The Coalition for Improving Maternity Services (CIMS) latest project, available only in New York until this week, has now launched nationwide. From their website:

“For years, consumers have enthusiastically shared online reviews of movies, restaurants, products and services, but readily available information about maternity care providers and birth settings was nearly unattainable-no longer. As part of the Transparency in Maternity Care Project, CIMS developed The Birth Survey as an online resource for new mothers to share their consumer reviews of doctors, midwives, hospitals, and birth centers, learn about the choices and birth experiences of others, and view data on hospital and birth center standard practices and intervention rates. The Birth Survey is now accessible throughout the United States.

“The Birth Survey is an on-going online consumer survey that asks women to provide feedback about their birth experiences. Women’s responses about specific providers and facilities will be available online to other women in their communities to help them decide where and with whom to birth. As they become available, the official facility-level intervention rates gathered from the state departments of health will be paired with the women’s survey responses to help families make their birthing decisions.”

If you’ve given birth in the past three years, help improve this resource by taking the survey here.

The American College of Nurse-Midwives’ response to the recently adopted American Medical Association’s resolutions regarding home birth and midwifery may be found here, and it is a delightful read. In particular, the thoroughly documented addenda to the letter is not to be missed.

In the past, medical lobbyists have frequently counted CNMs as allies in opposing state licensure of direct-entry midwives, and the AMA and ACOG have made much of their position that only certification from the ACNM should be considered adequate for midwifery practice. In light of this, the following paragraph from the addenda was of special significance (emphasis in the original):

“It should be noted that Resolution 205 erroneously states that ACNM has defined Certified Professional Midwives (CPMs) as “traditional, independent (of the health care system), non-formally trained and community-based providers of care during pregnancy, childbirth and the post-natal period.” ACNM does not define CPMs in this or any other manner, and will not do so. CPMs have their own professional organizations to represent them and standards which address their education, certification and scope of practice. ACNM is in dialogue with these organizations with the goal of working toward the highest quality midwifery care for women and families in all settings.”

Thank you, ACNM!

Karen Brody’s play Birth is coming to Cincinnati August 29-31. More information in this Cincinnati Community Press article or see the Birth & Beyond website.

The issues, problems, and controversies around modern maternity care continue to make headlines. This ABC News feature discusses the dearth of natural childbirth while looking at a mom whose unexpected early labor caused her to give birth in a Cincinnati hospital instead of the NY birth center she’d planned on. “As labor pains increased and Speier asked about breathing techniques, the doctor replied, “How do I know? I’ve only ever done two [natural childbirths].” The article goes on to talk about the risks of medicalizing normal childbirth and the rising cesarean rate, as well as the advantages of midwifery care.

This ABC News story comes down hard on the AMA and ACOG. It quotes an ACOG spokesperson claiming that the resolution “has nothing to do with Ricki Lake” and then points out that she was mentioned by name in the first version of the resolution. It quotes three different OB/GYNs who support the home birth choice and disagree with ACOG and the AMA’s position. And it frames the issue clearly as one of patient choice and autonomy: If the medical group wishes to let the public know how it feels about home births, why not simply issue a public service announcement? Why the call for “legislation?”

In the media spotlight after the first draft of resolution 205 came to pulbic attention, the AMA quickly removed the reference to Ricki Lake from the final version. With this continuing criticism of the resolution in the mainstream, national press, it will not be surprising if they also back down on the “legislation” language. Unfortunately, as Dr. Fischbein points out in the ABC piece, the AMA does not need legislation to have a “chilling effect” on the ability of doctors to work with home birth families and midwives: “If the AMA says home births are dangerous, fear of litigation will cause insurance carriers to refuse to support doctors who oversee midwives,” said Fischbein, who oversees four midwives in addition to his regular practice. The effect, Fischbein added, would be that he and other doctors would be forced to drop midwives who perform home births.”

We may have some work to do before we’re a household name, but Ohio Families for Safe Birth is working hard to get the word out about our mission and activities. Thanks to Melissa Lewis – who is also the photographer responsible for our beautiful header and index page pictures – OFSB is now on MySpace, and Krista Cornish Scott has set up a Facebook group for us. If you’re already a MySpace or Facebook user, link us, please!

Jennifer Block’s Pushed Birth weblog has printed two scathing responses to the American Medical Association’s anti-home birth resolution. The AMA and American College of Obstetricians and Gynecologists (ACOG) bias against autonomous midwifery and home birth is not shared by their colleagues in Canada and Great Britain, both of which have better maternal / child health outcomes than the United States. In both countries, midwifery care and the provision of home birth services is an integrated part of the health care system.

The first response is from Canadian researcher and physician Andrew Kotaska, who specializes in rural maternity care. He “invites ACOG to join the rest of us in the 21st century” and declares, “If ACOG and the AMA are passive-aggressively trying to coerce women into having hospital births by trying to legally prevent the option of homebirth, then their actions are a frontal assault on women’s autonomy and patient-centered care.”

The second response is from Britain’s National Childbirth Trust (NCT) and Independent Midwives’ Association (IMA). Their statement reads, “The NCT and IMA call on the ACOG to reconsider their position as a matter of urgency. Following the example of its international counterparts it should consider all available evidence on the benefits and risks of home birth… Home birth should be considered a mainstream option and offered as a regular choice for pregnant women using the health service, whichever country they reside in. For a healthy woman with a straightforward, low-risk pregnancy, home birth is a safe option… The views of the NCT and IMA are supported by UK Government policy which seeks to reduce unnecessary interventions in childbirth and increase the numbers of women who experience a normal birth.”

Being part of the Big Push for Midwives is of great value to OFSB in our mission of improving access to midwifery care here in Ohio. By bringing together birth activists from all over the country, the Big Push lets us draw on the wealth of experience and strategy of those who have walked the legislative halls before us. Even better, it lets us vicariously share in and celebrate the triumphs of other states. Every success bolsters the position of birth activists in other states that do not yet have CPM licensure.

This is a fantastic article, the kind of coverage we want to see a lot more of. North Carolina has been working hard to overcome opposition to their proposed midwifery bill. Russ (quoted in the article) is a very active member of the Big Push and Dr. Dorn’s North Carolina Physicians for Midwives was the model for our newly launched Ohio group.

From Columbus, this WOSU radio story highlights the growing popularity of water birth.

While our wonderful OFSB Lobby Day organizers in Columbus are passing out goodies to the legislators in honor of International Midwives Day, I wanted to share two excellent articles about the politics of health care in the U.S. and midwifery licensure specifically.

The first one, Midwifery is Messy, by Jennifer Braun, the program director of International Midwife Assistance, tells about her experience lobbying for midwifery legislation in Colorado in the early ’90s:

“I have a friend who was in Viet Nam. He explained to me that while I was working in the legislature, I was at war. I had seen things that I shouldn’t have seen and done things I might not feel that good about doing, but I did those things and saw those things for the good of the mission. It always seemed to me that the legislature was an altogether different world, not so much like a far away land that I’d gone to war in, but more like Narnia — a whole different ecosystem where very little was the same as back in my world.”

The second, a blog post by a naturopathic doctor in Oregon, relates the issue of midwifery licensure to the broader world of health politics:

“The US needs to realize that it should be protecting its citizens, and not big corporations. We protect the financial interests of pharmaceutical companies, while forbidding women to deliver babies in their homes. The health care industry needs to stay focused on life, rather than profit. Life is an unalienable right, not money.”

The UK’s Times Online has an article today in which home birth advocates respond to a doctor who has written a book advocating — apparently — pre-labor epidurals for every mother. Dr. Grant, the director of obstetric anesthesia at New York University Medical Center and the author of Enjoy Your Labor, slams the “multi-million dollar natural childbirth industry”, says opposition to anesthesia is misogynistic, and compares an unmedicated birth to an unmedicated appendectomy.

The author of the article apears to agree with Grant — “I’ll never forget the “post-match analysis” at my antenatal class, where intelligent, educated women offered grovelling apologies to our childbirth instructor for their “second rate” (i.e, anaesthetised) births. I couldn’t help feeling that two thirds of the class had forked out £150 to be made to feel like bad mothers before their babies had taken their first breath.” — but offers equal space to responses from Sheila Kitzinger and Michel Odent.

It appears to me that Grant’s view of the matter — a view that is hardly any less subject to bias and “vested interest” than that of the childbirth educators he maligns — is wildly anachronistic, pitting the straw man Puritan preacher thundering about the curse of Eve against a modern version of the feminist groups who crusaded for access to Twilight Sleep.

Let me be clear: I have no objection to any woman making an informed choice to use epidural anesthesia during labor. What I do object to is a maternity care system that systemically undermines physiologic childbirth and denies most women the opportunity to make a real choice. I object to the notion that the unhindered, unmedicated births of my babies — painful, empowering, overwhelming, unforgettable — are comparable to an appendectomy or a tooth extraction for which one might as well be numbed. 

Do we really have an epidemic number of epidural-seeking women denied pain relief by the “Natural Childbirth Industry”? The 2006 Listening To Mothers survey shows that 76% of women surveyed had an epidural — three times as many as “walked around” after they were admitted to the hospital and more than 12 times as many as used water immersion for pain relief. 7% reported “pressure from a health professional” to get an epidural. Dr. Grant’s problem with the “Natural Childbirth Industry” is not that women are being denied access to requested pain relief in labor. No, he doesn’t like the fact that women “receive incomplete and innacurate information” and have “guilt and fear” about epidurals.  I agree that complete and accurate information is  absolutely vital in giving women genuinely informed choice in childbirth, but I think I differ with him on where the culture of “guilt and fear” about birth is originating. In my experience, women seeking unmedicated childbirth tend to have educated themselves very thoroughly and there is much more widespread fear of the natural process of labor and childbirth than there is of epidurals.

I also suspect that anesthetists make more money from epidurals than childbirth educators do from labor pain.