Home Births
Mamas on Bedrest: The CDC’s Report on Certified Professional Midwives
January 27th, 2012Bedrest Coach Darline Turner-Lee reviews and comments on a recent press release issued by The Big Push for Midwives Campaign.
In the Press Release, the CDC notes an increase in home births in non-hispanic white women, yet decreasing or stagnat numbers amongst women of color. The press release also noted that
“The CDC report as well as other reports show that babies born to women cared for by Certified Professional Midwives (CPM’s) are far less likely to be preterm or born low birth weight, two of theprimary contributing factors not only to infant mortality, but to racial and ethnic disparities in birth outcomes.”
The Big Push for Midwives is hoping that this report from the CDC will spur action in legislation and amongst medical organizations to allow CPM’s to care for and be reimbursed for care given to women of color and low income women-women who might most benefit from CPM care.
Mamas on Bedrest: ACOG’s New Recommendations on Planned Home Births
February 4th, 2011
ACOG just released its new recommendations on planned home births.
As many of you may recall, last summer, ACOG “leaked” data from a study done by Dr. John Wax and colleagues at the Maine Medical Center stating that women who elected home births had a 2-3 fold increase in neonatal mortality. The study was published in the fall, but the data was publicized in July, Just as New York and Massachusetts were voting on whether or not to grant practice privileges to midwives. The study data was immediately criticized by the American College of Nurse Midwives, Childbirth Connection and a multitude of birth advocates. As the dust has settled, ACOG has reviewed its stance and published their latest recommendations in the most recent issue of Obstetrics and Gynecology. (Obstet Gynecol. 2011;117:425-428)
MedScape Summary of ACOG Home Birth Recommendations.
Each year some 25,000 women elect to give birth at home. A meta-analysis done of observational studies by Wax and colleagues concluded that there is a 2- to 3-fold increased risk for death for planned home births. Previous studies have also shown a decrease in neonatal mortality in regions with readily available transport to hospitals. In the United States, studies show that the lowest mortality rates in the presence of a highly trained midwife who is well-connected to the health care system. To reduce the risks, women who choose at-home birth should be informed about appropriate candidates for home birth. According to the committee, these include women:
- With absence of maternal disease previous to or during the pregnancy
- Singleton fetus
- Head down presentation
- Gestational age between 36 and 41 completed weeks of pregnancy
- Spontaneous labor or labor induced as an outpatient,
- Women who have not been transferred from a referring hospital.
- Women who have had previous cesarean deliveries should absolutely not undergo planned home birth
- Have at hand a certified midwife, certified nurse-midwife, or physician
- Have consultation access
- Have access to timely transport to a nearby hospital if needed.
The analysis also found that planned home births were associated with:
- Fewer maternal interventions, such as epidural analgesia, electronic fetal heart rate monitoring, episiotomy, operative vaginal delivery, and cesarean delivery.
- There were also fewer third- and fourth-degree lacerations and maternal infections and similar rates of postpartum hemorrhage, perineal laceration, vaginal laceration, and umbilical cord prolapse.
The percentage of planned home births will likely continue to grow, and according to this MedScape Editorial and many experts in obstetrics and gynecology and public health, it is incumbent on the medical profession to adapt and integrate the practice, though many physicians remain resistant to working with midwives. Said Eugene Declercq, PhD, professor of maternal and child health at the Boston University School of Public Health in Massachusetts, who takes issue with the numerous “flaws” noted in the Wax Study,
“I’d prefer to have people finding ways to work together, rather than this ceaseless interprofessional battle. The reality is that there are more and more women seeking planned home birth, and we need to make it safer for everybody.”
The complete MedScape News Editorial is located on the .
Where are you planning to give birth? Need help creating a birth plan? Let’s work up a plan together in your Complimentary 30 Minute Bedrest Breakthrough Session. Schedule your session by e-mailing info@mamasonbedrest.com.
Mamas of Color Rising: Advocating for Mother Friendly Births For Mamas of Color in Texas
January 11th, 2011Prior to 1989, Midwives practiced freely in Texas. Many Texas children were born via midwife assisted births and many of these births took place outside of the hospital. In 1989, The Texas Midwifery Act was amended to include mandatory basic and continuing education requirements which took effect in September, 1993. The law was further amended in 1997 when new rules were written to assist the Midwifery Board in implementing the law through disciplinary actions which could include removal of documentation and administrative penalties.
In 2002, midwives ceased to practice in hospitals in Austin.
Since that time, access to mother friendly childbirth practices has been essentially non-existent for low income women and women of color in the Greater Austin Area. These women have been at the whim of whatever Medicaid would cover and whatever treatments the obstetricians who accept Medicaid reimbursement are willing to provide. To say the least, low cost, high quality, minimally invasive care has been scarce.
Mams of Color rising, is a collective of mamas of color in the Greater Austin area fighting for birth rights for all mamas. Here is how they describe themselves:
“Mamas of Color Rising is a collective of working class and poor mothers of color based in and around Austin, TX. We are interested in organizing ourselves and other women/mamas of color around issues with accessing needs like food, housing, education and safety, finding out together what our larger ideal community looks like and building it together.”
Currently the main objectives of Mamas of Color Rising is to gain equal access to “Mother Friendly Birth Practices” for low income mothers of color. Their goals are:
- To Create a volunteer doula project for low-income women of color in Austin. This project will begin with 20 women of color being trained as doulas March 2011.
- To Work in collaboration with pro-midwifery lawyers and other organizations and to get Medicaid to cover Midwifery care in Texas
- To Start free pre-natal midwifery care in Austin with volunteer midwives. This will serve as as a pilot for a Medicare Proposal.
To that end, Mamas of Color Rising is working to train 20 women of color as doulas in the greater Austin TX area to serve the Austin Mamas of Color in need. These women will be trained this coming March, 2011. Mamas of Color Rising is raising funds to cover the cost of training for these women. This training will be the first step in launching a culturally based volunteer doula project for low-income women of color in Austin.
Currently, Mamas of Color Rising has raised $933 of the $2000 needed to train the doulas. If you are so moved, please consider donating to Mamas of Color Rising in support of the Doula Training Program. You can make a donation directly on their website mamasofcolorrising.wordpress.com via PayPal.
As Mamas of Color Rising has so aptly pointed out:
“Our vision of organizing around motherhood is not a biological one, it’s not just about biological moms, or even just moms, but about all of those members of a community who share in the often undervalued and invisible work of care-taking and parenting. It’s not just symbolic either, because unfortunately right now its mothers and other women who do the vast majority of the work of taking care of children, elders, and sick folks who cannot take care of themselves.(all unpaid!)
As Mamas of Color Rising, we want to present these issues for public conversation and struggle. We see this work as a way to challenge the patriarchal and isolating model of nuclear family units AND as a way of creating social justice for everyone because a society is only as good/strong/just, as how it treats its (women) children and elders.
If you agree, please support Mamas of Color Rising.
References:
: Addendum to Federal Trade Commission Department of Justice Hearings on Healthcare Competition
