Wednesday, May 5, 2010

Honoring Midwives on International Day of the Midwife

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.

Sunday, March 14, 2010

Blessings of a Mentor... *sigh*

I'm 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.

Wednesday, January 20, 2010

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

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

Friday, January 1, 2010

Midwifing MaMa...


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.)

Wednesday, December 23, 2009

Yes Kim, there really IS a Santa Claus!



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!!

Wednesday, December 9, 2009

SIX Ways to Increase the Safety of Motherhood

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.

Sunday, November 22, 2009

Frustration... You GET what you PAY for!

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!


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

Rondi E. Anderson MS, CNM and David A. Anderson PhDCorresponding Author Contact Information

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.