A Tale of Two Birth Centers: Massachusetts and New Hampshire

I belong to a really wonderful and supportive e-network of doulas in Massachusetts. The members provide a wealth of information and a depth of experience from which I am lucky to be learning. Just this week, one of the doulas wrote that she was compiling a list of Birth Centers in Massachusetts and nearby New Hampshire.

A list of Birth Centers in Massachusetts is not hard to compile, as there are all of two, and they are not without their controversies. The Cambridge Birth Center has a high transfer rate to Cambridge Hospital, and The North Shore Birth Center, in order to avoid closure, will comply with remote external fetal monitoring by OB's at the North Shore Hospital on the campus.

But then there's New Hampshire, with its 5 birth centers: The Birth Cottage, The Monadnock Birth Center, The Coastal Family Birth Retreat, The Concord Birth and Wellness Center, and The Longmeadow Farm and Birthing Home. All safe, non-medical, home-like environments that offer the CHOICE to birth at their center or at home! They are all owned and run by midwives, mostly licensed NH midwives and one or two Nurse-Midwives. Each of the websites has legislative updates on the status of midwifery, insurance, and homebirth in New Hampshire. One web site states it so plainly: Almost all insurance plans now cover out-of-hospital birth services with a NH Certified Midwife. It's a sentence that almost strikes me as funny, since it is so far from Massachusetts truth.


As a proponent for choices in childbirth, I have alway philosophically maintained that the 2 Birth Centers we have here in MA offer a middle-of-the-road choice between homebirth and hospital births. But when I hear what is happening just over the border (the MA/NH border, not the US/Canadian border!), I do worry about some of the ways Massachusetts Birth Centers are forced to operate if they are to be in existence at all. Tomorrow, the MA Joint Committee will hear Senate Bill 847, which creates a Massachusetts Board of Midwifery, which would make the practice of midwifery similar to New Hampshire's. Until that bill is passed, the 2 birth centers we do have - operating under the heavy thumb of their affiliated hospitals -- will struggle to maintain choices for pregnant women in Massachusetts.

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A Bumper Sticker (or a few of them!) is Worth a Thousand Words

Here's a photo that my brother-in-law took while vacationing in Philadelphia over the weekend. When I saw it, I jumped up and down, clapping my hands.

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Great Videos on OPTIONS in childbirth

Virgina’s Birth Matters video contest is conjuring up creative juices — and giving us fantastic ways to let people know that there are MANY options to how you birth a child!! Here is Part One of South Coast Midwifery’s video, and when that’s done, you can watch Part Two. Southcoast Midwifery is in California, where it seems all of my midwifery books are based! Massachusetts will get there!

–maria
(this has been cross-posted on the Massachusetts Friends of Midwives blog)

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May 5th: International Day of the Midwife

The International Confederation of Midwives has chosen May 5th to celebrate midwives and midwifery — the International Day of the Midwife. Commemorating the day this year is the start of their campaign, “The World Needs Midwives Now More Than Ever!” By 2015, the ICM hopes to have 350,000 more midwives in practice, particularly in sub-Saharan Africa and South Asia, where the high maternal-infant mortality rate continues. The ICM is working hard to make midwifery an active agent of change in the UN’s Millenium Development Goals , which seek to end hunger, poverty, disease, and barriers to education and equality. Focuses on Maternal and Child health are major components of the UN’s goals.

As I continue to consider midwifery as a career, I’ve been completely absorbed in the politics of Massachusetts midwifery, comparing and contrasting my training options and how each would effect my family, and asking myself if I am ready to make the committment. Me, me, me, me, me.

But only now, as I read about the International Confederation of Midwives and the UN Millenium Goals, do I get a global appreciation for midwives and the critical role they play all around the world for women’s health.

Maybe I will celebrate International Day of the Midwife by sending a card to my midwife, thanking her (again!) for the amazing care she provided for me in my most recent pregnancy; I could send out a prayer of hope and gratitude for the women who are practicing midwifery in conditions of poverty and want that I cannot even begin to imagine; and maybe, just maybe I will make the final decision to answer the ICM’s call to be one of the 350,000 midwives the world needs by 2015.

(this has been cross-posted on the Massachusetts Friends of Midwives blog.)

What's a "midwife?" Please let the ACNM know.

This week, the birth blogosphere was abuzz with news that the American College of Nurse-Midwives has changed its position statement on midwife certification and its definition of what a midwife is.

Essentially, what it boils down to is that the ACNM will not recognize a midwife unless she has received her academic and clinical training in a formal education program. The North American Registry of Midwives is the national agency which certifies professional midwives. After a midwife has met conceptual learning objectives and gained significant clinical experience with out-of-hospital births and prenatal care, she can become a Certified Professional Midwife. There are a number of formal education programs in which an aspiring midwife can enroll; however, an aspiring midwife can obtain her theoretical and conceptual learning through apprenticeship, under the guidance of wise, experienced and mentoring midwives. It's probably the oldest, most traditional form of learning there is.

There are many paths to learning, and it makes sense that the art of traditional midwifery honors learning through apprenticeship. NARM certification is rigorous; it recognizes different paths to learning, and ensures quality practice and standards of care through its certification process. Additionally, its standards for certification are used by the 26 states that regulate midwifery, states in which CNM's, OB's and CPM's practice collaboratively in a variety of birth locations.

It is curious that in its definition of a midwife, the ACNM wishes to split the midwives certified by NARM into separate camps, legitimizing one and squeezing out the other. It is particularly disheartening in the 24 unregulated states like Massachusetts, where the only opportunity to learn midwifery is through apprenticeship. What gain does the ACNM have in only recognizing some CPM's?

NARM has created a petition asking the ACNM to reconsider its statement and respect the knowledge and diverse training that those who hold the CPM carry. At this writing, the petition has over 1160 signatures. Please take a few moments to sign the petition, taking action to protect birthing choices, which includes access to qualified, trained, experienced Certifed Professional Midwives.

(this has been cross-posted on the Massachusetts Friends of Midwives blog)

MRSA infections at Beth Israel Hospital in Boston

Click the title above, and you'll be linked to an article about infection control at one of Boston's largest hospitals. The hospital was found in serious non-compliance with infection control protocols, resulting in staph and MRSA infections -- in mothers and their newborn babies in the labor, delivery, and maternity units.

I don't wish to bash the BI. Two of my three daughters were born there. I had good experiences there. I hadn't developed an interest yet in midwifery, doulas, and non-medicalized, normal birth; my care there was a good match for what I valued then. As I learned more about birth as a non-medical event, I chose not to return to BI for my 3rd daughter's birth, but I have no regrets about decisions I made in the past.

But the situation, which could probably happen in any hospital in the country, can prompt more discussion about out-of-hospital birth. A healthy woman with a healthy pregnancy who goes into labor spontaneously at term should have the right to a homebirth or non-hospital birth center with a qualified and trained midwife. In the comfort of her own home or in a home-like setting, with the intimacy of loved ones around her, she can move freely through labor, feed herself and drink to thirst as she needs to in order to maintain her strength, and allow her body to engage in the uninterrupted physiological process of childbirth. That kind of normal birth is not medical, so therefore doesn't need a hospital and the whole hospital package -- like infections due to non-compliance of infection control protocol, or medical interventions that are either unwanted or not truly medically necessary, which leads to further interventions, which can then create an emergency. At the risk of sounding prosaic, hospitals are for sick people.

A C-Section rate of 18%???

Click on the title above to read about the amazingly low c-section rate at a New England hospital (woe that it is not in Boston...). The national average is 34%, and the hospital credits the Midwifery Model of Care for its low c-section rate. Let's hear it for midwives!!

Ummm, WHO delivered that baby?

I have been co-moderating a mothers e-group for a few years. It is a wonderful, supportive, and caring resource of information for moms in Boston. Every now and then, a newly pregnant mom asks for recommendations on an OB or midwife (usually an OB). The responses come pouring in, women sharing their stories about the tender prenatal care they received from one provider or the wonderful support given by the OB who happened to be on-call when they went into labor. But the one thing that makes me crazy is that this is said, over and over again: "Dr. (insert name) delivered my baby."

It doesn't matter how it happened: medicated or unmedicated, induced or spontaneous, vacuums or forceps. Mothers deliver their babies. Doctors and midwives attend births, assist births, catch babies, and perform procedures, but Mothers Deliver Their Babies! Even the babies who are born via the surgical skills of high-risk OB's, their mothers deliver them from the safety of their bodies, releasing them into the big, wide open, world to give them life.

Is it REALLY about the epidural?

When I tell people I'm a doula, one of the responses I get is a shake of the head, coupled with "Nah, I go for the drugs!" Or "Why should I experience pain if I don't need to?"

I loved this entry from the blog "Empowering Birth." What woman wouldn't want to walk away from her non-medicated birth experience with the sense that now she can accomplish anything in the world? What woman wouldn't want that feeling from ANYTHING? What mother wouldn't want that feeling for her daughter? The craving for this experience is what motivated me to have my third child with midwives at a birth center.

But as I delve deeper into the world of birth -- as a mother who has had three wildly different birth experiences, as a doula who has attended many births, and as an aspiring midwife -- I dare to say that it is NOT about whether a laboring mom gets an epidural. Pain is subjective. What one woman can tolerate for 24 hours, another may not be able to tolerate for 24 minutes. Is one woman stronger than the other? Is one woman's birth better than the other? A woman's body has the ability to grow and birth a child. There is, in fact, nothing more natural than that act of creation and birth, epidural or drug free, at home or in a hospital. Witnessing a birth is a phenomenal, powerful experience no matter how the birth happened and what circumstances led to its unfolding.

Because I am a trained mental health clinician, I know that people have all kinds of experiences and make very different decisions than someone else would in the exact same circumstance. None of it is up for judgment, and as a birth professional with a background in mental health, I'm very cautious about even the mildest suggestion that a woman who chooses an epidural is less-than or that the babies had a less-than birth. In fact, I'm very cautious about the suggestion that a woman who chooses an elective, first-time cesarean is less-than.

My birth passion is more focused on freedom of choices. Is a pregnant or laboring woman making a decision about her baby's birth out of fear? Does she have the supportive people she needs to form a circle around her? Is she making an informed decision about her body, which decades of trends and popular culture have taught her to dislike and distrust, if not abuse? Natural childbirth is not only about the epidural. It is about our culture; our love and reliance of technology over our instincts. It is about our need to control a normal, healthy process that should be allowed to take its own path and power and time, and intervening only when it is medically necessary. It is about a culture that focuses on liability and lost income or productivity more than the intangibles, like faith and trust.

Actually, I think that the last thing natural childbirth is about is that epidural. It is about all that is normal about birth. That we don't know when it will begin, nor do we know how long it will take. It can surprise us, and yet if we can remain watchful while still being patient and respectful of the process, it will reveal itself as all that it is meant to be.

Faced with a doctor gap, more hospitals turn to "Laborists" to deliver babies

Please click on the title above to read a Boston Globe front page article, published 2/22/09, about how hospitals are dealing with a shortage of OB's. This is exactly the reason why we need more birth choices, particularly in Massachusetts. Midwives, both CNM's and CPM's, can ease the burden on L&D units by creating more birth center births and homebirths, as they do in most countries around the world! The midwives would be able to attend more births, and the OB's could care for the much smaller percentage of births that actually need obstetrical intervention.

I come from a family with a number of doctors, so I have a very personal understanding of the pressures MD's face because of liability and soaring malpractice insurance costs. Because of my family, I'm also not as quick as others are to blame OB's for the medicalization of birth. But imagine if birth in this country were not driven by fear -- the OB's fear of being sued and watching a life time of work go down the drain for themselves and their families; the expectant parents' fear that the totally normal and healthy process of birth will go utterly awry unless it is interfered with; the mothers' fear when they go post-dates, because they can't spare precious maternity leave days waiting around for labor to begin.

So who is benefitting from the 15 minute prenatal visit, from theVBAC bans, from the c-section rate that is nearly 40%? Who is dictating all these policies? This really is a call for a reform of the insurance and medical malpractice industry and how it has burdened health care and effectively damaged our understanding of birth.