Health bosses have moved to reassure expectant mothers in the county that there is enough staff to deal with rising birth rates in the county.
Concerns have been raised that women are being turned away by maternity units due to a shortage of staff or beds but the Norfolk and Norwich University Hospital said they are “in control” of the situation.
During 2008 there were 18 delivery suite closures with none in May, September, November or December. The delivery suite was closed for a total of 101 hours during 2008 and longest single closure was nine hours on July 10.
Although this has caused some degree of distress for mothers-to-be and their families hospital bosses said they have one of the best delivery suite records in the country.
A hospital spokesman said: “We have been recruiting more midwives during 2008 and we are still recruiting to fill eight vacancies. We have increased our midwifery staffing from 145 midwives to 165 and our midwife to birth ratio is: 1:32.
“A rising birth rate has been putting more pressure on maternity services generally. In the years before the new hospital opened the birth rate had been falling but it has been rising ever since NNUH opened. In 2001 our staff delivered 4,397 babies but that rose last year to 5,627.”
The Royal College of Midwives (RCM) claimed earlier this year that hospitals across the country had been unable to employ enough midwives to cope with rising birth rates because £330m of extra government funding to primary care trusts was not getting through.
http://www.eveningnews24.co.uk/content/News/story.aspx?brand=ENOnline&category=News&tBrand=enonline&tCategory=news&itemid=NOED14%20Feb%202009%2011:51:10:917
Tuesday, February 17, 2009
Births in public hospitals more likely to have complications
Julia Medew and Louise Hall
February 16, 2009
WOMEN who give birth in public hospitals are twice as likely to suffer serious complications and their babies are at greater risk of death, research shows.
An analysis of more than 780,000 full-term births in Australia between 2001 and 2004 found one in 1000 babies died in private hospitals, compared with three in 1000 in public hospitals.
It also concluded that women giving birth in public hospitals had twice the rate of severe perineal tearing. The rate of high-level resuscitation of babies in public hospitals was double that of private hospitals.
Obstetrician and co-author of the study, Associate Professor Stephen Robson of Australian National University, said the results, published in The Medical Journal of Australia today, were "startling", given the high rate of interventions in private hospitals. "Having a caesarean section, being induced and having an instrumental delivery usually increases complications, so we were staggered that in the private hospital group where these things happen more, the rate of complications was much lower," he said.
"We are loathe to draw too many conclusions, but it upends the orthodoxy that the more you intervene, the worse off the woman and her baby will be."
Professor Robson said he and his colleagues, Elizabeth Sullivan and Paula Laws of the Perinatal and Reproductive Epidemiology Research Unit at the University of New South Wales, took into account factors that would undermine fair comparison, such as smoking, diabetes and high blood pressure.
They also eliminated women with multiple pregnancies, premature deliveries and those with complications that were referred from private to public hospitals. "Our conclusion is that obstetrician-led care, the model of care where an obstetrician directly manages a woman's labour and delivery, confers quite an advantage," Professor Robson said, adding that experience may also contribute.
"If you look at the obstetricians who deliver babies in private hospitals they are generally highly trained, experienced people. If you look at public hospitals, there is more junior staff, midwifery-led care and a lot of trainees," he said.
The results are likely to spark debate as the Federal Government continues to assess different models of care as part of its review of maternity services.
Professor Robson said some factors not examined by the study, such as the socio-economic status of mothers, may have contributed, and urged more research.
But a spokeswoman for the Australian College of Midwives, Hannah Dahlen, said private hospitals tended to underreport adverse outcomes such as perineal tearing because of fear of medio-legal action.
President of the Maternity Coalition, Caroline McCullough, said the most important thing for women was to make informed decisions and have access to all types of care, regardless of the type of hospital in which they delivered.
"The medical lobby needs to pull its head in because it's not an either/or situation, it's about midwives and obstetricians and other health workers working together to support women in whatever choice they make," she said.
http://www.theage.com.au/national/public-hospital-births-double-risk-for-mother-and-baby-says-report-20090215-8861.html
February 16, 2009
WOMEN who give birth in public hospitals are twice as likely to suffer serious complications and their babies are at greater risk of death, research shows.
An analysis of more than 780,000 full-term births in Australia between 2001 and 2004 found one in 1000 babies died in private hospitals, compared with three in 1000 in public hospitals.
It also concluded that women giving birth in public hospitals had twice the rate of severe perineal tearing. The rate of high-level resuscitation of babies in public hospitals was double that of private hospitals.
Obstetrician and co-author of the study, Associate Professor Stephen Robson of Australian National University, said the results, published in The Medical Journal of Australia today, were "startling", given the high rate of interventions in private hospitals. "Having a caesarean section, being induced and having an instrumental delivery usually increases complications, so we were staggered that in the private hospital group where these things happen more, the rate of complications was much lower," he said.
"We are loathe to draw too many conclusions, but it upends the orthodoxy that the more you intervene, the worse off the woman and her baby will be."
Professor Robson said he and his colleagues, Elizabeth Sullivan and Paula Laws of the Perinatal and Reproductive Epidemiology Research Unit at the University of New South Wales, took into account factors that would undermine fair comparison, such as smoking, diabetes and high blood pressure.
They also eliminated women with multiple pregnancies, premature deliveries and those with complications that were referred from private to public hospitals. "Our conclusion is that obstetrician-led care, the model of care where an obstetrician directly manages a woman's labour and delivery, confers quite an advantage," Professor Robson said, adding that experience may also contribute.
"If you look at the obstetricians who deliver babies in private hospitals they are generally highly trained, experienced people. If you look at public hospitals, there is more junior staff, midwifery-led care and a lot of trainees," he said.
The results are likely to spark debate as the Federal Government continues to assess different models of care as part of its review of maternity services.
Professor Robson said some factors not examined by the study, such as the socio-economic status of mothers, may have contributed, and urged more research.
But a spokeswoman for the Australian College of Midwives, Hannah Dahlen, said private hospitals tended to underreport adverse outcomes such as perineal tearing because of fear of medio-legal action.
President of the Maternity Coalition, Caroline McCullough, said the most important thing for women was to make informed decisions and have access to all types of care, regardless of the type of hospital in which they delivered.
"The medical lobby needs to pull its head in because it's not an either/or situation, it's about midwives and obstetricians and other health workers working together to support women in whatever choice they make," she said.
http://www.theage.com.au/national/public-hospital-births-double-risk-for-mother-and-baby-says-report-20090215-8861.html
A nice story about home birthing midwife
CHARLESTON, W.Va. -- Nurse midwife Angy Nixon hugged her way around a recent meeting of home-birth advocates and moms. She admired the healthy babies held by their beaming mothers and exclaimed over how much they'd changed since she last saw them at their birth.
She shares an intimate bond with these women, who trusted her with their pregnancies and the deliveries of their babies, most of them in their own homes. Since 2003, Nixon's midwifery practice has been mostly home deliveries. She spent her first five years as a midwife delivering babies in a birth center.
"Women choose home births for a variety of reasons," she said, listing the reasons in no particular order. "Some want to save money. They expect the birth to be normal and are not afraid. They appreciate the privacy of their own homes. They control who's in the room."
Continue Reading
She shares an intimate bond with these women, who trusted her with their pregnancies and the deliveries of their babies, most of them in their own homes. Since 2003, Nixon's midwifery practice has been mostly home deliveries. She spent her first five years as a midwife delivering babies in a birth center.
"Women choose home births for a variety of reasons," she said, listing the reasons in no particular order. "Some want to save money. They expect the birth to be normal and are not afraid. They appreciate the privacy of their own homes. They control who's in the room."
Continue Reading
New Regulations of Midwives in Virginia
Obstetricians and certified professional midwives have differing philosophies when it comes to ushering babies into the outside world.
However, a bill before the General Assembly might bring them into a closer working relationship. At least, that's the hope of certified professional midwife, Brynne Potter.
Del. Matt Lohr, R-Harrisonburg, has introduced a bill that would amend the regulation of midwifery.
It would require that midwives inform patients of potential risks associated with delivering at home, "including but not limited to special risks associated with vaginal births after a prior C-section, breech births, births by women experiencing high-risk pregnancies, and births of twins or multiples."
Lohr said the bill is motivated by a desire to protect mothers and children, and was brought to him by Dr. Catherine Slusher, an obstetrician and gynecologist in Harrisonburg.
"Right now, midwives, when they begin working with patients, they have to go over forms about their practices and what they do, and what we're trying to add. ... is a notification sheet that basically educates patients on high-risk categories," he said. "It just comes down to safety.
"I certainly support midwives and support what they do. We just need to make sure we are giving these women all the information that they need."
A second Lohr-sponsored bill, which would deny reimbursement to midwives who attend high-risk home births, didn't make it out of committee.
While researching several cases involving midwives that went before the Virginia Board of Medicine, Lohr said he found that each involved a high-risk patient.
According to the Board of Medicine's Web site, a Virginia Beach midwife's license was suspended for at least two years following two stillbirths to morbidly obese women who delivered breech babies.
In one case, the mother carried strep B, and failed a one-hour glucose-tolerance test, according to a Board of Medicine order. The midwife moved up the woman's estimated due date, and waited more than 24 hours after her water broke before performing a vaginal exam, the order says.
Despite the fact that the baby was premature and she'd never delivered a breech baby, the midwife didn't send the patient to the hospital, and in fact didn't call paramedics until the lifeless baby was born, the order says. The midwife had the mother sign a consent form to continue the delivery despite the breech position of the baby.
"However, the informed consent to a home vaginal breech delivery signed by Patient A and her husband did not specify stillbirth or death of the baby as a risk of such a delivery," the order says.
The baby had a ruptured liver and a strep B infection, it says, and an autopsy indicated a C-section could have saved the baby, who was born in January 2008.
The same midwife was involved in another stillbirth last June. That mother was Rh negative and was 42, among other risk factors.
In that case, the midwife spoke to paramedics about the partially delivered breech baby, telling them to wait a half hour for her to get to the patient's home.
Lohr said the bill was originally met with some opposition, but now the midwifery lobby has come on board, Lohr said.
That's true, said Rebecca Bowers-Lanier, lobbyist for the Commonwealth Midwives Alliance.
"We decided that we not only support it, but [wanted to] strengthen it so that all midwives can work with the Board of Medicine in creating standard practices around informed consent and disclosure," Bowers-Lanier said.
While midwives provide informed consent throughout every stage of pregnancy, she said, "it hasn't been standardized, and they realize that."
Potter, who is the policy liaison for the Commonwealth Midwives Alliance, said she thinks the proposed legislation will be "precedent-setting."
"The thing I'm most excited about is medicine and midwives are going to be on the same page," she said. "I feel like this is the first step in a peace process between physicians and midwives practicing in Virginia."
Good communication between ob-gyns and certified professional midwives will benefit mothers and babies, said Potter, who practices in Charlottesville. The bill should help reassure physicians that midwives are providing their clients with adequate, informed choices, she said.
The midwives alliance is submitting a substitute to the bill that would require information given to expectant mothers be "evidence-based," Potter said.
"We will let the evidence, the research, the studies dictate what we tell our clients in terms of risks of home births," she said. "That is the midwife model of care."
Most women interested in having their babies at home are healthy, according to Potter, who says she attends about 40 births a year.
About two dozen certified professional midwives practice in Virginia, Bowers-Lanier said. These differ from nurse-midwives who mainly work in hospitals in collaboration and consultation with doctors.
Marshall University and Shenandoah University have recently teamed up to offer a master's degree in nurse-midwifery. Shenandoah has had the degree program for several years now.
"Certified professional midwives only attend births outside of hospitals," Bowers-Lanier said.
She said the C-section rate for women who use midwives is between 5 percent and 9 percent, compared to 31 percent for women who give birth in hospitals in Virginia. Bowers-Lanier said about 10 percent of women who intend to have home births wind up in the hospital.
"Most people go in for pain relief," she said. "They just can't make that final push and they need pain relief."
Slusher, of Harrisonburg Ob-Gyn Associates, said she and other obstetrician-gynecologists have seen cases of midwives attempting to deliver babies for women who have previously had C-sections. The American College of Obstetricians and Gynecologists recommends that labor only be tried if an obstetrician, anesthesiologist and operating room are immediately available, she said.
"These patients are at risk for uterine rupture," Slusher said.
That almost always results in a dead baby and is dangerous for the mother, she said.
"Our concern is for women to think it's an OK thing to do at home," Slusher said.
There have been failed attempts at home deliveries after C-sections, she said, which led doctors to realize this practice was occurring.
"I'm not opposed to people having choices and being able to do what they need to do, but I do think the people responsible for home deliveries ... need to also assume the responsibility to conduct them in a safe fashion," Slusher said. "I have no idea how many are going on in the region. What I'm concerned about is if one is going on and [the uterus] ruptures at home, [and] the mother and baby die, that's one too many. Especially, if that person wasn't appropriately counseled that it was an inappropriate delivery to try at home.
"Anything that we can do to make the home midwifery practices safer and more practical would be welcomed by the obstetric community because when they have disasters, they fall in our laps unexpectedly for cleanup. They fall into whoever's on call lap. You have inherited a disaster and get the privilege of dealing with it and owning it. When you have never been consulted throughout the entire pregnancy and when it's inappropriate, it becomes an even greater problem."
Contact Sally Voth at svoth@nvdaily.com
http://www.nvdaily.com/lifestyle/2009/02/legislation-would-impose-new-r.html
However, a bill before the General Assembly might bring them into a closer working relationship. At least, that's the hope of certified professional midwife, Brynne Potter.
Del. Matt Lohr, R-Harrisonburg, has introduced a bill that would amend the regulation of midwifery.
It would require that midwives inform patients of potential risks associated with delivering at home, "including but not limited to special risks associated with vaginal births after a prior C-section, breech births, births by women experiencing high-risk pregnancies, and births of twins or multiples."
Lohr said the bill is motivated by a desire to protect mothers and children, and was brought to him by Dr. Catherine Slusher, an obstetrician and gynecologist in Harrisonburg.
"Right now, midwives, when they begin working with patients, they have to go over forms about their practices and what they do, and what we're trying to add. ... is a notification sheet that basically educates patients on high-risk categories," he said. "It just comes down to safety.
"I certainly support midwives and support what they do. We just need to make sure we are giving these women all the information that they need."
A second Lohr-sponsored bill, which would deny reimbursement to midwives who attend high-risk home births, didn't make it out of committee.
While researching several cases involving midwives that went before the Virginia Board of Medicine, Lohr said he found that each involved a high-risk patient.
According to the Board of Medicine's Web site, a Virginia Beach midwife's license was suspended for at least two years following two stillbirths to morbidly obese women who delivered breech babies.
In one case, the mother carried strep B, and failed a one-hour glucose-tolerance test, according to a Board of Medicine order. The midwife moved up the woman's estimated due date, and waited more than 24 hours after her water broke before performing a vaginal exam, the order says.
Despite the fact that the baby was premature and she'd never delivered a breech baby, the midwife didn't send the patient to the hospital, and in fact didn't call paramedics until the lifeless baby was born, the order says. The midwife had the mother sign a consent form to continue the delivery despite the breech position of the baby.
"However, the informed consent to a home vaginal breech delivery signed by Patient A and her husband did not specify stillbirth or death of the baby as a risk of such a delivery," the order says.
The baby had a ruptured liver and a strep B infection, it says, and an autopsy indicated a C-section could have saved the baby, who was born in January 2008.
The same midwife was involved in another stillbirth last June. That mother was Rh negative and was 42, among other risk factors.
In that case, the midwife spoke to paramedics about the partially delivered breech baby, telling them to wait a half hour for her to get to the patient's home.
Lohr said the bill was originally met with some opposition, but now the midwifery lobby has come on board, Lohr said.
That's true, said Rebecca Bowers-Lanier, lobbyist for the Commonwealth Midwives Alliance.
"We decided that we not only support it, but [wanted to] strengthen it so that all midwives can work with the Board of Medicine in creating standard practices around informed consent and disclosure," Bowers-Lanier said.
While midwives provide informed consent throughout every stage of pregnancy, she said, "it hasn't been standardized, and they realize that."
Potter, who is the policy liaison for the Commonwealth Midwives Alliance, said she thinks the proposed legislation will be "precedent-setting."
"The thing I'm most excited about is medicine and midwives are going to be on the same page," she said. "I feel like this is the first step in a peace process between physicians and midwives practicing in Virginia."
Good communication between ob-gyns and certified professional midwives will benefit mothers and babies, said Potter, who practices in Charlottesville. The bill should help reassure physicians that midwives are providing their clients with adequate, informed choices, she said.
The midwives alliance is submitting a substitute to the bill that would require information given to expectant mothers be "evidence-based," Potter said.
"We will let the evidence, the research, the studies dictate what we tell our clients in terms of risks of home births," she said. "That is the midwife model of care."
Most women interested in having their babies at home are healthy, according to Potter, who says she attends about 40 births a year.
About two dozen certified professional midwives practice in Virginia, Bowers-Lanier said. These differ from nurse-midwives who mainly work in hospitals in collaboration and consultation with doctors.
Marshall University and Shenandoah University have recently teamed up to offer a master's degree in nurse-midwifery. Shenandoah has had the degree program for several years now.
"Certified professional midwives only attend births outside of hospitals," Bowers-Lanier said.
She said the C-section rate for women who use midwives is between 5 percent and 9 percent, compared to 31 percent for women who give birth in hospitals in Virginia. Bowers-Lanier said about 10 percent of women who intend to have home births wind up in the hospital.
"Most people go in for pain relief," she said. "They just can't make that final push and they need pain relief."
Slusher, of Harrisonburg Ob-Gyn Associates, said she and other obstetrician-gynecologists have seen cases of midwives attempting to deliver babies for women who have previously had C-sections. The American College of Obstetricians and Gynecologists recommends that labor only be tried if an obstetrician, anesthesiologist and operating room are immediately available, she said.
"These patients are at risk for uterine rupture," Slusher said.
That almost always results in a dead baby and is dangerous for the mother, she said.
"Our concern is for women to think it's an OK thing to do at home," Slusher said.
There have been failed attempts at home deliveries after C-sections, she said, which led doctors to realize this practice was occurring.
"I'm not opposed to people having choices and being able to do what they need to do, but I do think the people responsible for home deliveries ... need to also assume the responsibility to conduct them in a safe fashion," Slusher said. "I have no idea how many are going on in the region. What I'm concerned about is if one is going on and [the uterus] ruptures at home, [and] the mother and baby die, that's one too many. Especially, if that person wasn't appropriately counseled that it was an inappropriate delivery to try at home.
"Anything that we can do to make the home midwifery practices safer and more practical would be welcomed by the obstetric community because when they have disasters, they fall in our laps unexpectedly for cleanup. They fall into whoever's on call lap. You have inherited a disaster and get the privilege of dealing with it and owning it. When you have never been consulted throughout the entire pregnancy and when it's inappropriate, it becomes an even greater problem."
Contact Sally Voth at svoth@nvdaily.com
http://www.nvdaily.com/lifestyle/2009/02/legislation-would-impose-new-r.html
Friday, February 13, 2009
Christian Group Opens Six Birth Facilities in Philippines
RICHMOND, Va., Feb. 11 /PRNewswire-USNewswire/ -- Access to high quality health care facilities is important for mothers to have healthy newborns. In the Philippines, six new birthing centers have made giving birth much safer and less worrisome for women in Pili, Camarines Sur.
"We want to emphasize the importance of bringing pregnant women to health care facilities, which is the most important factor in preventing maternal and newborn mortality," said Dr. Sadia Parveen, Christian Children's Fund reproductive health specialist.
Thanks to funding from the CCF's Sky Siegfried Fund, six new birthing centers were officially launched in Pili, Camarines Sur in September.
Elisa, 38, was the first resident to give birth in one of the new facilities, delivering a healthy 7-pound baby girl in October at the Kabukludan Birthing Center. The other birthing centers are operating smoothly, according to CCF staff in the region.
"The health attendant and the midwife took good care of me before and after delivery," Elisa said. "I will recommend this center to my relatives because I feel at home and safe."
CCF Philippines, partnering with Mt. Zion Family Development Association - Christ the King Center, initiated the project, "Saving Women's Lives Through Improved Maternal Care." Goals of the project include reducing vulnerability of women to the risks related to pregnancy; providing women access to safe maternal and newborn care; and improving community health.
"A primary objective of this project is to build partnerships with groups such as the provincial and municipal health offices, local government units and the communities," said Parveen.
Plans are under way to make these centers more comprehensive in their primary health care approach, in terms of broadening their reach to cater to not only pregnant women, but also to women and children in general, Parveen said. This would help take comprehensive primary health care to the community level, and thereby bridge the gap between the public health infrastructure and the communities.
Pili, Camarines Sur, is located in the Bicol Region of the Philippines. More than half of the pregnant women in this rural area have traditionally received care from traditional birth attendants, also known as hilots.
The new facilities allow pregnant mothers quicker access to health care. According to the Rural Health Unit of Pili, only 40 percent of total pregnancies in 2006 were attended by professional health workers. This is consistent with findings from the National Demographic and Health Surveys, which show that women residing in rural areas usually receive little or no care from health professionals and are not informed of the dangers of pregnancy, such as miscarriage and pre-term labor.
The facilities offer patients access to trained health care workers. As part of the nearly $200,000 project, pre- and post-natal obstetric and pediatric care training was conducted by specialists from the Bicol Medial Center to 16 health professionals composed of midwives and nurses. Midwives, rural health nurses and volunteer nurses also attended a five-day training workshop on community-managed maternal and newborn care. Five village pharmacies have been formed and are ready to operate as well to provide medicine to mothers and newborns if needed.
Assisted delivery by skilled and trained personnel is associated with lower levels of illness and infant mortality, Parveen said.
CCF believes that what happens in the first years of life is the cornerstone upon which the child grows and develops. These new birthing centers are critical to CCF's goal of having healthy and secure infants in its programs.
The Sky Siegfried Fund is an annual gift from the Siegfried family. The family donates $500,000 and challenges CCF donors to match the gift. The Sky Siegfried Fund supports health initiatives throughout the world.
http://sev.prnewswire.com/health-care-hospitals/20090211/DC6950311022009-1.html
"We want to emphasize the importance of bringing pregnant women to health care facilities, which is the most important factor in preventing maternal and newborn mortality," said Dr. Sadia Parveen, Christian Children's Fund reproductive health specialist.
Thanks to funding from the CCF's Sky Siegfried Fund, six new birthing centers were officially launched in Pili, Camarines Sur in September.
Elisa, 38, was the first resident to give birth in one of the new facilities, delivering a healthy 7-pound baby girl in October at the Kabukludan Birthing Center. The other birthing centers are operating smoothly, according to CCF staff in the region.
"The health attendant and the midwife took good care of me before and after delivery," Elisa said. "I will recommend this center to my relatives because I feel at home and safe."
CCF Philippines, partnering with Mt. Zion Family Development Association - Christ the King Center, initiated the project, "Saving Women's Lives Through Improved Maternal Care." Goals of the project include reducing vulnerability of women to the risks related to pregnancy; providing women access to safe maternal and newborn care; and improving community health.
"A primary objective of this project is to build partnerships with groups such as the provincial and municipal health offices, local government units and the communities," said Parveen.
Plans are under way to make these centers more comprehensive in their primary health care approach, in terms of broadening their reach to cater to not only pregnant women, but also to women and children in general, Parveen said. This would help take comprehensive primary health care to the community level, and thereby bridge the gap between the public health infrastructure and the communities.
Pili, Camarines Sur, is located in the Bicol Region of the Philippines. More than half of the pregnant women in this rural area have traditionally received care from traditional birth attendants, also known as hilots.
The new facilities allow pregnant mothers quicker access to health care. According to the Rural Health Unit of Pili, only 40 percent of total pregnancies in 2006 were attended by professional health workers. This is consistent with findings from the National Demographic and Health Surveys, which show that women residing in rural areas usually receive little or no care from health professionals and are not informed of the dangers of pregnancy, such as miscarriage and pre-term labor.
The facilities offer patients access to trained health care workers. As part of the nearly $200,000 project, pre- and post-natal obstetric and pediatric care training was conducted by specialists from the Bicol Medial Center to 16 health professionals composed of midwives and nurses. Midwives, rural health nurses and volunteer nurses also attended a five-day training workshop on community-managed maternal and newborn care. Five village pharmacies have been formed and are ready to operate as well to provide medicine to mothers and newborns if needed.
Assisted delivery by skilled and trained personnel is associated with lower levels of illness and infant mortality, Parveen said.
CCF believes that what happens in the first years of life is the cornerstone upon which the child grows and develops. These new birthing centers are critical to CCF's goal of having healthy and secure infants in its programs.
The Sky Siegfried Fund is an annual gift from the Siegfried family. The family donates $500,000 and challenges CCF donors to match the gift. The Sky Siegfried Fund supports health initiatives throughout the world.
http://sev.prnewswire.com/health-care-hospitals/20090211/DC6950311022009-1.html
Wednesday, February 11, 2009
Midwifery often only option in isolated or rural areas.
A group of Kodiak residents is trying to help educate island mothers about birthing options and lowering the rate of Caesarean sections, currently 28 percent at Providence Kodiak Island Medical Center and slightly higher nationwide.
The group’s other long-term goals are to provide midwifery care on-island and possibly institute a birthing center in Kodiak as an alternative to the hospital.
Alaska has seven birthing centers statewide, most of which are in the larger cities like Anchorage, Juneau and Fairbanks. Kodiak has no midwife services.
An initial step in that effort was a presentation by Barbara Norton, Friday night at A Balanced Approach. Norton, who has delivered more than 800 babies since 1994 in various states and now works in Anchorage, gave a presentation to group of about 40 attendees stressing the importance of a normal birth.
In her presentation, she discussed what she felt were the advantages of midwifery, the problems with unnecessary C sections, and some alternative birthing techniques that don’t use excessive drugs.
“I think that birth is an amazing, empowering experience, that if women choose to take the risk and do this on their own power, the benefits are just beyond description,” Norton said. “It’s a life-changing event. Ninety percent of women really can do this without intervention, without drugs.”
Norton ended the seminar saying that even after the drama and trauma of childbirth is done, the experience “really isn’t just one day … the hardest part (can be) bringing the baby home.”
Zoya Saltonstall, an organizer of the movement and a physical therapist in Kodiak, is doing her part by teaching childbirth prep courses. Her current class is in its sixth week.
Saltonstall also is one of the few on-island doulas, a person who provides non-medical support for mothers before and after the birthing process. She said she is also working on getting doula certification with Childbirth International, which provides doula and childbirth education training to students worldwide.
“There does seem to be a demand for it in this community for doulas. Women seem to want the extra support,” she said.
Saltonstall only works with one client a month, needing plenty of leeway to handle the job’s 24/7 schedule around the time a baby is due.
Regarding Friday’s presentation, she said the turnout was better than expected and more would come.
“This is the beginning of more discussions and community forums on this topic.”
Mirror writer Bradley Zint can be reached via e-mail at bzint@kodiakdailymirror.com.
http://www.kodiakdailymirror.com/?pid=19&id=7237
The group’s other long-term goals are to provide midwifery care on-island and possibly institute a birthing center in Kodiak as an alternative to the hospital.
Alaska has seven birthing centers statewide, most of which are in the larger cities like Anchorage, Juneau and Fairbanks. Kodiak has no midwife services.
An initial step in that effort was a presentation by Barbara Norton, Friday night at A Balanced Approach. Norton, who has delivered more than 800 babies since 1994 in various states and now works in Anchorage, gave a presentation to group of about 40 attendees stressing the importance of a normal birth.
In her presentation, she discussed what she felt were the advantages of midwifery, the problems with unnecessary C sections, and some alternative birthing techniques that don’t use excessive drugs.
“I think that birth is an amazing, empowering experience, that if women choose to take the risk and do this on their own power, the benefits are just beyond description,” Norton said. “It’s a life-changing event. Ninety percent of women really can do this without intervention, without drugs.”
Norton ended the seminar saying that even after the drama and trauma of childbirth is done, the experience “really isn’t just one day … the hardest part (can be) bringing the baby home.”
Zoya Saltonstall, an organizer of the movement and a physical therapist in Kodiak, is doing her part by teaching childbirth prep courses. Her current class is in its sixth week.
Saltonstall also is one of the few on-island doulas, a person who provides non-medical support for mothers before and after the birthing process. She said she is also working on getting doula certification with Childbirth International, which provides doula and childbirth education training to students worldwide.
“There does seem to be a demand for it in this community for doulas. Women seem to want the extra support,” she said.
Saltonstall only works with one client a month, needing plenty of leeway to handle the job’s 24/7 schedule around the time a baby is due.
Regarding Friday’s presentation, she said the turnout was better than expected and more would come.
“This is the beginning of more discussions and community forums on this topic.”
Mirror writer Bradley Zint can be reached via e-mail at bzint@kodiakdailymirror.com.
http://www.kodiakdailymirror.com/?pid=19&id=7237
Midwifery Bill Defeated in South Dakota
The South Dakota legislature defeated a bill to allow Midwives to assist in home births. The debate comes down to the classic issue of doctors worried about liability and training, vs the perception that the doctors are protecting "their" turf.
Midwifery and Illegal Immigration
ALAMO, Texas (AP) — The citizenship of hundreds, possibly thousands, of people who insist they are Americans is being called into question because they were delivered by midwives near the U.S.-Mexico border. The federal government's doubts have arisen as many people in the border region try to meet a June 1 deadline to obtain U.S. passports so they can freely cross from one country to the other.
The people delivered by midwives have documents such as birth certificates and medical records. But the agency that grants passports is challenging the credibility of those papers, citing a history of some midwives fraudulently registering Mexican-born babies as American.
The passport applications being questioned include those of children of Mexican women who crossed the border to give birth in the United States, and even employees of the U.S. Customs and Border Protection agency who were born on the border and now work to protect it.
The government has "effectively reduced to second-class citizenship status an entire swath of passport applicants based solely on their being of Mexican or Latino descent and having been delivered by midwives in nonhospital settings in Southwestern border states," according to a federal lawsuit against the State Department filed last year in the border town of McAllen, about 120 miles south of Corpus Christi.
Immigration attorneys and the American Civil Liberties Union hope to have the case certified as a class action because they believe thousands of people could be affected, with most still living near the border.
Since 1960, 75 Texas midwives have been convicted of fraudulently registering Mexican-born babies as American. At one point, the government assembled a list of nearly 250 "suspicious" midwives but never explained what made them suspicious.
State Department spokesman Andy Laine declined to comment because of the litigation. The agency also declined to release statistics on passport application refusals.
After June 1, anyone re-entering the United States from Mexico or Canada will have to show a passport, not just a driver's license and birth certificate, which are the only current requirements.
For families who have lived in the area for generations, the border is just a river in the middle of one community. Many people live on one side of the border and work on the other.
"Going back and forth is as natural for them ... as going across town is for the rest of us," said Lisa Graybill, legal director for the ACLU in Texas.
If the lawsuit is not resolved before June 1, families "will have to choose if you're going to live in Mexico or you're going to live in the U.S. You won't be able to cross," said Lisa Brodyaga, the immigration attorney who filed the lawsuit against the State Department.
Anna Karen Ramirez had to sue the State Department to get her passport, even though she had a birth certificate, medical records and receipts from her 1989 birth at a clinic in Hidalgo, just south of McAllen. She also had signatures of two police officers who witnessed the event.
Ramirez's parents lived in Mexico and raised their daughter there. But they decided to have their child in the United States.
With the deadline looming, and the State Department suspicious of her citizenship, the family met several times with U.S. consular officials to obtain a passport, but their request was refused.
Ramirez's father, Narciso, drives a taxi back and forth across the border every day. He said he was warned that the family's dogged pursuit of the matter could threaten the visa that allowed him to operate his cab.
Anna Ramirez sued, and while waiting, voted unchallenged in the U.S. presidential election. A month later, she received her passport but never got a clear statement of citizenship.
"Every 10 years she's going to have to prove she's a U.S. citizen" to renew her passport, said her attorney, Naomi Jiyoung Bang.
The State Department practices are "a holdover from an older, less-regulated world," said Mark Krikorian, executive director of the Center for Immigration Studies, which advocates for more restrictive immigration laws. "It's what happens when modern standards collide with old country practices."
Krikorian said the government cannot just believe everyone, nor can it turn down everyone delivered by a midwife.
Because Ramirez is young, her parents were able to find documents the government requested. The midwife who delivered her was still alive and able to testify. They could also afford to hire an attorney to help.
David Hernandez had a harder time locating evidence.
He was born in San Benito, Texas, in 1964, to a Mexican mother who was visiting friends when she went into labor. Hernandez was delivered by a midwife who appeared on the suspicious midwife list, though without a conviction. He returned to Mexico with his mother.
The two moved back to the U.S. a few years later. He attended schools in Texas and served in the Army.
In response to government requests, he collected mounds of documentation including papers from his military service, immunization and baptismal records, and witness affidavits. When he requested his school records, he was told that his elementary school papers no longer existed.
In April 2008, the government refused his passport application.
"I was born here," he said last fall when the ACLU took on the case. "I've lived and worked here and served in the Army. I feel betrayed, like my country is stabbing me in the back just because my mother didn't have the luxury of having me in a hospital."
http://www.google.com/hostednews/ap/article/ALeqM5is0334GfYSqsu-cGgWEPXPdB4NrwD96912JO0
The people delivered by midwives have documents such as birth certificates and medical records. But the agency that grants passports is challenging the credibility of those papers, citing a history of some midwives fraudulently registering Mexican-born babies as American.
The passport applications being questioned include those of children of Mexican women who crossed the border to give birth in the United States, and even employees of the U.S. Customs and Border Protection agency who were born on the border and now work to protect it.
The government has "effectively reduced to second-class citizenship status an entire swath of passport applicants based solely on their being of Mexican or Latino descent and having been delivered by midwives in nonhospital settings in Southwestern border states," according to a federal lawsuit against the State Department filed last year in the border town of McAllen, about 120 miles south of Corpus Christi.
Immigration attorneys and the American Civil Liberties Union hope to have the case certified as a class action because they believe thousands of people could be affected, with most still living near the border.
Since 1960, 75 Texas midwives have been convicted of fraudulently registering Mexican-born babies as American. At one point, the government assembled a list of nearly 250 "suspicious" midwives but never explained what made them suspicious.
State Department spokesman Andy Laine declined to comment because of the litigation. The agency also declined to release statistics on passport application refusals.
After June 1, anyone re-entering the United States from Mexico or Canada will have to show a passport, not just a driver's license and birth certificate, which are the only current requirements.
For families who have lived in the area for generations, the border is just a river in the middle of one community. Many people live on one side of the border and work on the other.
"Going back and forth is as natural for them ... as going across town is for the rest of us," said Lisa Graybill, legal director for the ACLU in Texas.
If the lawsuit is not resolved before June 1, families "will have to choose if you're going to live in Mexico or you're going to live in the U.S. You won't be able to cross," said Lisa Brodyaga, the immigration attorney who filed the lawsuit against the State Department.
Anna Karen Ramirez had to sue the State Department to get her passport, even though she had a birth certificate, medical records and receipts from her 1989 birth at a clinic in Hidalgo, just south of McAllen. She also had signatures of two police officers who witnessed the event.
Ramirez's parents lived in Mexico and raised their daughter there. But they decided to have their child in the United States.
With the deadline looming, and the State Department suspicious of her citizenship, the family met several times with U.S. consular officials to obtain a passport, but their request was refused.
Ramirez's father, Narciso, drives a taxi back and forth across the border every day. He said he was warned that the family's dogged pursuit of the matter could threaten the visa that allowed him to operate his cab.
Anna Ramirez sued, and while waiting, voted unchallenged in the U.S. presidential election. A month later, she received her passport but never got a clear statement of citizenship.
"Every 10 years she's going to have to prove she's a U.S. citizen" to renew her passport, said her attorney, Naomi Jiyoung Bang.
The State Department practices are "a holdover from an older, less-regulated world," said Mark Krikorian, executive director of the Center for Immigration Studies, which advocates for more restrictive immigration laws. "It's what happens when modern standards collide with old country practices."
Krikorian said the government cannot just believe everyone, nor can it turn down everyone delivered by a midwife.
Because Ramirez is young, her parents were able to find documents the government requested. The midwife who delivered her was still alive and able to testify. They could also afford to hire an attorney to help.
David Hernandez had a harder time locating evidence.
He was born in San Benito, Texas, in 1964, to a Mexican mother who was visiting friends when she went into labor. Hernandez was delivered by a midwife who appeared on the suspicious midwife list, though without a conviction. He returned to Mexico with his mother.
The two moved back to the U.S. a few years later. He attended schools in Texas and served in the Army.
In response to government requests, he collected mounds of documentation including papers from his military service, immunization and baptismal records, and witness affidavits. When he requested his school records, he was told that his elementary school papers no longer existed.
In April 2008, the government refused his passport application.
"I was born here," he said last fall when the ACLU took on the case. "I've lived and worked here and served in the Army. I feel betrayed, like my country is stabbing me in the back just because my mother didn't have the luxury of having me in a hospital."
http://www.google.com/hostednews/ap/article/ALeqM5is0334GfYSqsu-cGgWEPXPdB4NrwD96912JO0
Monday, February 9, 2009
Study links obesity with birth complications
Researchers found that they were at high risk of premature birth, having an underweight baby or suffering pre-eclampsia, a condition which can be fatal.
Obesity has previously been linked to a number of problems during pregnancy but researchers wanted to know if these were more serious during a first pregnancy.
The study, the findings of which were published in the American Journal of Obstetrics and Gynaecology, followed 385 obese women having their first child in Britain and the Netherlands.
The research found that almost four in 10 of the women, 39 per cent, had to have a Caesarean section, a rate they claim is the highest ever reported in the world.
Previous studies in obese women found that just one in five had to have the operation instead of a natural labour.
Obese first-time mothers were also almost twice as likely to have a underweight baby than women who were not obese, and a third more likely to have an overweight baby, the study found.
They were six times more likely than first-time mothers of healthy weight to develop pre-eclampsia and twice as likely as other overweight women.
The risk of premature birth was also twice the national average.
Pre-eclampsia is a potentially deadly syndrome in which blood pressure becomes raised because of significant amounts of protein in the urine.
Because of the complications the women spent longer on average in hospital compared to other new mothers, an average of 4.6 days compared to a national average of just three days.
The study was carried out by Tommy's, the baby charity, the Wellcome Trust, and the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust in partnership with King's College London.
Lucilla Poston, who led the research, said: "There are a number of findings which are very surprising. The large proportion of small babies was particularly unexpected as obesity is more often associated with the birth of overweight babies.
"The high number of cases of pre-eclampsia found in this group was very concerning, as this is a serious pregnancy complication which, in extreme cases, can result in maternal and or fetal death.
"We must now start to consider first-time pregnancy as an additional problem in obese pregnant women, who we know are already more likely than thinner women to have a complicated pregnancy."
Premature births and small babies are at risk of suffering brain damage, breathing difficulties, learning problems and infection.
Mervi Jokinen, from the Royal College of Midwives, said: "Obesity is an issue that is becoming increasingly prominent in maternity care and midwives are aware of the complexities and potential problems that obesity brings into pregnancy.
"We need to ensure that women get early access to a midwife so that she can get lifestyle and weight management advice as soon as possible, and that this continues throughout the pregnancy and after the birth of the baby."
http://www.telegraph.co.uk/health/healthnews/4557980/Obese-first-time-mothers-at-more-danger-of-complications.html
Obesity has previously been linked to a number of problems during pregnancy but researchers wanted to know if these were more serious during a first pregnancy.
The study, the findings of which were published in the American Journal of Obstetrics and Gynaecology, followed 385 obese women having their first child in Britain and the Netherlands.
The research found that almost four in 10 of the women, 39 per cent, had to have a Caesarean section, a rate they claim is the highest ever reported in the world.
Previous studies in obese women found that just one in five had to have the operation instead of a natural labour.
Obese first-time mothers were also almost twice as likely to have a underweight baby than women who were not obese, and a third more likely to have an overweight baby, the study found.
They were six times more likely than first-time mothers of healthy weight to develop pre-eclampsia and twice as likely as other overweight women.
The risk of premature birth was also twice the national average.
Pre-eclampsia is a potentially deadly syndrome in which blood pressure becomes raised because of significant amounts of protein in the urine.
Because of the complications the women spent longer on average in hospital compared to other new mothers, an average of 4.6 days compared to a national average of just three days.
The study was carried out by Tommy's, the baby charity, the Wellcome Trust, and the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust in partnership with King's College London.
Lucilla Poston, who led the research, said: "There are a number of findings which are very surprising. The large proportion of small babies was particularly unexpected as obesity is more often associated with the birth of overweight babies.
"The high number of cases of pre-eclampsia found in this group was very concerning, as this is a serious pregnancy complication which, in extreme cases, can result in maternal and or fetal death.
"We must now start to consider first-time pregnancy as an additional problem in obese pregnant women, who we know are already more likely than thinner women to have a complicated pregnancy."
Premature births and small babies are at risk of suffering brain damage, breathing difficulties, learning problems and infection.
Mervi Jokinen, from the Royal College of Midwives, said: "Obesity is an issue that is becoming increasingly prominent in maternity care and midwives are aware of the complexities and potential problems that obesity brings into pregnancy.
"We need to ensure that women get early access to a midwife so that she can get lifestyle and weight management advice as soon as possible, and that this continues throughout the pregnancy and after the birth of the baby."
http://www.telegraph.co.uk/health/healthnews/4557980/Obese-first-time-mothers-at-more-danger-of-complications.html
New Midwifery Clinic - Jackson TN
When Heather Moore gave birth to her first child two years ago, she was under a physician's care. For her second pregnancy, she chose to go to a midwife instead.
"I really liked it when a doctor would sit down and talk with me during my pregnancy," she said. "But he didn't always do that. Sometimes he'd say 'Everything looks great,' but he wouldn't get specific."
Her midwife, Sheridan Skarl, said the difference in care between a physician and a midwife is time spent with the patient.
"It's also more cost-effective," Skarl said. Skarl is a certified nurse midwife.
Skarl works at Regional Hospital of Jackson, which recently opened Regional Midwifery Services, where Moore went for a check-up Tuesday.
Sharon Holley is another certified nurse midwife who works at the hospital. She believes in spending time with women and using each appointment as a time to educate, she said.
"A midwife works with women of all ages through all stages of life," she said. "We provide pap smears, gynecological care, birth control, pregnancy and post-partum care. We could see a woman through each stage."
Holley said one of the major differences in using a midwife for labor and delivery is that the number of Caesarean sections and other complications are lower.
About 30 percent of physician deliveries ended in Caesarean sections, while about 13 percent of midwife deliveries ended the same way, she said.
Also, midwife deliveries have fewer interventions, such as episiotomies, which enlarge the birth canal, Holley said.
Holley and Skarl do their deliveries in the hospital. Midwives nationwide either deliver in a hospital, a birth center or a patient's home, Holley said.
"The midwife approach to care is to say that pregnancy is a normal state for a woman, not an illness," she said. "With women, we want to empower them with that idea."
Skarl said more insurance companies cover the cost for midwifery services now, so the option is more widely available.
"Using a midwife allows a woman to be a part of her own pregnancy," she said. "We're here to assist, but we want their experience to be what they want it to be."
Moore, whose baby is due in a few weeks, said her second pregnancy has seemed easier with the help and instruction from Skarl. Her midwife has been helping her to maintain a good blood pressure rating and is keeping her from having too much stress.
"I like when everything is explained, and they ask how I'm doing," she said. "I feel good about this delivery."
Visit jacksonsun.com and share your thoughts.
- Tracie Simer, 425-9629
http://www.jacksonsun.com/article/20090209/LIFESTYLE/902090302
"I really liked it when a doctor would sit down and talk with me during my pregnancy," she said. "But he didn't always do that. Sometimes he'd say 'Everything looks great,' but he wouldn't get specific."
Her midwife, Sheridan Skarl, said the difference in care between a physician and a midwife is time spent with the patient.
"It's also more cost-effective," Skarl said. Skarl is a certified nurse midwife.
Skarl works at Regional Hospital of Jackson, which recently opened Regional Midwifery Services, where Moore went for a check-up Tuesday.
Sharon Holley is another certified nurse midwife who works at the hospital. She believes in spending time with women and using each appointment as a time to educate, she said.
"A midwife works with women of all ages through all stages of life," she said. "We provide pap smears, gynecological care, birth control, pregnancy and post-partum care. We could see a woman through each stage."
Holley said one of the major differences in using a midwife for labor and delivery is that the number of Caesarean sections and other complications are lower.
About 30 percent of physician deliveries ended in Caesarean sections, while about 13 percent of midwife deliveries ended the same way, she said.
Also, midwife deliveries have fewer interventions, such as episiotomies, which enlarge the birth canal, Holley said.
Holley and Skarl do their deliveries in the hospital. Midwives nationwide either deliver in a hospital, a birth center or a patient's home, Holley said.
"The midwife approach to care is to say that pregnancy is a normal state for a woman, not an illness," she said. "With women, we want to empower them with that idea."
Skarl said more insurance companies cover the cost for midwifery services now, so the option is more widely available.
"Using a midwife allows a woman to be a part of her own pregnancy," she said. "We're here to assist, but we want their experience to be what they want it to be."
Moore, whose baby is due in a few weeks, said her second pregnancy has seemed easier with the help and instruction from Skarl. Her midwife has been helping her to maintain a good blood pressure rating and is keeping her from having too much stress.
"I like when everything is explained, and they ask how I'm doing," she said. "I feel good about this delivery."
Visit jacksonsun.com and share your thoughts.
- Tracie Simer, 425-9629
http://www.jacksonsun.com/article/20090209/LIFESTYLE/902090302
Welcome!
Hi my name is Mike. I am not a midwife. I work for Utah College of Midwifery as the IT guy. I started this page as a way of discovering the many facets of Midwifery and how it is important to the ongoing national health care discussion. I believe that natural birth, with well trained and qualified midwives will lower pre and post natal care costs, thus making our healthcare system more effective. We'll discuss many issues that you may feel passionate about. We'll also have resources where you can learn more about midwives, and the practice of Midwifery in the United States and Canada.
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