In This Issue
CFM BOARD:
Willa Powell, CfM President
Nasima Pfaffl, CfM VP
Carolyn Keefe, CfM Board Member
Susan Hodges, CfM Past President
Who Are We?
CITIZENS FOR MIDWIFERY, INC. is a non-profit, grassroots organization of midwifery advocates in North America, founded by seven mothers in 1996. CfM's purposes are to:
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Promote the Midwives Model of Care.
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Provide information about midwifery, the Midwives Model of Care, and related issues.
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Encourage and provide practical guidance for effective grassroots actions for midwifery.
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Represent consumer interests regarding midwifery and maternity care.
CfM facilitates networking and provides information and educational materials to midwifery advocates and groups. CfM supports the efforts of all who promote or put into practice this woman-centered, respectful way of being with women during childbirth, whatever their title.
If you have questions about the group, feel free to drop us a line: Citizens for Midwifery, Inc., PO Box 82227, Athens,GA 30608-2227. You can also reach us at (888) CfM-4880 (ET) (toll free), or e-mail info@cfmidwifery.org.
Be sure to check out our web site.
As always, we want to hear your comments and suggestions!
CfM News Credits:
Editor: Nasima Pfaffl
Editorial Review: Susan Hodges
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Welcome
Fall 2010, Issue 1
Citizens for Midwifery (CfM) is thrilled to launch our new e-news! This e-news includes informative articles on CfM's new free membership structure, federal policy updates, information on the effort to get CPMs licensed in Illinois, a highlight on research on neonatal mortality and c-section, news about CfM and more. Scroll down to read more.
Welcome to the New CfM E-news
In the spring CfM conducted a member survey and found strong support for moving the CfM News to an e-news format. This online format will not only save trees and energy, it will also enable CfM to put more of your money toward our advocacy, materials development, networking, and outreach work rather than printing and mailing costs. It will also allow us to integrate more quick links to outside information, photos, videos, and social networking tools.
We hope you'll appreciate all the new tools this digital platform provides, all of which are in evidence in this first edition. For example, if you're a Facebook user please be sure to share your favorite articles in our newsletter with your friends by clicking the Facebook "Like" buttons. If you'd like to link to an e-news message outside of Facebook, a digital archive of all our new enewsletters is also available.
We also realize some of you will miss having a paper copy newsletter to read in the tub. So, to print an e-news edition visit our newsletter archive for a printable version of the newsletter.
On paper or online, the CfM News is the same high-quality advocacy newsletter with resources and information about CfM, midwifery, and birth issues – including news about developments and consumer actions promoting midwifery and the Midwives Model of Care across the country. We hope you will be as pleased with the CfM E-news as we are.
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New and Noteworthy
CfM Memberships Are Now FREE
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Anyone who signs up with CfM either on our signup page, on Facebook, or CfM’s “Grassroots News” yahoo group will now all be considered members of CfM and will receive the free CfM e-news. In this day and age of social networking the concept of CfM membership needed to evolve to include all the ways people communicate and participate in CfM’s activities. We hope you will be excited by this open membership structure and will encourage all your friends, clients, Facebook friends and associates to sign up for a free membership with CfM today.
Membership is now free, but CfM still needs your financial support. Please donate today! We are so grateful to all the individuals and midwifery practices who have been paid members with CfM over the years. Many of you have been faithful members for years. Your support has made all our work on behalf of consumers, midwifery, and the Midwives Model of Care possible. We hope you will continue to support CfM with an annual donation. If you are a midwife who has been giving “Gift Memberships” to your clients we hope you will continue to make a donation to CfM in honor of each of your clients and encourage your clients to sign up for free with CfM. Donations of any amount are greatly appreciated!
Your donations are fully tax deductible. Donate at our suggested giving levels, or in any amount you can. Donate today on the CfM website or by mail Thank you for your support.
LEARN, CONNECT, TAKE ACTION
Research: Neonatal Death Risk Triples with Cesarean Section
In 2006 the journal BIRTH published an analysis of cesarean section and neonatal mortality rates (using CDC data) with alarming conclusions. It received little publicity at the time, or even after a short description in 2009, but it certainly deserves our attention.
After exhaustive analysis of birth and death data for over 5 million infants, McDorman et al found that regardless of risk factors, babies born by cesarean section face a risk of death nearly three times that of vaginally born babies.
In a subsequent article published in 2008, the authors looked at the data with regard to "intent to treat"- ie, planned vaginal births and as close as they could get to "planned" cesarean, and found the same pattern. The authors concluded: "The finding that cesarean deliveries with no labor complications or procedures remained at a 69 percent higher risk of neonatal mortality than planned vaginal deliveries is important, given the rapid increase in the number of primary cesarean deliveries without a reported medical indication."
What can you do to avoid an unnecessary cesarean section? Use a midwife and have your baby at home or in a free-standing birth center! See CfM's fact sheet: Out-of-Hospital Midwifery Care: Much Lower Rates of Cesarean Sections for Low-Risk Women.
Citation:
1. MacDorman MF, Declercq E, Menacker F, Malloy MH. Division of Vital Statistics, NationalCenter for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland20782, USA. Birth. 2006 Sep;33(3):175-82.
2. MacDorman MF, Declercq E, Menacker F, Malloy MH. Division of Vital Statistics, NationalCenter for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland20782, USA.Birth. 2008 Mar; 35 (1): 3-8.
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United States Maternity Care Facts and Figures Updated
Check out Childbirth Connection's updated fact sheet on various national maternity statistics provided in "Evidence-Based Maternity Care: What It Is and What It Can Achieve." Data shows that six of the ten most common hospital procedures in 2008 were maternity-related. Cesarean section, was the most common operating room procedure in the country in 2008, and was performed on 1.4 million women. In 2006, the cesarean section rate varied by payer — from private insurance (34%) to Medicaid (30%) to uninsured women (25%)...read more
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ILLINOIS Getting Close!
Midwives and mothers have been working very hard to achieve licensing for CPMs in Illinois for a decade.
The Coalition for Illinois Midwifery (CFIM) and the Illinois Families For Midwifery (IFFM) have been working all out the last few years. An earlier version of The Home Birth Safety Act was passed by the state Senate with strong support. However, the Illinois House has been a continuing challenge. On May 5, 2010, SB3712, originally a veterinary medicine bill, was amended with The Home Birth Safety Act (House Amendment 1). The Amendment was filed by Representative Robyn Gabel, a champion of maternal child health. The Home Birth Safety Act has received support from many professional and community organizations, including the Illinois Public Health Association, the American Public Health Association, the Illinois Society for Advanced Practice Nursing, Illinois Chapter of the American Colleges of Nurse-Midwives, Illinois Maternal & Child Health Coalition and Health Medicine Policy Research Group.
A tenacious grassroots effort was successful in pushing this bill forward despite tremendous opposition from the Illinois State Medical Society. Many home birth midwives have been driven out or left Illinois because their practice is illegal and a record number of Illinois midwives have received cease and desist orders by the Illinois Department of Professional Regulation. The November veto session was a roller-coaster, with several days when the bill was to come up for a vote, but each time there was a postponement. There is still hope to pass this bill during the final two weeks of the 96th Session of Illinois' General Assembly in January. The Illinois State Medical Society is vamping up efforts to block passage. Support is needed to overcome this powerful physician lobby group. The key is grassroots activity- individuals visiting and calling their representatives and asking them to vote YES.
Illinois is home to the American Medical Association, and the Illinois State Medical Society has been virulently active in opposing this bill, spreading lies and misinformation about the bill and its provisions and effectively blocking it in the House.
To stay abreast of updates in IL, the The Illinois Families for Midwifery blogspot page includes updates as well as fact sheets. The Illinois Families For Midwifery & Coalition for Illinois Midwifery Facebook page is another way to keep up.
The next few weeks are crucial! If you live in Illinois, or have family or friends there, please let them know about this bill and ask them to contact their state representative to request they vote YES on SB3712, and then let the folks at Illinois Families for Midwifery know.
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The CFM Blog Highlight
 "Why I Care"
Some time ago I wrote a post about medical control as acceptable, in which I pondered the question of why do we care about birth, if many birthing women themselves don't really seem to care? Why do we make it any of our business what other women choose to do with their births?
Well, I've been doing some thinking and here is my list of why I care....click here to read more
Policy Spotlight:
MAMA Campaign Update
Thank goodness the pace of the MAMA Campaign has slowed a bit compared to last year's intense work related to the federal Health Care Reform efforts! But the MAMA Campaign and our MAMA CfM representatives have continued to work hard at the federal level.
And that work is bearing fruit. The campaign anounced on Novemeber 30th that Congresswoman Chellie Pingree (D-ME-01) will introduce a bill to amend the Social Security Act to mandate reimbursement for all licensed CPM services for women insured by Medicaid. Visit this post on The MAMA Campaign Blog to learn more. CfM thanks Representative Pingree for her support for increasing low-income women's access to the quality care provided by CPMs. Sign up with the MAMA Campaign to learn more this important piece of legislation.
What is MAMA?
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The MAMA Campaign is organized and directed by a formal partnership of six national midwifery and consumer organizations (including CfM) that represent and support Certified Professional Midwives, including over 1500 CPMs, and thousands of other midwives, consumers, midwifery educators, and midwifery advocates across the country.
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MAMA is working to get CPMs added to the list of federally mandated Medicaid providers! This is a key step for increasing access to CPMs and out-of-hospital birth for all women, and will help persuade more state governments to license these health-promoting, cost-saving maternity care providers.
What has MAMA accomplished?
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CPMs in licensed states, in licensed birth centers, now must be paid by Medicaid under the new health reform legislation! A great first step!
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The CPM is now recognized in Washington, DC! The MAMA Campaign continues to form alliances and connections with legislators and organizations and is now asked to consult regarding maternity care issues in DC.
What's next?
The MAMA Campaign continues actively working with our lobbyist on strategy and practical, targeted actions, to build support for federal recognition of Certified Professional Midwives across a range of governmental agencies. We are getting closer each day to the introduction of a bill that would amend the Social Security Act to get licensed CPMs Medicaid reimbursement in any setting!
Visit mamacampaign.org to get involved!
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Partnering to Improve Maternity Care Quality Act of 2010 Filed in House of Representatives!
Childbirth Connection announced on November 22, 2010 that Congressman Elliot Engel (D-NY) and Congresswoman Sue Myrick (R-NC) filed the Partnering to Improve Maternity Care Quality Act of 2010 (HR 6437). Childbirth Connection worked with the offices of Mr. Engel and Mrs. Myrick on this significant bipartisan legislation.
In Childbirth Connections E-news they stated:
This act is designed to improve the quality, health outcomes, and value of care for childbearing women and newborns covered by Medicaid and CHIP (Child Health Insurance Program).
One set of provisions will help measure, improve, and make decisions based on maternity care quality by:
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identifying a core set of available maternity care quality measures
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working with measure developers to create, test, and endorse quality measures to fill important gaps in available measures
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adapting the generic provider, facility and health plan CAHPS surveys (Consumer Assessment of Healthcare Providers and Systems) for measuring care experiences of childbearing women and newborns
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developing effective formats and processes for reporting results of quality measurement to those who are measured (clinicians, facilities, accountable care organizations, health plans) and to consumers, policy makers and payers
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conversion and testing of existing endorsed maternity care quality measures to eMeasures collected through health records and other electronic data sources
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reporting on the various elements of the maternity care quality measurement program, and identifying further mechanisms for maternity care improvement
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carrying out the work with ongoing multi-stakeholder consultation to strengthen the program.
Other major sections of the act will:
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create a demonstration project to test the impact of innovative payment reform mechanisms on the quality, value, and outcomes of maternity care provided to Medicaid beneficiaries
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support an Institute of Medicine report to identify essential, evidence-based services for childbearing women and newborns.
Partnering to Improve Maternity Care Quality includes provisions recommended in two Childbirth Connection reports: Evidence-Based Maternity Care: What It Is and What It Can Achieve (2008) and the "Blueprint for Action: Steps toward a High-Quality, High-Value Maternity Care System"(2010). Childbirth Connection issued Evidence-Based Maternity Care together with the Reforming States Group and the Milbank Memorial Fund. The Blueprint was developed through the Transforming Maternity Care project, a multi-disciplinary, multi-stakeholder collaboration that engaged leaders from across the health care system over two and one-half years in identifying priority actions for driving maternity care quality improvement.
Childbirth Connection encouraged their eNews readers to:
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MOMS for the 21st Century Act (H.R. 5807)
Maximizing Optimal Maternity Services (MOMS) for the 21st Century Act, H.R. 5807 was introduced in July by Representative Roybal-Allard. The introduction of this historic bill in Congress can be seen on YouTube. This legislation contains many of the recommendations from Childbirth Connections' "2020 Vision for a High-Quality, High-Value Maternity Care System" and the "Blueprint for Action."
Representative Roybal-Allard's explained the benefits of the The MOMS 21 bill in a letter to her collegues. She states the bill will:
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Create a national focus on maternity services by establishing an interagency coordinating committee to promote optimal maternity care by all federal agencies involved with the delivery of health services.
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Expand federal research on best maternity practices by establishing a Center for Excellence on Optimal Maternity Outcomes and directing the Center for Innovation within the U.S. Department of Health and Human Services to focus additional research on cost-effective, high-quality maternity care models
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Develop a comprehensive online database for consumers and health care providers containing up-to-date systematic reviews of maternal and newborn care practices
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Authorize a national consumer education campaign to inform women about evidence-based maternity care practices
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Support the education of a more culturally diverse interdisciplinary maternity care workforce with the establishment of targeted federal grant programs and an aggressive educational loan repayment program focused on maternity care shortage areas
Login to OpenCongress to view the full text of the MOMS for the 21st Century Act.
This legislation lists Certified Professional Midwives as part of the maternity care workforce that is critical to addressing the needs of quality evidence-based maternity care in the US. CPMs are seen as part of the solution at the federal level.
The MOMS 21 bill has been referred to the Committee on Energy and Commerce and the Committee on Ways and Means.
See RealityCheck, Seattle Examiner for a few articles regarding this legislation.
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Great Connections
CfM at the Midwives Alliance of North America Conference
What a great conference! CfM Board Members Nasima Pfaffl and Susan Hodges represented CfM at the conference, held October 14-17 near Nashville, TN.
Susan Hodges, to her great surprise, was awarded a MANA Outstanding Activisit Award. Susan recieved this award for her, "brilliance in rallying grassroots citizen support for the Midwives Model of Care and inspiring ordinary people all across the nation to speak out for choices in childbirth." Susan was recognized along with Ida Darragh and Kitty Ernst for their years of service.
Photo: Carol Nelson, Gera Simkins, Kitty Ernst, Ida Darragh, Brynne Potter, Susan Hodges, Nasima Pfaffl, Christy Tashjian. (c) Tina Williams 2010
A great array of plenary speakers brought messages both hopeful and thoughtful. Here are some highlights:
* ACNM President Holly Kennedy told of her research on maternity care in British hospitals and how many aspects of exemplary and respectful care have been incorporated into the institution, leaving most of us with our mouths agape in astonishment! It was wonderful to have the President of ACNM participate in the entire conference!
* Bridget Lynch , President of the International Confederation of Midwives, explained passionately the ICM strategy for making sure that midwives constitute an autonomous profession that can and will exist throughout the world into the future. Among other things, she discussed the ICM's document "A Global Call to Action: Strengthen Midwifery to Save Lives and Promote Health of Women and Newborns" and the role of each of the 4 "pillars" for strengthening midwifery.
* Disparities: MANA President Geradine Simkins and several other speakers focused on the problem of disparities in maternity outcomes in our own country. There was also a moving candle light vigil focused on overcoming disparities in birth outcomes.
Did you know that "1667 babies died in Florida in 2008, 501 in Wisconsin and 97 in DC. Do you realize that means more babies have died in some states, in ONE YEAR, than many grand midwives have delivered in a lifetime? The vast majority of these lost little ones are babies of color" (Jennie Joseph). Do you know the rates of infant mortality disparities in your state? Visit this CDC's Vital Stats Table (see page 20) to find out your states’ rate of infant mortality and how these differ by race.
Overall in 2006, the US had an infant mortality rate of 6.7 per 1,000 live births. African-American's had a rate of 13.3 per 1,000 or more than twice the infant mortality rate of whites; and they are 4 times as likely to die of complications related to low birth weight as whites.
It is important for all of us who are working to promote midwives and better birth practices to be aware, and to understand the many aspects of inequality and problems that contribute to these disparities.
The International Center for Traditional Childbearing (ICTC) has some resources for midwives and mothers of color. Also visit Common Sense Childbirth to learn more about Jennie Joseph's program to improve maternity care outcomes across racial populations.
* Increasing Midwives in the US
MANA also issued a 2020 Challenge:
20,000 midwives, assisting at 20% of all births in the U.S., by the year 2020!
View MANA's first YouTube video to learn more about the 2020 challenge and MANA’s strategic plan.
* More Info: Pictures of the conference and audio CDs of sessions are available for purchase on the MANA website.
* Finally, more good news: The next MANA conference, fall of 2011, will be held in collaboration with ACNM and be put on jointly by MANA and the Canadian Association of Midwives (CAM), and will take place on the Canadian side of Niagara Falls!
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Off the Shelf Book Review
Survivor Moms: Women's Stories of Birthing, Mothering and Healing after Sexual Abuse
By Mickey Sperlich & Julia Seng
Motherbaby Press, 2008
ISBN 978-1-89-044641-3
245 pages, softcover
www.midwiferytoday.com
Reviewed by Molly Remer, MSW, CCCE
Past sexual abuse is an unfortunately common experience for women. Anyone who works with women of childbearing age should be mindful and informed of the effects of an abuse history on the woman's experience of pregnancy, birthing, and mothering. Indeed, I consider this awareness to be a fundamental professional responsibility. Enter Survivor Moms, published by Motherbaby Press. This book is an incredibly in-depth look at the experiences and need of survivors of sexual abuse during the childbearing year.
One of the best and most unique features of the book is the "tab" format used for much of the clinical, research-based, or fact-based content in the book. Rather than lengthy chapters reviewing research and analyzing the phenomenon, textboxes containing quick facts and reference material are printed in the margins of many of the pages. The bulk of the narrative information in the main body of the text is then in the voices of mothers themselves, interspersed with commentary by the authors linking concepts, explaining ideas, and clarifying essentials. This is a powerful format that makes information readily and quickly available for reference as well as making the overall book very readable and approachable.
As someone with no personal abuse history who is currently pregnant, I did find the book to be a very emotionally difficult, intense, and almost overwhelming read at times. This is not a criticism in any way—sexual abuse is not a light or cheerful topic and it can be one that many people prefer to avoid. This is all the more reason for birth professionals to make a specific effort to be educated and informed.
Written both for mothers themselves and for the professionals who work with them, Survivor Moms is an essential part of any birth professional's library. As noted in the book's introduction, "We need to understand the impact of childhood abuse on birthing and mothering deeply, from hearing women's stories. We also need to understand it broadly—from looking at the impact on samples and populations, on the body and on the culture." Survivor Moms offers an accessible way of hearing those critically important stories and developing the necessary understanding to care compassionately for birthing women.
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Disclosure: I received a complimentary copy of this book for review purposes.
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Product Highlight
Midwives Model of Care Pocket Folders
Do you provide information packets for your clients? Do you need a professional-looking folder when you give information to legislators or state officials?
Use these beautiful and practical folders! They are high quality color pocket folders with the Midwives Model of Care all-over design on the front and the definition on the back. The folders are blue-green with the white logo image and gold letttering. The folder has two interior pockets with business card slots on both pockets.
Order 25 for just $25.50 (shipping included). Larger bulk orders (at lower cost/folder) are also available. Visit the CfM E-store to order Midwives Model of Care Pocket folders, Midwives Model of Care Brochures, and more.
About CfM
Note from the President
 Welcome to our first ever electronic newsletter! We are so excited about bringing Citizens for Midwifery into the digital age!
The CfM Board met on the weekend before Thanksgiving in Syracuse, NY and had a hugely successful several days of planning… planning that included the launch of this newsletter. Nasima Pfaffl managed this effort from inception to implementation, and I am grateful for her dedication to this effort. We are excited to make this transition, and we are determined to use your feedback and our own experience to improve as we go.
The sad news from the weekend retreat was that we were saying goodbye to longtime Board member, Carolyn Keefe. Thank you Carolyn for all you have contributed to CfM!
Founding member and immediate past President Susan Hodges was also part of our retreat, and we are so grateful that she is still willing and able to guide us and advise us in our planning for a little while longer. Susan will continue to serve on the CfM Board over the next year in an advisory role.
Arielle Bywater and her children Jem and Willa (c) Sharyn Peavey
We've also had to say goodbye to Arielle Bywater (photo above) and Stephanie Hucker (not pictured) who served on the Board this year. Arielle acted as CfM newsletter editor for two years and Stephanie has helped work on Grassroots News Messages. We want to recognize them now, and sincerely thank them for their service. Although they're not getting away that easy-- as they both plan to stay involved with CfM in other ways.
Molly Remer, photo credit Karen Orozco (c)2010
I'd also like to extend a congrats to past-CfM Board member Molly Remer. She is expecting a baby this Spring and we couldn't be happier for her and her family. Molly is our amazing blogger and Facebook gal. We wish her many baby blessings.
 Nasima Pfaffl, Carolyn Keefe, Hillary Boucher (and daughter), Lauren Korfine, Susan Hodges, Willa Powell.
We had a marvelous opportunity to meet with two of the three cofounders of Birthnet of the Fingerlakes in Ithaca, New York: Lauren Korfine and Hillary Boucher. The recently-passed Midwifery Modernization Act (MMA) was a major victory for midwives in New York State. Lauren and Hillary, along with Jeanette McCulloch, led the Free Our Midwives campaign, which was the consumer arm of the New York State Association of Licensed Midwives (NYSALM) effort to get the written practice agreement requirement removed from the licensing law.
We are still trying to grow our Board, and are still looking forward to hearing from anyone who is interested. Please email nasima@cfmidwifery.org if you are interested in applying to serve on the Board.
I'd love to stop here, but I must make a pitch. If you like what you see in this newsletter, if you value CfM's mission and work, please consider sending a donation to CfM. You can do that from our website.
Sincerely,
Willa
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