Thursday, August 27, 2009

How Pregnant Women and New Moms Should Prepare for H1N1 Flu

Midwives, pregnant women, and new moms, watch this webcast for the latest on what you should know about H1N1 flu. Features questions from the public and answers by experts from ACNM, CDC, and NIH.

Tuesday, August 25, 2009

ACOG Encourages Laboring Women to Quench Their Thirst

Women who decide to give birth in a hospital may soon have access to more than ice chips during labor. The American College of Obstetricians and Gynecologists (ACOG) just released a committee opinion recommending that clear liquids (water, juice, sports drinks, etc.) be provided to women who have uncomplicated labor or are scheduled for a planned cesarean.

ACNM has long supported a liberal approach to providing oral nutrition to women in labor, including drinks and solid food. But for decades, many hospitals have restricted women’s oral intake for fear of aspiration—a potentially fatal occurrence that involves stomach contents entering the lungs while a woman is under anesthesia. Thanks to improvements in anesthesia, aspiration in pregnant women is now extremely rare.

Midwives emphasize that birth is a normal process that under normal circumstances does not require fasting. They educate clients about the small but potentially serious risk of aspiration and watch women throughout labor to identify when food and drink need to be restricted. While ACOG’s latest weigh-in is old news to midwives, hopefully it will encourage more hospitals to adopt less restrictive, more woman-centered policies.

Friday, August 21, 2009

Midwifery News Roundup

At ACNM, we’re busy celebrating the 1000th baby born at Special Beginnings Birth and Women's Center and preparing for the next issue of Quickening (our newsletter for midwives). Until next week, check out these news links that we think are worth sharing:

Note: If you're viewing this on facebook, visit to view the links in the post.

Friday, August 14, 2009

Uninsured Women Lose Access to Midwives in South Carolina

On September 30, the five midwives providing services at the prenatal program at North Central Family Medical Center in Rock Hill, SC, will be out of work, and the uninsured women and families they serve will lose access to midwifery services. The clinic is planning to end the prenatal program because it has become too expensive.

Specifically, North Central says it is too expensive to renew their contract with the midwives’ employer, Piedmont Medical Center. Studies have shown that midwifery care saves money—and lives—through reduced risk of prematurity and low birth weight. So, why wouldn’t North Central want to pay for it?

A big part of the problem is that midwifery services for uninsured and underinsured women and families are paid through Medicaid, which does not foot the entire bill. Medicaid does not always reimburse midwives for the full cost of their services, and it does not cover legal immigrants who are a large part of the patient population at the clinic. If the situation continues as is, North Central says they will be an estimated $200,000 in the hole by next year.

Ending the prenatal program is, at best, a stop-gap solution. No matter what a woman’s insurance status, she won’t just stop being pregnant. She needs care. As one reader so eloquently commented:

“If North Central says it will lose $200,000 each year if the current midwife contract arrangement were to be continued—all it takes is ONE very premature, low birth weight baby to be born to a local mother who goes with NO PRENATAL CARE, and you're talking about a $200,000 to $300,000 intensive care nursery bill at Palmetto-Health Richland Hospital in one fell swoop!!!”
Simply put, eliminating midwifery services will magnify and shift the bill to someone else’s budget—the hospital and the tax payers who ultimately pay for Medicaid.

Tuesday, August 11, 2009

Washington State Stacks Financial Incentives in Favor of Vaginal Birth

The state of Washington is taking an innovative step toward tackling rising cesarean section rates by eliminating the profit motive. Beginning this month, the state’s Medicaid reimbursement for uncomplicated cesarean sections dropped from approximately $3,600 to about $1,000—the same reimbursement provided for complicated vaginal birth.

Because the cost of vaginal birth is lower than the cost of c-section, the new payment structure rewards health care providers for supporting vaginal birth rather than for performing c-sections. Nearly half of all births in Washington are reimbursed through Medicaid, so the change is expected to have far-reaching effects. In fact, the state has already received calls from hospitals requesting assistance to revise the protocols they use to decide when a cesarean section is necessary.

A recent article by Carolyn McConnell explains why this is an excellent way to improve maternal and infant health. It’s also in line with #5 and #7 of ACNM’s Seven Key Principles for Health Reform.

What do you think? Would you like to see the rest of the country adopt Washington’s new strategy?

Friday, August 7, 2009

Wilmington (NC)Women Ask, “Where’s My Midwife?”

Women receiving prenatal, postnatal, and routine gynecologic care at Carolina OB/GYN in Wilmington, NC, were surprised last week to find that midwifery services were eliminated from the practice. Patients were told to reschedule their visits with an obstetrician instead. Due in part to restrictive state laws governing midwife-physician collaboration, this change leaves local women seeking midwifery services with little to no alternatives.

One woman is 7.5 weeks away from delivery, and a commenter on WECT- Channel 6 News’ website says she found out her midwife was no longer with the practice when returning for her postnatal checkup just two weeks after giving birth.

Carolina OB/GYN stated, “This decision was based solely on operational requirements, not financial or quality issues.” North Carolina women are asking, “Where’s my midwife?”

Image source:

Tuesday, August 4, 2009

The Real Risk of Late Prematurity

A study in the August 2009 issue of Obstetrics and Gynecology shows that late prematurity is an independent risk factor for neonatal morbidity. For those of us who aren’t women’s health experts, that means babies born between 34 and 37 weeks of pregnancy are at greater risk for health problems than babies born on or after week 37.

Midwives already know that late prematurity puts babies at risk for complications, but this retrospective study involving nearly 10,000 low-risk pregnancies singles out late prematurity as an independent risk factor. After adjusting for potential confounders, including maternal age, birth weight, and mode of delivery, researchers found a 30-fold increase in complications like respiratory problems, hypoglycemia, and hypothermia in babies who were born at 34 weeks. Researchers also observed a “gradual and consistent decrease” in risk of neonatal morbidity as gestational age increased with risks leveling off at about 39 weeks.

Study authors note that late prematurity has increased dramatically over the past two decades to about 8% of all deliveries and 75% of preterm deliveries. Interestingly, ACOG recently revised their labor induction guidelines, encouraging avoidance of induction before 39 weeks of pregnancy (the previous recommendation was 37 weeks). Do you think this study had anything to do with this?