Mississippi Pushes to Legalize CPMs

Current MS law states that [paraphrase], “any woman whose sole occupation and source of income is catching babies is considered a midwife, and is not practicing medicine.” There is really no regulation at all, so I suppose the title of this post is a little misleading, because CPMs aren’t currently illegal. However, they are legal only by judicial interpretation, and I don’t know that there is anything to prevent the next judge in line to make an opposing interpretation, and say that all midwives are practicing medicine, and doing so without a license.

Last year, there was an effort made to make all non-nurse midwives illegal in the state of Mississippi. From what I understand, what happened was that there was one or more bad outcomes when midwives (or a midwife) from another state had come to Mississippi to practice, after she/they had lost licensure in their home state.  One or more nurses and/or doctors involved in the case were appalled, and got a bill passed through the House before any home-birth supporter found out about it, but we fortunately rallied against it, “raised a ruckus” about it, and got it killed in the Senate.

Then we got organized. 🙂

I became one of several board members of Mississippi Friends of Midwives, and we started working with midwives to get legislation passed to legally define midwives in Mississippi, and to have that definition be the CPM. There are several reasons for that, including, as I said above, that we’re possibly one judicial interpretation away from midwifery being defined as a practice of medicine, and midwives being then guilty of practicing medicine without a license. Also, for consumers, knowing that their midwife has been certified means that she has demonstrated her skills and ability as a midwife, so the consumer doesn’t have to just take her word for it. [This may be easy if the mom has 9 months or more to prepare for it, but what if she were recently moved to the state, or decided midway through her pregnancy that she didn’t want to give birth at her nearest hospital because they had a lot of rules and regulations she didn’t want to fight – such as requiring her to stay in bed, have an IV, get Pitocin, baby immediately to the nursery for hours, etc.] Also, no state that has passed CPM legislation has gone back and made CPMs illegal, so we view this as a protection of the CPM and of non-nurse midwifery as well as of midwife-attended home birth. Some states, such as Illinois and Alabama have made it illegal for CPMs and indeed all non-nurse midwives to attend births, and last year, Mississippi was just a few days away from joining their ranks. Since CNMs in Mississippi do not (perhaps legally cannot) attend home births, that would have made midwife-attended home-birth illegal. Since there are only a handful of CNMs in Mississippi, and none in the northern half or more of the state, that would have kept most of the state’s women from having a midwife attend them in labor.

Currently, we have legislation introduced into the House, HB 207, which was approved by the committee yesterday (Jan. 26). We’re not sure when it will come to the floor for a full vote, but based on the legislative calendar, it appears that the deadline for passage is Valentine’s Day, so it may be brought up as early as next week.

We’ve worked hard up to this point, with building support among midwifery advocates and home-birth supporters, and now it’s time to keep working hard, and to get others to work with us. Now is the time when the legislators need to hear from their constituents and from midwifery advocates and supporters. You don’t have to plan on giving birth at home in Mississippi (or anywhere else); you don’t even have to want to give birth at home; you just have to support the right of other women to have midwives legally attend them if they choose to give birth at home.

Last year when we killed the anti-midwifery bill, the state Capitol logged about 5000 phone calls on the issue. Is that a lot, or not very much? Perhaps in some states, that’s not too much, but it was “unprecedented” to the legislators, and perhaps set a record. Every phone call counts. Every email counts. Personal visits are most important. MS Friends of Midwives is working to coordinate visits and phone calls, primarily to make sure that every Representative is contacted in person, and also to make sure we know where the Representatives stand on this issue, and to provide education about what this bill does, what midwives do, etc. If they have any questions or problems with the bill, we want to be able to answer those questions. [So if you support us, please at least join us on facebook so we can better coordinate our efforts!]

Because the legislation was heavily modified and made much more simple in committee (much to our liking! thank you Omeria Scott!!) it is being considered as a “Committee Substitute,” which requires a 3/5 majority to pass, instead of just a simple majority. Now, more than ever, every vote counts. Last year, the anti-midwifery bill passed the House by a large margin; however, I don’t think that the legislators are against midwives. Many of our representatives and senators are older, and they and all their siblings were born at home, so don’t have a problem with it; plus, when many legislators were contacted about their voting for last year’s bill, they were confused by their constituents’ irritation at voting for the bill, because they thought they were voting for midwives and for keeping midwifery legal. They didn’t realize last year that their vote would have made midwife-attended home births illegal in the state of Mississippi.

The very good thing about Mississippi, is that we are a rural state, and apparently the legislators still realize that they were elected to represent their constituents, so finding out that one of their constituents supports a bill is worth a lot to them. In fact, in a recent meeting  with one of the legislators, when asked why the legislator voted for the anti-midwifery bill last year, the legislator said that s/he was contacted by a constituent asking him/her to vote for it. One person. Never underestimate the power of one!

What can you do to support our efforts and this bill? Many things!

  • If you are in Mississippi, you can call and email your Representative [full list here; find out who is your Rep here], telling him or her that you are a constituent, and that you support HB 207 [and if you’re not in Mississippi, or you are contacting other Representatives, you can leave off the “constituent” part ;-)].
  • If you know anybody in Mississippi, you can pass the word along to them so that they can call and email (and if possible, visit!) their legislators, asking them to support this bill. If you hear back from any of the Representatives, please pass the information along to our organization [our email is info at msfriendsofmidwives dot com], so that we can keep up with who has been contacted and how everybody is voting.
  • Also, donations would be greatly appreciated (even just a few dollars will help)! Mississippi is not a very populous state but it is a geographically big one, and it takes most of us on the Board a minimum of 3 hours (all highway time!) to drive to the state capital; it’s over 200 miles for me , and takes me close to 4 hours to get there, and 4 hours to get back home. As you may realize, it takes a lot of gas to drive 400+ miles, which costs money. We on the Board are just moms, and in addition to doing all this on a completely volunteer basis, spending quite a bit of time on this, all of us have given above and beyond that, including paying for things out of our own pockets when it was necessary. It would be nice to have some of the cost of gas or a hotel room offset by your generous donation. Really, no donation is too small!
  • Please join our newsletter! This is the single best way to get the information you need to know about this bill. While we update our facebook page often, you know how it is when you have several hundred friends plus probably another several hundred other groups and pages you like — it’s easy to overlook an update on your news feed. But the newsletter is sent to your email address, so will be there until and unless you delete it after you’ve read it. [And of course, your information will never be given or sold to anybody — this is strictly from us to you; and we only ask for your address (which is optional) so that we know who your elected representatives are, so we can urge you to contact them as a constituent, if necessary.]
  • You can also become a paid member on our Big Tent group (memberships start at only $15), follow us on Twitter, read our blog, and watch us on YouTube.
  • Finally, you can blog about it, share this post or other information on facebook and Twitter, and invite your friends to join our facebook group — all that social networking stuff we’re all so addicted to these days. 😉

A few years ago, Wisconsin was the first state to pass the CPM legislation on the first attempt. We hope to be the second. Thank you all so much for your support!

~*~

Updated to add: Here is a link to a spreadsheet with all the Representatives’ office email addresses and phone numbers.

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Northeast Mississippi Birthing Project

As a local group of Birthing Project USA, the Northeast Missisippi Birthing Project [blog] has as its goal improving maternal outcomes and reducing infant mortality. By providing at-risk pregnant women with a sister-friend to help them during pregnancy, mothers and babies have better outcomes. [“At-risk” includes teen moms, single moms, moms without insurance, etc., not necessarily a medical risk.] Our primary goal is the reduction of infant mortality. For more information, click the links I’ve already given, because the work is really wonderful and the results have been astounding. If you’ve been looking for something concrete to do to help pregnant women, this is something you really should look into. There are branches all over the United States, so you may be able to find out already started; or you may be able to start one in your area. For a brief overview of what we do, please watch the video below [btw, I made it, so of course I like it! :-)] —

I laughed until I cried!

A Man’s Guide to HomeBirth on Dr. Momma [Update: it was removed from Dr. Momma, but here it is in full.]

This is hilarious! Simply hilarious. I’ll give you a taste, but you must read the whole thing:

These are the items that men need to assist in a homebirth (not in order of use by the way): a black-light, princess wand (any type of wand toy will do,) fun-house mirror, catchers mitt/fishing net/soccer gloves, pocket watch, thesaurus, gum, woman who has witnessed a live birth, six pack of beer (or favorite alcohol), shovel, bucket, 1 dozen eggs, shredded mozzarella cheese, shower shoes, swimming shorts, push-up/pull-up bars or a wheelbarrow, old table covers (plastic holiday ones are best,) 1 big steak (or other red meat,) and 1 big cliche. Most of these items are for preparing for the birth, while a few are for the actual birthing….

So when I came down the stairs and was informed that she was in labor at 9am-ish, I felt ready this time since I just slept for 10 friggin hours. Alas, after hanging around downstairs for about ten minutes, my eyes rolled into the back of my head and I went and took a nap. On a side note, this is where the doula’s biggest strength lies – they are highly trained to withstand the Hypno-Fog. It was after that nap during the Hypno-Fog stage that I discovered that women who are about to go into labor cast this area-of-effect spell that can drop a man to the floor in a matter of minutes….

Kegels don’t do squat?

If there is one mantra, dogma, or axiomatic belief among women “in the know” when it comes to birth and babies, it’s that Kegels are wonderful, necessary, beneficial, etc. Now, someone is challenging that assertion. In short, the way the pelvic floor is understood is wrong, and needs to be changed. Tighter doesn’t necessarily mean better; it just means tighter, which may actually lead to a worsening of the problem. You need to read the whole article, because I’m skipping a lot (or else I’d be tempted to copy and paste most of it, but that wouldn’t be nice), but basically, squatting is what she recommends for incontinence and other things that Kegels are supposed to help.

If she just said that Kegels don’t work, I might be a tad suspicious that rather than being a lone voice of reason, she’s a lone voice for a reason [sorry, couldn’t help the chiasmus there :-)], although I’ve read enough from people who say that most women don’t do them right, and doing them “wrong” is worse than not doing any at all to know that there are many people who share her opinion at least to an extent. However, it was her suggestion of doing squats rather than Kegels which resonated with me.

Squatting is natural; doing Kegels is not, really. For most of human history, women (and men too) had to do a lot of physically demanding work, including a lot of squatting — tending the fire, garden, children, etc. Even in the absence of work, squatting was a natural way to rest and relax, if a chair was not available for whatever reason. Squatting is a normal part of life except for (primarily Western) adults who view squatting as either menial or childish. It’s not really a normal part of life to try to stop and hold the Kegel muscles, is it?

So, I’ll add this to my mental list of reasons to squat more regularly. What do you think of this article?

Pure-breds vs. Mongrels

Nope, not dogs, cats, horses, or any other animal. I’m talking about humans. Sorry if the term “mongrel” offends you, but I’m including myself in this group, and it seems a handy term to identify people of mixed genetic background. This is not necessarily so-called “mixed race” offspring, but anything that is not “pure-bred” (or shall I say “inbred”? — My dad was 100% Dutch — we can trace all of his ancestors back to Holland in the 1860s, and some of his ancestors all the way back to the 1500s or 1600s; so when I talk about inbreeding, I’m including him and all the other “genetically pure” or “ethnically pure” people like that). I kinda like to say “inbred” because “pure” sounds so hoity-toity and “holier than thou,” while “inbred” has negative connotations. Using terms like inbred and mongrel kinda puts us all on equal footing [“all men are created equal,” after all], even if these terms are negative sounding. I’m not intending to be offensive; I’m typing this with an amused smirk on my face, and hope you all can see the humor in it. You see, America is a great “melting pot”; although apparently some groups haven’t “melted” as much as others. When I lived in Chicago, one of my husband’s friends (a Jamaican) was married to a Polish woman who I believe was native-born American. She was pure-bred [inbred? ;-)] Polish, and she and her parents and extended family all spoke Polish to each other, but spoke English to others. It was actually pretty humorous — we went to their child’s birthday party, and because I was white, all her Polish friends and family thought I must be Polish too, so they started off talking to me in Polish. Needless to say, I got on better with the Jamaican grandmother because we both spoke English, than with the Polish grandmother, although those who were bilingual spoke English to me. Many big American cities have neighborhoods called “Little Italy” and “Chinatown” and so forth, because people from one country or another tended to congregate in one spot and maintain their ethnic identity, rather than truly “melt” together. This is also how my dad was able to be pure Dutch, though all his ancestors left Holland a few generations before he was even born — they all settled in a very “Dutch” part of the country, and continued the tradition of Dutch marrying Dutch (see why I call it “inbreeding”?)… until my dad met my mom who has a who-knows-what genetic background.

One of the things that people often say about America and our birth outcomes is that we are of mixed genetic heritage — good ol’ melting pot, with many people claiming ancestry in half-a-dozen different European countries, and others combining genetics from entirely different continents. I think that’s great; but there is a theoretical problem with this mixing, if, for example, a woman with a genetically small pelvis, thanks to generations of inbreeding (for example, Koreans marrying only Koreans and giving birth to Koreans for millennia), marrying a man with a genetically large head (like, apparently, the Dutch, judging by my dad’s family photos), and then ending up with a theoretical baby that has a head too big to fit through the mother’s pelvis. I say “theoretical” because I don’t know if it’s been proven. [Also, it seems to be at least an equal chance that the baby would end up with the mother’s small head and body, so it’s really being prejudicial to say that a hypothetical child would definitely be too big to be born vaginally.] I remember reading about (and I blogged about it previously) a study in which Asian women married to white men had C-sections at a higher rate than white women married to Asian men. However, I wonder how much of the C-section rate was due to the doctor’s prejudicial decision that the baby would be too big for the woman’s pelvis, so was quicker to call for a C-section than he would have otherwise. And I also think of that one “Baby Story” I watched with a short woman and a big and tall husband, and she was induced because the doctors feared that with her husband being that big, the baby would be too big if she went to her due date. Birthweight? Six pounds and change. Um, yeah; that’s big. [Sarcasm]

So, are America’s high C-section rate, and poor rates of things like maternal and infant mortality due to us being a genetic melting pot? Or is it possibly something else?

What got me thinking on this topic again was this article I read, about a New Yorker living in Japan (married to a Japanese man, having lived there for years), trying to have a home-birth. In the article, the woman said that 1 out of 10 couples in Tokyo is “mixed” — I wonder if that would be a better place for a study into the theoretical problem of mixed genetics leading to “unbirthable” babies. We could look retrospectively at birth records of the three groups: “pure bred” Japanese mothers and fathers; Japanese mothers and foreign fathers; and foreign mothers and Japanese fathers; and see what if any differences there are in the C-section rate and birth outcomes of the three groups. It wouldn’t totally do away with provider bias, but it seems more likely to me that Japanese doctors would be less likely to stamp a Japanese pelvis with “FAIL” than American doctors might be — nationalistic pride, if nothing else, perhaps?

At the least, it would be interesting to see if the C-section rate for Japanese mothers and gaijin fathers would be similar to that of the American study.

Skin-to-Skin in the O.R. after a C-section

Being born vaginally is good for babies, in part because it colonizes them with the mother’s good bacteria, setting them on the road to health; a C-section bypasses this normal process and may be part of the reason why babies born by Cesarean have higher rates of things like asthma. But putting the baby skin-to-skin with the mom, especially after a Cesarean, can restore some of this good colonization; otherwise, the baby will be colonized only with hospital bacteria. Skin-to-skin contact is also beneficial in facilitating breastfeeding. Typically, when babies are born, they have an innate ability and desire to get to the breast and self-attach; wrapping babies up in a blanket like a burrito prevents this. All too often, whether the baby is born vaginally or by C-section, babies are only briefly shown to the mom right after birth, and then are taken across the room for the newborn assessment and procedures, before finally being returned to their mothers securely swaddled in a hospital blanket. Then, many times, babies are taken to the nursery soon after birth for a bath, then kept in the nursery under the warmer for a few hours to warm back up, and then finally taken back to their mothers… just in time for them to fall asleep for a few hours. But it doesn’t have to be that way. Healthy babies can — and should — be placed skin-to-skin with their mothers immediately after birth, even with a C-section.

Update: Here’s a video showing skin-to-skin after a C-section


If you had a C-section, were you able to have your baby put skin-to-skin in the operating room? Did you even know that was a possibility? If you are a nurse or midwife, do you ever put babies skin-to-skin on their moms, even if they have a C-section?

Weigh in on this topic on the Breastfeeding with Comfort and Joy fan page [currently, it’s the most recent post, dated May 28]. Laura Keegan, the author of Breastfeeding with Comfort and Joy, will be giving Grand Rounds in June/July, so will have the opportunity to talk about this important topic to attending physicians, L&D nurses, and residents in OB, pediatrics, and family practice. She would love to have input from women about their experiences with skin-to-skin contact (or the lack thereof) after both vaginal and Cesarean births, to pass along to the doctors, nurses, and doctors-in-training. What did it mean to you to be able to hold your baby with nothing between you, and just a blanket put over both of you? What did it mean to you to be denied this? Please comment on the fan page post, and also spread the word (blog, share on facebook, Tweet about it, etc.), so that doctors and nurses can find out from you and other women what they otherwise might not hear.

Hope for pregnant women with heart disease

I just read this article and thought it was amazing. Often, women with pulmonary hypertension are advised not to get pregnant, and if they do get pregnant (or if they only find out that they have pulmonary hypertension while pregnant, which is unfortunately a common time for diagnosis), they are advised to undergo an abortion immediately. Why? Apparently after giving birth, the body can’t handle the fluid overload, so women frequently die. About 50-60% of women so affected die in the top health centers — with the best medicine and the best care, a greater than 50% mortality rate! Yet one doctor has a 0% mortality rate, out of 40 women. Doesn’t sound like coincidence to me!

The treatment sounds so simple, so obvious, when it’s explained: basically, since it’s the fluid overload with a term birth that overwhelms the heart and kills the woman, she is given a C-section at 35-36 weeks (less fluid build-up than at term), and then hospitalized for several days afterward while they draw fluid off with medicine and diuretics — nine liters — that’s almost two and a half gallons!

For many women with this condition, being advised to have an abortion is a horrendous decision — an unchoice. This doctor may give them hope.