Inside the Midwife's Bag

2012-01-22T18:31:00.012-05:00

~ HBMS Holistic Midwifery Skills Practicum ~

~ Spring 2012 ~

What: A 3-Part Series of 2-day Midwifery Skills for aspiring midwives,

taught by VA licensed CPM, by

Kim Mosny, CPM, LM [VA], senior midwife of the

Home Birth Midwifery Service

Regardless of whether you think they are "ready" to be signed off on the skills or not, everyone desirous of becoming a midwife needs the opportunity to listen,learn, watch, practice, and practice… and practice some more!

Part I ~ Basic Midwifery Skills: Learn how to…

1. Use aseptic technique;

a) Proper hand washing

b) Proper gloving and un-gloving

c) Assisting using both aseptic & sterile technique

2. Use both, a digital:

a) Hemoglobin meter;

b) Glucose meter;

3. Taking vitals on mothers & babies:

a) temperature,

b) blood pressure,

c) pulse/HR,

d) respirations,

e) reflexes;

4. Doing a Prenatal physical & prenatal exam;

Part II ~ Venipuncture, Starting IV’s & Suturing: (Students will practice venipuncture / IV’s on each other!)

1. Learn, watch, and then practice proper venipuncture technique

and drawing blood from various sites;

2. Learn, watch, and then practice starting an IV;

3. Learn, watch, and then practice suturing techniques.

Part III ~ Resolving Shoulder Dystocia, Estimating Blood Loss & Manage Postpartum Hemorrhage

1. Understand optimal fetal positioning (OFP).L earn & practice the maneuvers & techniques for managing a“stuck baby”… (modeled after renowned midwife Gail Tully’s Resolving Shoulder Dystocia Workshop)

2. Estimating blood loss & identifying a hemorrhage.

3. Learn techniques, herbal and allopathic treatment for managing a postpartum hemorrhage;

When: April 28 & 29 ~ May 19 & 20 ~ June 9 & 10

* Apr 28 & 29 (Sat/Sun)

* May 19 & 20 (Sat/Sun)

* June 9 & 10 (Sat/Sun)

We will offer another practicum, FALL Series 2012, for up to 10 participants depending upon the demand.

Please keep in mind that your instructor is an actively, practicing midwife, who is regularly “on-call” for clients due to have their babies; workshops may be POSTPONED or CANCELLED with little or no notice accordingly. The workshop will be re-scheduled or a refund offered for such cancellations.

Fees & Details:

TOTAL COST... Early-Bird: $450.00 (includes supplies), if Paid-in-FULL by March 15

After March 15: Total Fee: $500.00

A convenient, 3-payment plan option is available.

Overnight accommodations & transportation are YOUR responsibility. “Dutch” lunch on both days will be together as a group. “Dutch” dinner & evening activities will be planned by HBMS or you can go & do on own.

::: NOTE ::: There is NO REFUND for missing any day due to your own personal/family issues. Make-up days may be offered by your instructor, but HBMS is under no obligation to do so.

Registration must be paid by cash (do not send cash in the mail!), check, or credit card

(via PayPal) ONLY. (Returned check fee: $35)

PayPal payments should be sent to kmosny@yahoo.com & MUST INCLUDE 4% service fee.

Be sure to add a note indicating “HBMS Practicum”.

Note: The cost MAY change for the FALL 2012 Series.

Those interested in either Spring or Fall 2012 Series should contact me ASAP!

8-10 student spots are now open for the Spring 2012 series. REGISTER TODAY, DON'T DELAY!

SPRING Series Registration (Apr-June) is now

OPEN to the first 6 participants who REGISTER & PAY

for Part I ($200) or TOTAL Early-Bird ($450) by March 15.

Payments for Parts II & Part III ($150.00 each) are due:

Apr 28 & May 19, respectively.

To register for the HBMS Holistic Midwifery Skills Practicum, call or contact:

Kim Mosny, CPM, LM [VA]

Home Birth Midwifery Service

kmosny@RichmondMidwife.com

Cell: (901) 292-4876

13541 E. Boundary Road, Ste 101

Midlothian, VA 23112

Mail-in Student Registration ~ HBMS Holistic Midwifery Skills Practicum ~ SPRING Series (Apr - June)

Name:

Address:

City/State/Zip:

Phone:

Email:

Payment Enclosed:

The Captain of Her Own Ship

2012-01-12T17:28:00.037-05:00

Can you believe that WOMEN want CONTROL over their own birth environment? NO-ooooo... they shouldn't DO that, they should lie back with morphine-type drugs infused into the epidural space of their spines, quiet... not requiring anything from the doctors, nurses or other hospital staff.

Check out THIS load of fecal matter from "Dr" Fart's Phhhlog:

"By all means share your most important preferences with your providers, but think long and hard before you present your provider with a list of refusals and ultimatums. Birth plans have been encouraged by ancillary birth personnel (childbirth educators, doulas) as a thumb in the eye of obstetricians. They accomplish nothing besides gratifying a desire to defy authority."

So... YOUR Birth Plan, which respectfully outlines the important care issues regarding YOUR and your BABY'S birth & postpartum, IS... (per her majesty, "Dr" Fart-from-her-Mouth) a frivolous, self-serving rebellion, causing pain and anguish to the doctor... >cough, gag, vomit<

"...gratifying a desire to defy authority."

REALLY?? ... WHO is the BOSS, "Dr" Fart?
DARE I suggest that the MOTHER (OMG!) is the Captain of her Own Ship? That SHE carries the ULTIMATE responsibility to safeguard her ship and it's precious cargo? That the Birth Attendant is, both, the Navigator & the Engineer assisting the Captain, TOGETHER, through the course of the birth... all the while with the safety of mother and baby as the PRIORITY. What Captain purposefully runs her ship a-ground or into uncharted, dangerous waters?

"...thumb in the eye..."

Hmmmm, isn't that what you are SUPPOSED to do if you are being ATTACKED by a SHARK?

Ah ha! Actually quiet a clever analogy!

But seriously, Friends...

YOUR Birth Plan is a valuable piece of communication between you and your birth provider(s). Both midwives AND doctors value and respect that you have specific desires, wishes, and yes, perhaps some things you don't want, too! Even when planning a home birth, where you'd think that a Birth Plan essentially isn't necessary, it can serve to open the lines of communication with client and midwife.

Write down your specific needs, wishes & desires!
MAKE that LIST, so that you and your provider can discuss these important matters ahead of time. If you have the potential to be cared for by someone you don't know and who doesn't know you or your wishes... the Birth Plan becomes an ESSENTIAL component of your care plan between you and that provider.

No, it isn't the Birth Plan that accomplishes the goal of having a safe and satisfying birth experience. It is the collaboration of ideals of both mother & birth provider, together with the circumstances of the actual birth event, that provides the very best possibility of a good, joyous, and healthy outcome for mother and baby.

And just in case "Dr" Fart-from-her-Mouth is reading... Natural ChildBirth Advocates (among them: Doctors, Midwives, Nurses, Doulas, Childbirth Educators, etc.) very much RESPECT the process of birth and acknowledge that there ARE inherent risks that can affect this very normal, physiologic, bodily function. We KNOW that sometimes mothers and babies need medical interventions, medications, and operative procedures to safely see them through and beyond the birth. We ACKNOWLEDGE that Cesarean Section saves lives and is, indeed, defined as giving BIRTH. We recognize that sometimes NOTHING can be done to prevent a morbidity or mortality.

HOWEVER, we also KNOW that unnecessary interference and practitioner interventions employed out of "routine use" ideology, convenience, ease, time, or other non-evidence-based rationale DO, indeed, INCREASE risk of the birth process diverging from a normal, healthy course.

Your Birth Plan serves to map out your wishes, needs, beliefs and desires for your birth care. A birth attendant who does not respect the importance of this patient/practitioner communication should not be serving birthing women.

The MOTHER is the Captain of Her Own Ship.

Yahoo's Servers Have Been HACKED!!

2011-09-20T01:55:00.003-04:00

I apologize for any inconvenience... Yahoo's server has experienced a massive email hacker attack overnight.

If you have received any strange, weird, or clearly spam/phishing like email from kmosny@yahoo.com ... DO NOT CLICK ON ANY LINKS IN THAT EMAIL!!

If you need to contact me via email, use my gmail account: kmosny@gmail.com

Thank you,
Kim Mosny, CPM

2011-04-18T00:40:00.002-04:00

I LOVE the idea that a can post to my blog via TEXT MESG! Go ahead... call me a "Techy Midwife" ... it IS true!

New Pregnancy Resource: NaturallyBorn

2011-03-23T22:17:00.010-04:00

NaturallyBorn.net is a new pregnancy resource for YOU!

NaturallyBorn.net provides comprehensive information about pregnancy, birth, natural childbirth, home birth, water birth, birthing centers, midwives, breastfeeding and doulas. If you are looking for a birthing center, midwife, doula or progressive hospital with natural childbirth, we offer a full directory of birth centers, certified nurse midwives, certified professional midwives,birth doulas, and postpartum doulas who can assist with natural birth techniques such as waterbirth, hypnobirthing, and homebirth.

NaturallyBorn.net specializes in providing unbiased information and resources about natural childbirth options. Our Expert Q&A section for natural childbirth features licensed midwives, doulas, and other experts in the fields of natural childbirth and midwifery.

We are honored to be part of our community, and to be helping to raise the awareness among new parents about their birth options.

Our own Kim L. Mosny, CPM [Licensed in VA] is a founding member and expert contributor for NaturallyBorn.net. Look for her profile page, articles, Q&A input and other contributions!

Sign the Petition to Legalize CPMs in North Carolina

2011-02-24T18:30:00.002-05:00

Petitions by Change.org|Start a Petition »

The Birth Trust

2011-02-24T00:39:00.000-05:00

www.formidwifery.org/birthtrust

2011-02-17T18:02:00.001-05:00

~ HBMS Holistic Midwifery Skills Practicum ~

What: A 3-Part Series of 2-day Midwifery Skills for aspiring midwives,

taught by VA licensed CPM, by

Kim Mosny, CPM [VA], senior midwife of the

Home Birth Midwifery Service

Part I ~ Basic Midwifery Skills: Learn how to…

1. Use aseptic technique;

a) Proper hand washing

b) Proper gloving and un-gloving

c) Assisting using both aseptic & sterile technique

2. Use both, a digital:

a) Hemoglobin meter;

b) Glucose meter;

3. Taking vitals on mothers & babies:

a) temperature,

b) blood pressure,

c) pulse/HR,

d) respirations,

e) reflexes;

4. Doing a Prenatal physical & prenatal exam;

Part II ~ Venipuncture, Starting IV’s & Suturing: (Students will practice venipuncture / IV’s on each other!)

1. Learn, watch, and then practice proper venipuncture technique

and drawing blood from various sites;

2. Learn, watch, and then practice starting an IV;

3. Learn, watch, and then practice suturing techniques.

Part III ~ Resolving Shoulder Dystocia, Estimating Blood Loss & Manage Postpartum Hemorrhage

2. Estimating blood loss & identifying a hemorrhage.

3. Learn techniques, herbal and allopathic treatment for managing a postpartum hemorrhage;

When:

* Mar 26 & 27 (Sat/Sun)

* Apr 30 & May 1 (Sat/Sun)

* May 21 & 22 (Sat/Sun)

We will offer another practicum, FALL Series 2011, for up to 8 students depending upon the demand.

Fees & Details:

TOTAL COST... ** $402.00 (including supplies);

A convenient, 3-payment plan option is available.

Overnight accommodations & transportation are YOUR responsibility. “Dutch” lunch on both days will be together as a group. “Dutch” dinner & evening activities will be planned by HBMS or you can go & do on own.

::: NOTE ::: There is NO REFUND for missing any day due to your own personal/family issues. Make-up days may be offered by your instructor, but HBMS is under no obligation to do so.

** The cost ($402) of the HBMS Midwifery Skills Practicum is FINAL for the SPRING series.

Registration must be paid by cash (do not send cash in the mail!), check, or credit card (via PayPal) ONLY. (Returned check fee: $35)

PayPal payments should be sent to kmosny@yahoo.com and MUST INCLUDE 3% service fee.

Be sure to add a note indicating “HBMS Practicum”.

The cost MAY change for the FALL 2011 Series.

Those interested in either Spring or Fall Series should contact me ASAP!

8 student spots are now open for the Spring 2011 series. REGISTER TODAY, DON'T DELAY!

SPRING Series Registration (Mar-May) is now

OPEN to the first 8 students

to REGISTER & PAY for Part I ($134.00) by March 05.

Payments for Parts II & Part III ($134.00each) are due:

Mar 26 & Apr 30, respectively.

To register for the HBMS Holistic Midwifery Skills Practicum, call or contact:

Kim Mosny, CPM [VA]

Home Birth Midwifery Service

kmosny@RichmondMidwife.com

Cell: (901) 292-4876

13541 E. Boundary Road, Ste 101

Midlothian, VA 23112

Mail-in Student Registration ~ HBMS Holistic Midwifery Skills Practicum ~ SPRING Series (Mar-May)

Name:

Address:

City/State/Zip:

Phone:

Email:

Payment Enclosed:

It is Time to Reframe the Homebirth Conversation

2011-01-29T02:42:00.002-05:00

For Immediate ReleaseJanuary 26, 2011

Contact: Midwives Alliance of North America
Geradine Simkins, President & Interim Executive Director
executivedirector@mana.org

It is Time to Reframe the Homebirth Conversation:
Focus on Optimal Maternity Care and the Practitioners Who Can Provide It

In their recently released “Committee Opinion” on homebirth, the American College of Obstetricians and Gynecologists (ACOG) affirms the role of informed disclosure by saying, “...we have an obligation to provide families with information about the risks, benefits, limitations, and advantages concerning the different maternity care providers and settings.” Midwives and other maternity professionals, therefore, are surprised that ACOG relies on the widely criticized Wax publications on homebirth, when there are more credible and carefully designed investigations that assess the relative risks of birth sites. Further, members of the Midwives Alliance - an organization representing the profession of midwifery since 1982 - are concerned that this ACOG Committee Opinion was apparently not subjected to review by experts who understand how to evaluate the quality of scientific studies on homebirth.

We believe it is time to re-frame this conversation. Midwives and obstetricians have been debating the safety of homebirth for far too long. In North America today planned homebirth for healthy women, attended by skilled providers, with access to medical consultation when necessary, is a safe option. Midwives as primary maternity providers, across settings and nations, have been identified as contributing to improved health outcomes. In the U.S. this includes care by Certified Nurse-Midwives, Certified Professional Midwives, and Certified Midwives. Moving beyond this debate over place of birth will allow obstetricians and midwives to focus on the goals we have in common.

There are critical issues facing all maternity providers today. First, we must understand the bio-ethical principle of autonomy as it relates to the human right of self-determination in making health care choices. Only then can we support women in their mastery of self-determination as they navigate the complicated worlds of obstetrics and maternity care and attempt to make good decisions for themselves and their families.

Second, it is the responsibility of the entire maternal and child health care (MCH) community to promote access to care that promotes optimal health for mothers and infants. We have a responsibility to remove barriers to options that women choose, provide complete and transparent information to women during the childbearing year, and work collaboratively as a team for the benefit of families.

Third, we can no longer tolerate the abysmal maternal and child health disparities that exist for our most vulnerable women and populations of color. We have our plates full with the daunting task of improving the health status of all women and infants in the United States within a social justice framework.

We stand at the cusp of the greatest opportunity in decades to reform our ailing healthcare system into one that provides the highest quality care, with the fewest interventions, to achieve optimal outcomes, in the most cost-efficient manner. We must focus on widely implementing evidence-based maternity care practices that are appropriate for mothers and babies. We must address the fact that certain costly obstetrical practices that are not supported by science are overused, while other beneficial, low-tech practices are overlooked. Of particular concern to the Midwives Alliance and the clients we serve is the trend of increasing rates of cesarean sections, contributing to increased rates of premature birth, low birth weight infants and rising healthcare costs, while women across the country still struggle to find providers willing to attend vaginal births after cesarean (VBACs).

These are the current issues that together we must devote our most fervent attention towards seeking solutions. We can no longer be diverted by the distractions of disagreements among maternity professionals. We have serious work to do that cannot wait. We look forward to being in authentic dialog with ACOG - and all other stakeholders - as we plan and participate in a Homebirth Consensus Summit as a forum for building a common agenda for all involved in caring for mothers and babies. Women, infants, and families are counting on us to bring our complementary skills and acumen to the table and work together cooperatively.

Geradine Simkins, CNM, MSN
President & Interim Executive Director
Midwives Alliance Board of Directors

Reference:
1. Sakala, Carol and Maureen P. Corry. Evidence-Based Maternity Care: What It Is and What It Can Achieve. New York: Milbank Memorial Fund, 2008, 1.

CMA Action Alert

2011-01-07T00:40:00.000-05:00

January 2, 2011 ~ http://www.commonwealthmidwives.org/actionalert.htm

ACTION ALERT! YOUR VOICES NEED TO BE HEARD!!!

Dear Midwifery Supporters,

This is a call to action for all citizens of Virginia who have an interest in out of hospital birth services. The issue of access to medications for women using the services of Certified Professional Midwives (CPMs) is currently before the Board of Medicine (BOM). Strong citizen support is needed to communicate to the BOM that the women and babies who receive midwifery care in Virginia prefer for their midwives to be legally able to administer medications.

Although CPMs are trained to carry and administer some medications considered necessary for safe and effective midwifery care in out of hospital birth, the current Virginia statute for Licensed Midwifery specifically prohibits them to do so. For many women seeking out of hospital birth, this dilemma represents a compromise to optimal safety in rare emergencies that occur for healthy women (postpartum bleeding), as well as access and convenience for medications for their newborns (Vitamin K, erythromycin).

This gap in midwifery care requires a resolution. The Board of Medicine has recently convened a Midwifery and Medications Workgroup, whose task is to address this issue.

Please contact the Board of Medicine NOW to let them know that you care about this issue and expect to see a resolution as soon as possible! (Scroll for contact info and sample talking points.)

During the first meeting of the Workgroup (December 3, 2010), many issues were discussed among the members (2 CPMs, 1CNM, 1 OB, 2 Pediatricians, and a Citizen member). The CPMs on the workgroup and those that attended the meeting, made every effort to educate the rest of the group on the issues, concerns, and obstacles to resolution. Representatives from the Medical Society of Virginia indicated that they would like physician oversight of midwives to be established prior to supporting any changes in the scope of practice of Licensed Midwives.

Please plan to come to the next meeting of the Workgroup on Friday, February 4th at 9am to speak during the public comment period. Please prepare a brief written statement prior to the meeting.

The Workgroup was unable to come to agreement on a next step other than to meet again in February. In order to authorize another meeting, the group passed the following motion unanimously,

"The committee will discuss and develop a plan that will increase safety and access to necessary medications for home-birthing women and their newborns."

By passing this resolution, the group acknowledged that there is a concern, but that there is not yet a clear path to solving it.

Due to short notice from the Board of Medicine about the workgroup meeting, there was only ONE consumer present to represent all of you. As many of you know, it was largely due to the massive effort of every individual mother, father, grandparent, sister and cousin that allowed CPMs to be licensed in Virginia through the passage of our bill in 2005. This was not an easy effort and the sentiment from the medical community is largely unchanged. The Commonwealth Midwives Alliance (CMA) is once again asking midwifery supporters like you to come forward and bolster our goal to effectively serve the mothers and infants of the Commonwealth.

Letter Writing Pointers and Contact Information

Please write a brief personal note to the Board of Medicine today…

Address your letter to:

Virginia Board of Medicine Workgroup on Midwifery and Medications

Attn. Dr. William Harp, Executive Director;

Dr. Karen Ransone, President of the Board of Medicine;

Dr. Deren Bader, CPM, Chair of the Midwifery Advisory Board

Perimeter Center

9960 Mayland Drive, Suite 300

Henrico, Virginia 23233-1463

Please send your letter via email. Use the same header and send to: medbd@dhp.virginia.gov

(Cc) to: Dr. Deren Bader: deren@mountainviewmidwives.com

CMA President, Kim Mosny: kmosny@RichmondMidwife.com

The issue is clear: You have a right to safe and effective maternity care. CPMs are proven as safe providers of out of hospital birth. Virginia Licensed Midwives need access to the tools available to provide the care they are trained to offer.

Here are a few more things to consider:

Describe the beliefs you have about wanting someone who would attend your birth with the appropriate tools and competencies to assist in a normal birthing process. Explain that you want your midwife to be able to use all the knowledge and skills of her training. This includes administering medications when indicated.

If you have an experience that demonstrates how important it would have been for your midwife to be able to carry and administer certain medications, speak about the experience. For example, were you inconvenienced in needing to obtain RhoGam? Were you unable to get Vitamin K and/or erythromycin for your newborn because of the midwife’s restriction and thus you decided against those medications for your baby? Did you forgo medications due to inconvenience?

Please do not speak negatively about hospitals or hospital providers. Keep the tone of your letter positive.

Indicate that you will be monitoring the deliberations of the Workgroup and hope that its recommendations will be carefully focused on the evidence for best practice, and the health and safety of the Virginia families who choose home birth and the care of Licensed CPMs.

Thank you for your support of Virginia Licensed Certified Professional Midwives.

Sincerely,

Kim Mosny, CPM

President, Commonwealth Midwives Alliance

For questions or for more information please contact:

Kim Mosny, CPM ~ President

Commonwealth Midwives Alliance

13541 E. Boundary Rd, Ste 101

Midlothian, Virginia 23112

kmosny@richmondmidwife.com

(804) 651-0608

Be sure to join the Friends of CMA YahooGroup at:

Friends_of_CMA-subscribe@yahoogroups.com

http://www.commonwealthmidwives.org/actionalert.htm

Options abound for moms-to-be

2010-11-10T22:13:00.000-05:00

CLICK this LINK to read the Chesterfield Observer article featuring ME, Kim Mosny!!

Former Home Birth client, Stephanie Mazzella and
her 9-mon old daughter, Rowan, with Kim Mosny.

If ultrasound destroys sperm, why is it safe for a fetus?

2010-08-23T03:38:00.000-04:00

If ultrasound destroys sperm, why is it safe for a fetus?

Facts VS Bias: An Analysis of the Wax Study

2010-08-23T03:10:00.000-04:00

** sigh **

I have to completely re-write and re-compile all the information from a "Note" I posted on my HBMS FaceBook page, because FB "decided" that the content of my note "violated [their] Terms of Use." GRRrrrrr...
.

The note itself contained nothing "hateful, threatening, or obscene," nor did it "attack an individual or group, or advertise a product or service."

Thus, I must conclude that the photo, included with the note, of naked new mother holding her newly born baby was the material considered "obscene" by FB or was reported by someone who viewed my note. This is the photo that I attached to my FB Note. Obscene, isn't it?

Well, any whooooo.... on with my "Facts VS Bias: An Analysis of the Wax Study" note...

I was recently asked by a new client about the Wax Study, "Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis." Am J Obstet Gynecol, 2010; 203(3) DOI: 10.1016/j.ajog.2010.05.028, which concludes that babies born at home have a mortality rate THREE TIMES HIGHER than babies born in hospital.

Their conclusion is controversial because many large and rigorous studies have concluded that homebirth and hospital birth have essentially the same safety for mother and baby. Some recent studies, including one from British Columbia, Canada, reported that planned homebirths actually have better outcomes for the mother compared to planned hospital births.

The study originally intended for print publication in the September 2010 issue of the American Journal of Obstetrics and Gynecology (AJOG), was published online on July 1. Researchers and critics suspect that the early release was politically motivated to discredit midwives who attend the majority of home births in the U.S. and to discourage legislators from passing increasingly pro-midwife state legislation such as New York State's Midwifery Modernization Act (Bill S5007a/A8117b), which passed on June 28 with overwhelming bipartisan support, providing autonomous practice for all licensed midwives working in all settings.

The Coalition for Improving in Maternity Services ~ CIMS' advisor, 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 believes this is "an unabashed attempt to have poor science cover-unsuccessfully-a political agenda. I am very surprised that the [Journal] would publish it, let alone call it 'Editors Choice'."

So, how does one know WHAT to believe with regard to research, studies, meta-analysis, etc? How does one wade through the myriad of information available on the web to discover the FACTS and uncover BIAS, and political agendas?

Well, in THIS case, it is little 'ole ME to the rescue to help my clients and others interested in understanding quality research related to the safety of home birth. Thus, we begin with an exploration of much of the discussion surrounding this meta-analysis known as the Wax Study...

OK... So, now let us look at the research, articles, discussion and blogs regarding the Safety of Home Birth:

So... I will leave the rants and raves to the scientists, researchers, writers and other Blogsters.
I have compiled quite a bit of reading material here for those interested in learning.

What I KNOW is that home birth is SAFE. Home birth is made SAFER with one-on-one midwifery care and a skilled attendant at the birth. Safer still when a second attendant is present to assist the first.

Home birthing families do not choose home birth because it is "trendy" or "cool" or because some celebrity says they should. Women and their partners choose home birth because its their BEST CHOICE. It speaks to their sensibility, to their hearts, to their intellect, to their joy, to their minds, to their partnership, to their peace, to their spirituality, to their togetherness, to their concerns, to their interests, etc... etc... etc...

Home Birth is SAFE... otherwise I, a home birth midwife of 17 years, WOULD NOT/COULD NOT do this work. It is my calling, my job, my joy, my heart, my hands, my mind, my spirit, my responsibility, my promise, to protect mother's and baby's safe passage. Within that promise is the understanding that I am only the hand-servant through which health and life passes. I am not in control, as much as I might have thought I was in my early career, I have learned life & death's lessons, bitter-sweet and beautiful. I, too, surrender to the power of birth.

Home Birth is NOT for everyone. But for those who choose to give birth with midwives at home, let not your hearts be troubled by the controversy of biased agendas. It has and always will be YOUR RIGHT, YOUR CHOICE where and with whom to give birth.

The effective labour contraction ~ Midwife Thinking's Blog

2010-08-18T21:13:00.000-04:00

Such a GREAT post about labor contractions.... I have to share with my Blog Followers!

The effective labour contraction ~ Midwife Thinking's Blog

Midwife means "with women" but wait, there's more....

2010-07-21T21:40:00.001-04:00

NOTE: This article is not wholly my original content, but was adapted from an article shared by a student-midwife colleague (thanks Doran!) on a midwifery list serve. No authorship was offered, other than to refer to the author, "from a friend"... otherwise I would give credit where credit is due. Thus, I have "tweaked" and "fine-tuned" the original to fit my own perspective on the "job" of being a midwife. Enjoy.

Most folks would say that I "deliver" babies (though I like to say that I "catch" them) and this is true, but it is a fraction of what I do.... what this calling requires of me. The contrast between the “jobs” within my calling are surprising to me and unknown by many, if not most, who see the signs on my car and think they know who I am.

I am a teacher of an age-old "profession" which carries great responsibility. It is almost a given that a midwife will train others to be midwives, this is how midwifery has survived all of these years. Though I don't feel that I am a great teacher, I love to share what I know… there is much to glean from me and if someone is willing and observant enough, they will learn the art & skills of midwifery as they sit at my side, as they lend me a hand, and as they serve the women with me.

You'll see me at the copy place as I work for hours, making copies, putting together the information that I have been given, and that I have created, that gives the best informed consent I can provide. I want all those who hire me to know who I am and what the responsibilities are when they choose to give birth outside of a hospital. Making copies, creating folders and booklets of information, ordering books and DVDs, staying informed in all the ways available. It can be exhausting, but I know it is a necessary part of being a current midwife, one who teaches others how best to interview a midwife & plan a home birth. I need to continue to learn and to discover, especially what evidenced-based care is - and practice it.

I can find a fetus’ heartbeat and can tell if it is breech, without a doppler or an ultrasound machine. I know of many ways to cope with weeks of nausea and what is safe to take - whether herb or medication and can explain how to time contractions and what to do if your baby is jaundiced. I know many tricks to get a baby to nurse and how to make an herbal bath. I can recommend holistic treatments for a myriad of maladies and complaints for pregnancy from heartburn to urinary tract infection.

I keep my supplies stocked and inventory my bags, car, office & home supplies to ensure I have everything I need for every birth. You will sometimes find me sterilizing instruments at midnight or 1 in the morning because they didn't get done earlier in the day and a baby might decide it's not going to wait until the midwife has time the next day.

I am trained and certified to resuscitate newly born babies, the ones that seem to think that breathing is an option… I don't allow them this lazy notion and go to work, convincing them that it’s not so bad here after all. Nevertheless, the greatest teacher I have ever had was baby Caroline, who taught me that it was not MY decision whether she stayed or left and that I could do everything right and yet I was not in control. She left.

I know how to follow directions and to be more dependable than my mother ever thought I could be. The weather can have little affect on my travel - I go when I am called and it matters not how bad the roads, although I do hate the ice & snow! My partner knows and understands this, a midwife needs one of those, too - an understanding partner. In bad, icy weather, he drives me to a birth or postpartum visit, no matter the time of day or night.

There is no job "beneath" my title - I wipe away vomit, clean toilets, and feed the family dog. I hope to never feel that I have "earned" anything better. A midwife should always know that she is there to serve, in any way that is needed, and it has nothing to do with what her needs are.

I am an ambassador for all midwives when I enter a doctor's office, clinic, or hospital and I take this responsibility very seriously. I've learned that I gain more trust and respect by saying fewer words and respectfully admitting our need for assistance and collaboration during a consult or transport. I have worked hard, for many years, but respect has been attained and my clients have received better care because of this simple principle of humility. A midwife has to be strong for her clients, they need to know she will not waiver. I have learned to have a “thick skin” when entering a hospital, while being professional and cooperative all at the same time. A midwife needs to learn from those who may not even realize that they are teaching her. There is always something to glean and take with you for another time. A midwife never stops learning. I have changed and matured over time, learning to be mindful and learning to listen to the voice of intuition.

Most of the time I truly love what I do - though my back, neck, arms and legs may ache and I have gone without food and sleep or had to miss a family celebration. I love the associations and sweet friendships I have made and the relationship that last beyond the years and the miles.

Midwifery is a precious calling and it truly can be the easiest thing in the world, but now you know that it comes with much more than just “catching babies”!

Single-Layer C-Section Closure Ups Risk of Uterine Rupture

2010-06-26T22:17:00.003-04:00

From Reuters Health Information

NEW YORK (Reuters Health) Jun 21, 2010

Compared with double-layer uterine closure, single-layer closure following caesarean section doubles the risk of uterine rupture during a subsequent trial of labor, Canadian investigators report in the July issue of Obstetrics and Gynecology.

The researchers therefore recommend that "single-layer closure be reserved for women undergoing tubal ligation or those who require very expedient closure of the uterus." There is no consensus on the best way to close the uterus after c-section, the authors note. Single-layer closure has gained popularity because it shortens operative time and needs fewer hemostatic sutures.

Dr. Emmanuel Bujold, from Universite Laval, Quebec, and colleagues conducted a case-control study among women who underwent a trial of labor following a prior single, low-transverse cesarean delivery. Patients were selected from deliveries at nine centers in the Montreal area between 1992 and 2002.

The analysis included 96 cases of uterine rupture matched to 288 controls by time period and hospital. Rates of single-layer closure were 36% and 20% in the two groups, respectively,
"In multivariable analysis, single-layer closure (odds ratio 2.69) and birth weight greater than 3,500 g (OR 2.03) were linked with increased rates of uterine rupture, whereas prior vaginal birth was a protective factor (OR 0.47)," the team reports. All ORs were statistically significant. On the other hand, suture material had nothing to do with outcomes.

Dr. Bujold and associates say it's possible that a single, continuous suture technique does not approximate the tissues precisely together, and they suggest that single-layer closure leaves a thinner or weaker scar more prone to rupture.

Obstet Gynecol 2010;116:43-50.

Natural Childbirth —You CAN Do it !

2010-06-01T23:20:00.000-04:00

Right now, all over the world, tens-of-thousands of women are giving birth. Laboring in their own homes, in community birthing facilities (birthing homes & birth centers), and in hospitals, the vast majority of mothers, outside the US, give birth without the use of drugs and with minimal medical technology. They walk around, eat & drink, and actively push their babies out: sitting up, squatting, on their hands & knees, even standing! They remain safe, giving birth to healthy babies.
   Caught in the hands of midwives and given immediately to their mothers, babies suckle at the breast and gaze at the faces of their parents, rarely being separated. Having assisted throughout the labor & birth experience, the mothers’ partners share in the joy and work of birthing, often surrounded by other supportive family members and friends.
   In the United States, however, birth has become a medical event, separating families from their homes and loved ones. The medical model of obstetric care involves many interventionary procedures and the routine use of technologies, even though they have been proven to cause more problems than they prevent.“Just-in-Case obstetrics has become the modern way of managing birth in U.S. hospitals. The legal ramifications of “not” using such methods, should a complication or problem occur, are too great to risk, in the minds of most OB/Gyn’s today. In the last 80 years, the natural, normal function of birth, in our culture, has been taken out of the home and out of the family’s life experience. More often than not, birth is seen by mainstream American society as an emergency (watch an episode of “Private Practice”, “Trauma” or “Deliver Me”).
   The pain and discomfort of labor and birth is considered unacceptable by most medical professionals, having been trained to relieve pain, whenever possible. Women are told not to be “martyrs”... that they should not have to “endure” labor without drugs, as if birth were an excruciatingly, painful event. Many women insist on pain relief, most often through the use of epidurals, “as soon as possible” upon entering the hospital, often before hard, active labor has even commenced. The use of epidural anesthesia is at a record high today.
   Women share their birth experiences with other women much like men tell war stories. Using phrases like, “It was the most terrible pain I’ve ever had.” or “It was the worst experience of my life.” or “I don’t ever want to do that again.” When was the last time you heard a women talk about her birth as a “lovely” or “a wonderful, powerfully emotional experience”? It doesn’t happen much.
   With the pressures of their busy schedules, more and more women are opting for induction of labor with Pitocin® (a synthetic form of oxytocin, the natural chemical that causes uterine contractions, the let-down reflex of lactation, and orgasm) often before their due dates. Most do so due to the discomforts of term pregnancy, the desire to know when they will deliver, or so their doctor is sure to “be there,” rarely because the baby or mother is medically at any risk.
   The medical model of obstetrics deems that the routine use of technologies, drugs, and procedures, whether or not medically indicated, is necessary and prudent for all birthing women. All laboring women are considered “emergencies waiting to happen,” regardless of their risk factors or lack thereof. The American College of Obstetricians and Gynecologists’ (ACOG) current position is that home birth is unsafe, “Choosing to deliver a baby at home, is to place the process of giving birth over the goal of having a healthy baby.” Yet, they ignore the vast body of current research conducted across the globe to the contrary.
   The use of continuous fetal monitoring has been proven, in multiple studies, to be unnecessary; with outcomes for babies being no different than babies whose mothers are monitored intermittently (15 minutes out of every hour.) Outcomes for mothers are worse, however, with a higher rate of C-section and instrumental delivery, than those intermittently monitored. The monitor cords combined with the routine use of I.V. restricts movement and inhibits women from positioning themselves as they feel necessary, thus hampering their ability to cope with labor without pain relief... and thus, the domino-effect of cascading interventions begins. (see: http://www.richmondmidwife.com/Documents/DOMINO%20Effect.pdf)
   There are some serious, potentially fatal, risks associated with the use of epidurals, as well as many less serious risks that affect mothers and their babies. Yet doctors encourage women to get an epidural, claiming that its “safe” for her and baby, even though studies show that the use of epidurals causes slowed labor, often requiring pitocin augmentation. The combined use of these drugs can cause undue stress on the baby. For this reason, mothers are required to stay in bed and be continuously monitored.
   To speed stalled or slow-to-progress labor, a woman’s water (amniotic sack) is often routinely ruptured, even though doing so increases the risk of infection to both mother and baby, particularly in the hospital setting, where antibiotic-resistant bacteria thrive and are shuttled from room to room by the staff.
   Epidural numbness makes active pushing by the mother difficult, often requiring the doctor to perform an episiotomy (cutting the opening of the vagina) and use forceps or a vacuum extractor to pull the baby’s head out. Or the baby’s head can become wedged in a deep, transverse position (turned crossways in the pelvis) so that pushing or pulling the baby out vaginally becomes almost impossible, thus a C-section is necessary. And, there is growing evidence that epidurals cause infants to have poor initial rooting and suck reflexes, reducing their instinctive response to breastfeeding immediately after birth.
   Breastfeeding, while proven to be the most superior food for the human infant through and beyond the second year, is still a taboo subject in our culture. Only a small percentage of U.S. mothers are fully nursing their babies by the age of six weeks, while the average age of weaning in the world population is between 3 and 4 years old! Our society does not value breasts for their primary purpose and function in the nurturing of infants; only as sexual body parts, not to be seen or talked about in public. Breastfeeding in public is often frowned upon; mothers have been asked to stop nursing, to leave, or have even been arrested for indecent exposure, just for feeding their babies! Nursing mothers resort to hiding out in bathrooms, sitting in corners with their backs turned, and draping themselves with blankets, all for the sake of sparing others from embarrassment or offense. In most municipalities, thankfully, this is changing and breastfeeding mothers may feed their babies wherever and whenever they choose.
   So, what should YOU do? How can YOU have a healthy, safe, memorable birth experience and successfully breastfeed your baby? Consider for a moment the generations of women in your ancestral history who birthed their babies as described in the opening paragraphs. Remember that your own body is designed to give birth without gadgets, procedures, and drugs. Trust your own instincts and your body’s ability to do the work of birthing and breastfeeding.
   Educate yourself by reading many, many books, magazines, and research papers regarding safe maternal/child health care. Minimize your risk factors by taking exceptionally good care of yourself: eat healthy, whole foods; take a walk everyday; get sufficient rest; and refrain from unhealthy habits (no smoking, caffeine, alcohol or drugs.) Invest in an independent childbirth education class; one that will spend the majority of time teaching you labor-coping techniques and birth physiology, rather than telling you about procedures and what to expect when you enter the doors of the hospital.
   Consider hiring a professional Birth Assistant, known as a “Doula” or “Monitrice” to provide the emotional and physical support you will need in the foreign environment of the hospital. Women supporting women through childbirth has been an ageless tradition common to nearly all the cultures of the earth throughout the centuries.
   It is unfortunate but true that, in just two generations of humanity, we have, in large measure, lost the knowledge, confidence, and respect for the normality of pregnancy, birth, and breastfeeding. For these reasons, the addition of the modern-day Doula to the birth team can be and is a valuable asset, not to be considered a trend or fad.
   The professional Birth Assistant expresses confidence in a woman’s body to birth normally, respect for the process of “natural birth,” and recognition of the transcendent and life-altering aspects of childbearing. She helps pregnant couples actively choose their means of care, enabling them to reclaim the process of birth, improves the quality of their experience, gives them confidence, and empowers them. She maintains a respect for the integrity of the birthing family, believing that they must be the central focus of the birth team.
   Parents must be empowered to make their own best choices and enabled to follow through on those goals without intervention unless medically indicated. The Doula’s role as a labor support person is augmented by her role as advocate for the birthing family (maintaining the integrity of their experience.) An experienced Doula’s value is measured, in large part, in that she provides her clients with information, education, and practical options and alternatives to a medicalized birth experience, so that they may give birth to their baby safely, with minimal or no medication or interventions; with great confidence, strength, satisfaction, and joy!
   Not only does a woman remember her birth experience, but she remembers the people who are with her and who help (or do not help) her. She remembers how she was treated; good or bad; with or without respect and dignity; as important or as insignificant; as the one in control or as a victim. Empowering, affirming words and practical, helpful emotional and physical support during labor and delivery impress forever on a woman. By “mothering the mother” during birth, the Doula can influence how a new mother will mother her own child. Her birth experience helps frame how she sees herself, her womanhood, and is the rite of passage to her motherhood. One of the Doula’s most important jobs is to protect and nurture the woman’s memory of her birthing experience. This, in and of itself, is of great worth.
   Another of the Doula’s roles is to facilitate the integration of new ideas, options, and coping skills for the couple. This includes grieving over what isn’t the “fantasy birth” and/or the “perfect baby." If the birth process requires medical intervention or the outcome is unexpected, the mother often struggles emotionally with this transition. The Doula knows that, when a birth experience deviates from normal, emotional support of the mother is of critical importance.
   The Doula individualizes the support she provides to meet each individual’s needs, always considering their feelings paramount to those of others and of herself. Because the needs of a laboring woman change throughout her birth; the Doula’s goals are to respond to the current and pressing needs of the woman and her partner “at this time” — “for here and now." This is a valuable asset for the couple so that they may find their own way through their birth experience.
   Expectant couples deserve loving, friendly, empowering care throughout their pregnancy & birth. Thousands of women give birth every day, yet every birth is a uniquely personal experience. The Doula serves her clients with genuine concern for their birth memories.
   Providing quality labor support to birthing women has been shown to significantly reduce the need for medication and other interventions, dramatically reduce cesarean and forceps deliveries, reduce maternal fever and infant sepsis evaluations (minimizing separation), increase maternal confidence, and ultimately provide for better outcomes for the mother, baby, and a successful breastfeeding relationship.
   For these reasons, the purpose and value of professional labor support, especially in our culture, should not be taken lightly. Dr. Marshall Klaus, MD, co-author of Mothering the Mother says, "If a Doula were a drug, it would be unethical not to use it."
    We give birth but a few times in our lives, and the impact of those moments stays with us, molds us, and affects our whole society. Thus, the resurgence of home births, the increased interest in natural birth, and the care offered by midwives. Midwives specialize in understanding normal aspects of the childbearing cycle. They serve and care for childbearing women: before, during, and after their pregnancies. The midwife attends childbirth, provides support during labor and delivery, and supervises the general health care of women and children directly after birth. She is trained to recognize deviations from the normal, recommend holistic means for bringing the situation back into the realm of normal, or refer to another practitioner when necessary. She believes it is important is to provide time for questions, teaching, and time to listen to the concerns and needs of the women they care for. Thus, the average midwifery prenatal appointment lasts an hour.

    Midwifery is quite possibly the oldest profession on the planet, as women have been helping women to give birth since the dawn of humankind. The term midwife, derived from the Anglo Saxon word, “mit wif”, meaning "with woman," was first recorded in 1300. Written accounts dating to the 2nd century confirm the role of midwives in the birthing process. Modern midwives provide care to women during normal pregnancies and deliveries and collaborate with and or refer to obstetricians or other physicians if health complications develop or the pregnancy becomes high-risk.

    As trained health care professionals with expertise in supporting women to maintain a healthy pregnancy birth, midwives offer individualized care, counseling, education, and support to women and their newborns throughout the childbearing cycle. Midwives provide continuous support to women with low-risk, uncomplicated pregnancies during pregnancy and labor. Communication between midwife and her client is emphasized, and midwives focus on working with the woman to reduce the risk for complications during childbirth. Midwives also focus on the needs of the family, and encourage partner and family participation in the birth. They pay special attention to the family traditions, cultural values, and the personal preferences of the women in their care.
    Safety of highest priority in midwifery and studies show that outcomes are as safe or safer than similar birth attended by physicians and in hospitals. As part of their commitment to nonintervention, midwives do not advocate the use of pain medication, invasive procedures, and routine time management during the normal birthing process. They encourage women to actively participate in their birthing process.

The continuous presence of a midwife during labor can reduce:

the length of labor,
the need for pain medication,
the likelihood of forceps or other operative devices,
the possibility of cesarean delivery.

The Midwives Model of Care is based on the fact that pregnancy and birth are normal life processes.

The Midwives Model of Care includes:

Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle
Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
Minimizing technological interventions
Identifying and referring women who require obstetrical attention

The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section.    Copyright © 1996-2004, Midwifery Task Force

    Midwifery is based on a strong belief in partnership with childbearing women and respect for birth as a normal life event. Midwives strive to empower parents with knowledge and support their right to create the birth experience which is best for them. Midwives respect intimacy, privacy, and family integrity, and draw on their own patience and understanding to provide care during pregnancy and birth. Midwives trust birth. Midwives believe in normal birth.
   You are “made” to be able to give birth and to Do It very well! Seek out the very best and supportive people to assist you in your goal to give birth safely, to a healthy baby, in the manner that best suits your needs. You can make a difference in your own life and in the lives of those closest to you — your children and their children. Trust “Mother Nature” she has more experience than anyone on this earth! Essentially that means: Trust yourself!

Natural Childbirth —You CAN Do it !

Honoring Midwives on International Day of the Midwife

2010-05-05T19:37:00.009-04:00

Moving to Virginia to continue my work as a home birth midwife and midwifery mentor to aspiring midwives has been a rich blessing in my life!

I honor the Guardians of Normal Birth... Midwives. Wise Woman~With Woman
I am grateful to be one, myself... to hold sacred space with mothers & fathers as they labor to bring their new ones into their homes.

What an awesome and sacred calling to be a handmaiden in this work! I am humbled by each and every moment that I am able to continue the tradition.

We all have the opportunity to HONOR our Local Midwives and affect the lives of women and babies a world away from us...

Join me and the Home Birth Midwifery Service at the OmMama Birth & Baby Fair Saturday, May 8, Lewis Ginter Recreation Association, from 10-2!

Donate to Midwives for Haiti, a Richmond based non-profit organizing midwives and other clinicians from around the world to instruct Haitian women in delivering prenatal care and serving as skilled birth attendants.

Today is International Day of the Midwife! Celebrate the great joy of being a midwife or being cared for by one! Tell a friend about midwifery and how it has changed your life!

A couple of midwives have changed my life.

First, Janet Scoggin, CNM, in Tempe, AZ. She cared for me and caught my third child, and blessed me with my own calling to become a midwife.

Second, Margie McSweeney, RN/CPM. She was my mentor, taking me on as a green, thirty-something year old apprentice, eager to learn and help. A labor/delivery nurse who helped women at the "Med" in Memphis TN, to give birth without intervention, Margie midwifed mid-south families for 20 years. She challenged me, she taught me and later gifted me her practice when she moved to Boulder, CO in 1999.

A true gem among gems. Margie taught me the heart of midwifery, combining art & skill... being ever-vigilant all the while being ever-patient.

Thank you, Margie, for being one of my most important life teachers.

Midwives do indeed catch the future. It is my privilege. It is my blessing. It is my calling.

Blessings of a Mentor... sigh

2010-03-14T15:04:00.002-04:00

I am just sitting her on a drizzly, overcast Sunday afternoon, contemplating the blessings of being a midwifery mentor.

Not all the blessings are good ones, mind you, but in giving them serious consideration, even significant struggles are blessings in disguise. The struggles that come with being hard on and critical of an apprentice, for example, or calling her on a poor decision she has made, or having to even reprimand her because of unprofessional conduct, are difficult to wade through and beyond, yet they challenge me to be consistent, a good example, and both fair and stoic in my role.

Midwifery apprenticeships are not just about completing the clinical, hands-on training and experience ("getting one's numbers"), but more so about how to "BE" a professional midwife: How to talk to clients, how to counsel them, how to filter what you say, how to think critically and act succinctly, what to do and when, when to do and not do, how to direct clients and when, how to advocate and educate...

I am blessed by watching an apprentice's eyes well with tears, realizing that catching babies is truly her calling. And another's eyes glisten and light-up at the invitation to enter into training with me. My own eyes fill when I am aware of one who is struggling, faltering in her actions, and disillusioned. Blessed still to be the one she looks to for critique, for direction, for help. And I sigh.

The mentor midwife is looked up to and admired, and yet we are only human. We make mistakes, we are defensive of our practice like a mother bear to her cub, we seek after a level of accomplishment in our work that is sometimes unreachable, and we dream, dreams.

My work as a mentor gives me great joy and sorrow. I have to be hard and I have to be a friend; and mostly I have to be available... which, is sometimes, the hardest of all. I am the nurturer to so many, and nurtured by few. Mind you, this is not a pity party session... just the hard truth. And my blessing.

Health Care Reform ~ Answering a Niece's Questions...

2010-01-20T20:00:00.001-05:00

I recently received an email from my 20-something year old niece, who Cc'd: her email to other important adult family members (such as her mother and our father [her grandfather])...

Here's what she wrote:

Subject: I need your opinion

Would you mind answering this question? I need a few opinions on the subject (short)..

Do you believe that the approach to health care in the US constitutes a social problem? Is our health care system in need of reform? Why or why not? What type of reform would you advocate?

Thanks so much!!

Love
A.

Here's my response back to her:

I agree with my dad, that no answer to your question can be short and also address your query,
"Why" or "Why not"

So I will do my best to be concise rather than brief.

As a health care provider and business woman, I have a different slant on the entire issue of healthcare reform, and all that these issues create in the way of debate and dialogue. Being intimately involved in helping families to pay for their maternity care, for example, and participating in their struggle to get their insurance to pay for their care. causes me a great deal of angst & aggravation.
Helping clients to make their best health care dollar choices is the most frustrating. Many people decide that paying a "small co-pay" to the doctor and hospital is "better" than paying me $3000. But in reality, they often end up paying thousands of dollars more than my $3000 fee for a birth experience that is FAR and AWAY different from that which they desired and hoped for.

I have to work extra hours "proving" to insurance that they should pay my assistant fee of $700 because her attendance at the birth is essential to delivering quality, safe care to my client. Yet they are just fine with paying for a epidural ($800 - $1200) despite the fact that it increases the risk of birth and neonatal complications.... I could go on with this rant and tangent, but I shall move on...

You asked: Do you believe that the approach to health care in the US constitutes a social problem?

Absolutely!! The distribution of quality health care in the US is most certainly a social problem. Both Medicare and Medicaid recipients, as well as those without insurance, suffer the most. Their healthcare needs are met, yes, but often at substandard levels of quality. At the delivery point, meaning the care given by nurses and doctors, the attitude has become insensitive and unsympathetic. The
work of caring for and helping people to be well and healthy as been replaced with callousness, cynicism, impatience, lack of compassion, and an overall disregard for a patient's rights. This is no more evident than in the emergency rooms across our country. People wait of hours, sometimes giving birth, collapsing, or even dying in ER waiting room! A social problem... most certainly.

You asked: Is our health care system in need of reform? Why or why not?

Of course it is in need of reform! Why?

* The United States is the only wealthy, industrialized nation that does not ensure that all citizens have health care insurance coverage. At least 15% of the population is completely uninsured and a substantial additional portion of the population is "under-insured", or less than fully insured for medical costs they might incur. That lack of health insurance causes roughly 18,000 unnecessary deaths every year in the United States, according to the Institute of Medicine; while a 2009 Harvard study published in the American Journal of Public Health found a much higher figure of more than 44,800 excess deaths annually in the United States due to Americans lacking health insurance.
* The US health care system does not deliver equivalent value for the money spent. More money per person is spent on health care in the United States than in any other nation in the world, and a greater percentage of total income in the nation is spent on health care than in any other United Nations member state except East Timor. Despite the fact that not all citizens are covered, the US has the third highest public health care expenditure per capita. And medical debt is the principal cause of personal bankruptcy in the US.
* The US pays twice as much yet lags behind other wealthy nations in such measures as infant mortality and life expectancy. Currently the U.S. has a higher infant mortality rate than most of the world's industrialized nations. The USA's life expectancy lags 42nd in the world, after most rich nations, lagging last of the G5 nations: (Japan, France, Germany, UK, USA) and just after Chile (35th) and Cuba (37th)!

And there are plenty of other reasons beyond these bullet points. Here is a very good article on understanding health care reform from a business perspective:
Understanding Healthcare Reform ~ Rethinking the Business of How Americans Receive Their Healthcare

You asked: What type of reform would you advocate?

Now THAT is THE question isn't it? That is exactly what all the wrangling is about. Private sector, Gov't option? Universal Coverage? And HOW do we do that?
The debate stems from basic questions:

* Is health care a constitutional right? Or...
* Is health care a responsibility or obligation, meaning an individual must purchase it for herself and her family like we do for food or shelter?
* Should access to care be equitable, despite of income, socio-economic status, prestige or class? (i.e. Should the child of an unskilled hourly worker have access to the same care options as the CEO of a large corporation, or a U.S. Congress member, or a retired union member? Should the child of a corporate CEO have access to better quality care than the child of a laborer?)

I am of the opinion that health care is NOT a constitutional right (meaning that the government must provide it).

My rational: the framers of the Constitution were smart enough to simply state that one of the main goals of government is to “promote the general welfare” of its citizens.

More specifically the 10th Amendment to the Constitution states:
"The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people."

This will be used by the citizenry to challenge the current health reform bill as unconstitutional. Forcing a citizen to buy health insurance and fining those who do not, is unconstitutional, pure and simple.

What do I support?

* Health Insurance Industry Regulation ~ more regulatory control over the business/industry of Health Insurance so that people have easier access to coverage, and so that the services that they desire can be rendered by the provider of their choice, in the facility/place of their choice, and that the costs are controlled so that the bill is paid by insurance without question about the service or its veracity;
* Tort Reform ~ caps on the amount that can be sued for, limiting "defensive medicine" practice, and eliminating frivolous lawsuits,
* Easier Access as a Medicaid Provider ~ making easier for licensed providers like myself to become Medicaid providers and get paid for services rendered,
* Cost Transparency ~ currently patients have little idea of what health care really costs, which is considered to be one of the reasons health care in the United States is so expensive,
* Controlling Billing fraud and Overcharging for Services ~ this takes place in both government payment systems and private
* Controlling the costs of drugs & devices ~ Patients in the United States pay more for drugs and medical devices than patients anywhere else in the world
* Prohibiting Payments to Doctors and other health care providers by pharmaceutical companies and medical device companies
* Transparency in Error Reporting ~ Medical error transparency will improve safety. Safer health care leads to fewer lawsuits which then means lower healthcare costs overall.
* Reducing Prescription Drug & Medical Procedure Errors ~ Clearly, patient safety must be considered among the many issues in health care reform. It's ties to the cost of care, malpractice suits,etc... are important in the bigger picture.

Not a short or easy answer... but I took that time to give you one.

Smooch!
Kim

Midwifing MaMa...

2010-01-01T23:32:00.004-05:00

Our "MaMa," Corinne Acker Bowen Smith Leon Jester, passed peacefully on November 29, 2009 just before 9 pm. Her son, David (my partner), and I were with her as her life slipped quietly away.

She was in hospice care, at home, succumbing to Congestive Heart Failure (CHF) and COPD associated with the CHF. While on oxygen she was completely lucid and planned her entire funeral with us! (Yes, she really did!) She said she wanted everyone to wear black because it was the best way to honor the dead. She told me that she wanted to be dressed in black, she said, "because it is the most appropriate and most dignified color for a woman of my age."

As she was weaned from the oxygen (the 25 liter/min concentration she required to maintain normal O2 saturation was not feasible to continue, nor did she want to...) she asked me to make sure to paint her nails. She told David that she was not afraid and that she was ready to go. She told him that her brothers and sisters had come for her and they were waiting for her. We knew that. She had been talking to them Sunday a week before, both in her sleep and while awake! That was both cool and creepy at the same time, I must admit!

In the remaining 3 hours of her life, as we sat with her and helped ease any suffering with sublingual (oral) Morphine, I found myself midwifing her across the threshold of this life and into the next. Her transition was similar to women who give birth... she needed us right there, touching her, soothing her, and offering her melted ice cream and a cold cloth to her lips. I said similar phrases: "Its alright..." "You are doing just fine..." "We are right here helping you..." "Just let it happen, you are gonna be just fine." "Its okay to cry..." "You are a wonderful mother!" "That's right, that's good..." And as the end was near, "Let it happen, just go on, let it happen! You can do it." And she did, she passed across that seemingly impenetrable plane and became new again. How bittersweet it was to hold her, stoke her hair and midwife her as she died.

I learned a lot from Corinne that night. I learned that I have the capacity, somehow, to be strong and resolute, even amidst my own sorrow and during painfully sad moments. I learned that a dying person deserves to be honored and to have dignity in their final hours. I learned that strangers CAN be both the worst and the best resources available to you. I learned that hospitals and hospital personnel don't do death any better than they do birth. I learned that I can stand in the face of death and not be afraid. I learned that there is peace and serenity in death. I learned that my future may very well be in hospice and palliative care.

As I midwifed Corinne into her new life, I saw myself renewed and recommitted to the sacred. Birth & Death are inexplicably sacred... Thank you, MaMa, for being another important teacher in my life. I love you dearly and honor your memory in my heart, mind & spirit, every day! You were a beautiful, vibrant woman who loved life and loved living it fully! You can be sure that I will take good care of David as he takes care of me.

Rest in Peace, dear Corinne. You certainly deserve the break!
(Click on the above sentence to view MaMa's SmileBox memorial.)

Yes Kim, there really IS a Santa Claus!

2009-12-23T11:09:00.002-05:00

I am going "home" to NC for Christmas...

I had thought it all "bah humbug" and Gggggrrrrr.... thinking that I would be "On-Call" AGAIN at Christmastime...

BUT, a lovely "little" boy came into the world quickly last week, enabling me, yippee, to travel "home" to NC to spend the holiday with my FOLKS!

I am feeling all sparkly like tinsel!! hee hee

Merry Christmas and Happy New Year to everyone!!

SIX Ways to Increase the Safety of Motherhood

2009-12-09T13:04:00.000-05:00

Here are some ideas of ways to make motherhood safer for you...

Preconception Planning can reduce the number of birth defects, unplanned pregnancies, and give a woman and her family time to prepare their own health and lives for a new baby. For example, better nutritional habits lower a woman's risk of many pregnancy related complications, including anemia, problems associated with the amniotic fluid, and gestational diabetes, etc.
Prenatal Care is important. Most of what will go wrong in your labor and birth can be detected in the first visit to a qualified practitioner (doctor or midwife). So aim to have prenatal begin as early as you suspect you are pregnant.
The encouragement of Vaginal Birth After Cesarean (VBAC) for qualifying women, reduces the number of complications associated even with planned cesarean surgery. As our vaginal birth after cesarean rates rise, our cesarean rates fall.
Reduction in Intervention rates in labor. Dr. Calderyo-Barcia, world renowned high-risk obstetrician, exclaims that we should limit the use of labor inducing medications to medical necessities and follow the Food and Drug Administrations guidelines removing inductions for convenience. Prenatal care providers also encourage upright positioning and freedom of mobility to reduce instrumental deliveries (forceps/vacuum), and also other options for pain relief (massage, hydrotherapy, acupressure, etc.).
Use of Midwives as qualified care providers for low risk women. The majority of the babies in the world are birthed into the hands of midwives. Qualified midwives provide excellent care for the prenatal, intrapartum, and postpartum period.
Breast feeding as the best way to feed your baby. The American Academy of Pediatrics has endorsed a policy of Breast feeding for one year. To help encourage this in all countries the World Health Organization along with UNICEF have endorsed the Baby Friendly Hospital Initiative, which promotes policies to support Breast feeding, with helpful hints like, beginning Breast feeding as soon as possible after birth, preferably within one hour.

Frustration... You GET what you PAY for!

2009-11-22T22:45:00.003-05:00

PLEASE!! Forgive my Ranting and Raving and Venting... but I MUST just SCREAM a little!

I have recently canceled TWO client consultations because the clients stated that for "financial reasons" they could not consider a home birth.

WHAT is WRONG with this statement??

Do people REALLY understand WHAT they are "getting" for the deductible and co-pay they PAY to the doctor and the hospital?

Consider the costs of hiring an OB/Gyn to conduct a delivery and the costs associated with hospital birth:

OB/Gyn fee: $3000+
Hospital: $6000+ (if vaginal, uneventful, with no interventions)
Minimum Cost: $9000

Insurance will pay a percentage of scheduled benefits after deductible and co-insurance are met.
(Not to mention the "allowable" amount they will consider paying! And charges that they deny.)

So, consider this:

A $10,000 total bill [doc & hosp] (Remember... this doesn't include ANY additional costs such as:
anesthesia/medication, supplies, medications, newborn care, nursery fees, pediatrician fees, anesthesiologist fee, etc, etc... and certainly doesn't TOUCH the costs involved with complications, cesarean section, extended stays, and NICU care!)

Now, suppose the patient's Deductible @ $500 & Co-insurance @ 20%...
Patient Responsibility: $2500 AT LEAST.
ADD additional costs that are almost inevitable and the patient responsibility goes UP!

Consider that the cesarean rate for most doctors and hospitals is OVER 30% and that infant mortality and morbidity rates (death & health problems immediately after birth) put the US in the BOTTOM of the list of industrialized countries...

Now... there's me... a home birth midwife of 16 years and a small-business woman.

My fee is $3500 ! Self pay clients get up to $500 off in available discounts. And what does the client get for paying out of pocket?

a specially-trained home birth attendant and her assistant(s),
self-determination (her birth ~ her way, including water birth if she desires),
daddy intimately involved in labor support & helping catch baby if he desires,
no strangers, and plenty of one-on-one, continuous labor support,
no unnecessary interventions,
freedom to move as she wishes,
freedom to eat and drink what she wants,
freedom to birth in the position of her choice,
having her children, family and friends in attendance according to her wishes,
immediate skin-to-skin uninterrupted contact with her baby,
delayed cord clamping,
immediate breastfeeding,
the option to keep her placenta, to do with as she desires,
Midwives at her beckon call, 24/7,
shall I go on...??

DO NOT forget all the prenatal visits she has (average number visits: 11) that are an hour in length EACH.
Midwives that are on call 24/7 to answer her questions, continuous labor support, 24/7 postpartum and breastfeeding support...

COME ON PEOPLE!! This is a HUGE DEAL!

Your doctor won't take your call to talk about the nightmare that bothered you. He won't spend an hour with you at each visit to talk about the issues you need to know or talk about. He won't teach you how to avoid a cesarean section or how to turn your posterior baby around to anterior. He will teach you NOTHING about supplementation, nutrition, fitness, or complementary modalities to help you stay well. He won't educate you about your true informed consent and declination options regarding Rhogam; genetic, gestational diabetes & GBS testing; Circumcision; or the myriad of other important things on your list! He won't come to your home help your baby to latch on to your engorged breasts at 2am, spending the night to help at the next feeding.

Home birth midwives have a hospital transfer rate of ~10% and a cesarean rate of 3-4%.
Studies show that the risk of infant death at home or hospital is the same (for low-risk, term women).
Midwifery clients have:

higher satisfaction ratings about their birth experience,
breastfeeding success rates that are higher,
circumcision rates that are lower...
and the list goes on!

The study below indicates that an uncomplicated, vaginal birth at home costs 68% LESS than a hospital birth.
What is 32% of the $10000 total fee above? $3200. Most of my clients pay me $3000.
So there you are... Midwifery and home birth are a huge financial savings to women and their families!

You REALLY do GET what you PAY for!

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The cost-effectiveness of home birth

Rondi E. Anderson MS, CNM and David A. Anderson PhD

12 February 1999.

Abstract

As health care costs increase and a growing number of women are without insurance, the one health service that every family needs deserves further attention. Even for the 40% of births covered by Medicaid, safe birthing alternatives that permit a reduction in the $150 billion Medicaid burden would allow the United States to devote more resources to other urgent priorities. Informed birthing decisions cannot be made without information on costs, success rates, and any necessary tradeoffs between the two. This article provides the relevant information for hospital, home, and birth center births. The average uncomplicated vaginal birth costs 68% less in a home than in a hospital, and births initiated in the home offer a lower combined rate of intrapartum and neonatal mortality and a lower incidence of cesarean delivery.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

My RANT is complete.

My First Blogging Attempt...

2009-11-15T15:33:00.000-05:00

So, here I go...

I am an official Blogger now!

"Inside the Midwife's Bag" is a place where readers can explore the life and work of a home birth midwife (when she had TIME to actually BLOG about it!)

I hope you will return often and share my blogs with your friends.

Blessings Along Your Path!
Kim.

Inside the Midwife's Bag

The Captain of Her Own Ship

Yahoo's Servers Have Been HACKED!!

New Pregnancy Resource: NaturallyBorn

Sign the Petition to Legalize CPMs in North Carolina

The Birth Trust

It is Time to Reframe the Homebirth Conversation

CMA Action Alert

Options abound for moms-to-be

If ultrasound destroys sperm, why is it safe for a fetus?

Facts VS Bias: An Analysis of the Wax Study

The effective labour contraction ~ Midwife Thinking's Blog

Midwife means "with women" but wait, there's more....

Single-Layer C-Section Closure Ups Risk of Uterine Rupture

From Reuters Health Information

Natural Childbirth —You CAN Do it !

Honoring Midwives on International Day of the Midwife

Blessings of a Mentor... *sigh*

Health Care Reform ~ Answering a Niece's Questions...

Midwifing MaMa...

Yes Kim, there really IS a Santa Claus!

SIX Ways to Increase the Safety of Motherhood

Frustration... You GET what you PAY for!

Abstract

My First Blogging Attempt...

Blessings of a Mentor... sigh