Friday, August 15, 2008

The Birth Survey is Here!

Well, the moment we have been waiting for has arrived. The Birth Survey project has launched nationwide. This is an exciting moment!

Here are all the details and information about how you can help from the CIMS Grassroots Advocates Committee:

The Birth Survey Now Available Nationwide!

For years, consumers have enthusiastically shared online reviews of movies, restaurants, products and services, but readily available information about maternity care providers and birth settings was nearly unattainable--but no longer. The Birth Survey is now available to all women in the US who have given birth in the last three years. Women can now give consumer reviews of doctors, midwives, hospitals, and birth centers, learn about the choices and birth experiences of others, and view data on hospital and birth center standard practices and intervention rates.

Thank you to all the tireless volunteers who have worked so hard since 2006 to make this project a reality. And thank you to all our new project ambassadors and friends who are helping to make the Transparency in Maternity Care Project: The Birth Survey a reality.

To help spread the word about The Birth Survey, please:

  • Send E-mails out to your contacts encouraging them to take thesurvey (e-mail text provided at end of this message). Suggested language is provided below. An automated “Invite a Friend” email tool can be accessed here. Invite your friends with a personalized message!
  • Post the downloadable web banners and buttons to The Birth Survey on your personal or organizational websites. Download these here.
  • Add a link to The Birth Survey Project in your email signature and on your website.
  • Distribute postcards inviting women to take The Birth Survey. These cards can be downloaded here and printed as needed or preprinted cards can be ordered from CIMS here. Preprinted materials are currently being printed and will be mailed out in about two weeks.
  • Send Press Releases to local press outlets. Press releases will be sent out nationally on Monday morning 8/18. A pdf press release that can be used for distribution by anyone will be available here on Monday. We encourage those of you who have been trained as a Marketing Ambassador and have signed a MOU to request a customizable press release by e-mailing admin@thebirthsurvey.com. We will provide these ambassadors with a customizable press release in which their personal contact information can be added if they plan to act as a local press contact.
Thank you all for your support of this project. If you have questions please e-mail admin@thebirthsurvey.com.

Language for Distribution Below:

Longer Project Description for Distribution:

For years, consumers have enthusiastically shared online reviews of movies, restaurants, products and services, but readily available information about maternity care services was nearly unattainable—but no longer. The Coalition for Improving Maternity Services (CIMS) has developed www.TheBirthSurvey.com, a consumer feedback website where women provide information about the maternity care they received from specific doctors, midwives, hospitals, and birth centers. Families choosing where and with whom to birth can utilize this consumer feedback, along with data on hospital and birth center standard practices and intervention rates, to make more informed health care choices.

Have You Given Birth in the Last Three Years?

If so, take The Birth Survey and provide feedback on your doctor, midwife, birth center or hospital at www.TheBirthSurvey.com.

Help Spread the Word About The Birth Survey!

Forward this e-mail and download buttons, banners, and promo cards at www.thebirthsurvey.com. Are you interested in helping to get the word out about The Birth Survey in your community or working to obtain official facility level intervention rates? To get involved, contact us at info@thebirthsurvey.com.

Support this non-profit project by the Coalition for Improving Maternity Services (CIMS) by donating or becoming a member here and sign up for e-cims newsletter here.

For information visit www.thebirthsurvey.com or email info@thebirthsurvey.com.

Short Email Template for distribution:

Hi!

I found this great site, check out www.thebirthsurvey.com

The Birth Survey works by asking birthing women nationwide to provide feedback about their doctor, midwife, hospital, birth center or homebirth service. Responses are made available online free to other women who are deciding where and with whom to birth.

The Birth Survey is…

  • FREE
  • Available to women who have given birth in the US in the last three years
  • Accessible online 24/7 at www.thebirthsurvey.com
Take the Birth Survey and provide feedback on your maternity care experience at www.thebirthsurvey.com. Help women in your community or around the US find quality providers and birth settings that are compatible with their needs and philosophies.

Help spread the word about The Birth Survey! Forward this e-mail and download buttons, banners, and promo cards at www.thebirthsurvey.com.

Support this non-profit project by the Coalition for Improving Maternity Services (CIMS) by donating or becoming a member at http://www.motherfriendly.org/online_contribution.php and sign up for e-cims newsletter at http://www.motherfriendly.org/e-cims.php

Tuesday, July 15, 2008

A Celebration of Legal Midwives in Missouri!

July 12, 2008 ~ St. James, Missouri


According to the Missouri Supreme Court, Certified Professional Midwives became legal to practice in Missouri on July 4, 2008.

It's a long story, beginning with a little word, "tocology" and ending with a historic Missouri Supreme Court decision that overturned a lower court's ruling. The Missouri Supreme Court stated that the physicians associations who sued the State over the new midwifery law (passed in 2007) had no right to be in court over this in the first place. So, the injunction that they had placed against the midwifery law in August of 2007 was thrown out, and the law stood as passed.

And Certified Professional Midwives became legal to practice in Missouri on the day we celebrate in honor of FREEDOM!

Since most people already had 4th of July plans, we had to postpone our statewide celebration a bit. (Actually, the St. Charles and St. Louis Friends of Missouri Midwives area chapters held celebrations the day the court ruling was handed down - June 24 - and a few days later at their usual monthly meetings.)

Our statewide celebration was planned rather last minute and the Nisbett's graciously offered their spacious home near Rolla.
Here are a few pictures from the Saturday afternoon party (July 12).


The Nisbett's have a dream yard for children...


Their house is really kid-friendly (and fun) as well.
All the kids had a blast!



Jesse and Emily (who take care of all of the accounting and web up-keep for Free the Midwives!) were at the party showing off their new little girl - Ellie.

Senator Mike Gibbons (President Pro Tem of the Missouri Senate)
showed up while we were eating lunch.
Here he is, chatting with folks in the kitchen.



After visiting for awhile and joining us for dessert, Senator Gibbons spoke to our group, congratulating us on the recent court ruling allowing professional midwives to practice freely and reminiscing about several funny incidents that happened at the Capitol, involving "the midwives." He said that every grassroots effort that he has seen in his 16 years as a legislator pales in comparison to the one that the midwives have put on at the Capitol.
Eventually he had to head off and hit the campaign trail again (for his Attorney General race).


Collene agreed to be MC for our afternoon program, which was mostly informal story-telling by those who had been involved in trying to legalize midwives in Missouri over the last thirty-some years.

Dr. David Stewart, Ph.D, and his wife, Lee, joined us for the day and spoke first. They told their story of having their first baby at home in Rolla without a midwife or a doctor in the 1960's, because there was no one to attend a homebirth at the time. They have been working to allow access to Missouri midwives and homebirth since 1967. David Stewart has written many books on the subject and is the founder of NAPSAC International (International Association of Parents and Professional for Safe Alternatives in Childbirth).

Keith and Kim Nisbett came next in the history as they moved to Missouri in the late 1980's and were shocked to find that they couldn't open the Yellow Pages and find a midwife. Keith told the story of writing up the first midwifery bill with their illegal midwife in their bedroom and taking it to the Capitol where he learned the legislative process over the next few years as the bill passed the House of Representatives many times. It was always blocked by a filibuster in the Senate, till families eventually burnt out and went home for a few years.

Margaret spoke next about Friends of Missouri Midwives organizing in the 1990's and deciding that a foundation of public education was necessary before success would ever be secured at the Capitol. (She's speaking way in the back in a white shirt in this picture.)

Then it was Debbie and Mary's turn to tell the story of how tocology really happened behind the scenes the day it was passed in the Senate.
Right in the middle of telling the tocology story, much to our surprise, we looked up and saw Senator Chris Koster (also a candidate for Attorney General, and a friend of ours at the Capitol) walk in! He took a seat and listened intently to all of the details that most of the legislators were never privy to hear about.
(Above, Chris Koster and Jonathan Smith listening.)

Then Collene told a touching story about the 2008 legislative session. She talked about how she was walking around the Capitol on one of the very last days, knowing that Senate Leadership was killing our bill behind the scenes.
She said that in desperation, she finally went into the little coffee room near the chamber and shut the door. She told us all how she had knelt down on the floor by the ice machine and cried out to God, "Why does this have to be so long and so hard and so painful? Why does our bill never pass? I've been coming to this place for 20 years and, God, you know how much I HATE it! I don't ever want to come back! Why can't our bill just pass?!"

She said that she stopped and thought about it before she said it, but then she ended her prayer with, "But I will come back if I must."

Then she recounted the last agonizing day of session and the feelings she had as she left the Capitol, tears stinging her eyes when, once again, our bill hadn't passed... not because it wasn't a good bill, not because it didn't have majority support or any other good reason. But simply because it was all about a few men who wanted to ensure their campaign donations in an election year. She had gone home and cried and wondered why things were so unjust.

And then she nearly brought the whole roomful to tears when she said, "And now I see why God didn't let that bill pass and gave us something better instead. Now I'm so happy that I didn't get what I asked for when I was crying in the little coffee room. Justice was served, and better than I could have imagined or asked for."

Afterwards, Senator Koster (above, speaking) added his own funny stories about "midwives in the Capitol".

... And then we posed for pictures!
Mary, Senator Koster, Debbie

Lastly, we all took a big group picture, and people began to head for home, feeling extremely thankful that midwifery had become legal in Missouri in a way that was far beyond anything we had ever imagined or hoped for. We also went away, realizing the gravity of the situation and the need for us to guard our new-found freedom vigilantly.

Sunday, July 13, 2008

President's Editorial - Response from MANA President to Res. 205

President’s Editorial
July 11, 2008

Midwives Alliance of North America
611 Pennsylvania Avenue SE # 1700
Washington, DC
20003-4303

Contact:
Geradine Simkins
president@mana.org
888-923-MANA (6262)
info@mana.org
http://www.mana.org

Doctors Ignore Evidence,
AMA Seeks to Deny Women Choices in Childbirth

One wonders what process the American Medical Association (AMA) House of Delegates used to determine that “Resolution 205 on Home Deliveries” was a prudent and reasonable proposal to adopt. AMA Resolution 205 attempts to outlaw a woman’s choice to birth at home or in a freestanding birth center by calling for legislation to establish hospitals and hospital-based birth centers as the safest place for labor, delivery and postpartum recovery. Further, Resolution 205 seeks to establish that hospital-based midwives who work under the control of physicians are the only safe midwifery practitioners.

The Midwives Alliance of North America, which has represented the profession of midwifery since 1982 and whose members are specialists in homebirth, finds AMA’s Resolution 205 to be arrogant, patronizing and self-serving. We have three major objections to Resolution 2005. First, Resolution 205 patently ignores the vast body of scientific evidence that has documented homebirth to be a safe, cost-effective and satisfying option for women who prefer this alternative to hospital birth. Second, AMA Resolution 205 is seriously out-of-step with the ethical concept of patient autonomy in health care (encompassing both informed consent and informed refusal), which has gained widespread acceptance in the medical community. And third, Resolution 205 distracts from other critical issues in maternity care to which healthcare professionals should be giving substantial attention, including increasing access to care, improving perinatal outcomes, reducing health disparities and fostering client satisfaction. AMA Resolution 205 is anti-homebirth, anti-midwife, anti-choice and is unsupported by scientific evidence.

Why is the American Medical Association not asking the real questions instead of trying to debunk existing research evidence on the safety and efficacy of homebirth and attempting to corner the market on maternity care? For example, why are midwife-attended births far more likely to have fewer interventions, fewer postpartum infections, more successful breastfeeding rates, healthy infant weight gain and result in more satisfied, empowered mothers ready to embrace their newborns and parenting experiences? Why are so many women across the nation left emotionally traumatized by their childbirth experiences in hospitals and consequently why do rates of postpartum depression, anxiety and post-traumatic stress continue to escalate?

It is ironic that the AMA should have a quarrel with a known safe birth option such as homebirth at the same time when the epidemic rise in coerced or elective cesarean sections puts healthy mothers and infants at greater risk than normal vaginal birth and causes excess strain on the limited resources of our healthcare system. The rate of cesarean sections in the United States is unacceptable—one in three pregnancies end in major abdominal surgery—and the decline in availability of vaginal birth after cesarean (VBAC) is deplorable. It is unethical to expect that women and infants should continue to bear the brunt of increasing medical malpractice risks by over-treating them with obstetric technologies such as c-sections while denying them safe evidence-based options such as VBAC. It is past time that the AMA in collusion against homebirth with the American College of Obstetricians and Gynecologists (ACOG) realizes that women and their partners are choosing to labor and deliver at home and in freestanding birth centers to avoid ethically unsupported obstetric interventions.

Modern medical ethics have evolved to embrace autonomy—patient choices and patient rights—over medical recommendations based on paternalism or physician preference. In almost all areas of modern medicine, except obstetrics, the locus of control rests firmly with the client or patient and not with the medical provider. It is a commonly held principle that it is not appropriate to force medical treatment upon clients or patients against their will, including medications, blood transfusions, chemotherapy or even life-saving surgeries. Informed consent has appropriately become the gold standard in healthcare decision-making. Why then do the AMA and ACOG believe that they can promote legislative efforts to deny women choices in maternity care providers and childbirth settings? In the 21st century this concept is outdated and absurd.

The AMA and its members might consider using their considerable energy, intelligence and resources to focus on promoting the health and well-being of mothers and babies and devote less time to limiting women’s access to midwifery services. All maternity care providers should band together to reduce the unacceptably high rates of maternal and infant mortality and morbidity in the United States, increase access to maternity care for all women, reduce unnecessary cesarean sections, encourage vaginal birth and VBACs for healthy women, reduce health disparities of women and infants in minority populations, and promote increased breastfeeding. These challenging but attainable goals would improve the health of mothers and babies far more impressively than reducing the rates of homebirth.

The Midwives Alliance joins the other individuals and organizations, including individual AMA and ACOG members, who have grave concerns about the AMA taking the stand articulated in Resolution 205, and calls for the AMA to abandon this resolution. Midwives everywhere honor and respect the numerous friendly physicians with whom we already partner and look to the day when midwives and obstetricians will consistently work collaboratively to support women’s choices in childbirth and provide the best possible and most appropriate range of services for every situation.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
References

1. K.C. Johnson, B.A. Daviss, Outcomes of Planned Home Births with Certified Professional Midwives: Large Prospective Study in North America, British Medical Journal 2005; 330: 1416 (18 June).
2. Royal College of Obstetricians and Gynaecologists and Royal College of Midwives Joint Statement No. 2, April 2007. See
http://www.rcog.org.uk/index.asp?PageID=2023
3. Wiegers TA, Keirse MJ, Van der Zee J, Berghs GA. Outcome of planned home birth and planned hospital births in low risk pregnancies: prospective study in midwifery practices in the Netherlands. BMJ 1996; 313:1309–13.
4. Olsen O. Meta-analysis of the safety of the home birth. Birth 1997; 24:4–13.
5. Ogden J, Shaw A, Zander L. Deciding on a home birth: help and hindrances. Br J Midwifery 1997;5:212–15.
6. Canadian Institute for Health Research Giving Birth in Canada:
Regional Trends From 2001-2002 to 2005-2006.
http://secure.cihi.ca/cihiweb/en/downloads/Childbirth_AiB_FINAL_E.pdf
7. CMAJ Maternal mortality and severe morbidity associated with low-risk
planned Cesarean delivery versus planned vaginal delivery at term
http://www.cmaj.ca/cgi/reprint/176/4/455.pdf
8. Listening to Mothers II Report (2006.) Childbirth Connections,
http://www.childbirthconnection.org/article

Tuesday, June 24, 2008

Press Release - 6/24/08

News from Missouri Midwife Supporters
CONTACT: Mary Ueland (417) 543-4258, grassroots@friendsofmomidwives.org
FOR IMMEDIATE RELEASE: Tuesday, June 24, 2008

Missouri Women and Families Declare Victory
Independence Day Comes Early for Midwives as State Supreme Court Upholds Right to Practice
JEFFERSON CITY, MO (June 24, 2008)—Today's Missouri Supreme Court decision is a tremendous victory for Missouri families, who have been working for 25 years to gain legal access to professional midwives. The ruling increases access to maternity care in the state and allows women and families more birth options and affirms their ability to exercise their rights to choose how their babies are born.

In a 5 to 2 ruling, the Court upheld a law that legalizes Certified Professional Midwives (CPMs) who practice in the state. The Court determined that the physician groups that brought the suit to overturn the law lacked standing because their only interest in the case was economic.

“The Missouri Supreme Court made the right decision today, and after 25 years of legislative struggles to ensure more birth options for families, we are very excited,” said Mary Ueland, Grassroots Coordinator for Friends of Missouri Midwives (FOMM). “Now, we can commence with creating a system in Missouri where CPMs are part of a team of caregivers, where mothers are truly informed and able to determine their own birth preferences, and where midwives can appropriately transport when the need arises, without fear of reprisals, and without intimidation and harassment of the parents.”

The decision makes legal Certified Professional Midwives (CPMs) and removes the threat of prosecution to professional midwives who assist families who choose out-of-hospital birth. State and national birth and midwives advocates hailed the ruling as a triumphant and historic moment in Missouri’s history and evidence of a tipping point at hand on the national scale.

“Certified Professional Midwives must pass rigorous exams to obtain the credential, and participate in continuing education and peer review to keep current. They practice according to their Practice Guidelines within national standards for CPMs,” said Debbie Smithey, president of the Missouri Midwives Association, “Missouri was one of only nine states to prohibit CPMs from practicing, and now the number drops to eight states remaining.”

The Court’s opinion summary is posted online. The ruling makes Missouri the 23rd U.S. state to allow professional midwives.

“Today’s victory over Big Medicine is a real shot in the arm to the growing campaign to legalize midwives across the nation,” said Susan Jenkins, legal counsel for the National Birth Policy Coalition and a consultant to the Missouri midwives. “This case confirms the message that’s been reverberating loud and clear in both the mainstream media and the blogosphere ever since the American Medical Association launched its attacks against midwives and home birth last week—physicians do not have the right to speak for patients when it comes to deciding who delivers their babies. Missouri families now have legal access to CPMs, who provide high-quality, cost-effective care and fill significant gaps in the state health care system.”

Across the nation, many have stepped up to help in a case that has been likened to a David-and-Goliath battle, with midwives supporters hosting bake sales and garage sales to stand up to the enormously well-financed Missouri State Medical Association, an affiliate organization of the AMA. In February, an amicus curiae (friend of the court) brief was submitted by:
Citizens for Midwifery (CfM)
Midwives Alliance of North America (MANA)
National Association of Certified Professional Midwives (NACPM)
Our Bodies OurselvesThe National Birth Policy Coalition (NBPC)

The amicus brief submitted by the coalition urged the Court to reverse the injunction against the midwives law and made the case that increasing access to trained and qualified CPMs and out-of-hospital birth is beneficial to Missouri citizens.

The new Missouri Midwifery law was supposed to take effect Aug. 28, 2007, but the Missouri State Medical Association (MSMA) organized a well-financed challenge to the new law and was granted a temporary restraining order on July 3. Then on Aug. 8, Circuit Court Judge Patricia Joyce, who serves on the Board of Directors for St. Mary’s Health Center in Jefferson City, disallowed the Certified Professional Midwives provision contained within HB818 regarding portability and accessibility of health insurance.

Judge Joyce ruled the provision was unconstitutional and unrelated to health insurance, despite hearing from Assistant Attorney General John K. McManus and Midwifery Coalition attorney Jim Deutsch that decriminalizing midwifery does indeed relate to health insurance as they recalled that the Missouri Supreme Court has already ruled health insurance is interdependent on health services, and the two subjects are related.

During the Circuit Court appeal to Judge Joyce on Aug. 2, Deutsch cited nine other states where Medicaid covers home births attended by Certified Professional Midwives and many others where CPMs receive private insurance reimbursement. Both McManus and Deutsch argued that families obviously cannot get health insurance reimbursement for their midwives if their providers are considered felons by the state. They agreed that legalizing Certified Professional Midwives is a first step to home birth families being able to have their maternity care providers covered by insurance. They also cited the lower cost of midwifery care, which in turn could encourage insurance companies to lower their rates for healthy women.

Midwives Supporters Seek Donations to Help Pay Legal Fees
To help pay for the legal fees incurred over the past year, families across Missouri have undertaken fundraising efforts, including bake sales, garage sales, and other community fundraising events. “Through our own efforts, we have steadily chipped away at our legal bills, but we still need help,” said Laurel Smith, President of Friends of Missouri Midwives. Smith added that donations to help pay the legal fees of the coalition of midwives and their supporters can be made at http://www.freethemidwives.org/.

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

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

Friends of Missouri Midwives http://www.friendsofmomidwives.org/
Missouri Midwives Association http://www.missourimidwivesassociation.org/
Show-Me Freedom in Healthcare http://www.showmefreedompac.org/
Free the Midwives http://www.freethemidwives.org/
The Big Push for Midwives http://www.thebigpushformidwives.org/

NOTE: The Missouri Supreme Court’s ruling today legalizes Certified Professional Midwives and how they practice within their scope of practice for pregnant women, and has nothing to do with abortion, c-sections, or epidurals.

The Midwifery Amendment 376.1753. Notwithstanding any law to the contrary, any person who holds current ministerial or tocological * certification by an organization accredited by the National Organization for Competency Assurance (NOCA) may provide services as defined in 42 U.S.C. 1396 r-6(b)(4)(E)(ii)(I).

** * Tocology is the science of midwifery or obstetrics. The National Organization for Competency Assurance (NOCA) certifies more than 160 credentials, most of which are in the medical field. The Certified Professional Midwife (CPM) and Certified Nurse Midwife (CNM) are the only tocological certifications under NOCA. CNMs are already allowed to practice under their own statute. There are no ministers certified by NOCA. Therefore, the CPM is the only credential affected by this language.

** This portion of the US Code says “services related to pregnancy (including prenatal, delivery, and post partum services).”

Missouri Wins!!

The Missouri Supreme Court ruled today in favor of Missouri families by rejecting the case of the Missouri State Medical Association, et al. over language that was signed into law last year to legalize certified professional midwives in Missouri. The ruling was based on the fact that the MSMA et al did not have "standing" in the case - which means they have no true legal interest in the case as the only possible effect for them would be economic. Our lawyers made a terrific case on that!

You can see the opinon and summary here - http://www.courts.mo.gov/Courts/PubOpinions.nsf/0f87ea4ac0ad4c0186256405005d3b8e/f291298ad8cf21978625747100797615?OpenDocument The plantiffs have 10 days to request a rehearing. We've been told is it very rare for the SC to agree to rehear a case, but the decision won't be "final" until that's over. So keep praying.

If you'd like to help, the Missouri organizations and families who joined the case have $32,000 in legal fees still to pay. You can make donations of any size at freethemidwives.org.

The result of today's decision is that certified professional midwives are now legal in Missouri!