Skip to main content

New Best Practice Guidelines For Transfer From Planned Home Birth To Hospital

Posted by Midwives Alliance on April 24th, 2014

As midwives, we all know that the way a woman is received at the hospital during a transfer from a home birth can impact both her physical and emotional safety. Midwives, hospitals, and policy makers have a new tool designed to help create an optimal transfer environment.

The model blueprint, known as the Best Practice Guidelines: Transfer From Planned Home Birth To Hospital was designed as an open source tool that anyone can use in creating policies and procedures for optimal transfer.

The new guidelines are a landmark achievement by the Home Birth Consensus Summit (HBCS) Collaboration Task Force. Chaired by past MANA President Diane Holzer and including past president and current MANA Communications Chair Jill Breen, this is a multi-stakeholder collaboration among physicians, midwives, nurses and consumers who have worked together to support the safety and well-being of families who choose home birth by creating this tool that bridges practitioners and sites of birth.

You can read about the guidelines in Science and Sensibility and at the HBCS website. MANA is a proud endorser of the guidelines. The HBCS delegates are seeking additional endorsements, from both organizations and individuals. You can learn more and sign on here.

What We Know - And What We Can Change - About Cesarean Birth in the U.S.

Posted by Midwives Alliance on April 9th, 2014

When three women in early labor walk into a hospital in the United States, we know that one of them will have her baby by cesarean section. Why is the surgical birth rate so high, and what can we do about it? We know that full term vaginal birth with mother and baby enjoying skin to skin during the first hour, with baby at the breast, and an environment filled with love and familiar voices is what both science and instinct tell us is best for mother, baby, and family. How do we make this a reality for more women in the U.S.? Identifying the issues can help us develop the best solutions through education and implementation of what we learn.

What are some of the challenges women face in achieving normal physiologic birth?

1. Hospital birth procedures. Time limits on stages of labor, interventive or interruptive hospital routines, and lack of support for women with challenging labors and longer labors may all contribute to high c-section rates. Experience shows us that:

  • Each woman's labor has its own rhythm that works well for her and her baby.
  • Even minor interventions,  procedures, and interruptions can distract, slow down or even stop labor and can impact the progress.
  • Fetal heart monitors can restrict a woman's ability to move during labor and distract her and her team from the work at hand.
  • Continuity of care, even having one person such as a doula or midwife stay with a woman throughout her labor and birth can help her cope, decreasing the need for pain medication and increasing her confidence and ability to birth without intervention.

2. Inductions. The increasing rates of inductions may be a contributing factor in the high c-section rate.

  • Inductions with an unripe cervix or undescended fetal presenting part (the baby's head in a vertex presentation if well-flexed and low in the pelvis will work with the contractions to promote efficient labor and dilation of the cervix) may result in cesarean section.
  • The use of pitocin increases the need for pain medication, both of which may not be well tolerated by the baby and may lead to cesarean due to fetal distress - a classic snowball effect of one intervention leading to another. A new study also suggests that term newborns exposed to pitocin in labor have a higher rate of admission to Intensive Care than those who are not.

3. "Normal" pregnancy. Many "variations of normal" that used to be considered reasonable for vaginal delivery, such as breech and twins, are now candidates for routine cesarean section. Physicians may not have the training or skills to adequately assist due to inexperience in these types of vaginal births.

4. Restricted access to Vaginal Birth After Cesarean. Although we no longer believe "once a cesarean, always a cesarean," it has become harder and harder for women to find care providers to help them achieve a vaginal birth after cesarean. Although ACOG has modified its position on limiting VBACs to advanced care centers with 24 hour in-house operating room staff, liability insurance providers have been much slower to reinstate coverage to smaller hospitals who may have had excellent VBAC success rates 10 years ago but were forced to discontinue offering VBACs because of policy. Even large hospitals who have numerous providers in their on-call list may find it unrealistic to offer VBACs when all their providers are not on the same page. A woman may have to travel hours to find a provider and a hospital who will support her goal of normal physiologic birth after a previous C-section.

5. Birth culture. A cultural attitude that does not value normal labor and birth, does not believe in women's abilities to birth, and does not believe in pain as a positive force, does not foster a woman's confidence in herself, her body or her connection to her baby during labor and birth. Just recently, we saw a very public example of the devaluation of physiologic birth when a national sports commentator criticized a major league baseball player for missing the season's opening game in order to be at the birth of his child, and suggested the player and his wife should've opted for a scheduled a C-section.

Paving the Way for Change

We know that cesarean section, now considered "routine" surgery, has risks for both mother and baby, including infection, adhesions, anesthesia complications, unintended damage to mother's organs, unintended damage to baby, and respiratory compromise for baby. Repeated cesarean sections with subsequent pregnancies carry greater risks for mom with each surgical delivery. Also, delayed bonding and breastfeeding are often consequences of operating room and recovery room routines and incapacitation of mom.

Education and the implementation of our learnings are key to decreasing cesarean sections and making the benefits of normal physiologic birth available to more women and babies. Thankfully, more and more resources are available for women to get the information they need for the birth they want, including consumer organizations such as ICAN, Homebirth Cesarean International, and websites like MothersNaturally.org. For mothers who do have a cesarean delivery, they can minimize separation and delayed bonding by requesting support for skin-to-skin with baby in the operating room, breastfeeding with the help of a Certified Lactation Counselor (CLC) or International Board Certified Lactation Consultant (IBCLC) in the recovery room, and having a "mommy" surrogate (partner, family member, or friend) stay with baby for all necessary procedures and when mother is unavailable.

There are many ways we can work to make hospitals and surgical experiences more mommy, baby, and family friendly. Midwifery care in all settings, including birth centers and homebirth, is linked to lower C-section rates. Hospitals that achieve Baby Friendly certification focus on natural birth and breastfeeding. In May 2012, MANA, ACNM, and NACPM released a Joint Statement entitled Supporting Healthy Normal Physiologic Birth to provide guidance for the birth community in how we can change the culture of birth in the U.S. We are now encouraged by the recent Joint Statement for the Safe Prevention of the Primary Cesarean Delivery released last month by the American Congress of Obstetricians and Gynecologists and the Society of Maternal-Fetal Medicine as another impetus for finding solutions to the cesarean epidemic. 

This month is Cesarean Awareness Month. We have been - and will continue to - highlight stories, images, and research about cesarean birth, prevention, and VBAC all month long on Facebook and Twitter. We hope you will join the conversation with us there, and add your comments here on the blog.

Author Jill Breen, CPM, CLC, has been serving women, babies and families for 36 years as a homebirth midwife and natural family health consultant in central Maine. She has 6 children and 8 grandchildren, all born into the hands of midwives including her own. She is working on Best Practices Guidelines with several state and national task forces. She served on the MANA Board, most recently as President, and is currently Communications Chair.

 

Women's History Month – Keeping the Spirit Going!

Posted by Midwives Alliance on March 26th, 2014

Though March is officially Women's History Month, we would like to continue our reflections on the history of midwifery and maternal health care. Will you join us with your Throwback Thursday posts and pictures?

In 1982, the Midwives Alliance of North America was established as a non-profit (501 c 6) professional organization for all midwives. MANA grew out of a grassroots coalition of diverse types of midwives including nurse-midwives, lay midwives, direct-entry midwives, and traditional midwives from across North America. Since 1982, the Midwives Alliance has taken leadership in advocating for a maternity care model that encourages women to take charge of their reproductive health and that ensures optimal outcomes for mothers and babies. The safety and benefits of the midwifery model of care have been proven again and again in countries across the world, including the United States. MANA has a proud history of relentlessly advocating for women's autonomy in their reproductive lives through promoting midwifery as a high quality maternity care option.

Let's continue to celebrate more than 30 years of advocating for Midwifery care. Bring us back to your early days as a midwife, and let us recall those stories during Throwback Thursdays in April. Have an old conference guide? Photos? Tee shirts? Share your images, and memories on Throwback Thursday on one of our social media outlets. Post on Pinterest, Facebook, or Twitter, link to MANA, and use the hashtag #TBT so we can follow along!

Take a moment to honor Women's History by reminding us how far we've come, and how far we intend to go to bring quality, respectful midwifery care to all women.

Informed Consent and Hospital Transfer: A Mother's Perspective

Posted by Midwives Alliance on March 15th, 2014

Roanna Rosewood is an author and was a keynote speaker at MANA 2013 in Portland, OR in October 2013.

Someone else told me about the incident, years after it happened. It was too late to ask questions or involve myself. Too late to find out if I was the reason why my first midwife stopped catching babies, right after my attempted HBAC turned into another cesarean. But I can't help but wonder, if I had been given the opportunity to tell the doctor that staying home for so long was my choice, would it have stopped her from berating my midwife? If I explained that my midwife had recommended transport but I was the decision-maker, would my midwife have been spared the doctor's anger and – I can only speculate – its resulting fear?

I'm not suggesting that my midwife couldn't handle a disagreement. I'm recognizing that the balance of power surrounding birth has become so skewed that belligerent obstetricians are a real threat to midwives. The same outcome that an obstetrician's insurance can write off without question could lead to criminal prosecution and crippling legal fees for a midwife. Does this unjust disturb midwives as much as it does me? Or are you so accustomed to it that you can't tell where fear of persecution ends and your work begins?

I understand that the concept of patient autonomy was so foreign to the doctor that she felt justified in gently soothing me in one room while criticizing my midwife in the other. What I don't accept is that my midwife didn't tell me about it. I hired her to advise and inform me. I trusted her to advise and inform me. That I was out of earshot when doctor let-loose, didn't invalidate her responsibility.

I recognize that my midwife's choice to bear the doctor's wrath alone was a generous and loving act, made to protect the small shreds of sanctity that remained after they tied me down and cut me open. But what she didn't understand, what every midwife who tries to shield her client from our broken maternity care system doesn't understand, is that doing so perpetuates the problem.

Until hospitals are safe and respectful places to transfer to, the attempt to isolate expectant homebirth families in affirmation-filled, "just trust birth" expectation bubbles, isn't only risky for the mothers and babies who might end up needing to transfer to the most dangerous maternity care system in the industrialized world. It is also the abandonment of every midwife who risks her livelihood and freedom to practice without legal protection.

We trust midwives to reveal what we need to know about birth. But this isn't limited to the process of bringing our babies earth-side; we also need to learn that birthing women have not yet established their right to autonomy, informed consent, or to be the decision-makers for their own newborns' care. Homebirth families must be armed with the tools necessary to win the cultural and legal war being waged against physiologic childbirth and stand with the midwives who hold the space for it. At the very least, this includes:

  1. Understanding the manner in which the family, midwife, and records will be received in the case of a hospital transfer.
  2. Awareness of the evidence (or lack of) behind routine hospital interventions and strategies for refusing unwanted ones.
  3. A welcome invitation to join other families around the world who are working to establish human rights in childbirth, by participating in the birth revolution.

Just as mothers must find the courage to face contractions in order to move through them, with midwives on our side, so too will we find the courage to face and heal our maternity care system.

Roanna Rosewood is the bestselling author of Cut, Stapled, & Mended: When One Woman Gave Birth on Her Own Terms After Cesarean, an international birth empowerment speaker, and the managing director of Human Rights in Childbirth.

Introducing MANA's New President: Marinah Valenzuela Farrell

Posted by Midwives Alliance on March 6th, 2014

MANA has begun a new era!

Introduction by Geradine Simkins, DEM, CNM, MSN is MANA's executive director. You can learn more about her here.

Three years ago when I recruited Marinah Farrell to be on the MANA board, little did I know I would be introducing her to you today as your new President. I am thrilled to say that with her Presidency MANA has begun a new era in at least two important ways. First, Marinah is the first President who is not from the "Founding Mother" generation of MANA. She stands on the shoulders of the cadre of seasoned MANA leaders who will work hand in hand with her. And second, Marinah is the first midwife of color to be president of MANA, a milestone of serious significance for MANA. Welcome to your new position, Madame President, the torch has been passed to you. Shine on!

Marinah's Story

by Marinah Valenzuela Farrell

I can never think about my story without invoking the history and spirits of my ancestors. My grandfathers and grandmothers were fiercely elegant even amidst the poverty that surrounded them. I conjure memories of my grandfather's blue eagle-eyed silence as we rode his horse into the mountains of Mexico, an explorer of the wild and lover of herbal medicine. This knowledge he passed down to my mother, who passed it down to me.

My parents met in El Paso Texas, and I grew up in a place between the U.S. and Mexican borders. I grew to awareness that it was important to work for vulnerable populations because both of my parents were devoted to missionary work their entire lives. Much was given, and therefore, I have always felt much was expected. Thus, I work for many non-profit organizations here in Arizona and abroad. Everyday, I give thanks for the gift of midwifery and for the communities who invite me into their lives.

My first MANA conference (doesn't everyone have a story of their first MANA conference?!) was in Arizona. Ina May Gaskin and Marsden Wagner were there, as well as all types of midwives and birth workers and advocates. Being at MANA was a "coming home" and an all-star event of unforgettable individuals. From that time forward, I have loved MANA.

With the advent of technology, the aging of our tireless founding mentors, the explosion of maternal health organizations and the fast American pace of life, our board had to look hard at our grassroots style and wonder how in the world we would be able to keep up. We reject becoming pathologically "corporate," but also realize we need to adhere to business policies and practices in order to meet the accelerating demands of our organization. We want to remain an organization that honors all midwives, can professionally represent our members, can still be groovy and, more importantly, will be compassionately progressive.

Our learning curve became a slope. We prioritized trainings in organizational and cultural humility and how to be more supportive of gender freedoms. We created better systems of communications for the "virtual" demands of social and electronic media. We amplified our voice at International and National meetings because midwives are more supported than ever in some ways and yet more vulnerable to hostility because of it. Our Division of Research, whose Coordinating Council are pioneers each and every one, is an essential contribution we make to the midwifery profession. It facilitates us understanding what the big picture looks like in maternal and child health, and for everyone "out there" to understand the important role midwives play in that picture.

The founders of MANA packed into cars with their babies on a shoestring budget and met in hotel rooms to write bylaws and to be recognized as a profession. MANA was founded on a love of midwives and, ultimately, the families they serve, and this remains our core foundation. Looking towards the next 30 years, MANA is evolving to embrace the "new" tools of technology, social media and research. My vision is for every MANA member to have equal access to the profession and our organization because every community and every woman needs a midwife that best represents their own values and cultures. And, ultimately, MANA wishes to welcome a new generation of leaders into the movement to carry on this always hard, always beautiful, "groovy" work.

Peace, health and love to you, Marinah

To learn more about MANA's recent projects and strategic priorities, visit our new e-zine here.

Black History Month 2014 Is Ending, But Health Disparities Continue

Posted by Midwives Alliance on February 25th, 2014

Opportunities to make change year round

During the month of February, MANA has been highlighting birth workers of color and their role in improving outcomes for mothers and babies.

Although Black History Month ends this week, the impacts of health disparities in the U.S. continue year round.

MANA would like to bring attention to one national effort to create health equity: scholarships for birth workers of color.

The Birth Workers of Color Scholarship "Grand Challenge" is asking every midwifery program in the U.S. to offer one scholarship per year to women of color. As the site says:

"A midwife for every woman. That is our grand ideal. But what if you are a woman of color in America, where is your midwife from your unique culture?"

If you operate a midwifery training organization, please consider adding a scholarship today. For all of us there are many ways to get involved:

  • Raise awareness. Share the site widely and call on the organization that trained you to offer a scholarship.
  • Offer your assistance as a mentor or preceptor.
  • Offer scholarships for workshops or other trainings you provide.

This project is being spearheaded by Claudia Booker, CPM, Jennie Joseph, CPM, LM and Vicki Penwell, CPM, LM. Learn more at the Birth Workers of Color Scholarship site here.

Educate yourself and your community on maternal child health disparity in the U.S.

When the Bough Breaks free viewings extended for 2014.

To honor Black History Month in 2013 MANA created the opportunity for members, friends, and the community at large to have free access to When The Bough Breaks, a groundbreaking documentary that explores why black babies in the U.S. are more than twice as likely to die, be born too soon, or too small.

MANA has extended this opportunity for 2014. To learn more, email socialjustice@mana.org today.

Presenting and Honoring: Fatima Muhammad, MPH, of Phoenix, AZ

Posted by Midwives Alliance on February 24th, 2014

Celebrating Black History Month

Fatima Muhammad, MPH, is the Director of the new Tanner Community Development Corporation’s Birthing Project, based in Phoenix, Arizona. The mission of the TCDC Birthing Project is: "To empower our families with quality education, skills, and support that promote conscious conception, positive birth experiences and outcomes, resulting in healthy and nurturing parenting practices." Fatima began her journey in Maternal and Child Health as a doula in Tucson, AZ. A few months later she was offered a position at the Phoenix Birthing Project. While there, she worked to decrease high infant mortality rates in the African American community through training Arizona’s first group of Community based doulas, facilitating parenting classes and providing psychosocial support to African American pregnant and parenting families.

In addition to being the Director of TCDC's Birthing Project, Fatima continues her maternal and child health work as a midwifery student. "Becoming a midwife allows me the opportunity to provide quality healthcare services to our families. I believe getting back to our traditional birth practices is key to empowering, preserving and strengthening our community. I plan on practicing the best possible midwifery on all levels; mentally, physically, spiritually and skillfully, resulting in optimal birth outcomes," said Fatima. "My biggest challenges in this work thus far have been funding and finishing my midwifery license. These are no longer obstacles. I realize we are the ones we have been waiting for and no one can serve our community better than we can to improve our state of health."

When asked who her heroes are, Fatima responded, "My 'shero' is my mother. She knew how to make a way out of no way. Her love was so nurturing that it surpassed all of our hardships. My mother always reminded me that I could be or do anything! She taught me about strength, my power, and to value the gifts the Creator has given me as well to help others through the use of my gifts."

For more information on how to assist the TCDC Birthing Project please visit www.tcdccorp.org, or call 602.253.6904.

New Studies Confirm Safety of Home Birth With Midwives in the U.S.

Posted by Midwives Alliance on January 30th, 2014

by Geradine Simkins, CNM, MSN, Executive Director, Midwives Alliance of North America

In today’s peer-reviewed Journal of Midwifery & Women’s Health (JMWH), a landmark study** confirms that among low-risk women, planned home births result in low rates of interventions without an increase in adverse outcomes for mothers and babies.

This study, which examines nearly 17,000 courses of midwife-led care, is the largest analysis of planned home birth in the U.S. ever published.

The results of this study, and those of its companion article about the development of the MANA Stats registry, confirm the safety and overwhelmingly positive health benefits for low-risk mothers and babies who choose to birth at home with a midwife. At every step of the way, midwives are providing excellent care. This study enables families, providers and policymakers to have a transparent look at the risks and benefits of planned home birth as well as the health benefits of normal physiologic birth.

Of particular note is a cesarean rate of 5.2%, a remarkably low rate when compared to the U.S. national average of 31% for full-term pregnancies. When we consider the well-known health consequences of a cesarean -- not to mention the exponentially higher costs -- this study brings a fresh reminder of the benefits of midwife-led care outside of our overburdened hospital system.

Home birth mothers had much lower rates of interventions in labor. While some interventions are necessary for the safety and health of the mother or baby, many are overused, are lacking scientific evidence of benefit, and even carry their own risks. Cautious and judicious use of intervention results in healthier outcomes and easier recovery, and this is an area in which midwives excel. Women who planned a home birth had fewer episiotomies, pitocin for labor augmentation, and epidurals.

Most importantly, their babies were born healthy and safe. Ninety-seven percent of babies were carried to full-term, they weighed an average of eight pounds at birth, and nearly 98% were being breastfed at the six-week postpartum visit with their midwife. Only 1% of babies required transfer to the hospital after birth, most for non-urgent conditions. Babies born to low-risk mothers had no higher risk of death in labor or the first few weeks of life than those in comparable studies of similarly low-risk pregnancies. 

Importantly, this study also sheds light on factors that may increase risk. These findings are consistent with other research on pregnancy complications, but the numbers of these pregnancies were low in the MANA Stats dataset, making it impossible to make clear recommendations. This article from Citizens for Midwifery contains important information to share with families who are contemplating their birth options and weighing their individual risks and benefits.

This study is critically important at a time when many deeply-flawed and misleading studies about home birth have been receiving media attention. Previous studies have relied on birth certificate data, which only capture the final place of birth (regardless of where a woman intended to give birth). The MANA Stats dataset is based on the gold standard -- the medical record. As a result, this study provides a much-needed look at the outcomes of women who intended to give birth at home (regardless of whether they ultimately transferred to hospital care). The MANA Stats data reflects not only the outcomes of mothers and babies who birthed at home, but also includes those who transferred to the hospital during a planned home birth, resolving a common concern about home birth data.

This study adds to the large and growing body of research that has found that planned home birth with a midwife is not only safe for babies and mothers with low-risk pregnancies, but results in health and cost benefits that reach far beyond one pregnancy. We invite you to share this news in your communities, and join the conversation on our Facebook page, Twitter, and Pinterest

We are grateful to the ongoing support of the Foundation for the Advancement of Midwifery, which has been a major funder of the MANA Statistics Project.

** Note added 12:33 EST when the issue was published:

HUMANizing Birth

Posted by Midwives Alliance on January 16th, 2014

Tell a man that he could possibly have a heart attack when making love. Then tell him that it would be safer for him to come to the hospital and make love while being monitored by a physician. Do you think a doctor coming in to take his blood pressure and monitor his heart every 10 minutes would affect his performance?

This is the question Saraswathi Vedam asks when giving an analogy about women and their birth choices.

In many cases, women birth in an unfamiliar environment and are separated from their loved ones during labor. In an unfamiliar place with unfamiliar people, women are expected to perform at their very best and deliver on someone else’s time.

Even zoo animals do not have to experience such a thing.

But why do so many mothers?

Watch more of Vedam and her talk on HUMANizing Birth here:

Speaker bio:

Saraswathi Vedam, RM, FACNM, MSN, Sci D (h.c.) is Associate Professor of Midwifery at University of British Columbia. She serves as Senior Advisor to the MANA Division of Research, ACNM representative the MANA-ACNM Liaison Council, and Interim Executive Board Member, Canadian Association of Midwifery Educators.

She is also a co-author of two upcoming research articles on the largest dataset on planned home births in the United States. To learn more about the research, click here.

Blog post author bio:

Iola Kostrzewski is a volunteer online community manager for Midwives Alliance of North America. She is a doula and Midwifery student starting in September. She is mom of two boys and creator of Breastfeeding in Color. Her passions in birth pertain to birthing and breastfeeding outcomes within the African American community.

Accepting Abstracts to Speak at MANA 2014!

Posted by Midwives Alliance on January 13th, 2014

Topics  

We are pleased to announce the theme for the MANA 2014 Conference October 23-26 in St Louis is:

"The Spirit of Midwifery."

This theme speaks to MANA Conferences as a place where midwives of all types and backgrounds can gather and be nourished and enriched. We hope it resonates for you too and that you will consider submitting a proposal to present a talk, workshop, or poster at MANA 2014. This is an excellent way to share your expertise and knowledge with the midwifery community.

The deadline for submission is February 10, 2014. We are seeking pre-conference workshops (full and half day), breakout sessions, plenary talks, and poster presentations. You may submit your presentation for consideration in more than one category.

The initial abstract form is streamlined and efficient. If your presentation has been selected, you will be notified by early March, and you will then have approximately 4 weeks to complete the more in-depth form necessary for MANA to apply for CEUs from MEAC and ACNM. For details and to submit your proposal, click here.

Thank you!

The MANA 2014 Programming Committee

Syndicate content