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I have already written to you about the importance for including accurate scientific evidence to truly help shed light on the best choices for the health of mothers and babies during the birth process. Normalizing birth is essential for improving outcomes. Please watch the video at www.reducinginfantmortality.com to see an evidence-based plan to reduce infant and maternal mortality, which are abysmally high in the US.
To Whom It May Concern:
In a segment aired on the Today Show 9/11/09, your station purported to delve into "The Perils of Home Births." A large portion of the segment was devoted to interviews with a grieving family who had lost their baby. My heart aches for this family, but their experience does not shed light on the safety of birthing at home, just as the story of one family mourning the loss of a hospital-born baby is not evidence that all births should be removed from the hospital.
Biomedicine purports to be evidence-based, eschewing emotion-based "anecdotal evidence" for the stark light of fact. However, no scientific evidence was presented in your segment to support the contention that planned home birth with a Certified Professional Midwife is more dangerous for mom or baby that going to a hospital. As the segment itself points out, more babies die in hospitals (per 1000 babies born there) than at home. I am surprised, however, that the growing body of evidence which supports the safety of out-of-hospital birth was ignored. 2009 has seen the release of two studies, one from the Netherlands and one from Canada, which support the safety of birthing at home with trained midwives who are integrated into the health-care delivery system. While the impact of birth experience on an individual family is too important to allow for random assignment of families to home or hospital birth (as advocates of evdience-based care prefer), the Canadian study especially controls for variables remarkably well by comparing women in similar states of health who were cared for by the same practice. One important of scientific conclusions is that they must be replicable, and the studies mentioned above replicate the results of a 2005 study of out-of-hospital births with Certified Professional Midwives in North America. The best available evidence shows that out-of-hospial birth is nor more dangers for mother or baby. However, out-of-hospital birth has been shown to reduce rates of expensive medical insterventions including surgical birth.
Finally, it is important to remember that, far from being an advocate for evidence-based practices, the American College of Obstetricians and Gynocologists (ACOG) is an organization designed to advocate for the interestes of OB/GYNs. Rather than responding to the scientific literature cited above, ACOG has recently been soliciting anecdotal evidence on bad outcomes of out-of-hospital birth. When the professional organization of hospital birth providers tells us that the only safe place for birth is in the hospital, we must approach this with the same healthy skepticism with which we would approach claims from oil-industry executives on the dangers of wind energy.
I encourage the Today Show to further the health of childbearing women by featuring a segment on evidence-based maternity care rather than resorting to sensationalized scare-tactics which obscure the facts of this issue.
Sincerley,
Alison Duren-Sutherland
Homebirth Mom
I have a meeting scheduled Friday the 28th at 9AM with your South King County outreach director, Nate. As a member of MomsRising.org and a professional insurance biller, I am meeting with your staff to say that the health care system as it is is broken and must change. We need a not-for-profit public competitor to put the emphasis back on excellent, evidence based health care, instead of on the profits of insurance companies. And as a member of the MAMA Campaign, I am meeting with your staff to say that giving all healthy pregnant women access to Certified Professional Midwives outside of the hospital and Certified Nurse Midwives in the hospital with obstetricians handling complications will save the US money and improve outcomes for women and children. Please watch this important video about infant mortality, found here: http://www.reducinginfantmortality.com/. Thank you for the work you have always done for women's health and rights. This is one more issue where we need you to be our champion. Visit my blog (http://alison-cole.livejournal.com/) for more information or consider coming to the meeting on the 28th.
God Bless,
Alison Cole Duren-Sutherland
I have requested a meeting with you to discuss health care reform, but so far have been told that neither you or your staff have time to see me. I wanted to let you know that HEALTH CARE REFORM NEEDS TO HAPPEN FOR WOMEN.
THE CURRENT SYSTEM IS FAILING WOMEN AND FAMILES. As a student midwife, abortion-care worker, health care para-professional, medical insurance biller, and mom, I have first-hand experience with American medicine.
REFORM REQUIRES A PUBLIC OPTION. A not-for-profit public plan with clear billing instructions similar to Medicaid would reduce time wasted by doctors, patients and insurance companies arguing about coverage, leaving more resources for health care.
COST SAVINGS CAN BE REALIZED BY GIVING WOMEN A FULL RANGE OF REPRODUCTIVE CHOICE. I know that family planning and abortion rights are important to you, and I thank you for your work on these issues. Like women who choose contraception or abortion over carrying unwanted pregnancies, women who are carrying a pregnancy to term and wish to seek midwifery care in an out of hospital setting will save their insurer money, because the costs associated with a hospital birth will be substantially reduced. By honoring a woman's own wisdom about her reproductive choices, insurers win as does the dignity of the woman, who is given every opportunity to control her reproductive destiny.
In closing, I would request that you or your staff make time to talk to me and other moms about our experience with the health care system and why HEALTH CARE REFORM MUST HAPPEN NOW. We don't have a lot of money to spend lobbying legislators, but we believe the government can and must provide good health insurance, and we have ideas about how it can be done.
Thank you for all the work you do. May all your efforts be blessed.
Sincerley,
Alison Cole Duren-Sutherland
* I SUPPORT HEALTH INSURANCE THAT COVERS WOMEN MAKING THEIR OWN BEST CHOICES ABOUT REPRODUCTIVE HEALTH. Women who choose to prevent pregnancy when they are not prepared to be parents save money for their insurer (the state in the case of a public plan). Women who do not wish to be pregnant but are will save their insurer money by choosing abortion. Women who are carrying a pregnancy to term and wish to seek midwifery care in an out of hospital setting will save their insurer money because interventions will be reduced. Any reasonable insurer, while not mandating a woman to do any of these things, will provide her the coverage to do these things if she so chooses. By honoring a woman's own wisdom about her reproductive choices, insurers win as does the dignity of the woman, who is given every opportunity to control her reproductive destiny.
I have a lot of respect for the work of Certified Nurse-Midwives (CNMs), who are trained as RNs and go on to pursue graduate-level education in midwifery, similar to a Nurse-Practitioner or ARNP. Most practice in hospitals under the supervision of an obstetrician, and they are recognized in all 50 states. Because of their status as medical professionals, CNMs are able to both serve women who may never have heard or considered out-of-hospital birth and receive reimbursement from insurance and government-funded Medicaid programs. They provide humanized birthing care within the hospital, often reducing intervention and improving outcomes in poor or under-served communities. They are able to do this, again, because they are legal recognized throughout the country and by the government as health-care providers.
Certified Professional Midwives are not nurses. They are, I would argue, health care providers but not medical professionals. For most healthy women, birth doesn't need to be a medical event, and what they need is primarily someone to safe-guard and support the healthy choices they will make when given good information. CPMs practice exclusively in out-of-hospital settings, including homes and free-standing (i.e. not hospital affeliated) birth centers. They recieve the CPM credential after demonstrating that they have an agreed-upon set of skills which are necessary to facilitate normal birth and manage the rare emergency. Unfortuanately, in many states, CPMs are not recognized health care providers. Their clients must pay out-of-pocket for services, their access to medical referral is limited, and their practice is sometimes tolerated by Attorneys General who choose not to prosecute them for practiing medicine without a license. Thus, though many healthy women could be good candidates for out of hospital birth, they have never heard of CPMs or are too poor to pay for their care.
Health care reform could change all that. If the CPM was recognized as a health care provider by the federal Medicaid program, out of hospital birth care could spread to women who now could only be served by doctors and nurse-midwives, and the stage would be set for incorporation of CPMs into the health care system nationwide.
I wish the ACNM would rejoice and support this possibility instead of lobbying congress against the expansion of midwifery in the US. Their claim that graduate-level education is required to support a normal physiologic process falls flat in the face of the broad evidence that CPMs provide safe and competent care to healthy women and babies, and reports of dangerous abuse of intervention by birth attendants who receive the most post-graduate education.
- Mood:
disappointed
- Mood:
excited
This was the most major medical procedure I had ever had, and I was very nervous going in to it, but no one ever told me what to expect, what they were going to do to my body, what medicines I would be given, how I would feel afterwords. I ended up getting an infection, and having to return to the office, were I was seen by a different dentist who packed the holes in my gums with clove-soaked something that made me feel ill for days. The whole experience was disempowering, and as I said, I haven't been back to a dentist since.
At the time, I was a paramedical worker at a fabulous private women's health clinic, where I still work today, though in a different role. I spent my days there reviewing surgical informed consent forms with women seeking abortions. I would meticulously go through the steps of the procedure, unless a woman didn't want to hear what was going to happen, but either way I would review every possible complication of the procedure, give the woman statistics on how often those complications were likely to happen, and give her a chance to ask any questions she had about the procedure. When I went to get my wisdom teeth out, I expected something similar, and was shocked that it was nowhere to be found. How can anyone claim that I was provided with informed consent at that dentist's office? I knew I was getting my wisdom teeth out. That was it.
Soon after the wisdom teeth experience, I began working as a doula, supporting women and families during hospital births. There, I saw moms hooked up to external fetal monitor (EFM) belts as a matter of course. No one at the hospital mentioned to my clients that the monitors had never been shown to improve birth outcomes. No one mentioned that the monitors had been shown to increase cesarean section rates. No mom was ever given an informed consent form to sign authorizing the hospital to perform continuous EFM, or presented with the option of refusing the EFM all together.
Medicine pays lip service to informed consent, but ultimately our culture expects us to cede our power to our doctors. They are the experts, we are told, they know best. This is a problem in which we, as patients, are complicit. We need to get educated about our bodies and our health care, demand that our care providers give us complete information about our options, and make our own choices about how to promote our health. Ultimately, WE are our own primary care providers, as what we has a 24/7 impact on our health, while we may only see our doctors once or twice a year. One of the beauties of midwifery care is that it recognizes and promotes this vision of heath-care as client-centered.
I challenge every health care provider to provide the informed consent of two marginalized, but essential, areas of women's health care: abortion and midwifery.
Dear Senator Cantwell,
Thank you for all that you do for Washington State. I am writing today to let you know how important health care reform is to me, and give you a few points that I believe are essential to real reform of the health care system:
* A PUBLICLY-FINANCED HEALTH CARE OPTION IS VITAL. I work in insurance billing for a small medical practice, and it is ridiculous that private insurance companies make so much money off of trying to avoid paying for their member's health care. The system is too complicated to be understood by professionals like me, let alone health care consumers. I can only hope that a public option would provide clear, streamlined billing practices, as exists for Washington State Mediciad.
* WOMEN MUST BE ABLE TO ACCESS A FULL RANGE OF REPRODUCTIVE HEALTH CARE OPTIONS THROUGH PUBLIC HEALTH COVERAGE. This includes contraception, abortion, midwifery care and out-of-hospital birth. Providing coverage for all of these options will lead to significant cost-savings.
I encourage you to learn more about how Certified Professional Midwives and out-of-hospital birth reduce health care costs while optimizing outcomes. Please review the Milbank Report, found here: http://www.childbirthconnection.org/arti
*PROVIDING COVERAGE FOR WELLNESS-PROMOTING "ALTERNATIVE" AND "COMPLEMENTARY" CARE PROVIDERS WILL SAVE MONEY. Like midwives, practitioners like naturopaths, acupuncturists, massage-therapists, cranio-sacral therapists, etc provide alternatives to expensive drugs, surgeries, and hospital procedures.
Thank you for you service, and for reading this.
***
Emailed to the WA State Chapter of the American Medical Association in response to this bit of news:
I urge WA State Delegates to vote against the resolution which proposes to develop CPT (billing) codes to identify and label “non-compliant... Read More” patients at the American Medical Association’s (AMA) Annual Meeting next week. As a health care consumer, childbirth educator, and paramedical worker, I hope that Washington doctors understand that their patients are ultimately responsible for their own health-care decisions. Doctors need to be their patient's allies, not adversaries. This is especially important to me on issues of choosing a location and method of childbirth -- for pregnant women seeking quality care and good outcomes, “non-compliance” is often our only alternative to accepting care which is not evidence-based, such as mandatory repeat cesarean and continuous electronic fetal monitoring.
Thank you for your time.
Dear President Obama,
I am a mother, student midwife and abortion-care worker. I am writing to share my experience as a health care worker and consumer both within the Western medical establishment and in the alternative health care field in hopes that it will help you in rethinking the way our nation does health care.
My daughter was born at the beginning of the year. Being a parent is hard work. I knew this was true before I was a mom, but I didn't know how true it is. My ability to rise to the challenges of parenting comes in large part from the fact that I chose to be a parent. I had access to and coverage for contraception (and, had contraception failed, abortion) to ensure that I would not become a mother until I had the money, partner, and stable home to provide for a healthy, happy child. I don't know how I could have done this if I hadn't wanted to be a mother. Poorly-timed pregnancy often leads to poverty for women and children. I know you are committed to access to contraception and abortion, and I want to say only that I hope that any government-sponsored health insurance plan will give women affordable access to the birth control and abortion services that help us raise healthy families.
In keeping with my desire to optimize the health of my family, my daughter Ramona was born at home. I was given no drugs during labor, birth or postpartum. No machines or surgeries were required. Minimal waste was generated, and all the associated costs of inpatient admission to a hospital facility were avoided. In reality, most healthy women could achieve this type of safe, satisfying birth outside the hospital at a huge cost savings to the health care system. As the British Medical Journal states, "Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States." (http://www.bmj.com/cgi/content/full/330/7
I am studying to become a Certified Professional Midwife or CPM (http://www.nacpm.org/what-is-cpm.html),
I recently went back to work at the reproductive health clinic where I worked as a paramedical employee before Ramona was born. Now I am doing the insurance billing for this small business. Health care providers desperately need a universal, straightforward, and streamlined electronic system for being reimbursed by third-party payers and accessing patient records. Again, the money this would save in the long run is not insignificant.
I hear my daughter stirring, and will go soothe her back to sleep. Thank you for taking the time to consider my thoughts. I am praying for your success in all things.
Very Sincerely,
Alison Duren-Sutherland
***
Now you go there and post your vision. He needs our help. - Mood:determined
Negotiating the healthcare system these days on the behalf of a relative, I see things that horrify me: compromised patients are left to organize their own appointments and medical records, every office has a recording that answers the phone, information must be communicated in voicemails which go unreturned, supportive social services are unavailable in all but the worst of circumstances. People talk about waits and lack of doctor choice under a single payer system. Well, it's got to be better than this. And it's a shame that such a stigmatized area of medicine as reproductive health & abortion is the only place where I have yet found truly respectful medical care. People have asked me, why not become a nurse midwife or an OB? But medicine is not the place for me. All these things that I expect and can hardly find in the medical establishment are part and parcel of midwifery care at its best -- one provider who you see for your care, who takes your calls, who shows up to support you at your birth, who provides emotional support and education as well as healthcare. I don't think these things will ever really exist within American medicine, and rather than swim against the tides of the medical establishment, I'd rather sprout legs and walk upright on the solid ground of midwifery care,
- Mood: discontent
