Our North Star – Part 2

nativemama6So, if a birth center in every community is Our North Star, how do we get there from here?  I’ve got some ideas about that!  The first (obvious) step is to have legal, autonomous midwives in all 50 states.  We need Certified Professional Midwives, Licensed Midwives, Certified Midwives, Certified Nurse Midwives, all of them practicing in every setting!  Midwives at home, midwives in birth centers, midwives in hospitals!  The key here is the word autonomous, because, as Gloria Lemay pointed out in this blog post back in 2009, when midwives are working in a broken system that requires them to conform to outdated practices they are not truly practicing midwifery.  And that’s why we must all join forces and stand together in opposition to those who would deny us access to the kind of care we deserve.

In North Carolina, we have no path to licensure for CPMs and CNMs must obtain a physician’s signature in order to receive a permit to practice.  As many of you know, the North Carolina Friends of Midwives (NCFOM) have been working tirelessly since 2007 to get legislation passed to license and regulate CPMs.  Last week, they introduced two bills in the Senate – SB106 the Home Birth Freedom Act and SB107 a Decriminalization Bill.  If you live in North Carolina, please become a member at NCFOM.org to receive updates and legislative calls to action.  We need every voice to be heard, we need to be loud and firm.  We want access to midwives in every setting.

In Texas, they had what I would consider one of the best birthing environments in the country. . .until last week.  Turns out, there is a new legislator (who happens to be an anesthesiologist) that has a bill in drafting that will re-write the language in the birth center regulations.  The changes would eliminate Licensed Midwives from the regulations entirely and would put the physicians squarely in control of birth centers.  The bill has not been filed, but the fact that it has even been drafted is disturbing to say the least.

And then, there’s South Carolina. . .a very similar bill was filed by another physician limiting the ability of CPMs in that state by requiring that they have a supervising physician (sign petition here).  It would appear that the physicians in this country are going on the offensive in a ridiculous turf war over women’s bodies!

But who could blame them, really?  Let’s look at what has transpired over the last few years:

  • Last Labor Day, over 10,000  rallied in cities all over the country thanks to the incredible efforts of Dawn Thompson and the folks at ImprovingBirth.org who called for folks to question elective cesareans and early elective inductions.
  • On September 20th, One World Birth‘s film “Freedom for Birth” was viewed by over 100,000 people at 1000 screenings worldwide.  The film told the story of the ruling at the Hague that determined it is a woman’s basic human right to choose where and with whom she gives birth. It also told the story of the amazing mamas in Canada who marched to the hospital and asked the question “Where’s My Midwife?” in order to get the hospital to grant privileges to their local midwives.
  • Women in Australia are marching and organizing to demand access to home birth.
  • In January, the National Birth Center Study II was published revealing that women who are seen by midwives in an out-of-hospital setting only experienced a 6% c-section rate.
  • With 27 states now licensing CPMs, we have officially crossed the 50% mark.  According to the Big Push for Midwives website, there are currently 13 states working on legislation to license and regulate CPMs (NC, MD, IN, MD, DE, AL, MS, IL, SD, IA, MI, MA, NE).
  • And let’s not forget the Time Magazine article “Bitter Pill: Why Medical Bills are Killing Us” by Steven Brill that came out last week which exposes the unchecked greed driving prices in the hospital ever higher.
  • Right now, maternity care professionals are holding a conference in DC called “Workshop on Research Issues in Assessment of Birth Setting.”
  • Birth Centers like Jennie Joseph’s The Birth Place in Florida is reversing racial disparities by using the JJWay – treating women regardless of their ability to pay and helping them navigate the system in order to get the care that they need.

In this birth activist’s humble opinion, never has there been a better time to march in the streets and start a revolution.  If we hold the Birth Center as our North Star, the true way forward for maternity care, we can rise up and demand that the ‘powers that be’ begin to treat women the way they deserve to be treated – with respect and with scientific, evidence-based practices.  If you want to be a part of the revolution, join us in July at the Second Annual Birth Activist Retreat in Utah.

Our North Star – Part 1

On January 31st, the Journal of Midwifery and Women’s Health published the National Birth Center Study II, and the interwebs lit up with happy blog posts (like these: Childbirth Connection, Evidence Based Birth, Birth Without Fear, Science and Sensibility, ImprovingBirth.org, and our own).  The American Association of Birth Centers also created a ton of beautiful graphics to share on Facebook, touting the incredible findings of the study, like this one:


Birth Centers have been serving low-risk women for the last 35 years, and this new study shows that they set the bar pretty high for everyone involved with birthin’ babies.  With a C-section rate of only 6%, clearly midwife-led care is the gold standard.  This study basically proves, yet again, that when women are treated with respect and placed at the center of their care they can give birth to their babies just fine, thank you very much!

Last fall, my husband and I had the distinct pleasure of traveling to Pennsylvania to work on the Birth Center Impact Video Project.  We recorded interviews with folks in the communities surrounding two of the oldest birth centers in the USA – The Birth Center in Bryn Mawr and Valley Birth Place.  Each of these birth centers has been serving families for over 20 years!  A second film crew visited Birth Care in Bart, PA and Reading Birth & Women’s Center.  We edited some of the footage into four short films that depict the  Archetype of the Birth Center (videos below).

Imagine a world with a birth center in every community!  A world where all women began their pregnancy with midwives who viewed pregnancy as a natural life-process and helped each woman make choices regarding her pregnancy and birth that were best for her and her family.  Because moving birth away from the medical model is not simply about lowering the C-section rate and saving money, it’s about helping women to reclaim birth as a sacred, powerfully personal life experience.  In my opinion, the birth center model represents our North Star.  Let’s start moving maternity care in that direction!

The 4 Facets of the Birth Center Archetype in a community. . .

The birth center is:

Sanctuary where mothers give birth

Learning place for intimacy, birth, & family

Supportive community for women & families

Midwife’s place of business

New Study Highlights the Tremendous Benefits of Birth Centers

AABC_Logo_2011_RGB-LGEveryone knows that WMM? loves birth centers. Birth centers are a place where women can fully experience the midwifery model of care. Pregnancy and birth are viewed as normal, healthy, yet important life events. The peaceful, home-like atmosphere allows for woman centered care. And, of course, birth centers are generally operated by midwives and we love midwives! A new study shows that this model of birthing provides huge benefits. The National Birth Center Study II was conducted by the American Association of Birth Centers (AABC) and published in the most recent issue of the Journal of Midwifery Women’s Health, the official journal of the American College of Nurse-Midwives (ACNM).

The birth center study included 15,574 women who received care in 79 midwife-led birth centers in 33 U.S. states from 2007 through 2010. Out of the 15,574 women included in the study 84% gave birth at their intended birth center. Only 16% had to transfer care to a hospital and of those transfers the vast majority were for non-emergency reasons. Fetal and newborn mortality rates were low (0.47/1000 births and 0.40/1000 births, respectively) and were comparable to those in low-risk births in hospital settings. There were no maternal deaths. Fewer than 1 in 16 of the study participants had a cesarean birth. That statistic is so amazing that I want to write it again and again: only 6% of women giving birth at a birth center ended up needing a surgical birth!!! This is big news. In 2010 the U.S. Cesarean rate reached an astounding 32.8% of all births. If this statistic is adjusted to reflect only a population that similar to the low risk women giving birth at birth centers, it is still an estimated 24%. That means 1 and 4 healthy, normal pregnant women end up needing surgery. If these women received care at a birth center most of them could avoid have avoided that costly intervention.

bcbabyOn the topic of cost, the study highlights significant financial benefits as well. Given lower costs in the birth center setting as well as low rates of cesarean birth, the 15,574 births in this study may have saved more than $30 million in facility costs alone based  on Medicare/Medicaid rates, not including additional savings in costs of other providers, anesthesia, and newborn care in hospital settings. If even 10% of the approximately 4 million U.S. births each year occurred in birth centers, the potential savings in facility service fees alone could reach $1 billion per year. In addition, U.S. spending on maternity care could decline by more than $5 billion if only 15% of pregnant women gave birth via cesarean. That is some serious savings!

The benefits of birth centers are too significant to ignore. This birth option needs to be available to women everywhere. Birth centers are the gold standard in maternity care.

Anna is Pregnant – Episode 2, Midwifery Magic

Erica_pic2I have been having practice contractions forever, at least my whole last trimester. As my guess date approaches– tomorrow!– they have been increasing in intensity and frequency. I have even had a few that have made me think, “humm, will tonight be the night!?” Last night seemed to be one of those nights, so I called my dear midwife in the early evening just to give her an update. I knew I wasn’t in labor, but the slowly increasing activity seemed worth noting. She replied with an offer to come to my house just to check me.

Now I am someone with a history of shorter labors. My last one was about three hours; and only half of that time was I really sure that it was the real thing. So having someone who is willing to drive all the way to my home in the evening just to give me a bit of extra information and reassurance, is deeply comforting. This is part of the magic of midwifery care. For me this aspect of truly personalized care is what is most important.

Stay tuned my next blog will probably have a baby in it, maybe tonight will be the night!

The “Big” Walk-In is Happening Now!

The "Big Walk-In"You may be wondering what is this? Where are people walking and why? The “Big” Walk-In is the first in a campaign of three events sponsored by Improving Birth, The “Big” Walk-In, The “Big” Write-In and The “Big” Call-in. These events are Big because they are happening everywhere at the same time, however they could also be described as small because they are all simple things one person can do without very much time or effort. Thousands of “small” actions are building something “Big”.

Here are the details! The purpose of this event is simple: to raise awareness about evidence-based maternity care. To participate all you need to do is register at Improving Birth, print their friendly letter and evidence-based care fact sheet, and take them to the maternity-care provider of your choice. This could be the OB office who cared for you throughout your pregnancy or just the maternity-care office closest to your house. You could simply deliver the letter and information about evidence-based care or you could also include a personalized thank you note and a box of chocolates. You could go quietly on your lunch break or you could invite all your friends and deliver a whole bunch of letters at once. Whatever you choose, you are participating in something “Big”.

One letter may or may not make much difference, but if one practice were to receive ten letters they would pause and think. If they receive one hundred letters they will see that there is a demand for change. In addition to the positive effect your letter may have, you will have the satisfaction that comes with speaking out for the rights of mom’s and babies in your community. Are you ready to walk in?

Get it done!

Soooooooo, yeah. . .our friends at the NC Medical Society have stopped returning phone calls and are not responding to e-mail.  Apparently, one meeting was enough for them.  I keep thinking about an exchange with Haywood Brown at our last meeting.  We said, “If you don’t want to license CPMs, what is your plan for helping to make home birth safe for the families who chose it?”  He replied, “Go to the hospital.”  Uh, you’re not getting it.  Families will continue to chose home birth (and they are doing so in increasing numbers), lets license the women who are already serving our state and integrate them into the health care system.  It’s working all over the country, it can work here.

I was under the impression that Mr. Brown was in the minority at that meeting.  I felt that the rest of the attendees were genuinely interested in beginning a discussion about how to make home birth safe in our state.  I can see now I was wrong.  This is truly heartbreaking to me.  The physicians in North Carolina have determined that protecting their Scope of Practice is more important than doing what’s right for the consumers they are supposed to be serving.  Which is why we will be demonstrating our disappointment outside of their offices tomorrow in Raleigh!

I sat down this weekend with Lisa Fawcett, CPM and lobbyist for NCFOM.  We had a nice long chat about the history of NCFOM’s efforts to license Certified Professional Midwives in our state.  This is the first installment of “Couch Talk,” with more episodes to follow.  We need everyone now, more than ever, to get this job done.  See y’all in Raleigh!

It’s all about ME!

I am feeling a bit nostalgic today because tonight is the beginning of the Fourth Annual WILD Festival.  Four years ago, I was a brand new birth advocate.  I had just given birth to my second daughter at home with a CPM who was unlicensed in my state, and was more determined than ever to change maternity care for the better!  When my second child was born, I was amazed at how my work load had suddenly doubled, but my husband’s stayed the same.  WHA???  Mothers needed to be recognized for all they do for their families and communities!  I envisioned a weeklong celebration for moms to come out and cut loose at night – a night of comedy, an outdoor concert and “Birth” by Karen Brody.  And during the day, come together at the local YWCA to discuss issues that we all faced – getting dad more involved, balancing family and work, remembering to take care of yourself.  Somehow, we pulled it off!  But right in the middle of planning this fun-fest, two Certified Nurse Midwives were fired, sending our community into crisis mode.  Oye.

It amazes me that while we were working to bring women together to celebrate being mothers, we ended up coming together for more upsetting reasons.  This idea of bringing women together has long been a weird obsession for me.  I am the oldest of four girls, and I am super close with all of three of them.  But in my twenties, I was one of those women who had more guy friends as a result of being the victim of bullying by other girls in middle school.  You know the story – there have been countless books written on the subject (Queen Bees and Wannabes, Odd Girl Out, Reviving Ophelia, etc.).  Why was it that so many women were so nasty to each other?  I longed for a sense of community with women like the one I had grown up with, the closeness I had with my sisters.  So, when I met my midwife and saw that she was going out into the world on a regular basis to serve women, I was blown away.  And all along, she was putting her entire family and livelihood in jeopardy as a result of having no license.  Here was a shining example of women supporting women!  We need more of this!  So began my personal quest for more Wise Women – women who understand that we need to be coming together, not constantly tearing each other down.

Unfortunately, I also grew up a consumate good-girl-people-pleaser who was told that any emotion other than happy was unacceptable.  So when I became a birth advocate, I liked the fact that I had found an acceptable way to be angry about something.  Here was a system that was mistreating, some would even say abusing women.  Damn right I was angry!  And when the hospital/physician’s decided to ignore our request for a meeting after the CNMs were fired, we went out in the streets to let the world know that we were not going to be abused and ignored anymore.  Quite suddenly, we were getting requests from all over the country to come tell our story.  My outrage was being encouraged.  Kind of.

On the one hand, I was being invited to speak out about the fact that midwives were being mistreated, oppressed, and so were the women.  But I was also being sent a very different message from the same community – your ‘truth-telling’ is making it uncomfortable for those of us trying to keep our heads down and make a difference.  I was hearing the same thing I had been told as a little girl – no one will listen to you if you’re angry.  What a load of poo!  How is anything going to change if we don’t point out when people are behaving badly?  But no one wants to admit their behavior may be hurtful to others.   It’s the same reason my kids tell me I’m mean when I point out that they cannot hit each other.

Four years later, after my first foray into public displays of outrage, I am ready to move in a different direction.  At times, it feels as if all of my efforts have amounted to very little locally – the midwives in our community are behaving more outrageously toward each other than before; our local organization grew and then shrunk in numbers; we are still getting reports of women being mistreated by providers (including the midwives, yall!).  But, I have made some incredible connections in other parts of the country.  Places where the midwives WORK TOGETHER!  Places where physicians speak highly of other providers!  Places where women are able to give birth in the setting of their choice, with the provider of their choice, at their own pace.  Places where the providers celebrate their differences and remember that it’s NOT ABOUT THEM.  IT’S ABOUT THE WOMEN!

Holy crap!  Birth is working in other parts of this country.  What happens if we begin shining a huge, happy spotlight on those places?!  Won’t women and providers say, “Hey. If they can do it, why can’t we?”  So, I am working on a video project with the American Association of Birth Centers Foundation to grow more birth centers:

I am serving on the board of BirthNetwork National, an organization working in communities all over the country to bring professionals and consumers together to promote the Mother Friendly Childbirth Initiative.  And I am working on a program aimed at teaching young girls about birth and the amazing power of their bodies.

“Where’s My Midwife?” will continue to be a resource for folks who want to learn about how to protect their access to midwives in their community.  We are in the process of taking all the knowledge that we have accumulated in our efforts to increase access to midwifery care and organizing it into a tool-kit that others can use.  Having this tool-kit will enable us to help more people in a more efficient way.  But I am ready to focus my time and energy on growing more healthy communities.  As a dear friend keeps telling me, “You can only lead the willing.”

Improving Birth National Rally for Change Reaches Millions

Salt Lake City, Utah; Photo by Cara Baker

Did you hear the shouts for change? Do feel the ripples spreading out all over the U.S.A? This Labor Day almost 10,000 people participated in an Improving Birth National Rally for Change! Nearly 10,000 people used their physical presence to demand evidence based maternity care by standing together all on the same morning. We can only attempt to measure the impact of this historic event.

Salt Lake City, Utah; Photo by Earthside Birth Photography

Most rallies got some media attention. Improving Birth lists 68 different news stories on their website. That means countless numbers of people, who probably have no idea about birth politics or why birth even matters, got a taste for the change brewing in maternity care. Then there is Facebook, the National Improving Birth page reached 89,586 people in the week of the rally. The largest local page, San Antonio, TX reached 67,571. The modest page I administer for Salt Lake City, UT reached 10,571 people in the same week. The average reach of the 17 pages I have numbers for was 10,884 people, if you multiply this by the 110 rallies nationwide 1,197,318 were exposed to Improving Birth through Facebook in one week. I think my head would explode if I try to expand that number to the many weeks we have been promoting the rallies. There is also website traffic to measure and the people who drove or walked by a rally while it was in progress. We had a massive reach. Our ripples will be going out into the world for a long time!

Birth Salt Lake City, Utah; Photo by Vilo Photo

However, all of those numbers do not come close to showing us what it was like to be at a rally. As I have browsed hundreds of pictures from rallies all over the place, there is one clear thread. People are having fun. They are connecting with others in their communities, and their faces show the joy and satisfaction that come along with doing something they know is making a difference. There are children holding signs and playing with balloons. There are men and women standing side by side, many of them with a small child in their arms or attached to their bodies. People are cheering and chanting. People passing in cars are waving and honking. At our rally in Utah an elderly couple was passing by in their car. They slowed way down to read each sign, smiled and even stopped to talk to some of the rally participants. These types of interactions were a highlight for people everywhere.

Salt Lake City, Utah; Photo by Earthside Birth Photography

According to another number cruncher: since we had 75 people at last year’s rally and 9400 this year, the growth was 12533%. So, if we continue on the same growth rate, we can expect 1,178,133.33 people at next year’s rally. Imagine all the connections we will make, all the people we will influence, and all the relationships we will foster with our local hospitals as we demand change. The revolution is happening, and it is going to be fun!

Communities Across the U.S. Rally to Improve Birth

Change is brewing. Revolution is in the air. This coming Labor Day women and men in over 100 communities across the U.S. are coming together to demand that hospitals increase their practice of evidence based maternity care, as part of the Improving Birth National Rally for Change. Most of these rallies will take place in front of a local hospital. However there are some unique locations such as the Democratic National Convention in Charlotte, NC and the headquarters of the American Medical Association in Chicago, IL.

The founder of Improving Birth, Dawn Thompson, participated in our First Annual Birth Activist Retreat. At the retreat we decided that this event would be the first of many coordinated actions we would promote and organize as a collective of birth activists. When people all over the country stand together and speak in unison the message can not be ignored. There is power in unity. We can change maternity care. This rally is the first step.

Every hospital that is being honored as a rally site has received a friendly letter introducing Improving Birth and encouraging them to make concrete changes that will improve the care they provide. Most of the hospitals were chosen for their high cesarean rates. The rallies will let the hospitals know that the families they serve are ready for change. We are ready to be their partners in making this change happen. We will not give up!

Where’s My Midwife? Is proud to be a National Sponsor of this event. We hope you will attend a rally near you. This truly is the beginning of a full scale birth revolution! Don’t miss your opportunity to be part of history!

Support your Sisters

This morning, I was reminded of another reason I considered quitting this whole activist thing.  A local CNM commented on my last blog post regarding our meeting with the NC OB/GYN Society:

Hi Kirsti!!!! THANKS FOR ALL YOU ARE DOING!!!!!! Is it possible to include homebirth nurse midwives in the planning stages? I appreciate all Rob and Russ and Lisa are doing-please don’t misunderstand. I just know homebirth needs support from all providers and this is another perfect opportunity for professional midwives and nurse midwives to work together.

I could not agree more.  When the CNMs in NC lost their physician back-up, WMM? immediately began blogging about it, contacting the press and organizing public events to raise awareness of the crisis facing home birth families.  The leadership of NCFOM attended a Midwifery Joint Committee meeting to testify in favor of the emergency extension of the home birth CNM’s permit to practice.  And WMM? wrote a letter to the Board of Directors of NCACNM expressing our desire for the leadership from all parties to sit down and figure out a way to work together to increase access to midwives in all settings:

After we sent this letter, the home birth CNMs and their families formed a separate Facebook group and stopped communicating with us.  Shortly there after, we received a formal response from the president of the NC chapter of ACNM reiterating their inability to support licensure of CPMs, effectively giving us the brush off.  Apparently, they did not need or want our help until they found out we had had a meeting with the physicians.

From the beginning, WMM? has consistently asked the midwives in our state and in our country to stand together.  We have always honored our mission to increase access to ALL midwives in ALL settings because in countries with best outcomes, midwives are the primary maternity care providers.  Time and again, the physicians and CNMs I have spoken with point to educational requirements as a reason for not supporting CPMs.  But in all of the years since the CPM credential was created, no state has ever reversed their decision to offer licenses to CPMs.  In fact, Washington state is now calling for more CPMs to be licensed because the increasing number of families choosing home birth are saving the state millions of dollars.

But aside from all of that, what troubles me the most is the idea that physicians and Nurse Midwives get to decide whether or not families have access to midwives trained to attend women at home.  This speaks to the heart of the problem in maternity care – women are judged by their providers to be too stupid to make decisions about their own health.  We couldn’t possibly be smart enough to decide for ourselves which provider is right for us, so the physicians and midwives will save us from all that trouble by limiting our options to the ones they feel are best.  And which settings are best.  And which procedures are best (VBACs, water birth, etc.).

But I digress. . .to answer the question from the beginning of this post, ‘yes.’ As we expressed to your organization back in June, we would love for all interested parties to sit down and discuss how to make maternity care better for the families of North Carolina.