Archive for the ‘healthcare’ Category

What’s in the job?

Wednesday, July 6th, 2011

 

 

 

 

I wonder if most of us really know what the scopes of practice are for the providers we may choose  for pregnancy, birth, postpartum, and for the baby.  Keep reading to see if you really know what the jobs encompass.

As you go through the list I would like you to think about the language used, descriptors, and purpose of each type of provider. When we are approaching health care decisions especially who will care for us from pregnancy through birth, postpartum and for our babies, we need to make sure we are choosing the appropriate care for our individual needs and situation.

If anything strikes you or you would like me to add any provider types, please leave me a comment!

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OBSTETRICS AND GYNECOLOGY (OB/GYN)

Obstetrics and gynecology is a discipline dedicated to the broad, integrated medical and surgical care of women’s health throughout their lifespan. The combined discipline of obstetrics and gynecology requires extensive study and understanding of reproductive physiology, including the physiologic, social, cultural, environmental and genetic factors that influence disease in women. This study and understanding of the reproductive physiology of women gives obstetricians and gynecologists a unique perspective in addressing gender-specific health care issues.

Preventive counseling and health education are essential and integral parts of the practice of obstetricians and gynecologists as they advance the individual and community-based health of women of all ages.

Obstetricians and gynecologists may choose a scope of practice ranging from primary ambulatory health care to concentration in a focused area of specialization.   – from ACOG

Certified Nurse-Midwife

Midwifery as practiced by Certified Nurse-Midwives (CNMs) and Certified Midwives (CMs) encompasses primary care for women across the lifespan from adolescence beyond menopause, with a special emphasis on pregnancy, childbirth, and gynecologic and reproductive health. Midwives perform comprehensive physical exams, prescribe medications including contraceptive methods, order laboratory and other diagnostic tests, and provide health and wellness education and counseling. The scope of practice for CNMs and CMs also includes treatment of male partners for sexually transmitted infections, and care of the normal newborn during the first 28 days of life. -from ACNM

Certified Professional Midwife

Based on the MANA Core Competencies, the guiding principles of the practice of CPMs are to work with women to promote a healthy pregnancy, and provide education to help her make informed decisions about her own care. In partnership with their clients they carefully monitor the progress of the pregnancy, labor, birth, and postpartum period and recommend appropriate management if complications arise, collaborating with other health care providers when necessary. The key elements of this education, monitoring, and decision making process are based onEvidenced-Based Practice and Informed Consent. – from MANA

Direct Entry Midwife (including Licensed Midwife)

  • Not required to be nurses.
  • Multiple routes of education (apprenticeship, workshops, formal classes or programs, etc., usually a combination).
  • May or may not have a college degree.
  • May or may not be certified by a state or national organization.
  • Legal status varies according to state.
  • Licensed or regulated in 21 states.
  • In most states licensed midwives are not required to have any practice agreement with a doctor.
  • Educational background requirements and licensing requirements vary by state.
  • By and large maintain autonomous practices outside of institutions.
  • Train and practice most often in home or out-of-hospital birth center settings.

To learn more detail about all types of midwives go to Citizens For Midwifery

Nurse Practitioner

Nurse practitioners (NPs) are registered nurses who are prepared, through advanced education and clinical training, to provide a wide range of preventive and acute health care services to individuals of all ages. Today, NPs complete graduate-level education preparation that leads to a master’s degree. NPs take health histories and provide complete physical examinations; diagnose and treat many common acute and chronic problems; interpret laboratory results and X-rays; prescribe and manage medications and other therapies; provide health teaching and supportive counseling with an emphasis on prevention of illness and health maintenance; and refer patients to other health professionals as needed.

NPs are authorized to practice across the nation and have prescriptive privileges, of varying degrees, in 49 states. Nurse practitioners perform services as authorized by a state’s nurse practice act.  These nurse practice acts vary state-to-state, with some states having independent practice for NPs (not requiring any physician involvement), some with collaborative agreement required with a physician. -from ACNP

Family Practitioner

AAFP defines a family physician as, “a physician who is educated and trained in family medicine–a broadly encompassing medical specialty.”

Family physicians possess unique attitudes, skills, and knowledge which qualify them to provide continuing and comprehensive medical care, health maintenance and preventive services to each member of the family regardless of sex, age, or type of problem, be it biological, behavioral, or social. These specialists, because of their background and interactions with the family, are best qualified to serve as each patient’s advocate in all health-related matters, including the appropriate use of consultants, health services, and community resources. – from AAFP

Labor Doula

The labor doula assists the woman and her family before, during, and after birth by providing emotional, physical, and informational support. It is not within the labor doula’s scope of practice to offer medical advice or perform any medical or clinical procedure.

During pregnancy, the labor doula’s role is to assist families in preparing a birth plan, to provide information about birth options and resources, and to provide emotional support.

During labor and birth, the labor doula facilitates communication between the family and the caregivers. She supports the mother and her partner with the use of physical, emotional, and informational support.

During the postpartum period, the doula assists the mother in talking through her birth experience, answering questions about newborn care and breastfeeding within our scope of practice, and referring the family to appropriate resources as needed. – from CAPPA

Postpartum Doula

The postpartum doula provides informational and educational information to the family. Medical advice is not given; referrals to appropriate studies and published books are within the postpartum doula’s scope. The postpartum doula will determine ahead of time what duties she feels comfortable with performing for the postpartum family and she will share this information with the family prior to accepting a position with them.

CAPPA members do not perform clinical or medical care on mother or baby such as taking blood pressure or temperature, vaginal exams or postpartum clinical care. CAPPA standards and certification apply to emotional, physical and informational support only. CAPPA members who are also health care professionals may provide these services within the scope and standard of their professions but only after making it clear that they are not functioning as a labor doula, postpartum doula, or childbirth educator at the time of the care. For needs beyond the scope of the postpartum doula’s expertise, referrals are made to the appropriate resources.

CAPPA strongly recommends that members do not drive mother or baby unless there is a life-threatening emergency and an ambulance could not get to the family quick enough. – from CAPPA

Lactation Educator

Lactation educators fill an important function in educating and supporting families interested in learning about breastfeeding. This education may take place in the public, hospital, clinical or private setting. Lactation educators provide informational, emotional and practical support of breastfeeding. They may provide this service exclusively as breastfeeding educators, or may use their training to augment their support in other professions, in the cases of doulas, childbirth educators, nurses, dieticians, and postnatal or parenting educators. In addition to providing breastfeeding information, lactation educators offer encouragement, companionship, an experienced point of view, and foster confidence and a commitment to breastfeeding.

Breastfeeding education is not restricted to new families, but applies to the general public and medical staff as well. Due to the limited breastfeeding information given in standard medical and nursing training, and the rampant misinformation about breastfeeding that is so prevalent in our society, the breastfeeding educator serves as a resource for accurate, evidence-based information to the public and health care providers, as well as to childbearing families.

CAPPA does not issue Certified Lactation Consultant status, nor does the lactation educator program qualify a member to dispense medical advice, diagnose or prescribe medication. However, lactation educators provide a wealth of information about how and why to breastfeed; establishing a breastfeeding-friendly environment; basic breastfeeding anatomy and physiology; the normal process of lactation; deviations from normal; physical, emotional and sociological barriers to breastfeeding; overcoming challenges; and resources available (including medical referrals) for the breastfeeding family. They can also be a source of vital support, guidance and encouragement throughout the duration of breastfeeding. -from CAPPA

IBCLC (Lactation Consultant)

International Board Certified Lactation Consultants (IBCLCs) have demonstrated specialized knowledge and clinical expertise in breastfeeding and human lactation and are certified by the International Board of Lactation Consultant Examiners (IBLCE).

This Scope of Practice encompasses the activities for which IBCLCs are educated and in which they are authorized to engage. The aim of this Scope of Practice is to protect the public by ensuring that all IBCLCs provide safe, competent and evidence-based care. As this is an international credential, this Scope of Practice is applicable in any country or setting where IBCLCs practice.

IBCLCs have the duty to uphold the standards of the IBCLC profession by:
• working within the framework defined by the IBLCE Code of Ethics, the Clinical Competencies for IBCLC Practice, and the International Lactation Consultant Association (ILCA) Standards of Practice for IBCLCs
• integrating knowledge and evidence when providing care for breastfeeding families from the disciplines defined in the IBLCE Exam Blueprint
• working within the legal framework of the respective geopolitical regions or settings
• maintaining knowledge and skills through regular continuing education

IBCLCs have the duty to protect, promote and support breastfeeding by:
• educating women, families, health professionals and the community about breastfeeding and human lactation
• facilitating the development of policies which protect, promote and support breastfeeding
• acting as an advocate for breastfeeding as the child-feeding norm
• providing holistic, evidence-based breastfeeding support and care, from preconception to weaning, for women and their families
• using principles of adult education when teaching clients, health care providers and others in the community
• complying with the International Code of Marketing of Breast-milk Substitutes and subsequent relevant World Health Assembly resolution -from IBCLE

Pediatrician

A pediatrician is a child’s physician who provides:

  • preventive health maintenance for healthy children.
  • medical care for children who are acutely or chronically ill.

Pediatricians manage the physical, mental, and emotional well-being of their patients, in every stage of development — in good health or in illness.

Generally, pediatricians focus on babies, children, adolescents, and young adults from birth to age 21 years to:

  • reduce infant and child mortality
  • control infectious disease
  • foster healthy lifestyles
  • ease the difficulties of children and adolescents with chronic conditions

Click here for more information about the Physicians and Staff at the University of Maryland Children’s Hospital.

Pediatricians diagnose and treat:

  • infections
  • injuries
  • genetic defects
  • malignancies
  • organic diseases and dysfunctions

But, pediatricians are concerned with more than physical well-being. They also are involved with the prevention, early detection, and management of other problems that affect children and adolescents, including:

  • behavioral difficulties
  • developmental disorders
  • functional problems
  • social stresses
  • depression or anxiety disorders

Pediatrics is a collaborative specialty — pediatricians work with other medical specialists and healthcare professionals to provide for the health and emotional needs of children. – from UMM (I could find no concise scope of practice definition on the AAP website but here is their Scope of Practice Issues in the Delivery of Pediatric Health Care)

Doctors of Chiropractic

Defining Chiropractic Scope

Since human function is neurologically integrated, Doctors of Chiropractic evaluate and facilitate biomechanical and neuro-biological function and integrity through the use of appropriate conservative, diagnostic and chiropractic care procedures.

Therefore, direct access chiropractic care is integral to everyone’s health care regimen.

Defining Chiropractic Practice

A. DIAGNOSTIC

Doctors of Chiropractic, as primary contact health care providers, employ the education, knowledge, diagnostic skill, and clinical judgment necessary to determine appropriate chiropractic care and management.

Doctors of Chiropractic have access to diagnostic procedures and /or referral resources as required.

B. CASE MANAGEMENT

Doctors of Chiropractic establish a doctor/patient relationship and utilize adjustive and other clinical procedures unique to the chiropractic discipline. Doctors of Chiropractic may also use other conservative patient care procedures, and, when appropriate, collaborate with and/or refer to other health care providers.

C. HEALTH PROMOTION

Doctors of Chiropractic advise and educate patients and communities in structural and spinal hygiene and healthful living practices.

-from ACC

 

Creating a relationship 10 minutes at a time

Sunday, February 27th, 2011

It has occurred to me through my time with doula clients and students,  that many care providers serving hospital birthing mothers do not ask any questions of their pregnant patients during the 7-10 minute prenatal visits that lead to a substantive working relationship.

I have also learned that too often the pregnant “patient” does not know to tell her provider anything about what is going on in her life or pregnancy since she is not queried first.

Thinking there must be a way to better bridge this very real separation to solid patient-provider relationship building, I am drawing from my work as a midwife assistant in the making of this tip list.

Pregnant mothers your provider needs to know so much more about you and your pregnancy than blood pressure, weight, fundal height and fetal heart tones. I encourage you to freely offer the below information at every appointment to grow personalized care, advisement and support.

1) Appetite/Diet/Supplements – tell your provider if your appetite has increased or decreased between visits. Do you have food aversions? Are you taking any supplements or want to take supplements?

2) Sleep habits – tell your provider how you are or are not sleeping.  For example, are you having trouble falling asleep, falling back to sleep or staying asleep.

3) Nausea – Do you continue to have nausea? When? How often? Does it correlate with anything in particular?

4) Hemorrhoids – if you have them or not. What you are doing for them.

5) Varicose veins –  Are there veins sticking out or causing issue anywhere in your body?

6) Bowel habits – Are you experiencing normal or abnormal bowel habits?

7) Exercise – What have you been doing? Do changes need to be made?

8) Stress – Is there anything in your life that is really stressing you? Stress can impact pregnancy health. Important to discuss.

9) Related Providers – Are you going to any pregnancy related providers (such as chiropractor, acupuncturist, yoga, etc.)?

10) General  – Are you feeling well or not. Do you need more information or referrals?

There is so much more to you than a pregnant uterus. You are a holistic person who needs to be treated as such. I would venture that something much more individualized can come out of your care with simple sharing!

Here’s to whole care!

Wish List In 2011

Sunday, January 2nd, 2011

A clean slate. A fresh start. Hope and dreams reactivated. Passions toward change are stirred. All of this by the calendar rolling over from one year to the next. It is not just  anew year though, it is a new DECADE to set precedent in. To make a mark. Oh the possibilities and opportunities that are ours to reach for and accomplish.

In the spirit of all of this, I decided to make an #in2011 wish list on New Year’s Eve 2010 and with some help from a few friends here is what flowed out.

#in2011 breasts will be viewed as nurturing, comforting, and beautiful.

#in2011 the majority of women will be served under the midwife model of care for the majority are low-risk and will remain so.

#in2011 Childbearing women will be greeted with open arms by providers with their questions, needs and knowledge.

#in2011 pioneering social media women will gain even more ground in their work liberating childbearing women.

#in2011 delayed cord clamping and physiologic third stage will become the norm.

#in2011 doulas will be respected as educated, knowledgeable birth professionals by staff and care providers.

#in2011 childbearing women will be given opportunity not limited

#in2011 Those striving to improve the maternity system at the ground floor as educators will be mutually respectful and supportive.

#in2011 Doulas from all backgrounds and organizational affiliation will be open to one another, supportive, sharing.

#in2011 a woman with needs and opinions with not be marked for a cesarean because of it.

#in2011 Homebirth transports will be treated with dignity and respect.

#in2011 Stigma of mental illness and motherhood will be adsressed by every childbirth care provider. RT @WalkerKarra

#in2011 Childbearing women will not have to live in fear of their providers.

#in2011 We CAN change the world together for childbearing women. Put your words intro action.

#in2011 More birthing women will have low-intervention births that lead to healthier outcomes.

#in2011 Childbearing women will be seen, heard, respected and offered a variety of care options.

#in2011 there will be less imbalance of power between maternity patient and provider.

#in2011 childbearing women will rightfully claim their health records as their own -RT @midwifeamy

#in2011 we will wake up to and address the shameful disparities in access to and outcomes of maternity care RT @midwifeamy

#in2011 Less pointing fingers among insurance companies, providers & orgs that continues to feed this ever medicalized maternity system.

#in2011 I would like to see an equal playing field with accessibility to all to maternity research, guidelines, statistics…

#in2011 I would like see accountability for providers and institutions in their maternity care practices.

#in2011 I would like to see hospitals treat only the patients they serve the very best – high-risk or in-need mothers and babies.

#in2011 I would hope more women stop blindly trusting and do their own research for pregnancy, birth and postpartum.

#in2011 I would like to see arrogance leave the treatment room. It is not a personal affront for a patient to have an opinion and needs.

#in2011 I hope women are treated as holistic beings especially in pregnancy.

#in2011 I hope for care providers to be transformed into partners with their patients instead of authorities.

#in2011, I want to see care providers and family members taking postpartum mood disorders seriously. RT@smola04

#in2011 I hope women stop being treated with hostility and looked down upon for wanting something more in pregnancy, birth and postpartum.

#in2011 I would like to see more women receiving comprehensive postpartum care from their OBs and hospital based midwives.

#in2011 I hope that women will openly mentor those coming up after them to better understanding and expectations in birth.

#in2011 I hope social media efforts have even more impact on unveiling the hidden and progressing healthy birth practices.

#in2011 I hope less mamas are unnecessarily cut open in pursuit of delivering a baby.

#in2011 I hope to see midwives working together no matter the track they came up on. Being respectful and open.

#in2011 I hope to see women who have experienced amazing births be loud and proud sharing the good news without fear.

#in2011 I hope that midwives of all types will be fearless in their pursuit of their model of care for women.

#in2011I hope that hospitals and providers realize they need to offer individualized care to women and babies for the health of it.

#in2011 I would like to see women openly breastfeeding their children without shame or discrimination.

#in2011 A drop in the cesarean rate would be progress toward healthier practices.

#in2011 I want to see women in droves having their eyes opened and being fierce about the care they receive. About their maternity options.

#in2011 I would like to see less care providers offering up defensive and fear based medicine to their maternity patients.

#in2011 I hope for more accessibility to home and birth center births for women and babies.

#in2011 I would like care providers to view women as a sum of all parts, not a uterus growing a baby more valuable than she is.

#in2011 I would like to see more women taking charge of their care, taking personal responsibility and being powerful pregnant women.

#in2011 I desire more respect and autonomy for maternity patients.

#in2011 For women who want a VBAC to easily find an accommodating provider.

Is all this attainable in one year? Perhaps not, but pushing toward the positive and never taking the eye of the reason for all of this, the childbearing women and families, I do believe we can change the world and make the maternity care system as a whole a safer, healthier  and more respectful place.

What is on your 2011 wish list? If you would like to have it added here, leave a comment.

Reader Additions:

Kay Miller:

I hope that we (doulas/educators) can stop alienating the providers, instead partnering with them to provide the best care possible for the mamas and babies that we work with.
I hope that doulas/educators and providers can have mutual respect for one another, and realize the value of the care and support that each provides.
I hope that while we work to change the negatives of health care for pregnancy, birth, and postpartum, that we can remember to openly recognize and affirm the positives.
I hope that families will make decisions based on education and research, not on fear.
I hope that both “sides” stop using fear tactics to persuade families to make certain choices. A decision to home birth due to fear of hospital birth is still a decision based on fear.

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


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!

    ICAN and VBAC Ban Project – Get Involved Today

    Wednesday, January 30th, 2008

    This is taken from http://yourbirthmatters.blogspot.com/ written by a fellow ICAN Board member and all around amazing woman, Gretchen H.

    Please read, think and get involved.

    The VBAC ban project is finally up and running! What is this you ask? Well, simply put, we are going to call every hospital in the U.S. and find out what their policy is on VBAC. The International Cesarean Awareness Network did this a few years back and found out that over 300 hospitals officially “ban” VBAC (even though this is patently illegal). Needless to say, we are sure the situation is much worse now. But, the cool thing is that ICAN is about to launch a fantastic new website and included on that website is a map of the U.S. upon which every one of the hospitals we call will appear….with information about that hospital and its policies on VBAC. AND, there will be a way for anyone to leave feedback about that hospital, so you can see what other women experienced there. But, in order for this to happen, we need people to call! So if you are interested in helping out, please email me at advocacy@ican-online.org and I’ll get you set up and going.Help ICAN shine the light into the oppression that so many hospitals are inflicting on women.

    The International Cesarean Awareness Network, Inc. (ICAN) is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery, and promoting Vaginal Birth After Cesarean (VBAC).

    Pax,

    Desirre
    2VBA2C – If I would have only known more and had information like ICAN provides, I might not be a part of the sisterhood of the scar

    Finding The Right Midwife For Your Home Birth

    Friday, January 11th, 2008

    CHOOSING YOUR MIDWIFE: INTERVIEW QUESTIONS

    · What is your birth philosophy?
    · What is your training? Are you certified? If yes, with whom and why? If no, why not?
    · Are you licensed in the state of _____?
    · What is your scope of practice?
    · When would you find it necessary to go outside your scope of practice?
    · Are there any circumstances (physical, emotional, and/or spiritual) would you not take a woman as a patient?
    · When would you risk out a patient?
    · What is your style of practice (laid back, hands on, managing)?
    · How much time will be spent with me during each appointment? Do you come to my home or do I come to your office?
    · At what intervals will you see me during pregnancy?
    · What can I expect at a prenatal visit?
    · What routine tests are utilized during pregnancy? What if I decline these tests?
    · What routine herbs or supplements do you like your patients taking during pregnancy?
    · At what point in labor do you normally arrive?
    · What positions are you comfortable catching in? Birth stool? Hand/Knees? Squatting? Standing? Water?
    · What do you do in the event a complication arises during labor or birth? When would you transfer a patient?
    · Do you ever do episiotomies? If yes, when, why and how often?
    · How are post-dates (post-42 weeks) handled in your practice?
    · Do you ever encourage induction by pharmaceutical, herbal, AROM or other natural means? If yes, please describe.
    · Do you have a partner or an assistant?
    · Who would attend me if you are ill, had an emergency or are at another birth?
    · Briefly please describe the types of births you are most and least experienced with.
    · What if I hire a doula? Are there restrictions on the doula I may hire? If yes, why? What is your perception of the role of a doula at a homebirth?

    Points to ponder afterward:

    · Did you feel immediately comfortable and heard at the interview?
    · Was MW willing to answer questions in detail without being annoyed?
    · Are you comfortable with her scope of practice?
    · Are her expectations of you reasonable?
    · Are your expectations of her reasonable?
    · Are you able to take full responsibility for your decisions with this midwife?

    All Rights Reserved Desirre Andrews Birthing Touch 2008