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.

An Evening for Healthy Start

On Thursday, January 26th, from 6 to 9 pm, Sarasota Architectural Salvage will host the 3rd Annual “An Evening for Healthy Start” Fundraiser to benefit The Healthy Start Coalition of Sarasota County. The event will be emceed by former Sarasota Mayor Kelly Kirschner, and will feature live music by local Latin, Caribbean, Funk and Motown dance music band, Big Night Out.

The event comes at a critical time in the Healthy Start Coalition’s fiscal year, when funding for critical programs threatens to expire. This year’s event has the potential to raise more money for Sarasota’s pregnant women, infants and young children than in previous years, due to the generosity of several local business members and individuals, including those from the fields of obstetrics, perinatology, midwifery and pediatrics.

Sarasota Architectural Salvage paints an eclectic and distinctive backdrop for “An Evening for Healthy Start,” making it one of the most unique fundraising events of the season. Guests will be treated to light fare provided by local restaurants, including Nancy’s BBQ, Caragiulo’s, Nellie’s Deli, Carrs Corner Café, The Lollicake Queen, Gold Coast Eagle Distributing, Vin Cella and Local Coffee and Tea. The event will also feature a raffle and silent auction, featuring an exquisite pendant necklace from world-famous jewelry designer Ned Bowman of Bowman Originals in Sarasota.

Tickets are $20 in advance and $30 at the door, and include two beverage tickets and a coupon for Sarasota Architectural Salvage. To purchase tickets, call (941) 373-7070, or visitwww.SarasotaSalvage.com.

The Healthy Start Coalition of Sarasota County is a non-profit, 501 (c)(3) organization dedicated to improving the health and well-being of pregnant women, infants, and young children in the community. Healthy Start coordinates a variety of specialized programs to serve high-risk groups and address specific risk factors that contribute to fetal death, prematurity, low birth weight, and infant death. For more information, please call (941) 373-7070 or visit www.healthystartsarasota.org.

Maternally Yours to Air Exclusive Interview with CNN Hero of the Year Robin Lim

Last night, international midwife Robin Lim was named the 2011 CNN Hero of the Year, accepting an award of $250,000 for her non-profit birth clinic Yayasan Bumi Sehat in Bali, Indonesia. Maternally Yours, Sarasota’s Conversation about Pregnancy, Childbirth and Early Motherhood, recorded an exclusive interview with Robin just days before her win, and will air the interview on Tuesday, December 13th, on Sarasota’s community radio station, WSLR 96.5 LPFM.

“To say I am thrilled for her is the understatement of the century,” says Maternally Yours co-hostess Ryan Stanley. “This win will make real change for mothers and babies in Indonesia and worldwide—mothers and babies will live and thrive because of this award.”

Since 2005, Robin Lim’s clinic Bumi Sehat (translated as Healthy Earth) has treated nearly 113,000 patients and delivered nearly 4,000 babies for free in Bali, where rates of postpartum hemorrhage and maternal and infant mortality are among the highest in the world. “Ibu” (Mother) Robin is a midwife, well-known author and talented poet who has dedicated the last 13 years of her life to this clinic, despite constant financial, cultural and geographic challenges.

“The earthquake that we just had last month…was big enough that we have cracks in the building. The floor started to rise up in one of the birth rooms because of the movement underneath the ground. About twenty minutes after one of our moms gave birth, the floor actually exploded,” Robin told Maternally Yours last Wednesday. “When that happened, I committed in my heart to winning. Should we be gifted that money…from CNN on Sunday night, it will go toward building that clinic.”

Speaking from the Texas home of her daughter Deja Bernhardt (who directed the film Guerrilla Midwife about Robin’s work), Robin told Maternally Yours how she was feeling en route to Los Angeles to find out if she would be named CNN Hero of the Year. “I would say that nervous is one good word; I think it’s because it’s so much bigger than me,” said Robin. “I feel like this is the time for people to come out and vote for the concerns of mothers and babies and children, and that woman-to-woman, midwife-to-mother model of care.”

And, for eleven weeks straight, people voted.

During her acceptance speech last night, Robin Lim made a tearful plea for the world’s help in reducing maternal and infant mortality.

"Today on our Earth, 981 mothers in the prime of their life will die—and tomorrow again, and yesterday," said Robin. "We don't even know how many babies are lost, but all of us can help change that. The very best way that I know is to support your midwifery to mother care, so that the midwives can help lower the risks of motherhood, and we can save lives together—mothers and babies.”

Robin Lim is a friend and listener of Maternally Yours, which seeks to educate and inform women and families about the options, support, and evidence-based best practices available to them in maternal-child healthcare. “What you’re doing…is an exciting thing,” said Robin. “In this day and age, we’ve lost that radio medicine. You’re bringing it back in a beautiful way.”

To hear the exclusive Maternally Yours interview with 2011 CNN Hero of the Year Robin Lim, please tune into WSLR 96.5 LPFM Tuesday evening, December 13, at 6:00pm. The program is also available via live streaming on wslr.org, and podcast at podomatic.com/profile/maternallyyoursradio. For more information, please contact the hostesses of Maternally Yours at MaternallyYoursRadio@gmail.com.

About Maternally Yours: Maternally Yours is Sarasota's Conversation about Pregnancy, Childbirth and Early Motherhood. The Conversation airs on Tuesday nights at 6:00pm on YOUR Community Radio Station, WSLR 96.5 LPFM. The hostesses of Maternally Yours are Cheryl Kindred, Carmela Pedicini, Ryan Stanley and Laura Gilkey. The mission of Maternally Yours is to educate and inform our community about the options, support, and evidence-based best practices available to them in maternal-child healthcare.

About Bumi Sehat: Founded in 1995, Bumi Sehat is a non-profit, village-based organization that runs two by-donation community health centers in Bali and Aceh, Indonesia. We provide over 17,000 health consultations for both children and adults per year. Midwifery services to ensure gentle births is at the heart of Bumi Sehat and our clinics welcome approximately 600 new babies into the world each year. For more information, please visit www.balibumisehat.org.

About WSLR 96.5 LPFM: WSLR is an innovative, listener-supported, non-profit, non-commercial FM radio station dedicated to serving the Sarasota community. WSLR features locally produced programming and presents cultural, artistic, and political perspectives currently underrepresented in the media. Our goal is to inform and empower listeners to play an active role in WSLR and in their community. WSLR’s programming promotes equality, peace, sustainability, democracy, and social and economic justice. For more information, please visit www.wslr.org.

Vote Robin Lim as 2011 CNN Hero of the Year

Robin Lim, the midwife featured in the film Guerilla Midwife, shown on the International Day of the Midwife in Sarasota in 2010, has been chosen as a Top 10 CNN Hero of the Year Nominee. If she wins this honor, her non-profit organization Yayasan Bumi Sehat will receive $250,000. People can vote for Robin 10 times per day until December 7th. This money would help Robin save so many mothers and babies; her birthing sanctuaries offer free prenatal care, birthing services and medical aid to anyone who needs it, in areas of the world where postpartum hemorrhage, obstetric fistula, and lack of prenatal care claim far too many lives.

"Naturally I hope that being a CNN Hero will bring attention to the global need for better maternal and infant survival care," says Robin Lim. "Bumi Sehat has a huge responsibility keeping the two community health and childbirth clinics open. There is also the Bumi Youth Education Center, our scholarship program, village recycling and environmental stewardship.

"We do capacity building for Indonesian midwives from many islands and countries. Bumi provides free ambulance and emergency medical service, HIV/AIDs counseling and testing, pediatric care, free weekly special clinics to treat chronic illness. We have elderly and prenatal exercise programs. Bumi Sehat is open 24 hours a day, every day of the year. In the first eight months of 2011 Bumi Sehat has helped 20,500 patients and delivered nearly 400 babies for free!"

Quite close to the epicenter of the 2004 Indian Ocean tsunami disaster, Bumi Sehat operates a clinic which also sponsors capacity building for youth education and environmental protection. "Bumi Sehat needs the CNN #1 award, and will put it to use doing culturally appropriate sustainable care. Imagine a world in which each child is born with an intact capacity to love and trust. This is the world midwives work day and night to build."

Click here to VOTE for Robin Lim. A vote for Robin Lim is a vote for gentle birth, for mother and child survival, for culturally sensitive natural community health care and disaster relief, for midwife-to-mother care that effectively saves lives.

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.

Dr. Hill's Editorial on Preterm Birth

The following column can be found in today's Sarasota Herald-Tribune here. Born in Sarasota will post follow-up commentary shortly.

The burdens of pre-term births are significant -- in terms of the individual's lifetime health, the medical care required and the economic costs expended. Simply put, reducing the rate of pre-term births is in everyone's interest and must become a priority.

The most recent national statistics show a 3 percent drop in the pre-term birth rate, to 12.3 percent in 2008 from 12.7 percent in 2007. Prior to this decline, the rate of pre-term birth had steadily increased for more than 20 years.

The modest decrease was encouraging, but pre-term birth remains a serious health problem -- an epidemic -- with more than 540,000 pre-term births annually.

In Florida, the pre-term birth rate in 2008 was 13.8 percent and has not declined in recent years; in other words, one of every seven babies is born too soon.

Nearly 240,000 babies are born annually in Florida -- more than 32,000 of them prematurely.

Even worse, each year 1,700 babies in Florida do not live to their first birthday.

Prematurity is the leading cause of newborn death and has increased more than 30 percent since the 1980s -- in both Florida and Sarasota County. Many of the county's newborns suffer serious health problems or die because of their early births. Preventing pre-term birth (birth before 37 weeks of pregnancy) is critical to give more babies a healthy start.

These statistics are startling. Yet even more surprising is a growing trend of women electing to deliver their babies early.

Just because grandma is in town or daddy is off work is no reason to have a baby early.

A healthy full-term pregnancy is 39 to 40 weeks, yet we are seeing a rise in scheduled deliveries at 37 and 38 weeks -- a practice once thought to be safe.

But research is revealing the serious consequences of scheduling births even a few weeks too early. While not officially labeled "premature," babies born between 37 and 39 weeks are at significantly greater risk of complications compared with full-term babies.

More bothersome is a 2009 study that found many women do not clearly understand the definition of a full-term pregnancy.

Nearly a quarter of moms surveyed considered a baby of 34- to 37-weeks' gestation to be full term. Half defined full term as 37 to 38 weeks and 92 percent of women reported that giving birth before 39 weeks was safe. Some women mistakenly said that, since pregnancy is nine months, 36 weeks is safe as well. Clearly, this information shows we have a lot of work to do to educate mothers, their families and the community about the definition of a full-term pregnancy, which is 40 weeks.

Scheduled cesarean sections and elective inductions have become frequent and are viewed as an accepted way to avoid potential complications and problems during labor and delivery.

Unfortunately, those good intentions often result in health problems for newborns who may have to spend time in a hospital's neonatal intensive care unit, need a ventilator to help them breathe or have trouble feeding because of their early birth and may miss an opportunity for the benefits of breastfeeding.

The March of Dimes has invested millions of dollars in the fight to prevent pre-term births. Today the March of Dimes marks the eighth annual Prematurity Awareness Day by issuing its 2010 prematurity birth report card. Sadly, Florida will receive an "F" for the third consecutive year.

Florida can do better to help its pregnant women and their families lower the pre-term birth rate to a national goal -- 7.6 percent.

Hospitals and health care professionals can help by following guidelines to decrease elective deliveries before 39 weeks and recognize the warning signs of pre-term labor.

The March of Dimes has joined with other health organizations in an effort to eliminate early, elective scheduled inductions and cesarean sections -- those done without medical cause. The partners are launching an aggressive educational campaign for women and physicians.

With aid from the March of Dimes, a new tool has been developed in the fight to ensure all babies get to a full 40 weeks. In Florida, several hospitals -- including Sarasota Memorial Hospital and Manatee Memorial Hospital -- are taking a leadership role to address elective deliveries before 39 weeks and to teach the early recognition of symptoms and signs of pre-term labor.

These hospitals are using a new tool kit, which supports health-care providers, patients and hospital staff in changing delivery practices and making decisions to eliminate elective deliveries. Health care providers in Sarasota have always been concerned about reducing the risk and the number of pre-term births. We now expand our concern to ensuring babies have a full 40 weeks of pregnancy.

We want people in our community to know how they can lower the risk of an early birth by encouraging smoking cessation, preconception care and early prenatal care; promoting awareness of treatments for women with a history of pre-term births; avoiding multiple gestation from fertility treatments and unnecessary cesarean sections and inductions before 39 weeks of pregnancy.

Together pregnant women, their families and friends, policy leaders, the general public, health care professionals and hospitals can make a difference in the health of babies born in Florida and all across our county.

Washington Clark Hill, M.D., is a Maternal and Fetal Medicine Specialist at Sarasota Memorial Hospital and a member of the Board of Healthy Start Coalition of Sarasota County Inc.

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.

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

Letter to Elected Officials in Support of MOMS

Dear Congressman Buchanan, Senator LeMieux, and Senator Nelson:

Something monumental and potentially life-saving for America's mothers and babies happened last week on the House floor. Congresswoman Lucille Roybal-Allard introduced the Maximizing Optimal Maternity Services (MOMS) for the 21st Century Act (HR 5807), which places a national focus on evidence-based maternity care practices to help achieve the best possible maternity outcomes for mothers and babies. Your Florida colleagues in the House, Congresswoman Debbie Wasserman-Schultz and Congresswoman Kathy Castor, have co-signed this legislation. I am writing to implore you, as a mother, as a taxpayer, as a maternal rights advocate and as your constituent, to sponsor this act.

I have written you before to tell you that the United States currently ranks 41st in maternal mortality, yet we spend significantly more on childbirth than any other industrialized country. Moreover, our nation's 32% c-section rate, high premature birth and labor induction rates, and their subsequent repeat admission rates are all playing a major role in our nation’s escalating health care costs. Hospitalization related to pregnancy and childbirth costs approximately $86 billion each year, the highest hospitalization costs in any area of health care.

The MOMS for the 21st Century Act responds to this crisis by creating a new Health & Human Services focus on the promotion of optimal maternity care, an additional focus area for the Office on Women's Health, and an Interagency Coordinating Committee on the Promotion of Optimal Maternity Outcomes, a widespread consumer education campaign, and a bibliographic database of systematic reviews for care of childbearing women and newborns. Most importantly, it calls for accountability in accurate research and data collection, and the enhancement of an interdisciplinary maternity workforce, including Obstetricians, Certified Nurse-Midwives, and Certified Professional Midwives.

“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 last week. “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...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.”

As a consumer, I will do everything possible to offer you the utmost support from my community in sponsoring the Maximizing Optimal Maternity Services (MOMS) for the 21st Century Act (HR 5807). I look forward to hearing your response on this issue and will follow up with your legislative aides by telephone. Thank you for your service and your attention.

Hopefully,

Laura Gilkey, mother of two

Sarasota, Florida

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.

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.

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.

Introducing: 20% by 2020

The preliminary data for births in 2008 has been released by the CDC's National Center for Healthcare Statistics. Florida has risen to an all-time high 38.2% cesarean section rate. Sarasota Memorial Hospital's c-section rate for the same year was 41.7%, a slight increase from their 2007 reported data of 41.3%.

These numbers are simply dangerous. As they continue to increase (up over 50% in the last decade), so do our maternal mortality rates. These are a few facts taken from the Independent Childbirth Education Association:

-The World Health Organization (WHO) states that no region in the world is justified in having a cesarean rate greater than 10 to 15 percent.

-A cesarean section poses documented medical risks to the mother's health, including infections, hemorrhage, transfusion, injury to other organs, anesthesia complications, psychological complications, and a maternal mortality two to four times greater than that for a vaginal birth.

-An elective cesarean section increases the risk to the infant of premature birth and respiratory distress syndrome, both of which are associated with multiple complications, intensive care and burdensome financial costs. Even mature babies, the absences of labor increases the risk of breathing problems and other complications.

-Cesareans can delay the opportunity for early mother-newborn interaction, breastfeeding and the establishment of family bonds.

-The four most common medical causes contributing to the increase in cesarean section rates in North America are: routine repeat cesareans; dystocia (non-progressive labor); breech presentation; and fetal distress. Some reports suggest that more careful diagnosis and management of dystocia could halve the primary section rate. Combined with fewer cesareans for breech presentation (along with more cephalic versions), careful diagnosis of fetal distress and active encouragement of VBAC, these efforts have resulted in lowering cesarean rates to less than 12% in various parts of the world.

-Cesarean rates are influenced by non-medical factors. Rates are higher for women who have private medical insurance, are private rather than public clinic patients, are older, are married, have higher levels of education and are in a higher socio-economic bracket.

-Cesarean sections are sometimes performed for other than maternal or fetal well-being, such as avoidance of patient pain, patient or provider convenience, provider legal concerns or provider financial incentives.

What if instead of a slight increase each year in c-section rates, Sarasota Memorial Hospital and our community worked toward a slight decrease?

With only a reduction of 2.2% per year, we can put our obstetric community at the forefront of health care reform by achieving a very healthy model, saving taxpayers literally millions of dollars, and educating women and families in the process.

It has been done, and it is being done right now in other parts of the country. New Jersey, the only state in the nation with a higher c-section rate than Florida, is launching the "Worst to First 2010" campaign, in which seven hospitals have agreed to re-educate their staffs to achieve 10%-15% c-section rates. And on Staten Island, one hospital is taking powerful measures to create drastically different outcomes than its nearest competitor. The two New York hospitals sit just five miles apart and serve an almost identical demographic, yet one has the highest c-section rate in the city, and the other, the fourth lowest. Why? Because Staten Island University Hospital does not allow unnecessary inductions for first-time pregnancies at any point before the 41st week, since they are a main cause of c-sections. They also do not allow elective cesarean deliveries upon maternal request.

Therefore, it is with great hope, excitement and the vision of a long journey ahead, that Born in Sarasota introduces 20% / 2020, an initiative to encourage elected officials, hospital staff, maternity care practitioners and consumers to reduce Sarasota's epidemic cesarean section rates to 20% by the year 2020.

How can we expect obstetricians, our hospital, and our consumers to undergo this change?

1 : Engage our community in an educational campaign about the benefits of spontaneous labor and the risks of cesarean sections that are not medically necessary, to mothers, to babies, and to future pregnancies.

2 : Explicitly describe the difference between maternal request elective cesarean section, physician ordered elective cesarean section, and true emergency surgery. Increase transparency in billing codes so that maternal request elective cesareans are accurately reflected in medical billing.

3 : Increase access to Vaginal Birth After Cesarean. Arm consumers and practitioners with the latest evidence and legislation.

4 : Make informed consent and informed refusal a respected right of the maternity care consumer. Make the public acutely aware of the Patients' Bill of Rights.

5 : Develop a localized cost-savings analysis that will illustrate to the Sarasota County Public Hospital Board and to the taxpayer that a reduction in c-section will not only improve outcomes but save millions of dollars and reduce readmission rates.

6 : Encourage independent childbirth education classes regardless of maternity care provider. Aside from good health and low risk assessment, prenatal education (including includes thorough education of the childbirth process, inspiring real-life examples, pain-coping mechanisms that do not require medical intervention, and hands-on labor preparation techniques) is the most critical element to avoiding surgical birth. These classes also explore in full detail the risks and benefits of common obstetric interventions such as c-section, labor induction, episiotomy and epidural anesthesia.

7 : Reduce the high-risk population by engaging the childbearing public in a campaign about pre-pregnancy and prenatal nutrition, including the risks of obesity and high blood pressure at birth.

8 : Maintain continued demand for transparency in statistics, at the provider and facility levels. Encourage and advertise The Birth Survey at all maternity care provider offices and facilities in our community.

9 : Increase access and use of Licensed Midwives for low-risk, healthy pregnant women. Using midwives at homes and in Birth Centers safely and cost-effectively reduces intervention rates.

10 : Introduce a feedback system by which physicians receive detailed information about the c-sections they have performed, coupled with voluntary adoption of more aggressive protocols for inducing and augmenting labor. In one California hospital, this measure alone HALVED the c-section rate.

Born in Sarasota would appreciate your feedback on how to best execute this ten-step model toward healthier birth outcomes. It will take the entire community of consumers, physicians, midwives, doulas, hospital administrators, legislators, insurance agents and policy makers to make this happen. But we can save mothers and babies in the process. We want to hear from you!