Anonymous Donor Helps Healthy Start's "Save My Life" Program Combat Racial Birth Disparities

Maybe guns aren’t the biggest threat in Newtown.

Perhaps the biggest threat is the area’s staggering rates of poor birth outcomes, such as premature birth, fetal mortality, and infant mortality. Despite a statewide decrease in deaths among children younger than one year old, the infant mortality rate for African-Americans in Sarasota County has continued to creep upward. And disparities between rates of fetal mortality, infant mortality, and prematurity between blacks and whites continue to be alarmingly present. Sarasota County’s most recent 2008-2010 rolling average data indicates the African-American rates for fetal mortality is more than twice as high as whites; infant mortality is 3.5 times as high; and preterm birth is 1.7 times as high.

Aimed at reversing this alarming trend, the Healthy Start Coalition of Sarasota County created the “Save My Life” Program in 2008, an education and support-based Childbirth and Parenting Education program centered in the Newtown area. The Save My Life Program offers small group and individual classes on the importance of health during childbearing years and during pregnancy, stress reduction, childbirth education, breastfeeding education, in-home support for breastfeeding, and safe sleep practices for infants. Outreach efforts, education, and classes are offered by the only African-American Childbirth Educator in Sarasota County, Beverly Phelps.

“Early intervention to begin reversing this cycle must begin prior to pregnancy, and continue throughout pregnancy and after pregnancy. The early experiences of any human, from the beginning of pregnancy into the first few years of life are crucial,” said Jennifer Highland, Executive Director of the Healthy Start Coalition of Sarasota County. “By focusing on education, support, and prevention, we aim to improve chances young families will stay healthy.”

Funding for this vital program comes from donations and grants, both of which are currently threatened. After 3 ½ successful years, this program will end in spring of 2012 without additional funding. However, the Healthy Start Coalition has been presented with a unique opportunity to continue funding this important program: an anonymous donor has come forward with a $10,000 Challenge. If $5,000 is raised by the community before February 15, the donor will match it with another $5,000.

“This is an important opportunity for our Community to get involved in the health of our youngest citizens”, continued Highland, “It is time for us to rally as a community to save our babies!”

For more information, contact info@healthystartsarsota.org.

September: Infant Mortality Awareness Month

September is National Infant Mortality Month, but for Orlando midwife Jennie Joseph and her dedicated team, the fight to provide quality prenatal care to all expecting mothers and reduce the high infant mortality rate is a year-round campaign.

“Simply put, our babies are dying!” states Joseph, executive director ofCommonsense Childbirth Inc. and the founder of The JJ Way® Maternity Health Care System, a program that successfully demonstrates reduced levels of infant mortality. “People just don’t realize the impact of infant mortality in our communities.” Joseph’s innovative maternal child health (MCH) program is designed to educate the public, community leaders, and elected officials on te need to reduce infant mortality and the practical steps to achieving that goal.

Joseph, who also operates The Birth Place, a multi-site birthing center , women’s health clinic and midwifery training program in Central Florida, remains committed to eliminating one of this country’s saddest and most preventable medical concerns – the high death rate among African American newborns and babies under the age of one. Statistics show that the infant mortality rate among African-Americans continues to be more than twice the rate among White babies and, according to a new report out just last week, babies in the United States have a higher risk of dying during their first month of life than do babies born in 40 other countries[1].

Medical experts agree that the two most prevalent causes of high infant mortality are premature births before the 37th week of pregnancy, and low birth weight. The Florida infant mortality rate has hovered around 8% for all races and 14% for African American women annually[2]. “These fragile babies are actually a result ,” says Joseph. “The cause is the lack of access to quality maternity healthcare as well as a lack of education and support, particularly for disenfranchised women who face multiple obstacles to finding help.”

A 2007 study[3] conducted at The Birth Place, utilizing The JJ Way® Maternity Health Care System, provided 100 participants with education, support and vital prenatal care. As a result, there were only 4 low birth weight babies born overall and no low birth weight babies to the African American or Hispanic women in the study. While national agencies such as Healthy Start and March of Dimes have led the charge by stressing the need to address this serious issue, Joseph believes that increased community awareness is essential to the campaign to eliminate these disparities. To that end, Commonsense Childbirth and The JJ Way® have developed extensive training and certification programs to increase the number of maternity healthcare providers, doulas, childbirth educators and community agencies willing to tackle this problem.

Additional information including a video can be found at http://commonsensechildbirth.org/jj-way.

Jennie Joseph will be speaking at Bentley’s Cafe (805 Donald Ross Road Juno Beach) at 6:30pm on September 23rd. The event is open to the public. Ms. Joseph will also be holding a Doula Training September 24th and 25th at the Palm Beach Marriott. For more details regarding these events or information about Commonsense Childbirth, The Birth Place or The JJ Way, please contact Kathy Bradley at (321) 213-1112 or emailkathy.ccsmidwifery@gmail.com.

[1] http://www.myhealthnewsdaily.com/newborn-death-rates-1849/

[2] http://www.marchofdimes.com/peristats/pdflib/999/pds_12_all.pdf

[3] Funded by Winter Park Health Foundation, Evaluated by Health Council of East Central Florida

CIMS Responds to Skewed Homebirth Study

The following is republished with permission of the Coalition for Improving Maternity Services, an organization committed to mother-friendly childbirth and endorsed by over 1,200 organizations and individuals, including myself.

Raleigh, NC (July 9, 2010)-The Coalition for Improving Maternity Services (CIMS) is outraged that the publishers of the American Journal of Obstetrics and Gynecology (AJOG) accepted a poorly designed and methodologically unsound study in which authors concluded there is a 3-fold increase in neonatal mortality in planned home births compared with planned hospital birth.

"In our analysis of multiple studies from countries worldwide," stated CIMS Chair Michelle Kendell, MBA, AAHCC, "CIMS found that the authors of the study included confounding data, such as outdated and low-quality studies, low-risk and high-risk mothers, babies born preterm, babies unintentionally born at home, births attended by unqualified providers, and data from birth certificates that researchers have found to be notoriously inaccurate."

Although the authors acknowledged that most of the articlesreviewed had similar outcomes of low neonatal mortality, they based their conclusion on statistics drawn from questionable and poor quality studies.

Furthermore, the study's lead investigator Joseph R. Wax, MD, and his co-authors inexplicably eliminated the only high-quality study of planned homebirths in the U.S. that showed excellent health outcomes for infants and their mothers when attended by certified professional midwives. (Johnson & Daviss BMJ 2005).

In a press release, the American College of Nurse-Midwives, a CIMS Organizational Member, reported, "the authors' conclusion differs significantly from findings of many recent high-quality studies on home birth outcomes which found no significant differences in perinatal outcomes between planned home and planned hospital births."

Other research conducted by the CIMS Expert Work Group found that planned home births with a qualified care provider resulted in similar, not greater, perinatal mortality rates compared with a similar low-risk population of women having hospital births, despite lower intervention rates, including electronic fetal monitoring, use of IVs, pain medication, instrumental deliveries, and cesarean sections.

Lamaze International, a CIMS Organizational Member, also questioned the study's conclusion. Amy Romano, MSN, CNM, researcher and contributor on Lamaze International's Science & Sensibility blog, wrote, "high quality studies, conducted in low-risk women in integrated maternity care systems, find no excess risk for babies and significant benefits for mothers."

The Centers for Disease Control (CDC) reports that babies born at home are less likely to be born preterm and low birth weight compared to babies born in the hospital.

Mary Lawlor, CPM, president of the National Association of Certified Professional Midwives, a CIMS Organizational Member, stated the study "is far from the high-quality rigorous review that health care providers and the public expect."

Also, commenting on the study, Geradine Simkins, CNM, MSN, president of the Midwives Alliance of North America, a CIMS Organizational Member, stated, "The American public, particularly women in the childbearing years and those who care for them, have a right to high quality research on childbirth. Research literature should not be used to cause undue alarm or limit a woman's choice regarding care providers, including skilled midwives, and place of birth."

The study at the heart of this debate, "Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis", originally intended for print publication in the September 2010 issue of the American Journal of Obstetrics and Gynecology (AJOG), was published online on July 1. Researchers and critics suspect that the early release was politically motivated to discredit midwives who attend the majority of home births in the U.S. and to discourage legislators from passing increasingly pro-midwife state legislation such as New York State's Midwifery Modernization Act (Bill S5007a/A8117b), which passed on June 28 with overwhelming bipartisan support, providing autonomous practice for all licensed midwives working in all settings.

CIMS' advisor, Dr. Michael C. Klein, a senior scientist at the Child and Family Research Institute in Vancouver and emeritus professor of family practice and pediatrics at the University of British Columbia believes this is "an unabashed attempt to have poor science cover-unsuccessfully-a political agenda. I am very surprised that the [Journal] would publish it, let alone call it 'Editors Choice'."

According to the CDC, the number of women opting to have their babies at home has been increasing since 1990 and rose by 5% in 2005 and remained steady in 2006. This is significant because it marked the first time in 14 years that the percentage of out-of-hospital births increased in the U.S. In 2006 there were 4.2 million births in the U.S., of which approximately 25,000 (.59%) were home births. About 61% of home births were attended by midwives. Among midwife-delivered home births, one-fourth (27%) were delivered by certified nurse-midwives, and nearly three-fourths (73%) were delivered by other professional midwives.

"Women choose to have a home birth for many reasons," states Nicette Jukelevics, chair of the CIMS Coalition Building Committee. "For financial, cultural or religions concerns, lack of transportation in rural areas, or to give birth in a supportive, low-intervention, familiar environment. Other countries like Great Britain, Ireland, Canada, and the Netherlands support women's choice for home birth. The unsubstantiated controversy against planned homebirth with a qualified provider has been with us for many decades. It's time that women in the U.S. have the same right and opportunity to give birth as they choose."

About CIMS: The Coalition for Improving Maternity Services (CIMS) is a coalition of individuals and national organizations with concern for the care and wellbeing of mothers, babies, and families. Our mission is to promote a wellness model of maternity care that will improve birth outcomes and substantially reduce costs. This evidence-based mother-, baby-, and family-friendly model focuses on prevention and wellness as the alternatives to high-cost screening, diagnosis, and treatment programs. Media Inquiries: Denna Suko (919) 863-9482, dsuko@motherfriendly.org.

Rep. Kathy Castor Calls House Subcomittee Meeting to Reduce Florida's C-Section Rate

Three cheers for U.S. Representative Kathy Castor (D-Tampa). Last Wednesday, she led a a hearing in the House Subcommittee on Health about the risks of preterm births and their direct correlation to the soaring c-section rates, saying "We have a public-health crisis. Our rates are much higher than the national average." Read the following article by Cynthia Washam from Health News Florida, and please contact your elected federal officials and voice your support for Rep. Castor's platform.

Efforts to curb risky and unnecessary cesarean sections have had the added benefit of lowering preterm births nationally for two successive years. But not here in Florida, where C-sections and preterm births continue climbing above the rest of the country.

Castor spearheaded Since the early 1980s, preterm births have risen by a third to more than 12 percent of all births, according to the National Center for Health Statistics. They dipped just slightly between 2006 and 2008.

Here in Florida, the situation is worse. Florida also has a C-section rate of 38 percent, considerably higher than the 32 percent national average.

"If babies are not full term, a few will die," said Dr. Charles Mahan, dean emeritus of the University of South Florida College of Public Health and founder of the college's Lawton and Rhea Chiles Center for Healthy Mothers and Babies. "Many will have respiratory problems, often educational issues, attention-deficit disorder, things like that."

Mahan spoke at the House hearing about the link between elective C-sections and preterm births, and suggested drastic steps to bring both down.

Non-emergency C-sections promote preterm births because doctors try to schedule them before the patient goes into labor, which normally happens between 37 and 42 weeks gestation. The American College of Obstetrics and Gynecology (ACOG) advises members to avoid preterm deliveries by scheduling elective C-sections no sooner than 39 weeks.

ACOG Vice President Dr. Hal Lawrence III testified at the hearing that 96 percent of members follow the guidelines. But a miscalculation in the due date sometimes leads to births at 34 to 37 weeks, or late preterm.

"Seventy-one percent of all preterm births are late preterm," Castor said, "and C-sections account for nearly all the rise in late preterms."

Lori Reeves, Florida's program director for the March of Dimes, believes doctors' interest in avoiding nighttime and weekend deliveries when the patient is in labor leads them to schedule C-sections too early.

"More and more births are scheduled before that 39-week mark," she said. "It's more convenient for doctors to know when the delivery is going to occur."

Physicians once thought a couple days in neonatal intensive care would clear up the often minor breathing and other physical problems associated with late preterm births. But research in the past couple years suggests that many late-preterm youngsters suffer from subtle learning deficits that might not be apparent until they start school.

"Evidence shows that babies born even a couple weeks early do have a high risk of complications," Reeves said. "Some physicians might not have been aware of those risks."

Estimating the due date can be tricky, Mahan explained. Ultrasounds taken around 18 weeks of pregnancy give a good approximation of gestational age, while ultrasounds delayed until later can lead to miscalculations of up to three weeks.

Mahan believes no woman should get a C-section that's not medically necessary, even if she's definitely past 39 weeks. He recommended to the House subcommittee that Medicaid stop paying for all C-sections that are not medically necessary. He called for more vaginal births after cesareans (VBACs).

Although VBACs were common in the 1990s, many doctors and hospitals now consider them too risky to perform. As an incentive, Mahan told the committee insurers should pay physicians $2,000 for VBAC deliveries, $1,500 for vaginal births and only $1,000 for C-sections. Doctors now are paid the most for C-section births.

"The World Health Organization says the (C-section) rate should be 15 percent," Mahan said. "I would say with the obesity epidemic, 20 percent would be reasonable."

To approach that goal, the Florida March of Dimes, Department of Health and University of Florida are sponsoring the Florida Perinatal Quality Collaborative. Their first mission will be to slash the number of elective C-sections before 39 weeks gestation.

"We need to educate moms about their rights during pregnancy and we need to educate doctors to give informed consent," Reeves said.

She expects the program to begin this summer at five hospitals to be chosen. The collaborative will give the hospitals grants and information on how to train physicians to reduce preterm deliveries, and how to collect and assess data.

Physicians who perform elective C-sections will have to provide justification to the hospital. California and a few other states have reduced their C-section rates through similar efforts.

"It's a quality improvement and safety issue," said Mahan, who also is involved with the Collaborative.

Although ACOG and other medical organizations for many years have been calling for fewer C-sections, he believes doctors are ready to listen.

"Now that we're showing doctors this is causing problems, they're backing off," he said. "There's a lot of interest in turning (the preterm rate) around."

Note: Author Cynthia Washam is an independent journalist. Questions and comments about facts from the above article can be sent to Florida Health News Editor Carol Gentry.

Dr. Washington Hill Writes: Save Healthy Start

The following guest column appeared in today's Sarasota Herald-Tribune. Dr. Washington Hill, director of maternal-fetal medicine and medical director of labor and delivery at Sarasota Memorial Hospital, has been a long time friend and supporter of Healthy Start Coalitions. Please read his evidence based call to action for consumers and legislators to act now to stop the elimination of this life saving organization.

Florida enacted the nation's most comprehensive maternal and infant health-care program on June 4, 1991. It was called the Florida Healthy Start Initiative. The goal of Healthy Start is to reduce infant mortality, reduce the number of low birth- weight babies and improve health and developmental outcomes. It does all of these very well.

The key components of Florida's Healthy Start include universal prenatal and infant risk screening, care coordination and services, community-based prenatal and infant health-care coalitions, children's medical services expansion, and increasing Medicaid eligibility for pregnant women.

Florida has reached a crossroads with this program. The state House of Representatives has eliminated Healthy Start Coalitions in its budget and transferred the direct-service dollars, minus 15 percent of those dollars, to county health departments. Some health departments are not equipped to do this and in some instances are restricted from performing some of these activities.

The Senate budget has no such cuts. Over the next weeks, as the legislative conference committees are being formed, the fate of Healthy Start is really unknown.

Keep in mind that 1,912 infants in Florida did not even survive to celebrate their first birthday in 1990. That same year, 5,341 women did not receive any prenatal care whatsoever during their pregnancy and an additional 8,567 woman in Florida did not receive prenatal care until their third trimester. The Centers for Disease Control and Prevention identifies lack of prenatal care as one of the leading causes of infant mortality.

In the past, the Legislature recognized the need to reduce infant mortality and promote healthy childhood development and created the Healthy Start program to address those needs. For 19 years it has worked well and we need it to continue.

If the change proposed in the House budget occurs, program costs will increase, opportunities for additional fundraising will be diminished, community decision-making, education and partnerships to meet local needs here in Sarasota and around Florida will cease, and the momentum to decrease fetal and infant mortality prematurity and low birth weight babies in Florida will also be lost forever.

Thirty Healthy Start Coalitions now cover 64 of the 67 counties in Florida. These coalitions remove barriers to health care and effectively promote healthy outcomes and a healthy start for babies. While 25 of the 67 county health departments do not even provide prenatal care, Sarasota County is not one of them. We are blessed with a superb obstetrics program called Mother's Care Center.

Healthy Start Coalitions have also established provider networks to ensure all pregnant women have access to care. In Sarasota County this occurs through numerous, very competent healthcare providers and maternal-fetal medicine specialists. A change in delivery of the services would mean the loss of millions of additional dollars. In one year alone coalitions raised $32 million from other funding sources. This money was used to support projects targeted to meet the needs of individual communities. In Sarasota County more than $80,000 in in-kind services were provided to pregnant women or new moms in Healthy Start. More than $47,000 in additional grants and donations helped us run our programs. This is a perfect example of how public/private partnerships promote a "less government" approach to services.

The success of Healthy Start speaks for itself. I see that success every day at Sarasota Memorial Hospital and the county. Infant mortality has decreased 20 percent since the coalitions were established in 1991. By increasing access to care, Healthy Start prevents maternal and child health issues that are not only devastating but costly. First-year medical costs for a premature birth alone are about 10 times those for a full- term infant. The work of Healthy Start decreases the number of preterm births, high-risk infant births and high risk mothers. Sarasota County cannot afford to lose the benefits gained from Healthy Start Coalitions. If Healthy Start Coalitions are eliminated or their budget decreased as proposed, we will lose out on the benefits of this model, which has proven to be successful. This is a best-practice model that Sarasota County and Florida cannot do without.

We need to all make sure that the proposed elimination of funding for Healthy Start Coalitions around the state does not occur and recognize that the coalitions are a valuable resource in improving maternal and child health.

All of us understand the difficult decisions that our legislators have to make regarding the Florida budget. However, it makes no fiscal or ethical sense to eliminate Healthy Start Coalitions. The fiscal reality is that if Florida does not pay upfront for the prevention of maternal and child problems, it will pay after delivery an even higher cost to treat them.

Sarasota County and the rest of Florida need Healthy Start.

MHC Panel Wrap-Up from Sonia Fuentes

It was an absolute joy to co-plan Maternal Health Care in the 21st Century: Sarasota and Beyond with Sonia Pressman Fuentes, the co-founder of the National Organization for Women (NOW). Here is the letter she is sending to the editor of the Sarasota Herald-Tribune about the event.

On Sunday afternoon, Nov. 1, Sarasotans had a unique opportunity to learn about maternal health care issues and available resources in Sarasota County, Florida, and the U.S.—and about 250 of them took advantage of that opportunity.

Starting at 3:00 p.m. and for two hours afterwards, Laura Gilkey, vice-president, Florida Friends of Midwives, and I presented a top-notch panel of experts on Maternal Health Care in the 21st Century: Sarasota and Beyond in the ballroom of the Sarasota Hyatt Regency. Our panelists were: Ina May Gaskin, the most renowned midwife in the United States; Dr. Washington Hill, Maternal-Fetal Medicine Director, Sarasota Memorial Hospital; Jennifer Highland, executive director, Healthy Start Coalition of Sarasota County; and Representative Keith Fitzgerald, who represents Sarasota in the Florida House of Representatives. The panel was moderated by Kelly Kirschner, vice-mayor of Sarasota.

After the formal presentations, there was a question-and-answer period followed by refreshments. Available to all attendees was a 28-page Program and Resource Guide containing a glossary of terms, a listing of resources available in Sarasota, a list of people with expertise available at the program, and a list of recommended readings. Our program was sponsored by the Sarasota-Manatee chapter of NOW (National Organization for Women), SCSW (Sarasota Commission on the Status of Women), and FFOM (Florida Friends of Midwives). All at no cost to the attendees. That was made possible by the generous donations in money and in-kind by Sarasota businesses, organizations, and individuals.

Laura and I made this educational program available because the U.S. ranks 35th in maternal mortality and 33rd in infant mortality in the world. The U.S. spends more money on mothers’ health than any other nation in the world, yet in America women are more likely to die during childbirth than they are in most other developed countries.

We learned a great deal from our panelists. We learned about the problems caused by women in poor health, and those who are smokers, alcoholics, and drug addicts, becoming pregnant. We learned about the problems caused by induced labor and the performance of unnecessary Cesarean sections. We learned that statistics and other information on the incidence of induced labor, the rate of Cesareans, and maternal deaths in our community by obstetrician and hospital are not readily available. We learned about the success of special interest groups in preventing the passage of needed legislation in the Florida Legislature and the U.S. Congress. We learned about the system of postnatal care in The Netherlands where every new mother in the first eight to ten days after the birth of her baby is entitled to the services of an assistant, who will aid in the recovery of the mother and provide her with advice and assistance to care for her newborn. We learned that the maternal death rate in the US has not gone down since 1982 and the rate for African-American women has been three to four times higher than for whites since 1940.

As if to point up the timeliness of our program, two days later, on November 3, The New York Times published an article entitled “Premature Births Worsen US Infant Death Rate.” The article referred to the fact that about 1 in 8 U.S. births are premature and that early births are much less common in most of Europe. Among the reasons given for the high rate of prematurity in the U.S. were some of the very reasons discussed by our panelists, including the induction of labor and the overuse of C-sections.

Because of what we’ve learned, Laura and I now plan to build on this panel discussion and form an advocacy group to address these issues for Sarasota County, Florida, and the U.S. We welcome participation by anyone interested in working with us to achieve the goal of a healthy mother and a healthy baby in the case of every pregnancy.

Healthy Start Coalition Annual Meeting

This morning, I was honored to be a speaker and an award presenter at the Healthy Start Coalition of Sarasota County's annual meeting. In attendance at the meeting were Sarasota Vice Mayor Kelly Kirschner, Florida Representative Keith Fitzgerald, Jim McCloud and Lisa Merritt from the Newtown Health Advisory Council, and many other members of our community that have a vested interest in improving maternal and infant health in Sarasota.

Jenna Norwood, Chair of the 2009 Healthy Start Board of Directors, began the program by emphasizing the mission of the Healthy Start Coalition: to promote the health and well-being of pregnant women, infants, and young children in Sarasota County. She then presented the 2009 Mission Award to Rebecca Clapp, a Healthy Start Care Coordinator retiring this year after 37 years with the Sarasota County Healthy Department.

Then it was my turn to deliver a Message from Sarasota's Moms. I hope I spoke for all of you when I said that what Sarasota's moms need most is support. The support of our families, our friends, our care providers and our community. The support that comes from having the ability to ask a question of our care provider, and receive a sound, evidence-based answer. The support of knowing that the very best and latest research is being analyzed behind the scenes to give us the healthiest pregnancies, the safest deliveries, and the best outcomes for our babies. I also introduced the meeting's attendees to the upcoming panel discussion Maternal Health Care in the 21st Century: Sarasota and Beyond.

It was then my privilege to present the 2009 Family of the Year Award to Veronica Alvarez-Perez, who accepted graciously, with her two beautiful children, through tears of joy. Veronica embodies what Healthy Start is all about. This mother wanted to assure that her newly blended family thrived in a safe, loving environment, and could handle the stressors which they were facing. She followed through with all Healthy Start referrals for services, and attended all of her counseling sessions. She participated in the Healthy Families/Healthy Children program, sought out and received financial assistance and necessary baby items for her two month old, and even learned Infant and Child CPR. In face of hardships, she made sure her baby attended all well-child exams, and remained healthy through infancy.

Jennifer Highland, Healthy Start Executive Director (and panelist for Maternal Health Care in the 21st Century), then introduced the 16 minute film Reducing Infant Mortality. I was so pleased that she chose this groundbreaking expose, produced by filmmaker Debbie Takikawa. The film investigates possible reasons for the US's staggering 33rd ranking in infant mortality, including overuse of medical intervention and lack of prenatal care for many Americans. It also suggests paths to improving this condition, such as the Midwifery Model of Care and breastfeeding.


Jennifer concluded the film's presentation with a powerful message about Healthy Start’s fetal and infant mortality rates, leading risk factors, and how the community can work together to improve pregnancy health and have better birth outcomes.

Jennifer then presented the Lawton Chiles Award to Dr. Jerome Isaac. The Lawton Chiles Award is presented to an individual in the community whose contributions to prenatal or early child health in Sarasota County are characterized by exceptional commitment, wisdom, leadership, and vision. From Jennifer's introduction of Dr. Isaac:

"Research has long shown that breastfeeding is the number one way to promote infant health and prevent a variety of problems and adverse affects, some of which last a lifetime. The winner of this award has stood at the forefront of breastfeeding promotion among area pediatricians and hospitals. He understands the circumstances which can enhance or defeat successful breastfeeding, and many times seemed to be the lone figure in advocating for the breastfeeding dyad. We admire and wholly support his tireless efforts to help make sure infants receive the best start in life through breastfeeding, and hope he will be joined by many others in the medical community to fully adopt practices which support breastfeeding."

Dr. Isaac accepted the award with a powerful message of his own, encouraging other members of the pediatric profession to look at breastfeeding as a preventative cure for many of the chronic diseases that face their patients today.

Janice Baxter, Contract and Quality Assurance Manager for Healthy Start, presented the Community Partner of the Year Award to the First Step Mothers and Infants Program, for their collaboration with Healthy Start to develop a strong, focused incentive program for pregnant women and new mothers who are in the First Step residential treatment program for substance abuse and addiction. Recognizing that two of the top priorities for health improvement are stopping smoking and breastfeeding your infant, the staff in this program created a special incentive program to reward residents who have stopped smoking and who are breastfeeding their infants.

Healthy Start board members Shara Abrams and Kelly Kirschner then presented the Media Partner of the Year Award to Jackie Barron, of WFLA, News Channel 8. Kelly gave a personal account of his own struggle with the premature birth of his son, Bodhi, and Bodhi's need for the vaccine that prevents RSV, a potentially lethal respiratory infection. This vaccine is needed in a large percentage of premature babies, and was not covered by insurance. But because of Jackie's reporting to the public the dangers of RSV, the cost of the vaccine is now covered.

The Healthy Start Coalition of Sarasota County, Inc. is the only organization that is actively working to improve the health and well-being of Sarasota's pregnant mothers, babies, and infants. While the Coalition does receive government funding, it simply isn't enough to help this group execute and implement the programs necessary to literally save the lives of Sarasota's families. Please consider donating to this incredible effort.

Response to Today Show's Perils of Midwifery

Noah Kotch
TODAY Senior Producer
379E-1
30 Rockefeller Plaza
New York, NY 10112

Dear Mr. Kotch:

The TODAY Show, with its over 5 million viewers, has a public responsibility to air balanced journalism. A controversial issue such as maternal healthcare deserves investigation from many sides to paint an accurate picture. This was, unfortunately, not the case with the piece entitled The Perils of Midwifery, which aired Friday, September 11th. The title alone introduces this segment as a one-sided and biased presentation of the issue. America’s potential mothers deserve better.

The American maternity care system is broken. The U.S. ranks 35th for maternal mortality and 33rd for infant mortality worldwide, according to the most recent World Health Organization World Health Statistics. Widely recognized as barometers of a nation’s overall public health, these mortality rates show that maternal and child health is a serious problem in this country, one rarely recognized, and one that deserves comprehensive and fair coverage by the media.

For low-risk, healthy pregnant women, birth is a normal process in which credentialed midwives are highly trained to assist. Nowhere in your segment did you inform your viewers of the rigorous, experiential education a Certified Midwife (CM), Certified Nurse Midwife (CNM), or Certified Professional Midwife (CPM) receives. Peter Alexander said that the subject has sparked “passionate debate,” yet while we heard plenty from the American College of Obstetricians and Gynecologists (ACOG), we didn’t hear from a single midwife during the interview. Midwives in this country are members of the North American Registry of Midwives (NARM), as well as the Midwives Alliance of North America (MANA), a professional organization analogous to ACOG. Cara Muhlhahn, the midwife to the McKenzie family, is a Certified Nurse Midwife (CNM); CNM’s belong to the American College of Nurse-Midwives (ACNM). Any of these three groups (NARM, MANA, or ACNM) would have provided comprehensive resources for a balanced investigation.

We commend you for requesting an interview with Ms. Muhlhahn, and understand that she declined this request. Without her testimony, however, we have no way of knowing how, when, or why the McKenzie baby died. It was directly implied that this baby died because she was born at home. This may not have been the case. Furthermore, regardless of the reason for the McKenzie baby’s death, babies die in hospitals as well as in homes. There is much room for speculation and to imply that the McKenzie’s decision to birth at home with a midwife resulted in the death of their baby is simply exploitative. Midwives and physicians each have their place in maternal health care; only with true collaboration and mutual respect can we begin to heal a very broken system.

Peter Alexander called home birth with a midwife “extreme” because of the lack of drugs and doctors. Women who choose to give birth in this way were labeled as “hedonistic.” Mr. Alexander did briefly interject that studies show home birth with a midwife is as safe as hospital birth. The statement was, however, immediately followed by a familiar caveat against the evidence from the American College of Obstetricians and Gynecologists (ACOG), claiming that these studies are invalid because they fail to remove high-risk pregnancies from the equation. The latest study on the issue negates that argument, comparing low-risk pregnancies in hospitals with low-risk births at home with credentialed midwives. This study found that “planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death…and other adverse perinatal outcomes compared with planned hospital birth.”

During the beginning of the segment, your cameras focused on the book Ina May’s Guide to Childbirth, as one of the works cited in the movie The Business of Being Born. The author of that bestseller is Ina May Gaskin, pioneer of the modern midwifery movement. When asked about her thoughts on The Perils of Midwifery, Ms. Gaskin replied, “We need to get beyond simple-minded doctor- or midwife-bashing and look at some of the structural failings that prevent us from clearly understanding why too many mothers and babies are dying in our country around the time of birth. We need both midwives and physicians, and we need them to work together.”

Ms. Gaskin will be participating in a panel discussion in Sarasota, Florida, on November 1st called Maternal Health Care in the 21st Century: Sarasota and Beyond. A copy of the press release for this program is enclosed. Another panelist in this discussion is Jennifer Highland, MPH, Executive Director of The Healthy Start Coalition of Sarasota County. In a conversation about The TODAY Show segment, Ms. Highland said, “All practitioners--in midwifery OR medical practices --have their rightful place in the provision of safe and satisfying prenatal care and delivery. Each must exquisitely recognize their own limitations and accept the appropriateness of their services to each situation, without bias. Unfortunately, babies die no matter what the setting. Neither the hospital nor the home is immune…having a chasmic divide between sides will get us nowhere. United we stand, divided we fall.”

This must be just one of many letters you have received about the one-sidedness of The Perils of Midwifery. We trust The Today Show will do a second, more evenhanded program on this vital issue, and look forward to your response outlining your plans in this regard. As part of a more balanced presentation, you might be interested in covering Maternal Health Care in the 21st Century: Sarasota and Beyond on November 1st. We would welcome the Today Show’s reporters and photographers at this discussion. We hope the program will pave the road to improved maternity care in our own community.

NBC and the Today Show have an opportunity to present a balanced report on maternal healthcare in the US and to thereby display an earnest effort of leadership toward improving maternity care in this country.

Sincerely,



Laura H. Gilkey
Vice President, Florida Friends of Midwives
www.borninsarasota.blogspot.com
941.915.8115

Sonia Pressman Fuentes
Co-founder, The National Organization for Women
www.erraticimpact.com/fuentes
941.379.6215

(1) Encl.

Cc: Peter Alexander, TODAY / NBC News Correspondent
Matt Lauer, TODAY Anchor
Jeff Zucker, President and Chief Executive Officer, NBC Universal
Steve Capus, President, NBC News
John Eck, President, NBC TV Network and Media Works
Ina May Gaskin, Founder and Director, The Farm Midwifery Center
Jennifer Highland, Executive Director, Healthy Start Coalition of Sarasota County

Heads Up on Infant Mortality

September is Infant Mortality month, and Orlando Midwife Jennie Joseph is leading an international campaign to raise awareness of this important issue. Did you know that 1,687 babies died before age one in 2007 in the state of Florida alone? The 2009 Campaign for Healthier Babies is drawing attention to infant mortality by knitting one baby hat for every baby who didn't reach their first birthday, in what Jennie calls the 'Heads Up on Infant Mortality' program.

"Too many babies are being born too soon, too small, or too sick to survive," said Jennie Joseph, CPM, Executive Director of Commonsense Childbirth. Please join Jennie in her endeavor to promote early prenatal care and save the lives of our children!

How you can help:

- knit or crochet one or more baby hats
- teach someone how to knit or crochet a baby hat
- donate to the campaign
- encourage all pregnant women to start prenatal care right away - we can help, no one is turned away

The hats will be displayed at a rally in September (date & time TBA). You can help by knitting or crocheting one or more infant hats and bringing or mailing your hat(s) to:

The Birth Place
1130 E. Plant Street
Winter Garden, FL 34787
Call: (407) 656-6938
Email: Elena@TheBirthPlace.org

In Sarasota, you can save shipping costs by bringing your hats to Birthways Family Birth Center by September 1st, and midwives Christina Holmes and Sabrina Zehr will mail them for you!