What do Midwives and Women Think about Health Care Reform?

In August, ACNM endorsed the House health reform bill, H.R.3200. This week we're watching closely as the Senate Finance Committee is finalizing its own version of the legislation. These are controversial pieces of legislation. So, tell us what you think! Let’s voice our opinions and share informative resources to fuel the discussion. Is health care reform good for women, midwives, Americans? What do you like about the unfolding legislation? What don’t you like about it?

Here are few resources to get the conversation started:

• Why Reform Matters from the National Women’s Law Center talks about health care reform as it relates to women and families.
  
• The Kaiser Foundation explains the basics of health reform, tracks public opinion, and provides several interactive resources.
  
• The Media Consortium features independent journalism on health care reform.
  
• The Association of Women’s Health, Obstetric and Neonatal Nurses and the National Association of Community Health Centers have informative health care reform position statements and resources.

ACNM Invited to First Lady's Health Care Reform Discussion

This morning, ACNM Executive Director Lorrie Kaplan attended a White House event hosted by First Lady Michelle Obama designed to call attention to the deficiencies in our current health care system for women and their families.

“Women are being crushed by the current structure of health care,” said Obama. “If you're not experiencing it yourself, you know someone who is. This is why we are fighting so hard for health care reform. I invited this particular group of family advocacy groups and health care advocacy groups here today because your organizations have been fighting for decades for the empowerment of women.”

Obama recalled two particular incidents in which her family was affected by the US health care delivery system and aided by the health insurance they carried.

"This is very much a women's issue," she asserted. “The current system is unacceptable. We have to reform this system because it is holding women and families back.”

The bottom line? “When you're fighting an illness, you should not have to fight your insurance company at the same time. Getting sick should not mean that you will go bankrupt.”

ACNM has strongly supported health care reform as one of its top federal legislative priorities of this Congress. Read more about ACNM's federal legislative activities .

Mad Men and Birth, Sixties Style

Sunday night’s episode of Mad Men brought 60s-style birth to prime time TV. The moment that mother/wife Betty matter-of-factly proclaimed “It’s time,” birth activists across America probably sat poised on the edge of their couches anxious to see how the show would portray this birth. Contrary to typical television births, Betty and father/husband Don calmly proceeded to the hospital—no rush, no alarm, no emergency mode. In fact, most of what followed matched the reality of what it was like to give birth in the 1960s.

Upon arriving at the hospital, Don retired to the waiting room. Betty was “prepared for delivery” with a shave and a dose of twilight sleep (morphine and scopolamine). As the effects of sedation set in, Betty became a belligerent, sweaty, laboring woman hovering somewhere between painful reality and a drug-induced dream world. Hours later, she woke up with a baby in her arms and Don by her side.

Set in the early 1960s, Mad Men is littered with unfair treatment of women in the home and in the workplace. Watching this series has caused many female viewers to closely examine ways that they may be mistreated as women in today’s society—ways that they simply accept as part of the way things are. Maybe Sunday night’s episode of Mad Men will cause women to question the routine parts of modern birth and to wonder if we could (still) be doing better.

Dear Today

This afternoon, ACNM sent this letter in response to The Today Show segment “The Perils of Midwifery” (later renamed “The Perils of Home Births” online). We encourage midwives and their supporters to send their letters to TODAY@nbcuni.com and to adapt ACNM's letter for their own use to share with coworkers and clients. Thank you to the many ACNM members who have already sent letters in support of midwifery and homebirth.

The Non-perils of Midwifery

Earlier, the Today Show aired a sad, unfortunate piece called “Perils of Midwifery.” (They later updated the Web segment title to "Perils of Home Births.") Not only does it follow the heart-breaking account of a birth gone horribly wrong; it exploits the couple’s tragedy—turning it into a sensationalized story that scares women and grossly misrepresents midwifery.

The safety of midwife-attended births is well documented in a substantive and ongoing body of research. If ACNM, the professional organization for certified midwives and certified nurse-midwives, had been consulted during the development of this piece, the Today Show’s journalists would have known about these top 5 fact-based resources from the past year:

1. Evidence-Based Maternity Care: What It Is and What It Can Achieve says that midwives top the list of “underused interventions” that should be used “whenever possible and appropriate.” Several systematic reviews showing improved outcomes associated with midwifery-led care are cited.
2. A Cochrane Review concluded that “most women should be offered midwife-led models of care.”
3. A study published in the British Journal of Obstetrics and Gynaecology found that planned homebirth is as safe as hospital birth for women with low-risk pregnancies.
4. Just last week, Canadian researchers declared that “Planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death…and other adverse perinatal outcomes compared with planned hospital birth....”
5. Authors of an American Journal of Obstetrics & Gynecology article say they encourage midwifery care and “support future randomized trials to compare” home vs. hospital births.
   

Women and health care professionals need to be making decisions that are informed by evidence-based medicine—not reactionary interventions and unbalanced investigative journalism. Women deserve better.

Join the Fight Against Preterm Birth with March of Dimes

Did you know that preterm birth has increased by 20% over the past two decades? In our country, one in eight infants is born prematurely. That’s nearly half a million babies each year.

The March of Dimes (MOD) is inviting a multidisciplinary group of health care practitioners, health insurers, policy makers—and concerned citizens—to address this growing problem. On October 8 and 9, MOD, in collaboration with American College of Nurse-Midwives (ACNM), American Academy of Pediatrics (AAP), American College of Obstetricians and Gynecologists (ACOG), and Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), will sponsor the Symposium on Quality Improvement to Prevent Prematurity at the Hyatt Regency Crystal City in Arlington, VA.

In addition to presenting an impressive lineup of speakers, including ACNM President Melissa Avery, CNM, and Nancy Jo Reedy, CNM, the event aims to create an action plan to reduce premature births that are not medically necessary. Attendees will discuss quality improvement as an essential component in the strategy to prevent prematurity, promote health, and reduce costs. (We expect this will include underutilized strategies such as midwifery care!)

Register by Friday, September 11, and pay $200. (After Friday, the price jumps to $250.) Groups of 10 or more from one institution can e-mail conferences@marchofdimes.com to discuss a discounted registration fee.

Persistence Pays for Minnesota Midwife

by Brielle Stoyke, CNM, Minnesota Chapter Legislative Contact

Senator Al Franken and Brielle Stoyke, CNM

In December 2007, I was invited to a fundraiser for Al Franken. Franken was running for a Minnesota Senate seat. I went that night thinking maybe there would be an opportunity to talk to him directly about S. 662, the Midwifery Care Access and Reimbursement Equity Act, just in case he was elected. I didn’t get to talk to him long enough to mention midwifery, but I got my photo taken with him, which I tucked away for later.

He ended up winning the Senate seat, and I attended his celebration party in St. Paul. He had only been in office a few days and did not have a full staff yet. I didn’t even get near him that night, but was able to get the name of his new legislative health aide. So, I went home and e-mailed her about being a midwife, and specifically about S.662, and was sure to attach the photo of Franken and me from the 2007 party. Next, I e-mailed many of the CNMs in MN urging them to ask the senator to cosponsor S. 662.

Just a few weeks later, I was in my hometown of Duluth, MN, where I was offered an extra ticket to an event that Senator Franken was attending. I went with some friends, and we arrived an hour early. The venue staff were not seating yet, so we went across the street for a drink. When we arrived, we were pleased to find a private party in honor of the senator. I instantly recognized the staffer from the celebratory party in St. Paul and was talking with her, when I noticed a lull at the senator’s circle. So, I approached him and told him that I was a nurse-midwife from St. Paul and that I wanted him to cosponsor S. 662. He asked about the bill, and I told him it would increase reimbursement rates to midwives under Medicare. He looked puzzled. So, instead of explaining the details, I told him that I had been in contact with his legislative health aide, that S. 662 would provide equal pay for equal work, that his Senate partner Amy Klobuchar had signed the bill already, and that the bill had no opposition. He then asked me about my training, and I was proud to tell him I had a master’s degree in nursing, with a focus on midwifery. Right then one of my friends approached us with a camera and captured ‘my moment’ with the Senator on camera again! I followed up with his legislative health aide later that week and sure enough, he signed onto S. 662 just six short days later!

What did I learn from this experience? Success comes after persistence and teamwork. Never let an opportunity pass to talk to your legislator about what you do and why midwives deserve equitable reimbursement. Thanks to my fellow MN midwives for following up as well, and thanks to Senator Franken for supporting our bill!