Press Conference in Jackson, MS, on Monday!

Read all about it here — it’s the final countdown! The bill will die in committee, if it’s not acted on by Tuesday.

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.

MS Friends of Midwives on the radio

We were able to get a phone-in interview on a state-wide MS talk show, the Paul Gallo Show, on the SuperTalk MS network, with Board Member Bianca Wooden, and Mississippi Midwives Alliance member Renata Hillman, talking about midwives, midwifery, home-birth, and the bill that we hope will be introduced in the upcoming legislative session that will legally recognize the Certified Professional Midwife credential in Mississippi.

I will try to embed the player below (but I think it will only work on WordPress.org stuff, so if it doesn’t, you can click this link and play it externally):

A flawed study published in “a second-tier journal”

That was the conclusion of Dr. Nicholas Fogelson about the much-publicized recent meta-analysis on home-birth, in a comment on Science & Sensibility’s post about it. [Honestly, I didn’t know that the AJOG was so poorly respected. Makes me rethink what studies I’d look at, if it was published there.] In the S&S post, Amy Romano questions whether the meta-analysis was even appropriate, in light of the huge de Jonge study of over 300,000 planned home births in the Netherlands. She writes,

Lack of statistical power could not possibly be the rationale for conducting a meta-analysis on the safety of home birth. [The de Jonge study] contributed 94% of the data on planned home birth in the meta-analysis (321,307 of 342,056 planned home births). That study found virtually identical rates of neonatal death in both the planned home and planned hospital births, with relatively narrow confidence intervals.

The blog “Birth Sense” has two posts on this study: a prologue of sorts and then a discussion of the 12 studies included in the meta-analysis. And despite Dr. Fogelson’s comment that AJOG is a “low-impact” journal, many news sources apparently didn’t get that memo, and had no problem trying to make a huge impact with the sensational headlines that “home birth is three times as deadly as hospital birth.”

I have read numerous blog posts and news articles about this study and will include links to them below, but I want to comment on some things. First, since the study isn’t going to be released for a few more months, I haven’t read it (I know it’s available by request, and I presume for a price or if you have a subscription), so I’m not sure what I can add to what those who have read it have said. In some ways, what I’ve read has raised more questions than answers. The main question is, what were the inclusion criteria? From some sources, I’ve discovered that the original study had to have been published in English (a common enough restriction — gotta make sure the doctors don’t get bogged down in any bad translations from reading foreign language studies!), and also to studies that reported outcomes of mothers and babies in both home and hospital births (apparently the reason why the Johnson & Daviss 2005 article on CPM births, published in the BMJ was not included — they didn’t have a hospital “control group”).  But I wonder, did they not have any exclusion criteria for the size? They included one study that had 5 women in each group — a total of 10 women studied! If I may say so, “Good grief, Charlie Brown!”

Additionally, they included the Pang study, which itself was flawed, in that it reported not only planned home-births (with or without a qualified attendant), but it also included unplanned home-births — this despite a title that declares that it looked at planned home births. Nor was the study limited to the “term” period, but included births as premature as 34 weeks. Since I don’t have the meta-analysis in front of me, I can’t say how heavily it influenced the conclusion, but “garbage in, garbage out” — if the data going into the study is wrong, you can’t reach the right conclusion.

In all meta-analyses I’ve read, there has always been a discussion of inclusion and exclusion factors; if there are others besides the ones I’ve mentioned above, I’d like to know — out of curiosity, if nothing else.

Some of the articles I’ve read have touched on problems researchers may have in reconciling different studies, which may all have different designs, or look at different populations, etc. Again, I don’t have the study, so I don’t know if Wax and associates looked at all the different factors and did an appropriate exclusion or analysis of differing studies. Some differences among studies that I can think of that might need some statistical calculation or exclusion of some births (which may or may not have been included in any of the cited studies), include prospective vs. retrospective study design; inclusion of term, preterm or post-term births; cross-over (women planning a home birth who transferred to the hospital, or women planning a home birth who gave birth precipitously outside of the hospital); whether babies with congenital anomalies were excluded; whether the mothers were properly matched in the groups — same general age, income, health, parity, etc.; whether twins or breech or post-term babies were included or excluded (many studies are limited by design to “singleton vertex babies from 37-42 weeks gestation”); cause of death (for example, excluding accidental deaths by smothering or car wreck would be a good idea, I’d think, if possible); whether there was a trained birth attendant; quality of the original study, and undoubtedly many other things I can’t think of.

One of the confounding factors that some of the articles I’ve read, is that some of the studies examined only the early neonatal period (up to 7 days), while others examined the full neonatal period (up to 28 days). Which reminds me of another factor I should have included in the paragraph above — perinatal deaths including stillbirths, and also possibly intrapartum deaths. Several of the writers have noted that the largest study, the Dutch study, was not included in the actual analysis of the most loudly trumpeted conclusion, namely, that home birth carries a 3x death risk for babies when compared to hospital birth. The largest study which had almost 95% of all of the births in all of the studies, and showed no difference for neonatal death, was excluded for the purposes of  neonatal death. It seems that it is because that study only went up to 7 days. Was there not some sort of statistical analysis that could be done to extrapolate deaths that may have occurred from days 8-28, so that this study could have been included? Or, an analysis that could have excluded deaths from 8-28 days in the other studies? As I said, I have more questions than answers. I’d love to read the study for myself (and the Birth Sense link has links to all 12 of the included studies — some of them are abstracts but some of them are the full studies, so I may start by reading those), but I wonder if any of the questions I have would be answered if I did read it.

Now for the links that I read, in addition to those I cited above (some of them include other links to other articles, as well) — obviously, most of them are going to be favorable to the “this meta-analysis is junk” viewpoint, but not all of them are:

Now for some links to other home-birth related stuff that is not about this flawed study:

  • The Unnecesarean’s blog post on a new study in this month’s issue of Obstetrics & Gynecology that says it’s important to distinguish between planned and unplanned home births [and I’m just in the mood right now, due to lack of sleep, to say cheekily, “and next, they’ll tell us that water is wet, and the sun is hot!” :-)]; but seriously, it’s because many times “unplanned” home births are to women with known risk factors that may cause problems with either themselves or their babies
  • the NHS write-up of the de Jonge (Dutch) home-birth study
  • High Tech vs. Nature’s Way,” an article from Minneapolis-St. Paul
  • The College of Physicians and Surgeons of British Columbia “Resource Manual” on planned home births

Ahhh, now I can close out some tabs on my browser.

Oh, and Dr. Amy, I’m pretty sure you’ve been waiting for me to write this up since I know you read me (not to mention you probably have “home birth” on your Google Alerts, and probably regularly add other keywords to make sure you don’t miss any internet discussions), so if/when you comment, just remember that you have to stay on topic. No cut-and-paste jobs like you usually do, m’kay? Oh, and before you bluster that the studies which showed that home birth is safe only in the countries of the study (like the Netherlands and Canada), because of how their midwives are integrated into the health system, I want you to answer a question: if that is true, why don’t you try to integrate midwives into the health system in America, rather than trying to elbow them out? That would solve that problem. 🙂

Mississippi Friends of Midwives Button

If you look over on the right-hand sidebar, you’ll see a new button that can be added to your website or blog that links to the MS Friends of Midwives website. Here it is below:

If you’d like to add it to your blog or website (please, please!) 🙂 here is the button info for you to copy and paste:

<a target=”_blank” href=”http://www.msfriendsofmidwives.org/”><img src=”http://katsyfga.files.wordpress.com/2010/06/logo_full2.png&#8221; border=”0″ width=”200″ height=”40″ />

If you find that the width is too big or too small, you can easily change it by changing width=”200″ to width=”150″ or width=”250″ or whatever else will fit. Remember to change the height to match, so that the ratio stays the same — just divide the width by 5 to come up with the number for the height: for a width of 150, the height would become 30; for a width of 250, the height would be 50.

Thanks!

Update — to add to Blogger, you’ll need to Add a “Picture” gadget. In Mozilla Firefox (and possibly in other browsers), you can right-click the image above and “copy image location”; paste that in the Blogger gadget where it says “image”. You can also right-click the image and choose “copy link location” and paste that in the Blogger gadget where it says “link.”

International Day of the Midwife

Celebrate midwives and midwifery! If you like this video, pass it on.

ISO: Home Birth and/or Midwifery pictures and videos

I’m making several promotional/educational videos about midwives, midwifery, and home birth for our Mississippi Friends of Midwives group, and would like to have more pictures and/or videos that I can use. Here are the two that I’ve gotten done so far.

This second video is clips from my younger son’s newborn exam (we had no video nor pictures from my first home-birth). I edited it for length as well as due to background noise (my mother and sisters talking), so this isn’t the entire exam.

I may even be able to make a lengthier DVD production if I can get enough material. If you have any pictures or video that I can use of midwife-attended births (preferably a home-birth, but I wouldn’t exclude a hospital birth), or even pictures/video of an OB-attended hospital birth to use as a contrast to home birth, or you can video yourself talking about why you chose a home birth, if you’re a midwife why you became a midwife, etc. — if you would like to be included, you can email me the pictures and/or links at kathy_petersen_283 at yahoo dot com [note the spelling of my name!], and in the email please write some sort of statement giving me permission to use the pictures/videos for MS Friends of Midwives.

Thanks!