Strollerderby : midwifery

Placentas Washing Up in Illinois Sewer

Madeline Holler — Fri, 27 Feb 2009 23:27:00 GMT

A public health administrator in Champaign, Ill., is asking that whoever is dumping fresh born plancentas into the local sewage system to, you know, stop it.

For the third time, workers at the local water treatment plant found afterbirth caught in a filter designed to keep large foreign objects (including human organs!) out of the treatment facility.

The placentas are consider potentially infectious medical waste and regulations forbid disposal in the sewer system.

The department apparently believes the flushed placentas were from homebirths. From a letter released by the public health office:

The individual or individuals in the community that have been engaging in this practice must stop immediately and begin disposing of the medical waste associated with home births in an approved manner. ...

Local health authorities strongly encourage community members to alert the proper agencies if they have any information regarding the unauthorized disposal of medical waste.

Authorities are investigating.

I think there's probably more to this story. Illinois is another of many states were midwifery is basically, if not outright, illegal. But homebirths attended by illegal midwives happen frequently and have been documented. So I think there's probably something more to this case -- that it's not some illegal but skilled and trained midwife flushing placentas down the toilet. Then again, I watch too much Law & Order.

Be like me and throw the things in the trash.

My Illegal Homebirth

The Trouble With Wanting a VBAC

Damned if You Do, Doomed if You Don't (Breastfeed, That is)

If You're Not Birthing at Home, You're Irritated With Women Who Do

Photo: blog.wired.com

South Dakotans Don't Support Home Birth. Or Do They?

Miriam Axel-Lute — Wed, 11 Feb 2009 22:00:00 GMT

As the economy continues into the toilet, there seems to be a growing push to consider increasing the use of midwives (both hospital and home birth, nurse-midwives and certified professional midwives) as a way to cut down health care costs.

Of course, it's being met with a predictable backlash from doctors screaming about how dangerous home birth is.

In South Dakota, this time around, the doctors won and the house rejected a bill to allow certified professional midwives (the only credential that requires experience in out-of-hospital births) to attend home births. In South Dakota, as in many other states, certified nurse midwives can attend home births if they work with a doctor who approves it—but no doctor will approve it, effectively making the option nonexistant.

But no matter. No one really wants the option anyway. From the AP story: "South Dakota had more than 12,000 live births in 2007, and only 26 of those babies were born at home, said Doneen Hollingsworth, state Health Department secretary. Only 19 of those were intended to be home births, which indicates home births are not supported by most South Dakotans, she said."

Or, um, that you've made it illegal for the people who want to attend home births to attend them? If people who wanted a home birth were willing to do it alone they wouldn't feel the need for this bill would they? (And they do.)

(Not to mention that at least some of the other seven probably lied about whether their home births were planned to protect midwives working underground.)

Photo by dizznbonn.

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TV Producer Seeking Urban Home Birth to Film

Miriam Axel-Lute — Mon, 29 Dec 2008 21:28:00 GMT

Producer Zach Marion is looking for someone planning have a home birth and due in January or early February to add to the birth stories in an upcoming Discovery Health Network show promoting midwifery and home birth.

Since the two already on board involve organic coffee growers in Hawaii and a couple planning to erect a "birth teepee" in Utah, he suggests that maybe a more urban birth setting would round out the trio.

Unsure about having a film crew at your birth? (I hope, frankly, that you are at least a little unsure.) Marion knows strangers can be disruptive but says in filming dozens of births for "House of Babies," he and his crew have become practiced at fading into the background and becoming "a fly on the wall." Not to mention blurring out the bits network TV doesn't want to show in high-def.

So if you're due at the right time and want to do your part for home birth awareness (especially, say I, if you are not the "stereotypical" home birth mom), give Marion a ring. It'll mean dad won't need to worry about the camcorder.

Photo by mil8, via Flickr.

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U.S. Birth Centers in Danger of Closing

Miriam Axel-Lute — Thu, 18 Dec 2008 21:00:00 GMT

Everyone likes a best of both worlds solution, right? For many pregnant women, birth centers provide just that. For low-risk pregnancies, they are a comfortable, calm, non-hospital atmosphere in which to give birth. They often have pools, and kitchens for family members to cook in. They don't separate mother and baby after birth, but check vitals right there. And yet, for those uncomfortable with birthing at home, there are also a staffed and equipped medical facility, usually quite near a hospital and with established transfer protocols in place. They are often crucial in rural areas where hospitals are few and far between.

And yet, after 20 years, the federal Medicaid agency has all of a sudden begun to refuse to pay for them. (Why? Do they prefer to pay tons more for a hospital birth?) The agency claims there is nothing specifically in any legislation saying that it's a covered cost. (Ah, I see. Bureaucracy strikes again.)

This is not merely a case of the poor getting screwed either notes the American Association of Birth Centers. Other payers follow Medicaid's example, they say. Basically, if the law isn't changed, pronto, freestanding birth centers will be fighting for their financial lives. Many are already suffering from refused payments.

There is a chance to clarify the law when the SCHIP bill passes, but it has to be done before the Christmass recess, so AABC is asking everyone to call their congresspeople and let them know that this is in fact important—a no-brainer even (but perhaps you oughtn't to use that phrase).

Photo from Alma Midwifery.

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Midwives to Daschle: We're Cheaper and Better

Miriam Axel-Lute — Thu, 18 Dec 2008 16:30:00 GMT

The folks at The Big Push for Midwives are organizing to try to get upcoming HHS Secretary Sen. Daschle to make one of the community meetings on healthcare he attends one that they are holding in Missouri to discuss reforming maternity care.

There's good reason for this: Maternity care is one of the areas where the U.S. healthcare system exemplifies the lose-lose proposition of spending tons of money for piss-poor results in terms of maternal and infant mortality rates. There are better ways. As the Big Push folks report, "A recent Washington State study, using conservative cost estimates, estimates that the state's licensed midwives program, over two years, resulted in recoveries from Medicaid Fee for Service (FFS) alone at more than $473,000. Cost savings to the health care system (public and private insurance) is estimated at $2.7 million." That should catch any budget-minded appointee's attention.

On the other hand, I do have to quibble a little with the activists when they write: "The first step in maternity care reform centers on recognizing that our problems go beyond the secondary issue of insurance coverage and access to care." Yes, access to a broken system is a mixed bag and our problems go beyond insurance. But lack of health insurance isn't secondary. As much as I adore the midwife model of care, I'm willing to bet that lack of any prenatal care at all, health complications in mothers that went untreated because they didn't have insurance pre-pregnancy, and the stress of working extra jobs/hours to pay for unaffordable insurance total to a bigger problem for babies' health than even intervention-happy OBs. Besides, people without insurance won't get to see midwives either.

But nonetheless, Daschle should talk to the midwives at some point. Their message of better, cheaper, common-sense care is just the kind of thing the Obama administration might be able to see the value of.

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Taking the Midwifery Cause to . . . Postage Stamps

Miriam Axel-Lute — Thu, 06 Nov 2008 23:30:00 GMT

You've likely heard about the whole Stamps.com thing where you can order honest-to-god postage ("metered postage," the USPS hastens to add, not "real stamps." But they'll get your letter where it's going) with your own photos on it. Apparently they get touchy if you try to put anything "randy" or political (at least antiwar) on them though.

Happily for supporters of midwifery, however, the good folks at Stamps.com don't know just how political the choice of a birthing attendant can be, and they've got a lovely set of stamps available in partnership with the American College of Nurse Midwives that either say "Choose a Midwife" or give ACNM's website and have beautiful pictures of a pregnant belly and newborns (or ACNM's logo).

It's looks like ACNM has become a Stamps.com affiliate, which according to the site should be earning them "high commissions," which I'm glad to hear, since the cost for a sheet of their stamps comes out to well over twice the cost of the postage itself, even before shipping. If they sell, it sounds like a decent blend of fundraising and just getting the word out. I can hear the people in the mailroom now: "What was that on that envelope? . . . No, the stamp, not the crayon scribbles and apple juice spill."

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Six Steps to a Parent-Friendly Wedding

Would You Let a Midwife Perform Your C-Section?

Madeline Holler — Wed, 16 Jul 2008 18:14:00 GMT

Well, would you? What if she had trained for four years as a midwife and performed more than 100 c-sections under the eye of an actual surgeon? Still no?

Well, maybe me too. I don't know. But! I have the good fortune of not ...

being desperately poor and living in rural Mozambique, where there are but 18 OBs for the entire country (yes, the entire country and its 19 million inhabitants!). Because in that case, I'd say I'm allllll for it.

Last night, PBS's Wide Angle (the summer version of Frontline) aired a documentary about one woman who trained in this innovative program and, OK, sure, I'd let her have a whack at me. She was kind, totally cool under pressure and knew her stuff. You can watch a preview here and also a short take on midwives in the U.S. Or read more about Mozambique and its tragically high maternal and infant mortality numbers.

Of course, midwifery supporters such as myself have to approach the topic if midwives performing surgery with some caution. Having had a midwife-attended home birth in a state that had yet to legalize professional midwives, I know that doctors and lawmakers opposed to midwifery often scare people away from the idea of legalizing the profession by saying "they'll start performing c-sections!" or "now they'll do abortions!" So it bears pointing out that in Mozambique, training low-level healthcare workers in surgery (not just the midwives are picking up the scalpel) is a response to a severe shortage of doctors in the country. It's the best they can do for now.

Oh, and it's working!

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My Big Fat American Pregnancy

Photo: PBS.org/Wide Angle

Unassisted Birth -- Help Me Out

Madeline Holler — Wed, 09 Jan 2008 22:46:00 GMT

When I read stories about women who opt to give birth at home allllll by themselves -- no help from a midwife or a doctor or a staff of nurses -- I think to myself, "can you blame them?" I know, I know, a lot of you are thinking these people are just trying to be heroes or adhere to some kind of radical hippie code that shuns any relationship with established authority. Or you think they're narcissistic idiots who put their own childbirth dreams above the health and safety of an innocent child. Homebirth moms get that kind of talk too.

But I think all that's wrong. Quite wrong.

Pregnant women in the U.S. are in this totally weird position where our reproductive rights are, on both ends of the conception and pregnancy chronology, narrowing quickly. State judges, with the eventual help of the Supreme Court, are shrinking options on the early end of the spectrum. Doctors, hospital administrators, and insurance companies and legislatures (who make midwifery a crime) are taking away choices at the latter end.

Let's focus on the latter:

More than one third of all childbirth in the U.S. results in surgery -- a c-section. Some are, of course, necessary (but, like, 10 percent). A tiny percentage are the "too posh to push" variety and not indicated, but allowed (and hey, it's your choice, I won't stand in your way.). More are the "once-a-c-section-always-a-c-section," variety and then the rest, a significant number, could probably have been avoided all together.

It's the last two that, I think, push women to go the DIY route. In loads of hospitals all over the country, VBACs have been banned. Doctors and midwives are not allowed to do these vaginal births after ceseareans because of some studies that say there is an increased chance for uterine rupture in VBACs. Which may or may not be true, but that chance of which they speak is actually quite small. So what do you do? Avoid the hospital.

And avoidable c-sections? There a loads of ways to decrease one's risk of being pushed to have a c-section, but many can't be done in the hospital. Get in a tub, move around, stay off IV fluids, don't get hooked up to continuous fetal monitors, blah, blah, blah. They were in the birth plan! But the pressure! Look at what the quoted doctor has to say:

"What women need to appreciate is that the few hours of labor are the most dangerous time during the entire lifetime of the soon-to-be-born child," said Dr. Frank Chervenak, Chairman of Obstetrics and Gynecology at New York Presbyterian/Weill Cornell. "Because of this, I would argue ... all soon-to-be born children have a right to access immediate Caesarean delivery, and women who are denying this right are irresponsible."

So what do you do in your next pregnancy? That's right. Avoid the hospital and that attitude toward pregnancy and childbirth.

What about the child? Well there are risks to childbirth and those risks play out in different ways in each of the settings a woman might want to give birth in. Don't think women and babies don't die after childbirth in hospitals, which is NOT saying death in the hospital is certain and likely. Just like it's not certain and likely at home or unassisted.

What I'm trying to say is that women/patients/clients want what they want. Because there are so many possibilities. So many ways to do it right. So few ways that make it wrong (smoking crack comes to mind -- but who am I to judge?) Yet hospitals, midwives and doctors only allow for (without battles) a certain range of them. And that's fine for them and their jobs. But not fine for some women. So some women opt for birthing centers with midwives or doctors, or homebirth with midwives or (the few remaining homebirth) doctors. And some women opt to go it alone.

Unassisted birth is not for me, but like I said, who can blame them?

PS: Is it me or is that a fake belly on the woman in the picture? Just asking ...

Photo: ABC News

U.K. Gives Laboring Moms More Options for Pain

Madeline Holler — Thu, 18 Oct 2007 11:25:00 GMT

I assume most adults, parents or not, know there is more than one way to give birth. There’s vaginal delivery, with or without the epidural, there’s c-section, planned or emergency. There’s birth at a hospital, birthing center, convenience store or at home.

We make our choices, we have our babies.

Problem is, this list is hardly exhaustive, a fact that becomes apparent when we look at other countries. Even some of the options mentioned before are available only if you happen to live in the right state. Homebirth, or a hospital birth attended by midwives, or vaginal births after c-sections, for example, aren't legal or available for every American women who may want to safely attempt one.

Jennifer Block, author of “Pushed: The Painful Truth About Childbirth and Modern Maternity Care," blogged about childbirth in the U.K., where experts are encouraging homebirth for healthy pregnant women. She also makes this shocking revelation: many, many of the pain relief options available to laboring women in the U.K. are unheard of here in the States.

Apparently, women there can hook up to a TENS machine the size of an iPod, which delivers little electric shocks to muscle tissue and helps in relaxation through early labor contractions. Laboring Brits may also be offered hits of nitrous oxide for pain (that's the stuff in the dentist's office). The idea is to delay the epidural so women are able to move into different positions while laboring and also keep them free to sit in tubs, also widely available there.

Yeah, who isn’t a little sick of hearing about how much better healthcare and birth outcomes are in other countries – you know, like Bosnia – than in the U.S. It's just all the more shocking to know that the few variations on birth and labor support here in the States are truly very few.

Pregcellent: You Couldn't Pay Me Enough To Have a Home Birth

Kelly Mills — Wed, 10 Oct 2007 19:01:00 GMT

There's a thing in the Daily Mail about the pros and cons of home birth, and it's all pretty darn pro. I can see that. I mean, you get to avoid the unnecessary birth interventions that can happen in hospitals, and if you want to have your baby at home, you'll probably be more relaxed in that environment. I have some friends that went this route very successfully. I fully support the right of women to give birth at home or in a pool or a treehouse or wherever they feel most comfortable, with the exception of rush hour traffic.

That said, even though I was probably the recipient of some unnecessary medical interventions (when I went in for my prenatal visit a tech said my amniotic fluid was low and they induced my labor, but it turns out it probably wasn't low at all) I'd still never be able to give birth anywhere but in a hospital. Because I am an anxious person. Even though the chances of something going wrong are slight, I don't want to be a 15-minute drive away from a team of physicians and a good NICU. Shoot, I can't even leave the house without a box of bandaids in my purse. I did not have a beautiful, comfortable, meaningful labor. Was that because I was at the hospital? No, it was because my labor hurt like an unholy motherf*cker. As it turns out, I had back labor, which probably ought to be named "all-over-body agony" so I was glad to give the anesthesiologist a sloppy wet kiss on the mouth. So while I respect the miraculous, home-based birth experience of others, for me the only miracle came at the very end. If there's ever a next time, I just hope someone will knock me out with a club.

Strollerderby Playdate: Homebirth/Midwife Edition

Alisyn — Mon, 07 May 2007 11:03:00 GMT

From Rikki Lake, to this video, to a new law in Wisconsin, home birthing and midwifery are all over Babble and Strollerderby. It's got me reminiscing...

When I got pregnant with my older daughter, my husband (then fiance) and I were still living with Brandy, world's best roommate and midwife-in-training. Brandy was a wealth of resources on everything from home birth, to water birth, to labor coaching, to pregnancy in general. Ultimately, I chose a hospital birth, with an epidural about 10 hours into it - thank god - but I was well-informed enough to know how to speak my mind and take charge of my birth experience, thanks to the information and support that Brandy provided me with. I wish everyone could have their own Brandy (hey - if you live in Ashland, OR, and are pregnant, you can! Email me!) - but since not everyone can, these home birth and midwife blogs will substitute nicely.

Lay Midwives Win Right To Practice In Wisconsin

Patti — Thu, 03 May 2007 16:27:00 GMT

Wisconsin has just become the 25th state in the US to legalize the practice of lay midwives. The first license has already been issued by the state, and in addition, the new law allows midwives to practice without being involved in a formal health care practice.

Lay midwives are often as experienced as their degree-holding counterparts, but they have had to fight for recognition and the right to practice their vocation openly. Nurse midwives are praising the legislature's decision as a validation of the midwifery model of care for women's health. Approximately 1100 babies were born outside of hospitals in Wisconsin last year, and those numbers are expected to rise with the new regulations.

25 states down, 25 to go!

Independent Midwifery in England May Become Obsolete

Karen Murphy — Mon, 12 Mar 2007 17:06:00 GMT

Half my children were born attended by a midwife, and for me, having this choice made a huge difference in the birth experience both for me and for my children. I can't imagine having had this choice and then having it stripped away by well-intentioned but nevertheless not well thought-out (read: stupid) governmental regulations, but pretty soon if current government plans in England to require professional indemnity insurance for all midwives goes through, lots of would-be parents are going to be left with fewer choices when it comes to catching their babies. Midwives employed by the National Health Service (NHS: the U.K.'s publicly-funded, "free" health care system) won't be affected, but the NHS is overworked, underfunded, and understaffed, leaving a strong need for independent midwives to relieve the pressure and provide service for parents and babies. Efforts are being made to come up with a suitable alternative for the independent midwives, but it may end up being a case of "too little, too late". And I'd like to know what English parents will do then.

Strollerderby : midwifery

Placentas Washing Up in Illinois Sewer

The Trouble With Wanting a VBAC

Damned if You Do, Doomed if You Don't (Breastfeed, That is)

If You're Not Birthing at Home, You're Irritated With Women Who Do

South Dakotans Don't Support Home Birth. Or Do They?

TV Producer Seeking Urban Home Birth to Film

U.S. Birth Centers in Danger of Closing

Midwives to Daschle: We're Cheaper and Better

Taking the Midwifery Cause to . . . Postage Stamps

Would You Let a Midwife Perform Your C-Section?

Illegal Immigrant Shackled During Labor

Czech Law Forces Pregnant Teens Out of School

Newborn Son Brings Dead Dad Back to Life

My Big Fat American Pregnancy

Unassisted Birth -- Help Me Out

U.K. Gives Laboring Moms More Options for Pain

Pregcellent: You Couldn't Pay Me Enough To Have a Home Birth

Strollerderby Playdate: Homebirth/Midwife Edition

Lay Midwives Win Right To Practice In Wisconsin

Independent Midwifery in England May Become Obsolete