Monday, November 23, 2009

Click, Peel, Stick: How to Turn Holiday Cards into a Midwifery Advocacy Activity

by Melissa Garvey , ACNM Writer and Editor

Did you know that every year, Americans send 1.9 billion holiday cards? Today, ACNM is helping you turn this yearly task into a simple yet powerful advocacy activity with the launch of our 2009 midwifery stamps.

To participate, click on our stamps portal and follow the ordering instructions. Then place the stamps on your holiday mail to help raise awareness of midwifery across the country. Your purchase will also make a financial contribution to support midwifery. The A.C.N.M. Foundation will receive a portion of the sale for every midwifery stamps purchase that is made by a new customer.

Funded by the A.C.N.M. Foundation as part of the Public Education Project, the 2009 midwifery stamp was created by artist Kelly Moyer, winner of the ACNM Midwifery Art Contest. “This painting was inspired by the birth of my goddaughter,” says Moyer. “The image and colors represented best described the feeling at that time.”

Because midwives do more than care for pregnant women, our panel of judges appreciated that the painting portrays a non-pregnant woman and a baby. What do you like about the 2009 stamp?

Thursday, November 19, 2009

What Mammography and Continuous Electronic Fetal Heart Rate Monitoring Have in Common

by Melissa Garvey, Writer and Editor

Earlier this week the U.S. Preventive Services Task Force (USPSTF) issued revised breast cancer screening guidelines: women in their 40s who have no unusual risk factors for breast cancer should not receive routine mammograms for early detection of breast cancer and should instead begin routine screening at age 50.

This is proving upsetting especially to women who were diagnosed with breast cancer at a young age, which is understandable. At the same time, I can't help but wonder…is routine mammography for women in their 40s who have no risk factors for breast cancer akin to continuous electronic fetal heart rate monitoring (EFM) for all women with low risk pregnancies?

Fetal heart rate monitoring during labor is essential, but continuous EFM may send up red flags where none are needed. EFM readings vary by machine and clinician. Jump on an abnormal reading too quickly and you may end up with an unnecessary cesarean section—major abdominal surgery that carries heightened risks for both mother and baby.

In fact, ACOG recently revised their EFM guidelines and put it into perspective in a press release containing this insightful statement:
“Since 1980, the use of EFM has grown dramatically, from being used on 45% of pregnant women in labor to 85% in 2002," says George A. Macones, MD, who headed the development of the ACOG document. "Although EFM is the most common obstetric procedure today, unfortunately it hasn't reduced perinatal mortality or the risk of cerebral palsy. In fact, the rate of cerebral palsy has essentially remained the same since World War II despite fetal monitoring and all of our advancements in treatments and interventions."
So, what about these revised breast cancer screening guidelines? Here’s a snapshot of the National Breast Cancer Coalition (NBCC) analysis of the revisions :
“Mammography can miss cancers that need treatment, and in some cases find disease that does not need treatment, leading to overtreatment with toxic therapies. Harms for healthy women who do not have cancer can include unnecessary imaging tests and biopsies, unnecessary exposure to x-ray radiation, and psychological trauma and anxiety.”
“All breast cancers are not equal. Some patients will have fast-growing, aggressive tumors while others will have slower-growing, less aggressive tumors that are less likely to metastasize and, therefore, have a better prognosis. Screening is more likely to identify the slower-growing, less aggressive tumors because of longer asymptomatic periods. This “length-time” bias can make screening appear more beneficial than it is.”
Notice any similarities to continuous EFM?

What do you think? Are these revised guidelines a step toward backing off of our nation’s overuse of technology and interventions? Or was this a bad public health move?

Tuesday, November 17, 2009

It’s Time to Fight For Preemies

by Melissa Garvey, ACNM Writer and Editor

In honor of National Prematurity Awareness Month, Midwife Connection is participating in the March of Dime’s Fight for Preemies, a blog event to raise awareness of the premature birth crisis. Every year, 20 million babies are born too soon, and half a million of them are born in the U.S. Today is the day to put a face on prematurity by blogging for a baby you love. We asked ACNM Facebook fans to tell us their stories. Here’s what they shared [please note that some comments were edited to preserve patient privacy]:

Cristal M Churchill
I took care of a lady who had twin-to-twin transfusion. She was being seen by MFM [Maternal Fetal Medicine] and OB due to her high risk status! Then she came in laboring and was c-sectioned at 30 weeks. We were so worried about them that first night. I remember being there and crying with them. As I finish my CNM degree, this family will always hold a spot in my heart.

Sharon Harkey
My beautiful IVF nieces born at 31 weeks because one was IUGR [intrauterine growth restriction]. Luckily, I started teaching OB clinical 2 days later at that hospital with a group of 8 RN students. It gave me precious access to the NICU to visit them while they grew over the next 6 weeks. They will be 4 in January and are doing wonderful, thanks to those awesome nurses! And all my students are out there practicing with a better view of OB thanks to taking clinical with a CNM!

Lisa Weston
My beautiful daughter, Zoe, now 17...preterm labor with dilation at 28wk, home uterine monitoring, terbutaline, SROM [spontaneous rupture of membranes] and delivery of my 4#8oz girl at 34 wk. So strong-willed, so mad at the world from day 1...always precocious, graduating from high school, a semester early (natch!) in 4 short weeks.

Leigh Wood
35 weeks gestation, his mom had prom [premature rupture of membranes] at 32 weeks and held him in and safe until she could deliver with us instead of at a tertiary care center.

Jackie Robins
My precious Eli and Vinny, preterm labor held off til 36 weeks. Eli had nasal CPAP for several days. Thank God for the advances in NICU care!!!!!

Let’s continue the fight for preemies. If you have a story about a premature baby you know or cared for, add a comment to this post. (Midwives and other health care providers, please remember to observe HIPAA privacy regulations. If you're not a health care provider, feel free to share as much as you want!)

Thursday, November 12, 2009

Moms Reveal Telling Facts About Breastfeeding

by Melissa Garvey, ACNM Writer and Editor

Did anyone listen to the Bravado Breastfeeding Information Council (BBIC) launch event this past Tuesday? I was pleasantly surprised by the amount of solid facts they revealed from their database of 80,000 women. In case you missed it, here’s a snapshot of what they shared:
  • First generation breastfeeding moms need special support. Of first generation breastfeeding moms (women whose mothers did not breastfeed), only 40% said they received amazing support from their mothers, 30% hoped for more support, and 10% were actively discouraged in their efforts to breastfeed.

  • Breastfeeding works better with three. 75% of women said their decision to breastfeed was influenced by their partner. As one woman explained, “Without his support, I would have given up in the first week.”

  • Being friendly to breastfeeding moms is good business. Business owners take note: more than 85% of nursing mothers will go out of their way to visit a store or restaurant that is breastfeeding friendly.

  • It’s easy to create a breastfeeding friendly workplace. More than 80% of breastfeeding mothers are committed to continue nursing when they return to work, and they say all they need is a door, a plug, a refrigerator, and a sink. Panelists shared innovative ideas worth passing along on this topic. At one company, moms are able to reserve the breastfeeding lounge via their Outlook calendar. Some companies are also including their breastfeeding policy in the maternity leave paperwork, so women have plenty of time to consider their options and plan ahead.
Did you listen in, too? Tell us what you learned.

(Note to women: More information about breastfeeding is available from the Journal of Midwifery & Women’s Health. Read Bringing Your Baby to Breast: Positioning and Latch and What to Expect in the Early Days of Breastfeeding.)

Friday, November 6, 2009

Woman to Broadcast Birth on Internet with a CNM

by Melissa Garvey, ACNM Writer and Editor

Lynsee is a 23-year-old who is pregnant with her first child and one of more than 4 million women who will give birth this year. But there’s something different about this teacher who lives with her husband in Minnesota. She plans to broadcast her labor and birth live on the Internet.

The couple’s choice is sparking a wide range of reactions, from fascination to curiosity to, as one reader commented, “Eeeuw! Disgusting....”

Lynsee’s decision isn’t for everyone, but it is her decision. And it may actually have a positive influence on public perception of birth. For starters, Lynsee’s care provider is a certified nurse-midwife (CNM), which is an option not enough women know they can choose. Now more than 1,500 readers of the Watch Lynsee Grow discussion group on know about their options thanks to this telling Q&A:
Question: Lynsee, will you use a midwife? I did not, yet have always wondered what it would have been like to have the attention and care of a midwife.

Answer: Yes I am using a midwife! She is amazing!! She takes the time to talk with me about my concerns in the appointments and is supportive of my decision to try to go as natural as possible with the birth! She also is not afraid to tell me that things will not always go as planned and that she may not be able to meet all my needs. There are many doctors in her office, and I will be seeing some of these doctors in case I end up needing one of them for the delivery. But my midwife is wonderful!! She even takes time out of her daily life to call me just to 'check in.' Never heard about that from a regular doctor!!
Lynsee’s upcoming birth (she's due on November 19) is at the height of a trend toward more transparency in labor, birth, and care decisions. With more than 3 million birth videos on YouTube, the Internet is exposing the reality of birth—and that’s something many women are hungry for.

Whether Lynsee has the natural birth she prefers, an emergency cesarean section, or something in between, I have to agree with the reader who commented: “Don't want to see it? Don't watch. There are plenty of people who do want to know how this all works.”

Thursday, November 5, 2009

U.S. Infant Mortality Rate Compares Poorly with Europe

by Melissa Garvey, ACNM Writer and Editor

Just in time for Prematurity Awareness Month, the CDC released a new NCHS Data Brief that ranks the U.S. 30th in the world in infant mortality rate. At 6.8 infant deaths per 1,000 live births (5.8 when excluding births less than 22 weeks of gestation), the U.S. falls behind most European countries, Canada, Australia, New Zealand, Hong Kong, Singapore, Japan, and Israel.

What’s the reason for our poor performance in this critical indicator of national health? It’s our “very high percentage of preterm births.”

Since 1984, the percentage of preterm births (infants born before 37 weeks of gestation) in the U.S. has risen 36%. Lowering that percentage appears to be the key to bringing the U.S. infant mortality rate in line with the rest of the developed world.

The Data Brief goes on to show just how dramatic lowering the preterm birth rate in the U.S. could be:
“If the United States had Sweden’s distribution of births by gestational age, the U.S. infant mortality rate (excluding births less than 22 weeks of gestation) would go from 5.8 to 3.9 infant deaths per 1,000 live births—a decline of 33%.”
Sweden and Norway have the lowest infant mortality rates in Europe. Here’s an interesting fact that was not included in the Data Brief: In stark contrast to the U.S., Sweden and Norway (along with most of the developed world) use midwives as their primary birth care providers.