Tuesday, March 29, 2011

A New Direction for Midwife Connection

by Cassie Moore, ACNM Writer and Editor

We hope you’ve seen our fabulous new Web site—and hope you love it as much as we do! We’re also taking this blog to the next level, and we need your help. First, we’re moving the blog from Blogger to the new Web site. To find it from midwife.org, go to “News and Events,” then select “ACNM Blog.”

Content Hand-Picked for You

Previously, Midwife Connection was a blog for both midwives and their clients, or consumers. We’re redefining the blog so it’s just for midwives. That means more meaty content that you care about. Consumers and supporters are still more than welcome to visit, but the focus is going to be on midwives and your issues.

Bloggers Wanted

To make sure our content stays fresh, super relevant, and true to your voice, we’re asking ACNM members and student midwives to blog for us. We’d like to form a core group of contributors who will blog on a regular basis. Interested contributors should contact Cassie Moore, ACNM writer and editor, at cmoore@acnm.org. Let us know what areas you’d like to write about and why you are equipped to speak for and to midwives. Do you already have a blog where you discuss midwifery issues? We’d love to see it! If not, write a short (200 to 400 word) sample blog entry and include it with your e-mail. The most important thing is that you have a viewpoint and something to say. The deadline to become a blog contributor is rolling as we build our group, so don’t hesitate to contact us.

Spread the Word

Feel free to suggest blog topics to Cassie at cmoore@acnm.org. Repost our blog entry links that you like to your Facebook or Twitter. Subscribe to our blog using our new RSS feeds. If you have a blog, link to our blog from yours. As always, follow us on Facebook www.facebook.com/acnmmidwives and Twitter, www.twitter.com/acnmmidwives. If you’d like to do these things but don’t know how, ask Cassie and she’ll help!

Thursday, February 3, 2011

ACOG Committee Opinion on Planned Home Birth: Opening the Door to Collaborative Care

by Melissa Garvey, ACNM Communications Manager

Just this morning, ACNM released an Issue Brief in response to the ACOG Committee Opinion on Planned Home Birth published in the February 2011 issue of Obstetrics & Gynecology.

At just over two pages, the Issue Brief is worth the read. While acknowledging that much of the ACOG Committee Opinion relies on a widely-criticized, flawed 2010 meta-analysis, the Issue Brief goes on to highlight parts of the opinion that open the door to supporting childbirth choices through collaborative care for women and infants. Specifically, this new Committee Opinion acknowledges a woman’s right to make informed decisions about where to give birth, in contrast to ACOG’s sharply worded 2007 policy statement, which declared that “ACOG does not support programs or individuals that advocate for or who provide home births.”

This excerpted quote by ACNM President Holly Powell Kennedy summarizes the tone of the brief:
ACNM views the 2011 ACOG Committee Opinion as a crack in ACOG’s long-standing negative stance on home birth. “We can focus on the negative aspects of this committee opinion, or we can seize this opportunity to redefine the discussion,” said Kennedy. “Beliefs and values about how to accomplish those outcomes are culturally steeped, experientially-based, and stem partially from professional training and socialization. Moving to a place of mutual understanding and agreement will require that we all use midwifery skills: patience with process, respect, listening, knowledge, presence, and strong leadership. ACNM is committed to working collegially with all health professionals involved in maternity care to clarify, define, and advocate for the best care practices for women in all birth settings.”
Also of note, ACOG’s new Committee Opinion comes on the heels of ACNM’s announcement that the Transforming Birth Fund (TBF) has awarded funding to a consortium of maternity organizations to convene a multi-disciplinary Home Birth Consensus Summit in late 2011. This forum represents a real chance to inform and influence change in home birth policy and practice.

Friday, January 28, 2011

“Except When Medically Necessary” : Making informed choices about induction of labor

by Amy Romano, CNM

This post was originally published on Science and Sensibility for Lamaze International.

It’s not hard for women to find advice and recommendations to avoid induction of labor “except when medically necessary.” But what do those words mean and who decides when an induction is medically necessary?

Lamaze’s Healthy Birth Practice Paper cites ACOG Guidelines that define medical induction of labor as necessary in the following circumstances:

  • your water has broken and labor has not begun.
  • your pregnancy is postterm (more than 42 weeks).
  • you have high blood pressure caused by your pregnancy.
  • you have health problems, such as diabetes, that could affect your baby.
  • you have an infection in the uterus.
  • your baby is growing too slowly.

Yet a systematic review of the highest quality research found evidence only to support the first three. Even in these three cases, differences in important health outcomes were small, study methodologies have been criticized, and some important questions remain unanswered.

For the rest of this list and other so-called “medical” reasons for induction, we simply lack scientific evidence that induction offers any clear health benefits, and for other conditions the available evidence suggests induction is more likely to harm than help.

When trade-offs are uncertain for a proposed course of treatment, that treatment is known as “preference-sensitive care.” According to the Dartmouth Atlas of Health Care, a leader in studying practice variation, “Decisions about these interventions — whether to have them or not, and which ones to have — should thus reflect patients’ personal values and preferences, and should be made only after patients have enough information to make an informed choice, in partnership with the physician.”

As the Dartmouth Atlas has demonstrated for many types of medical and surgical interventions, however, decisions are more likely to reflect local practice patterns and the preferences of individual providers than the preferences of patients themselves. While the Dartmouth Atlas does not track induction rates, a 2004 study in New York State found that risk factors (at least those documented in birth certificate records) explained just 12.6% of the four-fold variation in induction rates across hospitals.

But what of the variation in the use of interventions when clear evidence suggests is harmful? Shouldn’t rates of those interventions be stable at or near 0%? Take, for example, the rate of elective (non-medically indicated) deliveries before 39 weeks. In a landscape where clinical consensus is hard to come by, all of the major players from ACOG and ACNM to the March of Dimes, the National Quality Forum, and the Joint Commission, have gotten on the no elective deliveries before 39 weeks bandwagon. Yet this week a major hospital watchdog group, The Leapfrog Group, partnering with Childbirth Connection and the March of Dimes, released for the first time hospital rates of elective deliveries before 39 weeks and the results are all over the map (pun intended). Some hospitals are in the low single digits, rates we know are possible when quality improvement efforts are taken seriously, while others report up to half or more of all births between 37 and 39 weeks are electively delivered.

Women need individualized, evidence-based information about the likely benefits and harms when considering induction of labor in the face of complications or significant risk factors. Childbirth Connection has launched a new web resource dedicated to Induction of Labor to help fill this need. But evidence is just one piece of the puzzle. Women also need information about maternity care practice patterns in their communities, since this factor seems to affect their likelihood of induction more than any other. Leapfrog’s voluntary database of elective early delivery rates stands to drive significant quality improvement. Let’s hope it’s just the first step toward full transparency of maternity care quality.

Friday, January 21, 2011

Protect Yourself from the Flu Season Peak

Did you know that flu season normally peaks in February or even March? If you’re a midwife, make sure your patients know that it’s not too late to get a flu shot. And whether you’re a health care professional or not, the CDC offers free materials to help you make informed decisions about how to best protect yourself this season.

Tuesday, January 11, 2011

The Disease That Every Woman Who Has Ever Had Sex with Anyone Needs to Know About

by Melissa Garvey, ACNM Writer and Editor

Did you know that cervical cancer is the second biggest cause of cancer death for women? Unlike breast cancer, cervical cancer is preventable. The cause is a virus called human papillomavirus (HPV), which can be detected and prevented from developing into cancer. Not all types of HPV lead to cancer, but we now know which types are responsible for up to 70% of all cases.

Some women reason that because they use condoms, have been monogamous for years, are on birth control, or are lesbian, they don’t have to worry about HPV. But every woman who has ever had sex with anyone is at risk of HPV infection.

So what can women do to prevent cervical cancer? Here are a few tips from Tamika & Friends, a nonprofit organization founded by cervical cancer survivor Tamika Felder:

  • Get Vaccinated: Women 9 to 26 years old are eligible to receive Gardasil, a vaccine that protects against the two types of HPV that are responsible for 70% of all cervical cancers. But take heed. Vaccination doesn’t necessarily equal immunity. If you’ve already been infected with HPV, the vaccine won’t protect you. And everyone who receives the vaccine still needs to be screened regularly because they aren’t protected from the remaining 30% of cervical cancer cases.

  • Get Tested: The two key tests for cervical cancer prevention include the Pap test and the HPV test. Click here for guidance on how often you should receive each test, and be sure to consider visiting a certified nurse-midwife (CNM) or certified midwife (CM) to receive screening services. (You can find a midwife here!)

  • Know Your Risk Status: Cervical cancer affects women of color unequally compared to white women. Hispanic women have twice the rate of cervical cancer as non-Hispanic white women, and African American women develop cervical cancer 50% more often than Non-Hispanic white women. If you are a woman of color, you deserve the best testing and best treatment. Know your options and make yourself heard.
Despite the fact that half of women who die from cervical cancer have never been screened or have not been screened in the past year, minimal funding and lack of awareness has led to only a small percentage of women eligible for free or low cost cervical screening under the CDC’s Early Detection Program. Tamika & Friends works with women so that they can get the funding and support they need to be adequately screened and, if necessary, treated.

Tuesday, January 4, 2011

Improving Conditions for Women Who Want to Birth at Home

by Melissa Garvey, ACNM Writer and Editor

Those of you who are tuned into ACNM on Facebook know that we promised to announce some exciting news this month about efforts to improve conditions for women who want to give birth at home. While ACNM supports a woman’s right to choose home birth, the American College of Obstetricians and Gynecologists remains opposed to home birth. So many stakeholders are polarized on the issue of home birth that many women who plan to birth at home and need to transfer to the hospital due to complications do not receive the respect and care they deserve. Some women even resort to birthing at home against medical advice and without the presence of their health care provider.

Women aren’t going to stop giving birth at home anytime soon. In fact, recent CDC statistics show that after a gradual decline from 1990 to 2004, the percentage of home births increased by 5% to 0.59% in 2005 and remained steady in 2006. So, what can we do to improve conditions for these women and their babies in spite of the controversial debate that continues among health care professionals, consumers, insurance providers, policymakers, and researchers?

ACNM is pleased to announce that the Transforming Birth Fund (TBF) has awarded grant funding toward convening a Home Birth Consensus Summit in 2011. Saraswathi Vedam, chair of the ACNM Home Birth Section, took a leading role in bringing this to fruition. She worked with an impressive list of co-applicants for the grant, including:

  • Midwives Alliance of North America (MANA)
  • American College of Obstetricians and Gynecologists (ACOG)
  • American Pediatric Association (APA)
  • National Association of Certified Professional Midwives (NACPM)
  • International Center for Traditional Childbearing (ICTC)
  • Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN)
  • Lamaze
  • American Association of Birth Centers (AABC)
The Home Birth Summit will be a two- to three-day meeting facilitated by the Future Search Network, a nonprofit organization that is internationally known for brokering lasting agreements and shared initiatives in highly volatile and polarized settings.

Additional funding will be needed to cover the full budget for the summit. While planning for the summit is well underway, individuals or organizations interested in supporting the summit are encouraged to do so through contributions to the A.C.N.M. Foundation, Inc., fiscal agent for the TBF grant.

To read more about Vedam’s leadership and the three-year history leading to this exciting news, read the full ACNM announcement.

Thursday, December 23, 2010

Midwife Connection Goes on Vacation

Midwife Connection is taking a holiday break. We will return to our regularly scheduled postings on January 4, 2011. Season’s Greetings and best wishes for a happy, healthy, and prosperous New Year from your friends at the American College of Nurse-Midwives.