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Tuesday, July 10, 2007

Other midwifery articles and letters:


MSMA Announces Preparations to Take New Midwifery Law to Court
Mary Ueland
Email: LegislativeChair@MissouriMidwivesAssociation.orgCell Phone: 417-543-4258Fax: 314-721-1149
Homebirth families around the state are appalled at the Missouri State Medical Association's plans to try to overturn the new law legalizing Certified Professional Midwives.Homebirth families have all been celebrating a victory since Governor Blunt signed HB 818 several weeks ago. The bill legalized Certified Professional Midwives and ended 48 years of the practice of midwifery being a felony in Missouri.Despite broad bi-partisan support in the Missouri legislature for the legalization of midwives and the passage of HB818, MSMA's tyrannical insistence on the felony status of midwifery in Missouri has now turned its efforts to the court system. The announcement of the planned law suit against the state of Missouri has claimed the top banner on the MSMA website.Those lobbying for the midwifery bill say that they were always willing to sit down and work out a midwifery law agreeable to all parties if the medical associations would have agreed to withdraw their intense opposition. However, they only intensified the opposition as time went on. The midwifery supporters say that the goal of the medical associations seemed to be making sure that no midwives would be available for mothers who choose to give birth at home in Missouri."The Missouri State Medical Association has never had any need to work with us, because they intended to maintain a complete monopoly on birth," explained Dr. Keith Nisbett, Ph.D., a professor and homebirth father who has tried to change Missouri's midwife law for nearly twenty years."The Missouri State Medical Association does not speak for me as a physician, nor do they speak for many of my physician colleagues who respect midwives and want to see them join us at the table as experts in healthy pregnancy and birth," said Dr. Elizabeth Allemann, MD, a physician from Columbia. "The MSMA has spent twenty years of time and energy fighting the legalization of midwifery in Missouri. You would think the sky is falling and terrible things are going to happen to doctors! That's the farthest thing from the truth. Midwives are well trained professionals and work well together with doctors."The midwifery supporters say that they are encouraged that other medical groups such as the Missouri Hospital Association are refusing to join the MSMA in the lawsuit. "It shows that the Missouri Hospital Association knows that there are more important things to focus on, like increasing access to healthcare for all of Missouri's citizens," commented Dr. Allemann. "For that, I applaud them.""There are so many other healthcare issues that need attention in Missouri. Why does the medical association spend so much time trying to criminalize my midwife and limit my access to the birthing service of my choice?" questioned Samanda Rossi, St. Louis Friends of Missouri Midwives area coordinator.Missouri women who choose home birth are more qualified to determine who should assist them than the MSMA. It is both demeaning and an insult to the intelligence of women to suggest that they would choose anyone other than a qualified professional to deliver their children.Midwifery is about access to healthcare. Some women do not have the choice whether or not to use a physician. The MSMA, if successful, is actually endangering the lives of women and their babies by denying access to trained professional midwives to attend homebirths. Every pregnant woman deserves to have a professional attend her birth who has been trained to recognize fetal distress, resuscitate a baby, and stop a hemorrhage.Mary Ueland, legislative chair for the Missouri Midwives Association, contends that MSMA is giving false information to its members and the public. "Anyone can look up the definition of tocology and see that bricklayers and professional golfers are obviously not certified in tocology. Because the truth will not cause concern among physicians or the public, MSMA is telling them lies about what the new law does. We had hoped that we could at least have a candid discussion of the facts with obstetricians."
The law says that those certified in tocology under the National Organization for Competency Assurance can provide prenatal, birth, and postpartum care. The two tocological certification processes certified by NOCA are the Certified Professional Midwives and the Certified Nurse Midwives.

The Missouri Midwives Association is dedicated to promotion, protection, support, and education for midwives in Missouri. www.missourimidwivesassociation.org

Friends of Missouri Midwives is a non-profit consumer group committed to expanding and educating about safe childbirth options for Missouri families. www.friendsofMOmidwives.org

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For more information about this topic, or to schedule an interview, please contact Mary Ueland at: 417-543-4258 or email Mary at: LegislativeChair@MissouriMidwivesAssociation.org

Reproductive war’s new front line Columbia Tribune
Reproductive war’s new front line Midwifery provides cost-effective health care.
Published Tuesday, July 10, 2007
In May, just before legislators were to recess for summer, Republican state Sen. John Loudon pulled a fast one. He snuck a one-sentence amendment having to do with women’s reproductive choice into an otherwise unrelated 123-page health insurance bill that Gov. Matt Blunt was certain to sign. The measure was approved unanimously before anyone noticed the add-on, and when they did, it caused such a ruckus that Loudon was stripped of his committee chairmanship.
Reproductive politics is war, and this was exactly the kind of sneak attack you’d expect from a partisan politician. Except that this amendment wasn’t about abortion. Actually, it supported a woman’s right to choose - a midwife, that is.
Lobbyists in Missouri tried to legalize midwives for decades. You heard that right. In Missouri and 10 other states, independent midwives cannot get a license, which drives them to practice out of state or underground. Loudon sponsored a bill that would have licensed and regulated certified professional midwives - CPMs, whose credentials are recognized explicitly or implicitly in most other states - and it was finally close to passing when a lone senator filibustered, killing it. So Loudon got creative, and literary, and quietly slipped some Victorian lexicon into the widely popular bill.
The amendment grants anyone with "tocological certification" the right to practice. Tocological is derived from the Greek word "tocos," which means birth. It was code for the CPM credential. Blunt signed the bill into law on June 4.
And faster than you can say tocological, the Missouri State Medical Association was in court, suing for malpractice.
The doctors claim that recognizing CPMs will make birth less safe. That’s incorrect. Midwives provide evidence-based care, and studies show they promote optimal births. A 2005 study of 5,000 low-risk women who planned home births with CPMs in North America - the largest such study to date, published in the British Medical Journal - found that 95 percent of the women had spontaneous, vaginal births, and their babies did just as well as babies born to healthy women in the hospital. The low-risk women who receive traditional obstetric care have far higher rates of cesarean surgeries and other invasive procedures.
CPMs aren’t nurses or doctors. They are trained to be the primary-care providers for normal pregnancy and childbirth in an out-of-hospital setting. Midwives are regarded with suspicion by many Americans, but in much of the industrialized world they are the norm - a woman only sees an obstetrician if she has a problem - and these countries have a far superior track record than we do in the United States. The women there have fewer cesareans, fewer birth injuries and fewer deaths.
In some states, such as New Mexico and Tennessee, CPMs are health-care providers like any other, who list themselves in the Yellow Pages and get reimbursed by Medicaid. In other states, such as Illinois and Indiana, they are outlaws. In such places, women who want an alternative to the hospital must go underground and find an illegal provider. As they give birth, they are accomplices to a criminal offense.
In Missouri, it’s a felony.
The Missouri State Medical Association would rather keep it that way. Arguing in court for an injunction last week, the physicians group claimed that the midwifery measure is unconstitutional because it is unrelated to the larger thrust of the insurance bill, which Blunt lauded as expanding Missourians access to health care. Here, too, the doctors are wrong: Midwives provide cost-effective care to which many women are now being denied access. And don’t consumers have the right to choose where and with whom they give birth? This is not only a major public health issue, it’s a women’s rights issue.
You don’t typically hear Sen. Loudon defending women’s reproductive choice - he’s one of the state’s most vocal abortion opponents - but here he’s proved himself a surprise hero. The chief opponent to the midwifery bill - the one who filibustered, Chuck Graham turns out to be a pro-choice democrat. Surely Loudon wouldn’t want to be labeled a champion of women’s reproductive choice, and Graham wouldn’t want to be branded a foe. But in this instance, the two men have swapped places.
Perhaps Graham and his physician allies could instead follow the lead of Sheldon Wasserman, an obstetrician and democratic state representative in Wisconsin. Last year, he voted for a bill that licensed CPMs in his state. "If women have the right to decide on abortion, don’t they have the right to decide where they give birth?" he said.
Missouri CPMs should be able to practice in the open. It makes the most sense all around, especially in the "Show Me State."
Jennifer Block is the author of "Pushed: The Painful Truth About Childbirth and Modern Maternity Care" (Da Capo, 2007).

Deciding How, Where to Give Birth
Monday , June 04, 2007 By Dr. Manny Alvarez Fox News
Once the decision to start or expand a family is made, parents-to-be face a sequence of additional decisions.
Expectant mothers may be confused by the many options available. And frequently, they don't fully consider what their wishes are for the birth. But they should.
Women today can choose to personalize the experience according to their needs. Elective C-sections, epidurals, water births, hypnobirthing and induced births are just some examples of the possibilities.
One of the first questions soon-to-be parents should ask themselves is whether to have a midwife or doctor present for the prenatal period and delivery. This decision also influences whether the birth is to take place at a hospital, birthing center or at home. While none of the choices is considered the "better" one, being prepared and informed does give women a more positive birthing experience.
Also, when deciding on a birthing plan, parents should remember that one option does not have to exclude another.
"Midwives collaborate with other health care professionals," said Diane Holzer, president of the Midwives Alliance of North America. "It is possible to plan a birth with a midwife, and have the midwife stay involved even if complications require intervention from a doctor."
Midwives are trained to handle certain situations that are considered abnormal, such as breech birth and posterior position. In these cases non-invasive techniques are used to deliver the child naturally. When more complicated problems arise, the midwife will work with an obstetrician (OB/GYN) or transfer care fully to the doctor.
The ability to build a relationship with a midwife is one of the reasons an increasing number of women are choosing them as their primary caregivers.
"Regular prenatal appointments are 30-45 minutes long, which allow us to get to know our clients and their families," said Elizabeth Brandeis, a midwife with the midwives collective of Toronto. "We also provide on-call care which not only increases client satisfaction but improves safety in clinical care."
During these consultations a midwife is able to discuss the risks and benefits of different scenarios, including the array of medical interventions available. A doctor will do the same, but many midwives are able to give their clients more time and can act both as a health care provider and emotional support system, Brandeis said.
OB/GYN and Midwives: The Differences
The leading benefit of entrusting an obstetrician with the prenatal care and delivery of a baby is the immediate access to hospital facilities. It is advised that women who have high-risk pregnancies choose the care of an OB/GYN. This provides the mother with regular monitoring of her health and the health of the fetus, as well as early intervention if complications arise.
Women who are in a "normal, healthy" pregnancy may not want or need routine interventions, such as IV's, artificial speeding up of the labor process or electronic fetal monitoring, but may get it under the care of a doctor.
Women who prefer to stay away from this, and who do not medically necessitate it, often choose the care of a midwife instead of an OB/GYN.
Although midwifery is still illegal to practice in a few states, the majority of states and Canadian provinces have some form of regulation and licensing for midwives. But expectant mothers should check state regulations before making a decision.
Some mothers may want to give birth at home or prefer natural pain management options, rather than the routine epidurals administered in hospitals.
Holzer said many women seek a more personalized experience than a regular hospital can offer. "Women want to approach birth as a celebration, instead of a disease or illness," she said.
Also, Holzer said, midwives are educated to deal with deviations from the norm, if they arise, but generally strive not to intervene with the natural process. In contrast, an OB/GYN is taught to actively "manage" the birth process using routine intervention.
"Many women want to work with more natural options, because giving birth is something very natural of course," said Holzer.
This often leads women to midwives and alternatives to conventional painkillers such as massages, water baths and relaxation techniques.
"Water birth is great," said Holzer, "but it does not necessarily mean the actual birth has to happen in the water. Sitting in a tub will help the body relax which helps with pain."
The woman can choose to use a warm water tub during contractions, and deliver the baby "on dry land", or she can remain in the tub for the actual birth.
Another technique that is becoming increasingly popular, according to Holzer, is hypnobirthing. This involves relaxation techniques being practiced by the couple prenatally. "This way, the woman learns how to relax to the partner's voice," she said.
And the best natural painkiller can be the presence of a person the mother knows and trusts. This can be a partner, a friend, a parent as well as the health care professional delivering the child.
The presence of someone close has shown to make a prominent difference in a woman's ability to manage pain. It is also the one factor a mother-to-be can plan for regardless of where the actual birth takes place, or whether any complications throw off the original birthing plan.
Giving birth should be a positive and empowering experience for every expecting mother. Ensuring this depends on being fully informed and finding a health care practitioner the woman trusts, whether that is an OB/GYN or a midwife. The goal is always to deliver the baby in a safe and healthy manner, but the method in which this happens is as personal a choice as the decision to become a parent.
Foxnews.com health writer Christine Buske contributed to this report.
Click here to check out Dr. Manny's book The Check List (Harper Collins, 2007), from which this article was excerpted.
Dr. Manny Alvarez is the managing editor of health news at FOXNews.com, and is a regular medical contributor on the FOX News Channel. He is chairman of the Department of Obstetrics and Gynecology and Reproductive Science at Hackensack University Medical Center in New Jersey. Additionally, Alvarez is Adjunct Professor of Obstetrics and Gynecology at New York University School of Medicine in New York City.

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