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Midwives Alliance of North America (MANA) Invites You to Research Home Birth!

October 31st, 2013 by avatar

This past weekend I attended the Midwives Alliance of North America (MANA) annual conference; Birthing Social Change in Portland, OR. The conference was attended by more than 300 midwives and their supporters. I thoroughly enjoyed the variety of general sessions and the concurrents I attended. Eugene DeClerq, (did you know he is an LCCE!) a principal investigator on the Listening to Mothers project and the genius behind the Birth by the Numbers website, was brilliant as usual in sharing all kinds of data about the state of birth in the USA. Another keynote speaker, Melissa Cheyney, PhD, CPM, LDM, Division of Research Chairperson for MANA, provided members with an update on the MANA Stats Project. The MANA Stats Project is a multi-year registry collecting data mostly about out-of-hospital births, though some Certified Nurse Midwives are using it for tracking both home and hospital births as well.

At the conference, two much-anticipated research studies were announced. You can learn more about the articles and MANA stats in a recent post at the MANA blog here. Science & Sensibility is looking forward to sharing a review and information about these studies with you here on our blog in the early part of next year, when they are released in the Jan/Feb 2014 issue of the Journal of Midwifery and Women’s Health.

The MANA Stats registry is currently collecting more than 1,000 records per month, mostly from midwives who attend out of hospital births in the United States. The first set of records – representing more than 20,000 births – is currently available to researchers. According to Melissa Cheyney, “These datasets include some of the only U.S. data that exists regarding physiologic, low-intervention labor and birth — data that are becoming more and more rare due to the increase in “routine” interventions in the hospital setting.”

As the data set grows and more records are added, the power and possibility of exploring information contained gets even more exciting. Did you know that the data is being made available to researchers interested in conducting some analysis? Could this be you? Professionals may think that they need to be affiliated with a large research institution, but that is not the case.

All researchers applying for the data are required to have what’s known as “IRB approval,” meaning an academic institution willing and able to ensure that the research design appropriately protects the subjects’ confidentiality. However, MANA has a unique program in place that allows non-academic researchers to access the data. The program connects mothers, advocates, and others interested in research with researchers that can provide support and mentorship. You can learn more about this program – called “ConnectMe” – here 

It would be wonderful if a Lamaze Certified Childbirth Educator with the skill and abilities to do some analysis joined forces with researchers through the “ConnectMe” program and this information could be published in a professional journal! The possibilities are endless. Do you think this could be you?

It was interesting and exciting to spend time with all the midwives who are working every day to to help women and babies experience safe, healthy births and are practicing the Lamaze International Six Healthy Birth Practices that we know leads to better birth outcomes.

For more information for researchers to learn more about the dataset and how to apply, click here.

Childbirth Education, Evidence Based Medicine, Healthy Birth Practices, Healthy Care Practices, Home Birth, Midwifery, New Research, Research, Research Opportunities , , , , , , , , ,

How What We Know About Midwifery Can Change Breastfeeding For All Families

August 6th, 2013 by avatar

As World Breastfeeding Week continues, the role of the midwife in promoting and facilitating breastfeeding for new mothers is examined. Midwifery clients and their babies exceed national breastfeeding rates compared to the general population and our authors today, Jill Breen, Jeanette McCulloch and Lauren Korfine take a look at some of the reasons behind this boost. – Sharon Muza, Community Manager, Science & Sensibility

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By, Jill Breen, CPM, President, Midwives Alliance (MANA), Jeanette McCulloch, IBCLC, Board Member, Citizens for Midwifery and Lauren Korfine, PhD, Citizens for Midwifery

© Luna Maya Birth Center (Cris Alonso)

As we honor World Breastfeeding Week, those of us who deliver or receive midwifery care have much to celebrate. In every study we can identify, midwifery care increases the likelihood that a woman will initiate breastfeeding (Hatem, Sandall, Devane, Soltani & Gates, 2008). Even with national breastfeeding initiation rates at a recent high of 77% (Centers for Disease Control and Prevention [CDC], 2013), depending on the setting, the rates of initiation and ongoing breastfeeding for women under the care of midwives well exceed national averages.

Preliminary data from a sample of more than 24,000 home and birth center births attended by midwives showed remarkable breastfeeding rates. Less than one percent of all mothers never breastfed. Eighty-five percent were exclusively breastfeeding through to the final postpartum visit, which is typically at the six week mark. A full 97% were at least partially breastfeeding at six weeks (Cheyney, 2012).

Benchmarking data that tracks breastfeeding initiation rates for families receiving care from certified midwives and certified nurse midwives showed significantly higher rates than those whose care was provided by an OB: 78.6% as compared to 51% at the time the report was compiled (American College of Nurse Midwives [ACNM], 2012).

What is it about midwifery care that helps women achieve rates of breastfeeding that meet or exceed the Healthy People 2020 objectives. And most importantly, how can we replicate these important factors in all settings, and with all types of providers?

Education

Research tells us that prenatal breastfeeding education significantly impacts breastfeeding success, either one-on-one or in a group (de Oliveira, Camacho & Tedstone, 2001). Midwifery care typically includes a strong prenatal education component, which includes discussions of infant feeding. CenteringPregnancy®, relatively new model of midwife-led prenatal care in a group setting, including breastfeeding education, has been highly successful (ACNM, 2012) and could be replicated in many settings. In addition, one key aspect of the homebirth model – significant one-on-one time spent prenatally – ensures a woman’s breastfeeding goals and preferences are aligned with education she receives before the birth (Midwives Alliance of North America [MANA], 2012).

Providing high-quality breastfeeding education as a regular, expected part of prenatal care, (either individually or in a group) – as it is with midwifery care – could significantly increase breastfeeding success.

Birth practices

A substantial body of research illustrates that, without a doubt, birth practices can greatly impact breastfeeding success. In their second edition book on the connections between birth and breastfeeding, Linda Smith and Mary Kroeger (2009) outline a number of birth practices that impact a mother’s ability to reach her breastfeeding goals. According to Smith & Kroeger: 

 “Solid scientific evidence shows that minimizing interventions in birth and policies that preserve normalcy are associated with faster, easier births; healthier, more active and alert mothers and newborns; and mother-baby pairs physiologically optimally ready to breastfeed.” (p. 24)

A growing body of research shows that skilled midwifery care, including home and birth center birth, is as safe for babies as hospital settings and results in lower interventions for mothers in low risk births (Vedam, Schummers, Stoll & Fulton, 2012). The significance of the lower intervention rate appears to be about more than the health and wellbeing of the mother, or her birth satisfaction. A mother-baby pair with fewer birth interventions appear to be more likely to establish successful breastfeeding. This makes reducing birth interventions an essential public health goal.

Reduced interventions are possible in all settings with all providers, not just under the care of midwives. The CIMS model of mother-friendly care outlines clear steps a birthing facility can take to ensure mother-friendly (i.e., low-intervention) maternity care (Coalition for Improving Maternity Services, 1996). These steps would not only improve birth outcomes and reduce costs, but would also likely increase breastfeeding rates. 

Ongoing support

With a drop of more than 25 percentage points between breastfeeding initiation and those breastfeeding at six months in the United States (CDC, 2013), part of what families lack is ongoing breastfeeding support. Notably, the CDC Breastfeeding Report Card included two new indicators this year – rates of skin-to-skin contact after a vaginal birth and rooming in at least 23 hours of a postpartum hospital stay (CDC, 2013). These indicators were chosen specifically because of the positive impact these practices have on breastfeeding rates.

Only 54% of babies born in the US are skin-to-skin in the first hour after a vaginal birth, although up from 41% in 2007 (CDC, 2013). This is in sharp contrast to what the overwhelming majority of mothers experience in the care of midwives. As described in the Midwives Alliance position paper on homebirth;

“Nursing the newborn in the first hours is undisturbed in the homebirth setting. Motherbaby closeness, motivation, encouragement, and knowledgeable guidance contribute to high success rates of breast-feeding for home birth families.” (MANA, 2012)

Typical breastfeeding support provided by a midwife extends well past the first 24 hours of life. Although we are unaware of research that supports this, anecdotal evidence suggests that the continuity a midwife provides in the first six weeks plays a large role. For example, one midwife describes her approach: “After birth we wait for self attachment, encourage skin to skin. But when a woman has trouble, I always start my conversation with, ‘What is it you want? What is your goal in breastfeeding?’” says Treesa Mclean, LM, CPM, a midwife based in California. “Then we make 24 hour plans. My role is listening to the mom, making a plan they like and meeting them where they are.” Midwifery care often extends past the typical 3 day and 6 week visit, with additional follow-up when needed to ensure breastfeeding is well-established. 

These practices – support in the early days through basic practices like skin-to-skin contact, maintaining proximity between a newborn and nursing parent, and providing a continuity of breastfeeding support – are all enjoyed by families who employ the care of a midwife. However, there is nothing in the midwifery model of care that is unique to these practices. Any provider – from home birth providers to hospital based OBs – can employ all or nearly all of these strategies, except in unique circumstances. We hope that all providers can learn from and replicate the practices of midwifery, with the goal of ensuring improved breastfeeding outcomes for all families.

 References

American College of Nurse-Midwives [ACNM]. (2012). Midwifery: Evidence-Based Practice. A Summary of Research on Midwifery Practice in the United States. Retrieved from  http://www.midwife.org/ACNM/files/ccLibraryFiles/Filename/000000002128/Midwifery%20Evidence-based%20Practice%20Issue%20Brief%20FINALMAY%202012.pdf

Centers for Disease Control and Prevention [CDC]. (2013). Breastfeeding Report Card: United States/ 2013. Retrieved from http://www.cdc.gov/breastfeeding/pdf/2013BreastfeedingReportCard.pdf.

Cheyney, M. (2012). “Research updates.” Conference presentation at the 2012 Annual Conference of the the Midwives Alliance of North America.

Coalition for Improving Maternity Services. (1996). “Mother-Friendly Childbirth Initiative.” Retrieved from http://www.motherfriendly.org/MFCI

de Oliveira, M. I. C., Camacho, L. A. B., & Tedstone, A. E. (2001). Extending breastfeeding duration through primary care: A systematic review of prenatal and postnatal interventions. J Human Lact17(4):326-343.

Hatem, M., Sandall, J., Devane, D., Soltani, H., & Gates, S. (2008). Midwife-led versus other models of care for childbearing women. Cochrane Database of Systematic Reviews, 2008(4). doi:10.1002/14651858.CD004667.pub2.

Midwives Alliance of North America [MANA]. (2012). Homebirth Position Paper. Retrieved from http://mana.org/sites/default/files/MANAHomebirthPositionPaper.pdf

Smith, L. J., & Kroeger, M. (2009). Impact of Birthing Practices on Breastfeeding, 2nd ed. Sudbury, MA: Jones and Bartlett Publishers.

Vedam, S., Schummers, L., Stoll, K., & Fulton, C. (2012). Home birth: An annotated guide to the literature. Retrieved from http://mana.org/research/homebirth-safety

About the Authors

© Jill Breen

Jill Breen, CPM, has been a homebirth midwife for over 35 years. She is the mother of 6 homeborn children and has 7 grandchildren, all born into the hands of midwives, including her own! She is the president of the Midwives Alliance of North America (www.mana.org).

 

 

 

© Lauren Korfine

Lauren Korfine, PhD is a mother of three, and she works as a doula, community educator, and consumer advocate. Prior to having children, she was a lecturer in psychology and women’s studies. She is a founding member of BirthNet of the Finger Lakes, a consumer advocacy and education organization. Lauren analyzes research and writes for Citizens for Midwifery. She received her degrees from Cornell and Harvard Universities, but her education from her three children. She lives with her family in Ithaca, New York.

© Jeanette McCulloch

Jeanette McCulloch, IBCLC, is the co-founder of BirthSwell and a true believer in the power of communications to create change. She is a board member at Citizens for Midwifery and the mother of two children, born with the love and support of midwives.

Babies, Breastfeeding, Childbirth Education, Evidence Based Medicine, Guest Posts, Healthy Birth Practices, Healthy Care Practices, Home Birth, Infant Attachment, Maternity Care, Midwifery, Newborns, Uncategorized , , , , , , , , ,

MANA Response to Recent AAP Home Birth Statement: High-quality out-of-hospital newborn and postpartum care is standard for midwives

May 2nd, 2013 by avatar

By Geradine Simkins, CNM, MSN, Executive Director of Midwives Alliance of North America

This week, the American Academy of Pediatrics released a policy statement on home birth. While the statement affirmed “the right of women to make a medically informed decision about delivery”, many advocates expressed concerns. The statement failed to recognize Certified Professional Midwives, the providers most likely to attend a home birth in the United States. In this response, the Midwives Alliance of North America helps families, providers, and policy makers understand the critical role CPMs play in safe, healthy birth options. – Sharon Muza, Community Manager, Science & Sensibility

High-quality out-of-hospital newborn and postpartum care is standard for midwives

 

© http://flic.kr/p/8d52Qc

The Midwives Alliance of North America welcomes the primary concept communicated in the American Academy of Pediatrics’ April 24, 2013, policy statement entitled “Planned Home Birth.” As should be expected, AAP reminds its practitioners that newborn infants—regardless of the setting in which they are born—deserve an equal and unbiased, high-quality standard of care. The Midwives Alliance joins with AAP in affirming the need for a collaborative and integrated maternity care system that addresses the needs of all mothers and infants, regardless of the provider type or birth setting a woman chooses.

We are disappointed, however, in AAP’s decision to align with the American Congress of Obstetrics and Gynecologists’ policy on home birth. Serving the needs of the growing number of families choosing to birth at home, Certified Professional Midwives attend the majority of intended home births in the U.S., when a skilled attendant is present, making them the primary care providers for newborns in the home setting.

Certified Professional Midwives are skilled maternity care providers

AAP’s itemized recommendations for infant and newborn care, contained in their policy statement, are standard practice for credentialed midwives. In that respect, we find much with which we agree. These standard newborn exams, screens, and preventative care practices are wholly part of a credentialed midwife’s scope of practice, and further endorsed by individual state health departments. We also note that as AAP Neonatal Resuscitation Program certificate holders (required for certification and recertification), credentialed midwives follow guidelines laid out in AAP’s recommendations, and typically surpass those standard recommendations by having at least two NRP- and CPR-trained attendants at out-of-hospital births.

In fact, the AAP’s guidelines for the care of infants intentionally born at home parallel those standards practiced by trained midwives in all birth settings. The practices listed—such as working medical equipment, emergency plans of transfer, thorough newborn exams, and so forth—are professional standards exhibited and documented by credentialed midwives, regardless of the place of birth.

The AAP policy statement, however, did not recognize or acknowledge Certified Professional Midwives (CPM), indicating that AAP may not have a thorough understanding of the training, skills, knowledge, and abilities of this country’s primary maternity care provider for infants born out of the hospital. The Certified Professional Midwife is the only national midwifery credential that requires practitioners to be trained specifically to provide prenatal, intrapartum, and postnatal care in out-of-hospital settings. CPMs are knowledgeable, expert and independent midwifery practitioners who have met the standards for certification set by the North American Registry of Midwives (NARM). NARM is accredited by the National Commission for Certifying Agencies (NCCA) to issue the professional credential of Certified Professional Midwife, which is the same agency that accredits the American Midwifery Certification Board to issue the professional credentials of Certified-Nurse Midwife, and Certified Midwife.  

Midwives are the providers of choice for out-of-hospital births, whether they occur at home or in freestanding birth centers. Offered since 1994, the CPM is currently the basis for licensure in 27 states while 11 additional states are actively seeking CPM licensure. In fact, one in nine newly certified midwives in the U.S. are Certified Professional Midwives.  

The AAP policy statement endorses birth center maternity care, which is another area in which we are in agreement. Recent numbers from the American Association of Birth Centers (AABC) indicate that a significant proportion of accredited birth centers are owned and operated by Certified Professional Midwives. A January 2013 study, The National Birth Center Study II , conducted by AABC and published in the Journal of Midwifery & Women’s Health, the official journal of the American College of Nurse-Midwives (ACNM), highlights the benefits for women who seek care at midwife-led birth centers. Findings also reinforce longstanding evidence that providers at midwife-led birth centers provide safe and effective health care for women during pregnancy, labor, birth, and the postpartum period.  

Midwives provide high-quality care that meets both national and international guidelines 

In highlighting the ethic of high-quality care for all infants across the spectrum—regardless of the site of birth—it should be noted that Certified Professional Midwives provide care intentionally similar to that of nurse-midwives and physicians. Yet we also know that CPMs are able to offer additional and valued care in terms of frequency of home visits and intense monitoring of newborns in their homes in the first weeks of life—a benefit not normally conferred to women and babies who have experienced hospital births.

This high-quality midwifery care includes routine newborn APGAR assessments, comprehensive head-to-toe physical examinations, measurements of length, head, abdomen and birth weight, monitoring vital signs including thermoregulation, assessment of respiratory sounds and patterns, assessments of cardiac sounds and peripheral pulses, assessment of gestational age and physical maturity, neuromuscular assessments, and assistance with initiation and ongoing assessment of breastfeeding. All findings are recorded in patient records and shared with mothers, per professional standards.

In addition, CPMs provide newborns with Vitamin K treatment, antibiotic eye ointment, umbilical cord care, metabolic newborn screening, glucose and bilirubin testing as indicated, and either perform Otoacoustic Emissions (OAE) hearing screens or refer to area audiologists. Midwives in a number of states are moving toward, or already offering, pulse-oximetry screening for Critical Congenital Heart Defects (CCHD) per AAP guidelines, in advance of many hospital systems. In the rare cases when newborns require consultation or referral, infants are transferred to the tertiary care system, and pediatricians where available, for active management.

Not only do Certified Professional Midwives and Certified Nurse-Midwives who attend home births provide the level of care outlined by the AAP, they provide it in a personalized, woman-centered, family-centered, culturally competent, and individualized manner that is qualitatively different from the customary assembly-line postpartum care commonly experienced in U.S. hospitals.

For example, in a home birth setting, the midwife typically conducts the initial newborn exam in the presence of the mother and family, which does not disrupt the crucial process of mother-infant bonding and breastfeeding, and is focused on being instructive to the family. Midwives provide holistic care to the mother-baby dyad in concordance with World Health Organization’s Baby-Friendly best practices.

As a way of illustrating important differences in care practices, we can point to the recent Breastfeeding Report Card issued by the CDC (2012) that indicates only six percent of U.S. hospitals are offering care that aligns with the international best practices outlined by Healthy People 2020.   By contrast in a 2005 study, 95% of babies born at home under the care of Certified Professional Midwives were exclusively breastfeeding at six weeks of age (Johnson & Daviss, 2005). This is just one area where midwives are well-trained, skilled, and uniquely positioned to help families succeed.

An opportunity for collaboration and integrated care 

Physician conversations about home birth and midwife-led birth will be better informed and more useful to maternity care consumers if AAP is able to become more cognizant of important changes in the landscape of U.S. midwifery. 

The release of the AAP policy statement on care of newborns born at home is an opportunity to reinforce the need for professional and seamless collaboration with members of community health care teams. We view this statement’s release as an opportunity to align best practices for all parties who care for and support families choosing home birth.

The Midwives Alliance stands ready to work with other pediatric and maternity care providers to establish best practices in the postpartum period to not merely provide the basic level of care in the first hours, days and weeks of life for the newborn as outlined in the latest AAP statement, but to elevate that standard to include support for breastfeeding and the personal attention that can prevent infant death and improve maternal and child health.  Babies born in all settings deserve this kind of care.

About Geradine Simkins

Geradine Simkins, CNM, MSN is an activist, midwife and author. She began as a direct-entry home birth midwife in 1976 and became a nurse-midwife twenty years later. For over thirty years she has provided health care for women, infants and families in a variety of settings, including attendance at births in the home, a freestanding birth center, and hospitals. Geradine’s work with migrant farmworkers and American Indian tribes focuses on addressing health care disparities and engendering a more equitable maternity care system for all women and infants.  Geradine is currently the Executive Director of Midwives Alliance of North America, a professional organization that promotes excellence in midwifery and is dedicated to unifying and strengthening the profession, thereby increasing access to quality health care and improving outcomes for women, babies and their families. She is the editor of the recently published book entitled Into These Hands: Wisdom from Midwives, an anthology of the life stories of 25 remarkable women who have dedicated their lives and careers to the path of midwifery and social change.  More info about Geraldine Simkins can be found here.

ACOG, American Academy of Pediatrics, Babies, Delayed Cord Clamping, Home Birth, informed Consent, Maternity Care, Midwifery, Transforming Maternity Care , , , , , , , , , ,

Book Review: The Essential Homebirth Guide: For Families Planning or Considering Birthing at Home

February 12th, 2013 by avatar

“Our goal is not to have every mother birth at home—our goal is to encourage parents to gather quality information, to gain exposure to a philosophy that screams trust in mothers and trust in babies, and to provide parents who do plan a homebirth to be well equipped with an understanding of how to thrive in that decision.” – Jane E. Drichta, CPM and Jodilyn Owen, CPM, authors of The Essential Homebirth Guide: For Families Planning or Considering Birthing at Home.

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The Essential Homebirth Guide: For Families Planning or Considering Birthing at Home by midwives Jane E. Drichta, CPM and Jodilyn Owen, CPM  is a new book on the birth scene, being released today both in print and as an e-book.  I had an opportunity to read an advanced copy and and will share my thoughts with Science & Sensibility readers in this review.

The Essential Homebirth Guide is a book that is long overdue and will be welcomed by consumers and healthcare providers alike. With the recent National Birth Center Study II  released last month, many women and their families may now be considering an out of hospital (OOH) birth.  Some areas of the US offer the opportunity to birth in a birth center, while other parts of the country have no birth centers available at all and homebirth is the only OOH option.  Even where birth centers are available, women in greater numbers are now considering birthing in their own homes, with midwives, for many reasons, including comfort, cost and choosing a location where they feel they have the best chance to achieve a low intervention birth.

Sitting down to read Drichta and Owen’s guide is like spending a long weekend with your very best friend.  A best friend who just happens to be a midwife.  Whether you are just starting to explore the idea of a homebirth or have already decided that homebirth is for you, you will find that all your questions get answered in an easy to understand, factual way, with all the details and inside information that only your best friend can provide.  Drichta and Owen even provide answers to the questions you hadn’t thought of yet, but would want to know if you choose to homebirth, such as the section on communicating your homebirth choices with friends and family.

The book is arranged into chapters, and then subtopics.  Each subtopic has a nice Q&A format, with all the major questions covered in easy to understand language.  Peppered amongst the topics are real life stories and musing submitted by homebirthing women and their families, as well as special “The Midwife Says:” sections that provide additional information.  The personal stories offer a peek into the thoughts and experiences of homebirthing women, and readers will feel comforted by their stories. References are included for each chapter, and there are several hearty appendices at the back for more information. Lovely black and white pictures are scattered throughout.

One of the things that I loved best in The Essential Homebirth Guide is how the authors use every opportunity to speak to the mother, helping to develop her self-determination.  Throughout the book, they reinforce that every mother knows both her body and her baby best.  Women who read this book will feel confident that they are (or should be) equal partners in their care with their healthcare provider and are capable of asking questions, gathering information and making decisions that feel right to them.

“…A lot happens between the time of conception and diapers, and it all matters.  It will affect you.  It will change you.  It will propel you into motherhood in a profound way and can leave you with feelings of power, health, and peace, or it may leave you with feelings of anxiety, fear, and even trauma.  What kind of emotional context do you want as you become a new mother? What kind of new mother do you aim to be?  Think about these questions first, and then start building your prenatal care to lead yourself down the road that ends with you – the kind of new mother you intend to become in the kind of health you strive to have…” The Essential Homebirth Guide

Jodlilyn Owen, CPM

Chapters on interviewing and choosing a midwife, what to expect during your prenatal care, prenatal testing options, information on the top ten pregnancy issues, preparing to birth at home, and what to expect after the birth all provide details on what normally occurs and include topics that can be discussed with your midwife along with things you can do to keep yourself healthy and low risk. In fact, this book is useful for any pregnant woman, as it will help facilitate conversations with hospital based healthcare providers, to help the woman who has chosen to birth in the hospital avoid unnecessary interventions. 

Drichta and Owen tackle some controversial subjects such as homebirth after a cesarean, home breech birth and homebirth of twins. No doubt, everyone’s comfort level is different and women (and their healthcare providers) process and understand risk in very individual ways.  These situations may not be for everyone, but the authors don’t ignore that these birth situations are occurring at home all around the country.  Information is power, mothers, when given accurate information in a respectful manner, will be able to determine what feels like the right decision for them.

I would have appreciated more information in the book on how low income families and women of color might find their way to homebirth in today’s maternity care climate, as the increase in homebirths has not been observed amongst those populations. Where I live, in the state of Washington, almost half of our births are paid for by the state, and we are fortunate that homebirth is an option for those families receiving state aid.  That is not the case for most of the rest of the country.

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I had the opportunity to ask Jane Drichta and Jodilyn Owen some questions about their book, and wanted to share my interview with Science & Sensibility readers.

SM: Why did you want to write this book, and why now? 

JO: This book has been running around in circles inside of our heads for years.  We make it a habit to check in with each other after most births, and so there are at least a decade of late night conversations here.  As we talked, we realized that we were running into the same problem; there was not one definitive source of information for homebirthing families.  We had websites and articles and handouts, but not one place where we could send parents for unbiased, evidence based information, served up with sides of common sense and love. Homebirth is becoming more and more popular, and the time just seemed to be right. 

SM:  What was the most challenging topic for you to cover in the book? How did you handle it? 

JD: The chapter on The Big Ten, which details ten common complications in pregnancy, was difficult to write.  We are used to speaking around these topics in very technical terms, and it was difficult to distill the information down to what mothers needed to know.  We were more interested in providing a model for how we approach these issues that any woman can adapt to her situation than being prescriptive about what one must absolutely do in a given situation.  When we started that chapter, it sounded like we were writing a term paper.  We completely lost the friendly, accessible tone that we were going for.  So that was a challenge.   

SM: What is the main piece of information that you hope that women will know/take away after finishing your book?

Jane E. Drichta, CPM

JD:  That they can do this.  That birthing at home is a viable option in 21st century America. That the desire to do this doesn’t mean you are crazy or hate the patriarchy, or that any of the other homebirthing stereotypes apply.  Women can birth at home more safely than ever before, and it is a real alternative for most women.

SM: What challenges do you see facing the potential growth of homebirths in the US?

JO:  The integration of homebirth midwives into our current health care system.  The politics around midwifery and its place in the system are myriad, and not something that we wanted to get into in the book.  However, we do support the right of women to birth in the place of their choice, with the provider of their choice, and that is sometimes difficult and can be limiting.

SM: If midwives and doctors read this book, what do you hope they take away from it?

JO: We hope they take away a few key points:  That mothers and partners should be held responsible to seek information and share decision making in their care, that a pregnant and birthing woman is in partnership with her baby and this dyad perspective should be promoted at all times with the language and behavior providers use, and that a woman is never just her numbers—she is a whole human being with a context worthy of their curiosity and respect.  

SM: How can childbirth educators use this book with their students?

JD: Simply presenting this paradigm of woman-centered, individualized, continuous care is a great way to open the door for discussions about creating intention for pregnancy and birth.   What is it that parents really mean to establish for themselves when it comes to their care and birth?  Understanding risk, breaking apart decision-making models, and tuning in to their inner-wisdom are just some of the great tools that educators can work through.

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I wanted to see what the authors had to say about childbirth classes for women considering homebirth and was delighted to find that they encourage all women to take classes and hold Lamaze International and our Healthy Birth Practices in high esteem.  ”We can’t find anything not to love here” is found in the childbirth class section under the Lamaze heading..

Overall, I really enjoyed reading this book and found it to be an easy read and full of information that I would find useful if I was still deciding where to birth or had already made up my mind to birth at home.  I could also see myself referring back to this as my birth got closer.  This book acknowledges that I am the best person to make this very personal decision about where to birth my baby. I think that healthcare providers who offer OOH birth services might want a few copies on their bookshelves to lend to potential and current clients, and childbirth educators might very well recommend this resource to parents in their classes who want to know more about what a home birth might be like.

Please consider coming back to the blog and sharing your thoughts after reading the book.  I would love to know what you think and if you would recommend this to clients and students.  If you would like to contact the authors, they can be reached through their website Essential Midwifery.

Disclosure: The authors of this book and I are all members of the professional birth community in Seattle, WA.  I have known them on a professional and personal level long before this book was even conceived.

Book Reviews, Childbirth Education, Evidence Based Medicine, Healthy Birth Practices, Healthy Care Practices, Home Birth, Maternal Quality Improvement, Maternity Care, Midwifery , , , , , , , , , , ,

Series: Welcoming All Families; Working with Gender Variant (Transgendered) Families

January 24th, 2013 by avatar

In the occasional series on Welcoming All Families, we have explored how to make our classes and practices welcoming for women of size and lesbians.  Today on Science & Sensibility, Certified Nurse Midwife Simon Adriane Ellis shares how to offer care and classes that are sensitive to gender variant families. Recently the American College of Nurse-Midwives (ACNM) released a position statement on Transgender/Transexual/Gender Variant Health Care. The ACNM stated that they “support efforts to provide transgender, transsexual, and gender variant individuals with access to safe, comprehensive, culturally competent health care and therefore endorses the 2011 World Professional Association for Transgender Health (WPATH) Standards of Care.”  Simon Ellis served on the task force and played a significant role in writing and advocating for this recently released position paper and worked with ACNM to see it through Board of Director approval in December 2012. – Sharon Muza, Science & Sensibility Community Manager

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Note: The term “gender variant” is used throughout this post to describe individuals whose gender identity is in some way different than the sex they were assigned at birth. Other related words you may have heard before include transgender, gender non-conforming, and gender non-binary. In this post, I specifically address the needs of gender variant people who undertake pregnancy. The needs of gender variant partners and family members also warrant deep consideration, but will not be the focus of this piece. 

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When asked, many birth professionals will tell you that they’ve never cared for a gender variant patient. Many of us claim that we don’t have the skills or the knowledge to do so. Turns out we’re usually wrong, on two fronts. First, chances are many of us have served gender variant people, without knowing it. And second, we are competent, compassionate, and well-trained professionals who already have what we need to provide excellent care and services to our gender variant patients. This post will provide a basic framework for approaching care, as well as some specific resources and suggestions to make your practice more inviting. I write it from both my perspective as a practicing Certified Nurse Midwife, and my perspective as a gender variant person (female-to-male).

Focus on What You Bring to the Table

We all bring ourselves – rich in beauty and flaws and experience – to each client encounter. We are our own building blocks of clinical or professional practice. Accordingly, when striving to provide care or services across difference, the first place to start is within ourselves. What do we bring? Among other things, we bring skills and biases.

Skills

As professionals who serve families in pregnancy and birth, the core of what we provide is compassion; we are incredibly dexterous at meeting people where they are at. We offer a strong and loving presence even in the intense terrain of labor, which takes a whole lot of humanity and skill. This is your number one asset for providing culturally responsive care to gender variant patients and clients. So keep doing what you do best! 

Biases

If someone asks you why you choose to do birth work, what do you say? Many of us would say that we are passionate about serving women, that we value women’s bodies and autonomy and we honor the journey to motherhood. Which is fantastic! We should! But what if your pregnant client doesn’t happen to identify as a woman? Does that change anything about the importance of their journey to parenthood? Does it make their birth experience less authentic and worthy of support? Of course not. Birth is birth, regardless of gender identity. And birth is our specialty. But many of us have a very hard time imagining pregnancy outside the concept of “woman,” which casts doubt on gender variant people who choose to carry a pregnancy. Being aware of and challenging your own biases and personal attachments to the concept of gender will help you prepare yourself for working with a more diverse client base. 

Don’t Pass the Buck

It is convenient to fall back on the idea that we, as birth professionals, are only trained to work with women and therefore are simply not qualified to work with gender variant people. In saying this, we falsely join two separate concepts – sex and gender – and we falsely absolve ourselves from responsibility. The urge to refer clients/patients to “someone who has more experience” is strong; often, it is grounded in sincere concern for the client’s wellbeing. But the truth is: with very few exceptions, there is no one with more experience.

In my work with gender variant parents, every single one of their doulas, childbirth educators, midwives, and OBs stated they had never before worked with a gender variant patient. There was no research these providers could review on the physical and emotional health needs of this population, no information on best practices. Each provider had to rely on the skills and knowledge base they already had, and do the best they could. And with compassion and clinical/professional acumen as their guide, it turns out they usually did an awesome job. The lesson to take from this is that 1) you are capable of doing a good job, and 2) a suggestion that the patient see “someone who has more experience” is usually little more than a referral to nowhere. 

Make Your Practice More Inviting

While there is no simple list of do’s and don’ts that you can follow (and the golden rule is, as always, to cater your approach to the needs of the specific client), I do think there are some basic principles that can be helpful in adapting your practice to meet the needs of gender variant patients and clients.

1. Build trust and offer accommodations

Fear of discrimination by providers and fellow patients or class participants presents a huge barrier to care for gender variant people. It is a source of great emotional and physiological stress. I can tell you that it is truly a terrible feeling. Take time to build trust, and to assess your client’s need for accommodations. Some clients will desire as much anonymity as possible, in which case you can offer one-on-one class sessions or facility tours, appointments at the beginning or end of the clinic day, assurances of privacy, and continuity of care. Other clients will desire facilitated integration, in which case you can offer assurance that you will address problems proactively, be available to address questions raised by other clients, and make a point to check in regularly on how things are going. If you need to refer the client to another provider, be sure to offer to call ahead and provide the patient’s background. Taking over the burden of explanation can be an enormous weight off your client’s shoulders.

2. Plan to offer additional emotional support

We all know that pregnancy is an intense and vulnerable time. Gender variant parents-to-be often have the additional struggle of profound isolation, coupled with the likelihood of heightened gender dysphoria during the course of pregnancy. With these things in mind, make yourself available to provide additional emotional support as necessary. Research LGBTQ friendly mental health providers in your area so you are able to make appropriate referrals if needed.

3. Keep your wording flexible

The language of birth work is extremely gendered. This can be isolating for gender variant clients. Work to make your language more inclusive by incorporating terms such as “pregnant parents,” “parents-to-be,” “new parents,” and “gestational parents.” Ask your clients what name, pronoun, and parenting term they would like to be addressed by, then respect their wishes in both individual and group settings. If you slip up and use the wrong name or pronoun, acknowledge it promptly and succinctly, then move on. If you work with a staff, make sure that all staff members are addressing the patient or client appropriately as well. Including fields asking for “preferred name” and “pronoun” on your intake or registration forms will send a clear (and very relieving!) signal to potential clients.

4. Don’t let curiosity get the best of you

I can tell you from personal experience that gender variant people are constantly asked about our gender identities. Regardless of the context or topic of discussion, we are expected to be willing and able to explain our innermost sense of self (or defend our right to exist!) at all times. This is stressful! While your curiosity may stem from a desire to better understand your client’s gender experience, and you should be open to hearing about their experience, focus on the pertinent issues at hand. Maintain your professional integrity and ask only what you need to know in order to provide excellent care.

5. Address issues proactively, especially in group settings

If you see clients in a group setting, consider a handout or brief talk at the beginning of each class (regardless of who is in attendance) affirming that there are many different types of families and that intolerance will not be allowed. Name behavior firmly but gracefully when someone acts inappropriately, and follow up with them individually outside of the class setting. Do not place the burden on your gender variant clients to defend themselves – instead, show them that you are a dependable professional who has their back and is willing to help other clients grow and become more accepting.

Thank you so much for your commitment to serving gender varient people!

Creating a class or practice that is welcoming to all families can involve sharing stories of all different families.  Choosing your media, handouts, posters and class material that includes all the different ways that families can look is important.  Please share your favorite resources for these types of supplies.  There is not a lot to choose from and we can all benefit from sharing information.  What do you do (or what have you done) to welcome gender variant families into your classes and practices?  Please share your experiences in the comments section.- Sharon Muza

Resources

Resources on this issue are few and far between, unfortunately, but here are some good places to start:

Basic vocabulary and introduction to the issue of gender variance: http://srlp.org/trans-101

2010 healthcare discriminatory survey: http://www.thetaskforce.org/downloads/resources_and_tools/ntds_report_on_health.pdf

Blog by a transgender dad who breastfeeds his son – lots of good information as well as personal reflections: http://www.milkjunkies.net/

Resources for gender variant parents – includes legal resources and family support resources: http://www.transparentcy.org/Resources.htm

Gender and the Childbirth Professional Facebook group – connect with other providers who work with gender variant clients, ask questions, post resources, etc.: https://www.facebook.com/groups/265359336861854/?fref=ts

My personal blog – occasional updates on midwifery, sexual health, and what’s it’s like to be a gender variant midwife: www.boimidwife.wordpress.com

It’s My Body, My Baby. My Birth – DVD for use in class that shows 7 natural births and interviews the couples.  One couple is gender variant.  http://www.itsmybodymybabymybirth.com/Home.html

Additionally, the ACNM Position Statement contains additional resources on this topic.

Thank you so much for your commitment to serving gender varient people!

 About Simon Adriane Ellis

Simon Adriane Ellis is a Certified Nurse Midwife, trained doula, and queer and gender variant person. He has a long history of social justice organizing around issues of racial and economic justice and LGBTQ rights, and brings these values to his work as a midwife. His practice is focused on providing empowering sexual and reproductive health services across the lifespan for people of all gender identities. He is currently working to publish his original qualitative research on the conception, pregnancy, and birth experiences of gender variant gestational parents. He hopes that this work will provide a broad call to challenge conventional assumptions about what pregnancy looks and feels like for all of our clients, regardless of gender identity. Simon can be reached through his midwifery practice, Essential Healthcare + Midwifery Services.

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