio-ethical principle of autonomy as it relates to the human right of self-determination in making health care choices. Only then can we support women in their mastery of self-determination as they navigate the complicated worlds of obstetrics and maternity care and attempt to make good decisions for themselves and their families.

Second, it is the responsibility of the entire maternal and child health care (MCH) community to promote access to care that promotes optimal health for mothers and infants. We have a responsibility to remove barriers to options that women choose,  provide complete and transparent information to women during the childbearing year, and work collaboratively as a team for the benefit of families. 

Third, we can no longer tolerate the abysmal maternal and child health disparities that exist for our most vulnerable women and populations of color. We have our plates full with the daunting task of improving the health status of all women and infants in the United States within a social justice framework. 

We stand at the cusp of the greatest opportunity in decades to reform our ailing healthcare system into one that provides the highest quality care, with the fewest interventions, to achieve optimal outcomes, in the most cost-efficient manner. We must focus on widely implementing evidence-based maternity care practices that are appropriate for mothers and babies. We must address the fact that certain costly obstetrical practices that are not supported by science are overused, while other beneficial, low-tech practices are overlooked. Of particular concern to the Midwives Alliance and the clients we serve is the trend of increasing rates of cesarean sections, contributing to increased rates of premature birth, low birth weight infants and rising healthcare costs, while women across the country still struggle to find providers willing to attend vaginal births after cesarean (VBACs).

These are the current issues that together we must devote our most fervent attention towards seeking solutions. We can no longer be diverted by the distractions of disagreements among maternity professionals. We have serious work to do that cannot wait. We look forward to being in authentic dialog with ACOG – and all other stakeholders – as we plan and participate in a Homebirth Consensus Summit as a forum for building a common agenda for all involved in caring for mothers and babies. Women, infants, and families are counting on us to bring our complementary skills and acumen to the table and work together cooperatively.

Geradine Simkins, CNM, MSN
President & Interim Executive Director

Reference:
1. Sakala, Carol and Maureen P. Corry. Evidence-Based Maternity Care: What It Is and What It Can Achieve. New York: Milbank Memorial Fund, 2008, 1.


 

12.Nov.2010 The Economics of Birth are Killing Us

I’ve just returned from the Midwives Alliance of North America Conference where we spent a lot of time discussing maternal and infant mortality.  What is clear from the data is that what we midwives do is the safest for mothers and babies. And it is also clear that what the US medical industry does to healthy women and children is causing death.  The world health community was present at MANA this year with the plea — help change US birth culture. Right now more babies die in Memphis than Sri Lanka, more mothers die here than in 40 other developed countries (and the CDC estimates that we under count maternal deaths by a factor of 3). (The workshops on maternal death in the US were chilling.)

Why does the world health community care what happens in the US? Because the US provides 50% of all international aid dollars.  By doing so, we export our model of care around the world. And our model of maternal and infant care is dangerous.  Why was the world health community at MANA?  Because we Certified Professional Midwives are the experts on physiologic birth. We don’t have access to inductions, augmentation, epidurals, vacuum extraction, c-section, etc.  We have become experts in how women’s bodies give birth. And we have documented our findings through the MANA statistics project. (See the CPM 2000 report in the British Journal of Medicine, for example) (And huge kisses to all of my clients who have consented to be part of the data collection project. Thank you. The world is watching.) [And here’s a little article from the Huffington Post that shows that mainstream Americans are watching too. http://www.huffingtonpost.com/tabby-biddle/women-speak-out-about-wha_b_781205.html?ref=fb&src=sp#sb=370053,b=facebook

MANA, the Canadian Association of Midwives, the Internation Confederation of Midwives, ACNM, along with support from the American Public Health Association and the World Health Organization are working jointly on public policy to improve maternal and infant health. And MANA has issued the 2020 challenge. By 2020 in the United States we need 20% more midwives and we need to be attend 20% of all births. It will take that level of saturation of the birth market for the midwives model of care to impact the US health care industry — and that’s when we will see a dramatic reduction in maternal and infant death rates.

The MANA 2020 challenge is very doable. Breaking it down to achieveable goals: each midwifery preceptor needs to take on 2 students and each midwife needs to do 45 births a year. We can do this.  Other countries have made this change to improve maternal and infant outcome.  Canada legalized direct-entry midwifery about the same time Monana did. Canada has the advantage of having a health care system as opposed to a health care for-profit industry. And now in Quebec there are more midwives than OBs. And direct-entry midwives are integrated into the health care system. They attend births in home, birth center, and hospital. In the same time frame, New Zealand made the same changes. We have bigger battles than either country because of our profit-based health care industry. But I know that 2 students and 45 births a year are doable. I am already doing it.

If you have ever considered midwifery as a possible career now is the time to act. Midwifery schools are accredited. Federal policy is changing. Science and the international health community are on our side. The women who brought midwifery back from the brink of extinction here in the US  have positioned us to succeed. Now we need to step forward and move midwifery into the mainstream. Mothers and babies need us.

For more information on Midwifery Education, here the Midwifery Education Accreditation Council

17.Aug.2010 SIDS and breastfeeding– the Analytical Armadillo puts breastfeeding as biological norm.

Here’s a great blog post from a kindred spirit.  I have mentioned in the past my bewilderment that we are explaining the benefits of breastfeeding as opposed to detailing the deficits of formula feeding. (An example: breastfed infants have higher IQs vs formula fed infants have lower IQs. Breastfeeding is the biological norm. Data should be presented in reference to that norm — i.e. the story is that formula fed infants have lower IQs).

Blogger “the Analytical Armadillo” looks at breastfeeding and SIDS.  The research is clear: formula fed babies die of SIDS at much greater rates. Why don’t we hear about this? Mothers who are supported can nurse. In the rare instance that nursing doesn’t work, formula is not the first option for infant feeding.  The World Health Organization is clear on this — babies should get mother’s milk at the breast. If that is not possible, babies should get their mother’s milk from a bottle. If a woman is not able to pump sufficient amounts of milk, a baby should get human milk from a bottle.  As a very, very last resort a baby should be given formula.  That the risk of SIDS jumps dramatically with formula feeding is just one example of why it is so important that babies get mother’s milk.

Formula and SIDS — a clear connection. Analytical Armadillo has been thinking about guilt and data. Check out  her blog.  The Analytical Armadillo.

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