I am finally taking a look at my much neglected website and realize that my last blog post was almost a year ago.  I admit that this blogging thing has not been on the top of my priority list (I think it completely fell off the list some time last spring).  After reading over my previous posts and seeing what I had hoped to do last year at this time I realize that I need to do a better job at setting and obtaining my goals.  

Just in the past 8 months: I started a new position with my agency that allows me to work from home.  I have helped start a local breastfeeding coalition and serve as Media Relations Representative.  I was on a radio show to talk about breastfeeding and being a doula.  I have met so many contacts that I wouldn’t have had such an easy time meeting on my own.  It’s been a good 12 months in so many ways but there is still something missing. 

I said last year I was going to start an ICAN Chapter for my area.  Did.Not.Happen.  However, I recently attended the ICAN Conference in St. Louis where I was able to meet so many amazing and inspiring women!  I came home completely exhausted and ready to put that goal back on the top of my list. 

These past 2 months have been enlightening to say the least.   The ICAN conference changed my life and my perspective of what I want to be doing with my time.  I miss attending births.  I miss the interaction with pregnant and new mothers & babies.  I’ve dreamed of opening a store for pregnant and new moms to offer products and services.  I have so much I want to do but have been holding back out of fear. 

Yesterday a door opened.  A feeling of calm and confidence has come over me that I haven’t felt is such a long time.  A feeling of relief coupled with a little fear of not really knowing what is going to happen but I trust that it will all work out.  Without going into detail I have offered to become a part-time contract worker for the breastfeeding program that I have been currently employed full-time.  It ultimately came down to them requiring that I take their group insurance over my private insurance (that we have already met the deductible for and have 100% coverage for the rest of the year).   I am at peace with the decision…even if they decide to let me go completely. 

I haven’t heard back but feel so much better.  I’m hoping that this will give me the freedom to be able to work more with ICAN & the breastfeeding coalition, network in my community, and take doula clients again.  I want to get my CBE certification so I can begin teaching childbirth classes. I want to get at least a CLC or other certification so I can work more with breastfeeding mothers.  I want to help get funding for our breastfeeding coalition that could possibly turn into a job.  There is so much more I want to do. 

Here’s hoping that the next 12 months are filled with new goals and accomplishments and less fear than this past year.

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As I look back on the past month I realize how fast time can pass especially when there is so much going on.  April came and went before I even had a chance to enjoy it.  May is hear and I’m excited about the 5th being recognized as the International Day of the Midwife (even here in Louisiana) as well as International Doula Month. 

I wanted to share a few pics on the two events I was able to attend to promote Cesarean Awareness Month for ICAN.  I’m still in the process of starting a chapter for North Louisiana and I am excited to know that there are others in my area who are willing to learn more and participate in spreading the word. 

NLMC Healthy Woman Anniversary Dinner

Head Start Resource Fair

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Although there are no practicing Midwives in North Louisiana, according to the Louisiana Association of Midwives Louisiana currently has twenty eight licensed midwives, twenty one of whom are Certified Nurse Midwives practicing in-hospital with board certified Obstetricians, and seven of whom are Certified Professional Midwives practicing out-of-hospital with Obstetrician backup. This year our Governor, Bobby Jindal, has declared May 5^th the International Day of the Midwife in Louisiana. There are several activities planned in South Louisiana to celebrate the hard work and dedication of Louisiana Midwives. You can go to the Louisiana Natural Birth and Louisiana Association of Midwives websites for more information.

My hope is by this time next year (and for years to come) North Louisiana will be able to celebrate along with our sisters to the south. The first step is to educate the public about the benefits of Midwives and raise awareness on the lack of access to birth choices in this area. Child bearing women and their families need to let their voices be heard! OBs in the area need to be open to working/collaborating with Midwives who wish to serve North Louisiana. We need to be doing everything possible to provide better maternity care and producing better outcomes for mothers and babies. As it stands North Louisiana has one of the highest Maternal and Infant Mortality rates in the country. We also have one of the lowest Breastfeeding rates. I believe if we had better access to holistic maternity and postpartum care our outcomes would improve dramatically. Our communities should be demanding better care and more choices for our families than the status quo.

Change is part of the reality of research, education, and evidence-based practices that are being implemented around the country. If our hospitals and OB practices are resistant to these changes then they are not doing what is in the best interest of our communities. Allowing women to birth the way they feel is best for them (including where and with whom they wish to birth) should be the primary focus of maternity care. Not every woman desires a medicated birth (induction, pain management, repeat C-section, etc) but if you are giving birth in the hospital (which is about 98% in this area) you have to fight almost every step of the way to have a mother/family centered birth and postpartum recovery. We need to do a better job of educating doctors, nurses, hospital administrations, etc on the benefits of natural and/or Midwife attended birth (in and out of the hospital).

It starts here.

Proclamation for International Day of the Midwife

WHEREAS, midwives have throughout time and in all nations provided healthcare to mothers, babies and their communities; and
WHEREAS, midwives offer pregnancy screening, prenatal care, childbirth education and counseling to pregnant women on health needs, pregnancy-related transitions, family relations and postpartum concerns; and
WHEREAS, midwives are dedicated to the care of pregnancy and birth and treat each woman’s pregnancy according to her unique physical and personal needs; and
WHEREAS, midwives provide a family-centered childbirth option that has grown in response to the choice of thousands of parents; and
WHEREAS, midwives offer to assist birthing women in a variety of settings according to what is appropriate, within hospitals, in freestanding birthing centers, and at home; and
WHEREAS, the World Health Organization and the Midwives Alliance of North America have noted the strong positive contribution midwifery care has on the health and well being of mothers and babies; now
THEREFOR, I, Bobby Jindal, Governor of the State of Louisiana, hereby proclaim May 5, 2010, as
INTERNATIONAL MIDWIVES’ DAY
and encourage the people of Louisiana to become better acquainted with the services offered by the midwives of our community and the contributions they make to the families of Louisiana.

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I’ve finally made the step to get a local ICAN chapter started for this area! I’ve been thinking about it for a long time now and really feel this is the right time. I’ve heard back from Ruthie Dicken and Lauren Cooper from ICAN and will be talking with them more in the coming week. I really feel that North Louisiana needs an ICAN chapter not only to help get the word out about issues surrounding maternity care, Cesarean prevention, VBAC, and everything in between but also to help women in this area who may be suffering from grief, anger, regret, or any other emotions from their Cesarean births.

We need to have a safe place for our mothers who may be struggling with their birth experience to vent, learn, and realize they are not alone. We get so caught up in our “Steel Magnolia” persona in the South that sometimes women forget that they have the right to be sad or disappointed in their birth experience. The “at least you have a healthy baby” mantra is echoed by just about everyone not realizing that it’s just as important to have a healthy mother.

I hope by bringing ICAN to this area women will feel they now have a voice and that a “sisterhood” of birth warriors will be formed around shared experiences.

The term “Steel Magnolia” may just take on a whole new meaning.

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I’m sitting here watching the
NIH Consensus Development Conference: Vaginal Birth After Cesarean: New Insights
From the NIH Website:

Background
Vaginal birth after cesarean (VBAC) is the delivery of a baby through the vagina after a previous cesarean delivery. For most of the 20th century, once a woman had undergone a cesarean (the delivery of a baby through an incision made in the abdominal wall and uterus), many clinicians believed that all of her future pregnancies required delivery by cesarean as well.

However, in 1980 a National Institutes of Health (NIH) Consensus Development Conference panel questioned the necessity of routine repeat cesarean deliveries and outlined situations in which VBAC could be considered. The option for a woman with a previous cesarean delivery to try to labor and deliver vaginally rather than plan a cesarean delivery was thus offered and exercised more often from the 1980s through the early 1990s. Since 1996, however, VBAC rates in the United States have consistently declined, while cesarean delivery rates have been steadily rising.

The exact causes of these shifts are not entirely understood. A frequently cited concern about VBAC is the possibility of uterine rupture during labor, because a cesarean delivery leaves a scar in the wall of the uterus at the incision site, which is weaker than other uterine tissue. Attempted VBAC may also be associated with endometritis (infection of the lining of the uterus), the need for a hysterectomy (removal of the uterus) or blood transfusion, as well as neurologic injury to the baby.

However, repeat cesarean delivery may also carry a risk of bleeding or hysterectomy, uterine infections, and respiratory problems for the newborn. Having multiple cesarean deliveries may also be associated with placental problems in future pregnancies. Other important considerations that may influence decision making include the number of previous cesarean deliveries a woman has experienced, the surgical incision used during previous cesarean delivery, the reason for the previous surgical delivery, her age, how far the pregnancy is along relative to her due date, and the size and position of her baby.

Given the complexity of this issue, a thorough examination of the relative balance of benefits and harms to mother and baby will be of immediate utility to practitioners and pregnant mothers in deciding upon a planned mode of delivery. A number of non-clinical factors are involved in this decision as well, and may be influencing the decline in VBAC rates. Some individual practitioners and hospitals in the U.S. have decreased or eliminated their use of VBAC.

Professional society guidelines may influence utilization rates because some medical centers do not offer the recommended supporting services for a trial of labor after cesarean (e.g., immediate availability of a surgeon who can perform a cesarean delivery and on-site anesthesiologists).

Information related to complications of an unsuccessful attempt at VBAC, medico-legal concerns, personal preferences of patients and clinicians, and insurance policies and economic considerations may all play a role in changing practice patterns. Improved understanding of the clinical risks and benefits, and how they interact with legal, ethical, and economic forces to shape provider and patient choices about VBAC may have important implications for health services planning.

To advance understanding of these important issues, the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Office of Medical Applications of Research of the NIH will convene a Consensus Development Conference from March 8–10, 2010. The conference will address the following key questions:

• What are the rates and patterns of utilization of trial of labor after prior cesarean, vaginal birth after cesarean, and repeat cesarean delivery in the United States?
• Among women who attempt a trial of labor after prior cesarean, what is the vaginal delivery rate and the factors that influence it?
• What are the short- and long-term benefits and harms to the mother of attempting trial of labor after prior cesarean versus elective repeat cesarean delivery, and what factors influence benefits and harms?
• What are the short- and long-term benefits and harms to the baby of maternal attempt at trial of labor after prior cesarean versus elective repeat cesarean delivery, and what factors influence benefits and harms?
• What are the nonmedical factors that influence the patterns and utilization of trial of labor after prior cesarean?
• What are the critical gaps in the evidence for decision-making, and what are the priority investigations needed to address these gaps?

Invited experts will present information pertinent to the posed questions and a systematic literature review prepared under contract with the Agency for Healthcare Research and Quality (AHRQ) will be summarized. Conference attendees will have ample time to ask questions and provide comments during open discussion periods. After weighing the scientific evidence, an unbiased, independent panel will prepare and present a consensus statement addressing the key conference questions.

I’m excited about the findings and presenting the consensus statement to ANYONE and EVERYONE associated with birth in North Louisiana. VBAC should be encouraged and supported over repeat C-section for women who are seeking one. Women should be given the opportunity of informed choice when it comes to the way they want to birth their children.
More to come as the conference progresses.

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Two very important press releases by: The Big Push for Midwives were issued this week. One dealt close to home with a bill in Mississippi that was killed after many concerned calls to the MS Legislature (a bill that would have made it nearly impossible to practice as a midwife) and another citing a report by the CDC that showed an increase in Out of Hospital (OOH) births on the rise even before the release of Ricki Lake’s documentary The Business of Being Born in 2008.

Below are the findings and statements issued by The Big Push for Midwives.

Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. ~ Margaret Mead

CDC Report: Demand for Out-of-Hospital Midwife Births Sharply Increases
Research Debunks Physician Group Claims that Actress Ricki Lake is Responsible for Rise in Out-of-Hospital Births

Envisioning a safer, less-costly model of maternity care in the United States.
Advocates oppose bill to regulate Mississippi midwives
THE ASSOCIATED PRESS • MARCH 1, 2010
http://tinyurl.com/yj5w9n4
From an email recieved from Susan Jenkins forwarded to her by Katherine Prown. Both are representatives from The Big Push For Midwives.

For all of you who have expressed interest in what was happening in Mississippi, or who otherwise care about licensing midwives, here’s a message from Katie Prown, Campaign Manager of the Big Push for Midwives Campaign, attaching a newspaper article with up-to-date information. Please note how effective an onslaught of phone calls to a legislature can be as well as the importance of creating relationships with the press, both of which the Big Push has been working on.
Best regards, Susan

What happened in Mississippi last week is a fantastic example of how much The Big Push for Midwives media outreach campaign is paying off in returns! The Associated Press is one of the outlets we’ve been consistently sending our press releases to and following up with, building relationships that culminated in a phone call to me when one of their reporters learned of the bill to restrict midwifery practice to nurse-midwives, thereby outlawing all other midwives in the state, as well as midwives from LA, TN and AL with practices in MS.

MS has so long been considered a “safe” state that no one has been keeping an eye on the legislature there. Had it not been for that phone call, it’s highly unlikely we would have learned about the bill until after it passed. Needless to say, this bill—which had sailed through the House and was on the fast track in the Senate until we caught wind of it—would have been disastrous for mothers and midwives in MS. Thanks to quick mobilization and the amazing powers of social networking, we dodged a bullet, so everyone who helped with this effort deserves many thanks.

Even better, advocates in MS not only organized quickly once our Push Alert went viral, but they’re building on the momentum to push for a substitute amendment to replace the bad bill with a good one and will come back next year should that effort fail. And they’ve definitely made an impression. The author of the bill, Rep. Holland, told one of the callers to his office that in all his years at the state house, he had never heard “such a ruckus” over a bill before. So nice work, everyone! And if you have a few minutes, click on the link and post a comment.

Many thanks! Katie
Katherine Prown, PhD | Campaign Manager | TheBigPushForMidwives.org | 414.550.8025

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After an amazing 2 days at the CIMS forum in Austin, TX I am more determined than ever to do whatever it takes to make significant changes to our maternity care system in North Louisiana. As I put the final touches on the rest of my website I am anxious and excited to start really promoting “normal birth” in my area. I already have the support of at least one OB/GYN and several other organizations. I have made contact with at least 2 more doulas although one is 35 miles away and the other 70 miles away but it’s a start. I hope that in the next year I will be able to recruit and train a few more doulas for this area. My “big picture” goal is to recruit and train midwives for this area. As it stands now this is what it looks like for the state of Louisiana and licensed midwives and it’s just not acceptable!

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 As a birth advocate I am saddened  that women have such limited choices in the way they are able to give birth in my area.  There are no licensed midwives, only a handful of doulas, and no birth centers.

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