Doula Video

My 3rd & 4th Births!

The third birth I attended was another special one...it was my first vaginal birth!  This first time mom arrived at the hospital 7 cm dilated and gave birth 5.5 hours later!  It was a very "easy" birth for me which was good because just 6 days later, I attend birth #4!

Caden

Tobias

Doulas

I know that I am not the only doula who feels this way...

Between births, sometimes I get the feeling of amazement that couples pay me to attend their births. It is such an honor for me to help couples through their birthing experience that I sometimes forget what a blessing it is for the couple to have someone present who is compassionate, knowledgeable and consistently advocating for their ideal birth.

I received a thank-you note today from a family that brought tears to my eyes:

Dear Erica,

I cannot thank you enough for the service you have provided since my husband and I decided to have you as our doula. Your passion for what you do, your knowledge and skills, and the calmness of your personality all contribute to the excellent job you performed, especially on the day when our baby was ready to come out and meet us. Thank you for being there for me, my husband and our baby. Having you as a wonderful part of this beautiful birth experience will be something for us to cherish for the rest of our lives.

May God bless you and your family abundantly!

This thank you letter is not only for me. It is for all of the doulas out there that forget what an important job we are doing. It is to remind us all that our services provide not only a lifetime of positive memories for families but also our compassion for beautiful births ripples through the community in so ways.

Response to ACNM's stand on CPM's

This is Simkins' letter in response to ACNM's letter to their members and Congress stating that they do not support federal recognition of CPMs.

TO: Open Letter to the ACNM Board of Directors and Executive Director

FROM: Geradine Simkins, CNM, MSN, MANA Board President

RE: ACNM Opposition to Federal Recognition for the CPM

DATE: July 17, 2009

I am a CNM and a member of the ACNM and I say very emphatically-not in my name! I do not support your recent decision to publicly and aggressively oppose the efforts of a broad-based coalition of six national midwifery and consumer organizations seeking federal recognition of the Certified Professional midwife. Your position, to me, is indefensible.

Lack of Evidence

For an organization of professionals that values evidence, I find it inexcusable that you have chosen an action that the evidence does not support.

* There is no evidence to support your claim that the majority of CPMs are not properly qualified to practice.

* There is no evidence to support the position that CPMs in general have poorer outcomes than CNMs or CMs.

* There is no evidence to support the position that CPMs trained though apprenticeship and evaluated for certification through the Portfolio Evaluation Process (PEP) of NARM have different outcomes than CPMs trained in MEAC-accredited schools.

* And there is no evidence to support the notion that a midwife with a Master’s Degree has better outcomes than one without that level of higher education.

The evidence we do have on the CPM credential indicates that the midwives holding this credential are performing well, have good outcomes, and are saving money in maternity care costs. The growing number of women choosing CPMs suggests that women value the care provided by CPMs. If future research should demonstrate the PEP process is unsafe or not cost-effective, then that would be the time to reassess and restructure the process.

Differing Values

We, as midwives, have values that underpin our professional practice. We cherish and honor those values. You have stated that your board made its decision because ACNM strongly values formal standardized education, and opposes federal recognition of CPMs who have not gone through an accredited program. I can accept that you strongly value standardized education. However, I strongly value multiple routes of midwifery education for a variety of reasons.

There is something important, powerful and valuable in a training process in which the student midwife or apprentice is educated in a one-on-one relationship with a preceptor and her clients in the community, as opposed to the tertiary setting where student midwives do not follow women throughout the childbearing year, and may never experience continuity of care or individualized care. In addition, by preserving multiple routes of entry into the profession, we are able to educate more midwives. We need more midwives! If health care reforms were to produce an adoption of the midwifery model of care as the gold standard this year, we could not possible supply “a midwife for every mother.”

Impact of Taking a Stand

By publicly and actively opposing federal recognition of CPMs as Medicaid providers, in addition to taking a stand about formal education, you are also taking a stand (willingly or inadvertently) for decreased access to midwifery care, for diminished choice for women to choose their maternity care providers and place of birth, and for restricted access to the profession. Is it worth it to sacrifice several things you value, just so you can take a stand for one thing you value? Is it possible for you as an organization to value something, but also realize that it is not the only valid way? Is it possible for you to respect the diversity of pathways to midwifery that the CPM represents? Standing aside on a potentially divisive issue does not require the ACNM to sacrifice any of its standards. It simply requires the ACNM to respect the standards of another part of the profession of midwifery.

Disingenuous Claims

It is disingenuous of ACNM to state in its Special Alert to ACNM Members on July 15, 2009, “ACNM’s decision to oppose this initiative followed unsuccessful attempts by ACNM and MAMA Campaign leaders to reach a compromise that both organizations could support…” There was no formal process or interaction, no negotiations, and no attempt at collaboration between ACNM leaders and MAMA Campaign leaders. There was one phone conversation in which the ACNM representative stated there was only one concession they would accept: federal recognition only for gradates of MEAC-accredited programs; this is not a compromise. The MAMA Campaign, of course, is promoting all CPMs to receive federal recognition as Medicaid providers, not just some CPMs.

Furthermore, it is disingenuous to suggest the World Health Organization (WHO) document sets a standard that has been embraced around the world. In fact, the WHO developed global standards for midwifery education without the input of the International Confederation of Midwives (ICM), an international partner of the WHO. The majority of members of the task force that developed the standards were not even midwives. There was not widespread input regarding the document nor targeted input by midwives. In response to this oversight, the ICM passed a resolution at the June 2008 Council meeting in Glasgow Scotland (I was there!) to develop global midwifery standards. A task force has since been convened and all member organizations (which includes MANA and ACNM) will be able to give input to the standards developed by the ICM. Generally, when the ICM develops a document that might supplant an existing WHO document (as was the case in the international definition of a midwife), the ICM document is eventually incorporated by the larger international community. This will be a long process and any new document will not be ratified by ICM until the next Council meeting in 2011.

Lack of Vision

What offends me most-as a CNM, an ACNM member, a member of the MANA/ACNM Liaison Committee, and the President of the Midwives Alliance-is the lack of vision this decision represents.

Why not embrace diversity and support innovation? Why not bring the turf wars to an end? Why not unite under the banner of midwifery and the values that we share in common? Why not set aside our differences and recognize that we are all midwives? Why not recognize that the work we do is more important than the credentials we hold? Why not support one another within the profession, because diversity is our strength not our weakness?

What We Do Matters

The healthcare debate has been in progress in Washington DC for over a decade, but never before has the possibility of real change been as promising as it is now. Now is the time when we may have a real opportunity to effect unprecedented changes in maternal and child health care that will have long-lasting affects for mothers, infants, families and communities. Women deserve high quality maternity care, affordable care, and equal access to care. Women deserve options in maternity care providers and in their place of birth. Vulnerable and underserved women deserve to have disparities in health care outcomes eliminated, and they deserve to have barriers removed that limit services, providers and reimbursement for maternity care.

Expanding the pool of qualified Medicaid providers to include CPMs will help address the plight of so many women around the country who receive poor quality maternity care or do not have access to care at all. We need to lower the cesarean rate and increase VBACs. We need to lower infant and maternal mortality and morbidity rates in the U.S. We need to offer women the opportunity to believe in their bodies again and to give birth powerfully and in their own time. We need to welcome babies gently into the world. We need to give the experiences of pregnancy and birth back to families. We need to support women to breastfeed and help shelter the process of maternal-infant bonding. These are the real issues. These are the things we deeply value. Midwives are the solution that can address each of these vital issues. All midwives and midwifery organizations united, together, working toward these common goals, could produce these kinds of improvements in maternity care. We do not have to think together; but we must pull together!

In Conclusion

I repeat to you-not in my name. As an ACNM member, I will not comply with your requested action; I will actively oppose it and encourage others to do join me in doing so. Your position on CPMs does not represent what I value, what I hope for, and what I work untold hours to achieve. I have written this letter at the urging of the fourteen members of the MANA Board of Directors. Seven of the Board members are CPMs, four are CNMs, one is a CPM/CNM, one is a CM, and one is a DEM. They represent a true cross-section of the midwives in practice in this nation. We stand for diversity, tolerance, and unity among midwives and within the profession of midwifery. We advocate and work for a midwife for every mother, in every village, city, tribe, and community in this country and across the globe.

Sincerely,

Geradine Simkins-CNM, MSN, President

MANA Board of Directors

Maria Iorillo-CPM, 1st Vice President

Christy Tashjian-CPM, 2nd Vice President

Angy Nixon-CNM, MSN, Secretary

Audra Phillips-CPM, Treasurer

Pam Dyer Stewart-CPM, Region 1

Regina Willette-CM, Region 2

Tamara Taitt-DEM, PhDc Region 3

Sherry DeVries-CPM, CNM Region 4

Elizabeth Moore-CPM, Region 5

Colleen Donovan-Batson-CNM, Region 6

Dinah Waranch-CNM, Region 9

With America being the leading country in over using technology during pregnancy and birth, it is nice to know that there are some politicians in America that still value the health of women and children and listen to the overwhelming statistics that state ultrasounds alter cell development and should only be used for medical diagnosis.  This is definitely a step in the right direction.  Read the article here (http://www.courant.com/news/local/statewire/hc-ap-ct-xgr-ultrasoundboujun24,0,2341415.story)

Early Labor Anticipation

There is something magical about early labor.  You know that there will be a beautiful baby born very soon.  You know that a family will enjoy one of the most memorable moments of their life.  It is almost like your own early labor anticipation.  You have time and energy to think about the magnificence of birth with a certain uncertainty of what lies ahead.  I begin to feel the adrenaline run through my veins, so I take deep cleansing breaths to calm the excitement of being part one of the most amazing times of life...birth.

Birth Video Junkie

So, I have become a birth video junkie :-)  I have spent many hours browsing all of the births on YouTube.  A few weeks ago I found Bastian's Birth.  There are 9 ten minute videos that take you through a good portion of a woman's beautiful unassisted birth.  It shows a lot of active labor and pushing and made a lasting impression on me.  Tell me what you think...

http://www.youtube.com/watch?v=-V2rj2ZkUSc

My 2nd Birth!

I attended my second birth on April 30th.  One of my best friends from middle and high school gave birth to a sweet baby girl, Tess.  I was honored to be a part of such a special day!

Co-Sleeping

So, when I was pregnant and raising my kids, I have always just followed my heart on what works best for our family...home births, co-sleeping, attachment parenting, homeschooling, etc.

Now that I am working with many different families, I am confronted with numerous questions on the multiple debatable topics around birthing and children (vaccinations, circumcisions, etc.)  There is a certain challenge to presenting information in a non-biased and honest way without pushing my personal opinions on them.  Yesterday, a mom that I am working with mentioned how a pediatrician does not support co-sleeping because of the high numbers of deaths that it causes every year.  He stated that there are around 100 deaths from co-sleeping each year in Texas alone!

So, I became curious about this statistic and started poking around the internet and asking questions.  It turns out that the American Pediatric Association and Consumer Product Safety Commission state that co-sleeping is not safe.  Well, this does not mean too much to me, but got me digging further.  I started receiving lots of input from co-sleeping adovocates and some anti co-sleeping supporters.  Needless to say, I was getting very confused.  I finally received a link to the 2008 DSHS Texas State Child Fatality Review(http://www.dshs.state.tx.us/mch/pdf/Texas%20Child%20Fatality%20Review%20Team%20Annual%20Report%202008.pdf).  This is a super comprehensive report of all the 2006 deaths of everyone under the age of 17.  From this report, there are two sections of greatest importance as related to deaths from co-sleeping.  The first one is on pages 47-48.  It states that there were 83 SIDS related deaths in 2006 of children one year old and younger.  38.8% of these deaths happened in an adult bed and 32.8% happened in a crib (these were the highest percentages with bassinette being the next highest at 10.4%).  This amounts to 26 SIDS deaths happened in an adult bed. Hmmmm....this still doesn't say if the child was co-sleeping in the adult bed.  Another interesting statistic is on page 57.  This chart shows the percentages of asphysxia infant deaths due to suffocation by sleeping place.  An overwhelming 60% of the 38 deaths happened in an adult bed (22 deaths)!   So, the total amount of infant deaths in 2006 in Texas in an adult bed is about 48.  This still doesn't state if an adult was sleeping with the child or not.  It also doesn't explain that if the parent was sleeping in the bed if the adult was intoxicated or on drugs.

Now every coin has two sides and there are multiple studies showing the benefits to co-sleeping.  Dr. McKenna has done extensive research into co-sleeping.  You can read all about his findings here:

http://www.nd.edu/~jmckenn1/lab/faq.html

Also, Mothering Magazine has multiple articles on the benefits of co-sleeping (http://www.mothering.com/search/node/cosleeping)  Just some of the benefits listed are the baby sleeping better, the baby not crying as much, closer bonding, etc.  There are also numerous articles supporting the idea that co-sleeping is safer than crib sleeping.  All of the co-sleeping advocates reinforce the importance of co-sleeping safely (not being intoxicated, not having lots of bedding, etc.)

So, here is my not so scientific personal conclusion...I KNOW that co-sleeping can be safe.  After all, our kids slept with us until they were 6 years old and they didn't suffocate.  We were very mindful about sleeping with the kids, especially when they were infants.  We didn't ever cover their heads, I always protected them with my arm and they didn't sleep on the edge of the bed.  I never even considered the fact that they could die while sleeping with us.  I only knew that it felt right.  Did they benefit from sleeping with us?  I believe they did.  I think that it reinforced the bonding that we shared during the day and it allowed them to sleep better.

So, how do I present this information to the parents that I am working with now?  I consistently tell them to do what is best for their family, be mindful of propoganda and FOLLOW THEIR HEARTS!

Good night!