Victory!!!

We have received word that HB 695 will not make it out of committee, due to “the overwhelming concern from the people”!! Thank you to everyone who called or emailed the legislators, urged your friends to do so, spread the word in any way, or just sent happy thoughts! [Ok, but I'm enough of a cynic and a skeptic to say, "how do you know a politician is lying? - his lips are moving," and to still be holding my breath just in case Sen. Bryan, the Chairman of the committee... has it wrong. We may still go down to Jackson on Tuesday, just to be sure.]

This close call has made those of us who are concerned with home birth realize that we need to be PROactive, and not just REactive, so we’re trying to organize and take steps to get legislation that will make CPMs recognized… and also to be able to be reimbursed under insurance and Medicaid. Any thoughts, tips, suggestions or ideas would be more than welcome!! I can speak only with certainty for myself, but I’m fairly sure that most of us in Mississippi are in the same boat, and that is to say, that we have no experience in this matter, so would appreciate the wisdom of those who have “been there, done that.”

I’ve seen that Oregon has what I would call “model” legislation [not that I've looked in-depth at this or any other state, so if you know of any good states, or know of anything bad about Oregon's laws, please fill me in] — basically, midwives can certify, register, get licensed if they choose, but do not have to. If they are licensed, they can carry and dispense certain medicines legally (like IVs and anti-hemorrhagic medicines), which is good.

Frankly, I don’t know much about the midwives that serve Mississippi, except that in my area, they’re awfully scarce. Since MS doesn’t recognize the CPM credential, there isn’t much reason for a MS-based midwife to spend the time and money getting that credential, other than to say, “I did it.” Looking on Google, I’ve seen some CPMs in Mississippi, but for the most part they seem to be living in other states, and serving areas not too far from their respective state lines. My midwives, who were based in Memphis, traveled as far as 75 miles or so from Memphis, which would get a pretty good chunk of North Mississippi. It seems there is a similar situation with midwives in Arkansas and Louisiana. [CPMs are illegal in Alabama.] However, if Mississippi laws were such that there was a reason to become certified (like, to get insurance reimbursement and/or to legally dispense medication), I daresay that more qualified midwives would choose to get certified. Since I know that some midwives don’t like government interference in their business at all, I wouldn’t want the legislation to make non-certified midwives illegal. I’m enough of a libertarian to think that the government shouldn’t be able to mandate who is allowed to attend our births.

The Memphis newspaper The Commercial Appeal ran a story on the legislation today in which they gave the origin of the bill. Apparently, a baby died in a hot tub last year, which is the reason for Mississippi’s horrible infant mortality rates. Seriously — that’s what the Representative who introduced the bill in the House said:

The Mississippi Board of Nursing suggested the legislation because of the state’s high infant mortality rate. Holland says he believes that rate would go down if more babies were born in hospital facilities.

“We had a baby die on the coast last year being delivered in a hot tub,” Holland said.

Uh-HUH. Riiiiight! Ok, if you’ve been reading this blog regularly for any length of time, you know how I always have to dig a little deeper and get the numbers, relying on the CDC linked birth-death certificate query. No, it’s not perfect, but it’ll have to do. Let’s see how many deaths were due to “other midwife” for the latest years they have available, 2003-2005:

I’ll be honest that I don’t know for sure why there were no results for “other midwife.” This may mean 1) there were no births attended by non-nurse midwives; 2) there were births attended by “other midwives” but no deaths in this time period; 3) birth certificates that should have been marked “other midwife” were instead marked as “other” or “unknown,” (or even possibly but not likely as CNM, MD or DO).

So, next step: check out how many births/deaths happened at term, and where (because some of these babies were born as early as 17 weeks gestation, so it doesn’t matter who the attendant is nor where the birth took place; and no midwife I know of would knowingly attend the birth of a baby before 36 weeks gestation — if the woman seems to be in labor, the midwife would tell her to go to the hospital and/or accompany her there herself, so if she was the birth attendant, it would probably be because she happened to be in the back of the car or ambulance with her on the way to the hospital).

Isn’t that interesting? From 2003-2005 there were 3 deaths among babies born at term in an out-of-hospital situation… but there were either 87 or 243 such births, and I don’t know why there is a three-fold difference between the “total” (243) births attended by “other” and the subtotal (87). If somebody knows, I’d appreciate a little illumination.  There is a slight discrepancy (51 births) between the bold total of the in-hospital births and the sum of the subtotals, and this may be attributable to weighting, but I’d say that a three-fold difference is more than the slight difference I would expect from weighting. The only thing I can reason I can think of would be that “other midwife” attended 156 out-of-hospital births with no deaths for these three years. [The reason I suggest that is that I remember doing a query quite some time ago, and realizing that if there were zero deaths in a category, the births just weren't included in the subtotals, but were in the totals. The query was trying to see how many births shared common factors with my first son's birth -- a home-birth with a CNM in Illinois in 2004 -- and when I changed it to "boy only," the line disappeared because no boys died in such circumstances that year.]

Now for the causes of death for these three babies:

In case you can’t read that, there was one death at 40 weeks, with the baby dying within an hour of birth, due to P21.9 (Birth asphyxia, unspecified); one death of a baby born at 40 weeks gestation, the death occurring after the first month of life, due to R95 (SIDS); and one death in a baby born at 42+ weeks gestation, after the first hour but within the first 24 hours of birth, due to R99 (Other ill-defined and unspecified causes of mortality). While each of these deaths is sad and tragic to the families who lost these babies, it is not realistic to believe that every baby will survive. Yes, it’s possible that these babies may have lived had they been born in the hospital, but that is no where near certain. There were 7 other babies born in the hospital with an MD attending, during this term period (5 at 39 weeks and 2 at 40 weeks) who died of the same code P21.9; and there were 193 babies born in the hospital (with a variety of attendants) from 37-42+ weeks who ultimately died of SIDS in the first year of life; and 9 hospital-born babies who died of ill-defined/unspecified cause of mortality (all with an MD in attendance at their birth).

So, back to the article — apparently some nurses got this legislation sponsored under the pretense that Mississippi’s high infant mortality rate (it’s #1, which is the worst, except for Washington, D.C.) is due to all these babies dying in out-of-hospital births. Who are all these babies dying after having been born outside the hospital?

That’s right — 12 total deaths after an out-of-hospital birth from 2003-2005: 3 “unknown” gestational age, 3 term births, 2 very preterm births (probably had a 65-75% chance of living, with the best possible care, at that gestational age… but they had a doctor for the birth attendant, which makes me wonder if it was really out-of-hospital), 1 extremely preterm birth (a 50/50 chance of living at that age, regardless of what is done), and 3 babies born at 20 weeks — no reasonable chance of living, regardless of what was done. The causes of mortality are prematurity for the two 20-week babies and one of the “unknown”; hydrocephalus for the 24-week baby; breech extraction and “ill-defined/unspecified” for the 27 & 28 week babies attended by doctors; the three causes of death for the term infants previously discussed above; and for the remaining two unknown gestational age, one died by assault (perhaps a teen mom strangled or smothered her newborn baby?), and the other died from some unspecified cause of the perinatal period.

There were a total of 127,602 births during that period in the whole state, with a state-wide infant mortality rate of 10.74 [11.46 for just 2005]. The hospital-birth infant mortality rate was 10.67 [11.40 for just 2005] — still worse than the #2-ranked state for infant mortality in 2005. And that’s assuming that all of these babies who died would have lived if they had been born in hospitals (which is false), and assuming that these births were all attended by midwives, rather than being either planned unassisted or unplanned unassisted births (in a taxi? on the side of the road with EMTs? who knows — you can’t tell from this data). So, leaving out the premature births, there are a total of 4 possible deaths that maybe, just maybe, were possibly somehow due to an intentional planned home-birth with a non-nurse midwife. Nope — four deaths does not change the numbers or ranking for Mississippi when it comes to infant mortality.

Local news coverage on the Mississippi Midwives bill

WMC-TV5 (the local NBC affiliate in Memphis) covered the story on HB 695 which is in committee in the State Senate. Read past posts for more info, but the nutshell version is that it would restrict “the practice of midwifery” to CNMs only, which would effectively make homebirth illegal, since there are few or more likely no CNMs in the state who attend home births. In fact, there are almost no CNMs at all. Here is the link to the video, and here is the write-up about it. Looks good!

P.s., Melissa Stallings, one of the CPMs featured in the story, was the midwife assistant and apprentice when I had my younger son.

My letter to my fellow Mississippians and my state Senators

My note on facebook which I slightly altered into a letter to the Mississippi Senators:

I was shocked to find out today that HB 695 which would amend current Mississippi state law to restrict the practice of midwifery to only Certified Nurse Midwives (CNMs) has passed the House and is in the Senate. This is a historic and unwelcome revision of long-standing Mississippi law which has always allowed for the free practice of midwifery.

There are only about 25 CNMs in the state (as of 2008) [Update - someone told me that there are only 2 CNMs that she knows about, both hospital-based and in the far South], and most serve the lower third of the state. This leaves the rest of us without the benefit of a legal home-birth attendant. Tennessee, Louisiana and Arkansas allow for CPMs (Certified Professional Midwives), and some may even allow for non-certified or “lay” midwives to legally practice (as current Mississippi law does). When I was pregnant with my son, now three years old, I was unable to find a local Mississippi midwife close enough to attend my birth, so chose a CPM from Tennessee. If this bill becomes a law, I fear that that option will no longer be available. What then? My choices will be limited to an unassisted birth or giving birth in a hospital.

A midwife is a safeguard of normal birth — monitoring the mother throughout pregnancy, just like a doctor (only better), and monitoring the mother and baby throughout labor. In most hospitals, this one-on-one labor care is nonexistent, replaced by machines monitoring the mother and baby, with nurses checking in only rarely. Sure, it’s more cost-effective since there can be a higher patient-to-nurse ratio, but it’s not better! With the close “with woman” care that homebirth midwives can give mothers, they can pick up on indications that labor may not be progressing normally, and take steps to put it back on track at home, or make an appropriate and timely transfer to the hospital.

Without homebirth midwives, women such as myself will be forced to give birth at home without a midwife in attendance, or to give birth in substandard conditions in a hospital. There are no baby-friendly hospitals in Mississippi. Our fair state consistently ranks at the bottom of most health criteria, including breastfeeding (see also this link). Home-birth is very “baby friendly” — what we need is more encouragement for women to have home birth, not less! This is just one of many benefits to babies of home birth. Among the many benefits to mothers are a much lower rate of interventions, including C-sections, epidurals, inductions, augmentations, episiotomies and vacuum- or forceps-assisted births.

Home birth is not for everyone. Many women would not choose it if they could; and some who want to give birth at home have risk factors that cause them not to be good candidates for a home birth, so give birth at a hospital. Yet most women are low-risk, and about 90% of women who plan on giving birth at home do so (and only a very small minority of the 10% who transfer to hospitals do so in an emergency; most are calm, routine transfers for pain medication or labor augmentation).

CNMs are wonderful — I had one during my first pregnancy (I lived in Illinois then). CPMs are likewise wonderful — I had one during my second pregnancy. As far as practice style went, there was no difference. The main difference between CNMs and CPMs is that CNMs are Registered Nurses who go on to complete midwifery training — training which is very similar if not identical to the midwifery training that CPMs complete.

With midwives already in short supply, changing the law to an even more restrictive one will be counterproductive. If you care about home birth, midwifery, the right of mothers to choose where and with whom to give birth, or just plain don’t like government interference, please contact State Senators and urge them to vote against this legislation! And for good measure, contact Representatives and express your disappointment that this bill passed.

Thank you.

And some links on this issue — the “Big Push for Midwives” facebook profile page and a page to sign up for updates; and a facebook group to keep everyone abreast of the situation in Mississippi.

Mississippi Midwives Facebook Group

If you’re on facebook, you can join this group to keep up with the latest news on the legislation to outlaw non-nurse midwives.

If you know of any other groups or organizations, big or small, official or unofficial, please let me know so we can join forces. Thanks!

Making Mississippi Midwives Illegal

I was horrified to find out that a bill has passed the Mississippi House of Representatives, and was sent to the Senate, to make CNMs the only legal midwives in Mississippi. My state was one of the few that was “alegal” — there was no language specifically protecting or prohibiting non-nurse midwives.

While it’s too late to contact the Representatives (I emailed mine anyway), you can email the Senators and ask them to vote against it. Even if you’re not from Mississippi, I would still appreciate a show of support for CPMs from citizens of other states. There are almost no CNMs in Mississippi anyway — none that I know of in the top half, perhaps the top 2/3 of the state; when I had Seth, my midwife (a CPM) was from Tennessee — I don’t know how that might affect midwives crossing state lines. Currently, CPMs are illegal in Alabama, but some Tennessee CPMs have set up a “birth house” just over the border to accommodate women who don’t want to give birth in the hospital, but live close enough to the border to drive there in labor.

My mind is still reeling — I feel like I’m writing pretty scattered, here — hopefully you can find the coherent thought in it, though.

I have nothing against CNMs — I had a CNM attend the birth of my first baby. This isn’t some sort of turf war — just trying to keep alive the only form of midwifery available in my area.

Please share the word, too, if you will. Thanks!

Update: — I just noticed that some of the email addresses of the Senators are incorrect — two at least are misspelled (one “seante” and another “.us” instead of “.gov”), and one email address was listed as the same address for at least 3 different Senators. Sandra has commented below with a list of email addresses which appear to be correct, so you may want to use those instead. The first list is by district whereas Sandra’s list is alphabetical, so you should probably use one of the other and not both, in order to make sure you get them all.

2nd Update: — if you’re on facebook (and maybe even if you’re not), here is a post I wrote that I hope was a little more collected, outlining why I support home birth. It is what I used as the base for my email to the Senators (mostly changing the end from “please contact” to “please vote against this bill”). Feel free to pass it around and use what you want from it in your own emails if you wish. I don’t know if emails make more impact if they’re similar or if they’re all unique (probably the latter), but if you don’t have time to write a response of your own, I don’t mind if you use portions of what I’ve written and make it your own.

3rd Update: — if you’re on facebook, you can join this group to keep up with what’s going on. If you know of any other groups (large or small, official or unofficial) that are involved in defeating this bill, please let me know, so we can join forces.

“You’re not instilling a lot of confidence into me, Doc!”

Thus said Marty McFly in Back to the Future. The scene was Doc Brown simulating the lightning bolt that would send Marty in the DeLorean back to 1985… and the model car caught fire. But it works for this news as well: research doctor is accused of having falsified data in at least 21 studies (and perhaps more), as far back as 1996. It literally makes me sick to my stomach to know that stuff like this goes on. Plus, at least two of the papers had the name of another doctor on them as a co-author, though the other doctor says he had no part in writing them, and the addition of his name was a forgery. Niiiiiiice. One of the basic tenets or underpinnings of research is that the authors, researchers, scientists and doctors are all academically and intellectually honest. While they may have hidden biases (or open biases), and they are human so may make errors, the automatic assumption is that they attempt to be as honest as possible. If we can’t trust the research, then we’re back to “he said, she said” — the blind leading the blind.

To me, this undermines the whole field of science and research. It shouldn’t, but it does. Sort of like the woman that finds out her husband is cheating on her, and then thinks all men are scumbags like her husband. Not fair, but understandable. I think of Dr. Hannah who did the Term Breech Trial which more or less completely eliminated the possibility of vaginal breech birth. Other researchers have questioned the conclusion of the paper, and the validity of some of the negative outcomes that were included in the paper. The Canadian Society of Obstetricians and Gynecologists has in fact reversed its recommendations, citing the problems with the paper, and is now suggesting that doctors learn how to properly manage breech birth. It seems that a couple of other major studies Dr. Hannah did have likewise come under similar criticism — though I don’t know that they have been retracted. Though the results may be invalid, I would assume that at least she was academically honest — I believe she did actually perform the research, and the data was real — so is better than that guy. Some people will point to his getting caught as an example of “the system working,” while others (like me) will say that if the system was actually working, it shouldn’t have gone on as long as it did. I understand that it is impractical to “police” doctors to make sure fraud like this doesn’t occur, and I’m not advocating treating researchers like two-year-olds. At the least, I’m asking for a return to integrity. Like in so many other areas, if people would “just do the right thing” then there wouldn’t have to be laws and fines and oversight committees and what-not. I don’t think that’s asking too much.

Prevent C-sections — learn about cervical scar tissue

This was an interesting post, and I thought I’d pass it along. If you’ve ever had a procedure done on your cervix (including, surgery to remove pre-cancerous cells, and, rarely, a D&C), you may have scarring, which can cause slow or no dilation, despite adequate contractions. One to save in the files…

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