Empowering Birth Blog

Please Support Certified Apprentice Trained Midwives

Hello everyone, please take a moment to sign this petition and preserve the option of professional, certified, apprentice trained midwives, not because I am studying to be one but because the evidence shows that the Portfolio Evaluation Process (PEP), which apprentice trained midwives follow, is safe.  Please check out and pass along this new page on the North American Registry of Midwives site, 10 Things You Should Know About PEP.  And if you would like more information on how to become a CPM (including the PEP process) click here.

Dear Friends-

A recently revised Position Statement from the American College of Nurse Midwives (ACNM) seeks to limit recognition of midwifery providers to those who have received their training through government accredited programs. The North American Registry of Midwives (NARM) oversees the credentialing of midwives who have received their training through time honored and evidenced based systems that emphasize clinical competency over all other criteria (Certified Professional Midwives-CPMs).

NARM has posted an online petition in an effort to organize our voices and convince the ACNM to reconsider its position on apprentice trained midwives. This letter seeks to unite US Midwifery under the common goal of providing women with access to the provider and setting of their choice for birth.

There are many great opportunities mounting to move midwifery forward on both the state and national level. We must stand together as a community of midwives if we are going to have a real voice for change in maternity care. Whether you are a CPM, CNM, a midwifery consumer, advocate, or none of the above, please go to : http://www.thepetitionsite.com/1/support-evidenced-based-midwifery-education to read more details about this issue and sign the petition to make your voice heard.

Respectfully,

The NARM Board of Directors

Alabama Midwifery Video

There is a new Alabama Midwifery video on You Tube.

Stopping the Rumor Mill

Well our midwifery gathering was a resounding success.  I will report more on the day in a future post but for the moment I wanted to address the topic of rumors.  At our meeting a midwife suggested using a phone tree to halt rumors about a difficult birth.  The phone tree could alert fellow birth workers that so and so had a rough birth, and that they would like to discuss it at the next peer review (for example) and that in the mean time they would appreciate the community's support. Now the phone tree idea might not be very practical but perhaps we can all, whether a birth worker or a mom, commit to stopping the rumor mill.  Rumors often lead to the process of judging others and are not at all empowering.

While I am on the subject of the rumor mill, I wanted to post a statement from Kristina Zittle, who has been the subject of more then one rumor lately.  Her story has been in the press but, as is often the case with the media, much of the story, especially the piece reported by the Board of Medicine, was left out or changed.  When we read the media's take on things, or a fellow blogger's and argue that we do not agree with some of the choices that were made on behalf of Kristi or her clients, it is important to remember that we don't have the full story. 

If I have learned one thing from Kristi's story, it is that I had better get good breech skills because I think the surprise breech when transport is not an option is always a possibility.  My dream is to move to Senegal for two years, reconnect with old friends, and do birth work (and hopefully get some breech skills in the process). 

So without further delay, here is Kristi's statement:

****Well, the story hit the front page of our local paper today.  And without comment by me--which my attorney felt was best--they succeeded in painting me out to be the most heinous and wicked of all people alive; unqualified and having no wits about me to determine what is and is not safe.

It is sad most of all that the precious families involved will have to deal with yet another issue when they should be left to move through the grieving process and even sadder still that no mention of the safety of homebirth or the truth to either of these cases will ever be mentioned or extolled.  The facts will remain that babies are born all over this world and in some cases regardless of where they are born, they will not make it.  I suffered this loss personally and was even in the hospital through it.  Of all people, I should know the sting of and the pain of great loss!

At any rate--I simply wanted to send one last update on the status of this situation which is mixed with many lies reported as fact in the newspaper this morning--I wanted you all who have prayed and supported me at some point over the past 8+ years to know the end of it.

I was planning to retire in January--why?  Because I have 9 children who need me more than women need me to help them bring their babies into this world.  The decision was in the making prior to the Lord testing my resolve with all that has occurred.  I have learned so much through all of this and am sure I have not even touched the tip of the iceberg in all I will be taught by this but a few things I wanted to share:

1.  It is absolutely amazing how strong and supportive those in the home birth community are!  I have received massive outpouring of love and care even for those who did not know the full truth of the stories.  They knew my heart, knew my skills, and simply trusted that they were not getting the entire truth but merely one very tainted side of the story.  This has been most humbling to me as I know I do not deserve the kindness--but it has been God's way of demonstrating His mercy upon me in a very tangible and physical way.
2.  I have realized that when babies die in the hospital, it is KNOWN that heroic measures must have been done finding no one to blame--but if a baby dies at home--heinous measures must have occurred and the one in charge will be blamed regardless.  I have also been reminded of whom I serve and as long as my heart is right and pure before Him--I have nothing to fear.
3.  I have learned that we do not have hindsight to make decisions based upon.  We must use the resources we have at the moment and do the very best we can--because of this we must understand that when others use hindsight to scrutinize us we have to glean what we can glean and release all the rest.  At the end of the day--being in peace with God is most important.
4.  I realized that you can be blamed for lack of truth.  But then I also remember that Christ was slandered and reviled; falsely accused and blamed--why?  All for lack of truth and truly finding out the real character and person that He is!  And through this I remember that He did not vindicate Himself.  He never said a word in His defense.  I am not saying this is like what He went through--nothing even close--but I can learn from His example and refuse to give place to the lies of these accusations.

The outcome of this has changed my life and further emphasized my need to retire for my own sanity and well being--it was too close to home after my own loss and trying to help them through theirs.

I can handle the slander; I know the truth before God.  I can handle the comments calling me a bad midwife; prior to these cases, I had never even had an emergency transfer and have well over 200 families who can attest to my skill and thoroughness of care.  I simply struggle to handle the fact that this will most likely draw out this grieving process for these dear families all the more!  I want them to have closure.  I want them to be left alone to grieve as they see fit.  So, I ask for you to please pray for these two families.  I know this is so hard on them.  They know that I did my best and did not neglect them or do heinous things or make bad decisions on their behalf.  They know I directed them and allowed them to make the choices they saw fit to make.  For me this boils down to a society who believes they can make and force choices on individuals in the "guise" of what is best for them.  Because, as a parent, I feel it is my right to choose what is best for me--and knowing my personal history and the unlikely ability to be served as I would desire--I feel I must fight for these rights to determine what is best, not on their standards but on my own before God.  My great concern here is that if the medical community has their way--women like me who have many "risk" issues as well as those who only have a few issues--will not be able to hire the midwife of their choice to serve them at all--for that matter; they will most likely not be able to ask advice of an herbalist or natural nutritionist if that herbalist or nutritionist is not saying exactly what the government wants them to say.  Our rights are at stake here.  I simply do not believe it is their right to determine who can and cannot birth at home.  Just like it would never be right for them to say everyone must deliver at home unless deemed a medical emergency.  Every couple should be able to choose what is best for them and have the ability to be able to be supported in their choice.

As for the hearing--since I was already going to give up my license in January--I have simply chosen to do so now.  I signed an order last week relinquishing my license to the state.  The order is still full of non-truths that are heinous; but the most important fact is that for me, this page of the book is over.  There are wonderful midwives in this state who have taken over the care of almost all of my clients and the rest had either already safely delivered at home or had transferred care out of homebirth. 

It is sad to me that hundreds of great deliveries must be ignored to highlight two very sad and grievous ones; but as I stand before God I know I did the best I could under the circumstances at the time.  I love these precious families and my prayers will go out for them as long as I am here on this earth.  I know I gave them my all and although I wish the outcomes would have been much different, can only know that God knew what the outcomes would be and perhaps knew having lost children before myself, I might be somewhat equipped to help them through the grieving process.

I appreciate all of your prayers and support and the many financial gifts I have also received for my legal fees.  God does always provide all that we need. 

If any of you have any specific questions you feel you need answers to, please feel free to contact me directly and I will be more than willing to share as much as is possible without compromising the integrity of my clients.  I know it is hard when you all are bombarded with in the media and with the Board of Medicine is absolutely not going to be filled with firsthand truth but second hand speculation from two organizations who want to rid the state of midwifery and home birth.

Bless you all,

Kristi, quiver-of-8@cox.net

 

See you after the 25th!

There is so much to tell but no time to tell it!  In short, I have joined The Big Push (never thought I would do this, I was rather super-idealistically against licensing midwives until recently when a series of events made me cautiously but firmly change my opinion).  I am currently organizing a gathering of Maryland/DC area midwives during which we will get to know each other, review our history, and have a panel that should lead to a rousing discussion on the pros and cons of licensing.  Given the fact that we move this weekend and that this meeting takes place October 25th, the smart thing to do would be to avoid blogging until the meeting is over. 
If a movement to decriminalize or license midwives grows out of our October 25th meeting, I will need to rethink my study plans.  I am considering taking a year or two off from intense studying (during which I would organize) and then begin a MEAC accredited program, possibly the National Midwifery Institute.  Still mulling things over...

MALI MIDWIVES

This is a long post but important to pass along.  I was a Peace Corps volunteer in Mali for almost three years and this work is very close to my heart.  If you can, please help out.  You can also visit Mali Midwives on Facebook.

MALI MIDWIVES

______________________________________________________________________

A Malian proverb says that a woman in labor has one foot on earth, and one foot in the grave.  The proverb is all too true: a woman in Mali has a 1 in 15 lifetime chance of dying from childbearing complications. Many women die because there are no doctors, nurses, or highly trained midwives rural villages.  In villages, where most Malians live, auxiliary midwives, or matrones, provide the vast majority of maternal health care. For most Malian women. matrones are first and only health care provider they will ever see. 

Mali Midwives  facilitates continuing education opportunities for rural matrones in Mali. Our goal is to raise $15,000 to sponsor our pilot project. You can donate online at malimidwives.chipin.com or go to Mali Midwives’ Facebook page.

Background

I worked with matrones in rural Koutiala, Mali first as a Peace Corps volunteer (1994-1996), and later as a midwife and researcher (2003-2004). I created Mali Midwives to address the needs of this committed group of women and to engage anyone who cares about maternal health and Mali. In my work with matrones, they have consistently shared their pride and frustrations in caring for women and newborns under difficult conditions. Without exception, matrones pleaded for opportunities to update their skills and knowledge. Matrones understand that women and children depend on them for their survival.

Unfortunately, Mali’s health system is overwhelmed.  Matrones attends 60% of all birth that involve a formally trained health worker. Yet, matrones fall at the bottom of the medical hierarchy. This leaves matrones to face enormous responsibility with few resources.

On average, Malian matrones have less than 8 years of formal education and have been at their posts for 11 years. Matrones’ initial training from the Malian Ministry of Health is not standardized and only lasts an average of 11 months. Once at their rural posts, matrones receive little support. Most matrones have no reference materials at all.  They work with little supervision, irregular salaries, and little or no peer support. 1 in 4 matrones report they have never had any continuing education at all.

Large aid agencies offer trainings targeting a few, highly trained providers but they rarely include matrones.  In a setting where 1 in 15 women die because of childbearing complications and 1 in 20 newborns do not survive their first month of life, it is imperative that matrones get adequate continuing education.

Pilot Project

Mali Midwives  will sponsor a continuing education event for the Koutiala region’s 123 rural matrones. The event is slated for January 2009. The continuing education topics were selected in collaboration with Koutiala’s medical director, Dr. Mama Coumaré and the matrones’ supervisor, Ms. Katy Dolo. The topics address major causes of maternal mortality. At the end of the continuing education session, participants will be able to:

1.  Provide care to childbearing women that reflects current recommendations for malaria prophylaxis and treatment, anemia prophylaxis and treatment, parasitic infection treatment and neonatal resuscitation.
2. Effectively use the partogram (labor graph that helps identify high-risk labors)
3. Understand Active Management of Third Stage of Labor (AMTSL; see Future Efforts, below) as a technique for managing the biggest cause of maternal mortality, post partum hemorrhage.
4. Recognize the importance of and strategies for establishing an emergency birth plan with pregnant women and their closest support persons.

Mali Midwives will organize three continuing education sessions to be held January 3rd and 11th, 2009.  Each three day session will accommodate 41 midwives. By repeating the session 3 times in 9 consecutive days, all 123 rural midwives in the Koutiala region will participate.

The continuing education will be provided by facilitators from well-established governmental and non-governmental agencies with specialties in maternal health. Responsibility for selecting the facilitators and finalizing educational sessions rests with Dr. Coumaré and Ms. Dolo since they are most intimately familiar with the matrones’ educational needs.

Evaluation

The goal of this continuing education event is to increase matrones’ knowledge of appropriate prevention and treatment of basic maternal health threats such as malaria and anemia. In addition, we want to increase matrones’ confidence in neonatal resuscitation, preparing families for births, and their knowledge about preventing post partum hemorrhage. A simple pre and post test will be administered as well as a six month follow up evaluation. This information will inform subsequent continuing education efforts.

Future Efforts

The January ’09 pilot project is an effort to provide continuing education for matrones.  Future efforts will build on the relationships formed this January and focus on integrating programs such the American College of Nurse Midwives’ Home Based Life Saving Skills (HBLSS) and the Active Management of Third Stage of Labor (AMSTL) into matrones’ continuing education.

In January, I will introduce the HBLSS program to local health officials. HBLSS trains local health care workers like matrones to educate pregnant women and their closest support persons to recognize situations that require a matrone’s help or a referral to a health center. It also teaches the support persons how to provide first aid while they wait for help. HBLSS has already been implemented in Liberia, Ethiopia, and Kenya with impressive results.

AMSTL is a life-saving, low-cost and low-tech strategy to prevent post-partum hemorrhage, the number one cause of maternal mortality. In the Spring 2008, Mali’s matrones were included in a study of this technique and are likely to be included in future efforts to train health care providers throughout Mali. If Mali Midwives is successful in January’s initial continuing education event, we will be positioned to support more long-term and complex training programs like HBLSS and AMSTL in the future.

Finances

Mali Midwives is grateful to The Village Project, Inc. for serving as our fiscal sponsor.  The Village Project, Inc. is a 501c3 with experience in organizing educational activities abroad. Contributions to Mali Midwives via The Village Project, Inc. are tax-deductible.  Donate online at malimidwives.chipin.com or on Mali Midwives’ Facebook page. Checks payable to The Village Project, Inc. with Mali Midwives written in the memo section can be sent to Mali Midwives c/o Nicole Warren, 1355 W. Hood Ave. Chicago, IL 60660.

The budget below was prepared collaboratively with our partners in Koutiala..  It reflects costs for the three 3-day events. I will bring funds to Mali and pay directly for the program expenses at the time the training occurs in January 2009.

Item    Cost (US dollars)
materials, facilities, food    1847
food & lodging    2777
Transportation    2469
per diem    7449
total cost    14541
existing funds*    1600
FUNDRAISING GOAL    12941
*two small fundraising events were held in 2007

You can get more information on any of topics listed here, as well as a more detailed budget by emailing us at malimidwives@gmail.com. 

Sincerely,
Nicole Warren, PhD, MPH, CNM
President, Mali Midwives

Home birth and Transport

At our retreat we discussed keeping your personal bias out of the equation when speaking with clients (I think we are all guilty of this at some time or another, aren't we?).  Despite the uniform emphasis on repressing personal opinions, I noticed a clear bias on absolutely and always accompanying your mom to the hospital during a transport.  I try not to believe in absolutes and always.  What about the midwife who risks arrest if she transports a couple to the hospital?  If arrested, she leaves her clients (perhaps someone in early labor) without a care provider.  And what if the transporting midwife is a woman of color and thus more likely to receive harassment in a hostile climate?  Let's be real, it is easier for us white women to work within the system, even when faced with a sticky situation.

 

The solution proposed was that perhaps the midwife shouldn't take on the client who is putting her at risk (for example, if you are in a state where it is illegal to attend a woman who would like to give birth vaginally after cesarean, then you shouldn't attend VBACs).   Let's say for a moment that a VBAC client who is determined to have a VBAC feels pushed to birth at home unassisted but is not comfortable with that choice.  She feels unsafe and torn between two equally unwanted options, birth in a hospital or unassisted birth.  Is that the alternative?  Putting women in a place where they feel pushed to make a choice (unassisted birth) that they are making only because they are denied care?  Now there are plenty of women who choose unassisted birth but it should be a choice, not a situation a a woman is forced into because the alternative, another cesarean for example, is not acceptable to the mother. I hesitate to go there but what if the mom's fear of an unattended birth interferes with the process of normal labor and the baby is compromised?

I would argue that there is a difference between "dumping" your client at the hospital (something I think midwives should never do) and educating your clients on the legal status of midwifery in their state and choosing, for example, not to attend non-emergency transfers.   I've heard that back in the day, couples would regularly tell their midwives, "please stay home, we don't want to get you in trouble."  People were protecting a valuable asset in their community, the midwife. A compromise could be to accompany the couple to a hostile hospital as the client's doula rather then the midwife.  Let's face it, there are some hostile hospitals out there and midwives have been arrested during transports. 

If you choose to transport with your clients, despite the risk of arrest, good for you, but be careful of judging the midwife who does not.  Readers, I would love to hear your thoughts on the matter.

I did learn some great tips on transports which I will share in another blog.  Remember that many midwives who attend home birth have transport rates under 5% so this is NOT a common occurrence.  

We have a New Midwife and Other News

We have a new midwife in town!  We chatted last week over tea while the kids explored.  Of course it was raining and so we headed upstairs for a bit more space. Am I glad that our tiny one bedroom temporary quarters is located in our friend's house and that we are always welcome upstairs.

Next weekend I am off to West Virginia for a Midwifery Retreat sponsored by Friends of Midwives.   I am looking forward to a weekend of learning and will give a full recap upon my return.  I am especially curious about the session on "Smooth Transport" as apparently transports have not been so smooth in the area. 

And the other news is, DRUM ROLL PLEASE, we found  house!  Only six more weeks of living in our teeny tiny little apartment.  My goal of moving before winter comes will be met. 

Baby Catchers Making Change

Hello all!
Please help spread the word.  A fellow doula, birth assistant, childbirth educator and student midwife emailed me the letter below about midwives doing great work.

Dear Sisters In Birth,

Please take a moment and check out the blog of a friend of mine from The Farm, Alyson Jones.  She is a midwife in British Columbia.  Early this year Alyson and her midwife friend decided to take their skills to Africa.  They contacted various programs, found family to take care of their kids, contacted their community to raise money for the trip and supplies, and studied the culture of Zambia and left on a 7- week adventure.  This trip was not designed to fulfill some NARM requirements but to help women and their families!

Here is her blog about her trip:

“Please take a moment to check out our blog at http://babycatchersmakingchange.blogspot.com/.  Marijke and I are going to Africa for 7 weeks this summer to work with and learn from local midwives. We are working to raise money and/or supplies to take with us in an effort to support women and their families.

Full details are in the blog.  It will only take a second of your time to see how you have make change!

Every minute of every day a woman dies needlessly during pregnancy and childbirth, most in the developing world!

Thank you for taking the time,

Alyson”

For those of us who watched the PBS Wide Angle special of “The Making of a Surgeon: Mozambique Midwives” here is another view of life for our sisters at Home.

Please take time to look at the links to organizations that are working to change women’s lives around the world.

Claudia Booker

Why We Must Stand Together

In my former life, I was a Ph.D. student (I left indefinitely during my first pregnancy) and an organizer for social justice at the Jewish Council of Urban Affairs in Chicago.  Much of my work centered around housing issues, specifically housing for the poorest of the poor, or public housing.  Few were interested in becoming intimately involved with the dwellers of Chicago's severely neglected, rat and crime infested high-rises where families struggled to survive.  I shared the poem below with those hesitant to get involved. I think it is an important one to read whenever we think that an issue is not MY issue.  Whether we decide to birth at home or in a hospital, with or without an epidural, assisted or unassisted, birth choice is an issue that touches us all, women and men.

First They Came for the Jews

First they came for the Jews
and I did not speak out
because I was not a Jew.
Then they came for the Communists
and I did not speak out
because I was not a Communist.
Then they came for the trade unionists
and I did not speak out
because I was not a trade unionist.
Then they came for me
and there was no one left
to speak out for me.

Pastor Martin Niemöller

If I rewrote the poem, it would go something like this:
First they came for the unassisted birthers, but I did not speak out, because I do not free-birth.  Then they came for those who birth at home with lay midwives, but I would would not speak out, because I would not have a home-birth with a lay midwife.  Then they came for those who birthed with Certified Professional Midwives, and I would not speak out, because I would not have a home-birth with a CPM.  And then they came for those who birthed in birth centers and with Certified Nurse Midwives, but I would not speak out because I would not have a birth in a birth center or with a CNM.  And then they came for me, and there was no one left to speak for me.

Dutch System of Midwifery Care Works

A new study1 looks at the process of midwifery-led delivery in the Dutch system.   Midwives make either no referral, referral (to an obstetrician) with urgency, or referrals without urgency once a woman is in labor.  The study, which examined 280,000 cases found that the midwifery-led referral system resulted in a small number of urgent referrals (3.6%) and satisfactory neonatal outcomes.  There were fewer referrals among women planning a home (rather then hospital) birth.

1MP Amelink-Verburg, SP Verloove-Vanhorick, RMA Hakkenberg, IME Veldhuijzen, J Bennebroek Gravenhorst, SE Buitendijk (2008) Evaluation of 280 000 cases in Dutch midwifery practices: a descriptive study, BJOG: An International Journal of Obstetrics and Gynaecology 115 (5) , 570–578     doi:10.1111/j.1471-0528.2007.01580.