Letter to the Editor: Sarasota Herald Tribune

Thank you to the Sarasota Herald Tribune for publishing my letter this morning.

Recently, Gov. Rick Scott signed the Healthy Pregnancies for Incarcerated Women Act (SB 524) into law. I applaud Sen. Arthenia Joyner, Rep. Betty Reed, Gov. Scott, and all who championed this legislation.

The practice of shackling incarcerated pregnant women (the overwhelming majority of which were arrested for nonviolent crimes) is barbaric, inhumane, and dangerous to the health of the mother and the baby. It interferes with the work of her health care provider, and makes the labor process more painful and more difficult than necessary. It increases trauma, and subsequent post-traumatic stress and post-partum depression, both of which increase rates of recidivism, drug use, and suicide. Conversely, when a woman gives birth with dignity and compassion, attachment to her baby is facilitated, giving that baby the greatest chance of physiological and emotional success in those first critical hours of life.

I strongly encourage the Florida Legislature to examine a prison nursery system, much like the ones in place in New York, Nebraska, California, Washington, Ohio and Indiana. Healthy maternal infant bonding strengthens a healthy society.

Laura Gilkey, Sarasota

Gilkey is the co-hostess of "Maternally Yours" on WSLR 96.5.

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.

Sunday's Letter to the Editor

Thank you to the Sarasota Herald-Tribune for printing my letter on Easter Sunday. I am hopeful that many readers will take action.

Regarding pediatrician Sean Palfrey's column "How patients can help doctors practice better, less costly medicine":

No discipline best illustrates the American medical trend of over-intervention than maternity care.

Despite spending more on maternity care than any other nation (about $98 billion annually), the U.S. ranks an abysmal 50th in maternal mortality, the World Health Organization reports.

Why are two to three American women dying of pregnancy- or childbirth-related causes every day? Because their care falls on one extreme or the other of appropriate. Many women are not receiving prenatal or postpartum care at all. On the spectrum's other end, many are receiving dangerous intervention that exceeds what is medically necessary for a healthy birth outcome.

What can we do? To start, we can adequately count the women who are dying, and discern their causes of death. Florida is one of only 21 states that has a check box on a woman's death certificate to note whether she was pregnant or recently pregnant when she died. The Maternal Health Accountability Act of 2011 aims to change that, making a nationwide data collecting system that establishes maternal death review boards in all states. I strongly urge you to contact your elected officials and convey your support of this bill.

SRQ Daily: Every Child Needs a Mother

Many thanks to SRQ Magazine for running the following guest column in today's SRQ Daily.

I type from an airplane somewhere between DCA and SRQ, my heartbeat quickening as I anticipate a joyous reunion with my husband and children. Yet for far too many American families, joy is replaced with grief, reunion replaced with loneliness. Saturday’s Healthy Mothers Healthy Birth Summit at Shenandoah University addressed the silent epidemic of maternal mortality in the United States.

Americans spend more on maternity care than any other nation in the world (approximately $98 billion annually), yet World Health Organization data shows 49 countries losing fewer mothers than we do. Some names might not surprise you—Sweden, the Netherlands, Germany, the U.K. But how about Slovenia, Bosnia, Kuwait and Bahrain?

Amnesty International researcher Nan Strauss presented the group’s report "Deadly Delivery: The Maternal Healthcare Crisis in the USA." Amnesty concludes that at least half of American maternal deaths are preventable, resulting from lack of prenatal/postpartum care, or from overuse of intervention such as labor induction or Cesarean section. "We have the research. We have the answers," said Strauss. "We're just waiting for the political will."

Florida midwife Jennie Joseph agrees. Her answer? The Midwives Model of Care, empowering the mother through knowledge and support, minimizing interventions and referring women who require obstetrical attention. The Summit’s experts recommend the midwifery model as the standard for low-risk, normal births.

Renowned midwife Ina May Gaskin then presented her Safe Motherhood Quilt Project (www.rememberthemothers.org). The quilt honors American women who have died of pregnancy or childbirth related causes since 1982.

So what can we do? We can begin by accurately counting and discerning the causes of our maternal deaths. The Maternal Health Accountability Act of 2011 (H.R. 894) would mandate a national data collection system, and establish maternal death review boards in every state. I encourage anyone who is concerned about this crisis to contact your representatives and urge their endorsement of this bill.

Every child needs a mother. I can't wait to get off this plane and show my babies how grateful I am to be theirs.

Guest Post: Fed With Love

by Abby Weingarten

Today, I watched my husband feed our miraculous, 16-month-old daughter a bottle, as he has done since she was a tiny infant.

And for the millionth time, I thought to myself, “What could be more precious than this picture?”

As you’re reading this, you might have questions. Maybe you’re confused about why a father instead of a mother is feeding a daughter, why our baby is not breastfeeding, or why I am somehow making excuses for that fact.

It’s OK. I know exactly how you feel.

Before our little girl was born, I had a plan. I had so many plans. I had decided how and where she would be delivered, and how and what she would eat. I assumed it was my responsibility, and my husband’s, to cement these items before her birth. I guess I never considered our daughter’s opinion on the matter.

As it turned out, my birth and breastfeeding plans, despite all my protestations, did not unfold the way I’d envisioned. As much as I tried to avoid an emergency C-section, it happened, and our nursing attempts were equally traumatic and ultimately failed.

For months afterward, I couldn’t evade the inner voices. “You should’ve tried harder!” and “Don’t you care about your daughter?” echoed tirelessly in my brain.

Yet, all the while, my serenity—the moments that pulled me out of those remorse spells—were the times I peeked in on my husband, our baby, and their magical bottle.

Those feeding times, as he rocked her in her nursery chair, meant everything to him. He would stay up all night with her while I recovered, and he’d happily tend to her every whimper. I know how incredibly important it made him feel.

Many of the most profound, beautiful and nurturing moments in our daughter’s life have been with her dad and their bonding bottle. To this day, the idea of weaning her off of it is too emotional a step for him, and neither of them is quite ready.

They often say that, if food is made with love, you can taste it and feel it. I know our daughter can and always has.

I sometimes wonder what it would have been like if things had gone according to “the plan” and it was only me that ever experienced that invaluable closeness with our girl.

For us, there was another way. For you, maybe it wouldn’t have been the right one.

But I’ll never erase that image in my mind of dad and daughter and the food that has inseparably linked them.

Whether it comes from a breast or a bottle, love is love. And our daughter, I know in my heart, is full.

Editor's note: This is a story that needed to be told. Much like the evidence supporting natural childbirth, the evidence supporting breastfeeding can be overwhelming to a fault: those that can truly not sustain the relationship, for whatever reason, must fight feelings of inadequacy that can even lead to postpartum depression in some cases. This story is another case-and-point: we should all be striving toward healthy practices for birth and postpartum care as a society. And we really should support each other. Period.

Gratitude: The Sarasota City Commission

Dear Mayor Kirschner and the City Commissioners, City Auditor, and Administrative Assistant for the City of Sarasota:

Thank you so much for your proclamation tonight honoring Licensed Midwives Week. I know that I speak on behalf of hundreds of Sarasota families when I tell you that such a recognition is much more than a piece of paper, much more than a pat on the back for our midwives. It shows our young families that our elected officials care about healthy maternity care practices. It gives pregnant women a vote of confidence that their local government supports their evidence-based decision to choose the safe and loving care of midwives for their prenatal, labor and delivery, and postpartum care.

In the words of our nation's most groundbreaking and well-respected midwife, Ms. Ina May Gaskin: "You all are creating a little oasis of sanity there in Sarasota. Keep building: this is such important work! Please give my greetings to Kelly Kirschner. I hope that we will soon see other cities and towns making similar proclamations." With our city, state and nation's cesarean section rates on a dangerous incline, and our nation's maternal mortality rate an abysmal 41st in the world, moments like the one you facilitated tonight offer beacons of hope to so many who work so hard for improved outcomes in maternal and infant health.

Many, many thanks to each of you.

Sarasota Licensed Midwives Week: Oct. 4-8

At the next Sarasota City Commission meeting, Monday, October 4th at 6:00 pm, Mayor Kelly Kirschner will proclaim October 4-8 Sarasota Licensed Midwives Week. The first full week in October is annually proclaimed Florida Licensed Midwives Week by the office of the Governor, coinciding with National Midwifery Week, which recognizes certified nurse-midwives.

This proclamation will pay tribute to the skilled, individualized care that licensed midwives offer women and their families throughout the childbearing cycle. It will signify the strong contribution licensed midwives make to the health and well-being of our community's mothers and babies through appropriate care and treatment in all phases of childbirth.

The Midwives Model of Care™ is based on the fact that pregnancy and birth are normal life events. The application of this model has been proven to reduce to incidence of birth injury, trauma, and cesarean section. The Midwives Model of Care includes:

• monitoring the physical, psychological and social well-being of the mother throughout the childbearing cycle;
• providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support;
• minimizing technological interventions; and
• identifying and referring women who require obstetrical attention.

I am so proud to live in a city that recognizes the value and service our midwives provide. I know that many people reading this blog share this sentiment, and I encourage you to bring your families to City Hall next Monday evening and show your support for this proclamation. Contact your local media, your elected officials, and most importantly your midwives, and communicate how important their service is to you. Spread the word about the overwhelming body of evidence supporting the safe, cost-effective, nurturing model of care these practitioners offer our families.

Healthy Start Coalition Annual Meeting

On Thursday, September 23, the Healthy Start Coalition of Sarasota County held their annual meeting. In attendance were many of our community's midwives, obstetricians, hospital staff, health department officials, leaders of health care organizations, families, educators, legislators and more.

Healthy Start Board of Directors co-chair Shara Abrams began the meeting by reminding guests of the uncertainty of the past year, with the Florida legislature coming dangerously close to eliminating all Healthy Start Coalitions. She also announced new Fetal and Infant Mortality Review (FIMR) Coordinator Beth Rubin. Jennifer Highland, Healthy Start Executive Director, then took the podium and gave an overview of Healthy Start (now in its twelfth year) and its services. She too spoke about the near-elimination in the legislature, as well as the downward shift in incoming young families to our community. Jennifer talked about some of the improvements made over the last year, despite the reduction in budget, including the addition of a Spanish speaking Certified Lactation Consultant to the care coordination team.

Jennifer went on to describe the Service Delivery Plan (SDP) 2010-2015, issued by Healthy Start this summer. I had the privilege of joining the Planning and Evaluation Committee of Healthy Start just in time to watch this incredibly thorough document's creation. The SDP identifies key risk factors and trends affecting pregnant woman and infants, and uses those to set forth an activity plan for the next five years. The statistics and research compiled to create these initiatives came from a variety of measures and sources, all referenced and double-checked, resulting in a comprehensive and thoughtful outline of steps. The SDP identified the following as the most affective negative trends in Sarasota County:

• smoking;
• substance abuse;
• obesity;
• maternal infections;
• unplanned pregnancies;
• high cesarean section delivery rate leading to unnecessary pre-term births;
• sub-optimal breastfeeding rates;
• and significant maternal and infant health disparities among African-Americans.

The SDP's plan of action outlines nine initiatives to execute during the next five years:

1. Implement "Right from the Start" and "text4baby" campaigns, both of which target pre/interconception, pregnancy, and infant health.
2. Promote uniform counseling messages and the "5 A's Approah" for women at risk of continuing tobacco use during pregnancy or between pregnancies.
3. Improve screening for drug abuse among pregnant women, and advocate for routine drug screening and treatment.
4. Provide education to the community and enhance Healthy Start services to reduce the hazards of obesity during pregnancy.
5. Improve public awareness of the risks of maternal infections during pregnancy and the importance of prevention and adherence to treatment protocols.
6. Offer updated family planning education to Healthy Start, MomCare and Healthy Families clients.
7. Improve public awareness of the dangers of elective C-sections prior to 39 weeks of gestation.
8. Improve breastfeeding rates among Healthy Start and Healthy Families clients by working along the continuum from pregnancy through the postpartum phase.
9. Increase and sustain education and support for preconception, interconception and pregnancy health for high risk African-American pregnant women.

After introducing two women who have been positively impacted by Healthy Start--one through taking advantage of its services, and one by recognizing high need and taking the path toward the field of obstetrics--Jennifer passed the microphone to Sarasota Mayor Kelly Kirschner, one of two keynote speakers for the morning.

Mayor Kirschner framed his message by sharing his personal journey with maternal and infant health--his oldest child, Bodhi, was born at 27 weeks gestation and spent three and a half months in intensive care. Kirschner's wife, Tracy, is a Certified Nurse Midwife who suffered a grand mal seizure as a result of sudden eclampsia during her pregnancy. After Bodhi's birth by emergency c-section, the couple watched by his side as Bodhi literally struggled for survival, using machines to help him breathe. Mayor Kirschner's message was clear: this was a necessary c-section, and the bill for Bodhi's care exceeds half a million dollars. His treatment, albeit appropriate and one for which the Kirschners are grateful, comes with repercussions today. The cesareans and resultant NICU admissions that are NOT necessary must be eliminated if we are to improve outcomes and healthcare costs.

Kirschner cited the recent Health News Florida article that connected high c-section rates and populations with high Hispanic percentages. Kirschner challenged some of these correlations, saying Florida has been home to Puerto Ricans, Brazilians, Chileans and others for decades, and that their presence here can't explain the sharp c-section increase. He focused instead on a hospital in Guadalajara, Mexico, that requires a second opinion, a documentation of reason, and monitoring and follow-up with the obstetrician when a c-section is suggested. Kirschner also reminded the Healthy Start members that while convenience, lack of VBAC access, fear of litigation, obesity and more are often called out as reasons for the high c-section rates, the highest increase is currently in women 25 and under--indicating that a lack of informed consent is perhaps the true culprit.

Mayor Kirschner summarized his message, inspired by Dr. Albert Bandura, by saying that a belief in self-efficacy is the foundation for change. We--mothers, fathers, families, policy makers, maternity care providers, hospitals, legislators, insurors--have to understand that to improve the practice of childbirth today, through a return to normalcy and appropriate care, is to reduce a high-cost impact tomorrow, both fiscally and physically.

Florida Representative Keith Fitzgerald was the second keynote speaker of the morning, and he continued Mayor Kirschner's sentiments with a plea to those present to get involved in their state government. He very honestly described the near-elimination of Healthy Start from a legislative perspective, which was enlightening to say the least: he said that the Coalitions were never intended to be eliminated, but rather cut in funding; however, proposing elimination allowed the Coalitions to rally, and allowed the State to then "save" the slice of the pie (albeit a smaller piece), making all parties look heroic. As these sorts of games continue to be played, it is more important year after year that consumers and advocates make their voices heard. Representative Fitzgerald adjourned with a strong message: It's up to YOU.

Jennifer Highland returned to the podium to present annual awards from Healthy Start for Volunteer of the Year (Liz Murphy), Business Partner of the Year (Sarasota Architectural Salvage), Community Partner of the Year (United Way 211), Family of the Year, the Mission Award (Shelley Rence), and the Lawton Chiles Award (Barbara White, Cyesis founder).

Jennifer then thanked outgoing Board of Directors members for their service, including six-year co-chair Jenna Norwood, who passed the "silver rattle" to incoming chair Shara Abrams. I am very honored to have been nominated and elected to the 2010-2011 Board of Directors for Healthy Start, along with many people whom I have respected in this community for years, and several new faces as well. Joining the board as honorary members are Representative Fitzgerald, Representative Ron Reagan, Ed Chiles, and outgoing director of Maternal Fetal Medicine at Sarasota Memorial Hospital, Dr. Washington Hill.

The mission of Healthy Start is to improve the health and well-being of pregnant women, infants and young children. I am privileged to join this group in this capacity, for I truly believe there is no organization in our community better poised to improve birth outcomes.

C-Sections Rise Again, 2020 Vision is Shared

Yesterday, I learned that the preliminary 2009 data for births in Florida was released. As a state, our c-section rates have increased to 38.9%. Here in Sarasota, this number has risen to a very dangerous 42.3%, up 2.1% from 2008. As I outlined in April in the 20/2020 vision, had this 2.1% increase instead been a decrease, we as a community would be on the path to healthier birth. Sadly, we still are not on that path.

WHY NOT? And what on EARTH are we going to do about it?

As if in answer to my question, I received an invitation tonight to join a webinar from Childbirth Connection, my preferred mecca of comprehensive maternity care research. The subject is the group's recently released action plan entitled Transforming Maternity Care: 2020 Vision for a High Quality, High Value Maternity Care System. This amazing group of researchers, medical professionals, maternity care practitioners, obstetricians, midwives, professors, healthcare administrators, doulas and childbirth educators has created a blueprint for action that will help consumers, care providers and facilities to step on the path toward healthier birth in this country.

At the core of the Transforming Maternity Care project are six aims applied to maternity care:

Woman-centered means that care respects the values, culture, choices, and preferences of the woman, and her family, as relevant, within the context of promoting optimal health outcomes. It means that all childbearing women are treated with kindness, respect, dignity, and cultural sensitivity, throughout their maternity care experiences.

• Pregnancy and birth are unique for each woman. Women and families hold different views about childbearing based on their knowledge, experiences, belief systems, culture, and social and family backgrounds. These differences are understood and respected, and care is adapted and organized to meet the individualized needs of women and families.

• To promote positive maternity care experiences, care teams engage in high-quality relationships with women and their families, based on mutual respect and trust.

• Caregivers and settings have a powerful effect on childbearing women. Attention is given to the power of language, communication, and care practices to create a climate of confidence and enhance outcomes of care, as well as women's childbearing experiences.

Safe means that care is reliable, appropriate, and provided in systems that foster coordination, a culture of safety, and teamwork to produce the best outcomes for women and babies and minimize the risk of harm. Maternity care processes impact outcomes for both mothers and babies; safe care considers and balances the risks and benefits to both recipients, taking into account the health status of each.

Effective means that the care is based on sound evidence applied properly to the circumstances of the individual pregnant woman and her baby to achieve desired outcomes. Effective care minimizes overuse, underuse, and misuse of care practices and services and emphasizes care coordination to prevent duplication, omission, fragmentation, and error.

Timely means that care delivery is structured so that all care is delivered at the time that it is needed. In maternity care, this means that the timing of the onset and course of all stages of labor and the birth of the baby are determined by maternal–fetal physiology whenever possible, and not by time pressures exerted externally without clear medical indication. In the context of informed consent/refusal in maternity care, timely means that whenever possible discussions and information to facilitate women's decision making around the time of birth are available well in advance of the onset of labor and again as relevant during labor. Finally, unnecessary wait times do not compromise safety, system efficiency, cost effectiveness, and satisfaction with maternity care.

Efficient means that the maternity care system delivers the best possible health outcomes and benefits with the most appropriate, conservative use of resources and technology. Overuse and misuse of treatments and medical interventions are avoided because they waste resources and can result in preventable iatrogenic complications. Similarly, efficient maternity care captures the unrealized benefits from effective underutilized measures.

Equitable means that all women and families have access to and receive the same high-quality, high-value care. Any variation in maternity care practice is based solely on the health needs and values of each woman and her fetus/newborn, and not on other extrinsic, nonmedical factors. Furthermore, an equitable maternity care system addresses disparities in the baseline health status of women related to class, race, ethnicity, and language to ensure optimal maternity care outcomes and experiences for every woman and her children.

In addition, Childbirth Connection has outlined very specific goals for each stage of pregnancy and birth. These goals drive the blueprint for action.

Care During Pregnancy: Summary of Goals

1. Each woman is engaged as a partner in her own care and education during pregnancy; she receives affirmation and practical support for her role as the natural leader of her care team to the extent that she so desires, and is encouraged to provide input to shape her own care.

2. Each woman's preferences are known, respected, and matched with individually tailored care that meets her needs and reflects her choices during pregnancy, delivered by a care team whose composition is also customized based on her needs and preferences.

3. Each woman has access to complete, accurate, up-to-date, high-quality information, decision support, and education to help ensure that she feels emotionally and psychologically prepared to make decisions during her pregnancy, and confident about her birth care options and choices well in advance of the onset of labor.

4. Education and care during pregnancy are designed and delivered to be empowering to women, emphasizing a climate of confidence.

5. Education and care during pregnancy include support for breastfeeding; most women make decisions about infant feeding well before they give birth.

6. Each pregnant woman receives personalized coaching and has access to high-quality resources for comprehensive health promotion, disease prevention, and improved nutrition and exercise for optimal wellness during her pregnancy.

7. Care during pregnancy is available when needed and can be accessed in a time and place that is convenient and accessible for each woman, as balanced with concerns for value and efficiency.

8. Care during pregnancy acknowledges the social context in which pregnancy occurs for each woman and includes opportunities for social networking and access to adequate professional and peer support during pregnancy.

Care Around the Time of Birth: Summary of Goals

1. Each woman has a comfortable, confident relationship of trust with her birth care provider(s).

2. Each woman is engaged as a partner in her own care around the time of birth; she receives affirmation and practical support for her role as the natural leader of her care team and approaches birth prepared and confident to express her preferences and make informed choices about key decisions for labor and birth.

3. Each woman can decide where to labor and give birth as appropriate based on her health status and that of her fetus/baby; she is free to make this choice without judgment and can change her mind without sanction, as an array of risk-appropriate birth setting choices is available and supported system wide.

4. Low-risk women planning hospital birth remain at home during early labor with adequate support and appropriate contact with their care team.

5. All maternity caregivers have knowledge and skills necessary to enhance the innate childbearing capacities of women. Each woman is attended in labor and birth in the manner that is most appropriate for her level of need and that of her baby and experiences only interventions that are medically indicated, supported by sound evidence of benefit, with least risk of harm compared with effective alternatives. Women and babies at high risk for complications for whom a higher level of specialized care is appropriate have specialty care available to them that adheres to the same basic values and principles.

6. Each woman is well-supported physically and emotionally throughout labor and birth; continuous labor support is built in to maternity care.

7. Each woman has access to a full-range of evidence-based, nonpharmacologic and pharmacologic strategies for pain management and relief as appropriate to each birth setting and to staff that is trained to implement them effectively.

8. Providers are trained to maintain skills and have system support to offer the fullest range of management options supported by evidence for women with special clinical circumstances.

9. Mothers and babies routinely stay together, skin to skin, receiving evidence-based care, support, and minimal disruption in the minutes and hours after birth to promote early attachment and the initiation of breastfeeding, whenever neither requires specialized care at this time.

Care After Giving Birth: Summary of Goals

1. Each woman, baby, and family receives care that effectively addresses their needs starting in the immediate postpartum period, and extending seamlessly forward across time, settings and disciplines to anticipate and respond to both continuing and new-onset mental, physical, and social needs that may develop throughout the first year of life and beyond.

2. Each woman receives strong support for breastfeeding through an array of community-based resources and the implementation of workplace supports for breastfeeding.

3. Each woman receives strong support for mother–baby attachment that includes educational offerings, experiential learning opportunities, and peer group support available through a web of services and support systems.

4. Each woman has adequate help to cope with the challenges of the period after birth, including physical changes, shifting priorities, changes in primary relationships, family planning, and issues related to sexuality, isolation, mother–baby codependence, and postpartum depression and other mood disorders. Care at this time includes opportunities to connect with people and services through innovative mechanisms and delivery models that emphasize community and social networking, and facilitate the development of longitudinal supportive relationships.

5. Each woman receives practical support at home as needed to cope with increased demands and fatigue in the period after birth and to develop confidence in her competence as a new mother. Each woman has access to social support, health care services and information, and practical advice and assistance in the period after birth. To this end, given consideration for value and efficiency, maternity care extends beyond the direct provision of health care services to routinely include postpartum services that facilitate optimal family development. This helps to ensure that each woman is valued and supported by society in her role as a new mother.

--

I am looking forward to joining Childbirth Connection in this vision, and hope that you will consider joining them as well.

The MOMS Act: Maternity Care Reform!

The very next day after the refreshing revision to ACOG's VBAC guidelines were released, my new favorite Congresswoman Lucille Roybal-Allard (D-California) introduced the MOMS (Maximizing Optimal Maternity Services) for the 21st Century Act on the House floor. Special thanks to Kathy Castor (D-Florida) for co-signing the legislation (Ms. Castor has been vocal in our own state about the correlation between our high c-section rate and premature birth). This has been a very exciting week along the path to healthier American birth! The following is from Congresswoman Roybal-Allard's office, describing her reason for the introduction and what she hopes it will achieve (including accountability for data collection, interdisciplinary maternity care including midwives, pregnancy and labor support including doulas and nutrition education, and more).

The United States spends significantly more on childbirth than any other industrialized country, but ranks far behind almost all developed countries in healthy child birth results for both mothers and babies. To address this national tragedy, Congresswoman Lucille Roybal-Allard introduced the Maximizing Optimal Maternity Services for the 21st Century Act which places a national focus on evidence-based maternity care practices to help achieve the best possible maternity outcomes for mothers and babies.

“Each year, more than 4 million women give birth in the United States. Caring for them and their babies plays a major role in our nation’s escalating health care costs. In fact, hospitalization related to pregnancy and childbirth costs approximately $86 billion each year, the highest hospitalization costs in any area of health care. Tragically, in spite of all the money we spend, the United States continues to rank far behind nearly all developed countries in perinatal outcomes, with childbirth continuing to present significant risks for mothers and babies, particularly in communities of color,” said Congresswoman Lucille Roybal-Allard, who co-founded the Congressional Study Group on Public Health and chairs the Congressional Hispanic Task Force on Health. “The MOMS for the 21st Century Act, which I introduced, addresses these disparities in our nation’s maternity health care system by making key reforms to improve the health and well-being of mothers and their babies in our country while bringing down maternity care costs.”

The Maximizing Optimal Maternity Services for the 21st Century Act (HR 5807) creates a national focus on maternity care by establishing an Interagency Coordinating Committee charged with promoting medical practices proven to provide the healthiest results for mothers and babies. The legislation authorizes a public awareness media campaign to educate the public about the best-proven maternity care practices. The legislation expands federal research on best maternity practices. The bill also authorizes data collection to pinpoint specific geographic areas of the country that lack maternity care providers.

Finally, the measure puts in place a concerted effort to create a more culturally diverse and interdisciplinary maternity care workforce. It establishes loan repayment programs for providers in maternity care shortage areas. It authorizes grant programs for maternity professional organizations to recruit and retain minority providers. It also calls for the development of core curricula across maternity professional disciplines to better ensure that providers are better trained and able to inform patients about all of their maternity care options.

“The MOMS for the 21st Century Act makes overdue reforms to our nation’s maternity care system to better ensure that providers and mothers have the best information available when making serious maternity care decisions,” Congresswoman Lucille Roybal-Allard said. “The fact is we have a maternity care system in the United States that has not traditionally adhered to evidenced-based practices. For example, there is widespread over use in our country of maternity practices, such as elective Cesarean sections and scheduled inductions. These procedures are beneficial and needed only in limited situations. When used routinely and indiscriminately and without medical necessity, these and other practices expose women and infants to unnecessary risks at high cost. On the other hand, credible science-based research tells us non-invasive maternity practices such as prenatal smoking cessation programs and centering of pregnancy group prenatal care, produce considerable improvement in maternity outcomes, such as healthier moms and babies. Yet these cost-effective evidence-based practices, which have no detrimental side effects, are significantly underused in our country.”

A longtime advocate on behalf of mothers, infants and children, the congresswoman has been honored by the March of Dimes and the Association of Maternal and Child Health Programs. Both awards recognize the congresswoman’s authorship of the Newborn Screening Saves Lives Act, which was signed into law in 2008. Enactment of the Newborn Screening Saves Lives Act established national newborn screening guidelines intended to make comprehensive newborn screening widely available throughout the country. The law also provides federal funding to educate parents and health care professionals about the importance of newborn screening, and improves the systems for follow-up care for infants identified with an illness through the newborn screening tests. In addition, the law requires the Centers for Disease Control and Prevention to ensure the quality of laboratories involved in newborn screening, and establishes a system for collecting and analyzing data that will help researchers develop better detection, prevention and treatment strategies.

Amnesty International Executive Director Larry Cox issued the following statement in support of the "MOMS for the 21st Century Act," introduced Wednesday evening in the House of Representatives by Rep. Lucille Roybal-Allard, (D-CA):

"Amnesty International commends Rep. Roybal-Allard for her commitment to improving the outcomes and disparities in maternal health in the United States. Access to good quality maternal health care is a right, not a privilege. It is shameful that as a nation we have neglected this right for so many women for so long. Amnesty International is grateful for Rep. Roybal-Allard's leadership and her recognition of the terrible human cost of this failure. We stand behind this significant legislative effort to ensure that all women have access to the maternal health care they need.

"The "MOMS for the 21st Century Act," if passed, will require the U.S. government to live up to its obligation to address this problem by developing a coordinated approach to maternal care that will improve women's access to quality, evidence-based care and will begin to address maternal health disparities. This is a first step to reducing the needless loss of women's lives that tragically affect so many families in the United States and preventing the complications that have risen steadily for decades.

What Do Today's Young Mothers Want?

This evening I attended my first meeting as a member of the Sarasota Manatee Chapter of the National Organization for Women. Of course, I have known about this trailblazing group since my adolescence, but became more deeply interested when planning Maternal Health Care in the 21st Century with one of NOW's founders, Sonia Pressman Fuentes. I decided to join today because of their discussion topic: What do today's young mothers want?

After the chapter's business was addressed, the discussion began. Group facilitator Judy Helgager honored the month of Mother's Day by bringing the needs of young mothers to NOW's table, with the intent to discuss ideas to attract this demographic into NOW membership. To prepare, Judy visited several popular "Mommy Blogs" prior to the meeting and read up on what issues were important to young mothers today.

Judy concluded that today's young mothers want to be valued. They want to stay home with their children and earn an income at the same time. They want their voices to be heard.

One of the reasons I was so excited to co-plan last year's panel discussion on maternal health with one of NOW's founders is that I have long found interesting the dichotomy of reproductive rights efforts within the feminist arena. While feminist groups have made great strides in related issues (currently the chapter is very active against H.B. 983), the right of a woman to give birth where, how, and with whom she chooses has largely been a non-issue.

I would argue in the context of tonight's discussion that one way to attract young mothers to feminist groups is by conveying the message that the right to transparent information about childbirth in this country is important. That women should be able to give birth naturally in a hospital if they so choose, without fear of unwanted intervention. That women can give birth at home with a licensed midwife and be within their legal rights and insurance network. That risks and benefits of common interventions be clearly discussed in public forums. That women will be supported before, during and after the births of their children. That groups such as NOW will communicate with elected officials about the high number of America's c-sections (42% in Sarasota)--many of which, data shows, are unwanted--and our absolutely unacceptable maternal mortality rates (currently 41st in the world).

For mothers, birth transforms women like no other single event in their lives. This singular event has the ability to empower a woman or traumatize her. The right to a healthy, informed, supported and conscious birth is the ultimate woman's right. These are the Rights of Childbearing Women, as produced by Childbirth Connection:

1. Every woman has the right to health care before, during and after pregnancy and childbirth.

2. Every woman and infant has the right to receive care that is consistent with current scientific evidence about benefits and risks. Practices that have been found to be safe and beneficial should be used when indicated. Harmful, ineffective or unnecessary practices should be avoided. Unproven interventions should be used only in the context of research to evaluate their effects.

3. Every woman has the right to choose a midwife or a physician as her maternity care provider. Both caregivers skilled in normal childbearing and caregivers skilled in complications are needed to ensure quality care for all.

4. Every woman has the right to choose her birth setting from the full range of safe options available in her community, on the basis of complete, objective information about benefits, risks and costs of these options.

5. Every woman has the right to receive all or most of her maternity care from a single caregiver or a small group of caregivers, with whom she can establish a relationship. Every woman has the right to leave her maternity caregiver and select another if she becomes dissatisfied with her care. (Only second sentence is a legal right.)

6. Every woman has the right to information about the professional identity and qualifications of those involved with her care, and to know when those involved are trainees.

7. Every woman has the right to communicate with caregivers and receive all care in privacy, which may involve excluding nonessential personnel. She also has the right to have all personal information treated according to standards of confidentiality.

8. Every woman has the right to receive maternity care that identifies and addresses social and behavioral factors that affect her health and that of her baby. She should receive information to help her take the best care of herself and her baby and have access to social services and behavioral change programs that could contribute to their health.

9. Every woman has the right to full and clear information about benefits, risks and costs of the procedures, drugs, tests and treatments offered to her, and of all other reasonable options, including no intervention. She should receive this information about all interventions that are likely to be offered during labor and birth well before the onset of labor.

10. Every woman has the right to accept or refuse procedures, drugs, tests and treatments, and to have her choices honored. She has the right to change her mind. (Please note that this established legal right has been challenged in a number of recent cases.)

11. Every woman has the right to be informed if her caregivers wish to enroll her or her infant in a research study. She should receive full information about all known and possible benefits and risks of participation; and she has the right to decide whether to participate, free from coercion and without negative consequences.

12. Every woman has the right to unrestricted access to all available records about her pregnancy, labor, birth, postpartum care and infant; to obtain a full copy of these records; and to receive help in understanding them, if necessary.

13. Every woman has the right to receive maternity care that is appropriate to her cultural and religious background, and to receive information in a language in which she can communicate.*

14. Every woman has the right to have family members and friends of her choice present during all aspects of her maternity care.

15. Every woman has the right to receive continuous social, emotional and physical support during labor and birth from a caregiver who has been trained in labor support.

16. Every woman has the right to receive full advance information about risks and benefits of all reasonably available methods for relieving pain during labor and birth, including methods that do not require the use of drugs. She has the right to choose which methods will be used and to change her mind at any time.

17. Every woman has the right to freedom of movement during labor, unencumbered by tubes, wires or other apparatus. She also has the right to give birth in the position of her choice.

18. Every woman has the right to virtually uninterrupted contact with her newborn from the moment of birth, as long as she and her baby are healthy and do not need care that requires separation.

19. Every woman has the right to receive complete information about the benefits of breastfeeding well in advance of labor, to refuse supplemental bottles and other actions that interfere with breastfeeding, and to have access to skilled lactation support for as long as she chooses to breastfeed.

20. Every woman has the right to decide collaboratively with caregivers when she and her baby will leave the birth site for home, based on their conditions and circumstances.

So...what do today's young mothers want? We want to be supported, valued and empowered with the knowledge that we have the most evidence-based information by which to make autonomous decisions about the health of ourselves and our children. It takes a village to raise a child. It also takes a village to raise a mother. It's time our country acted as our village and gave our mothers a clear message: You are supported. You are valued.

I will continue to support our local chapter of the National Organization for Women with the optimism that the tremendous leaps they have made will now translate to efforts to empower birthing women. I urge all mothers in my community to voice their support to this historic and powerful organization, and let them know that the right to a healthy birth is important to you.

Postpartum Visitation from SMH Nurses

The new postpartum visitation program at Sarasota Memorial Hospital is gaining much deserved recognition. Watch this home visit and hear nurses Judy Cavallaro and Mary Lewis explain this vitally important program, which is being accepted by almost 100% of new mothers that give birth at SMH.

Response: Ki-Moon's "Making Motherhood Safer"

(Please pardon the sound of the broken record in the background as I type.)

This morning's Herald-Tribune picked up a piece, beautifully written with the best of intentions, in the Opinion pages. The editorial called "Making Motherhood Safer" was penned by Ban Ki-Moon, the Secretary General of the United Nations. Ki-Moon sheds light upon the human rights crisis of women dying in childbirth around the world, in as high a percentage as 1 in 8 in some nations (i.e. Sierra Leone). He describes the struggle to find proper nutrition, the disparity in working hours and income, and the lack of trained attendants. These problems are very real, very scary and must be corrected. I wholeheartedly applaud the actions the United Nations and our own Government have taken, such as the UN Millenium Development Goal 5 and this year's Global Sexual and Reproductive Health Act. There are organizations that are on the ground today (e.g. Bumi Sehat Foundation International, All African People's Development and Empowerment Project) that are actively working to educate and offer women safe and gentle maternal health services. The rates of death in childbirth in these countries is absolutely unacceptable and demands and deserves the utmost priority of every government within the United Nations from which Ki-Moon writes.

However.

Ki-Moon also writes, "We (in the United States) know how to save mothers' lives. Some simple blood tests, a doctor's consultation and someone qualified to help with the birth can make a huge difference. Add some basic antibiotics, blood transfusions and a safe operating room, and the risk of death can almost be eliminated." These things most certainly do save lives in America, and no one doubts that childbirth is safer here than it was over a century ago. But the risk of death is very, very far from being eliminated. On the contrary, it has been steadily increasing since the 1980's, and now there are at least forty--yes, forty--countries in the world that lose fewer mothers than we do, yet we spend more on maternity care (by far) than any other nation in the world.

Sure, mothers in countries like Austria, Greece, Norway, Spain, Sweden, Switzerland, and the United Kingdom fare better than ours do, but so do mothers in Bosnia and Herzegovina, Slovakia, Slovenia, Estonia, Latvia, Lithuania and many more. And this is comparing our rates as a nation (currently 13.3 deaths per 100,000 live births, over three times our Healthy People 2010 goal). If you divide our nation by demographic, the numbers are staggering in places. For example, African American mothers in New York City die eight times more frequently (83.6 deaths per 100,000 live births). Not Sierra Leone, not in Somalia, not in Azerbaijan or Aceh or Haiti or Bangladesh. In New York City.

Why? Why are our rates soaring? Amnesty International has developed a task force to answer this question, and has issued the comprehensive Deadly Delivery: The Maternal Health Care Crisis in the USA. They took their findings to Washington this week in a Congressional Briefing, calling for a Department of Maternal Health under the Health and Human Services umbrella. I strongly support this proposition. We need and must demand accountability for states to accurately report the numbers and causes of maternal deaths (Florida is among the few that require this information on our death certificates). We need and must demand universal prenatal care, appropriate intervention during childbirth, and frequent postpartum visitation. Should a Department of Maternal Health be established, it may as well be subtitled the Office for Homeland Security; for that is the message our government would be sending our mothers. You are safe here. This is America.

Sarasota Memorial's Well Mom, Well Baby Program: Postpartum Visitation

The following was written by Sarasota Memorial Hospital about their new home health care program they are calling the Well Mom, Well Baby program. This is a huge step in the right direction toward postpartum care for all new mothers.

New moms and dads are leaving Sarasota Memorial Hospital with more than their bundles of joy. They’re also leaving with greater confidence in their parenting skills and the health of their newborn, knowing a reassuring house call is just a day or two away.

Sarasota Memorial began offering free home nurse visits last year to ensure the very best health outcomes for moms anxious to leave the hospital and return to other children at home and those who simply wanted to avoid the expense of a second or third day in the hospital. Parents found the visits so helpful Sarasota Memorial quickly expanded the free house calls to all new moms.

“Those first few days at home, even if it’s not your first time, can be a little scary,” said Anme Bass, who was delighted to hear about the new program after delivering her second son, Aiden, at Sarasota Memorial in March. She had planned to return home as soon as possible to her firstborn, Jacob, not yet two.

“You want to do everything right, but you don’t always know what the right thing is,” she said. “It was nice having a nurse right there in my own living room, answering questions that didn’t occur to me when I was in the hospital ... and understanding things I never learned the first time around.”

Comfort, Education & Support

The free one-hour nurse visit is scheduled at the mother’s convenience, usually during her first week home. The specially trained mother-baby nurses assess mom’s recovery and how the baby is progressing. The nurses look for common health issues, such as signs of jaundice, and counsel parents on when they should contact their pediatrician and what they can do at home, such as taking babies outside for some indirect sunshine.

They also are certified lactation consultants and look for signs that moms are struggling with postpartum depression or breast feeding – challenges experienced by nearly every new mom.

“It can be quite overwhelming in the beginning, especially if the mom is having trouble breastfeeding or not getting enough sleep,” said Mary Lewis, RN, one of Sarasota Memorial’s mother-baby home care nurses. “I’ve had moms burst into tears just a few minutes into our visit.

“But that’s the beauty of this program ... it’s very individualized. For that hour we are in their home – or longer if they need us – they have our undivided attention to help them through any fears or issues they are dealing with.”

Home Care Information

Sarasota Memorial Home Care is a Medicare-certified, licensed and accredited home health agency. Our private duty nurses and home health professionals provide care and support not only for new moms and babies, but anyone who needs a little extra care or support at home. For information, call 917-7730.

Response to Herald's "Maternal Deaths Decline"

This letter was printed in the Sarasota Herald-Tribune on Sunday, April 18th.

I disagree with those who urged The Lancet to delay publicizing the recent decline in global maternal mortality ("Maternal Deaths see surprising decline worldwide," Sarasota Herald-Tribune, April 14, page 1A). It should be a beacon of hope that improved nutrition, access to prenatal care, and the availability of skilled attendants is increasing. In 80% of the world, those skilled attendants are midwives. After witnessing the work of Ibu Robin Lim in the Sarasota Film Festival screening of “Guerilla Midwife,” I am inspired to believe that the resurgence of traditional midwifery worldwide is no small factor in this global shift toward healthier birth.

However, one disturbing trend remains missing from the Lancet findings. In the United States, maternal mortality continues to rise sharply. According to the recently released Amnesty International report "Deadly Delivery," U.S. maternal mortality ratios have doubled from 6.6 deaths per 100,000 live births in 1987 to 13.3 deaths per 100,000 live births in 2006, placing us 41st in the world in this category. The report attributes the increase to inadequate access to family planning, less than optimal health, late or inadequate prenatal care, inadequate or inappropriate care during delivery, and limited access to post-natal care.

The United States spends more on health care than any other nation in the world, yet we are failing our pregnant women. We must prioritize accountability of data collection, increase access to midwifery and to prenatal care, eliminate inappropriate obstetric intervention, and mandate postpartum visitation for new mothers.

A Village for a Family: March 21st

On Sunday, March 21, hundreds will gather from noon until dark at a Sarasota Florida cracker-style ranch in honor of a local family in need. The event, titled "A Village for A Family," is being sponsored by WSLR 96.5 and Sarasota’s Midwives, and will feature six local bands, refreshments, fun for children and a spirit of community. Proceeds will benefit the Augsburger family.

Colleen and Brad Augsburger welcomed their third baby, Kaya Soul, into the world on February 16th. Kaya was welcomed by big sister Ivy Magnolia and big brother Rylan Sky to create a new family of five. After Kaya's birth, Colleen was admitted to the ICU at Sarasota Memorial Hospital. A rare but dangerous bacterial infection, unrelated to but exacerbated by the event of birth, began causing organ damage and severe dehydration. Colleen had three surgical procedures at once on February 20th. She remained on a ventilator, on heavy blood antibiotics, and in critical condition for the following week. Due to the thorough postpartum care of her midwives, the quick and expert work of her team of doctors, and the round-the-clock spiritual vigil of her community, Colleen is home now, and beginning her long recovery process. Her family is strong and supported, but Brad will be unable to work as a painter while he cares for them and for his recovering wife.

A Village for A Family will raise proceeds for the Augsburger family while celebrating the amazing community that has rallied behind them. The Augsburgers have been fed by a different family each night since Colleen’s admission to the hospital. Baby Kaya was sustained for the beginning of his life by the generosity and nurturing of the mothers of his community. And through a PayPal account widely generated by social networking media, Brad has been able to pay bills and focus on his recovering family. They have also received donations from several local businesses, including hot restaurant meals from Ashley’s Food Delivery, organic vegetables from Jessica’s Stand, and donations of baby clothes from Mothers Helping Mothers. "Always a contributor to Mothers Helping Mothers, Colleen Augsburger is a model mother and a friend," says Terry Stottlemyer, director. I am confident Sarasota community members will join me in supporting Colleen, Brad, and their three beautiful children in this, their most devastating time of need."

The Stottlemyers will host the benefit A Village for A Family on March 21, and it won’t be the first time they’ve honored the Augsburger family. Their gorgeous homestead is where Brad and Colleen were married almost eight years ago. WSLR 96.5 will bring attendees an afternoon of top-notch local music beginning at noon, from artists such as Tanya Radtke, The Recycled Citizen, My Friend Scott, Cope, Stone Fish, and Radio-Free Carmela and the Transmitters. Guests will enjoy a fabulous raffle from local businesses, southern BBQ from Roadside Rib Shack, Budweiser from Gold Coast Eagle, and shaved ice from The Hukilau Hut. Children are most welcome for face painting from Upscale Artisans, a bounce house and more. The suggested donation is $10 for adults and free for children. The Stottlemyers’ ranch is located at 65 East Road, behind the Texaco station 1 mile east of I-75 off of Fruitville Road.

Augsburger Family Update

Today is Brad Augsburger's birthday, and he is receiving the sweetest gift of his thirty-five years: watching his wife move out of the ICU and into a regular recovery room. That is expected to happen later today. Colleen has been waking up slowly, eating and drinking tiny bits at a time and being up for half-hour stretches. This is great news. We could so easily be coping with a different outcome.

Last night, I had the uncanny experience of learning the story of Katy Hayes, a Texas mother of three who is fighting the same rare Streptococcal A bacterial infection that Colleen is overcoming (this woman's baby was born just 5 days before Kaya). As Colleen was giving birth to Kaya, Katy was in surgery for the removal of several septic organs. She remains unconscious, is still on a ventilator, and is undergoing dialysis. Just yesterday, her husband Al had to make the heartbreaking decision to allow her doctors to amputate her hands and feet, because the bacteria was attacking the tissue in her extremeties. Without amputation, her team of doctors warned that the bacteria would spread fatally.

I cannot underscore enough the importance of routine postpartum visitation and care. I am very grateful for the close observation of Colleen's midwives, family members and postpartum care team. Her warning signs were noticed immediately, and she was admitted to Sarasota Memorial Hospital in time to avoid a very bad outcome. I am also extremely grateful to the team of physicians and nurses that has worked around the clock to literally save Colleen's life. This is an example of collaborative care between midwives and doctors, and for that, on so many levels, I am grateful.

Baby Kaya, his siblings, and his daddy have been sustained by the most incredible community here in Sarasota, one that I attribute greatly to the two birthing centers here, their midwives, and their family of families. Mothers have pumped their milk to ensure Kaya's healthy beginning on this earth. The Augsburgers and their care team have been fed every night from a different family, and their food train is booked through mid-March. They have received donations of fresh produce, baby items and food delivery from local businesses. Brad would like to extend deep gratitude to those that have donated money while he is unable to work. He does not expect to be able to work again until April, so donations are still being graciously accepted so this family of five can reunite, heal, and care for each other, worry-free.

This next phase of recovery will be a long one, but a joyous one. More info on a benefit coming soon!