Women Would Be Better Off If Reform Passes

While President Obama and congressional Democrats discuss the public option and the absence of bipartisan support for health care reform, a front-page article in Monday’s edition of Politico proposes that highlighting the particular importance of proposed reforms to women may be the key to successful reform.

Women have a lot to gain if health reform legislation passes. Protections mentioned in the article include:

• Guaranteed maternity care
• Elimination of higher insurance premiums for women
• Protection from being denied coverage due to “pre-existing conditions” like cesarean section or domestic violence
  

Despite these protections that would address gender discrimination in health care, a Kaiser Family Foundation survey found that women are no more likely than men to think they “would be better off if reform passed.” According to the article, the problem is that women simply don’t know what is in the legislation for them.

Senator Sherrod Brown (D-Ohio) shared his perspective on just how monumental health care reform would be for women:

"Brown described the elimination of gender discrimination in health care as an historic advance comparable to landmark legislation prohibiting unequal treatment between men and women in employment, education and sports."

Do you know what’s in health care reform legislation for women? Learn more in an update from ACNM Federal Lobbyist Patrick Cooney or listen to his audiocast.

Peeling Back the Pink of Breast Cancer Awareness

by Melissa Garvey, ACNM Writer and Editor

Last weekend the National Breast Cancer Coalition (NBCC) launched an Emerging Leaders workshop—a program designed to train the next generation of breast cancer advocates. I attended as an ACNM staffer and was struck by the parallels between breast cancer advocacy and birth advocacy.

What I found most fascinating was the amount of misinformation about breast cancer that circulates in the media, the health care system, and even scientific peer-reviewed journals. Just as birth advocates challenge women and health care providers to reach beyond the traditional, medical model of birth practice to evidence-based, woman-centered care, NBCC is blowing the whistle on breast cancer screening, prevention, and treatment practices that are neither scientifically sound or patient friendly.

In honor of Breast Cancer Awareness Month, here are a few myths and truths from NBCC:

True or False?

1. Monthly breast self exams save lives.
   FALSE. The evidence actually shows that breast self exams (BSE) do not save lives or detect breast cancer at an earlier stage.
   
   
2. Most women with breast cancer have a family history of the disease.
   FALSE. Eight out of nine women who develop breast cancer do not have an affected mother, sister, or daughter.
   
   
3. Mammograms can only help and not harm you.
   FALSE. False positive results may lead to unnecessary, intrusive surgical interventions, while false negative results will not find cancerous tumors.
   
   
4. Hormone replacement therapy (HRT) increases your risk of breast cancer.
   TRUE. According to the Women’s Health Initiative (WHI) Postmenopausal Hormone Therapy Trials, an estrogen-plus-progestin replacement therapy increases the risk of breast cancer, heart disease, stroke and blood clots.
   

As a woman with no family history of breast cancer, myth #2 is the most surprising to me. Which of these myths and truths most surprises you?

My Midwives' Gifts of Care: Empowerment, Patience, Attention

Today’s blog post was written by a midwife supporter – Karen Yurish.

While I received numerous gifts of care from my midwives during my pregnancies and deliveries, the three I treasure most were their empowerment, patience, and attention. While in the tender stage of early pregnancy, it was easy to feel overwhelmed by everything new. From the first time I saw my midwives, I felt empowered--they trusted me to make the best decisions for myself and my baby and they trusted my body to successfully and safely birth my child. That reassurance at every prenatal visit gave me great confidence going into labor.

That confidence enabled me to trust my body through a day and a half of prodromal labor with my first daughter. In a birthing environment that often puts laboring women on a strict time schedule, the midwives waited patiently for my body to labor in its own way. I had returned home after my first visit to the hospital 12 hours into my prodromal labor, and the midwives trusted me to come back to the hospital when I felt my body was ready. After 36 hours of contractions that were never more than 10 minutes apart, I returned to the hospital and was delighted to learn I was finally dilated to four centimeters. My midwife‘s patience continued through my labor, sitting with me while I labored in the tub, supporting and encouraging me as I dilated the last few centimeters and breathed my way through transition, and patiently massaging my perineum through 45 minutes of pushing so I didn’t tear.

Finally, I am grateful for the attention I received from my midwives. Each prenatal visit ended with asking me if I had any questions--and I never felt rushed out of the office. They paid great attention to the details of the environment where I labored and delivered -turning off the fluorescent lights and bringing in a lamp for softer light, running the tub and keeping it warm, bringing me a pillow to use as I labored in the tub, warming me with hot blankets when I started to shake uncontrollably as I transitioned. They helped me try different laboring positions, refocused me, and attentively followed every aspect of my birth plan.

I am grateful for these gifts of care from my midwives; I feel blessed to have had such wonderful birth experiences.

Meet the Future of Midwifery

Why become a midwife? These passionate students share why midwifery is, without a doubt, their professional calling.



Five years have passed since I…first heard the word “midwife.” Now, I am two months away from completing the nurse-midwifery program at Georgetown University. I am a midwife because I care about women and their health…I care about empowering women to educate themselves about their bodies so they can make informed decisions… I am a midwife because I am concerned about more than just the physical health of the woman. I care about her family, her work life, her home life, and what keeps her awake at night. I give her a hug and tell her that I am proud of her – perhaps the gentlest touch and kindest words she has heard in months. I am a midwife because I want to make a difference.
-Allison Stitsworth, RN, BSN, SNM, Georgetown University

I have often been asked why I didn’t choose to become a physician. My answer is simply that I want to be a midwife. Midwifery encourages me to truly be a partner with the women under my care…it provides an opportunity to offer real service to fulfill a specific health or wellness need—whatever is most important to the woman I serve. As a student midwife, a mere three months away from graduation, I can honestly and confidently say that I chose the right path….To anyone contemplating a similar journey I say: jump in with both feet and give it all you have.
-Janelle Green, SNM, Georgetown University

Is midwifery calling you? Find out at Become a Midwife.

Birth in 50 Words or Less

Can you tell your birth story in 50 words or less? Yesterday, the women of www.wheresmymidwife.org started the challenge in honor of National Midwifery Week. Here is a sampling of the stories that rolled in:

• It was a wonderful pregnancy and a wonderful birth. I met my midwife at the hospital at about 5 p.m. She was patient and calm. She was by my side throughout my labor. I started pushing at about 10 p.m. At 1:13 a.m., my beautiful boy joined my whole family in that room. –Maria
  
  
• Twenty-four hours of labor and a beautiful birth, a perfect outcome. My husband, our mothers, my son, our birth helpers and my midwife stayed by my side, coaxing my little girl into the world at her pace with only whispers and gentle words and loving touch. My midwife, my midwife! –Ania
  
  
• Birth Haiku for Baby 2: Waiting and screaming. Baghdad on fire, and me too. War and life begin. –Candice
  
  
• First VBAC... I didn't believe I'd really push him out until his head was halfway out. I knew everyone expected a repeat section. But out he came and was placed on my chest. I grabbed one arm and one leg and cried... so grateful for the experience and my baby! –Christine
  
  
• First birth...long labor. I kept thinking this isn't how the books say it is supposed to be. Second birth....long labor. Two healthy babies, the goal. Yeah! –Caroline
  

What’s your story?

How Do You Practice Real Midwifery?

by Leslie Ludka, CNM, MSN

Editor’s Note: In honor of National Midwifery Week, we asked Leslie Ludka to write an encore post based on her article “Are You Practicing Real Midwifery?” (click on the article for a sneak peak at Quickening, ACNM’s members-only newsletter!). Leslie is a regular columnist for Quickening and is Director of Midwifery at Cambridge Hospital and Birth Center in Cambridge, MA.

Whenever I think about midwifery as a career, I remember Sister Angela Murdaugh’s words: “Midwifery is a calling. If you do not believe that you were called, you should get out of midwifery.”

But, how do we know if we were called? Does it have to manifest in a specific type of job in a specific type of setting? Is it only a calling if we can’t wait to get up every morning and rush to work? Does being financially successful make it a calling?

I’m not sure about you, but for most of us, midwifery is neither easy nor lucrative. In fact, there are times when midwifery is the hardest job in the world—just ask any midwife to tell you the story of that case that haunts her memories. We all have one. In fact, there are times when our work is so difficult that no amount of money would attract most rational people.

So, why would anyone choose midwifery? I believe that Sister Angela has it right. Midwifery is not a choice; it is a calling. We do not choose midwifery; midwifery chooses us. When I went to midwifery school, I never asked if there would be a job for me when I finished. I didn’t wonder how much money I would make. I know it sounds crazy, but the truth is, it didn’t matter. Midwifery is my calling.

A calling fulfills your personal mission in life. It feeds your spirit by using your unique gifts and abilities to satisfy your deep inner purpose. Following your calling means staying on the path of that which you feel most passionate about, even when it is difficult. A calling is about truly loving what you do.

As we celebrate National Midwifery Week, let’s honor the diversity of this amazing calling of midwifery by sharing with each other and our supporters. Tell us, how has midwifery called you: clinical practice, education, administration, or something else? How do you live your calling?

A Man’s Perspective on Midwifery and Gender

by Peter Johnson, CNM, PhD, FACNM

As a man who has dedicated his career to midwifery, I frequently answer questions like “How can you be a midwife?” “Aren’t you a mid-husband,” and “Don’t you want to be called something else?”

When I answer these questions from family, new friends, and acquaintances at parties, I give a simple answer. Midwife means “with woman.” The gender of the person with that woman is not the relevant factor. What is relevant is that the midwife—regardless of race, ethnicity, religion or gender—is practicing midwifery. The hallmarks of midwifery, like the belief that birth is normal, that skillful communication is a necessity, and that women benefit from the sustained presence of another caring human, are what make our profession unique.

Recently, however, I was approached with a thought-provoking ethical dilemma: How does midwifery guard against gender discrimination toward midwives who are men while simultaneously honoring the rights of women who prefer female care providers?

There are circumstances where women for religious, cultural, or personal reasons desire the care of another woman. Of course, this desire must be honored. I have, however, seen job ads saying “All-female OB/GYN practice seeking midwife” and hospital policies forbidding male nurses or midwives on labor and delivery. These practices make the dangerous assumption that all women seek women for their care, and these practices are discriminatory and dangerous.

Right now far more women are entering medical obstetrics than men, and many of those women are not delivering midwifery care. It is important that midwives and their supporters recognize that the care we know women deserve is not directly related to the gender of the care provider.

Midwives, what are you doing to encourage men in midwifery to join your practice, office, or university?

Women, does the gender of your midwife matter to you?

To Take or Not to Take the H1N1 Vaccine

by Eileen Beard, CNM, FNP

This week, the first doses of H1N1 (swine flu) vaccine will begin arriving at midwifery practices around the country. Although government agencies and health care providers are urging pregnant women to get the seasonal flu vaccine as well as the H1N1 flu vaccine, some women remain hesitant. Pregnancy is a time to avoid caffeine, alcohol, and unnecessary medications. So, why make an exception for a new vaccine?

As a certified nurse-midwife and mom of five (plus five step daughters!), I am typically cautious about new products. When it comes to H1N1 flu, however, I am absolutely convinced that vaccination is a must.

Because of the normal changes of pregnancy (for example, decreased ability to fight off infections), pregnant women are especially susceptible to the harmful effects of H1N1 flu. Research consistently shows that pregnant women are at increased risk for serious illness and even death from H1N1 infection and are four times more likely to be hospitalized.

If you’re still on the fence about vaccination, consider this: for the first time ever, a national coalition of eight organizations (including ACNM, March of Dimes, ACOG, and AWHONN) has come together to develop a clear statement about the seriousness of H1N1 flu and the importance of receiving the vaccination. This sends a pretty clear message in favor of heading to your midwife to receive that vaccine.

If one of your worries is thimerosal, a controversial component of vaccines, about half the doses of H1N1 flu vaccine to be released this fall are thimerosal-free and will be prioritized for children and pregnant women. Ultimately, only you can decide what is best for you and your family. I encourage you to give this issue serious consideration and make a decision as an informed health care consumer.

Need more information to make your decision? Check out these helpful resources:

• Share With Women handout from the Journal of Midwifery & Women’s Health
  
• Know What to Do about the Flu Webcast
  
• Updates from the Centers for Disease Control & Prevention (CDC)
  
• Don’t Blame Flu Shots for All Ills, Officials Say from The New York Times
  

Midwives Included in Health Care Reform

National Midwifery Week (October 4-10) starts this Sunday, and we have some wonderful news to kick off the week. Equitable reimbursement for certified nurse-midwives (CNMs) under Medicare is now included in both the House and Senate health care reform bills!

The midwifery equity provision made it into the Senate bill last night after Senator Kent Conrad (D-ND) introduced it as part of an amendment in the Senate Finance Committee.



In the coming weeks, the Senate bill and the House bill are expected to come up for vote in both chambers and are widely projected to pass. As it stands now, the only thing between CNMs and 100% reimbursement for their services under Medicare appears to be President Obama’s signature.

While this is a major step forward for the midwifery community, ACNM’s parallel effort to win inclusion of certified midwives (CMs) under Medicare and Medicaid was not successful. We’ve already identified additional strategies for continuing to pursue reimbursement for CMs.

Meanwhile, hats off to Senator Conrad for introducing the amendment and to Senator Blanche Lincoln (D-AR) for saying, “Without a doubt, the certified nurse-midwives in Arkansas have done a tremendous job and I want to thank Sen. Conrad for moving forward with that.”

Let the National Midwifery Week celebrations begin!