Thursday, March 25, 2010

Study shows that it is currently more dangerous to give birth in California than in Kuwait or Bosnia...

Although the number of deaths is relatively small — and pregnancy and birth are safe for the vast majority of women – it’s more dangerous to give birth in California than it is in Kuwait or Bosnia.

The California task force isn't waiting to determine the ultimate cause of these deaths. It has started pilot projects to improve the way hospitals respond to hemorrhages, to better track women's medical conditions and to reduce inductions.

Dr. David Lagrew, meanwhile, thinks he may have arrived at an answer. In 2002, Lagrew, the medical director of the Women's Hospital at Saddleback Memorial Medical Center in Orange County, noticed that many women were having their labor induced before term without a medical reason. He knew that having an induction doubled the chances of a C-section.

So he set a rule: no elective inductions before 41 weeks of pregnancy, with only a few exceptions. As a result, Lagrew said, the operating room schedules opened up, and the hospital saw fewer babies admitted to the neonatal intensive care unit, fewer hemorrhages and fewer hysterectomies.

All this, however, came at a cost: The hospital had to take a cut in revenue for reducing the procedures it performed. Lagrew doubts that any hospital has increased its C-section rate in pursuit of profit, but he adds that the first hospitals to adopt controls on early elective inductions have been nonprofits.

On average, a C-section brings in twice the revenue of a vaginal birth. Today, the C-section is the single most common surgical procedure performed in the United States.

Although the state hasn't released the task force's report, the researchers and doctors involved forwarded data to the national Joint Commission, which issued incentives for hospitals to reduce inductions and fight what it called "the cesarean section epidemic."

"You don't have to be a public health whiz to know that we are facing a big problem here," said Bingham, the executive director of the task force.

Online resources: To read more about maternal mortality rates and pregnancy-related deaths, go to

Other related links:,8599,1971633,00.html,9171,1880665,00.html

Sunday, March 14, 2010

Not Among Strangers...

I met Valerie El Halta many years ago... before she became a midwife. I attended Church with her younger daughters from the time I was 5 yrs old. She and my mother were friends. My mother taught her youngest child in pre-school. I suppose he's a grown man now... I babysat for some of her clients while they attended her childbirth class once...
I wish I had any 'idea'about midwifery and Home Birth way back then. Oh, to have learned at her feet... It might have immpacted my life and the births of my first two children. However, I suppose, we become who we are, partly because of our experiences, and I chose to become involved in birth because of those first two births.
I 'found' Valerie El Halta several year back through the magic of technology and the internet... I considered having her attend my 2nd home birth, but we lived so many miles (and States) away from one another. I've thought of her often over the years. Time and life moved on, I lost contact with her, and then today 'found' her again through the technology of the internet. I happened to read this article she wrote, and just loved the thoughts of birthing among 'friends', 'family' and "not among strangers". I hope it's alright that I reposted it here. It's lovely.

Not Among Strangers

by Valerie El Halta, CPM

© 2003 Midwifery Today, Inc. All rights reserved.
[Editor's note: This article first appeared in Midwifery Today Issue 50, Summer 1999.]
How important is the impact of the birth environment upon achieving an optimal outcome of the birth process?

The environment in which birth takes place has an enormous impact upon birth outcome. Labor progress, pain tolerance, necessity for medical intervention, fetal well-being and satisfaction with the birth experience may all be directly related to the mother's sense of "safe place" in which she brings forth her baby.

"Safe place" has little to do with physical surroundings alone. Yet for many a woman, the home in which she resides, feels loved and secure, has prepared for her baby and "nested" most clearly defines that place. "Safe place" also has to do with the people with whom the woman feels most secure and comfortable. The interaction of the several personalities, which may be involved during labor and birth, may either positively or adversely affect the laboring woman's sense of "safe place." As we come to understand the importance of how these personalities impact the birth environment, we, as caregivers, become more sensitive to the needs of the mother as she approaches the time of labor and birth.

Traditionally, birth has been a very private affair in which only the most intimate of a woman's relations would attend the laboring woman. Grandmothers, aunts and wise women of the village whom the woman most trusted were the ones to be called. In today's society, women have been taught to place their trust in the medical model of childbirth and in medical professionals rather than in persons with whom they are most familiar. They are taught to accept the place of birth that the medical professional chooses (because it is the medical professional's "safe place"?). For many women this is a difficult and sometimes impossible transition, one which so impacts the sense of the familiar that patterns of labor are changed and the sensation of birth pain intensified. Outcome is made less predictable, and birth comes to be regarded as a difficult and painful ordeal, fraught with danger. Moreover, if the woman is confronted with an unfamiliar and therefore "not safe place," a survival mechanism will kick in. She will protect her baby by preventing it from being born by ceasing to contract, keeping her cervix closed and in general "failing to progress."

Those of us who are certain that a woman's home is the most suitable environment for her to give birth in must be particularly aware of the influence we may have on the woman's sense of safety. The most well meaning midwife may nonetheless be a "stranger" to the mother and a threat to her need for privacy if she has not become at one in trust with the woman well before labor ensues.

It is important for all midwives to develop the skills necessary to facilitate the best possible communication with their clients. Learning to establish a relationship of trust with the woman will do more to ensure an optimal outcome than taking classes in anatomy and physiology!
The successful midwife is the caring person who has learned to listen with both her mind and her heart, she who has mastered "the chameleon effect" of being able to integrate into the woman's environment without prejudice toward her lifestyle, race, religion or personal idiosyncrasies.
It is this empathetic midwife to whom the woman may turn in her hour of greatest need, who will be there for her whether that need be physiological or psychological. When the midwife is able to establish this level of trust between herself and her client, her presence at the time of labor will not conflict with the woman's privacy needs and will often have a dramatic influence on the progress and time lines of labor as well as on the woman's perception of labor pain.
If we could ask babies where they would like to be born, I wonder how many would answer: "Oh, in a hospital, of course! I want to be sure that I will be born amidst all modern technology has to offer in the event that an emergency should occur." Or, might they answer: "I want to be born in an environment of peace, security and joy and be received into the loving arms of my mother."

I wish that instead of a written article this were a video I could share with you as I remember one of many special homebirths. My friend Melinda was about to give birth to her ninth baby. This was to be her seventh that I was privileged to attend. I am her sister and her friend, and "Auntie Val" to all the kids. We had spent the day canning salsa and making my sour cream chicken enchiladas. Melinda was in the shower when she called out to me that the baby was coming!

Picture a woman at rest on a big waterbed, reclining in her husband's arms while eight brothers and sisters reverently encircle her, awaiting the moment of birth (Silent Night). As my hands and warm compresses soothe the mother's stretching tissues and the head begins to show, the youngest child, two-year-old Emily, says, "Oh! I can see the baby's head!" Then a deep giggle and, "I want to see my baby's head again!" The baby comes forth, looks all around, breathes quietly, and rests on his mommy's breast. Melinda sighs and says, "It is always so worth it." Dad gently touches the baby's head (Holy Night). The children all begin to sing a special family hymn to the baby as he continues to gaze at his mommy (All is Calm). Does he recognize the voices? Oh, I know he does, he has heard them all for months. Emily says, "There is a snake on the baby's tummy," and giggles again (All is Bright). There is plenty of time for cord cutting, weighing and measuring. Now is the time for being—he is home, he is safe, he is much loved. He has not been born among strangers.

It has been my experience that when the mother is able to labor in an environment of her choice, with persons surrounding her who make her feel respected, loved and safe, that she is free to "give birth to" rather than "be delivered of" her baby. Where else than in her own home, laboring with those she has chosen, should this most important event take place?
Never—no never—among strangers.

Valerie El Halta Valerie El Halta, CPM, has been practicing midwifery for twenty-four years. She co-directed The Birth Center in Dearborn, Michigan with Rahima Baldwin Dancy for nine years. She now enjoys a busy homebirth practice and continues to write and teach. -->

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Wednesday, March 3, 2010

Alabama has a rich history of Midwifery

Historic midwife honored by Alabama Women’s Hall of Fame while modern midwives outlawed by state.
The Alabama Birth Coalition applauds the induction of midwife Margaret Charles Smith into the Alabama Women’s Hall of Fame. Smith, who died in 2004, was a health care pioneer who delivered nearly 3,000 babies in the Eutaw area between 1943 and 1981. In almost four decades of delivery, Smith never lost a mother despite serving the poorest citizens of the state.
Alabama outlawed the practice of midwifery in 1976, and Smith attended her last birth in 1981 when she was denied renewal of her license. In 1996, Smith published her autobiography, Listen to Me Good, with Linda Janet Holmes. Recalling her last days as a midwife, Smith wrote, “You could count on midwives. They took care of everybody, no matter what.”
Upon learning of Smith’s induction into the Hall of Fame, Jennifer Crook Moore, a Certified Professional Midwife and Vice President of the Alabama Birth Coalition, said, “Margaret Charles Smith is a legend for bringing so many babies safely into this world. Her wit, perseverance, spirit, compassion, and courageousness are all to be admired. She is a part of a rich tradition of midwives in Alabama and an inspiration to all midwives today. What an honor for Mrs. Smith, her family, and those Alabama families that she served so faithfully and competently,” said Moore. “But what a terrible irony that Smith is being recognized for a practice that is now illegal in this state.”
Inspired by Smith and scores of women like her who served this state, the Alabama Birth Coalition is working to change the law prohibiting midwives in Alabama. The organization’s work is fueled by the hope that, in the near future, Alabama families will once again have the option to enlist a midwife for prenatal care, birth and postpartum care.
“The first time I had the privilege of meeting Mrs. Smith was at a book signing for Listen To Me Good,” Moore said. “My copy is inscribed with this message: ‘Help keep midwifery alive in Alabama.’ It is my hope that Mrs. Smith's induction into the Alabama Women’s Hall of Fame brings us one step closer to achieving her goal.”

Judson College will honor Margaret Charles Smith’s remarkable legacy at the Alabama Women's Hall of Fame ceremony March 4 at 10:30 a.m. The ceremony is open to the public. Miss Margaret Documentary

(Article found in the Alabama Birth Coalition March 2010 e-Newsletter)

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Legislative Update:
Our bills have been submitted to both House and Senate. In the House, we are HB462, sponsored by Laura Hall. Laura Hall has sponsored our bills in the past and we are glad to have her doing so again this year. At the moment, HB462 has been referred to the House Health Committee. In the Senate, we are SB414, sponsored by Hank Sanders, and the bill has been referred to the Economic Expansion and Trade committee, which Senator Sanders serves on as vice-chair. According to Jennifer Moore, ABC legislative chair and citizen lobbyist, things are moving forward well and there is much positive buzz about our bills around the State House.Thank you for sending valentines to your legislators last month. Please continue to send handwritten letters to your legislators, letting your representative know that you encourage him/her to support HB462 and your senator know that you encourage him/her to support SB414.

Thanks to Our Supporters!
Thank you for helping us reach our fundraising goals. With the money donated by our supporters and the generous matching funds we received, we are able to retain the services of a lobbyist from Gafford and Associates for two years. We are seeing a huge difference this year--from the way our bill passed through the filing process to the reception we are receiving in legislators' offices.