Plea for Help!

Last winter as we took our midwifery battle to the Missouri Supreme Court, and the legal bills piled up in the tens of thousands of dollars, we found ourselves facing bills far larger than we had ever imagined incurring. And, really, we had no idea just how we would pay them.

But quitting and going home, leaving the midwives as felons for another year or decade wasn't an option. So we moved ahead, and scrimped and saved wherever we could. And many, many people donated so generously. We managed to pay off a good portion of the bill. And then we pleaded with our attorneys to waive the interest and give us time - a lot of time - to find money to pay the rest of the bill off. They graciously agreed to. And they have given us a lot of time - about 9 months.

Everyone celebrated the midwives' win in court, and some donations came in back in June when the decision was first announced. But by now, paying off our huge legal bill seems like old news to everyone. Donations to Free the Midwives (www.freethemidwives .org) have trickled to almost nothing as few people seem to think that we are counting on *them* to dig deep and help us finish paying off the bill. (Thank you to the few individuals who have faithfully gone above and beyond in donating in recent months, and the St. Louis FoMM group that has tirelessly continued to fundraisers for Free the Midwives!)

Our attorney has informed us that we need to get our outstanding legal bill of $26,258 paid off by the end of the year.

I know that you are probably tired of being asked for money. And it's Christmas, and you have gifts to buy. And the economy is a mess. Now isn't a good time. It would be nice if somebody else with a lot of money would just pay it....

But people make time and find money to pay for what they really value and want.
Do you have a midwife who risked 7 years of prison to attend your birth? She went out of her way to give you the birth you wanted. Perhaps you could prioritize this need and give generously, even in spite of it not being a "convenient" time for you?

Almost anybody could raise $500 or $1,000 if they really set their mind to it. There are a multitude of ways, even if you can't personally give that much yourself. Will you commit to giving/raising $1,000, $500, or even $100 or $50 before the end of the year?

Perhaps you can talk your mother-in-law into donating $200. Or your co-worker into giving you $20 to finish paying this bill off before the end of the year. Perhaps you can offer to match 50% of whatever your midwifery/doula/ childbirth education clients are willing to give by deducting that much from your usual fee? Perhaps you have an uncle and a neighbor who would each donate $100 if you simply called and asked. Or you can collect $1 from everyone at some of the clubs/get-togethers /meetings you attend. Or maybe you can ask your family to donate to Free the Midwives on your behalf for Christmas instead of buying you another sweater that you really don't need?

I just heard a story from a CPM the other day. She was talking about having to transport a baby by ambulance to the hospital a few weeks ago. It was amazing to hear her say, "I stood there with the paramedic and the cop and it was such a good, strange feeling to be at perfect peace and know that I had done the right thing AND wouldn't be going to jail.... to know that everything I did was just AND lawful!"

Was it worth all the money we spent?

Absolutely! It was totally worth everything that each one of us have given - our time, our money, our blood, sweat and tears so that women everywhere in Missouri can find a legal midwife!

So far, I have commitments from 2 people who have set a goal of giving $1,000 each from them and their friends by they end of the year. Can you commit to a similar goal? Please email me at: better_birth {at} yahoo.com and let me know what we can count on from you!

Thank you!

Mary Ueland
Cell: 417-543-4258

Please donate online at:
www.freethemidwives .org

OR by check or money order:

Free the Midwives
PO Box 2319
Rolla, MO 65402

Physician groups play dirty

News from Missouri Midwife Supporters

CONTACT: Mary Ueland (417) 543-4258, grassroots@...

FOR IMMEDIATE RELEASE: Thursday, June 26, 2008

Opponents of Midwives Launch Smear Campaign

In a Desperate Attempt, Play the ‘Abortion Card’

JEFFERSON CITY, MO (June 26, 2008)—Just hours after the Missouri Supreme Court ruling that declares Missouri families now have legal access to professional midwives to help deliver babies in the state, the coalition of physician groups that tried to fight the law in question have launched a misinformation campaign seemingly designed to cast doubt among citizens, and based on false claims that the new law will permit Certified Professional Midwives (CPMs) to perform abortions.

“To suggest that CPMs are trained to do abortions—or that they would even want to—is beyond the pale. CPMs are all about delivering babies—abortion is not within their scope of practice. Abortions are performed by obstetricians, not by midwives,” said Mary Ueland, Grassroots Coordinator for Friends of Missouri Midwives (FOMM). “But considering that the Missouri physicians association told their own members last year that this legislation would allow bricklayers and crane operators to deliver babies, I’m not surprised at this new attempt to distort the truth.”

Certified Nurse-Midwives (CNMs), who are licensed and regulated in all 50 states, are trained to deliver babies in the hospital and to provide family planning and well-woman care. Certified Professional Midwives (CPMs), by contrast, limit their scope of practice to the management and care of healthy women experiencing normal pregnancies. They also undergo specialized training to qualify as experts in the provision of out-of-hospital maternity care.

“This interpretation is incorrect and obviously so,” stated Susan Jenkins, Legal Counsel for the National Birth Policy Coalition and a member of the legal team for the Friends of Missouri Midwives. “The new law clearly references the federal Medicaid statutes to define the scope of practice for which CPMs are certified and, as everyone knows, the federal Medicaid program does not cover abortion, except under rare circumstances as defined by the Hyde Amendment. More importantly, CPMs are not certified to provide abortions by their certifying body, the North American Registry of Midwives, and this statute is directly linked to CPMs certified scope of practice. The basic certification of CNMs does not include abortion either.”

In a 5 to 2 ruling Tuesday, the Missouri Supreme Court upheld a law that legalizes Certified Professional Midwives (CPMs) who practice in the state. The Court determined that the physician groups that brought the suit to overturn the law lacked standing because their only interest in the case was economic. The decision makes legal Certified Professional Midwives (CPMs) and removes the threat of prosecution to professional midwives who assist families who choose out-of-hospital birth. State and national birth and midwives advocates hailed the ruling as a triumphant and historic moment in Missouri’s history and evidence of a tipping point at hand on the national scale.

The Court’s summary is posted online. With this ruling, Missouri joins the majority of other states where Certified Professional Midwives are legal. There are only nine remaining states where they are prohibited. Twenty-four states license CPMs.

Missouri is a priority of The Big Push for Midwives Campaign <http://www.TheBigPushforMidwives.org>, a nationally coordinated campaign to advocate for regulation and licensure of Certified Professional Midwives (CPMs) in all 50 states, the District of Columbia and Puerto Rico, and to push back against the attempts of the American Medical Association Scope of Practice Partnership to deny American families access to legal midwifery care. The Big Push for Midwives Campaign is the first initiative of the National Birth Policy Coalition (NBPC). Through our work, we are building a new model of U.S. maternity care delivery at the local and regional levels. At the heart of this new model is the Midwives Model of Care, which is based on the fact that pregnancy and birth are normal life processes.

Media inquiries about the Missouri Supreme Court case should be directed to Mary Ueland at (417) 543-4258, grassroots@.... Media inquiries about The Big Push for Midwives Campaign should be directed to Steff Hedenkamp at (816) 506-4630, RedQuill@....

######

Friends of Missouri Midwives www.friendsofMOmidwives.org

Missouri Midwives Association www.missourimidwivesassociation.org

Show-Me Freedom in Healthcare www.showmefreedompac.org

Free the Midwives www.freethemidwives.org

The Big Push for Midwives www.TheBigPushforMidwives.org

Good News for Missouri Midwives

News from Missouri Midwives Supporters

CONTACT: Mary Ueland (417) 543-4258, better_birth@yahoo.com

FOR IMMEDIATE RELEASE: Wednesday, February 20, 2008 Midwives Licensure Bill Passes Missouri Senate CommitteeComprehensive bill will decriminalize practice of midwifery, and license and regulate midwives (Jefferson City, Mo.) – Midwives advocates across Missouri and the nation today celebrated the passage of Senator John Loudon’s (R, Chesterfield) midwifery licensure bill, SB 1021, from the Missouri Senate Committee on Pensions, General Laws and Veteran’s Affairs. The long-anticipated legislation would decriminalize the practice of midwifery in Missouri and establish a board to license and regulate Certified Professional Midwives (CPMs).
The committee voted 5-1 before a hearing room packed with citizens from across the state, many of whom represented families who wish to choose a legal midwife to assist them during childbirth. Committee members combined the bill with SB870, a repeal of the midwifery provision in current statute. The resulting committee substitute is a comprehensive piece of midwifery legislation.
“Missouri needs legal midwives,” said Debbie Smithey, President of Missouri Midwives Association. “This bill will license and regulate the midwives whose legal status is currently in question before the Supreme Court.”Currently, Certified Nurse-Midwives, who work predominantly in hospital settings, are licensed and regulated in all 50 states, while Certified Professional Midwives, who work in out-of-hospital settings, are licensed and regulated in 24 states, with legislation pending in an additional 20 states, Missouri among them.
CPMs’ training as specialists in out-of-hospital maternity care qualifies them as essential providers during disasters in which hospitals become inaccessible or unsafe for laboring mothers and newborn babies. In addition, this bill will ensure that all babies born outside of the hospital undergo state-mandated newborn screenings and are provided with legal and secure birth certificates.
“We applaud the committee for their clear show of support for health care freedom in childbirth,” said Laurel Smith, President of Friends of Missouri Midwives, a statewide network of thousands of Missouri homebirth families, “The parents of our state have been deprived of the freedom to choose a legal midwife specifically trained in out-of-hospital maternity care for too long. We look forward to seeing this issue debated in the full Senate and anticipate the day when professional midwives are legally recognized and able to serve women freely.”
Missouri is part of The Big Push for Midwives Campaign

Media inquiries should be directed to Mary Ueland at (417) 543-4258, better_birth@yahoo.com.

For more info:Friends of Missouri Midwives

Missouri Midwives Association

Show-Me Freedom in Healthcare

Free the Midwives

The Big Push for Midwives Campaign

Why keep fighting? Part 1

I was asked at the Capitol Wednesday why this fight (and yes, it is a fight) is important to me as an individual. What I said was, "I hope to be a Midwife someday and I don't want to risk imprisonment to do it. I also don't think anyone should be able to tell me who can see, touch, and have general access to my vagina."
But the issue goes much deeper than that. My answer was what you would call the "Cliff Notes" version: short, sweet, and to the point. To understand WHY I'm here, I first have to understand HOW I got here. So, without further ado, here is my story.
I was thirteen when my mom got pregnant with my brother, Tumeric*, and like any other self-absorbed only child, I was less than thrilled. I had been the center of attention for thirteen years and I was not yet ready to give that honor up. I watched her belly grow with mixed feelings gravitating between awe and angst. She had a Blessingway towards the end of her pregnancy, and while I pretended to be bored to tears, I was secretly enthralled. With a crown of flowers atop her silky pregnancy hair, she looked like a queen. Her friends surrounded her with love, poems, songs, and well wishes for a healthy birth.
I don't remember the details leading up to Tumeric's birth as well as she does, but I do remember a lot of walking, squatting and moaning. The moaning stuck with me the most. I had never experienced something so primal as this low, guttural noise coming from my usually composed and somewhat dainty mother. Three generations of women gathered around her and followed her from room to room as she labored her child into this world. We all spoke in hushed tones so as not to disturb Mom or the aura she wished to have around her during labor. My role was quiet observer and bringer of the warm washcloths, not too warm and not too cool. As she prepared to push Tumeric out of her body, I remember feeling horrified at all the fluid coming from her. Then I saw it, this massive pile of dark, wet hair. My brother was about to be born! I couldn't believe the wave of emotions that hit me during those precious few moments it took him to glide out of her. It was all at once the most beautiful, wonderful, miraculous thing I had ever seen. Like the great Mother Goddess long ago, my Mom opened herself up and birthed a being unlike any other in this world. She was a Goddess in her own right. In that moment I felt connected to her, and the rest of the women in this world, in a way I hadn't known before. Those minutes changed me. I saw that birth was not scary, but instead a transformation of body, mind, and spirit. I saw that the body truly knew what to do, even when Mom wasn't sure. I saw her guided through this experience by not only the support of her favorite women, but also the innate knowledge inside her. I saw the potential in all women to labor unencumbered by anyone or anything and find not only that they could do it, and do it well, but that they could become warriors for themselves.
Three years later, she did it again. This time, though, she knew by experience that she was a warrior. She knew she could birth a child into this world on her own and had none of the fears she had before. My youngest brother was in a hurry from the get go. While Tumeric took his time entering this world, Mack* came barging in. He came so fast that the Midwife just barely arrived in time. I had only been awake for an hour when he made his entrance. Still groggy from being awoken at 3am, my memories of his birth are a little foggier. My most prominent memory from him is that he was born in the caul (amniotic sac still intact). It looked like Mom was blowing a bubble and I thought that was fascinating. I held a mirror to show her and she was not quite as fascinated. He was completely born a few seconds after that. My other memory of that birth was that I was supposed to catch him. Mom had said it was okay when the Midwife asked if I wanted to. Looking back, I'm glad I didn't. That right belongs, at least in my mind, to the mother or father or both. Mack's father caught him and seemed extremely surprised at how slippery he was. I was disappointed at the time, but that disappointment has long since passed. While Mom, Mack*, and everyone else were having some well deserved "down time", the Midwife and I chatted. She complimented my mature handling of the botched catching, and asked me if I had ever thought of being a Midwife. That's where it began. I'd heard the calling while watching Tumeric being born, but I hadn't realized exactly what to call it until then. She gave voice to that longing inside me.
*Names have been changed to protect the innocent.

Sucked In

I've been sucked in, I admit it. I've been looking daily at what other people are saying about ACOG's lovely position statement on homebirth. It's great. Usually, I have to search through mountains of crap before I get to what I'm looking for. Not on this topic. The women have spoken on this issue, and let me tell you, they're pissed!
In an unfortunate way, ACOG may have just paved the way for Midwifery to get the recognition it deserves. I have yet to see one positive comment about this statement (well, unless you count the she-devil of obstetrics, Dr. Amy, who seems to spend very little time actually practicing medicine as she is so busy blogging about us horrible, ignorant, lying homebirth advocates). Anyone who's involved with Midwifery in Missouri has known for at least the past three years that homebirth advocates are not a group of people to be messed with, but now I think the web world is finding this out. This statement was very close to a personal attack on anyone who chooses homebirth and I think many are taking it as such. Was it their intention to call us idiots? Did they mean to suggest that our mental, emotional, and physical health means nothing so long as our babies are healthy?
All women who want to have options for childbirth, at least more than the standard epidural or demerol, ice chips or popsicles, sitting in bed or laying down; have just been told that the only option that is safe and acceptable is accepting what ACOG says is safe and acceptable.
Excuse me for a moment but just who the F*%K do you think you are? Who are you, mighty obstetricians (who had to learn from Midwives) to tell me where, when, and with whom to have my baby? Safety aside, if I want to squat down on my front porch and pop my kid out for anyone passing by to see~it's my right! My vagina is not yours to command.

RCOG and RCM Statement

I found this post at The True Face of Birth
It makes me go, hmm...

Compare the below statement (long but worth reading) from the Royal College of Obstetricians and Gynecologists and the Royal College of Midwives with ACOG's recent statement about home birth. I hope for the day when ACOG can produce a similar document that actually examines the evidence and listens to what women are saying. Imagine what we could achieve if ACOG were an ally to all birthing women!

Home Births
RCOG and Royal College of Midwives Joint Statement No.2.
April 2007

Summary

The Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG) support home birth for women with uncomplicated pregnancies. There is no reason why home birth should not be offered to women at low risk of complications and it may confer considerable benefits for them and their families. There is ample evidence showing that labouring at home increases a woman’s likelihood of a birth that is both satisfying and safe, with implications for her health and that of her baby.^1–3

1. Introduction

1.1 The rate of home births within the UK remains low at approximately 2%,^4–6 but it is believed that if women had true choice the rate would be around 8–10%.7

1.2 The development of maternity polices over the last four decades, combined with frequent reorganisations of service structure, have impacted on the availability of home birth and have concentrated on births in hospitals.^8–10 Reasons for this appear to include:

• financial constraints
• the values and beliefs of organisations about maternity care
• lack of staff with the appropriate competencies.¹¹

1.3 Throughout this time, women and voluntary organisations have challenged the onedimensional approach to options for place of birth and have influenced the portfolio of evidence now available to support a return to a more diverse range of childbirth environments.^12–15

2. Review of the evidence: benefits and harms

2.1 The review of the diverse evidence available on home birth practice and service provision demonstrates that home birth is a safe option for many women.^2,16,17 However, this is not to define safety in its narrow interpretation as physical safety only but also to acknowledge and encompass issues surrounding emotional and psychological wellbeing. Birth for a woman is a rite of passage and a family life event, as well as being the start of a lifelong relationship with her baby. Home births will not be the choice for every woman.⁷

2.2 Randomised controlled trials to assess the safety of home births are not currently feasible. The observational data available show lower intervention rates and higher maternal satisfaction with planned home birth compared with hospital birth. Overall, the literature shows that women have less pain at home and use less pharmacological pain relief, have lower levels of intervention, more autonomy and increased satisfaction.^1,12,18–20 The studied interventions included induction, augmentation, perineal trauma and episiotomy, instrumental delivery and caesarean section. These are not insignificant interventions and may have considerable impact on a woman’s long-term health and emergent relationship with her baby, as well as her satisfaction with her birth experience.

2.3 Furthermore, the studies into women’s descriptions of home birth experiences have produced qualitative data on increased sense of control, empowerment and self esteem, and an overwhelming preference for home birth.^3,21–27

2.4 A distinction needs to be made between women who plan for a home birth and those who have an unintended home birth, as unintended home births or women who received no antenatal care are linked to a higher rate of both maternal and perinatal complications.²⁰

2.5 A proportion of women who plan a home birth are transferred to hospital,^9,13,14,19 most commonly for slow progress or needing pain relief not available at home, such as epidural anaesthesia. The most serious reasons for transfer are maternal haemorrhage, concerns about fetal wellbeing and the neonate born in an unexpectedly poor condition. Delay in transfer under these circumstances may have serious consequences. Owing to poor collection of maternity data, the comparative statistics for women being transferred in labour are unclear. Higher transfer rates are associated with nulliparity.^13,14,19,28 The discussion with women regarding their potential transfer in labour should include consideration of the distance between birth settings and of other local circumstances which may introduce delay in transfer.

3. Achieving best practice

3.1 Both the RCM and the RCOG believe that to achieve best practice within home birth services it is necessary that organisations’ systems and structures are built to fully support this service. These will include developing a shared philosophy, fostering a service culture of reciprocal valuing of all birth environments.

3.2 Comprehensive involvement by local multidisciplinary teams and users to underpin home birth practices within a clinical governance framework results in a quality service which demonstrates commitment to supporting women in their choices.^4–6 Equally, it supports the development of responsible and responsive practices that are maintained by effective clinical decision making.

4. Provision of information, informed choice and user involvement in planning the services

4.1 The key principles include providing unbiased information on birth environment options and being transparent about the potential advantages or disadvantages of home birth.^14,29–33 Written information regarding place of birth should be available for all women, all women should be encouraged to participate actively in the full range of antenatal care and women can make the choice for a particular place of birth at any stage in pregnancy.¹⁴

4.2 The support for women’s choices is linked to clinical assessments during pregnancy and labour, to update the care pathway.¹² It is acknowledged that there are no known risk assessment tools which have an effective predictive value concerning outcomes in the antenatal period and labour.^34,35

4.3 Home birth provision should take into account women’s individual needs, especially women from socially excluded, disadvantaged and minority backgrounds,^4,36–38 as they are less likely to access services or to ask for home births

4.4 The involvement of fathers/partners in planning and attending home birth is encouraged as pregnancy and birth are the first major opportunities to engage fathers/partners in the appropriate care and upbringing of their children.⁴

5. Continuity and communication

5.1 Continuing communication between health professionals, women and their families is requisite for continuity of care. ‘A midwife providing care to women, regardless of the setting, must take care to identify possible risk and pre plan to mitigate those risks through her approach to care, knowledge of local help systems and communication with colleagues and the woman and her family’.¹⁵ Planned referral pathways in pregnancy are designed to facilitate effective communication and feedback at all levels and with any agency involved in providing care.

5.2 UK maternity policies recognise that, for the majority of women, pregnancy and childbirth are normal life events and that promoting women’s experience of having choice and control in childbirth can have a significant effect on children’s healthy development.^4–6 The improved relationships built upon continuity of care and carer can lead to considerable advantages in the promotion of breastfeeding, reduction in smoking in pregnancy and improved nutrition for women.

5.3 Continuity of care is a complex concept as it can mean continuity of care from a team of midwives or continuity of carer by a single known midwife. Organisations need to explore ways of promoting home births within these care schemes, especially for socially excluded women.^36–39

5.4 Another aspect in ensuring effective communication is clear and detailed documentation of the care plan for home birth.^32,36

6. Service structure support

6.1 The recent recruitment and retention problems of midwives within the maternity services have led to some NHS trusts withdrawing home birth services or informing women at the last minute that staff are not available. For women to believe throughout their pregnancy that they will have a home birth and for this option to be withdrawn late in pregnancy or in labour is not acceptable and will lead to further pressure on labour wards and midwives, as they have to manage women who are disaffected by the service at the start of their labour. Any possibility of not being able to provide the service should be highlighted in early pregnancy.

6.2 It is essential that formal local multidisciplinary arrangements are in place for emergency situations, including transfer in labour and midwives referring directly to the most senior obstetrician on the labour ward and/or to the paediatrician. The midwife is responsible for transfer and must remain to care both for the woman and the baby during transfer and, where possible, continuing on in the transferred unit. These protocols need to encompass the independent practitioners providing home birth service. The use of ‘flying squads’ is no longer supported and in the event of an emergency, transfer in is the only option.

6.3 Other agencies have an integral role in the collaborative management of home birth services, particularly the regional ambulance service. Therefore, developing a service agreement with these agencies will provide an improved risk management framework; for example, in the event of emergency transfer ambulances should take women to the consultant obstetric unit rather than the accident and emergency department. Babies need to be transferred to maternity units where there are appropriate neonatal services.

6.4 The clinical and personal safety of the midwife practitioner at home birth requires extra resources. For example, it is the employer’s responsibility to set minimum agreed levels of equipment for carrying out the role, including equipment for communication.^33,40 In addition, midwives working alone in the community should have appropriate lone-worker arrangements provided by their local NHS trust or employer.

6.5 Midwifery supervision is integral to any midwifery practice and all organisations must ensure that there are adequate numbers of supervisors of midwives to ensure 24-hour access.⁴¹ Where a woman has a risk factor which may deem her unsuitable for a home birth it is advisable that the midwife involves a manager and supervisor of midwives.

7. Skills and competencies

7.1 Midwife practitioners must be competent within the home birth environment and may require enhancement or updating of their existing midwifery skills prior to providing home birth services.¹⁵ Midwives’ personal accountability for only undertaking duties for which they have competencies, is governed by Midwives’ Rules and Standards.⁴¹ The organisation’s responsibility is to provide resources for acquiring new or maintaining existing skills associated with home birth practices, both linked to facilitating and observing physiological labour, as well as acting on emergencies. The mandatory ‘drills and skills’ training must include environments outside labour ward and simulation models should be available to encourage practising of skills. Up-to-date registers should be kept of those participating in skills drills to ensure that all staff participate regularly in a rolling programme.⁴²

7.2 The advanced courses in obstetric emergencies and neonatal resuscitation require adequate funding for further training.

7.3 Risk assessment must take place with what limited tools are available. Careful selection of low-risk maternities is important to minimise complications. Ideally, this should be by senior midwifery and obstetric staff.

8. Record keeping, audit and user surveys

8.1 Contemporary and accurate record keeping is vital; as for all aspects of health care.^33,41,43 The health records maintained on various sites need to be stored as a complete set and most organisations now require computer input for the birth records and obtaining the baby’s NHS number. These computer programmes aid auditing practices, both personal and organisational. Areas of service or practice for audit should include home birth, transfer and intervention rates as a minimum. User satisfaction surveys and focus groups need to be linked with home birth services. There should be robust clinical governance systems for monitoring the quality of home birth services. These should include both qualitative and quantitative audit data. Consideration should be given to women’s experiences, stories, transfer rates, ambulance response times and emergency scenarios. In the case of serious adverse outcome a detailed root cause analysis should be undertaken.⁴²

9. Conclusion

9.1 The RCM and RCOG support the provision of home birth services for women at low risk of complications. If the service is provided by midwives committed to this type of practice within continuity of care schemes and appropriately supported, outcomes are likely to be optimal. Services need evidence-based guidelines, where possible. Good communications, adequate training and emergency transfer policies are vital.

References

1. Wiegers TA, Keirse MJ, Van der Zee J, Berghs GA. Outcome of planned home birth and planned hospital births in low risk pregnancies: prospective study in midwifery practices in the Netherlands. BMJ 1996;313:1309–13.
2. Olsen O. Meta-analysis of the safety of the home birth. Birth 1997;24:4–13.
3. Ogden J, Shaw A, Zander L. Deciding on a home birth: help and hindrances. Br J Midwifery 1997;5:212–15.
4. Department of Health. The National Service Framework for Children and Young People. Maternity Services. Standard 11. London: Department of Health; 2004 [www.dh.gov.uk/assetRoot/04/09/05/23/04090523.pdf].
5. Welsh Assembly Children’s Health and Social Care Directorate. National Service Framework for Children, Young People and Maternity Services in Wales. Cardiff: Welsh Assembly Government; 2005 [www.wales.nhs.uk/sites/documents/441/ACFD1F6.pdf].
6. 6. Scottish Executive. A Framework for Maternity Services in Scotland. Edinburgh: Scottish Executive; 2001 [www.scotland.gov.uk/library3/health/ffms–00.asp].
7. Department of Health. Changing Childbirth: Report of the Expert Maternity Group. London: HMSO; 2003.
8. Department of Health and Social Security. Standing Maternity and Midwifery Advisory Committee (Chairman J. Peel). Domiciliary midwifery and maternity bed needs. London: HMSO; 1970.
9. Campbell R, Macfarlane A. Where to be Born: the Debate and the Evidence. Oxford: National Perinatal Epidemiology Unit; 1987.
10. Tew M. Safer Childbirth? A Critical History of Maternity Care. 2nd ed. London: Chapman and Hall; 1998.
11. Demilew J. Homebirth in urban UK. MIDIRS Midwifery Digest 2005;15:4(Suppl 2).
12. Edwards N. Choosing a Home Birth. London: Association for Improvements in the Maternity Services; 1994.
13. Chamberlain G, Wraight A, Crowley P. Home Births: The Report of the 1994 Confidential Enquiry by the National Birthday Trust Fund. Carnforth: Parthenon; 1997.
14. National Childbirth Trust. NCT Home Birth In the United Kingdom. London: NCT; 2001.
15. Nursing and Midwifery Council. Midwives and Home Birth. NMC Circular 8–2006. London: NMC;2006 [www.nmc-uk.org/aFrameDisplay.aspx?DocumentID=1472].
16. Springer NP, Van Weel C. Home birth. BMJ 1996;313:1276–7.
17. Olsen O, Jewell MD. Home versus hospital births. Cochrane Database Syst Rev 1998;(3):CD000352.
18. Northern Region Perinatal Mortality Survey Coordinating Group. Collaborative survey of perinatal loss in planned and unplanned home births. BMJ 1996;3:371–5.
19. Davies J. The Midwife in the Northern Regions Home Birth Study. Br J Midwifery 1997;5:219–24.
20. Confidential Enquiry into Stillbirths and Deaths in Infancy. 5th Annual Report. Focus group place of delivery. London: Maternal and Child Health Research Consortium; 1998.
21. Viisainen K. Negotiating control and meaning: home birth as a self-constructed choice in Finland. Soc Sci Med 2002;52:1109–21.
22. Andrews A. Home birth experience 2:births/postnatal reflections. Br J Midwifery 2004;12:552–7.
23. Munday R. Women's experience of the postnatal period following a planned home birth; a phenomenological study. MIDIRS Midwifery Digest 2004;13:371–5.
24. O’Brien M. Home and hospital: a comparison of the experiences of mothers having home and hospital confinements. J R Coll Gen Pract 1978;28:460–6.
25. Goldthorp WO, Richman J. Maternal attitudes to unintended home confinements: a case study of the effects of the hospital strike upon domiciliary confinement. Practitioner 1974;212:818–53. Royal College of Obstetricians and Gynaecologists and Royal College of Midwives Joint Statement No.2 5 of 6
26. Alment EA, Barr A, Reid M, Reid JJ. Normal confinement: home or hospital? The mother’s preference. BMJ 1967;I:52–53.<>
27. Paddison J. Home Birth a Family Affair: A Qualitative Research Case Study of Home Birth and Social Boundaries. Wigtownshire: Impart Publishing; 2005.
28. Campbell R, Macfarlane A. Where to be Born? The Debate and the Evidence. 2nd ed. Oxford: National Perinatal Epidemiology Unit, 1994.
29. Emslie MJ, Campbell MK, Walker KA, Robertson S, Campbell A. Developing consumer-led maternity services: a survey of women’s views in a local healthcare setting. Health Expectations 1999;2:195–207.
30. Hundley V, Rennie AM, Fitzmaurice A, Graham W, Van Teijlingen E, Penney G. A national survey of women’s views of their maternity care in Scotland. Midwifery 2000;16:303–13.
31. Singh D, Newburn M. Access to Maternity Information and Support: the needs and experiences of pregnant women and new mothers. London: National Childbirth Trust; 2000.
32. Royal College of Midwives. Home Birth Hand Book: Volume 1: Promoting Home Birth. London: RCM; 2002.
33. Royal College of Midwives. Home Birth Hand Book: Volume 2: Practising Home Birth. London: RCM; 2003.
34. Enkin MW, Keirse MJ, Renfrew MJ, Neilson JP. A Guide to Effective Care in Pregnancy and Childbirth. 2nd ed. Oxford: Oxford University Press;2000. p. 52.
35. Campbell R. Review and assessment of selection criteria used when booking pregnant women at different places of birth. Br J Obstet Gynaecol 1999;550–6.
36. Hutchings J, Henty, D. Caseload practice in partnership with Sure Start: changing the culture of birth. MIDIRS Midwifery Digest 2002;(Suppl 1):538–40.
37. Sandall J, Davis J, Warwick C. Evaluation of the Albany Midwifery Final Report. London: Florence Nightingale School of Midwifery, King’s College; 2001.
38. Royal College of Midwives. Making Maternity Services Work for Black and Minority Ethnic Women: A Resource Guide for midwives. London: RCM; 2004.
39. Hodnett ED. Continuity of caregivers for care during pregnancy and childbirth. Cochrane Database Syst Rev 2000;(2):CD000062.
40. Royal College of Midwives. Safety for Midwives Working in Community. Position Paper 12. London: RCM; 1996.
41. Nursing and Midwifery Council. Midwives Rules and Standards. London: NMC; 2004 [www.nmc–uk.org/aFrameDisplay.aspx?DocumentID=169].
42. National Health Service Litigation Authority. Clinical Negligence Scheme for Trusts, Maternity. Clinical Risk Management Standards. London: NHSLA; 2007 [www.nhsla.com/NR/rdonlyres/F8184718–3AF9–400E–A3F3–5D9309E2 AA72/0/CNSTMaternityClinicalRiskManagementStandardsApril2007website.pdf].
43. Royal College of Midwives. Litigation: A Risk Management Guide for Midwives. 2nd ed. London: RCM Trust; 2005

Valid until April 2010 unless otherwise indicated.

This statement was produced on behalf of the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives by: Miss JL Cresswell FRCOG, Chesterfield, and Ms E Stephens RM and peer reviewed by: Ms J Demilew, Ms C Dowling, Dr MCM Macintosh MRCOG, Ms P McConn, Dr MP Mohajer FRCOG, Mr RJ Porter FRCOG and Mr PJ Thompson FRCOG.

The Big Push for Midwives responds to ACOG

PushNews from The Big Push for Midwives Campaign
CONTACT: Steff Hedenkamp, (816) 506-4630, RedQuill@kc.rr.com
FOR IMMEDIATE RELEASE: Thursday, February 7, 2008

ACOG: Out of Touch with Needs of Childbearing Families

Trade Union claims out-of-hospital birth is “trendy;” tries to play the “bad mother” card

(February 7, 2008) — The American College of Obstetricians and Gynecologists (ACOG), a trade union representing the financial and professional interests of obstetricians, has issued the latest in a series of statements condemning families who choose home birth and calling on policy makers to deny them access to Certified Professional Midwives. CPMs are trained as experts in out-of-hospital delivery and as specialists in risk assessment and preventative care.

“It will certainly come as news to the Amish and other groups in this country who have long chosen home birth that they’re simply being ‘trendy’ or ‘fashionable,’” said Katie Prown, PhD, Campaign Manager of The Big Push for Midwives 2008. “The fact is, families deliver their babies at home for a variety of very valid reasons, either because they’re exercising their religious freedom, following their cultural traditions or because of financial need. These families deserve access to safe, quality and affordable maternity care, just like everyone else.”

Besides referring to home birth as a fashionable “trend” and a “cause célèbre” that families choose out of ignorance, ACOG’s latest statement adds insult to injury by claiming that women delivering outside of the hospital are bad mothers who value the childbirth “experience” over the safety of their babies.

“ACOG has it backwards,” said Steff Hedenkamp, Communications Coordinator of The Big Push and the mother of two children born at home. “I delivered my babies with a trained, skilled professional midwife because I wanted the safest out-of-hospital care possible. If every state were to follow ACOG’s recommendations and outlaw CPMs, families who choose home birth will be left with no care providers at all. I think we can all agree that this is an irresponsible policy that puts mothers and babies at risk.”

The Big Push for Midwives calls on ACOG to abandon these outdated policies and work with CPMs to reduce the cesarean rate and to take meaningful steps towards reducing racial and ethnic disparities in birth outcomes in all regions of the United States. CPMs play a critical role in both cesarean prevention and in the reduction of low-birth weight and pre-term births, the two most preventable causes of neonatal mortality.

Moreover, their training as specialists in out-of-hospital maternity care qualifies CPMs as essential first-responders during disasters in which hospitals become inaccessible or unsafe for laboring mothers. In addition, CPMs work to ensure that all babies born outside of the hospital undergo state-mandated newborn screenings and are provided with legal and secure birth certificates.

Currently, Certified Nurse-Midwives, who work predominantly in hospital settings, are licensed and regulated in all 50 states, while Certified Professional Midwives, who work in out-of-hospital settings, are licensed and regulated in 24 states, with legislation pending in an additional 20 states.

The Big Push for Midwives > is a nationally coordinated campaign to advocate for regulation and licensure of Certified Professional Midwives (CPMs) in all 50 states, the District of Columbia and Puerto Rico, and to push back against the attempts of the American Medical Association Scope of Practice Partnership to deny American families access to legal midwifery care.
Media inquiries should be directed to Steff Hedenkamp (816) 506-4630, RedQuill@kc.rr.com.

ACOG Position Statement

I found this post at another blog and thought I'd share it.

The American College of Obstetricians and Gynecologists reiterated their statement on home births today. I’ve highlighted some of the statement I found interesting:

Washington, DC — The American College of Obstetricians and Gynecologists (ACOG) reiterates its long-standing opposition to home births. While childbirth is a normal physiologic process that most women experience without problems, monitoring of both the woman and the fetus during labor and delivery in a hospital or accredited birthing center is essential because complications can arise with little or no warning even among women with low-risk pregnancies.

ACOG acknowledges a woman’s right to make informed decisions regarding her delivery and to have a choice in choosing her health care provider, but ACOG does not support programs that advocate for, or individuals who provide, home births. Nor does ACOG support the provision of care by midwives who are not certified by the American College of Nurse-Midwives (ACNM) or the American Midwifery Certification Board (AMCB).

[For clarity: ACOG supports women to make their own choices, but does not support them making their own choices. Good. Let’s go on: ACOG does not support the Certified Nurse-Midwife who attends home births, but does support her in the freestanding birth center. ACOG does not support programs that advocate home births… which presumably includes health insurance and state health insurance programs that routinely, and often gladly, reimburse the CNM and CPM for providing this low-cost option to their subscribers.]

Childbirth decisions should not be dictated or influenced by what’s fashionable, trendy, or the latest cause célèbre. Despite the rosy picture painted by home birth advocates, a seemingly normal labor and delivery can quickly become life-threatening for both the mother and baby. Attempting a vaginal birth after cesarean (VBAC) at home is especially dangerous because if the uterus ruptures during labor, both the mother and baby face an emergency situation with potentially catastrophic consequences, including death. Unless a woman is in a hospital, an accredited freestanding birthing center, or a birthing center within a hospital complex, with physicians ready to intervene quickly if necessary, she puts herself and her baby’s health and life at unnecessary risk.

[Well! It looks like the home birth committee at ACOG has finally screened their copy of The Business of Being Born! It is very reassuring to see ACOG supporting freestanding birthing centers as a safe facility in which to give birth by VBAC. It may inspire the American Association of Birth Centers to rethink their stance on the subject as they currently do not recommend it. Additionally I wonder if ACOG realizes that a properly accredited birthing center is just like a home and not at all close to a hospital? Emergencies and other complications of varying degrees will have to be transferred out to a hospital just as they would a home birth.]

Advocates cite the high US cesarean rate as one justification for promoting home births. The cesarean delivery rate has concerned ACOG for the past several decades and ACOG remains committed to reducing it, but there is no scientific way to recommend an ‘ideal’ national cesarean rate as a target goal. In 2000, ACOG issued its Task Force Report Evaluation of Cesarean Delivery to assist physicians and institutions in assessing and reducing, if necessary, their cesarean delivery rates. Multiple factors are responsible for the current cesarean rate, but emerging contributors include maternal choice and the rising tide of high-risk pregnancies due to maternal age, overweight, obesity and diabetes.

[Does this say something closer to, “If you women would just have babies at a reasonable age, start taking care of your health, and stop asking for cesareans, we would have a lower cesarean rate!”? It would have been a nice addition to the paragraph to see how exactly they are helping physicians and institutions lower their cesarean rate because it doesn’t seem to be working.]

The availability of an obstetrician-gynecologist to provide expertise and intervention in an emergency during labor and/or delivery may be life-saving for the mother or newborn and lower the likelihood of a bad outcome. ACOG believes that the safest setting for labor, delivery, and the immediate postpartum period is in the hospital, or a birthing center within a hospital complex, that meets the standards jointly outlined by the American Academy of Pediatrics (AAP) and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers.

It should be emphasized that studies comparing the safety and outcome of births in hospitals with those occurring in other settings in the US are limited and have not been scientifically rigorous. Moreover, lay or other midwives attending to home births are unable to perform live-saving emergency cesarean deliveries and other surgical and medical procedures that would best safeguard the mother and child.

[To that I say to every home birth midwife of every credential: participate with MANA Statistics Project and continue to give ACOG numbers to reject as insignificant. Further, I wonder if ACOG has any clue that Certified Nurse-Midwives all over the US are attending home births? In my area they are pretty close to being the majority provider of such service. For the record, CNMs do not do cesarean surgeries just as “lay or other midwives” (licensed Certified Professional Midwives they meant to say) do not. I haven’t yet seen or heard anything a CNM would do that a CPM wouldn’t or couldn’t at a home birth.]

ACOG encourages all pregnant women to get prenatal care and to make a birth plan. The main goal should be a healthy and safe outcome for both mother and baby. Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby. For women who choose a midwife to help deliver their baby, it is critical that they choose only ACNM-certified or AMCB-certified midwives that collaborate with a physician to deliver their baby in a hospital, hospital-based birthing center, or properly accredited freestanding birth center.

[It’s rather insulting to the families who choose home birth and the midwives who provide the service to state that the experience is being chosen over safety. If the experience were the most important thing, why do I get so many questions on my current neonatal resuscitation provider status, if I have medication to stop a hemorrhage, how fast can I start an IV, and more? If that wasn’t important I’d spend most of my time sprinkling good wishes over women instead of arranging for their ACOG recommended prenatal care and screening!]

So, we all understand this right ladies? WE are not capable of making informed decisions about our labors (unless of course we choose an OB in a hospital). WE are selfish because we chose to give birth at home. WE are not important in the birth process, the baby is the only one who matters. WE are responsible for the high cesarean rates. WE are following the "trends".

Exactly which trend is this? I, for one, have been aware of and witnessing home births since I was 13. Yes, long before Ricki Lake ever thought of giving birth, let alone making a documentary about the broken maternity care system in the US. A friend of mine was born at home 27 years ago (as were her subsequent three siblings). Another friend has been having her babies at home for the past 9 years. So, whose example are we following? Oh, that's right we're doing what we're instinctively meant to do. We're doing what has been done for thousands of years. We're controlling ourselves and giving birth the way we see fit, the way we work best. No, home birth is not for everyone ~ but neither is hospital birth.

2008 Legislative Session

That's right, the time has come upon us to yet again fight the good fight. This year's legislative session promises to be interesting. Why?
First, the Missouri Supreme Court should be hearing arguments for/against the constitutionality of a single sentence put into a bill that Governor Blunt signed into law last summer. You remember, the one that had the "obscure" term tocology (quick, google it and see how long it takes you to find the definition) in it. The one that finally restored Missouri women's right to have a Midwife attended birth. The one the Missouri State Medical Association, among others, is wasting our tax dollars fighting against.
Second, two bills are up that support Midwifery. Representative Cynthia Davis (thank you, Cynthia) has filed HB1600, which removes Midwifery from the definition of the practice of medicine.
A Representative and Senator John Loudon are both filing Midwifery licensure bills. Thanks guys!
Third, and pooh, two bills are filed two repeal the tocology provision that passed last session.
Senator John Loudon filed SB870 and Representative Dr. Bob Onder filed HB1643. It is imperative to the ongoing legal battle, as well as Missouri families and Midwives, that these bills be defeated.
Write your legislators, write your local papers, visit the Captitol, and tell anyone who will listen how you feel about this subject.
"We will overcome"
Blessings and Peace