The Miami Midwife

Sheila Simms Watson LM, CPM

Thursday, July 29, 2010

MOMS for the 21st Century Bill Filed in House of Representatives!

Childbirth Connection is pleased to inform eNews subscribers that Congresswoman Lucille Roybal-Allard of California has filed the Maximizing Optimal Maternity Services for the 21st Century bill (HR 5807). Also known as “MOMS for the 21st Century,” the bill was filed with 25 co-sponsors.

This sweeping legislation aims to “promote optimal maternity outcomes by making evidence-based maternity care a national priority.” Key provisions include:

• establishing a focal area on optimal maternity care in the Office
on Women’s Health, Department of Health and Human Services
• establishing a federal Interagency Coordinating Committee on the
Promotion of Optimal Maternity Outcomes
• developing and carrying out a national consumer education
campaign about optimal maternity care
• developing, making publicly available, and keeping up to date a
bibliographic database of systematic reviews for care of
childbearing women and newborns
• identifying maternity care health professional shortage areas
• establishing Centers for Excellence on Optimal Maternity Outcomes
• directing the Center for Medicare and Medicaid Innovation to test
innovative maternity care models
• developing common core curricula for maternity care providers
• establishing payment for certified nurse-midwife teachers of
students in health professions education programs
• establishing a loan repayment program for maternity care
• providing grants to increase the diversity of the maternity care workforce.

Moms for the 21st Century includes key provisions recommended in two Childbirth Connection reports: Evidence-Based Maternity Care: What It Is and What It Can Achieve (2008) and the “Blueprint for Action: Steps toward a High-Quality, High-Value Maternity Care System” (2010). Childbirth Connection issued Evidence-Based Maternity Care together with the Reforming States Group and the Milbank Memorial Fund. The Blueprint was developed through the Transforming Maternity Care project, a multi-disciplinary, multi-stakeholder collaboration that engaged leaders from across the health care system over two and one-half years in identifying priority actions for driving maternity care quality improvement. Childbirth Connection was honored to work closely with Ms. Roybal-Allard’s office on this important legislation.

ENews readers are encouraged to:
• read the MOMS for the 21st Century bill
• read Rep. Roybal-Allard’s press release (PDF)
• watch Rep.Roybal-Allard’s floor speech to introduce the bill, and
• call Rep. Roybal-Allard’s office to thank her for exceptional
commitment to childbearing women and newborns: 202 225-1766.

ACOG Issues New VBAC Guidelines
A recent National Institutes of Health panel asked the American College of Obstetricians and Gynecologists (ACOG) to issue new guidelines that might increase access to vaginal birth after cesarean (VBAC), in consideration of an updated VBAC evidence report. The professional society has just released its updated VBAC guideline, which is published in the July issue of Obstetrics & Gynecology.

The new guideline persists in recommending that women who desire VBAC should give birth in facilities that provide immediate access to emergency cesarean, even though this is based on the lowest, Level C evidence (primarily consensus and expert opinion). Thus, this version is unlikely to increase access to VBAC in the many hospitals without 24/7 on-site surgical teams. On the other hand, the guidelines newly identify many clinical situations that are candidates for VBAC, including many women with: two prior cesareans, a suspected large fetus, and fetal gestation beyond 40 weeks. These changes could lead to increased use of VBAC in facilities with continuously present surgical teams. Childbirth Connection offers eNews readers tables comparing the new and previous ACOG VBAC guidelines (PDF).

Best wishes,

Maureen Corry
Executive Director
Childbirth Connection

Transforming Maternity Care
Blueprint for Action
Evidenced-Based Maternity Care
VBAC or Repeat C-Section
Resources for VBAC or Repeat C-

Our Bodies Our Blog
Pushed Birth
RH Reality Check
Science and Sensibility

Please donate to Childbirth Connection and help us keep the momentum going!

Childbirth Connection
281 Park Avenue South, 5 Fl
New York, New York 10010

Tuesday, July 27, 2010

Conflict escalates over midwives' scope of practice in Oregon

Published: Sunday, July 25, 2010, 3:00 PM     Updated: Monday, July 26, 2010, 2:49 PM
Joe Rojas-Burke, The Oregonian Joe Rojas-Burke, The Oregonian 
IMG_14.jpgSupporters of home-birth midwives rally in front of Andaluz Waterbirth Center in Portland on Friday.
During her first pregnancy, Heather Hermans looked forward to giving birth at home under the care of a midwife.

But when the big day arrived, in the midst of labor, Hermans began experiencing breathing difficulties. Her baby was breech -- positioned to emerge feet first -- increasing the risk. The midwife arranged for ambulance transport to Oregon Health & Science University, where an ob/gyn surgeon delivered a healthy baby boy by Cesarean section.

And that would have been that, except the surgeon and a nurse at OHSU filed a complaint about the midwife, Jesica Dolin, alleging she violated professional standards by attempting a breech delivery.

It was the beginning of an escalating conflict over the scope of practice of midwives in Oregon. Midwives assert they are qualified to care for women giving birth to twins and breech babies, or attempting vaginal birth after c-section. Doctors filing complaints with the Oregon Health Licensing Agency insist that such births are too risky to allow out of the hospital

In April and May of 2010, the Oregon Health Licensing Agency began investigating such complaints against five midwives. Like Dolin, all work for Andaluz Waterbirth Center in Portland, which is known for taking on breech and twin pregnancies, and women with a previous Cesarean.

Midwives say the complaints are baseless and meant to thwart competition from midwives and out-of-hospital birth centers.

"This is all harassment," said Roy Haber, the attorney retained by Andaluz, which on Friday announced a federal civil rights lawsuit against OHSU and the Oregon Health Licensing Agency. "They did not have cause to believe that any of these midwives had violated any standards," Haber said. The midwives aren't seeking damages, Haber said. The lawsuit will ask for an injunction ordering the state and OHSU to "cease intimidation and threats against midwives."

The licensing agency recently withdrew the investigations of five midwives, after Haber refused to hand over medical records. The licensing agency also withdrew the case against Dolin, who said the withdrawals show the complaints were without merit.

Officials with the state agency declined to comment on the allegations in the pending lawsuit or the investigations of Andaluz midwives. OHSU also declined to answer questions, but issued a written statement saying "OHSU fully respects and supports a family's right to choose the pregnancy and birthing options that best meet their needs and ensure the health and safety of the mother and child," and that its hospital-based certified nurse-midwives "are fully supported by, and work closely with, OHSU obstetrician-gynecologists."

Oregon law gives licensed midwives a relatively broad scope of practice. They are authorized to perform obstetric ultrasound, provide drugs, give oxygen and IV therapy, and administer local anesthetics and stitch wounds. They can give antibiotic eye drops to newborns, order lab work, and perform newborn metabolic screening. Haber said Oregon law unequivocally permits midwives to attend breech and twin births, and vaginal births after Caesarean in a home or birth center.

Safety remains a matter of fierce debate. Standards of practice vary widely from state to state, and studies are contradictory. In a report in February, University of Texas researchers who analyzed U.S. birth records from 2000 to 2004 concluded that the risk of infant death was twice as high in home birth compared with hospital birth.

But in two large Canadian studies last year, in Ontario and British Columbia, infants born at home fared just as well as those born in the hospital. Significantly, home-birth mothers experienced fewer complications. In the Ontario study, the rate of emergency c-sections was 5 percent among women who planned home births compared with 8 percent among those who started in the hospital. In the British Columbia study, women giving birth at home suffered less than half as many serious perineal tears, and about a third less postpartum hemorrhaging.

Hermans, who is pregnant again and planning a home birth with a midwife, said she can't understand why the OHSU surgeon and nurse filed a complaint about her case. She said women are capable of weighing the risks and benefits of home birth versus hospital birth, and that women should have the right to choose.

"The complaint misrepresented me and my birth," she said. "I was furious. They had no business doing that."

– Joe Rojas-Burke
© 2010 All rights reserved.

Saturday, July 10, 2010

The Women's Center at Jackson South Community Hospital will remain open!

Greetings all

I am overjoyed with the victory we all accomplished....The Women's Center at Jackson South Community Hospital will remain open! The Miami-Dade County Commission is going to reconsider the decision as part of their overall budget discussion in September. Commissioner Seijas stated, "We will find the $2.5 million to balance the budget." The commissioner's understand that the health of the community and the value the OB services at JSCH is more valuable than money. The commissioner's were outraged that the Public Health Trust (which was appointed by the commission) would attempt to close maternity services at JSCH without consulting the community.

Thank you to everyone who wrote a letter and/or signed the petition and those who came out last Thursday. Your voices were heard loud and clear. Please take a moment to write your commissioner a "thank-you" note. We will keep you updated on future updates and any needed action.

Here is a link to an article in the South Florida News.........


The Miami Midwife