Do Flashy Campaigns Make a Difference for Breast Cancer?

by Melissa Garvey, ACNM Writer and Editor

October is National Breast Cancer Awareness Month, and one Facebook campaign has already gone viral. It’s not a campaign imploring people to donate to breast cancer research. Instead, women are using their Facebook status updates to reveal where they like to put their purse.

As you can imagine, this leads to all sorts of sexual connotations–for example, “I like it on the couch,” or “I like it in the kitchen.” It’s similar to a previous campaign that encouraged women to post their bra color as their status update. It’s eye-catching, and people like it. But is it really making a difference for breast cancer?

According to the National Breast Cancer Coalition, these flashy campaigns do nothing for the millions of women who are struggling or will be diagnosed with breast cancer. In fact, NBCC has started an alternative approach by setting a deadline to end breast cancer by January 1, 2020. It’s different, well thought out, and bold. But is it possible?

If you had to choose between the Facebook “I like it” campaign and the NBCC deadline, which would you say holds the most potential to make a difference for women with breast cancer?

Houston Midwives Honor Rep Green at B.I.R.T.H. Fair

by Lynneece Rooney, CNM

Texas Representative Gene Green (D-TX) was honored at the 9th Annual Bringing Birth Information and Resources to Houston (B.I.R.T.H.) Fair earlier this month. An award honoring his support of women’s health was presented to him by certified nurse-midwives Melanie Dossey, Jackie Griggs, and Pat Jones, with hundreds of advocates in attendance.

Representative Green is the first and only federal legislator who represented Texas as a co-sponsor of the Midwifery Care Access and Reimbursement Equity Act of 2009 (H.R. 1101). (H.R. 1101 was part of the Patient Protection and Affordable Care Act of 2010; the law will raise Medicare reimbursement of certified nurse-midwives from 65% to 100% of the physician fee schedule.)

Greenhas shown continued support of women’s health care issues by sponsoring and co-sponsoring numerous women's health care related bills in the past, including the Medicaid Birth Center Reimbursement Act; Heart Disease Education, Analysis Research, and Treatment for Women Act; Birth Defects Prevention, Risk Reduction, and Awareness

How to Brand Midwifery

by Melissa Garvey, ACNM Writer and Editor

This week I came across an interesting post by Sam Ford about the problem many midwives and their supporters struggle with every day. How do you clearly communicate what a midwife is? It’s a loaded term with all sorts of cultural baggage and preconceptions, which typically triggers associations like home birth and no pain control.

Ford’s post didn’t grab my attention merely because of the subject matter. Many people who have come before him have astutely pointed out that the midwife brand needs a makeover. In fact, ACNM members say that limited public awareness of midwifery is the number-one barrier to practice. What impressed me is that Ford actually took a stab at evaluating why existing advocacy campaigns and PR initiatives have not made a large impact on the US public.

The biggest hurdle to overcome is that many have painted midwifery in extremes: as only for parents who completely oppose medical intervention, almost as eschewing all that modern medicine and technology has given us.

A thoughtful follow-up post at Babble.com further articulates the problem:

As a culture, we tend to see only the extremes. We love a good, clear fight, even at the expense of facts. When it comes to birth, there are “the crunchies” and there are “the medicalized maniacs.”

In between these two extremes is where you’ll find the majority of modern midwives. What does that look like? It depends. Midwives serve as primary care providers, giving annual exams, reproductive health services, and family planning counseling to women of all ages. Most midwives work in hospitals. Some work in birth centers or homes. They can order medications, ultrasounds, and epidurals. They exercise those privileges when needed or when requested by the mother. Most midwives spend a longer amount of time with their patients—just like nurse practitioners tend to give longer annual exams than OBGYNs.

How do you boil that down into a brand? It’s complicated. Try choosing a picture to represent midwifery. Should the midwife be a woman or a man? Should s/he be wearing a white lab coat, scrubs, professional attire, or casual dress? Should his or her patient be a teenager, a pregnant woman, or an older woman going through menopause? Even among ACNM staff, there are wide variations of opinion on this topic.

It’s almost as if there’s too much information to shove into a brand. At ACNM, we’re pouring resources into raising public awareness of midwifery. We just launched Evidence-Based Practice: Pearls of Midwifery. Last year we released midwifery postage stamps We’re vamping up our media relations and social media efforts. But there’s still more work to be done.

In your view, what is it that defines midwifery? Do you think it’s possible to rebrand midwifery in America?

Overcoming Barriers to Safe Maternity Care in Afghanistan

by Annie Clark, CNM, MPH

The majority of women in Afghanistan are constricted by traditional customs forbidding them to travel without a male companion.

Last month, NPR’s Morning Edition posted a story about midwifery in Afghanistan with Renee Montagne reporting from the remote region of Badakshan along Afghanistan’s northern border. The story provides a snapshot of the situation in Afghanistan where the maternal/infant health statistics are among the worst in the world. According to UNICEF, the estimated infant mortality rate is 165 per 1000 live births, and under-five mortality is as high as 257 per 1000. (You can also watch an excellent video summarizing the situation in Afghanistan here.)

A recent study undertaken in four Afghan provinces indicates that the country still has one of the highest maternal mortality rates in the world—estimated at 1600 deaths per 100,000 live births. Montagne reports on a USAID initiative to address these appalling statistics by recruiting and training midwives in rural areas. She personalizes the account with an illustrative example of midwife Farangis Sultani, who was chosen by her Village Health Council to participate in an 18-month community midwife training program and then return to serve her community and receive a salary.

In just six years, midwife training programs have increased the number of midwives in Afghanistan from 467 in 2002 to nearly 1700 in 2008 (2300 was the total number of midwives reported to me when I was in Afghanistan earlier this month). The objective is to train a total of 5000 midwives. This has not been an easy undertaking for a number of reasons, including the fact that up to 86% of Afghan women are illiterate, making it difficult to find candidates who meet the required prerequisites for midwifery training. The majority of women in Afghanistan are also constricted by traditional customs forbidding them to travel without a male companion. Consequently, few women in rural villages manage to deliver outside their own home. There was opposition to the concept of a midwife traveling alone to the home of a laboring woman, let alone staffing a clinic at night.

The NPR story highlighted the efforts of Jhpiego, an affiliate of Johns Hopkins University, which has been implementing a USAID-funded project to train community midwives. Jhpiego helped combat cultural barriers to training by promoting the establishment of Village Health Councils. When confronted with the problem and the possible solution, Village Health Councils independently selected young women candidates for midwife training and agreed to some flexing of cultural norms.

There are many additional donors and NGOs who are involved in efforts to address the high maternal and child mortality and morbidity rates in Afghanistan, including UNICEF, the World Health Organization (WHO), Merlin, Aga Khan, and University Research Company/Health Care Improvement Project.

Did you know that ACNM, as a partner with Jhpiego on the USAID-funded ACCESS project, helped launch the Afghan Midwives Association in May 2005? Find out more about the grant-funded ACNM Department of Global Outreach at www.midwife.org/global.cfm.

How to Present Evidence-based Midwifery Care Like a Pro

by Melissa Garvey, ACNM Writer and Editor

This week we launched an exciting project that has been in development for more than a year. Evidence-Based Practice: Pearls of Midwifery is a professionally developed presentation featuring nearly 100 fully referenced slides to assist midwives and their advocates (expectant moms, active dads, other health care providers, everyone!) in explaining the science and art of the midwifery maternity care model. Designed to showcase the evidence-based foundation of midwifery practice, Pearls of Midwifery emphasizes the proven benefits of physiologic labor and childbirth for mothers and their newborns.

Pearls of Midwifery is a long-overdue resource. In the words of ACNM President Holly Powell Kennedy, CNM, PhD, FACNM, FAAN, “Despite the recent plethora of information on evidence-based maternity care practices, there continues to be an underuse of many beneficial interventions while some harmful practices persist. We must continue sharing the evidence with our clients and other health care providers to ensure that all women receive the safest and most effective maternity care.”

Evidence-Based Practice: Pearls of Midwifery includes suggested speaking notes for each slide and a checklist that can be printed and shared.

Pearls of Midwifery is free to ACNM members and available for nonmembers to purchase in the ACNM Live Learning Center for just $69. Where do you plan to use this new resource?

Title V Turns 75

by Elaine Germano, CNM, DrPH, FACNM, ACNM Senior Education Policy Analyst

2010 marks the 75th anniversary of Title V of the Social Security Act, the only national program that focuses solely on improving the health of all mothers and children. To celebrate, the Health Resources and Service Administration’s (HRSA) Maternal and Child Health Bureau (MCHB) is hosting a commemorative event next week—Wednesday, October 20, in Washington, DC—to highlight the past, present, and future of the program.

Many midwives have served in MCH bureaus at the state and local level, and midwifery practice is often strongly supported by government officials in those bureaus. For more information, resources on Title V, a 75th Anniversary widget, and ideas for community service projects, visit www.hrsa.gov/mchb75.

HRSA is also calling for YouTube video submissions about maternal child health programs that have impacted your life, community, or country. Submission topics related to midwifery include:

• Adolescent health
• Family-centered, community-based, coordinated systems of care
• Maternal child health research
• Obesity
• Oral health
• Prenatal and perinatal care
• Women’s health
  

How are You Celebrating National Midwifery Week?

by Melissa Garvey, ACNM Writer and Editor

We’ve been thrilled with the updates rolling in about how midwives and their supporters are celebrating National Midwifery Week across the country. Check out these highlights and make a comment to tell us how you’ve been celebrating.

On Sunday, October 10, Andrea Bendewald will give a unique “Blessing the Hands” to the remarkable midwives of Los Angeles who work tirelessly serving women and families. A dedicated group of more than 300 midwives and supporters, including Ricki Lake and Carrie Ann Moss, will gather at Golden Bridge Yoga. The event honorees are Peggy O’Mara, editor and founder of Mothering magazine, and Congresswoman Lucille Roybal-Allard (D-CA), who is a consistent supporter of women and infants’ health and is the congresswoman who introduced the Maximizing Optimal Maternity Services for the 21st Century Act (MOMS 21—H.R.5807) to promote evidence-based maternity care.

Governor Beshear proclaimed Midwifery Week in the state of Kentucky.

Where’s My Midwife? is hosting daily activities throughout the week, culminating with the National Walk for Midwives on Saturday, October 9. New York City, San Francisco, and Seattle midwives are also hosting Miles for Midwives walks.

The Morgan Library and Museum features a photograph of the pioneering nurse-midwife Mary Breckinridge in their current exhibition "Anne Morgan's War: Rebuilding Devastated France." You probably know Breckinridge’s story—many consider her the founder of nurse-midwifery in America—but before creating the Frontier Nursing Service, which brought midwives on horseback to women in the rural mountains of Kentucky, she volunteered with Anne Morgan's civilian relief organization in the devastated regions of France. She was one of the group's most distinguished volunteers, drawing on her wartime experience to make a huge difference in people's lives (and the very future of prenatal and infant care) back home.

An International Approach to Mainstreaming Midwifery in America

by Peter Johnson, CNM, PhD, FACNM

As we celebrate Midwifery Week—a time to recognize our profession and celebrate our achievements—I am struck by the good work midwives are accomplishing globally. National Public Radio aired a story last week that highlighted the work of my organization, Jhpiego, that is taking place in the far northern region of Afghanistan. While listening to Renee Montagne’s interview with a young Jhpiego-trained midwife, I felt proud, but it also reminded me of the work left to be accomplished both around the world and here in the United States.

Jhpiego, which serves to “innovate to save lives of women and their families,” has been doing creative work for nearly 37 years and has always maintained close ties to ACNM. Our nearly 800 midwives, nurses, physicians, and public health professionals strengthen midwifery education in war-ravaged countries like Afghanistan and Liberia, support care to women and families living in urban slums of Kenya, and prepare midwives to reduce the mother-to-child transmission of HIV in Southern African countries. The great majority of these professionals are native residents in the countries where we work.

My travel building cherished relationships with new colleagues from around the world has convinced me that we have more in common than one may think. For example, we all seek to build a stronger health care system that respects the autonomous role of the midwife. We all want midwives and other health care professionals to have the best possible work environment and access to the equipment and supplies needed to do their jobs. We want midwives to have a quality education that forms the foundation for life-long learning and growth.

Even our challenges, while apparent on a different scale in low resource countries like Afghanistan, are largely the same. We all struggle to find the resources to educate our midwives and offer them a living wage for their services. We work to develop autonomous regulatory structures that provide midwives with a framework for optimal practice. We strive to optimize midwives’ work environment so that they can maximize their effectiveness in practice. Even in America, where midwives often serve the most vulnerable of society’s women, these struggles are apparent. There are far too few of us because of our inability to overcome these challenges, and women suffer because of it. Let us use this week to celebrate midwifery globally while mobilizing our midwives here at home to overcome our shared challenges. Let us reflect on the lessons learned by midwives around the world that can “mainstream” midwifery practice in America.

Does Health Care Reform Do Anything for Midwifery?

This post originally appeared on RH Reality Check in honor of National Midwifery Week.

by Eileen Ehudin Beard, CNM, FNP, MS, ACNM Senior Practice Advisor

Most midwives would agree that The Patient Protection and Affordable Care Act has several concrete benefits for the midwifery profession. The act establishes reimbursement for certified nurse-midwives (CNMs) at 100% of the Medicare Part B fee schedule, which means that as of January 1, CNMs will be reimbursed at the same rate as physicians. The law also recognizes freestanding birth centers under Medicaid, which allows birth centers to receive reimbursement for their facility fees.

But since these parts of the legislation have not yet gone into effect and do not affect all midwives, does health reform really mean anything for the thousands of US midwives and their patients?

The answer is yes! To the prospective midwifery student, I can now say that more money will be available for graduate nursing education and that there will be more help with loan repayment for midwives who practice in maternity care shortage areas. When I am asked how reform legislation has impacted midwifery practice thus far, I can say it has brought the evidence forward as we move towards some major changes and improvement in care for women and infants.

There is a new focus on evidence-based practice, which I believe is the direct result of health care reform legislation. A dialogue is taking place among the stakeholders in this country about how we can do better for mothers and newborns. This year, Childbirth Connection published two reports in addition to hosting a symposium called Transforming Maternity Care: A High Value Proposition. One of the reports, the Blueprint for Action, reinforces the importance of evidenced-based maternity practices. The American College of Nurse-Midwives is about to release a PowerPoint presentation entitled Evidence-Based Practice: Midwifery Pearls, to help midwives spread the facts about evidence-based practice. Evidence-based practice in maternity care is definitely in the limelight. Also, the National Institutes of Health (NIH), discussed vaginal birth after cesarean (VBAC) at a Consensus Development Conference.


But there is still more work to be done. Passage of the “Maximizing Optimal Maternity Services for the 21st Century Act" (MOMS 21) is the next step to help move this nation forward as we create a focus on maternity services. If the bill passes, there will be expanded federal research on best maternity practices and support for the education of a more culturally diverse interdisciplinary maternity care workforce. There will also be a national consumer education campaign to inform women about evidence-based maternity care practices.

For midwives, this legislation has brought renewed hope to a system of care that spends more than double per capita on childbirth than other industrialized countries, yet ranks far behind almost all developed countries in perinatal outcomes. For years midwives have been the champions of reducing risks in childbirth and eliminating disparities in communities of color. We have fought hard over the past several years to have federal legislation address concerns of midwives and the women we serve. A major barrier for women who want a midwife has been inadequate reimbursement for services. We know that midwives provide health care services to women of all ages and play a significant role in access to quality, affordable primary care, gynecology, family planning, and maternity services. Passage of MOMS 21 will enhance the viability of midwives as well as increase the incentive for hospital and physician practices to employ them.

The times, they are a changing, and we have renewed hope that the four million women who give birth in this country will have many safe, affordable maternity care options—and that the care they receive will be based on the evidence of best practices.

Happy National Midwifery Week! Have You Thanked Your Midwife Yet?

It’s National Midwifery Week 2010! To help you celebrate, we’ll be posting more frequently this week. Check back often and don’t forget to take advantage of our National Midwifery Week resources.

Birth, Trust, and Cultural Divides
by Lorene Gilliksen, CNM

As I celebrate my daughter’s 26th birthday, I’d like to acknowledge the help I received during my pregnancy from Mei Ka Chin, my midwife. Emily is my only child, so I suppose I am 26 years postpartum.

When I was pregnant, I worked at North Central Bronx (NCB) Hospital as a staff midwife. Mei Ka was a lead midwife there, and my friend and neighbor. As a patient, I felt confident and well-cared for because I knew that I had Mei Ka’s complete attention.

We are all thankful for midwives who listen to women and extend the values of midwifery into communities worldwide. Mei Ka is special because she listens beyond and across cultural infrastructures. She puts the dislocated, fretful, and disenfranchised at ease. Only later, as I worked at a hospital that served immigrants to the Midwest, did I think about Mei Ka’s special skills. As I attended the births of women from several continents, I thought about the courage required to give birth in a foreign city, without one’s mother, and without one’s mother tongue.

As current research on pitocin and trust reminds us, a woman needs to feel safe in order to labor. Childbirth generates a ripple effect of trust. These ripples of trust are a woman’s confidence in her body’s ability to do the work, the relationship she has with her partner, the web of immediate family support, and wide social networks. Midwives facilitate the effectiveness of these relationships. Mei Ka recognizes how each ripple contributes to a woman’s sense of safety.

Mei Ka has devoted her life to being present with women. (The word midwife means “with woman.”) She is now in Shanghai bringing new life into one of the world’s biggest cities. Mei Ka Chin wears a cell phone around her neck. She’s on call all the time. She was on call 26 years ago. She is on call now. Thanks, Mei Ka!

ACNM Members: Read the full version of Lorene's essay in the upcoming fall issue of Quickening.