Florida Friends of Midwives

Florida Celebrates National and State Midwives Week this October

2011-09-27T08:35:00.002-04:00

Florida Friends of Midwives is proud to join the American College of Nurse Midwives, the Midwives Association of Florida, and communities statewide in celebrating National Midwifery Week and Florida Licensed Midwives Week during the first week in October.

Midwifery Week is a chance for midwives and the women they serve to reflect on their experiences and midwifery's contributions to women's health care, including attending births and providing well-woman care. Throughout Florida, regional groups of Florida Friends of Midwives are celebrating with awareness events, social gatherings and local Mayor's proclamations.

One such proclamation will be read at the Sarasota City Commission meeting October 3rd. “Midwives make a strong contribution to the health and well-being of mothers and babies through proper care and treatment in all phases of childbirth," says Sarasota Mayor Suzanne Atwell. “I look forward to welcoming all those involved in this important effort.”

Midwives have a long and valued history in Florida. The state first passed legislation to license direct-entry midwives in 1931, and the first Certified Nurse Midwife was licensed in Florida in 1970. Florida’s midwives have continued to tirelessly serve the families of Florida and to ensure the continued availability of safe, evidence-based birthing options for Florida’s families.

Florida Friends of Midwives celebrates midwives in Florida and throughout the world during this special week. For more information about midwifery in Florida, please visit flmidwifery.org.

ABOUT FLORIDA FRIENDS OF MIDWIVES (FFOM): Florida Friends of Midwives (FFOM) is a nonprofit grassroots organization dedicated to promoting the Midwives Model of Care and supporting the practice of midwifery in Florida. Florida Friends of Midwives was formed to support midwives who offer safe, cost-effective, evidence based care to Florida's Families. FFOM members are consumers and birth advocates committed to organizing the community to support midwives and to assure the continued availability of midwifery care in the State of Florida. For more information, please visit flmidwifery.org.

SPOTLIGHT: Samantha McCormick of Baby Love Birth Center

2011-04-15T12:27:00.005-04:00

Midwifery is about education and empowerment to me. Sadly, far too many women blindly follow whatever their OB/GYN tells them to do. Facebook and other online resources have significantly increased the opportunities for people to learn about alternatives to "traditional" care, but the responsibility still rests on the individual to choose to educate themselves. Popular media, movies, and TV shows continue to show birth as scary and horribly painful which serves to reinforce misconceptions about birth. It prevents many people from believing how empowering and peaceful birth can be for a prepared and educated woman. Skepticism and fear still prevent many people from considering natural childbirth.

It seems to me that interest in out-of-hospital birth is increasing, and I think the internet has a huge role in that. The old adages "a picture is worth a thousand words" and "seeing is believing" are totally true. Before the ease of viewing videos on YouTube and Facebook or Netflix, one might have read books about natural birth, but there were few options to watch a natural birth. Now anyone can find literally thousands of examples of peaceful natural births - these videos can serve to counter the negative fear-based birth images on TV and in movies.

Ricki Lake's the Business of Being Born has played a huge role in opening people's eyes to alternatives from using an OBGYN and giving birth in the hospital. We often hear from new clients that watching that film helped convince them to come to the birth center.

When a woman chooses an out-of-hospital birth, many times her friends and family are skeptical and concerned for her and the baby's safety. Showing concerned friends and families videos can often overcome their skepticism.

I have been practicing for 15 years. When I first started in a Birth Center in New Jersey, it was pretty much unheard of for the client's mom to have had a natural or out-of-hospital birth. In the past 5 years, we hear more and more that a new client's motivation was that her mom had a natural birth or wished that she had. We lost a whole generation of experience with natural childbirth when birth moved into the hospital in earnest in the 1950's.

The "hippie" movement of the late 1960's and 70's created a call for alternatives. I think we all owe pioneers Ina May Gaskin and Barbara Harper a huge debt of gratitude for rescuing the natural birth movement. They (and others I do not mean to overlook) not only learned and practiced midwifery, but they wrote about it and publicized it. For the longest time, the best way we could show natural birth was Barbara Harper's Gentle Birth Choices film. Ina May also filmed births and promoted her safe techniques for resolving shoulder dystocia, tight cord around baby's neck and breech birth, neatly countering the common concern "but what if something goes wrong?"

I also credit Michel Odent with bringing waterbirth to the US. Although water labor/birth is not for everyone, in my experience water in some form (shower/tub) makes natural birth achievable. He also promoted the idea that attendants and family should leave the mom undisturbed, following up on the work of Lamaze and Dick-Read that fear and tension increase pain.

I see midwifery care and out-of-hospital birth increasing in popularity, especially when this generation of moms’ children grow up and have kids of their own. Although there will always be those who claim out-of-hospital birth is dangerous and impossible, the proof is right there on the internet of how wrong they are.

www.waterbirthbaby.com

Building Community: Footsteps for New Moms

2011-03-19T17:05:00.006-04:00

During pregnancy and following the birth of a baby, a wide range of emotions are possible. Often there are the expected feelings of excitement and joy, along with feelings of anxiety and worry. Mothers may also feel overwhelmed, uncertain, and frustrated. Being pregnant can be difficult and caring for a newborn is challenging. Regardless of how prepared a woman is or how much she looked forward to her pregnancy and her baby's birth, the perinatal period may include some unexpected "highs" and "lows."

Footsteps for New Moms is a monthly support group sponsored by BirthGirlz, which is offered the second Monday of the month at their Design District Office. The group is facilitated by a trained therapist and operates under a peer support model.

Persistent depression during the perinatal period can have devastating consequences, not only for the women experiencing it but also for the baby, other children and family. Peer support can be a very effective form of treatment for perinatal mood disorders and can serve as the main form of support for mild cases and in combination with therapy, medication or other modalities for severe cases.

Symptoms of postpartum depression

Changes in sleep patterns, either being unable to sleep or sleeping too much.
Fatigue or lack of energy.
Changes in appetite, either eating too little or too much.
Feeling hopeless, a loss of control or great sadness.
Crying for no reason.
Having no feelings or too much concern for the baby.
Irritability or outbursts of anger.
Feeling little interest in daily activities.
Feelings of guilt.
Anxiety or panic attacks.
Difficulty making decisions.
Suicidal thoughts.
Scary and repetitive thoughts about the safety of the baby

If you or anyone you know has the above symptoms, please encourage them to join the group and benefit from the opportunity to meet with other local women who are dealing with or have recovered from postpartum reactions and mood issues, including depression, anxiety, post traumatic stress (birth trauma) and baby blues. For additional information contact Michelle Fonte of BirthGirlz at 786-704-8328.

CPM Bill Introduced: A Milestone for Mothers and Midwives!

2011-03-19T16:53:00.003-04:00

Join the Celebration for HR 1054!

The MAMA Campaign is thrilled to announce that Congresswoman Chellie Pingree (D-ME-1) has introduced HR 1054, the "Access to Certified Professional Midwives Act of 2011" in the U.S. House of Representatives.

"I believe it's important that women are able to have the birth experience they want, regardless of where they live and how much money they make. That is why it's impo
rtant that women with Medicaid coverage have the same access to high quality, safe, and cost-effective services," Congresswoman Pingree said. The Congresswoman is known in Maine and Washington, DC as a sensitive, independent voice for social and health issues that affect families everywhere.

The Midwives and Mothers in Action (MAMA) Campaign expresses sincerest appreciation to Congresswoman Pingree and celebrates this milestone in the history of direct-entry midwifery in the United States. MAMA is also deeply grateful to Rep. Gwen Moore (D-WI-4) and Rep. Jim McDermott (D-WA-7) for their support and leadership in co-sponsoring HR 1054 with Representative Pingree.

Increasing women's access to the care of CPMs will support better outcomes for mothers and babies, reduced disparities in outcomes for vulnerable populations, and provide significant cost savings for Medicaid and the health care system. We are most grateful to Representative Pingree for her vision and support for childbearing women and their families.

This is Your Milestone!
Your support, your letters to members of Congress, meetings with your legislators in Washington, DC and in-district, and all of the dollars that you have contributed to this cause have made possible the introduction of HR 1054. You should be proud of yourselves - the MAMA Campaign Steering Committee thanks you!

Now the Work Begins....
MAMA will be counting on our energy and involvement in the coming weeks and months as this train gains steam and we forge ahead to garner the support of Congress for enacting HR 1054 into law. Read more here.

Keep MAMA Going in 2011!
Help Keep MAMA Going in 2011! Florida Friends of Midwives as an organization has made contributions to the MAMA Campaign on behalf of Florida's Mothers and babies. But MAMA still needs our help! MAMA now needs the support of our grassroots - mothers and fathers, grandparents, midwives, doulas, and other advocates - to keep the momentum going. Please celebrate with MAMA - show Congress you care, too - by making your contribution today. MAMA will put your dollars to work, making a difference for mothers and babies! Together we can move mountains!

We're in need of new Board Members!

2011-03-19T16:42:00.002-04:00

We can't believe it either, but it's been more than three years since Florida Friends of Midwives (FFOM) was resurrected. As we move forward with FFOM and begin to craft a future for the group, a crucial step is ensuring we have a full and functioning Board of Directors whose job it will be to guide and shape the organization in the years to come.

First and foremost FFOM is an organization of consumers. We're in need of three new board members, and are seeking board members whose experience and involvement in the birth community has given them the skills and knowledge to play a central role in the important work of FFOM. Members of the board of directors should represent the interests of the membership of FFOM in furtherance of its mission.

Right now we are looking for three industrious and daring women to accept the following positions:

Legislative Committee Chair
Fundraising Committee Chair
Membership Committee Chair

What do these positions do?

The Legislative Committee Chair gathers and facilitates the flow of information relating to legislation that affects access to midwifery in Florida, and brings those issues to the board and membership for discussion and possible action.
The Fundraising Committee Chair serves as a resource to our members and Regional Groups on fundraising techniques and programs and manages our annual fundraising campaign.
The Membership Chair is responsible for the maintenance of a current membership database, renewal of memberships, collection of dues, and initiatives to encourage new membership.

Our Board of Directors meets monthly by phone and twice annually in person.

If you know someone you would recommend or you wish to be considered as a candidate for the Board of Directors, please email us at info@flmidwifery.org.

Legislative Update - Capital Testimony

2011-03-19T13:05:00.004-04:00

The following is a testimony that was presented jointly by Midwives Association of Florida and Florida Association of Birth Centers last week to the Health Care Appropriations Subcommittee. FFOM endorses this testimony and encourages your support of these allied organizations.

Good Afternoon Chairman Hudson and Members,

In this tough budget year I am glad to have the opportunity to share with you a good investment. Birth Centers are an investment that has a high PE (price per earnings) ratio. - A licensed midwife and a birth center is the perfect combination for a healthy birth outcome. The State of Florida in its wisdom has recognized the need to utilize prenatal funds more efficiently and to increase the limited availability of care providers. Families view midwifery services in a birth center as a quality, cost-effective alternative to traditional physician hospital births.

The Florida Health Finder lists over 20 free standing birth centers that are located th

roughout the state. As you are aware prenatal providers in some counties are scare.

Presently a birth center is reimbursed by Medicaid an average of $2,000 per birth. A hospital birth would cost more than double the cost. At this time Medicaid pays for 10 prenatal visits. Birth Centers promote optimum care – they encourage the pregnant woman to start prenatal care at 10 weeks and goes to 42 weeks of pregnancy. That is a total of 16 visits.

Did you know that Birth center service also offer additional free services to their clients and at no cost to the taxpayer?

Initial and ongoing diet evaluation and nutrition guidance. We know how important it is for the pregnant mother to be healthy during her pregnancy.
They offer exercise for pregnancy, birth and postpartum -a birth center offers. This could lower the incidence of post-partum depression.
Child Birth Classes – not only do they educate the pregnant mother what to expect during her pregnancy. Provide awareness to parents to put their baby to sleep on their back to reduce SIDS.
Parenting and infant care classes
Baby Safety Education.
Breastfeeding support – research shows breastfeeding reduces infant illness; babies are healthier, which saves the Medicaid dollars in visits to the physician.
Breastfeeding also has long-term health benefits:
Reduced incidence of diabetes, heart disease, childhood obesity……

And last but not least – importance of family planning and baby spacing.

All of this for $2,000.

Most birth centers use a formula of 1/3 Medicaid, 1/3 self paid and 1/3 private health insurance. Some birth centers have 50% or more Medicaid patients. A proposed 20% reduction of an average of $400.00 per patient would cripple the fiscal health of a birth center. Many would be forced not to see Medicaid patients in order to keep their door open.

We are aware of the budget climate and I hope this information will be valuable you continue to craft the budget. Let us know a good investment when we see one!

Thank you for listening and your dedication to our state and our soon to be born citizens.

TIPS: How to Contact Elected Officials

2011-03-19T11:55:00.003-04:00

As we find ourselves in the Spring 2011 Legislative Session, it is a critically important time to contact our elected officials and make our voices for midwives heard. The following will give you some ideas on how to best get your message across to legislators during this busy time.

GETTING STARTED

Identify your legislators and learn about their background, affiliations and voting record. These websites will help get you started, and our FFOM Legislative Committee can help you find more information.

State House of Representatives: http://www.myfloridahouse.gov
Florida State Senate: http://www.flsenate.gov

Schedule a meeting with your legislators. Most legislators spend the majority of time in their home districts, as the legislative session is quite short. Take advantage of the opportunity to meet with your representative or senator between sessions to foster a relationship and introduce the concerns of FFOM to him/her.

When meeting with your elected officials, bear in mind that a brief visit is all that is necessary as follow-up phone calls and letter will enhance the impact of your meeting. During your meeting, keep the following in mind:

Introduce yourself – as a constituent. Thank the legislator for taking the time to meet with you. Identify yourself as a member of FFOM and share a little about our mission and the people we serve (keep it brief).
State your purpose. If appropriate, be clear about what legislation you are supporting or opposing. Mention it by bill number and topic. Focus on one topic per meeting. Let the legislator know your position and why you are asking her/him to vote for that position.
Let the legislator and her/his staff members know that you FFOM have information and expertise. Let them know we can be a resource to them on midwifery related issues.
Give them a chance to talk about their perspective on your issue.
Ask for their vote and try to get a commitment at the meeting.
Let them know you plan to stay in touch.

Remember: KEEP IT BRIEF. At most, you can expect 30 minutes of their time. During session or other busy seasons, a 10 minute conversation will be the average. Follow up with a thank you letter right away.

LETTER WRITING TIPS

Writing letters, particularly after an in-person visit, help to keep midwifery issues and related legislation on the table with your representatives. The more often they hear and see information from FFOM about our concerns, the more important the issue will seem. Here are some hints to make your letters well received:

1. Use the correct address and salutation (i.e., Dear Senator name, or Dear Representative name, or Dear Governor name). While the legislature is in session, send letters to Senate or House offices. Between sessions, use the local office in your area.

2. Describe the bill by popular name and by House or Senate file number, or clearly describe the issue.

3. Be brief and clear. Write about one issue per letter, and state the issue and how you want your elected official to vote in your first sentence. Letters should be no longer than one page, however longer letters may be appreciated if you have some new information on the subject.

4. Be specific. If possible, give an example of how the issue affects your district.

5. Be timely. Make sure your legislator will have sufficient time to consider your request.

6. Know your facts. Inaccurate or misleading information will hurt your credibility.

7. Be polite in your requests for support or opposition. Never express anger, make demands, or threaten defeat at the next election. You will want to have future contact with the legislator.

8. Use your own words and stationary rather than form letters or postcards. In addition, write legibly or type – your letter could be discarded if it is not easy to read.

9. Be constructive. Explain an alternative or better solution to the problem and offer to be a resource on the issue.

10. Send a note of appreciation when your elected official supports your issue. When he or she does not support your issue, explain why you think a different decision should have been made. It might make a difference the next time.

PHONE CALLING TIPS

Phone calls can be used to follow-up on letters and meetings, but are often best used for immediate action requests, just prior to votes or new legislative activity. Multiple calls from multiple constituents just prior to a vote can help impress upon the legislator how important this issue is to the people s/he represents. Below are some guidelines for phone calls:

1. State your name, address and indicate that you are a constituent.

2. Give the name and House or Senate File number of the legislation, or clearly explain the issue.

3. State whether you oppose or support the legislation and how you want your legislator to vote. Include a statement on how the issue affects you personally.

4. You will usually be speaking with a secretary or aide who is checking pro or con and the call will last a very short time. Keep the phone call under five minutes unless the aide or legislator prolongs the conversation.

5. Listen to the legislator’s point of view.

6. Take down the name of the aide with whom you spoke so that you will have a contact person in case you need to contact the legislator again.

7. Thank them for their time, both on the telephone and with a note of thanks for the conversation that includes a concise summary of your opinion.

8. Do not call too often and risk becoming a nuisance.

9. Do not lie or try to talk your way around questions to which you do not know the answers. Say that you will get back to the legislator or aide, and then do so.

EMAILING TIPS

Email remains a controversial method of contacting your senators and representatives. Though it seems like a quick and easy way of getting your message to many officials, the use of email generators and other programs have made some offices less likely to respond to email. If you do choose to email your legislators, follow the guidelines under letter writing, and be sure to reference your address and that you are a constituent at the very beginning of your email. Those offices that filter emails often do so based on whether or not the author is a constituent.

Ultimately, FFOM recommends that you use email judiciously, relying more on the “old school” forms of communication to build the relationships that will be critical to forwarding the FFOM agenda in the coming years.

KEEP US POSTED!

Finally, please let us know when you have contacted someone so that our team can follow up with them. Our organization represents many constituents from all over the state and some parts of the country. The more we contact different officials, the more likely we are to find representatives that are willing to lend an ear, or better yet, champion a cause.

Homebirth Summit Seeks to Build Consensus

2011-01-22T07:30:00.003-05:00

Fewer than 1% of families in the United States choose planned home birth, yet the subject of birthing at home has been the subject of intense and polarizing debate. Elsewhere in the world (e.g., Canada and the United Kingdom), the majority of babies are delivered by midwives and collaborative efforts across professions seek to expand access to integrated home birth services. Last month, the Transforming Birth Foundation awarded a grant to the American College of Nurse Midwives intended to underwrite a U.S. Home Birth Consensus Summit.

Already three years in the making this much anticipated meeting will be facilitated by the Future Search Network, a nonprofit organization that is internationally known for brokering lasting agreements and shared initiatives in highly volatile and polarized settings, around issues related to poverty, health care access, regional and ethnic conflict, and education.

The Home Birth Consensus Summit will be a two- to three-day multidisciplinary summit with the goal of developing areas of consensus on the provision of home birth services in the United States. Invited participants will include representatives from a variety of stakeholder sectors in positions to inform and influence a change process, and/or commit to measurable steps, including consumers and consumer advocates, home birth midwives, maternal/child health collaborating providers (including pediatrics and nursing), obstetricians (including at least one family practice obstetrician and one resident), hospital systems and administration, health plans and liability insurers, health policymakers, legislators and regulators, and public health, epidemiology, and research professionals.

The successful grant proposal was submitted under the leadership of ACNM Home Birth Section Chair Saraswathi Vedam, RM, CNM, MSN, Sci D (h.c.), Associate Professor and Director, Division of Midwifery, University of British Columbia. Joining ACNM as co-applicants of the grant were Midwives Alliance of North America (MANA), American College of Obstetricians and Gynecologists (ACOG), American Pediatric Association (APA), National Association of Certified Professional Midwives (NACPM), International Center for Traditional Childbearing (ICTC), Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), Lamaze, and American Association of Birth Centers (AABC).

According to a statement from the American College of Nurse-Midwives, “Invited participants will include representatives from a variety of stakeholder sectors in positions to inform and influence a change process, and/or commit to measurable steps, including consumers and consumer advocates, home birth midwives, maternal/child health collaborating providers (including pediatrics and nursing), obstetricians (including at least one family practice obstetrician and one resident), hospital systems and administration, health plans and liability insurers, health policymakers, legislators and regulators, and public health, epidemiology, and research professionals.”

ACNM will provide additional information about the Home Birth Consensus Summit when the dates are established as well as following the meeting. For details visit their website www.midwife.org

Afghanistan Midwives on NPR

2010-10-27T21:26:00.003-04:00

by Jim Wildman

Midwife Farangis Sultani tells the story of a woman who was in a great deal of pain last winter. The woman was in labor — and her family had brought her to the Shatak village clinic after a three-hour walk on the back of a donkey.

Farangis delivered the woman's baby, but quickly determined there was a twin baby still inside the womb. "It was horizontal," she says. "If she delivered a baby that was horizontal, she was going to die."

The young midwife did what she could — and "with God's hand" — the second baby was born successfully. Mother and twin children were healthy — defying the statistics in Afghanistan's Badakhshan Province, where pregnant mothers and newborns die too often because villagers live too far from health care.

"These women are like guardian angels for infants and mothers," says Zafaran Natiqi, head of women's affairs in Badakhshan.

It's a career path that has the backing of elders in the province, even though Afghanistan's culture doesn't normally allow young and married women to work outside the home. Village councils actually vote to select the midwife candidates from their own community.

"I come from a very religious family," says Mawlawi Zabihulla Atiq, the leader of the provincial council. "I realize this is a necessity. It's how we can protect our pregnant women and daughters."

Farangis Sultani has recorded each delivery she's performed in a giant log book. She points an entry that describes what happened last winter:

When I helped that woman, I felt proud. It's an honor for me, for the people who trained me, and for my family.

Jim Wildman is a senior producer of Morning Edition, traveling with NPR's Renee Montagne on her reporting trip to Afghanistan.

FFOM Position Against AHCA 59-A

2010-10-19T00:41:00.006-04:00

Florida Friends of Midwives believes that a woman has a right to choose her birth attendant and her place of birth. It has come to our attention that the Agency for Health Care Administration (AHCA) is currently seeking to amend the rules that govern the operation of birth centers in Florida. The proposed rule changes, should they be adopted, will restrict a woman's access to out-of-hospital birth for conditions that are widely accepted by the CDC and other regulatory bodies to be safe and normal factors not worthy of high risk status.

This past March, AHCA held an administrative hearing to review proposed birth center rule changes. Prior to that hearing our understanding was that any changes would serve the purpose of bringing birth center rules into greater symmetry with the rule that govern the practice of licensed midwifery. It was also our understanding that interested parties including state midwifery professional organizations and consumer advocacy groups would be kept apprised of further meetings and decision-making regarding this issue. Unfortunately it is now clear that there have been several meetings held in the last several months and additional language was been incorporated into the proposed rule changes based in large part from internal suggestions by the Board of Nursing. These proposed changes include: eradicating the option for vaginal birth after cesarean (VBAC) in birth centers; increasing mandatory prenatal testing without recourse; limiting access for any woman who has ever tested positive for Group Beta Streptococcus bacteria; removing the ability for licensed midwives in birth center settings to administer lidocaine; eliminating informed consent for multiparous women; and finally, restricting care providers including licensed midwives, certified nurse midwives, family practitioners or obstetricians, from practicing as they would in a hospital or out of hospital setting, including conducting physicals, evaluating risk score criteria or other limitations that bind them beyond their own practice regulations.

These changes were proposed in a way that does not follow the accepted and appropriate method for amending rules as per Florida's Sunshine law. It also effectively keeps the licensed midwives, certified nurse-midwives and obstetricians who own birth centers out of the process, as well as the women and families who utilize their services.

Please visit our website at www.flmidwifery.org for additional information including a copy of the most recent proposed rule changes and a template letter for contacting AHCA staff. Right now it is essential that consumers make our voices heard. Should this rule change be accepted, as many as one half of the women who currently choose to give birth in Florida's birth centers will be unable to do so legally.

Letter to ACOG President Dr. Richard Waldman

2010-09-29T21:48:00.004-04:00

Florida Friends of Midwives has added our organization's name to a list of endorsers to the following letter from the Coalition for Improving Maternity Services. We encourage all who are in support of this letter to endorse it here.

Richard N. Waldman, MD

American College of Obstetricians and Gynecologists

PO Box 96920

Washington, DC 20090-6920

Dear Dr. Waldman:

The Coalition for Improving Maternity Services (CIMS) supports the March 2010 National Institutes of Health (NIH) Consensus Statement on VBAC (vaginal birth after cesarean) and welcomes the American College of Obstetricians and Gynecologists' (ACOG) revised guidelines, Vaginal Birth After Previous Cesarean Delivery (August 2010) aimed at providing women increased access to VBAC and clearly emphasizing women's autonomy and their right to make informed decisions about how they choose to give birth. However, CIMS is concerned that ACOG's unrevised recommendation that trial of labor after cesarean (TOLAC) should take place in hospitals where resources for emergency cesarean are "immediately available" will continue to deter providers and hospitals from supporting this option.

The NIH found that this "immediately available" recommendation was based on consensus and expert opinion rather than strong support from high-quality evidence. The NIH also reported that this recommendation has influenced about one-third of hospitals and one-half of physicians to no longer provide care for women who want a VBAC. All women in labor face unpredictable risks that may require an emergency cesarean, not just women laboring for a VBAC. This recommendation selectively applies a higher standard of safety for women who choose a trial of labor.

CIMS urges ACOG to reassess this specific guideline and remove the current barrier to women's access to VBAC.

In addition to respecting women's autonomy, the current guidelines emphasize the need for physicians to discuss the benefits and risks of both trial of labor and elective repeat cesarean early on in the pregnancy. This is a recommendation that CIMS strongly supports. The NIH identified the importance of evidence-based processes that incorporate women's values and preferences to help women with a previous cesarean make informed choices about mode of birth. Similarly, a key recommendation identified in the multi-stakeholder consensus report, Blueprint for Action: Steps Toward a High-Quality, High-Value, Maternity Care System is expanding the opportunities and capacity for a shared decision-making process and developing tools and resources to facilitate informed choices in maternity care.

In the light of these recommendations, CIMS urges ACOG to revise its patient education publications and on-line consumer resources to include comprehensive information on the benefits and risks of cesarean section and VBAC.

CIMS, whose mission is to promote the Mother-Friendly Childbirth Initiative, an evidence-based wellness model of maternity care that will improve outcomes and reduce costs, urges ACOG to reconsider the "immediately available" recommendation and update its decision-making consumer resources. We believe that ACOG can make an even greater impact on increasing VBAC, reducing cesareans, and ultimately avoiding unnecessary harms to mothers and infants.

Sincerely,

Michelle Kendell, MBA, AAHCC

Chair, Coalition for Improving Maternity Services (CIMS)

On behalf of CIMS and the following organizational members of the Coalition for Improving Maternity Services (CIMS)

Co-Signed By:

Academy of Certified Birth Educators

American Association of Birth Centers

American College of Nurse-Midwives

The Big Push for Midwives

Birth Matters Virginia

Birth Network National

Birth Network of Santa Cruz

Choices in Childbirth

DONA International

International Childbirth Education Association (ICEA)

Lamaze International

Midwives Alliance of North America

North American Registry of Midwives

Our Bodies Ourselves

Perinatal Education Associates

Tatia Oden French Memorial Foundation

toLabor: The Organization of Labor Assistants for Birth Options and Resources

Where's My Midwife?

City of Sarasota, State of Florida Proclaim October 4-8 Licensed Midwives Week

2010-09-29T10:21:00.001-04:00

At next week’s City Commission meeting (Monday, October 4, 6:00pm), Sarasota Mayor Kelly Kirschner will proclaim October 4th through 8th as Sarasota Licensed Midwives Week. Mayor Kirschner’s recognition will pay tribute to the skilled, individualized care that Sarasota’s licensed midwives offer women and their families throughout the childbearing cycle. It will signify the strong contribution licensed midwives make to the health and well-being of our community's mothers and babies through appropriate care and treatment in all phases of childbirth.

The week has also been proclaimed Florida Licensed Midwives Week by the office of Florida Governor Charlie Crist, coinciding with National Midwifery Week, a time to recognize the contributions of Certified Nurse Midwives (CNMs), Certified Midwives (CMs) and Certified Professional Midwives (CPMs) nationwide. The American College of Nurse Midwives (ACNM) publicly announces the week with an introduction to midwifery. "The heart of midwifery care for women and newborns lies more in the nature of that care than in its specific components. Midwifery practice has a firm foundation in the critical thought process and is focused on the prevention of disease and the promotion of health, taking the best from the disciplines of midwifery, nursing, public health and medicine to provide safe, holistic care."

HISTORY OF MIDWIFERY IN FLORIDA: Midwives have a long and valued history in Florida. The state first passed legislation to license direct-entry midwives in 1931. In the 79 years since, Florida’s licensed midwives have continued to tirelessly serve the families of Florida and to ensure the continued availability of safe, evidence-based birthing options for Florida’s families. In 1992, Governor Lawton Chiles declared the first-ever Licensed Midwives Week. More women than ever before are seeking out licensed midwives for maternity care.

ABOUT MIDWIFERY IN FLORIDA: In Florida, two types of midwives are allowed to practice: Certified Nurse-Midwives and Licensed Midwives (a Florida state licensure), also known as direct-entry midwives. Throughout the state, about 11.2 percent of births are estimated to be managed by midwives, rather than by OB-GYNs. Many birth centers and midwives have reported a significant increase in business in the past year. This increase is believed to be a result of various factors, primarily a greater number of women seeking alternative birthing choices due to an unhealthy increase in caesarean sections and other unnecessary interventions that frequently occur in hospital settings. In a 2006 report on Florida Licensed Midwives, midwives had a caesarean section rate of 6.3 percent compared to a 36.64 percent statewide average in hospitals the same year.

In honor of this week, Florida Friends of Midwives (FFOM), a non-profit grassroots organization dedicated to promoting and supporting the practice of midwifery in Florida, will be hosting various community events throughout the state this week and during October to celebrate the more than 110 currently practicing licensed midwives. For more information of midwifery in Florida, please visit www.flmidwifery.org.

“We are humbled by the dedication of the mothers who worked so hard to have this week declared licensed midwifery week,” says licensed midwife Miriam Pearson-Martinez. “We hope that the events happening all over the state this week serve to raise awareness regarding the benefits of midwifery care.”

The proclamation in Sarasota will be read by Mayor Kirschner at the beginning of the City Commission meeting, Monday, October 4th, at 6:00 pm in Sarasota’s City Hall. Florida Friends of Midwives encourages all families who have benefited from the care of licensed midwives to attend this special recognition.

About Florida Friends of Midwives: Florida Friends of Midwives is a non-profit grassroots organization dedicated to promoting the Midwives Model of Care and supporting the practice of midwifery in Florida. Florida Friends of Midwives was formed to support midwives who offer safe, cost-effective, evidence based care to Florida's families. For more information, please visit www.flmidwifery.org.

SPOTLIGHT: Commonsense Childbirth School of Midwifery

2010-08-30T22:31:00.004-04:00

Commonsense Childbirth School of Midwifery (CCSM) was established in January 2009 to provide education and training in the art of out-of-hospital birth to individuals seeking to become Florida Licensed Midwives. Our goal at CCSM is to educate andprepare students to become skilled, caring midwives to serve women and families in their communities.“I am excited to be able to direct a midwifery school (for the second time) and look forward to bringing a unique approach to midwifery education,” said owner and Executive Director Jennie Joseph, LM, CPM. “My focus will be on the clinical aspects of midwifery training and I will apply my international and individual experiences to a very strong and clinically sound format.”

A British trained midwife, Jennie Joseph comes from the European perspective where midwifery is a trusted, respected and necessary profession. When she emigrated to Florida,Jennie encountered American professional, racial, ethnic and gender prejudice. Motivated to make a change in her adopted community, she started the Hand-In-Hand Women and Family Support Services, providing private, group and volunteer childbirth education, breastfeeding counseling and doula/labor support services.

As a Florida Licensed Midwife, Jennie opened The Birth Place, a full-service midwifery clinic with home and birth center delivery including waterbirth. She served as Director for the School of Complementary Medicine’s Midwifery Program in Oviedo and became active in a number of community organizations such as ICTC, the Florida Black Women's Health Organizations, the March of Dimes "Sisters/Companeras" Program, and founded Commonsense Childbirth Inc. a Florida non-profit corporation dedicated to providing prenatal, birth and postpartum services to indigent teens and women who might otherwise not receive care.

In 2003 Jennie developed The JJ Way™ a unique MCH model of care to address the difficulties and inequities in health care service and delivery which have negatively impacted perinatal health outcomes, especially for minorities. The model consists of clinical, outreach and training components. The Easy Access Clinic model, replicated in several communities, uses The JJ Way® Model of Maternity Care to help close the gap in Black infant health disparities. Astudy in 2007 of birth outcomes for The JJ Way® program serving at-risk minority women showed NO low birth weight or premature babies among African American or Hispanic patients at The Birth Place.

“I am fighting for access, connections, knowledge and empowerment within our communities,” explains Jennie, “truly 'getting to the heart of the matter' because we believe in A midwife for EVERY mother.”

Jennie has published a photo journal “Beautiful! Pregnancy Perfected The JJ Way” which depicts the impact of her maternal child healthcare system on positive pregnancy outcomes. A portion of proceeds from the sale of this book goes to support Commonsense Childbirth.

A much sought-after speaker, in any given week Jennie may be found advocating for maternal and child health in a variety of venues: in Washington, DC speaking to a congressional committee, being recognized at the Tribeca Film Festival in Manhattan, presenting her model at a national conference, and still running her full-service midwifery practice, teaching and precepting her CCSM students. Most recently the Foundation for the Advancement of Midwifery awarded a 2010 technical assistance grant to Commonsense Childbirth, providing consultation in the areas of finance, fundraising, and strategic planning.

In all her works, Jennie seeks to create excellence. CCSM is committed to providing the finest educational program throughout the national and international direct-entry midwiferycommunity for individuals with a desire to provide a high standard of care for childbearing women and their families. The student is taught to differentiate between low-risk and high-risk pregnancies, work within midwifery legal scope of practice, collaborate with other medical professionals, and to organize and operate as a professional midwife after licensing.

CCSM believes that midwives should be based in their communities where they are able toprovide culturally competent maternity care, education, guidance and social support to women and their families. Recognizing the rich cultural diversity in Florida and the increasingly diverse populations in our communities, CCSM seeks to recruit a student population that is culturally and ethnically reflective of our communities to prepare students to provide effective midwifery services responsive to the needs of Florida consumers.

As CCSM Academic Director, Justine Clegg, LM, CPM, brings her midwifery education experience from Miami Dade College (1993-2008) and the South Florida School of Midwifery. A Florida Licensed Midwife for 24 years, she is also a Licensed Mental Health Counselor, Certified Lactation Counselor, and has served as Chair of the Council of Licensed Midwifery, on the MEAC and NACPM Board of Directors, chaired the Dade County Fetal and Infant Mortality Review team for 5 years and helped develop the NARM certification process. She is a “founding mother” and Continuing Education Coordinator for the Midwives Association of Florida (MAF). She is currently on the Board of Directors of the Association of Midwifery Educators (AME).

CCSM meets academic and clinical requirements for the North American Registry of Midwives (NARM) and the Florida midwifery practice act, F.S. 467, including the Core Competenciesof the Midwives Alliance of North America (MANA) and the American College of Nurse Midwives (ACNM). Core Competencies identify the essential knowledge base required of an entry-level midwife. The curriculum is also consistent with the Curriculum Framework developed by the Florida Department of Education and the requirements of Florida law.

Graduates will receive a Diploma from CCSM and will be eligible to sit for the North American Registry of Midwives (NARM) national certification examination. The NARM is the Florida licensing exam for the Midwifery profession. Students must pass the NARM exam and be licensed by the Council of Licensed Midwifery to work as a Midwife in the State of Florida. Upon graduation the student will have compiled a notebook of materials and practice protocols to be prepared to practice as a Florida Licensed Midwife.

The academic environment at CCSM is geared to the adult learning style. A cadre of credentialed faculty and preceptors supports a strong educational program in this fledgling school. Teaching methodologies use a variety of strategies to engage all learning levels, to develop clinical skills, critical thinking and problem solving abilities. Classes are interactive and student participation is required. Programs are varied in format. Research is facilitated and encouraged.

An education based on the art of traditional midwifery and knowledge of medical science must be strong clinically as well as academically. Students start clinical placement in their first semester. CCSM provides clinical experience concurrent with academic coursework, giving relevance to classroom material. Preceptors who work with our students include Licensed Midwives, Certified Nurse Midwives and Medical Doctors who are licensed in Florida. We believe it is important that students rotate through various types of clinical settings to learn valuable skills and be prepared for all venues of practice. Programs are designed to help students develop and refine clinical, communication and decision-making skills essential to safe, compassionate midwifery practice. It is imperative that midwives regard the dignity and rights of clients and families, communicate effectively, be able to differentiate between low-risk and high-risk maternity clients and to make arrangements for collaboration or referral.

CCSM students care about their community. Our program includes a volunteer requirement each semester. One student volunteered in Haiti after the recent earthquake. Last semester students drove to Tallahassee to participate in Midwifery Capitol Day event April 21, 2010 with Justine Clegg and MAF lobbyist Dawn Steward, to educate Florida legislators about midwifery practice.

Classes are held on Fridays in Winter Garden. Tuition for the Three-year Program is $19,320 and $5,250 for the Four month program. In addition to the three year and four monthdirect-entry midwifery education programs, CCSM offers Doula training, Childbirth Education and Lactation Counseling certification courses. CCSM is an approved CEU provider for Florida licensed midwives through CEBroker. Orientation for the next midwifery class starting in January 2011 will be announced in the fall. Email ccsmidwifery@gmail.com to be added to our mailing list.

Commonsense Childbirth School of Midwifery is owned and operated by Commonsense Childbirth, Inc, a non profit Florida corporation. The Advisory Committee consists of community leaders, midwives and other healthcare professionals interested in CCSM’s efforts to provide the finest program of study within the international midwifery community. CCSM is approved by the Florida Council of Licensed Midwifery and licensed by Florida Department of Education Commission for Independent Education. CCSM is a member of the Association of Midwifery Educators (AME) and will be seeking accreditation through the Midwifery Education Accreditation Council (MEAC).

For more information contact:

• Commonsense Childbirth School of Midwifery (CCSM)

1150 E Plant Street Suite F, Winter Garden, FL 34787

407-654-8140.

CCSMidwifery@gmail.com

Facebook Page
• NARM
• Council of Licensed Midwifery
• MEAC
• The JJ Way
• Association of Midwifery Educators
• Midwives Association of Florida

Midwives for Haiti

2010-08-29T22:14:00.001-04:00

Midwives for Haiti is a non-profit organization that was founded by Nadene Brunk, Certified Nurse Midwife. This Virginia based 501c3 organization was founded in 2004. Since its inception, Midwives for Haiti has provided Haitian women with the proper education and tools to keep women and babies safe during the birthing process.

Lack of proper prenatal care and skilled birth attendants makes Haiti the most dangerous place in the western hemisphere to have a baby. In Haiti 48 of 1,000 infants die during birth and 520 of 100,000 women die during labor. These statistics are detrimental to the social development and well-being of so many families in Haiti.

Midwives and Clinicians from all around the world come together through Midwives for Haiti and teach Haitian women proper prenatal care and teach the skill of being a proper birth attendant.

Midwives for Haiti depends on volunteers and donations to continue to help so many in that part of the western hemisphere. If you’d like to contribute in any way, please visit www.MidwivesforHaiti.org, or follow them on Facebook.

Response to the July AJOG Meta-Analysis Against Homebirth

2010-07-07T21:28:00.008-04:00

Florida Friends of Midwives supports and aligns ourselves with the efforts of The Midwives Alliance of North America (MANA) and The Big Push for Midwives. In July's American Journal of Obstetrics and Gynecology, an article denounced homebirth for increased neonatal mortality. This conclusion was based on a study that our allied organizations have proven misleading. Florida Friends of Midwives endorses the following responses to the study from both MANA and The Big Push.

Response from the Midwives Alliance of North America:

A new meta-analysis rushed to on-line publication well before its availability in print, concluded that less medical intervention, which is a characteristic feature of planned home birth, is associated with a tripling of the neonatal mortality rate compared with planned hospital births. In a study published online on July 1, 2010 in the American Journal of Obstetrics and Gynecology (AJOG), researchers at Maine Medical Center in Portland, Maine analyzed the results of multiple studies from around the world. The lead investigator, Joseph R. Wax, MD, Department of Obstetrics and Gynecology, Maine Medical Center, stated, “Our findings raise the question of a link between the increased neonatal mortality among planned home births and the decreased obstetric intervention in this group.”

However, Canadian researchers whose data showing the safety of home birth in a well-organized and regulated system, were used in the meta-analysis, are sharply critical of the study. Dr. Michael C. Klein, a senior scientist at the Child and Family Research Institute in Vancouver and emeritus professor of family practice and pediatrics at the University of British Columbia said the U.S. conclusions did not consider the facts. “A meta-analysis is only as good as the articles entered into the meta-analysis—garbage in, garbage out. Moreover, within the article, Wax et al did their own sub-analysis of the studies in the meta-analysis, after removing out-of-date and low quality studies, and found no difference between home and hospital births for perinatal or neonatal mortality. Yet in the conclusion, they choose to report the results of the flawed total meta-analysis, which showed the increased neonatal mortality rate.” Klein said that this is apparently a “politically motivated study in line with the policy of the American College of Obstetricians and Gynecolgists (ACOG) who is unalterably opposed to homebirth.”

Saraswathi Vedam, a nurse midwife and researcher at the University of British Columbia who is considered to be an expert on assessing the quality of literature related to homebirth, states that the study is deeply flawed for several reasons, particularly, “the authors’ conclusions are not supported by their own statistical analysis.” Vedam states that Dr. Wax et al acknowledges the consistent findings of low perinatal and neonatal mortality in planned home births across the best quality studies they reviewed “but amazingly Wax does not emphasize or even mention this in his sole conclusion.” This begs the question of whether the author’s analysis and reporting of reviewed articles on homebirth do not support his foregone conclusion about the safety of homebirth.

The Midwives Alliance of North America, a professional organization of over 1200 members, believes childbearing women and those involved in maternal and child health policy should be made aware of the flaws and erroneous claims in the Wax et al study. There is a substantial body of evidence-based literature from well-designed studies that establishes the safety of planned homebirth with a skilled birth attendant. The fact that the American College of Obstetricians and Gynecologists maintains its position in opposition to homebirth, despite the evidence of its safety and efficacy, makes one question ACOG’s motive in publishing Wax’s substandard study.

Midwives are the primary care providers in out of hospital settings. Whether their work is studied and scrutinized here in the US or abroad the findings are consistent. Trained midwives are qualified health professionals with the requisite expertise to provide mothers and newborns with outstanding care, using less intervention, resulting in maternal and infant outcomes as good as those in hospital settings under the care of obstetricians.

The American public, particularly women in the childbearing years and those who care for them, have a right to high quality research on childbirth. Research literature should not be used to cause undue alarm or limit a woman’s choice regarding care providers, including skilled midwives, and place of birth.

Response from The Big Push for Midwives Campaign:

As New York and Massachusetts moved to pass pro-midwife bills in the final weeks of their legislative sessions, the American Journal of Obstetrics and Gynecology fast-tracked publicity surrounding the results of an anti-home birth study that is not scheduled for publication until September. Described as unscientific and politically motivated, the study draws conclusions about home birth that stand in direct contradiction to the large body of research establishing the safety of home birth for low-risk women whose babies are delivered by professional midwives.

“Many of the studies from which the author’s conclusions are drawn are poor quality, out-of-date, and based on discredited methodology. Garbage in, garbage out.” said Michael C. Klein, MD, a University of British Columbia emeritus professor and senior scientist at The Child and Family Research Institute. “The conclusion that this study somehow confirms an increased risk for home birth is pure fiction. In fact, the study is so deeply flawed that the only real conclusion to draw is that the motive behind its publication has more to do with politics than with science.”

Advocates working to expand access to out-of-hospital maternity care questioned the timing of AJOG’s public relations efforts on behalf of a study that won’t be published until next fall.

“Given the fact that New York just passed a bill providing autonomous practice for all licensed midwives working in all settings, while Massachusetts is poised to do the same, the timing of this study could not be better for the physician groups that have been fighting so hard to defeat pro-midwife bills there and in other states,” said Susan M. Jenkins, Legal Counsel for The Big Push for Midwives Campaign. “Clearly the intent is to fuel fear-based myths about the safety of professional midwifery care in out-of-hospital settings. Their ultimate goal is obviously to defeat legislation that would both increase access to out-of-hospital maternity care for women and their families and increase competition for obstetricians.”

The United States recognizes two categories of midwives: Certified Nurse-Midwives, who are trained to practice in hospital settings and who also provide primary and well-woman care, and Certified Professional Midwives, who undergo specialized clinical training to provide maternity care in out-of-hospital settings. Research consistently shows that midwife outcomes in all settings are equivalent to those of physicians, but with far fewer costly and preventable interventions, including a significant reduction in pre-term and low birth weight births, and as much as a five-fold decrease in cesarean surgeries.

The Big Push for Midwives Campaign represents thousands of grassroots advocates in the United States who support expanding access to Certified Professional Midwives and out-of-hospital maternity care. The mission of The Big Push for Midwives includes educating state and national policymakers about the reduced costs and improved outcomes associated with births managed by CPMs in private homes and freestanding birth centers.

Bumi Sehat Haiti Needs Midwives

2010-05-12T14:40:00.003-04:00

Bumi Sehat Haiti is currently looking for Midwives skilled and willing to volunteer their time in Haiti. They especially need volunteers during July through September 2010.

They are a village based clinic, established in response to the earthquake in January 2010. Their primary focus is maternal and infant needs in Jacmel, Haiti. Bumi Sehat Haiti is helping to provide access to high quality health services to Haiti’s women—a population that has faced a disproportionate burden of disease well before the January earthquake. Maternal mortality rates are shockingly high—670 deaths per 100,000 births. In comparison, the U.S. maternal mortality rate is 11 deaths per 100,000 births, according to World Health Organization statistics. BSH's clinic in Jacmel, is active and busy, with hundreds of women seeking prenatal, birth and postpartum care. Women from surrounding tent camps and shelter's are encouraged to come for free health care.

The need is great and the people are hopeful. Please find us at www.bumisehatbali.org and follow the links for further information on volunteering.

Items for On-Line Auction-Need for Financial Support for Haiti

It has been five months to the date that the earthquake happened in Haiti that devastated 60-80% of Jacmel where the Bumi Sehat birth clinic is located. Thanks to supporters, the clinic is up and running and is steadily busy with births and prenatals as well as educational classes for mothers. The clinic is in need of funds to support the women of Jacmel.

Bumi Sehat is holding an on-line auction to raise funds for a few projects at the clinic site in Haiti. They are looking for artwork, jewelry, gift certificates (preferably nationally recognized stores as the auction will be available to anyone in the US), airline tickets, etc. to be donated for this auction. Please contact Heather Maurer at embracethegoddess@yahoo.com if you have an item to donate.

Purchase a Bumi Box

Bumi Boxes are still available for purchase to support birthing mothers and will need to be bought on a continuous basis to support new birthing mothers. They contain all the supplies for each birthing woman and her new born baby.

To make an online donation please visit:
http://www.sakthifoundation.org/haiti

State of Florida Celebrates International Day of the Midwife

2010-04-30T00:57:00.001-04:00

April 30, 2010 (Florida) -- May 5th is the International Day of the Midwife, a day set aside in 1991 by the International Confederation of Midwives and observed in over 50 nations worldwide. In 1992, Florida Governor Lawton Chiles joined in this celebration by adding Florida to the growing list of states and countries that observe this day.

The World Health Organization states: “On the International Day of the Midwife, we pay tribute to the work of the midwives who are key healthcare providers in facilities and communities. They provide the high‐quality and cost‐effective package of care desperately needed by millions of women around the world. The World Health Organization recognizes the contribution of midwives to the reduction of maternal and newborn mortality and renews its support to quality midwifery!”

Special Events Throughout Florida

In honor of this day, Florida Friends of Midwives, a non-profit consumer organization dedicated to promoting and supporting the practice of midwifery in Florida, will host events throughout the state, and support those hosted by sister organizations. On May 5th, The Florida School of Traditional Midwifery will host their annual celebration of the day in Gainesville, featuring special guests Jill Sonke and Cindy Nelly of the University of Florida Center for the Arts in Healthcare Research and Education (CAHRE). Sonke and Nelly have spearheaded arts in medicine missions in Rwanda, the Congo, and most recently Haiti. On May 6th in Sarasota, Florida Friends of Midwives will host an exclusive screening of Guerrilla Midwife, a documentary recently showcased at the Sarasota Film Festival. The film follows midwife Robin Lim along the streets of Bali and into the Acehnese refugee camps of the Indonesian Archipelago, where the midwifery model of care is put to the test, at the epicenter of the turmoil following the December 2004 Tsunami. And on May 8th, the Miami Florida Friends of Midwives chapter will show the film Laboring Under an Illusion, an anthropological exploration of media-generated myths about childbirth.

A Florida Midwife’s Perspective of International Midwifery

No stranger to the international disparity in childbirth practice, Orlando Licensed Midwife Jennie Joseph was the first foreign-trained midwife to be licensed under the Midwifery Practice Act in Florida in 1994. “I trained as a midwife in England 31 years ago and graduated in May of 1981 with the knowledge that midwifery was the 'gold standard' of care for women worldwide,” says Joseph. “Imagine my surprise on arriving in the US in 1989, where I quickly discovered a total lack of interest, understanding or even acknowledgment of the importance of midwives for a nations health.”

Ms. Joseph is executive director of The Birth Place, a free-standing birthing facility in Winter Garden, and the developer of The JJ WAY, a Maternal Child Healthcare delivery model for indigent women. “Today, I begin to have hope that American's are opening up to the benefits of midwifery in matters of choice, safety, empowerment and economy; that we realize that the midwifery model of care can be the vehicle that moves us higher up on the list of countries providing exemplary maternity care for it's citizens, and that truly 'a midwife for every mother' is not an impossible dream,” says Joseph. “A heartfelt thank you to all the midwives - past, present and future and Happy International Midwives Day!”

Midwives have a long and valued history in Florida. The state first passed legislation to license direct-entry midwives in 1931, and the first Certified Nurse Midwife was licensed in Florida in 1970. Florida’s midwives have continued to tirelessly serve the families of Florida and to ensure the continued availability of safe, evidence-based birthing options for Florida’s families.

About Florida Friends of Midwives: Florida Friends of Midwives is a non-profit grassroots organization dedicated to promoting the Midwives Model of Care and supporting the practice of midwifery in Florida. Florida Friends of Midwives was formed to support midwives who offer safe, cost-effective, evidence based care to Florida's families. For more information, please visit www.flmidwifery.org.

Response to Report on Decline in Maternal Health

2010-04-18T10:20:00.003-04:00

This letter was printed in the Sarasota Herald-Tribune on Sunday, April 18th. Laura Gilkey is the Vice President of Florida Friends of Midwives.

I disagree with those who urged The Lancet to delay publicizing the recent decline in global maternal mortality ("Maternal Deaths see surprising decline worldwide," Sarasota Herald-Tribune, April 14, page 1A). It should be a beacon of hope that improved nutrition, access to prenatal care, and the availability of skilled attendants is increasing. In 80% of the world, those skilled attendants are midwives. After witnessing the work of Ibu Robin Lim in the Sarasota Film Festival screening of “Guerilla Midwife,” I am inspired to believe that the resurgence of traditional midwifery worldwide is no small factor in this global shift toward healthier birth.

However, one disturbing trend remains missing from the Lancet findings. In the United States, maternal mortality continues to rise sharply. According to the recently released Amnesty International report "Deadly Delivery," U.S. maternal mortality ratios have doubled from 6.6 deaths per 100,000 live births in 1987 to 13.3 deaths per 100,000 live births in 2006, placing us 41st in the world in this category. The report attributes the increase to inadequate access to family planning, less than optimal health, late or inadequate prenatal care, inadequate or inappropriate care during delivery, and limited access to post-natal care.

The United States spends more on health care than any other nation in the world, yet we are failing our pregnant women. We must prioritize accountability of data collection, increase access to midwifery and to prenatal care, eliminate inappropriate obstetric intervention, and mandate postpartum visitation for new mothers.

Action Alert: VBAC Ban in Florida Birth Centers

2010-03-08T22:10:00.003-05:00

On Wednesday, March 24th, the State of Florida's Agency for Health Care Administration will move to permanently ban Vaginal Birth after Cesarean (VBAC) in Florida birth centers. Currently, women who choose to give birth normally after surgery must do so in a hospital that will allow it, which encompasses only half of those in the state, or at home with a Licensed Midwife and physician consult sign-off. VBAC's are currently not permitted in birth centers, but only because of a 'de facto ban' due to outdated language in the regulations. After a request that the language be updated to include legalized VBAC's at birth centers with Licensed Midwives and physician consultation, the State used the opening to move to make VBAC's illegal in state licensed birth facilities.

Allowing the pursuit of VBAC at home or at a state licensed birth center with a Florida Licensed Midwife will keep healthy, safe options open for Florida's families, and will dramatically reduce taxpayers' investment in unnecessary surgery.

For these reasons, I urge you to sign this petition and make your voices heard in support of legalizing VBAC's in Florida's licensed birth centers:

To: Florida Agency Health Care Administration

While we recognize the need to change outdated language in the rule, it is our position that the state consider similar language to that of F.S. 467. Such language would work to insure the patient received competent care from a licensed practitioner and respects the right of the patient to make an informed decision. We ask the State of Florida to remain a regulatory body and not take on the role of medical surrogate. (Sign here)

For more information, please visit http://www.vbacsummit.org/VBACBAN.html.

FFOM Hosts Maternal Health Weekend in Sarasota

2009-11-08T10:29:00.016-05:00

Last weekend, Florida Friends of Midwives sponsored and co-sponsored several events aimed at improving maternal health care locally and throughout the country. Headlining the weekend was Sunday afternoon's panel discussion Maternal Health Care in the 21st Century: Sarasota and Beyond. Present for this and all other events was the world's leading midwife, Ina May Gaskin.

Ms. Gaskin began her visit to Sarasota with a Clinical Conference for the medical staff of Sarasota Memorial Hospital (SMH) on Friday, October 30. Her presentation was entitled "Combining the Best of Modern Obstetrics with Respect for Nature and Traditional Midwifery Approaches." Her objectives were threefold: to explore the knowledge base and skills common to traditional midwifery; to understand the need for both modern obstetrics and (authentic) midwifery; and to build positive relationships between the two professions (especially with regard to home birth midwives). Present at the conference were SMH Director of Maternal-Fetal Medicine Dr. Washington Hill; Sarasota County Health Department OB/GYN Dr. John Abu; Licensed Midwives Christina Holmes and Alina Vogelhut; and several members of the hospital staff and the community, including childbirth educators, nurses and retired physicians. The presentation will be available via podcast on the SMH Continuing Education website.

Friday afternoon found Ina May Gaskin touring both of Sarasota's freestanding birth centers (Birthways Family Birth Center and Rosemary Birthing Home), and having lunch with Sonia Pressman Fuentes, the co-founder of the National Organization for Women (NOW). Two of the most influential women in recent American history, the pair discussed the shift in birth culture in the last half century, the difference between American governmental structure and that of most European countries with better maternal outcomes, and the role of the feminist movement in changing the American perception of birth.

Saturday morning, October 31, Ina May Gaskin presented the Safe Motherhood Quilt Project at the Selby Public Library. Ms. Gaskin spoke to Sarasota's SNN News Channel 6 before the presentation, saying "In 2007, the World Health Organization reported that there are forty other countries that do better at preventing maternal death than the United States." Three panels of the quilt were shown in the library's Geldbart Auditorium, after having been hung from the atrium balcony during the week prior. These three panels contained 58 squares, each representing a woman who has died of pregnancy or childbirth related causes in America since 1982. Ms. Gaskin argues that simple measures such as a unified federal death certificate and an increase in percentage of hospital autopsies would dramatically improve U.S. maternal outcomes. The presentation was followed by a booksigning benefiting the project, as well as Florida Friends of Midwives (FFOM), a non-profit grassroots organization dedicated to promoting and preserving access to midwifery care in Florida. Ms. Gaskin signed copies of her classic Spiritual Midwifery, the gold standard prenatal education book Ina May's Guide to Childbirth, and her newest release, Ina May's Guide to Breastfeeding, said by Dr. Christiane Northrup to be "the best thing ever written on the subject."

Sunday afternoon at 3:00 pm, Ina May Gaskin met in the Hyatt Regency Sarasota Ballroom with Dr. Washington Hill once more, as well as Sarasota Healthy Start Coalition executive director Jennifer Highland and Representative Keith Fitzgerald, for a panel discussion called Maternal Health Care in the 21st Century: Sarasota and Beyond. The discussion was moderated by Sarasota Vice Mayor Kelly Kirschner, who shared his perspective as a City Commissioner that improved maternal health is a formula of community growth.
The panel was a free program which included refreshments and a 28 page Maternal Health Resource Guide, all made possible by the hard work of the sponsoring organizations and the generosity of several business partners. Approximately 250-275 people attended the discussion, including several guests of expertise in the field of maternal health and associated disciplines.
Dr. Washington Hill was the first to speak, pointing to a collaborative model of care as the standard for positive outcomes, and encouraging open communication between the many components of maternal health care and its providers.
Ina May Gaskin followed, discussing maternal death, its possible prevention and ways to move toward accurate recordkeeping, and the importance of prenatal health. She illustrated strategies in other countries with much better outcomes than ours, such as the Netherlands, which provides its new pregnant women with paid postpartum care.
Jennifer Highland, executive director of the Healthy Start Coalition of Sarasota County, then presented a staggering display of statistics illustrating Sarasota's place in Florida and the rest of the country in categories such as infant death, fetal death, smoking during pregnancy, breastfeeding rates and more. Jennifer suggested that Sarasota County's high cesarean section percentage be closely examined and reversed to improve preterm birth rates and NICU admissions, and that prenatal health be a priority of all parties involved.
Finally, Florida House of Representatives Health and Family Services Policy Council member Rep. Keith Fitzgerald gave the audience a history of health insurance, an overview of health care reform issues, and a call to action. When talking about the frequency of special interest groups' appointments with him and his colleagues, Fitzgerald asked: "Where are you?"

Questions were then taken from audience members, who asked about tort reform, individual OB/GYN's c-section rates, and women's intuition--among many other things.

After the panel discsussion, Florida Friends of Midwive s (FFOM) hosted the tribute An Evening with Ina May Gaskin in the Boathouse of the Hyatt Regency Sarasota. Guests received keepsake tickets, signed a book of gratitude for Ms. Gaskin, and viewed a tribute DVD of her work and its manifestation through the midwives and midwife-assisted births here in Sarasota. Special thanks to Radio-Free Carmela and the Transmitters and Tanya Radtke for providing music for the evening. Net proceeds of approximately $2500 will help FFOM in their strategy to protect Florida's midwives and their laws, and to improve public awareness of the Midwives Model of Care.

Safe Motherhood Quilt Project in Sarasota This Week

2009-10-26T21:36:00.002-04:00

Beginning today, three panels of The Safe Motherhood Quilt Project are on display at the Selby Public Library. The Safe Motherhood Quilt Project is a national effort developed to draw public attention to the current maternal death rates in the United States, as well as to the gross underreporting of maternal deaths, and to honor women who have died of pregnancy-related causes. The three panels currently on display in Sarasota represent 58 mothers who have died of pregnancy or childbirth related causes in the US since 1982. There are several other panels throughout the country just like them.

Project founder and world's leading midwife Ina May Gaskin will be presenting these panels on Saturday, October 31st, at 11:00 am. Following her presentation she will sign copies of all three of her books (Spiritual Midwifery, Ina May's Guide to Childbirth, and Ina May's Guide to Breastfeeding), in benefit for Florida Friends of Midwives and The Safe Motherhood Quilt Project.

News from the MAMA Campaign

2009-10-06T07:48:00.002-04:00

Florida Friends of Midwives endorses the MAMA Campaign. Please read this update, including an incredible list of accomplishments in just a few short months.

What a summer this has been for Midwives and Mothers in Washington, DC! Now, as the health care bills pick up speed in Congress this fall, we need your support and your dollars more than ever. Billy Wynne, our lobbyist, wrote to us this past week: “You should feel very good about the massive education campaign you’ve undertaken and the broad support you’ve gained …now it’s crunch time!”

Just since May, the MAMA Campaign has accomplished a lot by acting quickly and effectively.
We have:

Drafted an amendment to recognize and reimburse CPMs in Medicaid
Hired a national health policy and lobbying firm to guide our advocacy work in DC
Held a “fly-in” of more than twenty MAMA activists to Washington, DC, in June who met with over 30 key congress members
Traveled to DC nearly every week since then and followed up with supporters to keep the pressure up
Prepared a cost-analysis based on Medicaid data from a health policy study in Washington State that was submitted to the Congressional Budget Office on our behalf by Chairman Waxman’s office
Met with 8 top Medicaid officials in Baltimore in July, an unusual opportunity for a provider group new to Capitol Hill
Monitored and adjusted our strategy weekly as the proposed legislation twists and turns through Congress
Secured the support of important national groups: Childbirth Connection, the National Women’s Law Center, the National Women’s Health Network, Raising Women’s Voices, Our Bodies Ourselves, the Coalition for Improving Maternity Services, American Association of Birth Centers, and state midwifery and consumer groups

And we have continued to manage the campaign using the pro-bono skills and expertise of top leadership in six national midwifery and citizen organizations as well as activated superb grassroots support across the country.

Over these next weeks we will continue to have opportunities to include Certified Professional Midwives in the health care bills. However, the time is growing short and we really need your help. As Billy says, it’s crunch time!

Every step of the way you have stood behind us. Thank you! Together we have raised $100,000 for the Campaign this summer – 2/3 of our goal and a truly stunning fundraising coup for our movement! We are so grateful to you!!

Now we need your help to get across the finish line!
Will you give $10, $25, $50 or even $100 to continue our work for federal recognition of CPMs? Just click to donate.

Will you help us identify potential major donors? Write to president@nacpm.org with ideas.

And of course, be sure to keep the letters to your legislators coming – we need that “dull roar” from the states and districts to move our provision over the top! Constituents are the ones that legislators are listening to. That’s you! Find letter templates and instructions on our website.

Thank you so much! We look for to hearing from you!

Mary Lawlor, CPM
President, NACPM
National Co-Chair, MAMA Campaign

Susan Hodges
President, Citizens for Midwifery
National Co-Chair, MAMA Campaign

Florida Celebrates Licensed Midwives Week October 5-9

2009-10-06T00:02:00.004-04:00

Governor Charlie Crist has signed a proclamation observing October 5 through the 9 as Licensed Midwives Week in the State of Florida, upholding midwives for being “dedicated to the care of pregnancy and childbirth and treat[ing] each woman’s pregnancy according to her unique physical and personal needs.” Governor Crist’s proclamation also recognized midwives for their role in the need to “improve birth outcomes in the State of Florida and ensure that women are given proper care and treatment in all phases of childbirth.”

In honor of this week, Florida Friends of Midwives (FFOM), a non-profit grassroots organization dedicated to promoting and supporting the practice of midwifery in Florida, will be hosting various community events throughout the state this month to celebrate the more than 110 Licensed Midwives in the Sunshine State.

Florida Licensed Midwives Week coincides with National Midwifery Week, a time to recognize the contributions of Certified Nurse Midwives (CNMs), Certified Midwives (CMs) and Certified Professional Midwives (CPMs) nationwide. The American College of Nurse Midwives (ACNM) publicly announced the week with an introduction to midwifery. “The heart of midwifery care for women and newborns lies more in the nature of that care than in its specific components. Midwifery practice has a firm foundation in the critical thought process and is focused on the prevention of disease and the promotion of health, taking the best from the disciplines of midwifery, nursing, public health and medicine to provide safe, holistic care.”

Midwives have a long and valued history in Florida. The state first passed legislation to license direct-entry midwives in 1931. In the 77 years since, Florida’s licensed midwives have continued to tirelessly serve the families of Florida and to ensure the continued availability of safe, evidence-based birthing options for Florida’s families. In 1992, Governor Lawton Chiles declared the first-ever Licensed Midwives Week. More women than ever before are seeking out licensed midwives for maternity care. According to the latest data from the Florida Council of Licensed Midwifery, births managed by Licensed Midwives in the state grew by about 5.5% from 2005 to 2006.

“We are honored every day to serve Florida’s mothers, babies, and families,” says Sarasota Licensed Midwife Alina Vogelhut, LM. “It means so much for our profession to be honored by Governor Charlie Crist and the State of Florida.”

Midwifery in Florida

In Florida, two types of midwives are allowed to practice: Certified Nurse-Midwives and Licensed Midwives (a Florida state licensure), also known as direct-entry midwives. Throughout the state, about 11.2 percent of births are estimated to be managed by midwives, rather than by OB-GYNs. Many birth centers and midwives have reported a significant increase in business in the past year. This increase is believed to be a result of various factors, primarily a greater number of women seeking alternative birthing choices due to an unhealthy increase in caesarean sections and other unnecessary interventions that frequently occur in hospital settings. In a 2006 report on Florida Licensed Midwives, midwives had a caesarean section rate of 6.3 percent compared to a 36.64 percent statewide average in hospitals the same year.

For more information of midwifery in Florida, please visit www.flmidwifery.org.

About Florida Friends of Midwives

Florida Friends of Midwives is a non-profit grassroots organization dedicated to promoting the Midwives Model of Care and supporting the practice of midwifery in Florida. Florida Friends of Midwives was formed to support midwives who offer safe, cost-effective, evidence based care to Florida's families. For more information, please visit www.flmidwifery.org.

Announcing: Commonsense Childbirth School of Midwifery

2009-10-01T09:44:00.004-04:00

(from Executive Director Jennie Joseph, LM, CPM)

Thank you for your interest in Florida's newly licensed direct-entry midwifery program. I am proud to offer the Three-year Midwifery Program and the Four Month Pre-licensure Program for foreign-trained midwives only (midwives licensed/certified in another country).

Both programs will lead to a Diploma in Midwifery and, after passing the NARM (North American Registry of Midwives) exam, an opportunity to become a Florida Licensed Midwife (LM) affording practice in Florida under Chapter 467 FS and the ability to provide prenatal. labor and delivery and postpartum services for Florida families. Candidates may also apply for the nationally accredited credential Certified Professional Midwife (CPM) after passing the NARM.

I am excited to be able to direct a midwifery school (for the second time) and look forward to bringing a unique approach to midwifery education.My focus will be on the clinical aspects of midwifery training and I will apply my international and individual experiences to a very strong and clinically sound format.

I welcome the renowned Justine Clegg MS, LM, CPM as our Academic Director. Justine is a Florida Licensed Midwife and Licensed Mental Health Counselor. Involved in maternal and child health since 1973 as a La Leche League leader, childbirth educator, founding member of the Midwives Association of Florida, homebirth midwife and political activist, she earned her M.S. in counseling in 1991 and has served as Director of the Midwifery Program at Miami Dade College since 1994. She was a founding Board member of MEAC (Midwifery Education Accreditation Council) and helped develop the NARM (North American Registry of Midwives) certification process, as well as being the current Board Secretary of the Association of Midwifery Educators. She will join me in presenting an academic program crafted to produce confident, accomplished midwives, ready and able to serve their community with heart and passion.

As we begin classes in January 2010 we will be operating under the initial Provisional License # 4052 as issued by Florida Department of Education. Please note: we have been informed that we cannot start the 'distance learning' component of our program until we have completed the first year. At that time we will need to re-apply to the state of Florida for the ability to add 'distance learning'. After one year the state will issue our 'full' license. To that end we will proceed in January 2010 with an ON-SITE PROGRAM only.

Classes will be held on Fridays at 1150 E. Plant St. Winter Garden. I will only be seating a very small class initially with a view to expanding the following year. Tuition for the Three-year Program is $19,320 and $5,250 for the Four Month Program. Our upcoming Orientation is scheduled for October 9, 2009 at The Birth Place, Winter Garden. Please email docsophie@gmail.com for more details or to rsvp.

Thank you!

Jennie Joseph LM, CPM
Executive Director

A Letter from the MAMA Campaign

2009-09-28T13:57:00.002-04:00

Dear Florida Supporters of Midwifery--

As Florida constituents you all are in a unique and special position to help encourage federal recognition of CPMs by helping The MAMA Campaign.

The MAMA Campaign is an effort by six national organizations to include CPMs as Medicaid providers in the evolving healthcare reform legislation currently under consideration. Visit www.mamacampaign.org for more information about the campaign and to signup for news and alerts.

This week, the MAMA Campaign is trying to get letters from constituents sent to the offices of Senator Nelson and/or Congresswoman Kathy Castor of the 11th district in Florida. Anyone who lives in Florida can write as a constituent to Senator Nelson. We only need people who are constituent’s of Congresswoman Kathy Castor to write to her. To find out if you or someone you know lives in Castor’s Tampa Bay area district, visit http://www.govtrack.us/congress/findyourreps.xpd?state=FL&district=11.

Congresswoman Castor is on the House Energy and Commerce committee and Senator Nelson sits on the Senate Finance Committee. These committees will make decisions about changes to Medicaid in the current health care reform efforts, including whether or not CPMs will be added to the list of approved Medicaid providers. Hence, as Floridians, you are in a special position to help influence these critical legislators. This inclusion of CPMS as federal Medicaid providers would be an important step in increasing access to CPMs across the country.

Both Congresswoman Kathy Castor and Senator Bill Nelson have indicated some support for our amendment. But ours is only one of many potential amendments to the health care bills, all demanding their attention. We need you to write a letter of encouragement to Senator Nelson and/or Congresswoman Castor, telling them to take action on this issue.

Please forward this letter writing request to other Floridians who support midwifery. If you have clients, friends, relatives or ANYONE who is a constituent who will write a letter to Representative Castor and/or Senator Nelson please ask them to do so. It is important to send letters as soon as possible! These personal letters from constituents are critical and make a huge impact. Please write and fax or email a short letter TODAY!

MAMA CAMPAIGN INSTRUCTIONS AND TALKING POINTS FOR E-MAILED OR FAXED LETTERS FROM CONSTITUENTS OF SENATOR NELSON OR REPRESENTATIVE CASTOR

1. Handwritten or typed letters may be faxed to the number provided below.

2. Please fax your letter to the legislator’s Washington, D.C. office. This is the best way to get the letters to them quickly and effectively. If you are unable to send a fax, the next best thing is to send your letter by using the legislator’s web-based e-mail form. If you would like to help but can’t fax a letter, or send an email, a phone call to their Washington, D.C. office, is also helpful.

Rep. Kathy Castor (FL-11th)(Tampa): Visit http://www.govtrack.us/congress/findyourreps.xpd?state=FL&district=11 to see if you are a constituent.

DC Fax: (202)225-5652
DC Phone: 202-225-3376
Web Email Form: https://writerep.house.gov/writerep/welcome.shtml

Sen. Bill Nelson (FL)
DC Fax: 202-228-2183
DC Phone: 202-224-5274
Web Email: http://billnelson.senate.gov/contact/email.cfm

3. Please include the following crucial language in your letter; this is what you are asking your legislator to do:

FOR REP. CASTOR: "I am a constituent and I ask that the Congresswoman support efforts to improve the maternity care system by adding Certified Professional Midwives to the list of providers covered by Medicaid. Will Congresswoman Castor raise this issue with Energy & Commerce Chairman Henry Waxman as a priority for her, to see if we can get this important provision in the final House bill? It’s so crucial that we expand access to maternity care as a component of health reform.”

FOR SEN. NELSON "I am a constituent and I ask that the Senator support efforts to improve the maternity care system by adding Certified Professional Midwives to the list of providers covered by Medicaid. Will Senator Nelson please raise this issue with Finance Committee Chairman Max Baucus as a priority for him, to see if we can get this important provision in the final Senate bill? It’s so crucial that we expand access to maternity care as a component of health reform.”

4. A short letter is sufficient. But, if you wish to write an expanded, more personalized letter, at the end of this document are a list of talking points to help you explain why Senator Nelson or Representative Castor should ask their appropriate chairman to add this amendment to the bill. You do not need to use all the talking points. We encourage you to make this a personal letter from you. We do not want these to look like form letters. We do suggest, because the chairmen are looking for cost-savings wherever they can find them, that you might want to emphasize the second and fourth bulleted points in the list of talking points below.

Note: For clarity’s sake, please be sure to write out “Certified Professional Midwife” rather than “CPM”.

5. Share a brief personal detail if possible and relevant, for example: “Two of my children were born at home attended by Certified Professional Midwives. I believe all women regardless of their income should have access to the safe, high-quality, cost-effective care provided by Certified Professional Midwives.”

6. Sign off with your name, address, and contact information.

7. If Senator Nelson’s or Representative Castor’s office would like more information about our efforts to pursue this important Medicaid improvement, they may contact Mary Lawlor with the National Association of Certified Professional Midwives at president@nacpm.org or on her cell phone at 917-453-6780. She and other Campaign members will be in D.C. during the next few weeks and may be available to meet his/her staff.

8. Please send the MAMA Campaign a copy of your letter. Email it to info@mamacampaign.org or FAX to 802-536-4142.

Again, anyone who lives in Florida can write as a constituent to Senator Nelson. We only need people who live in Congresswoman Kathy Castor’s district to write to her. To find out if you or someone you know lives in Rep. Castor’s district which includes: Tampa and St. Petersburg and parts of Hillsborough, Pinellas and Manatee counties, visit http://www.govtrack.us/congress/findyourreps.xpd?state=FL&district=11. PLEASE forward this writing request to other Floridian’s who support midwifery. These letters are incredibly important.

If you haven’t already, please sign up with the MAMA Campaign at www.mamacampaign.org to get e-alerts and find more information and handouts. Please donate to the campaign at www.mamacampaign.org. Thanks so much for all you are already doing and for all you will do this week!

THANK YOU!

Nasima Pfaffl
Citizens for Midwifery/MAMA Campaign
321-733-6156
nasima@cfmidwifery.org

Talking Points :

CPMs are highly-trained, credentialed clinicians who provide effective, evidence-based maternity care. They are the only maternity care providers specifically trained in attending births outside the hospital and, by assisting in births at home and in birthing centers, offer women an important choice in how their babies are delivered.

I support the basic principal that health reform should make obtaining care MORE AFFORDABLE for all American. Adding Certified Professional Midwives to the Medicaid list would SAVE MONEY by reducing health care costs immediately.

Each mother on Medicaid who chooses an out-of-hospital birth with a Certified Professional Midwife would lower Medicaid costs, since Medicaid would otherwise be paying for a hospital birth at greater cost and with much greater likelihood of an expensive cesarean section.

Research demonstrates that midwives who attend births outside the hospital (at home or in a birth center) have much lower rates of unnecessary and potentially dangerous medical interventions such as inductions and cesarean-sections with at least as good outcomes in terms of maternal and infant mortality, at substantially lower costs.

Because Certified Professional Midwives provide thorough individualized care that promotes healthy pregnancies, the babies are healthier – more are full term and full weight, avoiding costly health problems.

Of the twenty-five states that now provide a path to licensure for Certified Professional Midwives, only 9 include CPMs in their state Medicaid programs, so low-income women on Medicaid have difficulty obtaining services. This falls short of genuine and consistent patient choice and access. Certified Professional Midwives and women who want access to them are seeking federal Medicaid reimbursement for their services as one important step to increase access to this kind of maternity care.

All women deserve to have access to quality, comprehensive maternity care, in the communities where they live, with a choice of qualified provider and services that are fully recognized and reimbursed by both private and public payers.

As the #1 reason for hospitalization, but with declining quality outcomes in the U.S., it is essential for health care reform to include maternity care.

Purchase Tickets - An Evening with Ina May Gaskin

2009-09-18T11:09:00.008-04:00

Single or Multiple tickets may be purchased by clicking Buy Now.

Tickets on Sale Friday for An Evening with Ina May Gaskin

2009-09-16T20:04:00.005-04:00

Tickets to An Evening with Ina May Gaskin go on sale via PayPal on Friday, 9/18, at approximately 10:00 am. Only 150 guests will have the privilege of dining with Ina May, so please get your tickets early!

Tickets include dinner, a cash bar, and live music with Radio Free Carmela and the Transmitters at the gorgeous Boathouse of the Sarasota Hyatt Regency Hotel. Doors will open at approximately 5:30 on November 1st, immediately following the free panel discussion Maternal Health Care in the 21st Century: Sarasota and Beyond, at the same hotel. The panel discussion is free but reservations are strongly recommended, and may be made by emailing laura@kangaroopromotions.net.

Links to buy tickets may be found Friday morning on the Florida Friends of Midwives website (http://www.flmidwifery.org/) as well as on the blog http://www.borninsarasota.blogspot.com/.

Tickets are $35 for the event only, or $60 with a signed book of your choice--Spiritual Midwifery, Ina May's Guide to Childbirth, or her newest--not even released yet--Ina May's Guide to Breastfeeding!

I hope to see many of you there...this is the opportunity of a lifetime to pay thanks to someone who is directly responsible for paving the way to the availability of direct-entry midwifery we all care about so deeply. Thank you and I can answer any questions you have!

Laura Gilkey, Vice President
Florida Friends of Midwives

FFOM Wants to Hear Your Birth Story

2009-09-02T21:33:00.005-04:00

Due to the volume of quick responses, the ACOG website survey on homebirth was password protected after 18 hours. The effort to flood them with positive birth stories was an immediate success. Visit the Citizens for Midwifery Grassroots Network and The Big Push for Midwives campaign for more information. Thanks for your support!

The ACOG survey demonstrates that the opposition to home birth is powerful and organized. Midwives and consumers of midwifery care need to stay informed, and be ready to support midwives politically. Stay connected to events and actions in Florida by joining Florida Friends of Midwives. There is an e-group, forums, and a newsletter to keep you informed of important events.

We still want to hear your positive birth story! To tell your birth story to support midwives, please submit it to the Florida Friends of Midwives website. Follow the instructions below, and email birth stories to stories@flmidwifery.org.

How to Submit Your Birth Story:

If you would like to submit of your birth with a Florida midwife, here is what to do:

1. Submit your story in a .txt or .doc format. All stories should be accompanied by photographs in .jpeg, .jpg, .eps format.

2. Include your name and a title for the story.

3. Stories should be ¾ page to 1 ½ pages. Try to separate your story in to several paragraphs.

Please spell check your story before you send to us! It sounds very basic, but it is important and helps us get the stories up sooner. We will make corrections if necessary, but you will help us out greatly if you spend some time checking your story for accurate spelling and grammar.

We will notify you if your story is used and provide you with a link to view it on the website. Again, please be aware that we may edit your story for grammar, punctuation, spelling and length if necessary. It may take us up to a month to post your story, if it's used. Try to be patient with us.

VERY IMPORTANT! You MUST include a statement with your story that you give FFOM permission to print your story. We cannot publish it to the web without this statement!

Ina May Gaskin to be Honored in Sarasota

2009-09-02T00:37:00.001-04:00

Ina May Gaskin, the world’s leading midwife, is coming to Sarasota to participate in a panel discussion entitled Maternal Health Care in the 21st Century: Sarasota and Beyond, taking place at 3:00 pm on November 1st in the Sarasota Ballroom of the Hyatt Regency Hotel. Immediately following the program, Florida Friends of Midwives will host An Evening with Ina May Gaskin at the Hyatt Regency’s waterfront Boathouse, to begin at about 5:30 pm. Tickets for this event, going on sale in September, will cost $35 and will include dinner and live music from Radio-Free Carmela and the Transmitters. Guests will view a tribute to Ms. Gaskin’s work, enjoy a cash bar, and participate in a silent auction and raffle. All proceeds will benefit Florida Friends of Midwives, a non-profit grassroots organization dedicated to promoting and preserving midwifery access in Florida.

Ina May Gaskin is internationally recognized as the mother of modern midwifery, and has been credited with the re-emergence of direct-entry midwifery in the United States since the early 1970's. Ms. Gaskin is founder and director of the Farm Midwifery Center, founded in 1971 and located near Summertown, Tennessee. By 1996, the Farm Midwifery Center had handled more than 2200 births, with remarkably good outcomes, noted for low rates of intervention, morbidity and mortality. Ms. Gaskin herself has attended more than 1200 births. She is author of Spiritual Midwifery, Ina May’s Guide to Childbirth, and Ina May's Guide to Breastfeeding, to be released October 1st. She was President of Midwives' Alliance of North America from 1996 to 2002. The Gaskin maneuver, a low-interventive effective method for dealing with shoulder dystocia, is the first obstetrical procedure to be named for a midwife. Ms. Gaskin is also the originator and coordinator of The Safe Motherhood Quilt Project, a national effort developed to draw public attention to the current U.S. maternal death rates. Three panels of The Safe Motherhood Quilt will be on display at the Selby Public Library from October 26 – October 31. For more information about the Quilt Project, please visit www.rememberthemothers.org.

In addition to participating on the panel and being honored at the tribute dinner, during her stay in Sarasota, Ms. Gaskin will be presenting a Clinical Conference to the medical staff at Sarasota Memorial Hospital on Friday, October 30th, and presenting the Safe Motherhood Quilt Project at the Selby Public Library on Saturday, October 31st at 11 am. For more information about any of these events, please contact Laura Gilkey at laura@kangaroopromotions.net.

ABOUT FLORIDA FRIENDS OF MIDWIVES: Florida Friends of Midwives (FFOM) is a nonprofit grassroots organization dedicated to promoting the Midwives Model of Care and supporting the practice of midwifery in Florida. Florida Friends of Midwives was formed to support midwives who offer safe, cost-effective, evidence based care to Florida's Families. FFOM members are consumers and birth advocates with a common goal: to preserve the legal protection afforded to Florida's midwives and birth centers. They are committed to organizing the community to support midwives and to assure the continued availability of midwifery care in the State of Florida. For more information, please visit www.flmidwifery.org.

Waterbirth Workshop with Barbara Harper

2009-08-30T17:26:00.005-04:00

ONE DAY COURSE IN GAINESVILLE SEPTEMBER 9TH

Learn all the specific physiologic reasons why water immersion and waterbirth work the way they do. Discuss "delivery" or birth techniques and tricks, like using pictures on the bottom of the tub to determine blood loss; reevaluate 2nd stage moves and maneuvers; shoulder dystocia in the tub; keeping water warm - why or why not; protocols, etc. Lots and lots of information, videos and studies from 25 years of research, experience and collecting data. Worth every penny!!

This workshop is taught by Barbara Harper, whose expertise in waterbirth and gentle, undisturbed birth is widely sought in all areas of the globe. She has lectured in 43 countries, including many medical schools, nursing schools, midwifery programs and university women’s studies departments. Barbara has been interviewed by hundreds of newspapers and magazines and has appeared on dozens of radio and TV shows to talk about her work with waterbirth and gentle birth.

The class is $255 for providers, $125 for nurses, doulas, and childbirth educators, and $75 for pregnant moms or couples. It will be held on Wednesday, September 9, 2009, from 9:00am - 4:30pm at the United Church of Gainesville, 1624 NW Fifth Ave.

For more information, please call (954) 821-9125, or email Barbara Harper at barbara@waterbirth.org.

Florida Friends of Midwives Endorses MAMA Campaign

2009-08-26T22:19:00.003-04:00

Florida Friends of Midwives endorses the MAMA Campaign, a collaborative effort by the National Association of Certified Professional Midwives (NACPM), Midwives Alliance of North America (MANA), Citizens for Midwifery (CfM), International Center for Traditional Childbearing (ICTC), North American Registry of Midwives (NARM), and the Midwifery Education Accreditation Council (MEAC). This partnership is now at work to gain federal recognition of Certified Professional Midwives so that women and families will have increased access to quality, affordable maternity care in the settings of their choice.

Help ensure that low income women on Medicaid all across the country can choose midwifery care – Donate Today! Any amount you can give will help Certified Professional Midwives be recognized under federal Medicaid law. If every supporter in Florida donated $25 and if busy midwives and birth centers donated $500 or $1,000, we would be well on our way to meeting our fundraising goal. Help us sustain the work of organizing and lobbying that it takes to make our voice heard in Washington, DC. Donate today at www.mamacampaign.org.

Heads Up on Infant Mortality Campaign

2009-08-19T03:05:00.004-04:00

September is Infant Mortality month. Did you know that 1,687 babies died before age one in 2007 in the state of Florida alone? The 2009 Campaign for Healthier Babies is drawing attention to infant mortality by knitting one baby hat for every baby who didn't reach their first birthday.

"Too many babies are being born too soon, too small, or too sick to survive," said Jennie Joseph, CPM, Executive Director of Commonsense Childbirth. Please join Jennie in her endeavor to promote early prenatal care and save the lives of our children!

How you can help:

* knit or crochet one or more baby hats
* teach someone how to knit or crochet a baby hat
* donate to the campaign
* encourage all pregnant women to start prenatal care right away - we can help, no one is turned away

The hats will be displayed at a rally in September (date & time TBA). You can help by knitting or crocheting one or more infant hats and bringing or mailing your hat(s) to:

The Birth Place
1130 E. Plant Street
Winter Garden, FL 34787
Call: (407) 656-6938
Email: Elena@TheBirthPlace.org

FFOM Welcomes Ina May Gaskin to Sarasota

2009-07-31T10:07:00.001-04:00

Sarasota, FL (July 31, 2009) -- On November 1, 2009, Sarasota will host a discussion entitled 'Maternal Health Care in the 21st Century: Sarasota and Beyond.' The program will feature a distinguished panel of internationally recognized speakers. The Sarasota-Manatee Chapter of the National Organization for Women (NOW) is sponsoring the event, along with co-sponsors Florida Friends of Midwives and the Sarasota Commission on the Status of Women. The discussion will take place at the Hyatt Regency Sarasota. The public is welcome to attend at no cost.

The panelists for this discussion are:
--Dr. Washington Hill, MD, FACOG, Labor and Delivery Medical Director and Maternal-Fetal Medicine Director at Sarasota Memorial Hospital;
--Ina May Gaskin, MA, CPM, Founder and Director of The Farm Midwifery Center;
--Rep. Keith Fitzgerald, PhD, Florida House of Representatives, District 69; and
--Jennifer Highland, MPH, Executive Director of the Healthy Start Coalition of Sarasota County.

The discussion will be moderated by Kelly Kirschner, MA, Sarasota City Commissioner and Vice Mayor, and will last approximately an hour and a half. Time will be allotted for audience questions and answers, as well as refreshments following the program.

This panel will review current trends in maternity care in Sarasota within the context of the U.S. and the world and target paths to improving maternity care locally and nationwide. Topics for discussion include:

maternal mortality,
obstetric intervention rates and risks,
legislation,
legal reform and malpractice concerns,
insurance coverage,
community education and awareness,
the midwifery model of care,
informed consent and refusal,
transparency in maternity care,
the availability of prenatal care (including education, counseling, and doulas), and
the upcoming expansion of Sarasota Memorial Hospital to include new labor and delivery rooms.

Hosting a panel discussion about maternal health care issues was the brainchild of Sonia Pressman Fuentes, co-founder of the National Organization for Women (NOW). “After spending a lifetime improving the legal status of women and fighting gender discrimination in the US and the world, it is exciting for me to be involved in a field new to me, that of improving maternal health care options for women in Sarasota, the US, and the world,” says Fuentes. Joining her in planning the event is Laura Gilkey, local childbirth advocate and board member of Florida Friends of Midwives. "With a panel representative of obstetrics, midwifery, legislature and public health, perhaps Sarasota can begin a conversation that will pave the way toward becoming a national model of community healthcare reform through improved maternity care," says Gilkey.

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For more information, please contact Laura Gilkey at laura@kangaroopromotions.net / (941) 915-8115. Interviews are available at the request of the press. Planning and agenda updates for the panel will be posted on the website www.borninsarasota.blogspot.com.

About the National Organization for Women (NOW): The National Organization for Women (NOW) is the largest organization of feminist activists in the United States. NOW has 500,000 contributing members and 550 chapters in all 50 states and the District of Columbia. Since its founding in 1966, NOW's goal has been to take action to bring about equality for all women. NOW works to eliminate discrimination and harassment in the workplace, schools, the justice system, and all other sectors of society; secure abortion, birth control and reproductive rights for all women; end all forms of violence against women; eradicate racism, sexism and homophobia; and promote equality and justice in our society.

About Florida Friends of Midwives (FFOM): Florida Friends of Midwives (FFOM) is a non-profit grassroots organization dedicated to promoting the Midwives Model of Care and supporting the practice of midwifery in Florida. Florida Friends of Midwives was formed to support midwives who offer safe, cost-effective, evidence based care to Florida's Families. Our members are consumers and birth advocates with a common goal: to preserve the legal protection afforded to Florida's midwives and birth centers. We are committed to organizing the community to support midwives and to assure the continued availability of midwifery care in the State of Florida.

About the Sarasota Commission on the Status of Women (SCSW): The Sarasota Commission on the Status of Women (SCSW) was re-established in Sarasota County to empower women through education, research, and advocacy.

ABOUT THE PANELISTS:

Dr. Washington Hill, M.D., FACOG
Labor and Delivery Medical Director / Maternal-Fetal Medicine Director, Sarasota Memorial Hospital
B.A., Rutgers University, College of South Jersey, Camden, New Jersey, 1961
M.D., Temple University School of Medicine, 1965
Obstetrics and Gynecology Residency, William Beaumont General Hospital, 1970
Post Graduate, Maternal-Fetal Medicine Fellowship, University of California, San Francisco, 1984
Board Certification, American Board of Obstetrics and Gynecology with Special Competence in Maternal-Fetal Medicine, 1989 with Recertification 1978, 1993 and 1998

Dr. Hill is the Past President of the Medical Staff and Chairman of the Department of Obstetrics and Gynecology at Sarasota Memorial Hospital, Sarasota, Florida. He is currently Director of Maternal-Fetal Medicine. He is also Clinical Professor Department of Obstetrics and Gynecology at University South Florida College of Medicine, Tampa Florida and Clinical Professor Department of Clinical Sciences OB/GYN Clerkship Director-Sarasota Campus Florida State University College of Medicine Tallahassee Florida. After earning his medical degree at Temple University and interning at Walter Reed General Hospital in Washington, D.C., Dr. Hill spent the next nine years as a Medical Officer in the United States Army. During this time, he conducted his residency training in Obstetrics and Gynecology at William Beaumont General Hospital in El Paso, Texas. Upon finishing his residency, he was an Obstetrician and Gynecologist in Germany for three years. After twelve years of private practice in Obstetrics and Gynecology, Dr. Hill completed a fellowship in Maternal-Medicine at the University of California, San Francisco and Children’s Hospital of San Francisco in 1984. While there, he was also a Research Fellow at the Cardiovascular Research Institute. Following completion of his fellowship in Maternal-Fetal Medicine, he has practiced this subspecialty for over 20 years first at the Sutter Perinatal Center and the University of California-Davis School of Medicine, Sacramento, California, and then at Creighton University, School of Medicine, Omaha, Nebraska; Meharry Medical College, and Vanderbilt University School of Medicine, Nashville, Tennessee. He served as Chairman of the Department of Obstetrics and Gynecology at Meharry Medical College, School of Medicine, educating minority medical students and residents from 1990 until 1992, when he took his current position as Director of Maternal-Fetal Medicine and the Perinatal Center of Sarasota Memorial Hospital in Sarasota, Florida. Dr. Hill is a leader in Maternal-Fetal Medicine. He has a strong interest in education, patient care, teaching and clinical practice. He is a regular participant at conferences which teach perinatal healthcare providers management and use of research in caring for high risk pregnancies. He has been a leader in the development of a center of excellence known throughout the nation for the care of high risk pregnant patients. Dr. Hill is a frequently sought after speaker in the community and at medical centers around the nation in high risk pregnancy management. He is Board Certified in Maternal Fetal Medicine and Obstetrics and Gynecology. He also serves around the country as a consultant for maternal-fetal medicine and medical legal issues. In his “spare time,” he likes to travel, especially to Africa on medical missions and will be happy to recruit to go also. He also enjoys sports, music and collecting African artifacts when not engaged in his teaching duties. Dr. Hill is the author of at least 60 articles in refereed journals and the book, “Ambulatory Obstetrics.” He contributes regularly to the medical literature and provider education. A native of Camden, New Jersey, Dr. Hill is married to Pauline Hill.

Ina May Gaskin, M.A., C.P.M.
Founder / Director, The Farm Midwifery Center
State University of Iowa, Iowa City, Iowa, B.A., English, Summa cum laude, Highest honors
Northern Illinois University, DeKalb, Illinois, M.A., English
North American Registry of Midwives
Certified Professional Midwife
Tennessee Licensed Certified Professional Midwife

Ina May Gaskin, MA, CPM, is founder and director of the Farm Midwifery Center, located near Summertown, Tennessee. Founded in 1971, by 1996, the Farm Midwifery Center had handled more than 2200 births, with remarkably good outcomes. Ms. Gaskin herself has attended more than 1200 births. She is author of Spiritual Midwifery, now in its fourth edition. For twenty-two years she published Birth Gazette, a quarterly covering health care, childbirth and midwifery issues. Her most recent book, Ina May’s Guide to Childbirth was released in 2003 by Bantam/Dell, a division of Random House. She has lectured all over the world at midwifery conferences and at medical schools, both to students and to faculty. She was President of Midwives' Alliance of North America from 1996 to 2002. In 1997, she received the ASPO/Lamaze Irwin Chabon Award and the Tennessee Perinatal Association Recognition Award. In 2003 she was chosen as Visiting Fellow of Morse College, Yale University. Ms. Gaskin has lectured widely to midwives and physicians throughout the world. Her promotion of a low-intervention but extremely effective method for dealing with one of the most-feared birth complications, shoulder dystocia, has resulted in that method being adopted by a growing number of practitioners. The Gaskin maneuver is the first obstetrical procedure to be named for a midwife. Her statistics for breech deliveries and her teaching video on the subject have helped to spark a reappraisal of the policy of automatically performing cesarean section for all breech babies. As the occurrence of vaginal breech births has declined over the last 25 years, the knowledge and skill required for such births have come close to extinction. Ms. Gaskin’s center is noted for its low rates of intervention, morbidity and mortality despite the inclusion of many vaginally delivered breeches, twin and grand multiparas. Their statistics were published in “The Safety of Home Birth: The Farm Study,” authored by A. Mark Durand, American Journal of Public Health, March, 1992, Vol. 82, 450-452. Ms. Gaskin was featured in Salon magazine’s feature “Brilliant Careers” in the June 1, 1999 edition. She is the originator and coordinator of The Safe Motherhood Quilt Project, a national effort developed to draw public attention to the current maternal death rates, as well as to the gross underreporting of maternal deaths in the United States, and to honor those women who have died of pregnancy-related causes since 1982. Her newest book, Ina May's Guide to Breastfeeding, will be released October 1st, 2009.

Rep. Keith Fitzgerald, Ph.D.
Florida House of Representatives, District 69
University of Louisville, B.A., 1979
Indiana University, Ph.D., 1987

Representative Keith Fitzgerald was elected to represent State House District 69 in 2006. His district includes the northern part of Sarasota County and a small portion of Manatee County. Representative Fitzgerald was born in Springfield, OH and grew up in Louisville, KY. He holds a B.A. from the University of Louisville, and a Ph.D. from Indiana University. Representative Fitzgerald has lived in Sarasota and taught political science at New College of Florida since 1994. He and his wife, Angela Baker, have nine-year-old twins. Representative Fitzgerald is a lifelong public servant. From the time when he worked in high school and college as a reading tutor for dyslexic children until his present job as a college professor at New College of Florida, he has been an educator. As a Ph.D. in political science, he has studied politics his whole life, taught at colleges and universities and conducted scholarly research. Representative Fitzgerald serves as the Democratic Ranking Member on the Policy Council and as a member of the Finance and Tax Council, Health and Family Services Policy Council, Select Policy Council on Strategic & Economic Planning and the Military and Local Affairs Policy Committee. Representative Fitzgerald also serves as Policy Chair for the House Democratic Caucus. His prior leadership positions include service on the Advisory Council of Faculty Senates, the Board of Trustees at New College of Florida and the Sarasota City Charter Review Board.

Jennifer Highland, M.P.H.
Executive Director, Healthy Start Coalition of Sarasota County
University of South Florida, M.P.H. Public Health, 1995

Jennifer’s passion for helping mothers and infants began, of course, with the birth of her children. Most of her early career in Louisiana, Georgia and Texas was as a registered nurse working in hospital settings, in clinical nursing and staff development. Her education positions allowed her to utilize her graphic art skills in the development of printed educational materials and newsletters for hospital staff and nurses. After she moved to Florida and became a mother, Jennifer volunteered for the Breastfeeding Advocates of Sarasota County and completed her Master of Public Health Degree from USF, graduating in 1995. Jennifer was the Project Coordinator for the first and on-going national breastfeeding promotion campaign, “Loving Support Makes Breastfeeding Work,” through her employment with Best Start, Inc., in Tampa. She then became trained as a Childbirth Educator and taught at Sarasota Memorial Hospital. Her work at Healthy Start began in 2001 as the Contract/Quality Manager. Her role expanded to include professional education. In 2006 she became the Executive Director.

MODERATOR: Kelly Kirschner, M.A.
Sarasota City Commission (District 3 Commissioner / Vice Mayor)
B.S. Foreign Service, Georgetown University
M.A. Latin American Studies, Georgetown University

Kelly is a lifelong Sarasotan. He has served the Sarasota community as President of the Alta Vista Neighborhood Association as well as having been an active member of the Coalition of City Neighborhood Associations. Believing strongly in public service, Kelly has worked for the White House Office of Public Liaison; served as a Peace Corps Volunteer; and led a USAID community conservation project in rural Guatemala. Kelly lives with his wife, Tracy, son, Bodhi, and daughter, Selby, in District 3.

EVENT SPONSOR: Sonia Pressman Fuentes, JD
The National Organization for Women (NOW)
B.A. Cornell University 1950
J.D. University of Miami School of Law 1957

Sonia Pressman Fuentes, who was born in Berlin, Germany, of Polish parents, came to the U.S. with her immediate family in 1934 to escape the Holocaust. She graduated as valedictorian of her high school in Monticello, New York, Phil Beta Kappa from Cornell University, and first in her class at the University of Miami (FL) School of Law. She was an attorney for the U.S. Department of Justice, the National Labor Relations Board, the Equal Employment Opportunity Commission (EEOC), and the U.S. Department of Housing & Urban Development in Washington, D.C. She was the first woman attorney in the Office of the General Counsel at the EEOC and drafted a number of the Commission’s landmark guidelines and decisions. She was a co-founder of NOW, WEAL (the Women’s Equity Action League), and FEW (Federally Employed Women) and a charter member of VFA. She was the longest-serving board member in the history of NWP (National Woman’s Party). She also served as an attorney and executive, respectively, at the headquarters of GTE Service Corporation and TRW Inc., and was the highest-paid woman employee at each of those headquarters. In 1993, she retired from the federal government, thereafter wrote her memoir, Eat First—You Don’t Know What They’ll Give You, The Adventures of an Immigrant Family and Their Feminist Daughter, and embarked on new careers as a writer and public speaker. For further information, see her website.

EVENT COORDINATOR: Laura H. Gilkey, BLA
Florida Friends of Midwives (FFOM)
B.L.A. Landscape Architecture, University of Florida, 2000

Laura Gilkey serves on the Board of Directors for Florida Friends of Midwives, and is the Florida Coordinating Ambassador for The Birth Survey: The Transparency in Maternity Care Project. Laura is an endorser of The Mother-Friendly Childbirth Initiative and a member of the Coalition for Improving Maternity Care Services. She is a project coordinator and quilter for Ina May Gaskin's Safe Motherhood Quilt Project, intended to raise awareness about American maternal mortality. Laura has recently joined the Planning and Evaluation Committee for the Healthy Start Coalition of Sarasota County, whose mission is to improve the health and well-being of Sarasota's pregnant women, infants, and small children. Professionally, she is the marketing manager for Michael A. Gilkey, Inc., landscape architecture studio, and is the owner of Kangaroo Promotions, Inc., a creative marketing firm in Sarasota.

Each One Reach One: 2009 Membership Drive

2009-07-23T09:47:00.003-04:00

We are so excited to announce our 2009 membership drive, 'Each One Reach One!'

We are asking each of our individual and business members to sign up at least one of your friends, your clients, your family members, your neighbors or your colleagues for an annual membership to Florida Friends of Midwives. Let them know what their support means to you and to the future of birth choices in Florida. Let them know that by joining Florida F riends of Midwives, their belief that Floridians should have access to midwifery care has a voice. Let them know that without the voice of Florida Friends of Midwives two decades ago, we would not have the legal right to birth with Licensed Midwives today and they can be a part of that legacy of dedicated women.

Florida Friends of Midwives thanks you for your support and we want to show it! The current Florida Friends of Midwives member who bring us the most new members by Labor Day 2009 will receive your choice of item from our Café Press store, as well as a feature in the next edition of the Florida Friends of Midwives newsletter and on our website.

Thank you for your continued support of Florida Friends of Midwives. Together, we can make a real difference to promote and protect midwifery care in Florida. Please contact us with any questions, suggestions, or concerns, at membership@flmidwifery.org, or toll-free at (800) 925-1014.

Thank you for your continued support!

ChipIn: Contribute to our online fundraiser!

2009-07-23T09:38:00.002-04:00

Help us fundraise online!

Our online ChipIn fundraising event for our 2nd Annual Fundraising Campaign is now live and ready to collect money! The key to a successful ChipIn event is getting the word out, so here are a few tips for spreading the word about Florida Friends of Midwives ChipIn to your friends, family and clients:

1. Invite Your Social Network
Send a personal note to those that you want to contribute and tell them about our cause. Then, make sure that they can contribute easily - by posting a widget (tip #2) or creating a ChipIn Page (tip #3).

2. Post a Widget
The ChipIn Widget is a simple application that shows information about your ChipIn on any Web page you place it on. If you have a blog, a social networking profile, or your own Web site, just cut and paste your ChipIn widget code and you can let all of your visitors know about your ChipIn event! To create a widget for our event visit this URL: http://www.chipin.com/mywidgets/id/59b524ca9806356e

3. Visit our ChipIn Page
If you want a quick and easy way to share our ChipIn event, we have our own page at http://flmidwifery.chipin.com/2nd-annual-fundraiser which allows you to let your friends, family, and clients know more about what you are collecting money for and stay up-to-date on your progress..

4. Set a Target Amount that You want to Contribute to our Fundraiser
Although a target amount is optional, people are always more likely to contribute when a goal has been set. Even if you're not sure how much money you'll be able need to raise, we still recommend setting a target amount, as you can always change it later.

5. Ask Friends to Help You Promote
You can get other people to help you promote your ChipIn by asking them to copy your widget and post it on their own web sites. Just give them this URL: http://www.chipin.com/mywidgets/id/59b524ca9806356e

Support Florida Friends of Midwives annual fundraising campaign!

Call for Regional Group Leaders

2009-07-21T09:01:00.000-04:00

As the work facing FFOM becomes clearer, the need for committed volunteers is critical. Over the next few weeks, you will see several requests for committee members.

Think about ways in which you can help preserve birth options in our state. Where do your talents lie? What can you contribute?

As Regional Groups Coordinator, I am charged with the task of recruiting at least one Regional Group Leader for each of the 8 regions shown here.Some regions may ultimately be represented by more than one individual, depending of the size/number of metropolitan areas in a region. The following should answer your questions about why these groups will be so important in the work of FFOM.

Why are Regional Groups so important?

Florida is a diverse state, and the characteristics of its population, economy, communities, and environment vary widely from Pensacola to Miami, from Jacksonville to Clearwater. When FFOM was originally founded in 1989, it was made up of several regional friends of midwives groups who all decided to get together so they could become more effective. We'd like to keep that idea alive through the creation of regional groups. Regional groups will provide a local and regional perspective to our work and help us adequately address the issues that impact every region of the state.

What do Regional Groups do?

Regional groups are local groups of parents and professionals who share information, offer support, and protect the rights of women and families to make informed choices within their local community. Regional groups can get together for social and networking functions. We encourage local leaders to hold regular meetings and engage in bigger projects by participating in FFOM's educational, advocacy, and fund raising efforts.

If you are interested in leading a Regional Group in your area or have questions about regional groups, we encourage you to contact us at regions@flmidwifery.org.

Action Alert: Birth Center Reimbursement

2009-07-17T16:07:00.002-04:00

Medicaid Birth Center Reimbursement Act Introduced in the Senate

This has been a very busy week week in Washington, DC! In the Senate, U.S. Senators Barbara Boxer (D-CA) and Mark Begich (D-AK) introduced S.1423 the Medicaid Birth Center Reimbursement Act to ensure Medicaid birth center facility fee payments to states.

In the House, the health care reform bill H.R. 3200 "America's Affordable Health Choices Act of 2009" was introduced. This bill includes the birth center bill language but it does not guarantee that all state Medicaid plans will cover the facility fee.

It is CRITICAL that we have strong co-sponsorship for our bills in the House and the Senate. This means that we need YOU and your colleagues, family members, clients and friends to contact your federal Senators and Representatives RIGHT AWAY.

IMPERATIVE ACTIONS

Continue to work in the House and the Senate to secure co-sponsors for our bills (H.R. 2358 and S.1423).

Call your U.S. Senators and Representatives. Click here for directions on how to contact your Representatives and Senators and what to say. After you have made your calls, please call or email AABC's lobbyist Karen Fennell and tell her who you talked with and any comments or additional information requested. Call Karen at 301-830-3910; Send email here. This report to Karen is important so that she can follow-up.
Invite your Senators and Representatives to an Open House at your birth center during the August recess (the entire month of August). Invite the media and your clients to come. This is a win-win. The legislators and the birth center will receive positive press. We will develop an "Open House" packet and post it online in a few days for you to adapt for your community.
Attend the town hall meetings on health care reform that are being held across the country and make your voice heard at those meetings.

We MUST be prepared with strong co-sponsorship to move our legislation. Who is already a co-sponsor?

House Bill H.R. 2358
Sponsor: Susan Davis (CA)
Co-Sponsors: Gus Bilirakis (FL), Lois Capps (CA), Robert Whittman (VA), Tammy Baldwin (WI), Sander Levin (MI), Diana DeGette (CO), Eric Massa (NY), and Janice Schakowsky (IL)

Senate Bill S.1423
Sponsor: Barbara Boxer (CA)
Co-Sponsor: Mark Begich (AK)

We need EVERYONE to take action and ensure that our bill is passed as soon as possible!

Sincerely,

Jill Alliman, CNM, MSN
Chair, Legislative Committee
American Association of Birth Centers

Sarasota Fundraiser: Charity Mom and Baby Yoga Class

2009-06-25T14:23:00.002-04:00

Rosemary Court Yoga is offering a charity Mom & Baby Yoga class on Tuesday, July 7 from 10-11am. Donations will be accepted & donated to Florida Friends of Midwives.

Mom & Baby Yoga class instructor Kassandra Devlin is offering an energizing and rejuvenating class focusing on mothers' postpartum needs: regaining alignment, toning the pelvic floor, and building core strength. Babies are welcome and can be incorporated in the yoga poses or can nap/play on a mat. Recommended age is pre-crawling.

Please pass this along to your friends and come out and support yourself, support your baby, and support midwives!

Fight Florida's Ban on VBACs in Birthing Centers!

2009-06-22T00:34:00.005-04:00

Join the fight to change the State of Florida's ban on Vaginal Births After Cesarean (VBAC) in birthing centers.

Currently the State of Florida's legislative rule governing birth centers is written in a manner which has now been used to restrict women from choosing VBACs with any licensed practitioner in a free standing birth center.

The Florida Alliance of Birth Centers has retained an attorney to challenge the legislative rule banning a woman from attempting a vaginal birth after c-section in a birth center. With c-section rates in some Florida hospitals topping 70%, women's choices are being limited.

PUSH BACK for VBAC's.

Visit the Birthgirlz website for more details and please donate today.

Until midnight tonight, any donation made to this worthy cause will be matched.

An Invitation to Join the Midwives and Mothers in Action (MAMA) Campaign

2009-06-12T13:40:00.002-04:00

Come visit our new website at www.mamacampaign.org

Sign up to be part of the campaign
Endorse the campaign as an Individual or as an Organization
Share your birth story
Donate and volunteer

Please forward this invitation to family and friends.

The goal of the Midwives and Mothers in Action (M.A.M.A.) Campaign is to increase women's access to midwives and to quality, affordable maternity care by securing federal recognition of Certified Professional Midwives (CPMs). The MAMACampaign is a partnership between the National Association of Certified Professional Midwives (NACPM), Midwives Alliance of North America (MANA), Citizens for Midwifery (CfM), International Center for Traditional Childbearing (ICTC), North American Registry of Midwives (NARM), and the Midwifery Education Accreditation Council (MEAC).

Contact Us: info@mamacampaign.org

MAMA Campaign

c/o NACPM
243 Banning Road
Putney VT 05346
or call Citizens for Midwifery's Info line at 888-236-4880

The Midwives and Mothers in Action (M.A.M.A.) Campaign is launched!

2009-06-10T11:35:00.003-04:00

The goal of the M.A.M.A. Campaign is to increase women's access to midwives and to quality, affordable maternity care by securing federal recognition of Certified Professional Midwives (CPM). We have hired a federal lobbyist, a campaign manager will be hired by next week, and the M.A.M.A. Campaign website is almost complete.

This campaign is a partnership of the National Association of Certified Professional Midwives (NACPM), Midwives Alliance of North America (MANA), North American Registry of Midwives (NARM), Midwifery Education Accreditation Council (MEAC), Citizens for Midwifery (CfM), and International Center for Traditional Childbearing (ICTC). This historic partnership is now at work to get federal recognition of Certified Professional Midwives so that women and families will have increased access to quality, affordable maternity care in the settings of their choice. We look forward to working with everyone who supports this work and in concert with other national initiatives to achieve our common goals.

Our federal lobbyist, a specialist in health policy, will move our agenda in Washington, D.C. Billy Wynne is a former Senate staffer, an expert in Medicaid and health care reform, with a diverse portfolio of connections. He is excited to be promoting the values and important services provided by Certified Professional Midwives and is implementing a strategy with the M.A.M.A. Campaign Steering Committee, based on our priorities, for achieving success in this Congress.

A campaign manager will be hired by next week to work with the network of volunteers already lining up to support the M.A.M.A. Campaign. A campaign website is nearing completion; watch for the website launch announcement at the end of this week!

Your support will be essential to the success of the campaign. Watch for weekly updates and action alerts about how you can become involved!

We look forward to working with you in this effort!

The M.A.M.A. Campaign Steering Committee

ACTION ALERT: Health Care Reform

2009-06-02T21:04:00.002-04:00

Dear Midwifery Supporters,

Florida Friends of Midwives supports The Big Push for Midwives in their current federal legislative efforts. They have been hard at work presenting evidence in Washington that access to Certified Professional Midwives and out-of-hospital maternity care would save billions of US healthcare dollars while simultaneously improving birth outcomes.

Now, it's Florida's turn to show our support. Please read the following ACTION ALERT carefully, and take few moments to let our current administration know that this issue is important to you and your family.

Thank you,
Board of Directors
Florida Friends of Midwives
_____________________________________________________________________________________

As many of you may know, the White House issued a call this week asking citizens from across the country to send emails about what they would like to see in health care reform. Not long afterwards, the server accepting the emails crashed.

Why? Because it got flooded with emails about the President's birth certificate!

Now the press is reporting about it, just as they did when grassroots organizers for the legalization of marijuana set the record for the most number of emails sent during the transition-a mere 6000. We can top that!

It turns out there is another, lesser-known online form for submitting comments about health care reform. Let's use it!

If we top 6000 emails-and I know we can-we will set a new record and get the White House's attention on how strong support for out-of-hospital maternity care and Certified Professional Midwives is.

So please go to the following link and fill out the form with a short, simple message about why you want all women, including those on Medicaid, to have access to out-of-hospital maternity care and Certified Professional Midwives who are specially trained to provide it.

http://www.healthreform.gov/communityreports/comments.html

Pick one or two points to include in your own words: And always use the title, Certified Professional Midwives, spelled out.

Certified Professional Midwives are specially trained as experts in out-of-hospital maternity care and deliver babies in private homes and in freestanding birth centers.

Research consistently shows that low-risk women planning to deliver their babies at home under the care of Certified Professional Midwives experience outcomes equal to low-risk women who deliver in the hospital, but with far fewer costly and preventable interventions, including a five-fold decrease in cesarean section.

Babies delivered under the care of Certified Professional Midwives have significantly reduced rates of prematurity and low-birth weight, two of the leading contributing factors to racial and ethnic disparities in birth outcomes and to the costs associated with long-term care.

David Anderson, Professor of Economics at Center College with a specialization in the costs of out-of-hospital maternity care, calculates that increasing use of Certified Professional Midwives and of out-of-hospital maternity care by less than 10% would result in savings of $9.1 billion annually, while actually improving outcomes.

The state of Washington reports a savings of $3.1 million dollars over a period of two years to the state Medicaid system when women experiencing healthy, low-risk pregnancies give birth with licensed midwives instead of in the hospital.

The recent Milbank Report conservatively estimates savings of $2.5 billion dollars a year if the cesarean surgery rate is brought down to 15% in the U.S.

Certified Professional Midwives are the only providers specially trained in out-of-hospital birth in the event that hospitals become unsafe for healthy pregnant women during a disaster.

Thank you to everyone who is reaching out-it only takes a few minutes but it is so very helpful. We are making amazing progress in DC and now is not the time to let up! So please forward this to family and friends who can help, and thank you for doing your part to get Certified Professional Midwives and out-of-hospital maternity care included in health care reform.

ATTENTION MIDWIVES! Yes, we are shouting at you! Please send this action alert with a personal appeal to your networks of clients-it only takes a few minutes, and people are especially motivated to act when they get a personal request from their midwife.

STATE GROUPS! Please be sure to post this alert to your state lists!

Katherine Prown, PhD
Campaign Manager
TheBigPushForMidwives.org
414.550.8025
Envisioning a safer, less-costly model of maternity care in the United States.

Leadership Positions with Florida Friends of Midwives

2009-06-02T20:58:00.004-04:00

As the end of Florida Friends of Midwives (FFOM) second year of renewal draws closer, it has again become important to determine who in our community is willing and able to play a leadership role in what has to this point been the work of a small but dedicated contingent of individuals. FFOM has been structured to include several committees each of which is in need of members.

They include:

Fund raising (fundraising@flmidwifery.org)
Legislative (legislative@flmidwifery.org)
Communications & Public Relations (communications@flmidwifery.org)
Advisory Council (advisory@flmidwifery.org)
Membership (membership@flmidwfery.org)

If you are interested in serving on these committees, but not in a leadership role, please contact the committee chairs directly at the email addresses listed above.

In addition it is a priority to form regional groups in the following areas:

North Florida - East/West - (Tallahassee, Gainsesville, Jacksonville, Pensacola)
Central Florida - East/West -(Sarasota, Tampa, Clearwater, Daytona, Melborne)
South Florida - East/West - (Miami, West Palm Beach, Broward, Fort Myers, Naples)

Right now we are looking for FFOM members (consumers) who might be interested in serving as chairs for any of the Communications & Public Relations and Fundraising committees listed above and who might volunteer to coordinate regional groups in their area.

Last but not least, we are looking for one industrious and daring woman :-) to accept the position of Treasurer on the Executive Committee of our Board.

If you think any or these positions sounds like something you might want to do please let us know as soon as you can. Email us at info@flmidwifery.org.

ACTION ALERT: Congressional Briefing this Thursday, 5/21

2009-05-19T21:17:00.005-04:00

This Thursday, May 21st, at 8 am, a Congressional briefing will convene at the Sewall-Belmont House, 144 Constitution Ave. N.E., Washington, D.C. The topic of this briefing is the critical role that out-of-hospital maternity care (and the Certified Professional Midwives who are trained to provide it) can play in health care reform by reducing costs and improving outcomes.

Background: A recent study commissioned by the Washington State Department of Health found that Licensed Midwives saved taxpayers and private insurers approximately $2.7 million per year. A similar study conducted for Florida would prove that number much higher. In 2007, we welcomed 239,143 babies into the Sunshine State, as opposed to 88,958 in Washington. Medicaid currently covers about 49.6% of all Florida births (37.2% of which are cesarean sections) vs. 45.6% in Washington (29% c-section rate). Using these statistics, mathematics tells me that Licensed Midwives in Florida save taxpayers and private insurers over $10 million ANNUALLY.

A joint Milbank report released last year conservatively estimates that if the national cesarean section rate were reduced from its current 31.8% to the 15% World Health Organization recommended maximum, we would save at least $2.5 billion dollars per year in government-subsidized health care alone (not including private insurance companies). As currently only 26 states license midwives, this dollar amount will only increase with greater access to midwifery care, resulting in fewer interventions.

Studies show that low-risk women who plan out-of-hospital births with Licensed Midwives have outcomes equal to low-risk women who deliver in the hospital, but with far fewer preventable, costly interventions.

Do you believe that Licensed and Certified Professional Midwives play an important role in our health care system?
Do you believe that out-of-hospital births are safe for low-risk, healthy women attended by Licensed Midwives?
Do you believe that our current cesarean section rates (37.2% in Florida) are too high?
Do you believe that our government should support an initiative that would simultaneously save taxpayers money and improve birth outcomes?

If you answered yes to any of these questions, please consider taking a moment over the next couple of days to contact our federal legislators (contact links below). Ask them to consider officially co-sponsoring the briefing on Thursday. Suggest that they send a 'Dear Colleague' letter to encourage Congressional attendance. Most importantly, invite them to attend the briefing, as their doing so would represent your interest as their constituent.

Please read this Call to Action from The Big Push for Midwives, including talking points and tips for speaking with legislators. Remember, they work for you. Your voice will be heard.

US Senator Mel Martinez
US Senator Bill Nelson

Bilirakis, Gus M., Florida, 9th (*note:he's the one that co-sponsored the bill for medicaid reimbursement of birth centers)
Boyd, Allen, Florida, 2nd
Brown, Corrine, Florida, 3rd
Brown-Waite, Virginia, Florida, 5th
Buchanan, Vern, Florida, 13th
Crenshaw, Ander, Florida, 4th
Castor, Kathy, Florida, 11th
Diaz-Balart, Lincoln, Florida, 21st
Diaz-Balart, Mario, Florida, 25th
Hastings, Alcee L., Florida, 23rd
Grayson, Alan, Florida, 8th
Klein, Ron , Florida, 22nd
Kosmas, Suzanne M., Florida, 24th
Mack, Connie, Florida, 14th
Meek, Kendrick, Florida, 17th
Mica, John, Florida, 7th
Miller, Jeff, Florida, 1st
Posey, Bill, Florida, 15th
Putnam, Adam, Florida, 12th
Rooney, Tom, Florida, 16th
Ros-Lehtinen, Ileana, Florida, 18th
Stearns, Cliff, Florida, 6th
Wasserman Schultz, Debbie, Florida, 20th
Wexler, Robert, Florida, 19th
Young, C.W. Bill, Florida, 10th

International Day of the Midwife T-Shirts!

2009-05-02T07:24:00.017-04:00

To kick off our second annual fundraising campaign in high fashion, we have issued an International Day of the Midwife / Florida Friends of Midwives t-shirt! International Day of the Midwife is Tuesday, May 5th, but this t-shirt has an impactful message year-round:

The World Needs Midwives Now More Than Ever.

We have removed the date and year so that these shirts will be timeless and relevant for years to come. Please show your support for Florida Friends of Midwives and for this special observance by ordering your t-shirt today! Shirts are $15 and come in standard sizes S, M, L and XL. Shipping is $4; if you live in Sarasota, please email Laura Gilkey at membership@flmidwifery.org to avoid shipping charges.

Transparency Needed as C-Section Rates Rise

2009-03-28T09:15:00.000-04:00

CIMS, the Coalition for Improving Maternity Services, a group working toward transparency in maternity care, announced last week that the 2007 US birth statistics, just released, show that 31.8% of births are via cesarean section. The percentage of cesarean deliveries has increased by 50% since 1996 and is more than double the World Health Organization’s recommended rate of 15%.

Currently, cesarean rates vary widely across the US. The 2007 birth data highlight this variation; for instance, a woman giving birth in New Jersey has a 73% higher chance of having a cesarean than a woman in Utah.

This strong variation in rates isn’t only geographic; it is also seen among individual hospitals in a community. For example, in 2006, New York City, one of the few places facility-level rates are available, St. Vincent’s Staten Island Hospital had a rate of 44.5% compared to 17.2% at North Central Bronx Hospital. Many believe that this variation is due to high risk sicker mothers and babies that these hospitals serve; however, that is only part of the story. Extensive research has shown that these huge variations are strongly linked to the practices and policies of individual hospitals and providers not just the health status of mothers and babies.

“Most women believe that they will only have a cesarean section if they experience complications in pregnancy or labor. But research tells us that most of the factors affecting a woman’s risk of a cesarean have nothing to do with her health or that of her baby. One of the most effective strategies for avoiding a preventable cesarean is choosing a provider and birth setting with a low cesarean rate. In the United States, we are seeing increased public reporting of outcomes and procedure rates for facilities in surgical and cardiac care, but, access to maternity care data remains almost non-existent,” says Amy Romano, MSN, CNM, a transparency expert for CIMS.

C-section can be a life-saving procedure, but it is a major surgery that carries extensive risks for both mother and baby, risks that are not present in a vaginal birth. Research conducted by the World Health Organization shows that these risks of cesarean outweigh the benefits when the c-section rate exceeds 15%. Currently, women have no way of knowing if their local hospitals exceed this recommended rate.

“Women can unknowingly increase their risk of unnecessary surgery based on their selection of where and with whom to birth. To enable women to make informed choices, maternity care data must be available at the facility level. Whether requiring a c-section or planning a natural birth, women need data in order to choose the facility that most closely matches their needs,” said Elan McAllister, Founder of New York’s Choices in Childbirth and Co-chair of the Transparency in Maternity Care Project.

Transparency empowers consumers, and studies have shown that public reporting of intervention rates and outcomes leads to better healthcare. New York and Massachusetts are the only states with legal mandates to require release of facility-level maternity care obstetrical intervention statistics such as cesarean sections. Unfortunately, such information remains unavailable in most parts of the country, but a CIMS project is working to change this fact.

To help expectant parents to make informed health care decisions about where and with whom to birth, CIMS developed the Transparency in Maternity Care Project: The Birth Survey. CIMS has trained local level ambassadors across the US to interface with their state departments of health to work to make facility-level intervention rates available to the public. As intervention rates are obtained, including the rate for c-sections, they will be included in publicly accessible free reports.

Transparency of health care information is increasing across the US and maternity care must be included in this movement. Otherwise, women are choosing their place of birth blindfolded and potentially increasing their chances of having an unnecessary cesarean section as rates across the country continue to rise above recommended levels.

Jana Borino: A Retrospective

2009-02-27T15:45:00.003-05:00

In Memoriam ::
Jana Borino
December 5, 1964 -
February 13, 2009

This biograpohy was reproduced from the program to Jana's memorial service, with permission from the collaborative authors. The service was held at Kanapaha Botanical Gardens in Gainesville, Florida. Guests were encouraged to wear bright colors, children were invited to speak, and the service closed with all present joining in song.

Jana Borino was born on December 5, 1964 to parents Carl and Sue Borino in Belleville, NJ, and was raised in Pompano Beach and Plantation, FL. Jana was an independent spirit who, from an early age, enjoyed music and dancing. Jana grew up along side her brother Carl Borino and her sister Terri Borino-Gordon. At the young age of 11, Jana valiantly braved Hodgkin's disease. During these early years, Jana was greatly influenced by her paternal grandmother, Tessie Borino, who gave her a respect for the birth process and the rearing of a child. At age 18, Jana packed her car and moved to Gainesville, Florida where she met her husband of over 26 years, Keith Gretter. When Jana became pregnant with their first daughter Chelsea, she became a client of the Birth Center of Gainesville, and delivered Chelsea at home with the assistance of a Midwife and some of her closest friends. This personal experience at the age of 19 ignited a passion in Jana for the field of midwifery.

After such an incredible birth herself, Jana knew that she wanted to become a Midwife so that she could be of assistance to other families looking for an alternative to a hospital birth. Jana attempted to enroll in Midwifery school, but her dreams were quickly halted when an amendment was added to the Midwifery bill in the state of Florida. This amendment prohibited any new students from gaining licensure, or allowing them to legally practice Midwifery in the state of Florida. Jana believed strongly in the values that midwives bring to communities and began a crusade to once again legalize the practice of direct-entry midwives. In 1992, the hard work of many individuals across the state, including Jana, paid off when Florida Statue 467, The Midwifery Practice Act, that allowed for the licensing of direct-entry midwives in Florida was once again opened. Jana felt deeply that Gainesville needed a Midwifery school that would allow students to become Licensed Midwives upon completion. Jana's vision came to fruition with community outreach and education, trips to Tallahassee, and many fundraising events. Jana met with numerous state officials to develop a curriculum framework for educational programs under the new law. During this time in Jana's life she also gave birth to their second daughter, Emma. Emma's homebirth assisted by a Midwife only strengthened Jana's commitment to her vision of a Midwifery school in Gainesville. Jana's many roles in her community and in her home were supported directly by the love and compassion of her husband Keith. His continued support allowed Jana to reach each and every goal she set for herself, her community, and her family.

Once the law was passed, Jana brought together a group of strong and intelligent women to form the founding Board of Directors of the Florida School of Traditional Midwifery (FSTM), and soon after these women accepted their first class. Jana was the founding mother and Executive Director of the FSTM for over 13 years. Jana made many contributions to the school with her incredible teaching, fundraising, grant-writing and public-speaking skills. Not only did Jana fight for the advancement of Midwifery in the state of Florida as well as nationally, she attended numerous births as a Midwife's Assistant for over 20 years. Jana also served on many boards and committees of national, state and local midwifery organizations, including as a board member of the Foundation for the Advancement of Midwifery. This foundation recently created a grant called "The Jana Borino Award for Community Development," to honor Jana's numerous contributions to the field of Midwifery.

Almost 13 years ago, during a beautiful homebirth, Jana and Keith brought their third daughter, Tessie into the world. Shortly after that, Jana was diagnosed with breast cancer, which she battled and braved for the past 10 years. After a long and valiant fight, Jana passed away peacefully in her home in Gainesville, FL on February 13, 2009, surrounded by her loving family. Although many of us remember Jana as a pioneer, visionary and powerhouse in the field of Midwifery, Jana herself was most proud of her role as mother to her three beautiful daughters, Chelsea, Emma and Tessie. Even though she was tireless in her work in our community, she always kept the girls close to her heart and encouraged their growth into strong and healthy women.

Jana was passionately committed to her friends. They would all laugh in a heartfelt way when each of them would say they were Jana's best friend...and they were. Jana had the special gift of making each person feel loved, special and worthy. She insisted that each live their dream and find the commitment within themselves to make a difference in our world. Her determination to be a voice for women, children, and families came through time and again in her role as a community leader, mother and friend.

As Jana's spirit leaves her physical body and begins its new journey, we know we will never be the same. Left behind is a legacy of families whose lives have been forever touched by the mission of this extraordinary woman. All of us in Jana's life know that this world is a better place because of her.

C-sections increasing infant mortality

2008-08-22T13:38:00.003-04:00

In the June entry, we examined how c-sections could be increasing maternal mortality in the United States. Now let’s examine the other half of the equation – the baby. As of 2006 our infant mortality rates fall all the way to the second worst in the modern world, according to reports published in an article by CNN (www.cnn.co m/2006/HEALTH/parenting/05/08/mothers.index./). Most of the European nations rank better, and several studies and reports have noted that the United States offers inferior health care regardless seemingly better supply of medical resources. It is also noted that those same countries regularly employ midwives as care providers while our society seems to shun these women – treating them as nothing more than relics. However, midwives are excellent assets to good prenatal care and have lower rates of c-sections.

Studies have shown that c-section babies have poorer outcomes than their vaginally born peers. One such study published in Birth looked at a group of babies born in uncomplicated vaginal births and a group of babies born by planned, uncomplicated c-section births (www3.interscience.wiley.com/cgi-bin/fulltext/118622106/HTMLSTART). When the two groups were compared, it was found that babies born via c-section had higher mortality rates. Another such study published in BMJ also concluded that infants in the occipital anterior position faired better during vaginal delivery than a c-section – either planned or not (www.reuters.com/article/healthNews/idUSSAT17412420071031). Why would this be? As previously discussed, there are risks involved with a c-section, such as a potential for injury to the baby during the incision process. Also, babies born via c-section do not have the benefit of passing through the birth canal where some of the fluid in their lungs is pushed out, leading to higher rates of respiratory distress. Of course, there are many more risks involved, but these are just two examples of what could go wrong during a c-section.

Another factor in this epidemic would be the number of elective c-sections being performed prior to 40 weeks. Because each baby is different, we run the risk of extracting a baby from=2 0the womb before s/he is fully developed and ready to be born. The March of Dimes discusses the risks associated with being born prematurely as difficulties in breathing, feeding, temperature regulation, and jaundice (www.marchofdimes.com/pnhec/240_19673.asp). With the increase of non-medically needed, elective c-sections comes the increase of babies being born prematurely. Prematurity increases mortality. The CDC lists prematurity as being the second leading cause of death in infants (www.cdc.gov/MMWR/preview/mmwrhtml/mm5642a8.htm). A study published in Pediatrics also found that preterm births account for a little over one third of infant deaths. This is alarming in a country where we seem to have so many neonatal intensive care units.

So what should we do to decrease the infant mortality rate? First of all, we should look to our peers in Europe and Japan to see what type of care they provide. As previously stated, those countries tend to treat midwives more like competent care providers and trust the thousands of years of collective experience midwives have accumulated throughout the history of humankind. Secondly, we should seek to increase educational outlets for women aspiring to become midwives and teach our doctors, doctoral students, patients, and others involved in patient care about the risks involved with ro utine medical interventions. We want healthy families – that means both healthy mothers AND healthy babies!

Florida Friends of Midwives Responds to the Closure of Miami Dade College's Midwifery Program

2008-08-17T21:47:00.003-04:00

Despite strong opposition from the community, Miami Dade College's Midwifery Program to close indefinitely

MIAMI, FL (August 14, 2008) – Florida Friends of Midwives (FFOM), a non-profit grassroots organization dedicated to promoting and supporting the practice of midwifery in Florida is disappointed and concerned with the indefinite closure of Miami Dade College's Midwifery Program, a vital program to the local community and to communities statewide. Despite strong opposition expressed by students, mothers, midwives and concerned members of the community, the College cited tough economic times as the reason for their decision.

On Friday August 8, 2008, the College held a meeting at the Medical Campus to formally announce the closure of the program and return prepaid tuition to currently enrolled students. At that meeting, members of the public showed up to express their disappointment and dissatisfaction with the closure of the program. The College claims tough economic times have caused them to close programs with low enrollment and high costs. However, Midwifery is the first and only one out of over 200 degree-granting programs offered at Miami-Dade College to be eliminated as a result of those cuts.

Students, who had already completed all course requirements to be admitted into the program, were devastated. Some students had relocated to South Florida, and many had already taken out loans to cover tuition costs. "Miami Dade College doesn't understand that we didn't choose to be in this career program just to have any degree – this is our passion," said Melissa Chin Casey, who was set to start the Midwifery Program in the Fall 2008 semester. "It's insulting and cruel for the administrators to say the program was cut because of low enrollment, when we are practically beating down the door for them to let us in. As a public education institution, they have failed this community."

MDC's accredited Direct-Entry Midwifery Program was the first in the country to be offered at a public institution, offering students a more affordable option compared to the programs offered at private colleges and universities. Since it's inception in 1994, over 80 midwives have been trained and graduated the program.

"This community has endured a great loss with the closing of this program," said Tamara Taitt, president for Florida Friends of Midwives. "Many of the women who have graduated from this program have become indispensable to our community by providing quality and personalized pre- and post-natal care."

Obstetrical care in South Florida has come under scrutiny in recent years as the rate of caesarean sections in the state of Florida has increased to an all-time high of 36.6% in 2006 which is well above the World Health Organization and Healthy People 2010's recommendations of 15%. Specifically, Palm Beach County had a cesarean section rate of 39.3%, Broward was 41.2%, and Miami-Dade was 45.5%. According to the Florida Council of Licensed Midwives, Florida Licensed Midwives had a cesarean section rate of 6.3% in 2006. There is also expected to be a significant shortage of Obstetricians in the tri-county area within the next three years.

Miami Dade College is a public institution and has an obligation to the public it serves. FFOM believes it is unjust to close a program that is crucial on a number of levels. To take away this program is to take away one of the only affordable opportunities in this country for women to become Licensed Midwives through an accredited program.

FFOM urges the College to reconsider the closure of the Midwifery Program and also ask for continued support from the community in our efforts to keep this program open.

About Florida Friends of Midwives
Florida Friends of Midwives is a non-profit grassroots organization dedicated to promoting the Midwives Model of Care and supporting the practice of midwifery in Florida. Florida Friends of Midwives was formed to support midwives who offer safe, cost-effective, evidence based care to Florida's families. For more information, please visit www.flmidwifery.org.

# # #

Response to AMA Resolution 205

2008-07-13T23:19:00.003-04:00

Recently, the American Medical Association (AMA) released a resolution in favor of lobbying for legislation stating that hospitals are the safest place to birth:

RESOLVED, That our AMA develop model legislation in support of the concept that the safest setting for labor, delivery, and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex, that meets standards jointly outlined by the AAP and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers.” (Directive to Take Action) (http://www.ama-assn.org/ama1/pub/upload/mm/471/205.doc)

While this does not blatantly state the AMA will seek to outlaw home birth, one can imagine that legislation dictating that women should give birth in a hospital or birthing center within a hospital would imply women will forfeit the right to give birth at home. The AMA makes this resolution based upon issues of safety. However, safety may not be the true issue behind this resolution.

According to a study published in the British Medical Journal by Kenneth C. Johnson and Betty-Anne Davis, home birth is just as safe as giving birth in the hospital and associated with lower instances of intervention in low-risk pregnancies (http://www.bmj.com/cgi/content/full/330/7505/1416?ehom). In fact, the ratio of women undergoing continuous electronic fetal monitoring (EFM) is remarkably lower at home than in the hospital.. From my personal experience, the belts for the EFM were uncomfortable and easily moved by my unborn children. Isn’t it obvious that you wouldn’t receive accurate readings of the baby’s vital signs if s/he kicks it away? Moreover, a study published in The Journal of Perinatal Education shows that routine interventions do not improve maternal and infant outcomes (http://www.lamaze.org/Default.aspx?tabid=461, http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1905822). In fact, these routine interventions – which are more often than not performed in hospitals20– cause more harm than good in low-risk pregnancies and lead to unnecessary c-sections. The World Health Organization (WHO) actually recommends the midwifery model of care for the majority of pregnancies and seeks to lower the number of unnecessary c-sections being performed (www.who.int/entity/making_pregnancy_safer/documents/newsletter/mps_newsletter_issue5.pdf). It would seem the medical model of care in this country is currently failing us in that c-section rates have sky-rocketed, along with the rates of interventions.

I suggest instead of lobbying for legislation stating what setting is best for childbirth we review the United States Constitution, the Bill of Rights, and the Patients’ Bill of Rights. Passing any legislation that would define where a woman could give birth is a blatant violation of our rights as citizens of this country. We should also review studies from all ends of the spectrum to make informed choices.

Could C-sections Be Increasing Maternal Mortality?

2008-06-13T21:57:00.004-04:00

The adage “healthy baby, healthy mother” is touted by people everywhere. One half of that equation – the mother – must provide care for herself and her newborn for at least a couple of decades. However, we have seen a rise in the maternal mortality rates here in this country. In 2003 and 2004, the maternal mortality rates rose to 12 per 100,000 and 13 per 100,000 respectively (http://www.kaisernetwork.org/Daily_Reports/rep.index.cfm?DR_ID=47116). To make that easier to understand, 1 in 7692.31 women will die during childbirth or the six week post-partum period. The United States of America boasts advanced technology, state-of-the-art gadgets, and renowned research facilities. Why then are we experiencing a surge in what was once thought of as a third-world country issue? Perhaps we need to look no further than the rising c-section rates.

The CDC statistics have shown a continued increase in the c-section rates here in this country to the tune of 50% in the last ten years (www.int.com/articles/2008/04/22/opinion/edlanger.php). The truth is that 1 out of every 3 pregnant women will undergo a c-section. A c-section is a major abdominal surgery that carries the same risks as any other abdominal surgery, yet women are increasingly being convinced of all the benefits involved in a c-section. “You won’t have bladder dysfunction.” “You’ll avoid vaginal tearing.” “You can schedule your baby’s birthday!” All of these so-called benefits are given much more emphasis than the risks: injury to intestines or bladder (still think you can avoid that bladder dysfunction?), injury to the baby, post-partum hemorrhage, infertility, death. In fact, women are 3 times more likely to die during a c-section than a vaginal birth according to a large study published in the Lancet (http://www.wddty.com/03363800369784516151/c-section-aftershocks.html, Lancet, 1999; 354: 776). I would like to assert the clear correlation between the rising c-section and maternal mortality rates and make the case women everywhere to be on high alert.

Let’s examine some probable causes as to how the c-section rate is affecting the maternal mortality rate. In the United States, we have seen a rise in obesity, which seemingly sets up pregnant women for a c-section. Speculation and early research claims obese women have weaker contractions due to obesity-related health problems (http://www.medicineonline.com/news/12/8821/Obese-pregnant-women-may-have-weaker-contractions.html). “Fetal distress” may also be cited as a reason for c-section in obese women when, in fact, the monitors are simply not working through the mother’s fat tissues. Another cause of the rising c-section rate is the increasing number of older first-time mothers. It would seem that many women delay having families in order to complete higher education and start careers. Older women are much more likely to end up with a c-section regardless of whether they are high risk or low risk (http://www.webmd.com/baby/news/20070312/older-moms-have-more-c-sections). Furthermore, hemorrhage and sepsis are the leading causes of maternal mortality throughout the world – both of which are risk factors in c-sections (www.who.int/reproductive-health/publications/interagency_manual_on_RH_in_refugee_situations/ch3.pdf). While we could discuss all of these causes in further depth, I trust that my assertation that the rising c-section rate is increasing the maternal mortality rate has been made clear.

I’m a believer in the saying that “prevention is the best medicine,” and I would like to further assert that simple preventative measures can both lower the c-section rates and the maternal mortality rates. First of all, I suggest every single pregnant woman learn as much as she can about the pros and cons of c-sections and other medical interventions. Perhaps with more knowledge, women wouldn’t be so apt to choose an elective c-section. Secondly, eat a healthy, balanced diet and get plenty of exercise. No one can go wrong with that recommendation, whether young, old, male, female, white, black, green, or polka-dotted. Thirdly, seek consultation from a midwife. Midwives have lower rates of c-sections and can provide excellent prenatal care for most pregnant women. Finally, know your rights as a patient and exercise your right to refuse treatments. If no medical indications show a necessity for c-section, simply repeat these words: “I do not consent.” Your doctor may not like hearing those words, but it is his or her responsibility to respect your wishes as his or her patient. You are the boss, you are paying them for their services, and you certainly wouldn’t take insubordination from an employee.

Need More Midwives

2008-05-14T16:53:00.000-04:00

Recently, Florida’s birthing atmosphere has experienced a major epidemic. Due to the rising costs of medical malpractice, OBGYNs are increasingly nitpicking patients in order to decrease their chances of litigation and maximize their profits. Some OBGYNs are even discontinuing practicing obstetrics simply because it carries too many risks of litigation and not enough compensation. Medical students are afraid to go into the obstetric field because they’ve heard all the bad stories surrounding medical malpractice suits and insurance premiums. For more details on this issue, you may read the article “More S. Florida obstetricians stop delivering babies” in the Sun Sentinel (http://www.sun-sentinel.com/news/local/palmbeach/sfl-flpobgynpnapr14,0,6542600.story).

Enter midwifery. Two midwifery schools here in Florida are the Florida School of Traditional Midwifery in Gainesville and the International School of Midwifery in Miami. However, more programs are being offered in other locations around Florida as the need arises for more midwives. For starters, did you know that midwives can offer care to many patients who currently see OBGYNs? If patients began seeing midwives, more OBGYNs could get back to their basis of their practice – caring for high-risk pregnancies. Not only would this take pressure off of the obstetricians, but this would also offer many women the wonderful opportunity to experience the midwifery model of care. You can read more about the midwifery model of care at the Citizens for Midwifery website (http://cfmidwifery.org/mmoc/index.aspx).

Midwives come in a variety of settings and types. To start with, midwives practice in hospitals, birthing centers, and even your own home. Depending on your wants and needs, a midwife can definitely accommodate your desired location. Next, midwives in Florida practice as either Licensed Midwives (LMs) or Certified Nurse Midwives (CNMs). Much in the way you would choose among a Family Practitioner, Obstetrician, Perinatalogist, or Maternal-Fetal Specialist, you have a choice of what type of midwife you’d like to attend your birth. An excellent explanation of the differences among these types of midwives can be found here (http://www.naturalbirthandbabycare.com/midwives.html). This source also cites the wonderful fact that midwives can care for more than just low-risk patients. Even women with prior c-section deliveries can receive care from a midwife.

As far as becoming a medium or high risk patient, it is still very possible to receive both prenatal care from a midwife and visit a specialist for whatever may ail you. For example, having gestational diabetes does not necessarily risk you out of a midwife’s care – she can simply send you for visits with a perinatalogist from time to time while still maintaining you as a patient. Women with prior c-sections generally do not need a repeat c-section as most causes for the previous c-section do not reoccur in subsequent pregnancies. Many women have gone onto have success homebirth deliveries after a c-section with both mother and baby turning out happy and healthy.

A Reflection on the ACOG Statement on Homebirths

2008-03-21T23:05:00.002-04:00

By: Misty M. McGovern, Student Midwife

Much has been said in my community in the few weeks about the recent ACOG (American College of Obstetricians and Gynecologists) anti-homebirth anti-midwifery press release. If you are a member of even just one natural parenting, natural birthing, midwifery or attachment parenting group, you have probably heard plenty of outrage about it. I find this subject to be of the utmost importance to myself and to all other women in this place we call "home". We must assure that women's rights, not doctor's pocketbooks, are protected first and foremost. As women, we have a responsibility to ourselves, and to our sisters and daughters, mothers and aunts, to make our voices heard and to speak up for ourselves and all women in this country and worldwide.

The German philosopher Arthur Schopenhauer (1788 - 1860) once said: "All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident." I love this quote, and used it as a tag line in all of my signatures for a very long time. It can be tested against so many things and found to be true. I think back to acupuncture. Not all that long ago, in my lifetime, acupuncture was considered irrational, illogical and irresponsible. Then, it was considered down right *dangerous* by western society. If you used it in place of allopathic medications, you were basically considered to be writing your own death certificate.

Thousands of years of predictable results, even documented results, were not good enough to convince our doctors of the safety and efficacy of the treatment, even when our western lab-made medicines could do nothing more. However, now that the gold standard of double blind studies have "proven" that acupuncture indeed does work, and quite well, attitudes are changing! Now, the acupuncturists, and those who had been "sold" on acupuncture already knew this, they didn't need double blind studies to tell them, just age old experience. Acupuncture is now more accepted in our society, and you can find an acupuncturist almost as easily as you could find a McDonald's! Acupuncture has even been incorporated into nursing textbooks and has turned into a viable (though, granted, not ideal in the eyes of western medicine) alternative or adjunct to western treatments.

The same can be said about homebirth, and midwifery. For thousands of years women relied on other women to help them through their labors and births. It was a sacred event into which men were not welcomed in most societies. Women were empowered with the task of bringing forth life, and allowing the human species to continue on. But at some point in history we relinquished our power to the doctors. Even in the early obstetrical years, properly trained midwives consistently had better maternal and fetal outcomes than did doctors. This fact, though often overlooked by the "professionals", still holds true today.

This brings me back to Arthur Schopenhauer. First, midwifery and homebirth were ridiculed. This began in the late 1840's (possibly quite a bit sooner, depending on who you ask!) when midwifery was looked at as second class care for poor people. When I was in high school in the 1990's, my best friend's aunt had a baby using a midwife. I asked my mother what a midwife was exactly and she replied, "Oh, that's what poor people use to deliver babies when they can't afford a doctor. It's quite irresponsible!" That was all I knew of midwifery until researching it on my own after deciding to have children. Midwives of today continue to battle ridicule!

"...Second, it is violently opposed." This is where I really think we are now. This is part of the reason that I think midwives, midwifery advocates, and women as a whole should both rejoice, and scream even louder in protest as a result of the recent ACOG statement! We are making a difference, and we are causing change. This change is evident in the fact that ACOG and its members feel attacked by midwifery. They feel like midwifery is a threat to their pocket books, and this has them all in a bunch! We must keep them backed into a corner with our superior care of women; our superior maternal/fetal outcomes; our superior cesarean section rates; and our superior breastfeeding rates! We should continue to make them shake in their boots about us, until they finally realize that which we all already know: that competent midwifery care is ideal for the normal, healthy, low risk pregnant woman's care.

Eventually, this will be "accepted as self-evident." To quote ACOG, "The main goal should be a healthy and safe outcome for both mother and baby." We already know that in low risk, normal pregnancy, women that birth with midwives who maintain non-interventive policies fare far better statistically than induction, epidural, lithotomy position, cesarean section happy OBGYNs. We don't need their "scientifically rigorous" studies to prove it to us. The ACOG statement just brings us one step closer to our ultimate goal, which is a total reintegration of the midwifery model of care for women and babies throughout the country, and the world. Let’s take the outrage that we feel boil up from deep in our bellies upon reading the statement and turn it into energy to create positive change. After all, women are strong, and tired of being bullied. We're ready to take back what is ours, one empowered birth at a time.

Choosing A Care Provider

2008-03-12T17:18:00.001-04:00

When choosing a primary care provider, we don't ordinarily rush to hire a surgeon to handle our every need. A sneeze does not indicate a necessity for rhinoplasty, nor does a headache always require brain surgery. So why then is it that women are rushing into the arms of surgeons to give birth? Obstetricians are surgeons who go to medical school to specialize in surgical techniques for labors and deliveries gone wrong. It wasn't until the late 19th century that the practice of routine intervention became commonplace, more than likely due to the advent of antiseptics, antibiotics, and anesthesia. Before the popularization of obstetrics, midwives cared for most pregnant women during labor and delivery. Thousands of years of history and experience refined their skills and abilities into what we now know as modern midwifery. The scope of midwifery covers much of the natural processes of pregnancy and childbirth, yielding only to complications in which medical intervention becomes necessary and life saving. Midwives are trained to minimize interventions and respect the natural birth process, which yields better outcomes for mothers and babies.

Midwives practice evidence-based care. "Evidence-based" means using results of the best research about the safety and effectiveness of specific tests, treatments, and other interventions to help guide maternity care decisions. You may be surprised to learn that most maternity care in the United States is NOT evidence-based. Midwives receive training in labor and delivery just as an obstetrician does; however, the midwife is more akin to your primary care physician who refers to a specialist – for complications outside of the general practice scope. In some states, including Florida, midwives receive licensure as well. While we are more likely to hear about cases in which bad outcome are associated with midwife-attended births, those situations most certainly do not represent the majority of such births. The National Birth Center Study (Rooks et al., 1989) found that birth centers were a safe alternative to hospitals for women at low-risk of birth outcomes, and used fewer resources than hospitals did. A systematic review of midwife-led birth centers reached the same conclusion (Walsh & Downe, 2004). Similarly, a recent study of more than 5000 women intending to birth at home attended by Certified Professional Midwives found a similar rate of intrapartum and neonatal mortality rates as in low risk hospital births, but with lower medical intervention rates (Johnson & Daviss, 2005).

Midwife means "with woman." Midwives provide personalized care that respects individual and cultural differences. With a midwife, you become an active partner in your care working with your midwife to decide the course of your pregnancy and birth. Whether you are a first-time mom or a fifth-time mom, a new baby will change your life in wonderful and unpredictable ways. The outcome of a birth is more than a healthy mom and baby – it’s a family. Midwives treat you as a whole person while addressing your physical, emotional, psychological, and spiritual needs throughout pregnancy, birth, and the postpartum period. Remember midwives when you think of pregnancy and childbirth. Healthy, low-risk women have the option of hiring a midwife to care for them during pregnancy. Women have the right to choose what type of practitioner will provide their prenatal care.

The Cesarean Epidemic

2008-03-10T09:14:00.002-04:00

The most common operating room procedure in U.S. hospitals, c-section involves considerable morbidity in women and babies and considerable expense for private payers/employers and Medicaid/taxpayers. - Childbirth Connection

The percentage of United States’ births delivered by cesarean section has increased substantially in recent years, climbing 50 percent over the last decade from 20.7 percent of all births in 1996 to a new record high of 31.1 percent in 2006 (1,2). These statistics are featured in a new report released in December 2007 by U.S. Centers for Disease Control and Prevention (CDC) National Center for Health Statistics, and are based on data from over 99 percent of all births for the United States in 2006. Consistent with the rise in the national rate, the 2006 C-section delivery rate was 36.0% of all deliveries in Florida up from 22.6% in 1997. In a 2006 report from the Agency for Health Care Administration (AHCA) Center for Health Statistics C-section rates were found to be higher among women of Hispanic ethnicity and among women ages 30 years and older in 2004. South Florida had the highest rate of any region. Of the ten facilities statewide who had the highest cesarean rate six were located in Miami-Dade County. (9) In 2006, the C-section rate for Miami-Dade was a staggering 44.8%. While many experts contend that there is no “ideal” cesarean rate, the World Health Organization (WHO) maintains that in a developed country, the proportion of cesareans should not exceed 15%; beyond that, the maternal injury and death consequent to major abdominal surgery being to eclipse the lives and health saved.(3) More women suffer from infection, hemorrhage and death, and babies are more likely to be born prematurely or die.

There is little evidence that a vast, growing segment of the female population wants or needs major abdominal surgery to give birth. (5) Until the 1940’s, cesarean delivery was rare and only utilized as a last resort to save the baby, many times at the cost of the mother’s life. One in 16 women died. Advances in surgery, antibiotics, transfusions and anesthesia have made an operation that was nearly always fatal as recently as the mid-19th century routine 150 years later. Despite these advances, serious consideration should be given to the risks involved in cesarean surgery. Recent mortality figures from a large study of over 150,000 elective Cesarean operations in Britain show that mothers run nearly three times the risk of dying from a Cesarean section than from a natural delivery. Additionally a woman having a repeat C-section is twice as likely to die during delivery and twice as many women require re-hospitalization after a C-section than after a vaginal birth. (6)

Not only is the health of the mother impacted. Since vital statistics data on cesarean sections was first collected in 1989, the infant mortality in the United States for total cesarean deliveries has consistently been about 1½ times that of vaginal delivery. (7) It had long been assumed that the difference was due to the higher risk profile of mothers who undergo the operation. Many have pointed to changes in the population of childbearing women, such as more older women who have developed medical conditions and more women with extra challenges of multiple births. While there are some overall changes in this population, researchers have found that cesarean section rates are going up for all groups of birthing women, regardless of age, the number of babies they are having, the extent of health problems, their race/ethnicity, or other breakdowns (7). A study of almost six million births published in the September 2006 found that the risk of death to newborns delivered by voluntary Cesarean section is much higher than previously believed. This study, according to the researchers, is the first to examine the risk of Cesarean delivery among low-risk mothers who have no known medical reason for the operation. Study authors used the Healthy People 2010 criteria for low-risk (women with a full-term, singleton infant in head down presentation) and included only women who had no reported risk factors or complications of labor and delivery identified on the birth certificate. (14) Among this group there was a 49% increase in odds of cesarean delivery from 1996 to 2001, after statistical adjustment for maternal age, race, education, birth weight and parity. Researchers found that the neonatal mortality rate for Cesarean delivery among low-risk women was 1.77 deaths per 1,000 live births, while the rate for vaginal delivery was 0.62 deaths per 1,000. The risk in first Cesarean deliveries persisted even when deaths from congenital malformation were excluded from the calculation. (7) In other words, there is a change in practice standards that reflects an increasing willingness on the part of professionals to follow the cesarean path under all conditions.

Despite these cautionary statistics the rising trend of surgical birth persists. The overall increase in cesarean sections is due in large part to a notable rise in primary section rates, from 14.6 percent in 1996 to 29.0% in 2004. This increase is also partly attributable to the decline in Vaginal Birth After Cesarean (usually abbreviated VBAC) at an all-time low of 9.2 percent in 2004. (13)A woman who has a primary cesarean section has a greater than 90 percent chance of having a subsequent cesarean delivery. A policy statement published by The American College of Obstetricians and Gynecologists (ACOG) in 1998 recommended a surgical team and anesthesiologist must be available twenty-four hours a day in order for VBAC to be safe. Many hospitals who fall short of this criteria have been choosing not to allow women to attempt VBACs within their facilities because they cannot provide 'immediate' surgery if needed. A large number of physicians feel that the risks of uterine rupture (developing a tear in the wall of the uterus) that accompany VBAC are too high and that an elective or scheduled c-section is the best option for a mother who had the surgery for a prior pregnancy. Yet evidence is growing that scars in the uterus which accompany cesarean surgery can cause placental abnormalities that endanger both mother and baby in future pregnancies, and that the risk of these abnormalities increases dramatically with a subsequent cesarean. (8) Cesareans are inherently riskier than normal vaginal birth, but repeat cesareans carry even higher risks.

Today, more than ever physicians may be turning to Cesareans sections in order to avoid potential litigation. Under the specter of lawsuits C-sections have gradually become more about caution and convenience than life or death. Many obstetricians contend that patients are driving this trend with their almost unreasonable aversion to even the smallest risk. (4) The tragedy behind this phenomenon is that a cesarean is not a guarantee of a happy outcome. In comparison with other industrialized nations, the United States ranks second-to-last in infant survival and for the first time in decades the number of women dying in childbirth has increased. (10) Some experts cite consumer demand as a contributing factor in the rising cesarean rate. A New York Times article published December, 2007 noted that there was some evidence that a growing number of women were requesting Cesareans. (4) Yet, findings from the large and well-designed United States national study, Listening to Mothers, reported that less than 1 percent of mothers (only 1 of 1,300 women surveyed) who had a first cesarean actually requested one. The survey, conducted by the Childbirth Connection (a leading nonprofit organization that works to improve maternity care), also noted that, in contrast, nearly 10 percent of those surveyed reported feeling pressure by a health professional to have a cesarean delivery, and 42 percent believed that fear of being sued leads physicians to perform unnecessary cesareans (9).

In the US, the profit motive explains may explain rising rates of Cesarean. According to the HealthCare Cost and Utilization Project (HCUP), a 2000 study conducted by the U.S. Department of Health and Human Services Agency for Healthcare Research and Quality, childbirth accounts for more than four million hospitals stays annually and over $33 billion dollars in aggregate charges in 2003 alone. Many health professionals are feeling squeezed by tightened payments for services and increasing practice expenses. The flat "global fee" method of paying for childbirth does not provide any extra pay for providers who patiently support a longer vaginal birth. Some payment schedules pay more for cesarean than vaginal birth. A planned cesarean section is an especially efficient way for professionals to organize hospital work, office work and personal life. Average hospital charges are much greater for cesarean than vaginal birth, and may offer hospitals greater scope for profit. (11) In the private American healthcare system, doctors and hospitals find cesarean sections more profitable than natural births.

There is no denying that cesareans save lives when performed as an emergency intervention. Many cesareans are the clear result of medical necessity, but others occur in circumstances where there are other options available including many which are medically appropriate. A great majority are performed as a result of a labor that has gone on too long or at the first deviation from the norm, such as a “non-reassuring” fetal heart rate on a monitor. There is an overall lack of support for normal physiological birth evidenced by the dwindling number of women who labor without the assistance of induction or augmentation. A rising number of women are being pushed into the operating room after failed inductions and fetal distress caused by augmentation. (12) The practice of “defensive” medicine, heightened by rising malpractice premiums has created a climate of fear which not only affects the care providers, but the clients they serve. The escalating C-section rate in the U.S. should be a major public health concern. It represents a complex and difficult problem whose solution demands strategies that are multifaceted and comprehensive. Although doctors, hospital, and insurance companies (who often represent warring interests), do contribute to the high rate of cesareans, it is not only with them that blame should be placed. These facts point to a failure in the United States’ system of maternity care. Yet this is not the only issue. The increased rate of cesarean deliveries nationwide may be partly due to a lack of consumer knowledge. Most mothers are healthy and have good reason to anticipate uncomplicated childbirth. Cesarean section is major surgery and increases the likelihood of many short- and longer-term adverse effects for mothers and babies.(1) One primary influence in determining routine care regardless of its proven risks and benefits lies in the perception of birth as a dangerous and life threatening event. Consumers must take a proactive approach to educating themselves about the physiological process of natural birth and the impact of interventions on a woman's ability to birth normally. (15) Education is the key word in preventing unnecessary cesareans and having a safe birth experience. When a cesarean section is necessary, it can be truly life-saving, but birth is a safe and natural process that generally succeeds without intervention.

(1). Childbirth Connection. New National Survey Results from Mothers Refute Belief That Women Are Requesting Cesarean Sections Without Medical Reason. Press release. March 20, 2006.

(2). Declercq E, Norsigian J. Mothers aren’t behind vogue for Cesareans. Boston Globe April 3, 2006.

(3) WHO, Appropriate Technology for Birth; Jose Villar et al., Caesarean Delivery Rates and Pregnancy Outcomes: The 2005 WHO Global Survey on Maternal and Perinatal Health in Latin America, Lancet 367 (2006): 1819-29.

(4). Bakalar, N. Voluntary C-Sections Result in More Baby Deaths. New York Times Sept 6, 2006.

(5). McCullough, M. C is for caution: C-sections on the rise. Philadelphia Inquirer June, 10, 2007

(6) Hall MH, Bewley S. Maternal mortality and mode of delivery [letter]. Lancet, 1999; 354: 776

(7) Declercq, E, Menacker F, MacDorman MF, Malloy, M, Infant and Neonatal Mortality for Primary Cesarean and Vaginal Births to Women with “No Indicated Risk, United States, 1998-2001 Birth Cohorts, Birth: Issues in Perinatal Care 33:3 2006 175-182

(8) Health Outcome Series: Cesarean Deliveries in Florida Hospitals, AHCA State Center for Health Statistics May 2006

(9) Declercq, E. et al., Listening to Mothers II: Report of the Second National U.S. Survey of Women’s Childbearing Experiences (New York: Childbirth Connection, 2006)

(10) Organisation for Economic Co-operation and Development (OECD) Health Data 2007: Statistics and Indicators for 30 Countries July 18, 2007

(11) Why Does the National U.S. Cesarean Section Rate Keep Going Up? (New York: Childbirth Connection, 2007)

(12) Block, J. The C-section epidemic. Los Angeles Times September, 24, 2007.

(13). Declercq, E, Menacker F, MacDorman MF, Rise in “no indicated risk” primary cesareans in the United States, 1991-2001: Cross sectional analysis, BMJ 2005; 330:71-72.

(14) U.S. Department of Health and Human Services. Maternal, infant and child health. In: Healthy People 2010, 2nd ed. Washington DC: U.S. Government Printing Office, November 2000, pp. 16-30-31.

(15) The Cesarean Epidemic - A Response, Independent Childbirth, 2007

Announcing the Florida Friends of Midwives Website!!!

2008-02-26T21:20:00.002-05:00

The website for Florida Friends of Midwives is finally finished! Words cannot express how happy I am.

You may visit the site at - www.flmidwifery.org

We have some Phase 2 and Phase 3 updates planned for early March and April, but for now, the site is done.

MANY MANY MANY MANY MANY MANY thanks to Lori Manning, my best friend of almost 15 years, who is a professional web designer and donated her time to designing the FFOM website. She really came through for me and us and put in over 100 wo-man hours into making the FFOM site fabulous. Lori has been pregnant during this whole process and lives in New York City. She literally worked on the site right up until she was 41 weeks pregnant. I can't put a price on the value of what she has done for the Florida Midwifery community by gifting us her amazing skills to create this site, but the proof is there on the site for all to see. I shall be eternally grateful to her for putting up with my demands these last few months. Thank you Lori :-)

MANY MANY thanks to FFOMer Angela Bailey who has agreed to be our Assistant Webmaster and who really really come through in the final hours with her HTML and coding skills to help us get to the finish line. Her ongoing assistance has been invaluable.

For all others who helped - Sandi Blakenship, Sharon Dejoy, Heidi Dahlborg, Rebekah Finklea. Thanks for your kind words, your writing skills, your time. I/We couldn't have done it without you!

Join FFOM Today!

2008-01-29T00:58:00.000-05:00

As we move forward with Florida Friends of Midwives and begin to craft a future for the group, one of the most important steps is to establish FFOM as an official legal not-for-profit entity and formally solicit membership. We need your help! Efforts great and small are needed to help this organization grow and to spread the word about midwifery care in Florida. FFOM welcomes as members all individuals, families, businesses, and organizations who want to support and
promote midwife-attended births in Florida. Membership fees support the ongoing work of FFOM in its educational, informational and future legislative efforts .

Become a “Supporter”. Joining Florida Friends of Midwives can cost as little as $1 for one year of membership.

Our membership categories were developed with working, growing families in mind. We want you to contribute as much as you are able. Whether you join at the $1 or $150 level, you are demonstrating your commitment to the future of midwifery in Florida. As a member of FFOM you become part of a growing movement of mothers and families committed to preserving and protecting midwifery in our State.

Not a member yet?

Follow these simple steps.

1. Join the FFOM Yahoogroup!

2. Download the membership form in the files section.

3. Mail in your membership form today.

Its time to organize to support normal birth in Florida!

2008-01-29T00:09:00.000-05:00

At the 2007 Midwives Alliance of North America (MANA) Conference in Clearwater, Florida we decided to restablish the long silent Florida Friends of Midwives. We had no idea the response from consumers would be so great. We are so excited to note the amount of interest in FFOM and how our Yahoogroup has expanded in just three short months. WELCOME and thank you for your interest in this important cause.

This group has re-formed to discuss ways of organizing to cultivate a strong consumer voice in support of midwifery our State. It is our hope that FFOM will not only be a great place to support midwifery, but also for you all to support each other and educate other women about birth!

In Florida:

Licensed Midwives can attend homebirths legally.
16 birth centers are owned and operated by Licensed and Certified Nurse Midwives (www.birthcenters.org).
Two midwifery schools accredited by MEAC (www.www.meacschools.org)
Medicaid and insurance coverage of licensed and nurse midwifery care is mandated by state law.
Over 1500 babies are born into the arms of licesned midwives each year and that number is climbing.

What's the bottom line? Women have easy access to birth centers and homebirth midwifery care. In Georgia, one State away, there is one birth center and home birth (direct-entry) midwifery is illegal. Midwives can actually get arrested for attending home births there, and mothers looking for midwives have to find an "outlaw" midwife to attend them! In Alabama and North Carolina the story is much the same. Families who desire the care of midwives for homebirth, must seek that care without the networks and resources the women of Florida enjoy.

It is easy to forget just how good we have it here. The great conditions Florida's residents enjoy are due to political organizing done in the 80's and 90's by many - including crucial grassroots efforts by the Florida Friends of Midwives. Consumers and advocates of midwifery care lobbied our state government and succeeded in getting mother friendly laws passed in our State.

Political circumstances over the next few years are going to require a really strong family-mother/consumer voice in support of midwifery. Yes, homebirth midwifery is in danger of becoming illegal again in Florida if we do not organize to protect it.

Let's work hard as guardians of birth choices for ourselves, our sisters, our friends and perhaps most importantly - our daughters!

Heidi Dahlborg, LM
Midwife, Sarasota

Tamara Taitt
Region 3 Representative
Midwives Alliance of North America (MANA)

Shannon Mitchell
Information Services Director
International Cesarean Awareness Network (ICAN)

To join the FFOM Yahoo group visit:

http://health.groups.yahoo.com/group/FloridaFriendsofMidwives/