Tuesday, March 30, 2010

A Salute to the Nurses and Midwives of General Hospital

Yesterday I attended Lois Capps' thank you rally for people who helped to get the health care bill passed. It was held in the parking lot of the Community Health Care buildings across from the old General Hospital building. It was a surreal experience standing there looking at that building where so many babies were caught by Certified Nurse Midwives over the years and hearing Representative Capps speaking about a bill I passionately hope will encourage an upswing in the numbers of women receiving midwifery care in this country.

I couldn't really concentrate on what she was saying because my mind kept wandering over and walking the halls of that ugly old building thinking of all the uninsured babies born there over the years. Remembering the excitement of being present at the first hospital waterbirth in the county in one of their rooms. Thinking about the wonderful nurses and midwives who worked so hard at General Hospital over the years to create our most pro-natural hospital birthing option in the county. They always led the way, clearing a path for our other hospitals to follow; from postpartum family rooming in to birthing chairs, from the creation of the breastfeeding warm line to birthing tubs. Perhaps their most important contribution was becoming certified by the World Health Organization as a "baby friendly hospital".

It was a bittersweet moment thinking about the General Hospital nurses and midwives trying so hard to create a free-standing birth center within the shell of a building the county supervisors left behind and knowing the new health care reform might breath life back into their dream. How fitting to be listening to Congresswoman Capps, a former nurse, who has continued caring and fighting for women and children her whole life. It shouldn't surprise me. During my career I've met so many "Nurse Hathaways" walking the halls of our hospitals. Women who truly care about making things better for birthing women and their babies.

Although I was invited to attend this event I didn't actually work on getting passage of the legislation. Instead I worked on making sure birthing women's voices were represented in the bill. Women all over the country were similarly working through two grass roots organizations, the Mama Campaign and Childbirth Connections. I'm working on a piece that I hope will come out in the Women's Press about my experience with Lois Capps and the democratic process. Stay tuned.

Here is the article: Adrift on the Ocean of American Democracy.

Monday, March 29, 2010

Good Newsweek Article on V-BACS

Why don't more doctors support a woman's desire to birth naturally after a previous c-section? This is the question posed in a recent Newsweek article. Claudia Kalb does a good job explaining the relationship between the ACOG guidlines for V-BAC, hospital & doctor liability, the latest research put forward by the National Intstitute of Health, and where a woman's choice fits into it all.


Thanks to our local chapter leader of International Cesarean Awareness Network for bringing this article to my attention.

Wednesday, March 24, 2010

The Day President Obama Signed the Health Care Bill

Published in the SLO Tribune on Friday March 26, 2010

Hidden in the thousands of pages of the Health Care Bill that President Obama signed into law were some items very few people were aware of that will effect women all across the country. They target issues concerning maternity care and they have the power to change our beliefs about where, how and with whom women should be giving birth in our country.

Did you know forty-two % of all births in the U.S. are paid for through Medicaid reimbursement? Now women will have a choice of how they use that money. They can continue to choose to birth in a hospital with a doctor but they can also choose to have a Certified Nurse Midwife attend them in a hospital, or they could attend them at an out of hospital birth center. Another option is to have a Certified Professional Midwife attend them at an out of hospital birth center. This doesn’t just represent more freedom for women to choose the birth the want it also represents a huge cost savings to the Medicaid budget. The average hospital birth with a doctor attending costs approximately $20,000. It skyrockets to $60,000 for a cesarean section birth. With our national cesarean section rate climbing every day this is a serious chunk of change. On the other hand the average cost for a birth center birth is approximately ¼ of that or $5000. Not all women should be birthing in birth centers with midwives but if just 5% of women choose this option it will mean millions of dollars a year saved.

Did you know until today they was no widespread standardized assessment of the maternity care being offered in this country? Statistics relating to the benefits and risks of current practices in use today, such as, induction of labor, medication to speed labor, or drugs for pain relief were not being kept in a national database. Over time this data base will yield important information for women and their care providers. Helping them base their care on informed choices.

Did you know women were being denied health care coverage because they had given birth by cesarean section? This was being labeled a pre-existing condition which ruled them out of further care. On top of that the current stance of the American College of Obstetricians and Gynecologists about vaginal birth after cesarean section makes it impossible for many women in the U.S. to do anything except have a repeat cesarean section for all future births. Until today women were faced with the choice of letting their insurance company limit the size of their family or pay about $60,000 per child.

Did you know until today your insurance company could deny you care simply because you were pregnant? Stopping this practice has the potential of effecting millions of women and babies. Guaranteeing access to quality maternity care impacts not just this generation but the next as well.

Thank you to Representative Capps for working to pass this important legislation for women and babies. When asked about this piece of the bill she said, "I know that bringing a new life into the world can be the most profound moment in a woman’s life. And I am proud that this new legislation will afford women more choices regarding the setting in which this momentous occasion can occur. One of the many important provisions in the new health reform legislation is the increased access to care in a variety of settings, including for women who choose to obtain prenatal care and deliver their babies in freestanding birth centers. I was proud to support this provision that assures these centers Medicaid reimbursement for providing this important service in promoting women’s health."

Tuesday, March 23, 2010

E-Mail Correspondence with Congresswoman Capps

Here is the e-mail I sent to Betsy Umhofer, Representative Capps' local Liaison and Congresswoman Capps' reply.

Dear Ms. Umhofer,

I would like to thank you and Representative Capps for your work on the Health Care Bill, especially the part that includes Medicaid reimbursement for Certified Nurse Midwives & Certified Professional Midwives working in out of hospital birth centers. Your work will provide quality maternity care for many women in our community who seek out of hospital birth experiences. I have written a piece about the legislation on my blog: http://slolaboroflovedoula.blogspot.com/2010/03/historic-health-care-bill-for-women.html.

I am currently working on an opinion piece about it for either New Times or Women’s Press. Would Congresswoman Capps care to send a quote about why she supported this piece of the overall bill and what she hopes will come from it?

Here is Congresswoman Capps' reply

"I know that bringing a new life into the world can be the most profound moment in a woman’s life. And I am proud that this new legislation will afford women more choices regarding the setting in which this momentous occasion can occur. One of the many important provisions in the new health reform legislation is the increased access to care in a variety of settings, including for women who choose to obtain prenatal care and deliver their babies in freestanding birth centers. I was proud to support this provision that assures these centers Medicaid reimbursement for providing this important service in promoting women’s health."

More Great News About the Health Care Legislation!

This just e-mailed to me from Childbirth Connection, another group that worked hard to get important items for women and babies included in this bill.

Dear Friend, On Sunday, March 21, the House of Representatives took a courageous and giant step toward a better health care system for America’s women, babies and families with the passage of the Patient Protection and Affordable Care Act. This legislation will make a significant difference in the lives of millions of women, babies and families by expanding access to health insurance, ending insurance industry practices that discriminate against women, and improving the quality and cost of health care.

Childbirth Connection worked hard over the last year to ensure that the special needs of women and babies were considered in health care reform. We are happy to report that our efforts resulted in provisions in the bill for measuring and reporting on the quality of adult health care covered by Medicaid. Because Medicaid pays for about 42% of births in the country, this provision offers important opportunities for using performance measurement to improve the quality and value of maternity care. Childbirth Connection is committed to ensuring that the new performance measurement program gives appropriate attention to childbearing women and newborns. We will work on implementation with the Centers for Medicare and Medicaid Services and other stakeholders.

This accomplishment would not have been possible without the support of many individuals and organizations committed to significant improvements in maternity care access and quality. Special thanks to Representatives Elliot Engel and Lois Capps, as well as the staffs of the House Energy & Commerce and Senate Finance Committees for supporting these important quality improvement provisions. We also thank the many national organizations and countless individuals who advocated for these provisions.

Other provisions in the bill that will benefit women and babies include:

Health insurance coverage for women before, during and between pregnancies
Medicaid reimbursement for licensed caregivers offering services in licensed birth centers
Medicaid reimbursement of the birth center facility fee
100% reimbursement of Certified Nurse-Midwives’ services in Medicare Part B
Elimination of denial of insurance coverage due to pre-existing conditions such as being pregnant, having had a cesarean section, or being a victim of domestic violence
Workplace protections for nursing mothers
Screening for postpartum depression
Prenatal and postpartum nurse home visits for low-income, first-time families and their children Coverage for a range of preventive services including screening for diabetes and heart disease.

This is all great news for women and families, but there’s still more to do. Please contact your senators (click on “Web Form”) and ask them to pass the reconciliation bill to further strengthen health care reform provisions.

With the President’s signing of the Patient Protection and Affordable Care Act into law today, please join with Childbirth Connection in celebrating the path-breaking provisions that will be carried out in the weeks, months and years ahead.
Best wishes,

Maureen Corry
Executive Director
Childbirth Connection

Historic Health Care Bill for Women, Maternity Care and Midwives

I just watched President Obama sign into law the health care bill. People may disagree about this bill and what it means for our future. I'm not going to discuss the total bill. What is important to me is something few people are aware of. Buried in this bill is a very important piece of legislation that speaks directly to women & midwives. Because of the passage of this bill women on Medicaid can now seek midwifery care from both a Certified Nurse Midwife or a Certified Professional Midwife and birth their babies in out of hospital birth centers. This is a huge step forward for CPMs in their desire to be acknowledged as birth professionals providing safe care for healthy moms and babies during birth. It will make birth centers more financially viable due to Medicaid reimbursement and therefore will lead to more birth centers being opened and more out of hospital births occurring. This is greatly needed at this time in our country to balance the current medical birth climate and bring down the huge cost of maternity care.

I was very proud to watch our Representative, Congresswoman Lois Capps, at the signing ceremony. I would like to thank her for her dedication and work, for her caring about women's health issues and for her support of midwives & midwifery. I would like to thank the women who cared enough to take the time to sit down with me and Betsy Umhofer, Rep. Capps local liaison, and present to her why she should support this important piece of legislation: Jessica Elliott, past president of BBRN & current midwife in training, Edana Hall, Licensed Midwife, Miday Johnson, Certified Nurse Midwife, Megan Bochum, past local International Cesarean Awareness Network leader and student midwife, Janet Murphy, Cal Poly Child Development Specialist, and Stephanie Wilson, LMST and SLO-Child Abuse Prevention Council Postpartum Depression Specialist. It was women like this all around the country speaking up that made this moment in our history happen. Congratulations!

Monday, March 22, 2010

A Victory for Mothers and Babies!

I am too busy to write but there has been lots of important news about birth lately in the news. Here is the latest as of this morning. . .

This is an e-mail sent to me from the Mama Campaign, an organization that is dedicated to getting women more access to quality midwifery care in all birth settings.

Midwives and mothers, babies and families, are victors today! With the passage of the Senate health care reform bill in the U.S. House of Representatives on Sunday, March 21, and the signature of the President in the coming days, several provisions that will significantly benefit mothers and babies will now be the law of the land! These provisions will increase access to birth options for low-income women across the country, and will improve the quality of maternity care for all women in the years to come. The MAMA Campaign is proud to have had a role in improving conditions for midwives and mothers in this landmark legislation. The following are now law:

MAMA Campaign’s “partial victory”:
*Senator Cantwell’s provision that will have the effect of requiring Medicaid reimbursement for licensed CPMs offering services in licensed birth centers
*American Association of Birth Center’s provision that mandates Medicaid reimbursement of the birth center facility fee
*Childbirth Connection’s provision requiring quality assessment and improvement measures specific to maternity care
*American College of Nurse Midwives’ equitable reimbursement act for Certified Nurse Midwives
*Giving birth, having a cesarean section, or being the victim of domestic abuse will no longer be considered pre-existing conditions and used to deny insurance coverage to women!

What Happens Now With This Legislative Process?Last night, the House of Representatives passed the Senate health care reform bill that contains the above provisions and the President will sign this bill into law in the coming days. The House also passed a companion reconciliation bill, popularly called a “side car" or "fix it”, to address the House’s concerns about the Senate bill. This companion bill now goes to the Senate for consideration. It is expected that debate will begin in the Senate on Tuesday, and that Republicans will introduce a number of amendments, with debate taking several days. The Senate will be considering this bill under the reconciliation process which requires a simple majority to pass, and Democrats appear confident that they have the votes to pass this bill in the Senate.

Thank You for Your Role in This Victory!Thank you to each and every one of you who supported the MAMA Campaign and these provisions for women and families. Every letter that you wrote and every dollar that you gave made a difference! We look forward to working with you this year as the MAMA Campaign continues the effort to cover all CPM services in all settings in the Federal Medicaid program.Moving Beyond Health Care Reform- MAMA Continues to Fight for CPMsMAMA continues to be on the move for midwives and mothers in Washington, D.C!

The MAMA Campaign Steering Committee met in Washington, D.C. two weeks ago, March 5th – 7th, to evaluate the campaign to date and to re-commit to working together to achieve our central goal: to amend the Social Security Act to require the reimbursement of all CPM services in the Federal Medicaid program. On March 5th, 8th & 9th, steering committee members met with 35 Congressional offices on behalf of midwives and mothers. It was clear in these visits that our policy gained significant support in 2009 in key offices and that this support can be leveraged as we move forward in 2010.

You will be hearing from us over the next weeks and months, asking for your input, your engagement and your support as MAMA continues to do our part to improve maternity care in the U.S. and to increase women’s access to Certified Professional Midwives.

Thank Your Legislators!If your Senators and Congress Members voted for health care reform, including the provisions for women and families, please write to them to thank them. If your legislators voted against health care reform, please write to ask them to ensure in Federal legislation that women have access to Certified Professional Midwives, a high-quality, low-cost option. As always, your legislators need to hear from you on behalf of midwives and mothers!

Support Your MAMA! In celebration of the passage of our “partial victory” and in support of our on-going work to cover all CPM services in all settings in the Federal Medicaid program, please consider donating to the MAMA Campaign today!If you have any questions, concerns or comments please contact the campaign at mailto:info@mamacampaign.org..

Sunday, March 21, 2010

Deciding about Giving Vitamin K to Your Newborn?

This is a topic most parents don't even know they should be making a decision about. Instead it simply happens as part of the routine procedures birthing moms and their newborns are subjected to within a hospital setting. Over the years some of my clients have opted out of doing Vitamin K in any form. When I first became involved in the birth community the home birth midwives were not giving Vitamin K at all. Now most of these same midwives have begun giving oral Vitamin K. Conversely to ask that your newborn not receive Vitamin K injection within the first moments of life created quite a stir in our local hospitals when I started going to births. It had to be OK'd by the pediatrician with the parents signing an "against medical advice form." These days our local nurses feel comfortable with delaying the injection for close to 2 hours and will not try too hard to dissuade you if you are refusing it out right. You need to talk this over thoroughly with your midwife or OB and pediatrician ahead of time. Licensed Midwife, Edana Hall told me some local pediatricians will not do a circumcision unless the newborn has recieved injectible rather than oral vitamin K. If you are planning to circumcise your son before you leave the hospital it is recommended he receive a vitamin K injection. If you are thinking about refusing the Vitamin K all together, I would encourage you to wait until after the birth to make a final decision. Some of the risk factors can occur during the birth process and should weigh into your final decision.

You need to do more research. Here is a link to an informative article a past client sent me about this topic. Dr. Mercola explains the reason to give Vitamin K to your newborn. He includes a list of risk factors which would make it more important for your individual baby. He also explains why it should not be done by injection. He discusses the science proving the effectiveness of oral Vitamin K and how it should be given. There is also some explanation of using supplementation of the breastfeeding mother's diet with oral Vitamin K as a delivery method for the baby.


Thanks Marilyn!