How much worse can they make themselves look?

The AMA is really making themselves look pretty bad here. Open mouth and insert foot. They've joined ACOG's movement with recent resolutions (Resolutions 204 and 205) both to completely BAN all homebirths AND births in freestanding birth centers and criminalize mothers who choose to continue doing this, plus they are going after the entire midwifery model of maternity care by suggesting all non-nurse midwives be OUTLAWED, and nurse midwives come under even greater levels of OB control. Um, what? And, to make it even better, these resolutions are made with absolutely no medical basis. They don't mention a single study, a single statistic, or even a promise that this would be good for mothers and babies. Nope. Their resolutions read more like, "I'm scared for my job and Ricki Lake has made this powerful movie that makes us look really bad so now we better just throw everyone in jail and make it a law that all pregnant women must pay us directly...no other options."

Reaction in the normal birth world is mixed. Some are scared, just because it does suggest there will be a fight ahead and the AMA is waaaaay more powerful than any midwife group (the AMA controls the entire insurance industry, for example). Others think this is good publicity for midwifery and for homebirths. Because their statements are sooo outrageous and have no medical basis, they do seem rather ridiculous. Kinda like shooting guns with no bullets. I have a difficult time seeing how this could ever become a real law...given there is NO medical research supporting the AMA and ACOG's statements (quite the opposite actually).

Well, I'll tell you how much this has changed my mind. I had a very nice talk with my HOMEBIRTH-ONLY, NON-NURSE MIDWIFE yesterday. I'll be seeing her apprentice as my primary midwife, so not only is she NOT a nurse, she isn't even certified OR licensed. HA! And thankfully, my right to do this is completely protected by the fabulous state of Oregon.

PA Court tells State Medical Board to shove it

Big news in the midwifery world on Friday. I know lots of people across the country were tuned in to hear the outcome of this one. Thankfully, the humans came to their senses and an innocent midwife pervailed!

Diane Goslin has been a practicing midwife for like 25 years, and she's attended over 3,000 births. In that time, she has received one (ONE!) complaint against her - and it wasn't even by a parent or family she was serving. It was by a coroner, who examined an infant's body from a birth she had attended. You see, the coroner found the infant's death had nothing to do with the birth or the midwife, but he didn't like that the midwife had attended the birth at all so he complained to the PA Medical Board. What a kind fellow.

So Diane was ordered to cease and desist her midwifery practice and was brought up on numerous charges, including practicing medicine without a license, and given $11,000 in fines. Diane is a Certified Professional Midwife (CPM), an internationally-recognized certification for midwives. But silly Pennsylvania doesn't recognize them and therefore won't give them licenses of any kind. There were a bunch of rulings, and it looked like homebirth midwifery was about to be shutdown in Pennsylvania. But Diane fought hard, and she had thousands of supporters along the way. Save Homebirth joined the fight. The Amish and Mennonite (Diane's primary customers) came out in full force to support her. You can see some amazing pictures here.

Well, it all worked. Diane won. The court decided that practicing midwifery was not the same as practicing medicine, and therefore Diane wasn't guilty of practicing medicine without a license. AND, the court gave the PA Medical Board a slap on the wrist for trying to claim she was practicing as a nurse-midwife, because the Board is only allowed to police women who are trying to do this, and at no time did Diane advertise or call herself a CNM. PLUS, the court decided Diane was denied due process in these charges. Wow. You can read the final ruling here.

This is amazing news for all supporters of midwifery and homebirth. Midwifery is not "practicing medicine" and it should never be judged as such. Midwives should never be prevented from practicing because of misunderstandings about what they do. If states are afraid of midwifery (and that is what it comes down to here - FEAR), they need to take the time to learn what a midwife does and what a midwife doesn't do. If they would open their minds just a little, they would realize that supporting midwifery (and specifically homebirth midwifery) is not only cheaper, but better for the health of mother and baby.

Man, I'm so glad Pennsylvania saw the light. And now onto the local fight - whether or not Oregon will begin mandatory licensure for all practicing midwives (it is currently optional). OMC (Oregon Midwifery Council) is debating how to coordinate a unified front and what they should be arguing for. More to come...

She was meant to be a midwife

SageFemme is definitely in the right profession. Kudos to her for handling a 13 MINUTE shoulder dystocia of a nearly 13 lb baby girl. At home. With no broken bones. And full resuscitation. Oh. My. God.

Baby girl is doing well.

SafeFemme is also an amazing photographer of the births she attends, and has created this gorgeous montage of some of her homebirths. Beware - not for office viewing.

A great response to ACOG's stupidity

This is an awesome, honest, and accurate response to ACOG's statement on homebirths.

I couldn't have said it better. And I agree whole-heartedly with her point that ACOG's statement was defensive, insulting, and paternalistic.

Citizens for Midwivery offers facts as talking points

This is a really nice collection of talking points (in no particular order) from Citizens for Midwifery (CfM):

• Twenty-four states license direct entry midwives, several for more than twenty years. Twenty-two use or recognize the Certified Professional Midwife (CPM) credential administered by the North American Registry of Midwives (NARM) as the basis for licensing, and two states have voluntary licensing. In all theseyears, no state has repealed their midwifery law for any reason. Furthermore, in 9 states licensed midwives receive Medicaid reimbursement for their services. These records demonstrate that CPMs do not pose any threat to the health and safety of pregnant women and newborns.
  
• An economic analysis of the cost benefits of a licensed midwife program (Washington State) indicate that the cost savings to the health care system (public and private) is estimated to be ten times the cost of the program, even with this licensing program being the most expensive in the country. (Midwifery Licensure and Discipline Program in Washington State: Economic Costs and Benefits, (A report to the Washington Department of Health), Health Management Associates, October, 2007)
  
• Contrary to ACOG’s uninformed assertion, many rigorous scientific studies, published in leading medical journals, have found that for a healthy woman having a normal pregnancy, a planned, midwife-attended home birth is as safe as a hospital birth and with far lower rates of medical interventions. The most recent is also the largest study, based on prospective reporting for all the births attended by Certified Professional Midwives in 2000, published in 2005 in the British Medical Journal . ("Outcomes of planned home births with certified professional midwives: large prospective study in North America." Kenneth C Johnson, senior epidemiologist, Betty-Anne Daviss, project manager. BMJ 2005;330:1416 (18 June). Also see CfM’s summary fact sheet.
  
• About 99% of births in the US take place in hospitals. If standard obstetric practice is so good, why does the US rank so abysmally when it comes to maternal mortality and neonatal mortality?
  
• The Complete Mothers’ Index 2007 shows that mothers in the US have a higher lifetime risk of maternal mortality than the mothers in 27 other developed countries.
  
• The World Health Report (from the World Health Organization) indicates that the neonatal death rate (death in the first 28 days of life) is greater in the United States than in 35 other countries.
  
• ACOG claims that "complications can arise with little or no warning even among women with low-risk pregnancies". However, complications seen in low-risk women laboring in hospitals are often related to the many routine practices and interventions that disturb the birth process and cause or lead to complications and more interventions. In fact, most of these practices were adopted without being studied for safety, and many are still routine even after being studied and found to be either worthless or harmful or both. (Enkin et al. A Guide to Effective Care in Pregnancy and Childbirth) Midwives attending home births avoid unnecessary interventions and the use of drugs, allowing normal birth to proceed. They are trained and experienced in noticing any signs of problems and taking appropriate action, including transfer to medical care in a hospital when necessary, which is rarely. (see the BMJ article cited above)
  
• The press release states "ACOG acknowledges a woman’s right to make informed decisions regarding her delivery…" but goes on to say that ACOG does not support any of the alternatives to a doctor-controlled birth in hospital or birth center, or anyone who provide or supports home birth. So how is ACOG supporting informed decisions?
  
• ACOG claims that an "emerging contributor" to the rise in cesarean section rates is "maternal choice." However, there is no evidence for this claim. In fact, recent surveys of mothers found that less than 0.08% of pregnant women request a C-section. Applying these numbers to a recent figure for annual births, a scant 2,600 out of 4.1 million pregnant women actually requested a C-section. (Declercq ER, Sakala C, Corry MP, Applebaum S. Listening to Mothers II: Report of the Second National U.S. Survey of Women’s Childbearing Experiences. New York: Childbirth Connection, October 2006.) Clearly, this number is so small it could not possibly explain the doubling of cesarean section rates in the last decade. Furthermore, when he was President of ACOG, Benjamin Harer publicly promoted maternal choice cesarean sections on popular TV news and talk shows, for reasons for which there was not evidence. (for example: Benjamin Harer on Good Morning America, 2000. Having actively worked to create a market for cesarean sections for no medical reason, based on lies and misinformation, ACOG is now blaming women for the increased cesarean rate??
  
• When attending births outside the hospital, both Certified Nurse Midwives and Certified Professional Midwives referred fewer than 5% of mothers for cesarean sections, while obstetricians were performing cesarean sections on nearly 20% of low risk mothers in hospitals. (see CfM fact sheet with references)
  
• Some women are going to choose to deliver their baby at home, for a variety of very legitimate religious, social, health or economic reasons. These women deserve to have the best care available the care of a well-trained midwife with experience in out-of-hospital settings. (Firefly Mama thinks this is the most important point!)
  
• While ACOG states that childbirth is a normal physiologic process, today’s obstetrical profession performs cesarean sections for nearly one third of births, induces labor in nearly half of births, and administers drugs of one kind or another to more than two thirds drugs that pass through the placenta and harm the baby. In fact, almost the only women who give birth with no interventions are those who give birth at home. (Listening to Mothers: Report of the First National U.S. Survey of Women’s Childbearing Experiences. New York: Maternity Center Association, October 2002.)
  
• Apparently obstetricians are not trained to support normal birth, but oppose the very health care providers who are: midwives who are trained and experienced in attending births outside the hospital. The Certified Professional Midwife credential is the only maternity are credential that requires experience in out-of- hospital settings.

Childbirth Connection addresses ACOG's policy

From Childbirth Connection:

ACOG Place of Birth Policies Limit Women's Choices Without Justification and Contrary to the Evidence

In October 2006, the American College of Obstetricians and Gynecologists (ACOG) released a Statement of Policy on "Out-of-Hospital Births in the United States." Following feedback from ACOG members and from Childbirth Connection and many other concerned organizations, ACOG issued a revised Statement of Policy on "Home Births in the United States" in May 2007. This Alert and Response describes Childbirth Connection's concerns with the statements and their implications for mothers and babies.

What place of birth policy did ACOG set in "Out-of-Hospital Births in the United States" (October 2006)?
The earlier statement asserted that "studies comparing the safety and outcome of U.S. births in the hospital with those occurring in other settings are limited and have not been scientifically rigorous." ACOG also claimed that the hospital "is the safest setting for labor, delivery, and the immediate postpartum period." Consequently, it concluded, ACOG "strongly opposes out-of-hospital births" and "does not support programs or individuals that advocate for or who provide out-of-hospital births." However, the statement failed to cite any evidence to support the assertions and failed to acknowledge impressive existing evidence regarding the safety of planned home birth and out-of-hospital birth center birth.

What place of birth policy did ACOG set in its revised statement, "Home Births in the United States" (May 2007)?
The revised statement was identical to the previous statement with the exception of limiting the focus to home births rather than to all out-of-hospital births and acknowledging the safety of birth in out-of-hospital birth centers that meet standards of relevant accreditation organizations. The revised statement concluded by stating that "ACOG strongly opposes home births" and "does not support programs or individuals that advocate for or who provide home births." Again, no study was cited to support this position, and existing research in support of planned home birth was overlooked.

What was the response to the earlier statement?
Some ACOG members objected to the policy, and numerous organizations submitted letters of concern and posted the letters online. These included American Association of Birth Centers, American College of Nurse-Midwives, Consumers United for Evidence-based Healthcare, Lamaze International, and White Ribbon Alliance for Safe Motherhood. In addition, Childbirth Connection and other consumer advocacy organizations together sent a letter identifying special concerns from a consumer perspective. Joining together with Childbirth Connection were Center for Medical Consumers; National Partnership for Women and Families; National Women's Health Network; and Our Bodies, Ourselves, as well as the Executive Director of Families U.S.A. signing as an individual. In general, the letters asked ACOG leaders to review the policy in light of the plethora of high-quality scientific evidence supporting the safety of planned out-of-hospital birth.

What were the major concerns of the consumer groups?
The joint letter from organizations writing from the perspective of best interests of mothers and babies expressed several concerns. First, the groups were troubled that the policy would undermine women's choices and legal right to informed consent about where to give birth and noted that ACOG's own document, Ethics in Obstetrics and Gynecology (2004), strongly supports women's right to informed consent.

Moreover, the groups were troubled by the complete lack of evidence to support the statement's assertions and its failure to acknowledge impressive existing evidence. With respect to home birth, they noted a large prospective study of 5,418 American women planning home births with Certified Professional Midwives (Johnson and Daviss 2005), and a systematic review of home birth (Olsen 1997). With respect to birth in out-of-hospital birth centers, they pointed to the large prospective National Birth Center Study of 11,814 mothers who began labor in out-of-hospital birth centers (Rooks et al. 1989) and a systematic review of care in out-of-hospital birth centers (Walsh and Downe 2004). Notably, both of the large studies achieved 4% c-section rates whereas about one mother in three now gives birth by major surgery in the United States. All four studies found very low rates of many widely used obstetric interventions and no sign that the settings or conservative use of obstetrical procedures involved extra risk when out-of-hospital births were compared with low-risk women giving birth in hospitals. The systematic reviews concluded that there is no a priori basis for denying planned out-of-hospital birth. The large prospective studies were published in the most prestigious general medical journals, New England Journal of Medicine and BMJ.

The letter from the consumer groups also pointed out that in rejecting the strong available evidence ACOG displayed a double standard. The letter referenced an analysis of ACOG's recent obstetric practice recommendations that found that just 23% are Level A, that is, "based on good and consistent scientific evidence," whereas 35% are Level B -- "based on limited or inconsistent scientific evidence," and fully 43% are Level C, "based primarily on consensus and expert opinion" (Chauhan et al. 2005). In evidence-based medicine, expert opinion when not backed by sound research is the lowest and least reliable level of evidence (Oxford University 2001). Despite the weak scientific evidence for over three-quarters of ACOG’s professional practice recommendations, some obstetricians feel that they are vulnerable to malpractice claims and suits if they deviate from ACOG policies, and recent research supports this (Ransom et al. 2003). Finally, the letter to ACOG from the consumer groups pointed out that the policy endangers the health and well being of mothers and babies in two ways. First, in opposing those who support out-of-hospital birth, ACOG could jeopardize appropriate physician back-up for the considerable number of women who will continue to choose out-of-hospital births. All health professionals need to be able to call on other health professionals for specialized services that are beyond their expertise and scope of practice. Obstruction of such professional collaboration jeopardizes the welfare of mothers and babies and is of grave concern. Second, in taking the position that all women should give birth in hospitals, the statement would consign low-risk women to the high rates of invasive procedures and other interventions that are now the norm in U.S. hospitals, as measured in Childbirth Connection’s Listening to Mothers II survey (Declercq et al. 2006).

Did the revised policy statement address concerns of the consumer groups?
The revised policy statement reflects the best available evidence about planned birth in out-of-hospital birth centers, but continues to reject home birth without justification and contrary to the best evidence. After describing results of the best available research and concern about typical maternity care in U.S. hospitals, the consumer groups wrote:

"These major [out-of-hospital] studies set a standard for what is attainable among healthy low-risk pregnant women in North America and raise troubling questions about current practice trends. Care in these settings should be emulated rather than denigrated."

Another available research review is consistent with the studies and systematic reviews cited above: Stotland and Declercq (2002).The current ACOG policy statement about place of birth continues to raise troubling questions about: current standards of maternity care in the United States, ACOG's disregard for best available evidence, and ACOG's infringement on rights of childbearing women.

References:

American College of Obstetricians and Gynecologists. Ethics in Obstetrics and Gynecology, 2nd ed. Washington, DC: ACOG, 2004.

American College of Obstetricians and Gynecologists Executive Board. ACOG Statement of Policy: Home births in the United States. Washington, DC: ACOG, May 2007.

American College of Obstetricians and Gynecologists Executive Board. ACOG Statement of Policy: Out-of-Hospital Births in the United States. Washington, DC: ACOG, October 2006.

Chauhan SP, Berghella V, Sanderson M, Magann EF, Morrison JC. American College of Obstetricians and Gynecologists practice bulletins: An overview. American Journal of Obstetrics and Gynecology 2006;194:1564-75.

Declercq ER, Sakala C, Corry MP, Applebaum S. Listening to Mothers II: Report of the Second National U.S. Survey of Women's Childbearing Experiences. New York: Childbirth Connection, October 2006.

Johnson KE, Daviss B-A. Outcomes of planned home births with Certified Professional Midwives: Large prospective study in North America. BMJ 2005;330:1416.

Olsen O. Meta-analysis of the safety of home birth. Birth 1997;24:4-16.Oxford University, Centre for Evidence-Based Medicine.

Oxford Centre for Evidence-Based Medicine levels of evidence, 2001. Available at http://www.cebm.net/index.aspx?o=1025 (accessed June 20, 2007).

Ransom SB, Studdert DM, Dombrowski MP, Mello MM, Brennan TA. Reduced medicolegal risk by compliance with obstetrical clinical pathways: A case-control study. Obstetrics & Gynecology 2003;101:751-5.

Rooks JP, Weatherby NL, Ernst EK, Stapleton S, Rosen D, Rosenfield A. Outcomes of care in birth centers: The National Birth Center Study. New England Journal of Medicine 1989;321(26):1804-11.

Stotland NE, Declercq ER. Safety of out-of-hospital birth in industrialized nations: A review. Current Problems in Obstetrics, Gynecology and Fertility 2002;25:134-44.

Walsh D, Downe SM. Outcomes of free-standing, midwife-led birth centers: A structured review. Birth 2004;31:222-9.

ICAN responds

ICAN’s Response to ACOG AND AABC Statements on VBAC and Homebirth
Redondo Beach, CA, February 7, 2008:

The International Cesarean Awareness Network would like to publicly condemn both the AABC (American Association of Birth Centers) and the ACOG (The American College of Obstetricians and Gynecologists) for their statements this week that limit not only women’s choices in birth but imply that birth is a fashion trend rather than a safety concern.

Since VBAC is the biological normal outcome of a pregnancy after cesarean, ICAN encourages women to get all of the facts about vaginal birth and elective repeat cesarean before making a choice. This decision should not include weighing the choices of your doctor’s malpractice payments but only be a concern of the mother, her baby and their health and safety.

Since some mothers will make the choice to give birth outside of the hospital, we encourage the AABC to not cave into ACOG’s demands that all women give birth in a hospital facility with a surgical specialist, but instead allow women to make their own choices about care providers, birth settings and risk factors. ICAN respects the intelligence of modern women and accepts that the amount of information available about VBAC and elective cesarean should serve as informed consent.

ICAN further encourages the governments of individual states to look closely at their cesarean rates (31.1% national cesarean rate as of 2006) and the informed consent laws that apply and help women to reach a standard of care that lowers the risks of major surgery and the risks of elective or coerced cesarean without medical indication. Women and children should not bear the brunt of malpractice risks being conveyed into physical, mental, emotional and spiritual health risks in order to protect their physicians.

Mission statement: ICAN is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery and promoting vaginal birth after cesarean. There are more than 94 ICAN Chapters across North America, which hold educational and support meetings for people interested in cesarean prevention and recovery.

AABC statement

ACOG statement

Big Push for Midwives fights back

This is the first (of many, I'm sure) responses to ACOG's statement.


PushNews from The Big Push for Midwives Campaign
CONTACT: Steff Hedenkamp, (816) 506-4630, RedQuill@kc.rr.com
FOR IMMEDIATE RELEASE: Thursday, February 7, 2008

ACOG: Out of Touch with Needs of Childbearing Families

Trade Union claims out-of-hospital birth is “trendy;” tries to play the “bad mother” card

(February 7, 2008) — The American College of Obstetricians and Gynecologists (ACOG), a trade union representing the financial and professional interests of obstetricians, has issued the latest in a series of statements condemning families who choose home birth and calling on policy makers to deny them access to Certified Professional Midwives. CPMs are trained as experts in out-of-hospital delivery and as specialists in risk assessment and preventative care.

“It will certainly come as news to the Amish and other groups in this country who have long chosen home birth that they’re simply being ‘trendy’ or ‘fashionable,’” said Katie Prown, PhD, Campaign Manager of The Big Push for Midwives 2008. “The fact is, families deliver their babies at home for a variety of very valid reasons, either because they’re exercising their religious freedom, following their cultural traditions or because of financial need. These families deserve access to safe, quality and affordable maternity care, just like everyone else.”

Besides referring to home birth as a fashionable “trend” and a “cause célèbre” that families choose out of ignorance, ACOG’s latest statement adds insult to injury by claiming that women delivering outside of the hospital are bad mothers who value the childbirth “experience” over the safety of their babies.

“ACOG has it backwards,” said Steff Hedenkamp, Communications Coordinator of The Big Push and the mother of two children born at home. “I delivered my babies with a trained, skilled professional midwife because I wanted the safest out-of-hospital care possible. If every state were to follow ACOG’s recommendations and outlaw CPMs, families who choose home birth will be left with no care providers at all. I think we can all agree that this is an irresponsible policy that puts mothers and babies at risk.”

The Big Push for Midwives calls on ACOG to abandon these outdated policies and work with CPMs to reduce the cesarean rate and to take meaningful steps towards reducing racial and ethnic disparities in birth outcomes in all regions of the United States. CPMs play a critical role in both cesarean prevention and in the reduction of low-birth weight and pre-term births, the two most preventable causes of neonatal mortality.

Moreover, their training as specialists in out-of-hospital maternity care qualifies CPMs as essential firstresponders during disasters in which hospitals become inaccessible or unsafe for laboring mothers. In addition, CPMs work to ensure that all babies born outside of the hospital undergo state-mandated newborn screenings and are provided with legal and secure birth certificates.

Currently, Certified Nurse-Midwives, who work predominantly in hospital settings, are licensed and regulated in all 50 states, while Certified Professional Midwives, who work in out-of-hospital settings, are licensed and regulated in 24 states, with legislation pending in an additional 20 states.

The Big Push for Midwives (http://www.TheBigPushforMidwives.org) is a nationally coordinated campaign to advocate for regulation and licensure of Certified Professional Midwives (CPMs) in all 50 states, the District of Columbia and Puerto Rico, and to push back against the attempts of the American Medical Association Scope of Practice Partnership to deny American families access to legal midwifery care.

Media inquiries should be directed to Steff Hedenkamp (816) 506-4630, RedQuill@kc.rr.com.

ACOG declares war

The American College of Obstetricians and Gynecologists (ACOG) has declared war against all non-nurse midwives and homebirth. We've known their stance on the issue, but now it is public and in a press release. And, they've tossed in a number of lies to help make their point.

Deep down, I really do believe that someday they will be sorry they fought so hard for inferior care.

The full text of the press release:

ACOG NEWS RELEASE
For Release:
February 6, 2008
Contact:
ACOG Office of Communications
(202) 484-3321
communications@acog.org

ACOG Statement on Home Births

Washington, DC -- The American College of Obstetricians and Gynecologists (ACOG) reiterates its long-standing opposition to home births. While childbirth is a normal physiologic process that most women experience without problems, monitoring of both the woman and the fetus during labor and delivery in a hospital or accredited birthing center is essential because complications can arise with little or no warning even among women with low-risk pregnancies.

ACOG acknowledges a woman's right to make informed decisions regarding her delivery and to have a choice in choosing her health care provider, but ACOG does not support programs that advocate for, or individuals who provide, home births. Nor does ACOG support the provision of care by midwives who are not certified by the American College of Nurse-Midwives (ACNM) or the American Midwifery Certification Board (AMCB).

Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre. Despite the rosy picture painted by home birth advocates, a seemingly normal labor and delivery can quickly become life-threatening for both the mother and baby. Attempting a vaginal birth after cesarean (VBAC) at home is especially dangerous because if the uterus ruptures during labor, both the mother and baby face an emergency situation with potentially catastrophic consequences, including death. Unless a woman is in a hospital, an accredited freestanding birthing center, or a birthing center within a hospital complex, with physicians ready to intervene quickly if necessary, she puts herself and her baby's health and life at unnecessary risk.

Advocates cite the high US cesarean rate as one justification for promoting home births. The cesarean delivery rate has concerned ACOG for the past several decades and ACOG remains committed to reducing it, but there is no scientific way to recommend an 'ideal' national cesarean rate as a target goal. In 2000, ACOG issued its Task Force Report Evaluation of Cesarean Delivery to assist physicians and institutions in assessing and reducing, if necessary, their cesarean delivery rates. Multiple factors are responsible for the current cesarean rate, but emerging contributors include maternal choice and the rising tide of high-risk pregnancies due to maternal age, overweight, obesity and diabetes.

The availability of an obstetrician-gynecologist to provide expertise and intervention in an emergency during labor and/or delivery may be life-saving for the mother or newborn and lower the likelihood of a bad outcome. ACOG believes that the safest setting for labor, delivery, and the immediate postpartum period is in the hospital, or a birthing center within a hospital complex, that meets the standards jointly outlined by the American Academy of Pediatrics (AAP) and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers.

It should be emphasized that studies comparing the safety and outcome of births in hospitals with those occurring in other settings in the US are limited and have not been scientifically rigorous. Moreover, lay or other midwives attending to home births are unable to perform live-saving emergency cesarean deliveries and other surgical and medical procedures that would best safeguard the mother and child.

ACOG encourages all pregnant women to get prenatal care and to make a birth plan. The main goal should be a healthy and safe outcome for both mother and baby. Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby. For women who choose a midwife to help deliver their baby, it is critical that they choose only ACNM-certified or AMCB-certified midwives that collaborate with a physician to deliver their baby in a hospital, hospital-based birthing center, or properly accredited freestanding birth center.

# # #

The American College of Obstetricians and Gynecologists is the national medical organization representing over 52,000 members who provide health care for women.

Updates

I haven't posted in a while. I know. I think my blog is going to suffer a little in the coming months as I near the end of my school career. My stress and anxiety are just overwhelming sometimes, and it leaves me wanting to lurk more than post on the internet. So I will try to speak up when I can, but know that if I'm MIA, its cause I'm buuuuuuuuusy.

So updates...

Last weekend I attended Neonatal Resuscitation Program with Karen Strange, and it was an AMAZING class. We learned far more than just resuscitation of newborns. We learned about newborn physiology and some techniques to encourage a peaceful transition from intrauterine to extrauterine life. And, I got to meet Sage Femme, someone I've admired for a while and hope to interact with more frequently.

Alder is coming up on 9 months now. He still isn't crawling, and has no teeth. He's been on the verge of crawling for about 2 months, so I'm starting to wonder if he'll skip crawling all together. He's doing okay with standing if propped up in that position.

The life-after-school question is still up in the air. A big job came up but I've decided to pass because it is: 1) in Eugene, 2) full-time, and 3) research focused, and I want none of these things. My advisor has remained noncommital about whether I can work for him after graduation, so I'm starting to assume that means no. He's sending some hints that it is no, though I think if he really KNEW it was no, he'd just tell me no. Anyway, I'm definitely not counting on that. Right now I'm excited about developing my doula and childbirth education business, and possibly getting the opportunity to do some assisting at homebirths in the near future (Pssst...any area MWs reading this...I'm available!).

School is coming along, but pissing me off too. I'm still revising my final chapter, and time just keeps passing. My advisor is being tough on some of the revisions, so we aren't setting a defense date yet. Now it looks like I may stray into spring term. If so, at least my advisor has offered to pay me (a teeny, tiny amount) for spring term too. But dammit, I gotta finish!!

What else...

We got a new tv today. (grin) Finally...my piece o' junk tv can be retired, in favor of the nice, new, CLEAR imagine of our LCD flatscreen. As a LOST junkie, I can't wait to see my favorite characters on the big screen.

I've been doing a draft of our taxes, and it looks like we're going to get quite a little refund this year. Thank goodness...cause we're shopping for a minivan this summer and need more for that downpayment.

Not much else really. Just busy...and stressed.

Penny and Me

I had a FABULOUS time in Seattle at Penny Simkin's workshop on attending laboring mothers who've experienced early childhood sexual abuse or previous birth trauma. It was really phenomenal, and should be required training for all birth attendants. Among the attendees was Karen Strange, CPM, instructor for neonatal resuscitation program, which she's teaching in Corvallis in a week. I'll be in on that class too.

More soon. I've got some catching up to do at home. It was a long 2.5 days away from the kids.

Midwife gift

It is customary to give your midwife a gift if you have appreciated your services after a homebirth. I always knew I wanted to give my midwife something handmade. After Ava's birth, we hoped I would have time to make some stained glass, or that Keith would have time to do some pottery. But that didn't happen, so her gift ended up being a check (which is always welcome, as homebirth midwifery does not make you rich!). But this time I really wanted to find the time to make a special gift. And somehow, even though I've got two kids and am finishing my PhD and work as a birth doula, I managed to make it happen. The piece above was actually quite easy to make compared to my previous pieces. There were far less curves to grind out on this one. The lead came and solder are silver in color, though you can't tell from the picture. I like this pattern quite a bit. I think I'll be making another one for myself.

Oh, and the really cool thing about this - the week before I gave my midwife this piece, she was at my house for the Blessingway of another expectant mommy and she commented on the large fish and turtle glass piece I have in my bathroom window. She said it was really gorgeous and remembered that I used to do glass work and was glad to see I'd gotten back to it. :) I didn't tell her at the time I had this gift for her, because it wasn't finished yet. But it made me feel really good to know she was going to appreciate my gift. And she did.

Mega update

I've lost all sense of time. Seriously, minutes pass in seconds, days pass in minutes, and weeks pass in the blink of an eye. I remember as a kid when life passed at the slowest snail's pace, but now it is more like a rocketship. Somebody put on the brakes, will ya?

Life in our household has been continuing full-steam ahead. Nothing major has happened in the last week, except for the most minor case of the sniffles in both kids. My computer at school (where I have the most uninterrupted time to blog) doesn't like Blogger, so I've been unable to post from there and frankly, posting time at home is almost non-existent lately.

So the VBAC birth that was going on last week obviously ended. I was not called to stay the primary doula. Baby was born later that night via emergency cesarean, after a transfer from the birthing center for what the doula described as "scary" decelerations. While at the hospital, the mom was able to continue laboring all the way to 8 cm (that is 7 cm further than she got last time), but then FHT took such a serious dive a cesarean was performed immediately. Turns out there was a serious cord entanglement going on, and baby wasn't coming out without bringing the placenta with it. Healthy boy, 9.5 lbs. Mom is really happy she got to experience so much labor.

In other news, daycare woes continue. Ava is now registered for 3 afternoons a week starting after Thanksgiving, but that is not a convenient schedule for us at all. With some luck, all the right changes will take place in the next 6 weeks, and we'll get both kids in there for 2 full days/week by January 1. Cross your fingers for us. We're still on the waiting list for the campus daycare center, but it looks like that will be July before space is available.

We've been getting our wills and advanced directives together around here. We already had a will, but seeing my aunt's death and the aftermath associated with her will and assets, I've realized how important it is to have everything meticulously prepared. I've been learning about trusts. There are just so many ways to take care of your loved ones after you die. Confusing stuff. Not like we have much to leave em (and not like we plan on dieing for 50 years), but I wanna make sure they get every penny!

Potty training! I think we are officially potty-trained here. Accidents are extremely rare now and almost predictable because of the circumstances. We still haven't tackled nap or night training because Ava has no access to the potty during those times, but it is coming soon.

Night weaning! Alder has night-weaned himself. This has been going on for about 2 weeks. I can't believe it. Last night he slept for 10.5 hours STRAIGHT. And he's not even 6 months. I'm so thankful we've gotten here with absolutely no urging on our part. Franny, I hope your next one takes a cue from Alder. Granted, things were still very rough 2 months ago, but to completely sleep through the night ON HIS OWN at less than 6 months...that is just worth almost anything.

Not much else going on. Keith and I are dreaming of our new minivan that we hope to get next summer.

Oh, and 2 days ago I finished writing the final manuscript of my dissertation. It needs major editing, and I still have to write a brief introduction and brief conclusion to the whole dissertation, but that should only take a couple of days. I can't believe I'm almost there. Hopeful defense date in late January.

And one more thing! I'm on the verge of signing up for my first class towards the long path to midwifery. I'm thinking this will be a one or two classes at a time, maybe a couple of times a year thing...so the entire curriculum will take probably 5+ years (I'm thinking of going for the AS degree which includes the CPM first, then possibly the MSM if I'm still into school and all). But that sounds about right to me. I have no apprenticeship lined up anyway. It takes time to figure those things out, and until I'm done with the PhD and have earned a little money, I can't even fathom an apprenticeship with no income.

Okay, that is all now.

Am I gonna be a midwife?

Maybe. The birth bug has definitely got me strong. Today I attended a training session for wanna-be midwife's assistants. It was really great - all like-minded ladies together for a day of playing with instruments, practicing techniques, and talking birth, baby, and pregnancy. The training was offered by several midwives from the Midwifery Access Project in Eugene, OR. Three other doulas from my local Corvallis group went down with me, so it was a great time had by all.

Five years ago, I never had any idea I would become this involved in birth work. I guess it started when I began planning my first pregnancy, long before I actually met the man who eventually became my husband. I just knew I wanted to have a natural, drug-free birth. Over time, I realized my vision was to have my children at home. So once I was married and we were ready to have children, my time had come. After my first homebirth, I knew the hands-off midwifery model was definitely my cup of tea. I became the uber birth nerd that I continue to be, and I got interested in doula work. I still didn't have an interest in being a primary midwife though. Eventually I started to consider being a midwife's assistant. Someday, I'd love to attend some training workshops on The Farm.

Anyway, fast foward to now. I have a handfull of births under my belt and a few more in the hopper. I've had my second child. I've realized that though I intend on a career in academia at some point, I know it isn't where I still spend the rest of my working days. And I'm starting to think about the long path to being a real, primary midwife. For me, it could be a VERY long path though. For now, I'm just thinking I'll soak up any birth experiences I can get - as a doula, as an assistant, as an apprentice, as a friend. I know I can't take an assistant/apprentice role until I finish school. But after school is done, that might be a good time for something like that. We'll see. I think I've got the sleep on this one. In the meantime, I'm gonna make an appointment with my midwife to go over my charts. Now that I've had the class, I think I can read them and understand. I'm sure I might let slip that I've attended this class and could be interested in attending births if she was ever searching for someone.

Doula Meeting

Tonight was a great night. Tonight I hosted a meeting of local doulas at my house, and it was wonderful. There were 13 doulas here, one of whom is also a homebirth midwife and one of whom is also an L&D nurse, plus another midwife who catches babies at our local hospital. At every meeting (we have these every month), I always walk away with a renewed enthusiasm for birth work. The energy is so loving and positive. And we usually tell birth stories too. Some of these women are becoming my true friends. And one of them was at my birth with Alder.

Tonight's primary areas of discussion were advertising funds and hearing from the hospital midwife about doula relations with doctors and nurses. The advertising issue is really important to most of us, as this is how we primarily attract clients. With 17 doulas in Corvallis right now (and still growing), we can't all create fliers and have them sit on the obstetrician's desk. So the doulas of Corvallis came together and created a network that could advertise as a group and develop our own website. We have much greater power and influence as a group too. Since forming just 18 months ago, doulas have become much more accepted in our hospital. The word is getting out about the wisdom of having a doula.