Archive for the ‘consumer’ Category

Picking Your Care Provider – Interview Questions

Thursday, July 28th, 2011

Being an active participant in your pregnancy and birth journey begins with choosing your provider. You can begin the search for the right provider fit prior to becoming pregnant, in early pregnancy or anytime before your baby is born. So much of how your pregnancy and birth unfold are directly related to your care provider so this is really a key element. Every provider is not the right fit for every mother and vice verse. If you already have an established provider relationship, these questions can be used as a re-interview tool.

When asking these questions, take care to really listen to the answers. If a provider will not meet with you prior to you becoming a patient, that can be a red flag.

______________________________________________________________________

Begin by expressing your overall idea of what your best pregnancy, labor and birth looks like to provider.

  • What are your core beliefs, training, experience surrounding pregnancy and birth?
  • Why did you choose this line of work?
  • What sets you apart from other maternity providers?
  • How can you help me attain my vision for pregnancy, labor and birth?
  • If I have a question, will you answer over the phone, by email or other avenue outside of prenatal appointments?
  • How much time will you spend with me during each appointment?
  • What routine tests are utilized during pregnancy? What if I decline these tests?
  • What is the average birth experience of first time mothers in your practice?
  • How do you approach the due date? What do you consider full term and when would I be considered overdue?
  • What are your patient intervention rates? (IV, AROM, continuous monitoring, episiotomy, etc.) Cesarean rate? VBAC rate? Induction rate? What induction methods are used? When are forceps/vacuum used? These numbers are tracked.
  • What positions are you comfortable catching in? Birth stool? Hand/Knees? Squatting? Standing? Water? How often do patients deliver in positions other than reclined or McRoberts positions?
  • How do you feel about me having a birth plan?
  • What if I hire a doula? Do you have an interest in who I work with or restrictions? If yes, why?
  • Do you have an opinion on the type of childbirth or breastfeeding class I take? If so, what and why?
  • Are you part of on call rotation or do you attend your own  overall? Will the back-up or on-call CP honor the requests we have agreed on?
  • Are there any protocols that are non-negotiable? If you cannot refuse – you are not consenting.
  • What if I choose to decline a recommended procedure or intervention in labor or post birth, how will that be viewed?
  • When will I see you during labor?
  • What postpartum care or support do you offer?
  • Will I be able to get questions answered or be seen before the 6 week postpartum visit?

Points to ponder afterward:

  • Did you feel immediately comfortable and respected at the interview? If already with a CP, do you feel comfortable, respected and heard at each appointment?
  • Were there red flags or white flags?
  • Was or is care provider willing to answer questions in detail without being annoyed?
  • Is choosing your care provider based on your insurance or lack of insurance?
  • What are you willing to do in order to have the birth you really desire? Birth location?
  • How much responsibility are you willing to take for the health care decisions for you and your baby?

Grateful For My Births

Wednesday, November 24th, 2010

Focusing on Thanksgiving, I asked others to submit a “Why I am Grateful For My Birth(s)” blog post.  In the spirit of that, here is my own blog posting. Stay tuned for the Carnival of posts to be up by Thanksgiving morning.

I myself have had four varied labors and births, one of which could be considered a “normal” and natural birth experience.

From my first labor and birth, I learned that maternal ignorance no matter the intention can get you into the OR  I had to travel 45 minutes to my birth location, was only a 2 cm but nurse admitted me because she did not want me to go all the way home (she of course did not tell me that or we would have rented a hotel room nearby to labor in), I then allowed the same nurse to perform AROM at 3 cm’s because she figured it could speed things up because early labor you know is slow often for first time mothers.Walked stairs for hours but….. Now came the pitocin because my waters were broken and I was not moving fast enough. Then came horrid, blinding back labor. At some point I got a partial dose of fentanyl. Then another. Finally in transition about 20 hours in, I thought I wanted the epidural. I did not get one as I was complete and pushed for nearly four hours. Then finally after a failed vacuum assist to rotate his head and help me I ended up in a cesarean for deep transverse arrest for an acynclitic, deflexed baby head.

Baby number 2 27 months later and I was for sure in no way going to get to the hospital before I was in very well established labor. VBAC, whatever, I knew if things were okay. I would never have pitocin in labor again or have my waters broken. So I labored beautifully, with no fear, hey there was some ivory tower mama left in me still. After having contractions work up to 2 minutes apart and 90 seconds long, I decided it was time to leave. My husband ran back in the house and put a water proof pad on my seat (what a very intuitive man). On the way during the 15 minutes ride to the hospital, my water broke, I mean BROKE – kaplooey. Yep water proof crib pad saved the passenger seat if our minivan. In triage I was checked and behold I was a stretchy 9 cm’s. Everyone was so happy. A VBAC good for you mama. No saline lock. Some monitoring. Then the trouble started.  The on-call doc came in and was impatient. I pushed for about an hour (mind you I was a VBAC) and when he was low enough she cut an episiotomy and used forceps on him.  Very little conversation, my husband just said she insisted and there he was. So a natural labor and almost natural birth. I still felt great. Episiotomy was far less painful than surgery…. I got my VBAC. Though  my baby ended up in NICU overnight because of forceps. That was awful. We were both very mad after we could process it. He nursed well nonetheless. Took him home the next day.

Labor and birth number 3 is told in detail on my blog post A Woman’s Voice Birthed Into Fullness so I will not report on it here.

My 4th labor and birth had me in the place of I am arriving at the hospital very late in labor even though this time I was a 1VBA2C mama. Funky contractions of a few hours each over three nights including one trip to the hospital thinking it MUST be labor, had me sitting at 7 cm’s dilated WITHOUT being in labor. How did I know that? I asked my midwife to check me every day after the short bout of contractions. I just laughed and laughed about being in “transition” dilation wise but not being in labor. On the fourth night of when the contractions started, I said OKAY I am having this baby. I did some nipple stimulation and acupressure over an hour, next thing I know 3 minutes apart contractions then closer. We got to the hospital I was 8 cm’s, walked for a half hour. Then I was 9 cm’s and pattern was back strong. Midwife came. After some odd and funny asides. I allowed AROM baby was +1 and in good position. She promised me. PROMISED me as I glared her down that this would not cause another cesarean. Baby was in perfect position. Gulp. OK. I trusted her and knew she did have our best interest at heart. No baby did not fall out. Have I mentioned I have an android pelvis? I was completely shortly after that and pushed. He was born about 45 minutes later. That for me was such a short amount of time to push. He was in my hands and on my chest with the exception of maybe two minutes for FIVE hours post birth. FIVE. He had about a 14.5″ head and came out over an intact perineum.  I was, well, normal, everyday, usual. Yep. I basked in the no nonsense aspects of it.

I learned so much through all my labors and births. Through #1 that though I made many excellent choices in my care provider and birth location, heck we even took out of hospital independent birthing classes, that maternal ignorance and a willingness to believe no nurse would do something that could cause harm was really am ivory tower point of view that women can just have babies. I knew I could birth, but knew I needed to know even more.

Through #2 that on-call providers can be dangerous people and that I COULD birth.

With #3 my voice came into being. I turned into who I am now. Like a butterfly with the roar of a lioness.

And #4 oh my baby. I became normal, just like every other woman who had a natural labor and birth. Just another birthing woman. Not special. I really liked that title.

Yes I am grateful or I would not be the advocate, doula, educator, flag waving proponent of informed consent AND refusal, strive to help and support women in their childbearing years…. oh so much more. I am grateful because in all of this I have found my calling.

Thank you to K, L, J and D for being my sons.  Thank you to bad on-call doc, well meaning but harmful nurse, horrid nursery staff, and C.E. the midwife who believed in me and my body as much as I did.

Tell NBC What YOU Think – ICAN meets mother-sized activisim

Sunday, February 7th, 2010

http://blog.ican-online.org/2010/02/07/mother-sized-activism-nbc/

The International Cesarean Awareness Network wants you to get involved and speak your mind about what you think of the NBC “Live in the OR” piece from last week. Here is the link to ICAN’s official response.

The only way that mass media will be responsible for what they put on the airwaves is for real people, the  consumers to speak their minds.  Please click on the above think and go for it. Be heard. It does make a difference.

Affording the Birth You Want

Monday, February 1st, 2010

Many times over I have heard something similar to “If only my insurance would cover the childbirth class, doula, that provider or birth location. Then I could have the birth I really want for me and my baby.” That statement sadly says to me that women are settling for a provider, birth location, type of birth even that would not otherwise be chosen.  Even so far as having a repeat cesarean because the insurance covered location or provider does not “allow” VBAC.

So practically how is someone going to get the desired provider, location or birth? First think of appealing to the insurance company to add a specific location (even home) or provider (even a  home birth provider) to the plan. This may or may not come to fruition, but unless the process is undertaken it isn’t even a possibility. Second, think outside the insurance box.  Be creative. I am a believer that almost 100% of the time there is a way. It may not be easy, simple, or lack stress but likely possible.

Here are some of my ideas for paying for the birth location, care provider, education, or doula support really desired.

Ask for family, friends, co-workers to donate to fund(s) in lieu of routine shower gifts (you will likely not use most of that “stuff” anyway no matter how much you think you will).

Trimming Down = Money Savings

  • Satellite/Cable tv – Lower or cancel service.
  • Cell phone – lower minutes, negotiate new fee structure, change plans.
  • Household utilities – Lower thermostat, take short showers, heat or cold proof home.
  • House phone – Get rid of all extras on phone that you don’t need or go VoIP. Even set-up answering machine.
  • Food – Grocery shop sales only (no impulse buying), use coupons, eat at home, brown bag to work, no more fancy coffee drinks.
  • Entertainment – Get Netflix instead of going out to the movies, visit with friends or family in their homes or yours.
  • Shopping – Cut back on extras you do not need to live.
  • Vehicle – Car pool whenever possible, only run multiple errands together, walk if possible, use public transportation is available.
  • Housing – Move to a lower rent area or to a smaller home. Even consider moving in with family to maximize savings.

Extra Cashflow

  • Sell any unneeded items via yard sale or something akin to Craig’s List. This can apply to second vehicle as well.
  • Take on a second job that can be done from home or even with a multi-level company.
  • Ask husband or partner to temporarily take on a second job.
  • Do you gourmet cook,  write, musically talented, sew, knit, paint or craft? You may be able to sell your creations or services.

Miscellaneous

  • Barter
  • Ask for payment plan.
  • Look for less expensive supplies such as a “fishy pool” versus renting an AquaDoula.
  • Choose a birth center or a home birth as the cost is significantly less than even a no-intervention natural hospital birth. Also your prenatal care is included in the fee unlike a planned hospital delivery.
  • Hire a training doula. Often a lower fee.
  • Start a savings account before you are pregnant.
  • Plan ahead and pay down any existing debt prior to getting pregnant or in early pregnancy.

I hope some “light bulb” moments are had and there is encouragement in the ideas. There is almost always a way.

If I have left anything off the lists, please feel free to leave a comment and I will add.

Some thoughts on birth and being a consumer.

Sunday, January 3rd, 2010

While “teaching” childbirth class the topic of being a consumer is addressed often in a variety of ways.  I have a firm belief that a woman has the ability to understand, be well educated, and make her own decisions. It is in no way in my job description to tell someone else how she must birth or how to do it in the right way.  She is the one who needs to take the information, explore it and apply it to her self and situation.  Being a consumer in her childbearing year is a key component.

I have a great and deep sense of obligation to give truthful, helpful, real life applicable information to the families I am blessed to work with.  Because of this my mantra is,  “You go home or stay home with your baby and are the one who must live with the decisions and outcomes from them. Not the doctor, midwife, nurse, doula, educator – no one else.  We all go home to our own lives. So if you have to live with all that happens then do your best to choose wisely to what you can live with.”  No mother escapes the outcomes and the legacy it leaves behind forever no matter who makes the decisions for her. Even if it seems easier at the time to allow others to call the shots, I can hope the epiphany of this will help the pregnant woman to push for what she really needs and wants instead of being a passenger in her own process.

Birth options are integrated into prenatals and/or class structure as we discuss birth philosophy, birth planning, re-interviewing care provider, realistic expectations for chosen birth location, and interventions and medications.  Most often I find that women have no idea that there are so many options available for the asking or available in a reasonably close proximity to our local area.  This tells me that care providers expect the burden of knowing the options is to be on the pregnant woman to find out about, explore, and ask for.  She may find that in this process she and her care provider/birth location are either well on or not on the same page with her needs and desires.  This is where she can decide if needed to seek another provider and/or birth location.  There almost always is a way, it may mean more work, effort, and at times out of pocket expense. Some women choose to relocate, ask for help with out of pocket expenses in lieu of baby shower gift, petition insurance to cover the “right” provider…

Really as a consumer the burden is on her to find the right fit and go for it.  It is not for her to fit into whatever is the local expectation for her as a birthing woman.  This comes down to something akin to buying a car because the dealer tells you this is the car you must buy because everyone else has bought it and even though it clearly does not suit your needs, you still buy it.  I have never heard of that happening, yet I hear of women day in and day out having this sort of exchange from prenatal care through the birthing day with their care provider and/or birth location staff.

When it comes down to it, I really want women to have what is individually needed and desired. Who is paying the bills? Who is keeping the hospitals, birth centers, ob/gyns and homebirth midwives in business? Those caring for birthing women ought sit up and take notice. You all wouldn’t exist without birthing women paying for your services.

Every provider or birth location has a practice style, protocol base,  etc.  So why not honestly explain expectations, protocols, practice style in detail at the first visit or during the tour so the mother who is hiring you or birthing at your location can decide whether or not right off the bat if this is a solid fit? No one provider or location is going to fit with every mother nor is every mother going to fit with every provider or location.  Whatever a provider or birth location is good at, expects,  and is striving to be, put it out there so the mother coming in knows what she is buying in to.

My dream is that every birthing woman will know all the options and subsequently exercise her want to the care she desires even if it means walking with her cash or insurance card, since ultimately she lives with all that transpires positive, negative, or in between.

Shocking quotes regarding maternal choice to VBAC birth

Friday, October 16th, 2009

Joy Szabo has been in the news lately for desiring a second VBAC for her fourth baby (vaginal birth, emergency cesarean, and vaginal birth).  She has been denied locally in her area of Page, AZ to have a vaginal birth. Due to this situation, the International Cesarean Awareness Network has been assisting her in fighting the VBAC ban along with seeking out additional options.

After reading the latest article regarding Ms. Szabo, I am completely dumbfounded by the remarks made by other readers of her story.  I am stunned by how it seems the general populous regards a woman’s autonomy and medical rights.  I am also including positive comments as counterpoint. Where do you fall?  What do you believe? Many of these comments point me in the direction of what is so wrong with the system.  That of physician and hospital trumping patient.

You decide is the comment pro or con?

“…..it seems like many people do not grasp malpractice and insurance companies. This is not about the hospital, but about medical professionals and hospitals not wanting litigation. Can you blame them? After spending tens of thousands of dollars on an education before making a dime, I would do what I needed to to avoid a lawsuit, too! … we go to doctors because they DO know what is best for our health! Like another poster said, in health care, the customer is NOT always right.”

“My son was born by c-section, then my daughter vaginally, with no adverse affects. While I agree it’s the doctor’s decision to take the risk or not, it seems over-the-top conservative. Does the doctor’s insurance premium go up if this procedure is performed? Then charge more and give the patient the option.”

“C-sections are done in the US more routinely than in any other developed country but our infant mortality rate is not lower but higher. Doctors do not want to deliver on weekends, at night, if the mother is one week over her electronically determined due date. Yes complications can happen, more so if you are made to stay in a bed hooked up to monitors, a monitor screwed in to the baby’s head, your water broke prematurely, inducement before the baby or mother are physically ready to give birth. All of this leads to more injuries and deaths than needed. Doctors look upon birth as an illness, not the process that it is – an inexact human birth. I am not suggesting giving birth in a field alone, but a c-section has a greater risk than the V-Bac especially if she has had one already. C-sections for true emergencies yes, otherwise no.”

“Did anyone else notice that when they list the risks of a C-section, they failed to mention that the mother is 4-7 times more likely to DIE than with a vaginal birth.?!?!?! They also fail to mention all the potential complications to her health, the roughly 30% rate of problems following the surgery (some severe enough to require rehospitalization) and the challenges associated with caring for children while recovering from major abdominal surgery.  Good for this mom and I hope more mothers will take courage from her”

“This story is exaggeration. If the woman wants a vbac, she just has to show up at that hospital in labor and refuse a section. They can’t force her to have a c-section no matter what they would prefer she do. You can’t force a woman to have a c-section under any circumstances, so as long as the docs and nurses say she and the baby are tolerating labor, she has no reason to fear being forced into an operation.”

“I worked in the hospital for 5 years and then in a birth center for the last 4 years. I had to get out of the hospital because I started feeling guilty about my complicity in that system in which so much goes on behind closed doors of which the patient is never informed. I’ve had docs tell me in the lunch room that they are doing a c-section because they have an important golf game, fishing trip, or hot date. Then they go into the room, lie to the woman and say, ” oh your baby is too big, your progress is too slow, it’s never going to happen.” the woman believes them and thanks them so much for saving their babies lives. Over and over and over again. In Miami we have over 50% c-section rate, and it’s way more convenient for the docs. If VBACS are not allowed at more and more hospitals, the rest of the country will soon be like it is here…..”

“I find this decision by the hospital(s) to not do a VBAC as a little crazy. My older brother was born (in 1955) by C-section; both me (in 1958) and my younger brother (in 1962) were born vaginally. NO COMPLICATIONS. It could be done 50 years ago, but not now??”

“The risk of MAJOR complication from a second cesarean is TEN TIMES that of the risk of uterine rupture in a VBAC mother. Someone please explain to me how an “elective” repeat cesarean is safer than a VBAC? Especially since more than 75% of uterine ruptures occur PRIOR to the onset of labor. How is a scheduled cesarean at 39 weeks (which is the ACOG recommendation) going to save the mother who ruptures at the dinner table at 34 weeks? Using their logic, we should all go live at the hospital the moment we become pregnant after a previous cesarean, just in case our uterus blows up and we need an OB and an anesthesiologist “immediately available”.”

So what do you think?  It worries me that is seems the mother’s rights do not count for much. That in some of the comments the idea of  forcing a cesarean is no big deal if it makes the doctor’s position safer.

I think that most people are woefully under educated on childbirth and what safety really means.  A conservative physician errs on the side of evidence not defensive practice.  Do your own research. Be your own advocate.

Reprinting of Open letter to ACNM

Sunday, July 19th, 2009

Below is a reprinting of an open letter written to ACNM after a special alert notice.  Women and families no matter what insurance or lack thereof should be able to have access to any and all midwifery care.  Consumers CAN make appropriate choices for their own care.
As a consumer the idea of shutting out one group, is akin to hacking away at a vital, useful appendage.  It take ALL the limbs whenever possible for the body to work well.  Curtailing one from being recognized offers more imbalance in our maternity system and limits what families have available.  Is this the sort of step that ultimately leads to that vital limb being cut-off completely not just injured?  There is room for ALL types of midwifery care from the direct-entry to the ACNM.
TO: Open Letter to the ACNM Board of Directors and Executive Director

FROM: Geradine Simkins, CNM, MSN, MANA Board President

RE: ACNM Opposition to Federal Recognition for the CPM

DATE: July 17, 2009

I am a CNM and a member of the ACNM and I say very emphatically-not in my name! I do not support your recent decision to publicly and aggressively oppose the efforts of a broad-based coalition of six national midwifery and consumer organizations seeking federal recognition of the Certified Professional midwife. Your position, to me, is indefensible.

Lack of Evidence
For an organization of professionals that values evidence, I find it inexcusable that you have chosen an action that the evidence does not support.

  • There is no evidence to support your claim that the majority of CPMs are not properly qualified to practice.
  • There is no evidence to support the position that CPMs in general have poorer outcomes than CNMs or CMs.
  • There is no evidence to support the position that CPMs trained though apprenticeship and evaluated for certification through the Portfolio Evaluation Process (PEP) of NARM have different outcomes than CPMs trained in MEAC-accredited schools.
  • And there is no evidence to support the notion that a midwife with a Master’s Degree has better outcomes than one without that level of higher education.

The evidence we do have on the CPM credential indicates that the midwives holding this credential are performing well, have good outcomes, and are saving money in maternity care costs. The growing number of women choosing CPMs suggests that women value the care provided by CPMs. If future research should demonstrate the PEP process is unsafe or not cost-effective, then that would be the time to reassess and restructure the process.

Differing Values
We, as midwives, have values that underpin our professional practice. We cherish and honor those values. You have stated that your board made its decision because ACNM strongly values formal standardized education, and opposes federal recognition of CPMs who have not gone through an accredited program. I can accept that you strongly value standardized education.  However, I strongly value multiple routes of midwifery education for a variety of reasons.

There is something important, powerful and valuable in a training process in which the student midwife or apprentice is educated in a one-on-one relationship with a preceptor and her clients in the community, as opposed to the tertiary setting where student midwives do not follow women throughout the childbearing year, and may never experience continuity of care or individualized care. In addition, by preserving multiple routes of entry into the profession, we are able to educate more midwives. We need more midwives! If health care reforms were to produce an adoption of the midwifery model of care as the gold standard this year, we could not possible supply “a midwife for every mother.”

Impact of Taking a Stand
By publicly and actively opposing federal recognition of CPMs as Medicaid providers, in addition to taking a stand about formal education, you are also taking a stand (willingly or inadvertently) for decreased access to midwifery care, for diminished choice for women to choose their maternity care providers and place of birth, and for restricted access to the profession. Is it worth it to sacrifice several things you value, just so you can take a stand for one thing you value? Is it possible for you as an organization to value something, but also realize that it is not the only valid way? Is it possible for you to respect the diversity of pathways to midwifery that the CPM represents? Standing aside on a potentially divisive issue does not require the ACNM to sacrifice any of its standards. It simply requires the ACNM to respect the standards of another part of the profession of midwifery.

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

Furthermore, it is disingenuous to suggest the World Health Organization (WHO) document sets a standard that has been embraced around the world.  In fact, the WHO developed global standards for midwifery education without the input of the International Confederation of Midwives (ICM), an international partner of the WHO. The majority of members of the task force that developed the standards were not even midwives. There was not widespread input regarding the document nor targeted input by midwives. In response to this oversight, the ICM passed a resolution at the June 2008 Council meeting in Glasgow Scotland (I was there!) to develop global midwifery standards. A task force has since been convened and all member organizations (which includes MANA and ACNM) will be able to give input to the standards developed by the ICM. Generally, when the ICM develops a document that might supplant an existing WHO document  (as was the case in the international definition of a midwife), the ICM document is eventually incorporated by the larger international community. This will be a long process and any new document will not be ratified by ICM until the next Council meeting in 2011.

Lack of Vision
What offends me most-as a CNM, an ACNM member, a member of the MANA/ACNM Liaison Committee, and the President of the Midwives Alliance-is the lack of vision this decision represents.

Why not embrace diversity and support innovation? Why not bring the turf wars to an end? Why not unite under the banner of midwifery and the values that we share in common? Why not set aside our differences and recognize that we are all midwives? Why not recognize that the work we do is more important than the credentials we hold? Why not support one another within the profession, because diversity is our strength not our weakness?

What We Do Matters
The healthcare debate has been in progress in Washington DC for over a decade, but never before has the possibility of real change been as promising as it is now. Now is the time when we may have a real opportunity to effect unprecedented changes in maternal and child health care that will have long-lasting affects for mothers, infants, families and communities. Women deserve high quality maternity care, affordable care, and equal access to care. Women deserve options in maternity care providers and in their place of birth. Vulnerable and underserved women deserve to have disparities in health care outcomes eliminated, and they deserve to have barriers removed that limit services, providers and reimbursement for maternity care.

Expanding the pool of qualified Medicaid providers to include CPMs will help address the plight of so many women around the country who receive poor quality maternity care or do not have access to care at all. We need to lower the cesarean rate and increase VBACs. We need to lower infant and maternal mortality and morbidity rates in the U.S. We need to offer women the opportunity to believe in their bodies again and to give birth powerfully and in their own time. We need to welcome babies gently into the world. We need to give the experiences of pregnancy and birth back to families. We need to support women to breastfeed and help shelter the process of maternal-infant bonding. These are the real issues. These are the things we deeply value. Midwives are the solution that can address each of these vital issues. All midwives and midwifery organizations united, together, working toward these common goals, could produce these kinds of improvements in maternity care. We do not have to think together; but we must pull together!

In Conclusion
I repeat to you-not in my name. As an ACNM member, I will not comply with your requested action; I will actively oppose it and encourage others to do join me in doing so. Your position on CPMs does not represent what I value, what I hope for, and what I work untold hours to achieve. I have written this letter at the urging of the fourteen members of the MANA Board of Directors. Seven of the Board members are CPMs, four are CNMs, one is a CPM/CNM, one is a CM, and one is a DEM. They represent a true cross-section of the midwives in practice in this nation. We stand for diversity, tolerance, and unity among midwives and within the profession of midwifery. We advocate and work for a midwife for every mother, in every village, city, tribe, and community in this country and across the globe.

Sincerely,

Geradine Simkins-CNM, MSN, President

MANA Board of Directors

Maria Iorillo-CPM, 1st Vice President
Christy Tashjian-CPM, 2nd Vice President
Angy Nixon-CNM, MSN, Secretary
Audra Phillips-CPM, Treasurer
Pam Dyer Stewart-CPM, Region 1
Regina Willette-CM, Region 2
Tamara Taitt-DEM, PhDc Region 3
Sherry DeVries-CPM, CNM Region 4
Elizabeth Moore-CPM, Region 5
Colleen Donovan-Batson-CNM, Region 6
Dinah Waranch-CNM, Region 9
Cristina Alonso-CPM, Region 10 Mexico
Michelle Peixnho-CPM, Midwives of Color Section


Rise and Shine Birth Thoughts

Sunday, July 12th, 2009

Normal, natural birth is spoken of all the time in the birth world.  It is discussed on many levels from the evidence of being overwhelmingly the safest and healthiest way to birth, to the emotional aspects of privacy, safety and support,  to following the money trail of interventive birth versus natural birth and so much more in between.

I ponder and sometimes struggle with what to share with expecting families and  how to share it.  Why the struggle?  This normal, natural birth viewpoint is counter-cultural.  I, along with many peers believe in the inherent design of women and babies to work as intended.  There is lack of belief in routine intervention, non-evidence based protocols or practice style that is created around pregnancy and birth being a tragedy in waiting.

Even in trepidation, the truths must be shared and not hidden simply because most of what is seen and heard in our culture is the opposite (think as an example of the media and the dramatic voice over person on those birthing shows).  The longer I am in this field and calling of work, I believe that protecting women from the truth for whatever reason is harmful.  I participated in a Henci Goer session several years ago at a conference that set this ideal permanently within me.  She asked many questions for the participants to answer.  One question was regarding telling options to expecting families even if they are not available locally – should you or shouldn’t you?  I stood for quite a time in front of the large paper on the wall while holding the marker in my hand.  There were many NO’s on the paper in front of me and it took some courage for me to write a commanding YES! next to their responses. I had bucked the trend.  Not easy, not a bit. When all the sheets were gathered and Henci peered at them to discuss all of the responses, she overwhelmingly said we have an ethical obligation to tell it all.  Phew I was not wrong in my group of peers, but sadly most of them said no probably out of the same fear as I had in answering the questions.  That moment gave me great strength and clarity not because Henci said so, rather because I stood in my conviction and faced the fear of being apart from others in the truth.

Why is it of the utmost importance to share all?  Because no one else goes home or remains home with that baby.  The care provider, staff, doula, educator….they all go home to their own lives.  Each expecting family must be able to live with the decisions made during pregnancy, labor, and birth.  Natural birth has many benefits but it isn’t consequence or risk free, so that too must be spoken of.  Each woman must decide what she needs and can best live with as a mother, wife, partner, even as a woman in her community who will go out and share her experiences with others.

I will often tell expecting families who contact me about childbirth education classes that they will receive much more than the anatomy, physiology, comfort measures, etc. from my course.  That very likely it will challenge to the core their beliefs and value systems surrounding what they know in their own birth culture of family, friends and personal history.

I love this work.  I hope someday to be replaced by the community based education women ought get back to. If not, I along with many others will be here to keep the conversation and education moving forward.

Childbirth Preparation: Prenatal Ponderings

Thursday, April 17th, 2008

Today pregnant women need to be consumers and self-advocates. Many childbirth classes are teaching strategies to better these skills. This is not by chance, but rather by the often one-size-fits all packaging and management from pregnancy onset to labor through immediate postpartum in the care provider offices and hospitals of today.

Many routine tests are done prenatally. Though prenatal care and these tests can help further healthy outcomes for moms and babies, too often women can be funnelled into a cycle of unnecessary fear, stress and choice limitation while in reality still healthy and maintaining normal pregnancy.

Below is a listing of common prenatal tests and practices for you to question (what is it for, what does it improve upon, what can it lead to in other tests or interventions, is it for low-risk moms and babies, what will I do with the information), research and decide on are:

  • pregnancy test by urine dip or blood work
  • ultrasound to date the pregnancy
  • blood pressure reading each visit
  • weight measure each visit
  • urine test – check for protein in the urine
  • fundal height measurement as pregnancy furthers
  • gestational diabetes testing
  • triple screen testing (AFP)
  • just because ultrasounds
  • ultrasound for fetal size
  • routine ultrasound for fluid level as “due date” approaches
  • biophysical profile(s) as “due date” approaches or passes
  • membrane sweeping

It is vitally important that you are equipped and aware of your care provider’s philosophy and usual practices.

What are you willing to do? What are you willing to bypass? How responsible for your pregnancy and birth are you willing to assume? At the end of the day you are ultimately the one who has to live with the choices you or your provider make.

Be a driver – you are more likely to arrive at the destination you desire.

Childbirth in the hospital – Navigational Tips

Thursday, April 3rd, 2008

There are many reasons why a woman chooses to birth in the hospital. Women have the right to choose where and with whom she will birth regardless of what another would choose.

Women need the tools to navigate the hospital setting. She and her baby ARE unique. They are human beings. Laboring women are often placed under one-size-fits-all standing orders and protocols. Because of this, pregnant women need to be very careful regarding the books read, the types of birthing shows viewed, the care provider chosen and the childbirth class taken prior to entering the hospital to birth.

Here are some tips for a truly healthier and safer experience:

  • Take the hospital tour – ask lots of questions – induction rate, induction medications and/or procedures routinely used, average cesarean rate for first time moms, VBAC rate, pitocin use rate, epidural rate, use of non-medical pain relief, natural childbirth rate, IV use versus saline lock, percentage of moms who utilize doulas, is pain management highly suggested to every laboring mom, monitoring norms, availability of tub or shower for labor, standard protocol on eating and drinking in labor, use of non-supine pushing positions, mobility in labor, are the labor and delivery nurses open to anything goes in labor, what is protocol on immediate postpartum baby care, is there a lactation staff available….
  • Read the pre-admit paperwork. If you are not sure what it says, ask a paralegal or lawyer to look at it. Be certain that you agree with what you are signing.
  • Do not sign epidural or cesarean consent form at pre-registration. You want to be fully consented during true decision making time. Be sure though to be familiar with benefits, risks and consequences of everything ahead of time.
  • Take a non-hospital childbirth class or independently run class within the hospital.
  • Only agree to induction for a true medical reason – (suspected big baby, pre-pre-eclampsia, being tired of pregnancy, care provider going on vacation, relative will be in town, being past your “due date”, just because you can – are not medical reasons)
  • When induction is necessary – choose a foley catheter to ripen the cervix over misoprostol (cytotec, miso, or the little pill) and if labor establishes upon cervical ripening – decline pitocin or ask to keep it very low over a longer period of time.
    Keep your “water” (amniotic sac) intact until it breaks on its own. This can keep infection probability much lower, lessen risk of cord prolapse, and lessen the discomfort of contractions among many other things.
  • As long as a mom and baby are low-risk – wait until well into active labor to arrive at the hospital – contractions 3 minutes apart and lasting a minute or more. Shortening the time in the labor and delivery room usually keeps interventions and medications to a minimum.
    Any birth and immediate postpartum preferences need to be discussed PRIOR to labor with your care provider. A concise birth preference plan can be given to the nurse upon arrival.
  • In the event a cesarean is necessary (hopefully not created by interventions and medications in labor), discuss with your care provider prior to labor what you would like to have occur (partner in OR, no separation of baby from mom, pictures taken, etc. – for a complete list, please email me).
  • Make postpartum baby care decisions prior to arriving at the hospital. You do not need to have a pediatrician or family practitioner picked out ahead, as the floor doctor will oversee your baby’s care. If you are unsure of what you want, it is always acceptable to delay any immunization, vitamin K injection, eye ointment, etc. until you have the opportunity to investigate further. As a parent you have the right to say yes or no to anything.

    The key thing to remember is that as a consumer, you are paying your care provider for a service, for the hospital staff to attend you respectfully, and for the use of the room you are renting. You do have rights. Protocols and practices are not laws. You can say yes or no to anything or everything.

    As a woman you are making parenting decisions throughout labor, delivery and early postpartum that should be respected, honored and can have lasting consequences. There is no do-over.

    Remember to be a driver – not a passenger!