Re-Virgination

I am writing about this for several reasons:

When men began to attend births (and other body issues) they would write about their findings and other men would discuss them.

I would like to know if anyone has ever seen this and what their thoughts are

A woman birthed with me (a normal homebirth). She incurred a small anterior tear which was not repaired and she was advised sitz baths with healing herbs (calendula, malva, rosemary and aloe) and to keep her legs closed. About one month ago at a post partum visit she stated that she felt her yoni had "closed". Assuming I understood what she was talking about I discussed pelvic floor with her and "things coming back together".

She was in fact right.

She came in for a pap smear one month after that conversation and I found that she had a "closed" yoni. She had grown a spider web type tissue across her inner labia leaving her introitus about the size of my pincky finger (which is by the way, very small). The tissue is very thin and only covers this area, from below her urethra to half way down her yoni introitus. I consulted our pediatrician who observed the woman and explained that this was a "Synercky" (sp. Sinerquia) and she had seen it in newborns, who are born with an overdeveloped hymen. She explained that basically this woman had revirginated. We giggled and stood in awe around her.

So we discussed a de-virgination plan between the three of us: she should come back without her baby, a bottle of wine and some romantic CDs and we would romantically "release" her of her new found virginity.

What is so stunning about this to me is the power of the mind and psyche to heal the body. The woman is question is a single mother with deep concerns about the fact that she became pregnant "out of wedlock". Her family had a hard time integrating the news as they are conservative and catholic. So this woman is a Saint?! She regained her virginity though a gentle postpartum after a beautiful homebirth. And through intention.

Now that may just be one more reason why homebirth is so special! And why women are so magical.

Once again, Science proves what Nature knows

Last week a study was published out of Canada comparing homebirth rates with midwives to hospital births with midwives and physicians. What is so good about this study is that is compares and compares and compares (three times because of the three factors it studies!). The study carefully looks at outcomes among Canadian women over four years within a common health care system, which means that in general these women can be compared. Also important to the study is that those who birthed at home had planned to do it- it wasn't an accident. The results show, as you will read below, that results of midwives are comparable to those of a physician. If you read the results of the study you will find that the results of the midwife attended homebirth are BETTER. Not just similar, B.E.T.T.E.R. This includes perinatal mortality (who new? in fact it appears in Canada LESS babies die at home). Homebirths also incurred LESS interventions (thats a no-brainer) or adverse maternal outcomes, which are defined as third and fourth perineal tear and post partum hemorrage.

So my question is- if the midwives are proving far better outcomes consistently then why is the research so controversial? Is it because women still have to work three times as hard to get half the recognition? Why is it that women's choice in birth is so controversial and questioned? Why is it that so few Maternal Health organizations recognize the Midwifery Model of Care?

How ss it that if midwives have BETTER outcomes than physicans, they are COMPARABLE?

If physicans had better outcomes than midwives than wouldn't they be deemed safer? So why doesn't someone just stand up and say it? OK, I will....

HAVING YOUR BABY AT HOME WITH A MIDWIFE IS SAFER THAN HAVING IT AT THE HOSPITAL.

GOT IT??????

now, read the study! and congratulate the authors, they did a fantastic job.

Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician

Patricia A Janssen ¹, Lee Saxell ², Lesley A Page ³, Michael C Klein ⁴, Robert M Liston ⁵, Shoo K Lee ⁶

¹ School of Population and Public Health, the Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, BC; the Child and Family Research Institute, Vancouver, BC
² Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, BC
³ Nightingale School of Nursing and Midwifery, King's College, London, UK
⁴ Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC; the Child and Family Research Institute, Vancouver, BC
⁵ Department of Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, BC; the Child and Family Research Institute, Vancouver, BC
⁶ Department of Pediatrics and the Integrated Centre for Care Advancement Through Research, University of Alberta, Edmonton, Alta.

	Abstract

Background: Studies of planned home births attended by registered midwives have been limited by incomplete data, nonrepresentative sampling, inadequate statistical power and the inability to exclude unplanned home births. We compared the outcomes of planned home births attended by midwives with those of planned hospital births attended by midwives or physicians.

Methods: We included all planned home births attended by registered midwives from Jan. 1, 2000, to Dec. 31, 2004, in British Columbia, Canada (n = 2889), and all planned hospital births meeting the eligibility requirements for home birth that were attended by the same cohort of midwives (n = 4752). We also included a matched sample of physician-attended planned hospital births (n = 5331). The primary outcome measure was perinatal mortality; secondary outcomes were obstetric interventions and adverse maternal and neonatal outcomes.

Results: The rate of perinatal death per 1000 births was 0.35 (95% confidence interval [CI] 0.00–1.03) in the group of planned home births; the rate in the group of planned hospital births was 0.57 (95% CI 0.00–1.43) among women attended by a midwife and 0.64 (95% CI 0.00–1.56) among those attended by a physician. Wo men in the planned home-birth group were significantly less likely than those who planned a midwife-attended hospital birth to have obstetric interventions (e.g., electronic fetal monitoring, relative risk [RR] 0.32, 95% CI 0.29–0.36; assisted vaginal delivery, RR 0.41,95% 0.33–0.52) or adverse maternal outcomes (e.g., third- or fourth-degree perineal tear, RR 0.41, 95% CI 0.28–0.59; postpartum hemorrhage, RR 0.62, 95% CI 0.49–0.77). The findings were similar in the comparison with physician-assisted hospital births. Newborns in the home-birth group were less likely than those in the midwife- attended hospital-birth group to require resuscitation at birth (RR 0.23, 95% CI 0.14–0.37) or oxygen therapy beyond 24 hours (RR 0.37, 95% CI 0.24–0.59). The findings were similar in the comparison with newborns in the physician-assisted hospital births; in addition, newborns in the home-birth group were less likely to have meconium aspiration (RR 0.45, 95% CI 0.21–0.93) and more likely to Abstract be admitted to hospital or readmitted if born in hospital (RR 1.39, 95% CI 1.09–1.85).

Interpretation: Planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician.

Birth Camp!

This week Brenda and I created Birth Camp! This is the Spanish version of Mayan Moon Retreat Week directed at Mexican midwives, students, doulas, mothers and plain ol' curious passionate birth workers.

The week will take place during the Mexican independence celebrations, so mid-week we will have a break from intensive workshops.

The schedule includes working with the pelvis- both our own and the women who with acompany during birth, incorporating grief, exploring homeopathy as well as Mayan ritual and sacred space.

I am excited about this space because I constantly recieve emails from Mexican women who want to study at Luna Maya and sadly we cannot take on all the apprentices we hear from. This week long intensive is a way for us to circle together and share all we know about birth to renew our ancestral wisdom and commitment to our path.

If you love the idea, but don't speak spanish, stay tuned and check our webpage because I have already posted the dates for Mayan Moon Retreat Week in February 2010.

At the end of the day the students asked me for the second time, why dont you start a midwifery school? Well, I'll try to come up with an answer for that.

In the meantime, show your interest and commitment to continued growth and the profound importance of re-birth through intensive circle and join us for Birth Camp! See you in September!

Universal Standards for Midwifery Education

Last month, the World Health Organization published the "Global Standards in Nursing and Midwifery Education". In this document the WHO suggests universal standardization of midwifery education, and raising the standard to university level education. Below you can read the MANA Board response to this document, which you can read at:

http://www.who.int/hrh/nursing_midwifery/hrh_global_standards_education.pdf

As someone who works in a region where female education is complicated, stressful, financially straining and a far priority from cultural values I am curious about the realistic application of these standards. I'd love to hear comments about this initiative.

August 1, 2009

Task Force on Global Standards in Nursing and Midwifery Education

Nursing and Midwifery Resources for Health

World Health Organization

Dear Sirs,

Attached you will find the CPM Issue Brief which we are sending to you for your consideration in response to the “Global Standards for the Initial Education of Professional Nurses and Midwives.” This document was developed by a coalition of four midwifery organizations, including the Midwives Alliance of North America describing the role, expertise and educational

model of the Certified Professional Midwife. This competency based model of Direct Entry Midwifery has been developed successfully in a country noted for its economic, social, racial and geographic disparities in access to health care services and perinatal outcomes.

Certified Professional Midwives have proven to be a viable, safe and cost effective route of not only competency-based midwifery education but also for providing evidence-based care with excellent outcomes. This model is currently being replicated or considered for replication in a number of countries including Germany, Australia, New Zealand, Mexico and Guatemala.

We would like to point out that, although you state that the Standards were developed by a long list of experts in the field, there is a surprising lack of midwives on the Task Force. Most notably there is a blatant lack of participation of the International Confederation of Midwives, as well as a lack of participation from other midwifery councils including the Midwives Alliance of North America, the American College of Nurse Midwives, the Royal College of Midwives among others.

We question why internationally established and recognized councils were not consulted and included within the task force created by an organization that represents global health interests. We would also like to point out that most members on the Task Force are not midwives themselves.

Another important concern we have with the document is regarding the standards themselves. Global Standards in midwifery education assume global standards in opportunity. Our countries and regions are a far cry from being able to offer women equal access to educational and economic opportunities. Global Standards also assume a global standard in health,

reproductive history and risk. The World Health Organization is fully aware that many women in rural indigenous communities lack access to educational opportunities and to the economic resources to complete formal and university level education. It is completely unrealistic to expect women from poor, marginalized and indigenous communities from around the world to be able to complete a university degree in nursing and midwifery. It is also known that health providers who complete university degrees generally do not serve poor and marginalized communities, especially if these are rural.

Around the world in developed and developing nations, successful models of inter-cultural and integrated care have proven positive outcomes. Within the U.S. for example, the Certified Professional Midwife is skilled at attending normal, low risk, out of hospital births, and is skilled at referring to specialized care when the need arises. In rural Guatemala and Mexico, traditional midwives learn to refer high-risk women to professional midwives and family physicians who in turn may refer to specialized care. Diversity in economic and cultural realities requires diversity in health care provision.

We are concerned that the standardization of Midwifery education to a University level would leave millions of women around the world without access to skilled birth attendants, resulting in an immediate impact in the increase of maternal and infant mortality and morbidity rates. Furthermore, this would leave the poorest, most marginalized and most vulnerable

women and infants far from care provided by competency based care providers. Through the implementation of the Standards of Education health promoters, trained traditional midwives, direct entry midwives and Certified Professional Midwives would be left outside of the health system leaving millions of mothers and babies vulnerable to unassisted birth and no primary care at all. We do not believe this is in the interest of the World Health Organization or of the general public.

We hope that you will appreciate and embrace the important contributions to accessible high-quality maternity care provided by competency based health care providers. In addition, we encourage you to carefully consider the low cost model that has been successfully developed by the Midwives Alliance of North America and our partner organizations to enhance

our vision of “one midwife for every woman”.

Sincerely,

Geradine Simkins, RN, CNM, MSN

President

Midwives Alliance of North America

MANA Board of Directors

Maria Iorillo CPM, 1st Vice President

Christy Tashjian CPM, 2nd Vice President

Angy Nixon CNM, MSN, Secretary

Audra Phillips CPM, Treasurer

Pam Dyer Stewart CPM, Region 1

Regina Willette CM, Region 2

Tamara Taitt DEM, PhDc Region 3

Sherry DeVries CPM, CNM Region 4

Elizabeth Moore CPM, Region 5

Colleen Donovan-Batson CNM, Region 6

Dinah Waranch CNM, Region 9

Cristina Alonso Midwife, Region 10 Mexico

Michelle Peixnho CPM, Midwives of Color Section

Open Letter to the ACNM Board of Directors and Executive Director

Think together, no.

Pull together, yes.

-Michelle Ellsworth

TO: Open Letter to the ACNM Board of Directors and Executive Director

FROM: Geradine Simkins, CNM, MSN, MANA Board President

RE: ACNM Opposition to Federal Recognition for the CPM

DATE: July 16, 2009

I am a CNM and a member of the ACNM and I say very emphatically—not in my name! I do not support your recent decision to publicly and aggressively oppose the efforts of a broad-based coalition of six national midwifery and consumer organizations to seek federal recognition of the Certified Professional midwife. Your position, to me, is indefensible.

Lack of Evidence

For an organization of professionals that values evidence, we find it inexcusable that you have chosen an action that the evidence does not support.

• There is not evidence to support your claim that the majority of CPMs are not properly qualified to practice.
• There is no evidence to support the position that CPMs in general have poorer outcomes than CNMs or CMs.
• There is no evidence to support the position that CPMs trained though apprenticeship and evaluated for certification through he Portfolio Evaluation Process (PEP) of NARM have different outcomes than CPMs trained in MEAC-accredited schools.
• And there is no evidence to support the notion that a midwife with a Master’s Degree has better outcomes than one without that level of higher education.

The evidence we do have on the CPM credential indicates that the midwives holding this credential are performing well, have good outcomes, and are saving money in maternity care costs. The growing number of women choosing CPMs suggests that women value the care provided by CPMs. If research in the future demonstrates that the PEP process is not safe or is not cost-effective, then that is the time to reassess and restructure the process.

Differing Values

We, as midwives, have values that underpin our professional practice. We cherish and honor those values. You have stated that your board made its decision because ACNM strongly values formal standardized education, and opposes federal recognition of CPMs who have not gone through an accredited program. We can accept that you strongly value standardized education. However, we strongly value multiple routes of midwifery education for a variety of reasons.

There is something important, powerful and valuable in a training process in which the student midwife or apprentice is educated in a one-on-one relationship with a preceptor and her clients in the community, as opposed to the tertiary setting where student midwives don’t follow women throughout the childbearing year, and may never experience continuity of care or individualized care. In addition, by preserving multiple routes we are able to educate more midwives, not fewer. We need more midwives! If health care reform were to turn around and adopt the midwifery model of care as the gold standard this year, we could not possible supply “a midwife for every mother”.

Impact of Taking a Stand

By publicly and actively opposing federal recognition of CPMs as Medicaid providers, in addition to taking a stand about formal education, you are also taking a stand (willingly or inadvertently) for decreased access to midwifery care, diminished choice for women to chose maternity care providers and place of birth, and restricted access to the profession by potential candidates. Is it worth it to sacrifice several things that you value, just so that you can take a stand for one thing that you value? Is it possible for you as an organization to value something, but also realize that it is not the only valid way? Is it possible for you to respect the diversity of pathways to midwifery that the CPM represents? It does not require the ACNM to sacrifice its own standards. It simply requires the ACNM to respect the standards of another part of the profession of midwifery.

Disingenuous Claims

It is disingenuous of ACNM to state in its Special Alert to ACNM Members on July 15, 2009, “ACNM’s decision to oppose this initiative followed unsuccessful attempts by ACNM and MAMA Campaign leaders to reach a compromise that both organizations could support…” There was no formal process or interaction, no back and forth negotiations, no attempt at collaboration that occurred between ACNM leaders and MAMA Campaign leaders. There was one phone conversation in which the ACNM representative stated that there was only one compromise that they would accept: federal recognition only for gradates of MEAC-accredited programs. While there are multiple educational paths to achieve it, the CPM credential embodies a single standard body of knowledge and experience. It cannot be split into parts. Therefore, the MAMA Campaignis promoting all CPMs to receive federal recognition as Medicaid providers, not some CPMs. There is no room for compromise when one side gets everything they want and the other side does not get what they want at all.

It is also disingenuous to suggest the World Health Organization (WHO) document sets a standard that has been embraced around the world. In fact, the WHO developed global standards for midwifery education without the input of the International Confederation of Midwives (ICM), an international partner of the WHO. The majority of members of the task force that developed the standards were not midwives. There was not widespread input regarding the document. In response to this oversight, the ICM passed a resolution at the June 2008 Council meeting in Glasgow Scotland (I was there!) to develop global midwifery standards. A task force has since been convened and all member organizations (which includes MANA and ACNM) will be able to give input to the standards developed by the ICM. Generally, when the ICM develops a document that might supplant an existing WHO document (as was the case in the international definition of a midwife), the ICM document is eventually incorporated by the larger international community. This will be a long process and any new document will not be ratified by ICM until the next Council meeting in 2011.

Lack of Vision

What offends me as a CNM, an ACNM member, a member of the MANA/ACNM Liaison Committee, and the President of the Midwives Alliance is the lack of vision that your decision represents.

Why not embraces diversity and support innovation? Why not bring the turf wars to an end? Why not unite under the banner of midwifery and the values that we share in common? Why not set aside our differences and recognize that we are all midwives? Why not recognize that the work we do is more important than the credentials we hold? Why not support one another within the profession, because diversity is our strength not our weakness?

What We Do Matters

The healthcare debate has been in progress in Washington DC for over a decade. But never before has the possibility of real change been so promising as it is now. Now is the time when we may have a real opportunity to impact changes in maternal and child health care that will have long-lasting affects for mothers, infants, families and communities. Women deserve high quality maternity care, affordable care, and equal access to care. Women deserve a variety of maternity care choices in providers and place of birth. Vulnerable and underserved women deserve to have disparities in health care outcomes eliminated, and they deserve to have barriers removed that limit services, providers and reimbursement for maternity care.

Expanding the pool of qualified Medicaid providers to include CPMs will help address the plight of so many women around the county who receive poor quality maternity care or do not have access to care at all. We need to lower the C-section rate and increase VBACs. We need to lower infant and maternal mortality and morbidity rates in the US. We need to offer women the opportunity to believe in their bodies again and to give birth powerfully and in their own time. We need to welcome babies gently into the world. We need to give the experiences of pregnancy and birth back to families. We need to support women to breastfeed and help shelter the process of maternal-infant bonding. These are the real issues. These are the things we deeply value. Midwives are the solution that can address each of these vital issues. For all midwives and midwifery organizations to be united under this banner is what is really important, not a continuation of turf-war battles that distract us from reaching our common goals. We do not have to think together; but we must pull together!

In Conclusion

I repeat to you—not in my name. As an ACNM member, your actions this week do not represent what I value, what I hope for, and what I work untold hours to achieve, nor do your actions represent what my Board of Directors values. I have written this letter at the urging of my Board of Directors. There are 14 members of the MANA Board —seven CPMs, four CNMs, one CPM/CNM, one CM and one DEM; truly a cross-section of the midwives that practice in this nation. What we stand for is diversity, tolerance and unity among midwives and within the profession of midwifery. What we advocate and work for is a midwife for every mother, in every village, city, tribe and community in the country and across the globe.

Sincerely,

Geradine Simkins CNM, MSN, President

MANA Board of Directors

Maria Iorillo CPM, 1^st Vice President

Christy Tashjian CPM, 2^nd Vice President

Angy Nixon CNM, Secretary

Audra Phillips CPM, Treasurer

Pam DyerStewart CPM, Region 1

Regina Willette CM, Region 2

Tamara Taitt DEM, Region 3

Sherry DeVries CPM, CNM Region 4

Elizabeth Moore, CPM, Region 5

Colleen Donavan-Bateson CNM, Region 6

Dinah Waranch CNM, Region 9

Cristina Alonso Midwife, Region 10 Mexico

Michelle Peixnho CPM, Midwives of Color Section

Where there is No Neonatologist

Q: What is a Neonatology?

A: Neonatology is a subspecialty of pediatrics that consists of the medical care of newborn infants, especially the ill or premature newborn infant. It is a hospital-based specialty, and is usually practiced in neonatal intensive care units (NICUs). The principal patients of neonatologists are newborn infants who are ill or requiring special medical care due to prematurity, low birth weight,intrauterine growth retardation, congenital malformations (birth defects), sepsis, or birth asphyxias. (Wikipedia)

Q: What does a Neonatologist do in a hospital?

A: Supervises and works in the Neonatal Intensive Care Unit making decisions about unwell and premature infacts.

Q: How many neonatologists are there at the Regional hospital that attends to San Cristobal and the Highlands of Chiapas?

A: One

Q: And how many shifts are there?

A: 5. Morning, afternoon, night. Weekend day and weekend night.

Q: And when does the Neonatologist work?

A: Morning shift from monday to friday

Q: When do most births occur?

A: At night and on weekends

Q: So, who monitors the Neonatal Intensive Care Unit at the Hospital on weekends?

A: A Pediatrician

Q: Is a pediatrician qualified to manage an NICU and make decision regarding neonates in intensive care?

A: Not unless he or she has done specific certified training on this issue

Q: So basically you are saying that aside from mornings from mondays to fridays the NICU is not run by qualified staff?

A: Exactly

Q: At what consequences does that bring?

A: That over the weekend babies die that should not die because they are not intubated, ventilated or recieve appropriate treatment.

Q: And what is being done about this?

A: For the moment, nothing.

Q: So babies are dying over the weekend at the Regional Hospital because there is no qualified personel. Is there another hospital that has an NICU in the area?

A: No, the nearest one is the pediatric hospital in Tuxtla Gutierrez.

Q: So what would your advice be?

A: I would suggest that babies born on weekends make sure that they are at term, suffer no asphyxia, do not aspirate meconium or amniotic fluid, do not have any congenital anomalies because they have a very low probability of making to to monday.

Q: Thank you.

Intimacy

This week in Family Circle we talked about intimacy. The family's had asked to talk about sex, but I thought before talking about sex life after the baby, perhaps we should talk about intimacy first. We sometimes give sex and our sex life a lot of weight and consider that either we have a sex life or we don't. That if we have sex, we have intimacy as a couple and if we don't we don't. And this is a measurement of our relationship.

What we challenged the families is to think of Areas of Intimacy, as gradients, or degrees, instead of an all or nothing. As a couple we can look into these areas of intimacy and think about how we are doing within them. Perhaps we will find that one area is really strong and another is really weak. Then what we can do is put more effort into re-inforceing certain areas.

Consider these areas of intimacy:

As Parents: How we make decisions as parents (not the time we spend with our kids, but as a couple talking about how we parent)

Spiritual: We may share a religion, or a sacred process or thought or ritualize certain events or moments

Recreational: How we share having fun, what we like to do together

Asthetic: Our appreciation of what is beautiful to us

Crisis: Walking together through crisis, either an external crisis where we lean on the other or an internal relationship crisis where we are pulled together by our effort to reconcile and heal

Emotional: How we share, live and communicate our emotions

Sexual: How our sex life is lived, discussed and felt

When we consider intimacy by areas we can assess our balance or imbalance on a qualitative scale. We can work on enforcing certain areas and we will find that the better our intimacy gets in one area, the better it gets in another area. For example, if we agree that on saturday mornings we will bike ride together because we enjoy doing that, we will probably find that on saturday nights our sex gets better!

What we discussed in Family Circle (the first tuesday of every month at Luna Maya) was that during pregnancy couples can work on improving specific areas of intimacy so that when baby comes we can communicate our needs for intimacy as a couple, separate from the all consuming parenting.

If a couple has already had a baby and the couple feels astranged, perhaps they can check out these areas and see where there is possibility for improvement. Sometimes, its ok to pump milk, leave baby with grandma for a saturday morning so that mom and dad can have a bike ride and share some intimate time together.

It is important to remember that the new baby lives with two (sometimes) adults, and these two have a relationship that will immediately affect the baby. Lets give ourselves time as a couple to work on our areas of intimacy. We will teach our kids the importance of this and foster intimacy and communication among our newborns.