A soapbox of two midwives practicing in Central Virginia..

Click on the rainbow to watch a short slideshow from my trip

Though you might not know it from my  previous post about squeezing lemons in our Capital this week, I have actually just returned from the jungles of Belize feeling somewhat transformed and completely inspired by my Professional Training in the Arvigo Techniques for Maya Abdominal Massage (MAM).  It wasn’t just the breathtaking views from Rosita Arvigo’s mountain top home where the class was held.  It wasn’t only jungle walks to said mountaintop from the camp along the Macal River where I slept at night to the sound of Howler monkeys in the trees overhead.  And finally, it wasn’t just the fact that I spent 7 entire days without making a single meal for myself or others.  What actually facilitated this feeling of deep satisfaction and well-being were the healing techniques themselves.  [Read more →]

Start with two lemons: Two bills introduced by a freshman Delegate from Harrisonburg who “loves midwives” but lends his ear to obstetricians in his community who feel quite differently.

Throw out the rotten fruit: HB 2167- a bill intended to eliminate VBAC births at home but written in a way that singled out low-income women from accessing midwives for normal birth after cesarean birth.  Happily, the strong surge of consitituent phone calls, emails, and letters to the Delegates of the General Assembly put a prompt end to this bill in the Health, Welfare, and Institutions (HWI) committee.

Re-examine remaining fruit: HB 2163- a bill that requires the regulations of Certified Professional Midwives in Virginia to include discussing information about risks associated with VBAC, twins, breech, and “other high risk pregnancies” was upheld by the HWI committee on the same day.  The lesser of two evils, this bill is redundant and sets a higher standard for informed choice for midwives than any other profession.

Slice through the skin and squeeze the juice: “Higher standard of informed choice for the profession of midwifery”.  Isn’t this what we have been trying to say all along?  Informed Choice is the hallmark of midwifery care.  How can we oppose a bill that clarifies that for us?  The concern is that the Board of Medicine will get to oversee the development of standardized documents…what will they require us to say?

Add Sugar: How about making the bill better, stronger, and able to leap tall buildings?  Why not clarify that the information the CPM gives her client be “evidence-based“? If accepted, this phrase would be precedent setting in VA statute. Imagine if ALL informed choice were evidenced-based?  Imagine if the Board of Medicine reviewed all practitioners based on evidenced-based practice rather than community standard of care, which is often driven by defensive medicine and convienience. The bill then changes from redundant to strenthening of the Midwives Model of Care.

Add water, and maybe a few other fruits: While we’re at it, let’s try to fix another problem that the Board of Medicine is having with the practice of midwifery.  Our statue specifies that a woman cannot be required to seek the care of another health care professional during her care with a midwife.  This was included by wise individuals who knew that in other states that license midwives, a requirement for a woman to be evaluated by physician in order to have a home birth was an obstacle to practice as no physician would be willing to assume liablity for the outcome of his/her “approval”.  This phrase in the statute, however, prevented the Board of Medicine (BOM) from moving forward with its NOIRA request last February  (scroll to 2008 action alerts at this link) to set limits on the scope of practice for CPMs. This came up at last Friday’s Midwifery Advisory Board meeting.  The BOM has a lengthy process for determining that a change in statute is necessary, but an end result of a recommendation for removal of the phrase that blocked their NOIRA is not something that we want.  The midwives think a better solution is to use the bill that is before us to give a compromise to the Board.  How about if we clarify what we already do in situations that involve potential risks in  pregnancy and birth: offer options for consultation or referral to a physician as part of our informed choice?  This gets at the heart of the cultural divide between physicians and the midwifery community.  The opponents of home birth genuinely believe that midwives can’t possibly be giving women informed choice that includes risks and we are potentially even keeping them from seeing physicians in a timely manner by not offering or facilitating consultation or transfer of care.  Midwives say they get little or no support in some communities in Virginia (Charlottesville is not in that category, UVA is a FABULOUS model for good collaborative relationships) when they do try to consult.  Many OBs don’t want our clients and they refuse our calls for appointments. Something needs to change and while we don’t want to fix our problems through legislation, this bill is moving forward and there is an opportunity to offer a gesture towards a peace process by reiterating consultation and referral as part of informed choice.

Stir and serve: A draft amendment (which would technically be called a “substitute”) has been offered to Delegate Lohr.  Along with lobbyists from the Medical Society and VA ACOG, Delegate Lohr has agreed to amend his bill at the request of the Commonwealth Midwives Alliance.  The VABirthPAC Board of Directors has also reviewed and approved the new language.  Now, we offer it to the rest of the Commonwealth in the hopes that you will also agree that this is a worthy bill.  We have the opportunity to have an historic precedent….medicine and midwifery on the same side of a bill.  We hope that this gesture will move us forward to the necessary place of problem solving, rather than fighting at the Board of Medicine and in Virginia communities.

The proposed substitute language will be voted and (hopefully) adopted this Thursday by the Senate Health Licensing Subcommittee.

Please contact Delegate Lohr today to let him know that you support the substitute amendment for HB 2163 and to thank him for listening to midwives.
You can also contact the members of the Senate Health and Education Committee to let them know that they should support HB 2163, with the substitute.

Thanks for all you do for birth-

Brynne

UPDATE: HB 2163 passesd the Senate Health Licensing Subcommittee with a unanimous vote on Thursday, February 12.

More and more women are asking us about the benefits of ingesting their own placentas after their birth.  The practice is becoming more well known, CBS just did a story on it.  The benefits are considered worth the yuck factor; better milk supply, reduced postpartum depression and more balanced hormones in the weeks following birth. 
There are some intriguing recipes that you can try- the simplist is to just dehydrate it and put it in capsules.  Many of our clients bury their placenta and plant a tree or shrub to commemorate their baby’s birth. 

What did you do with your placenta?

Since your bill would essentially mandate surgery for the underprivileged women in your community, I highly encourage you to become educated about the risks of cesarean section, especially when a woman has more than one.  The maternal death rate is rising in our country.  The CDC has acknowledged that the death rates are actually under reported and that many of these deaths are attributed to the rising c-section rate and the associated complications for future pregnancies.

Dear Delegate Lohr:
 
Thank you for your prompt reply and your attention to this important issue of access to midwifery care. I appreciate your willingness both to hear and act upon some of the items we discussed this week. Thank you for your promise to pull HB 2163 from the docket.

I am looking forward to reviewing your amendments to HB 2167.  Without seeing the actual wording, I remain a bit unclear as to how this bill will affect CPM practice. As I discussed on Wednesday, the issue of VBAC (vaginal birth after cesarean) is an evolving area of medical and cultural understanding. Since the scientific and medical experts still disagree about the best route for a woman to take for all of her birth options, l contend that legislation seems premature.  The next several years would be expected to bring about emerging information that will help to inform the most evidenced based decision making for women and their providers.

When we understand that the rate of uterine rupture (the primary concern among some obstetricians for VBAC deliveries) is 27 out of 10,000, we know that 400 women will need a repeat c-section to prevent 1 uterine rupture during labor. Since uterine rupture itself has varied degrees of severity and since midwives do not induce or augment labor and because they provide constant, hands-on care and one-on-one monitoring to identify the slightest variation in heart tones well before they become a problem and take appropriate measures to stabilize or transport, many researchers, mothers and Virginia DMAS have all made the evidenced-based decision that Home VBAC (or HBAC) is a reasonable choice for families to consider. Every study has shown that when providers follow these guidelines, the risks associated with VBAC are reduced to the very same level as for other extremely rare events, all of which CPMs are trained to identify and assess well before they become emergencies. Link to Research on Uterine Rupture

I make the comparison between VBAC at home and repeat c-section because the option of VBAC in hospital is not available to many women in the Commonwealth.  Many hospitals and providers in Virginia have “No VBAC” policies, which leaves women no other choice but to stay out of the hospital for their normal birth.  Since your bill would essentially mandate surgery for the underprivileged women in your community, I highly encourage you to become educated about the risks of cesarean section, especially when a woman has more than one.  The maternal death rate is rising in our country.  The CDC has acknowledged that the death rates are actually under reported and that many of these deaths are attributed to the rising c-section rate and the associated complications for future pregnancies. When you factor in the reality that many of your constituents plan very large families, the physical and financial burdens of 5-10 future surgeries is staggering.  [Read more →]

Please take action now to stop two bills HB 2163 and HB 2167 introduced into the House to limit the practice of Certified Professional Midwives.  These bills have been introduced by Delegate Matthew Lohr- Harrisonburg. 

URGENT: Please send him an email TODAY telling him that you would like him to pull these bills from the docket and to work to help increase access to midwives, rather than restrict it.  You can also call his office: (804) 698-1026.

NEXT: Contact your legislators and tell them that you oppose HB 2163 and HB 2167.  You can visit the VA Birth PAC to find out who your legislators are and register to receive updates on this important issue.

STILL MORE: Contact everyone you know who lives in the Harrisonburg area.  Ask them to contact Del Lohr TODAY to express their concerns about these bills.  He filed these bills for a single constituent, he needs to hear from 50 who oppose them.

STAY TUNED:  We will be sending updates through all available channels.  If you are not registered with the VA BirthPAC…please do so NOW!  We need all of our voices united!!!!!

[Read more →]

The monthly Birth Circle meetings sponsored by Birth Matters Charlottesville have become incredibly popular in the midwifery community.  These informal gatherings generally involve birth stories, resources sharing, and building connections among expecting and new moms in the Charlottesville area.  The group is not midwife or home birth exclusive. In fact, the compelling nature of the group comes from the respect of all perspectives on birth choices and options.

The gathering is girl heavy.  And at the request of a few regulars who want to bring their guys for a fun night out, Birth Matters is sponsoring a Couples Birth Circle on January 23 at 7pm at the Body Mind Spirit yoga studio at 923 Preston Ave in the Preston Plaza (next door to Integral Yoga Natural Foods). 

Can’t wait to hear how it goes!

This image by Susan Tibbles accompanied Jennifer Block’s Op-Ed about midwives.

On Christmas Eve, Pushed author Jennifer Block opined in the LA Times that homebirth and Certified Professional Midwives must be key elements of Obama’s healthcare reform strategy.  Read the article or more cool stuff on Jennifer’s blog, PushedBirth.

She highlights some pretty startling facts: Not only is childbirth the most common reason for a hospital stay — more than 4 million American women give birth each year — it costs the country far more than any other health condition. Six of the 15 most frequent hospital procedures billed to private insurers and Medicaid are maternity-related. The nation’s maternity bill totaled $86 billion in 2006, nearly half of which was picked up by taxpayers. 

Anyone know the average cost of a birth in Charlottesville?

Many of you have already heard about the new film, Orgasmic Birth, but the mainstream is about to get an earfull when 20/20 takes on the question of whether orgasms in labor are possible, and if so…how do you get one?

http://abcnews.go.com/Health/story?id=6120045&page=1

It’s great to see this kind of story about birth.  The fact that the secret to pleasure in labor is leaving mothers alone speaks well for all kinds of reasons.  The most common concern I’ve heard from natural childbirth advocates is that women will feel disappointed if they don’t have an orgasm in labor.  After watching the film, I have to say that the births are very realistic and not overly portrayed as all pleasure.  The labors are intense, and we get to see that there is more than pain in these women’s expressions…a whole lot more.

Have any of you experienced a labor sensation like an orgasm or actually had one in labor?

This is one of our clients. Please pass this request on to anyone you know who might be willing to share extra breast milk.
Thanks,
Brynne

On September 3rd, I gave birth to a beautiful baby girl (Haylie Peyton) via an outdoor water birth at home. It was everything I had hoped for and more. The birth went so well that I was overcome with this feeling that EVERYTHING would go as planned. I quickly learned that wasn’t the case. [Read more →]

An article published this month is the journal of the American College of Obstetrics and Gynecology recommends labor prior to a primary cesarean as a preventive measure against uterine rupture in future pregnancies.

A powerful argument against medical induction, the researchers tracked over 10,000 women from their primary c-section to the end of their second delivery. Of 10,160 women who had a trial of labor, 39 (0.38%) had a uterine rupture. Women whose primary cesarean delivery was planned or followed induction of labor had an increased risk of uterine rupture and this risk remained after adjustment for other factors. Women with a history of either spontaneous labor or vaginal birth had one uterine rupture for every 460 deliveries; women without this history who required induction or augmentation to proceed with a VBAC attempt had one uterine rupture for every 95 deliveries.

Conclusion: Labor before the primary cesarean delivery can decrease the risk of uterine rupture in a subsequent trial of labor. A history of primary cesarean delivery preceded by spontaneous labor is favorable for VBAC.

Other findings: Augmentation is still bad for VBAC. The study also showed that women with a previous c-section who were induced or augmented for their trial of labor had a greater relative risk (4.24 fold) of uterine rupture.

The study authors convey a desire to see their research actually change the standard of care for all women. If implemented, this standard would likely lower the primary c-section rate in the first place. The authors state, “Our results can inform protocols for treating women who intend a first trial of labor,” …which means: let/encourage a women to spontaneously labor (don’t induce) and you can protect her uterus from damage, now and in the future.