Midwives deliver

America needs better birth care, and midwivescan deliver it.

By JenniferBlock
December 24, 2008

Somehealthcare trivia: In the United States, what is the No. 1 reason people areadmitted to the hospital? Not diabetes, not heart attack, not stroke. Theanswer is something that isn't even a disease: childbirth.

Not only is childbirth the most common reason for a hospital stay -- more than4 million American women give birth each year -- it costs the country far morethan any other health condition. Six of the 15 most frequent hospitalprocedures billed to private insurers and Medicaid are maternity-related. Thenation's maternity bill totaled $86 billion in 2006, nearly half of which waspicked up by taxpayers.

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Birthing the old-fashioned way

Just a few days before her due date, Claire Alexander was told byUCSF Medical Center that she should stay at the hospital forobservation. Her baby's heart rate showed a deceleration and theattending obstetrician wanted to monitor it.

But instead of checking into a hospital room, Alexander returned toher home in the city's Richmond district, climbed into a tub of waterwith her husband, and pushed out a healthy baby girl.

"We floated in the tub with her for a little while enjoying thepostbirth euphoria," Alexander says. "It was an amazing experience."

Home birthing is on the rise in San Francisco.

California licensed midwife Maria Iorillowas at the birth guiding Alexander through the experience. Iorillo wasalso at UCSF when a labor and delivery nurse hooked Alexander up to amonitor and an on-call resident said, "We strongly advise you to stayhere."

But Alexander knew she wanted to give birth at home--she had planned on this for months--and Iorillo requested that Dr. Julian Parer, an expert on fetal heart tones, assess the situation. Dr. Parer determined that Alexander was safe to go home.

"I think Maria views herself and the hospital as partners,"Alexander says. "She's not intimidated in the face of the medicalestablishment yet she works hard to not create a confrontational sceneat the hospital. Sure, she wants what the mom wants, a home birth. Butthe primary thing is the safety of mom and baby, and deliberate,thought-out, informed decisions are what she's after. She stood up forme when I was too intimidated by the machinery, the staff, and thehospital gown to stand up for myself."

Many women who birth at home deliver in a tub.

In San Francisco the old-fashioned way of birthing is back in style.More and more women such as Alexander want to birth in their own bed ortub, free from medical interventions such as labor-inducing medicationand C-sections that are staples of hospital deliveries. According tothe National Center for Health Statistics, home birthing accounts forless than one percent of all U.S. deliveries, and this number hasremained the same for many years. But in San Francisco, the number ofhome births is rising. According to the San Francisco Department ofPublic Health, 94 women delivered outside the hospital in 2006. The2008 number is currently 128 and will likely climb to 140 or higher bythe end of the year, according to the department's Office of VitalRecords.

"When I started in this business in 2006, we had only one birth tub," says Cara Vidano, owner of Natural Resources,a pregnancy and childbirth resource center in the Mission district."Now, I have eight and they're booked three months out. Every month, Iget calls from people who want a birth tub and I have to turn themaway."

"I'm busy, busy, busy--booked through summer," says certified nurse midwife Nancy Myrick of Rites of Passage."I limit my business to three to four home births a month, but thereare months when I get 20 phone calls. Two years ago, there were somemonths when I had only one birth."

Many midwives such as Myrick believe the 2008 documentary the Business of Being Bornis one of the reasons for the increase. Executive-produced by formertalk show host Ricki Lake, the movie makes a strong case for drug-freehome births and suggests that the rise in C-section surgeries in recentyears (one in three births end in a C-section) is a "doctor-friendly"trend that helps hospitals avoid malpractice suits and moves women outof the maternity ward faster. It reveals that in most advancedcountries, midwives reduce the need for Cesareans and improve survivalrates for mothers and their children.

"San Francisco was one of three cities where the Business of Being Born premiered," says licensed midwife Abigail Reagan, who started her practice Rebirth Midwiferyfive years ago. "The film was supposed to run for three nights afterthe premiere. But the crowds were so great that it screened for threemore weeks. After that, the phones started ringing."

Midwife Maria Iorillo counts 10 toes on a baby she helped deliver.

Midwife Maria Iorillo says the San Francisco community has fosteredthe home birthing movement. The city is full of midwives and St.Luke's, UCSF, and Kaiser hospitals all work with them and providecollaboration if necessary (CPMC doesn't allow home birth collaborationdue to insurance issues). "Even in the East Bay, it's not as friendlyand cooperative," says Iorillo, who opened her home birthing practice Wisewoman Childbirth Traditions in 1987. "At Alta Bates, they don't have any doctors who are willing to work with you. Kaiser in Oakland is a little better."

Most home births are attended by a midwife, a licensed health careprofessional trained to provide prenatal care, guide labor and birth,address complications, and care for newborns. Most midwives charge$4,000 per birth (much less than the price of delivering in a hospital)and insurance companies often cover half the cost. Midwives say theyaccept only low-risk clients, and the pregnant woman typically choosesa collaborating hospital. An estimated 12 to 20 percent of all homebirths transfer to a hospital, mostly for pain medication and laboraugmentation. Midwives insist they practice preventively, knowing whentechnology only available at a hospital is necessary.

A study published in 2005 in the British Medical Journalfound that home birthing had a similar mortality rate to that oflow-risk hospital births. This particular study took into account allhome births involving a certified professional midwife (CPM) in theUnited States and Canada in 2000. "A lot of home birth studies arebased on birth certificates and don't take into consideration peoplewho didn't plan a home birth," Iorillo says. "Some of these women hadno prenatal care and didn't have a midwife present at the birth."

Despite the evidence supporting planned home birth as a safe optionfor women with low-risk pregnancies, the home setting remainscontroversial. The American Medical Association and the American College of Obstetricians and Gynecologists (ACOG)believe a hospital or an accredited birthing center is the safestsetting for labor, delivery, and the immediate postpartum period.

"ACOG doesn't formally oppose home birthing but our positiondefinitely implies that," says Dr. Erin Tracy, an ob-gyn atMassachusetts General Hospital and vice chair of ACOG Massachusetts."No one at ACOG is advocating for criminalizing home birthing. We justpersonally think it's much safer to give birth in a hospital or at abirthing center. I think the vast majority of women who give birth dofine, no matter where they do it. But there is a certain number oflow-risk pregnancies that become high-risk minutes before their babiesneed to be delivered. How does someone who needs help within minutesget from home to a hospital in time? Another concern is the lack ofavailability of potentially life-saving techniques, including Cesareansections, blood products, and medications in the home setting."

But while some doctors argue that things can go wrong at home, manywomen opt for a home birth because things went wrong for them at thehospital the first time around. Claire Alexander says her experiencewith her first child led her to a home birth. When she checked into thehospital, attendants failed to recognize that Alexander was far alongin her labor and left her and her husband alone in the room. "I reacheddown and I could feel the baby's head. The outcome was good but I feltlike we could have easily done this ourselves at home."

***

Posted By: Amy Graff (Email) | November 19 2008 at 07:35 AM

The Homebirth Choice

by Jill Cohen

© 1992 Midwifery Today, Inc. All rights reserved.

Updated September 2008

Contents

1. Why Homebirth?
2. Considerations
3. Practitioners
   • Who Assists at Homebirths?
   • Types of Midwives
4. Midwifery
   • A Brief History of Midwifery
   • How to Choose a Midwife
5. Prenatals
6. Labor
7. Complications
8. Birth
9. Resources

This document discusses homebirth as one of many avenues toward asuccessful birth—one that results in a happy and healthy mom and baby.We offer this in support of education, freedom of choice andempowerment of women and their families. While aimed at parents, thoseconsidering the profession of midwifery will also find it a usefuloverview of what a midwife does. It was written from the perspective ofmidwives in the US. For another viewpoint, read about HomebirthIn England.

1. Why Homebirth?

In most cultures throughout history, women have given birth at home.The majority of women worldwide continue to birth their babies innon-hospital settings today. In many cultures birth is viewed as anintegral part of family life. The advent of obstetrics in this centuryhad a tremendous effect on childbirth customs in the United States. Thebirthing process became segregated from mainstream family life. Manywere led to believe that the only safe birth was a hospital birth.Though doctors and hospitals took credit for statistics that indicatedthat birth was more successful than in previous centuries, in realitybetter nutrition, hygiene and disease control improved outcomes. Eventoday US statistics don't support the premise that the only safe birthis a hospital birth. The US ranks 28th among industrialized nations forhealthy births, at 7.0 infant deaths per 1000 births. (These data arebased on 2002 statisticsfrom the Maternal and Child Health Bureau: US Department of Health andHuman Services.) Hospitals have never been proven a safe place to havea baby.

By the 1950s, most births in the US were taking place in hospitals.Cesareans, epidurals and heavy doses of pain medication became thenorm. Women were denied feeling and experiencing birth through theirbodies, and the drugs were having adverse effects on mothers and babies.

In the 1960s and '70s, women began to question and challenge the wayobstetricians were treating them—as though childbirth were a sickness.Women began to reclaim their power, and the homebirth movement was born.

The 1990s became a time of maternity awareness. People wereconcerned with making all of pregnancy and birth a family experience.Today, a carefully monitored homebirth has been proven to be very safeand successful for women who have been helped to stay low-risk throughnutrition and good prenatal care. (See Johnson,K.C., and B.A. Daviss.2005. Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ 330: 1416)

2. Considerations

A mother choosing a homebirth must, above all else, deeply desire togive birth at home. Even though a homebirth can save money, cost aloneis not sufficient motivation. The most successful homebirthers arehighly committed and trust their body's natural ability to birth. Theydevote time and energy to finding the right birth practitioner, doingtheir own research and taking care of themselves.

For some mothers, the prospect of being at home in familiarsurroundings provides tremendous comfort and reassurance. Others mayfeel uneasy that more technical medical assistance isn't at hand. Witha skilled midwife and a non-meddlesome approach, homebirth is safer.

Families that choose homebirth may be confronted by family membersand friends who, conditioned by a society afraid of out-of-hospitalbirths, challenge their decision, feeling it is both unwise and unsafe.Again, a strong inner commitment is required to stand up for the rightto birth as the family chooses. Showing family members the evidence issometimes helpful.

3. Practitioners

Who Assists at Homebirths?

Homebirth practitioners include naturopaths, family practitioners,nurses, physician's assistants, chiropractors and midwives. Anyoneattending homebirths can be said to be practicing midwifery. In thisarticle, we will concentrate on homebirth with a midwife.

Types of Midwives

There are three types of midwives [Editor's Note: For more information on the different kinds of midwives, please see Finding a Midwife on the Citizens for Midwifery Web site]:

Certified Nurse-Midwife (CNM)

A Certified Nurse-Midwife is a registered nurse who is educated inthe two disciplines of nursing and midwifery and has been certified bythe American College of Nurse-Midwives(ACNM). She may work through a hospital, in a birth center or in anindependent homebirth practice in collaboration with a physician. Onlyabout 150 CNMs do homebirths, however, because they are required tohave a written collaboration agreement with a physician.

Certified Professional Midwife (CPM)

A CPM is certified by the North American Registry of Midwives(NARM). She has generally passed both a written test and a skills exam.Her training may be through an academic setting or it may be throughthe time-honored apprenticeship model, or even a combination of thetwo. Apprenticeship is encouraged. CPMs work in birth centers or athome. As of 2007, 24 states regulate the practice of homebirthmidwifery through either licensure, certification or registration withthe state.I In 11 states, the practice of direct entry midwifery isillegal (Source: MANA.org). More complete definitions and explanations can be found in Paths to Becoming a Midwife.

Lay Midwife

A lay midwife is a woman who has apprenticed with an experiencedmidwife and may have attended school or workshops and classes tosupplement her education. She attends births at home or in birthcenters. She may be affiliated with a physician, but she is not underthe physician's directive. She either chooses not to be certified orcertification may not be available in her practice region.

4. Midwifery

A Brief History of Midwifery

Midwife means "with woman." Traditionally, women have attended andassisted other women during labor and birth. As modern medicine emergedin the West, birth fell into the realm of the medical. Since women werebarred from attending medical schools, men became the birthpractitioners. Having never had a baby themselves, they were unable toapproach women and childbirth with the inner knowledge and experienceof a woman. Childbirth became viewed as pathological rather thannatural. Medical techniques and interventions that were unnecessary andoften dangerous became commonplace.

During the 1960s and '70s, along with the women's movement andrenewed interest in homebirth, the midwifery movement rekindled. It hasbeen growing steadily ever since. Midwives are becoming more and moreinvolved with birthing families and have been instrumental inredefining birth as a natural event in women's lives. Midwiferyempowers women and their families throughout pregnancy and birth.

How to Choose a Midwife

Midwives have varying styles and levels of expertise. It isimportant to choose a midwife with whom you feel confident andcompatible. The following questions may help a pregnant woman select amidwife who is well-suited to her and her family:

• How did she become a midwife?
• What training has she had?
• Is she certified or licensed with any organizations?
• Does she belong to any midwifery organizations, attend conferences and workshops, subscribe to professional journals?
• What is her basic philosophy of childbirth?
• How many births has she attended as the primary midwife?
• Does she handle higher risk situations, such as twins or breeches?
• What is the fee for her services, how must it be paid, what does it include?
• What kinds of services are included in prenatal care? (May includeearly detection of problem areas for the mother and baby; nutritioninformation; exercise recommendations; in-home care; recommendationsfor parent education via books, videos or classes.)
• Does she work with another midwife or assistant at births?
• What does she do if two of her clients are in labor or birth at the same time?
• How do clients reach the midwife? Does she have a pager or cell phone allowing 24-hour access?
• How does she handle problems or complications that develop during labor?
• What standard and emergency equipment does she carry? What herbs ormedicine does she use? Which ones does she not carry and why?
• Does she have any affiliation with a physician who can answerquestions about unusual developments either during the pregnancy or inan emergency?
• What is her policy for transporting to a hospital?
• What medical facility would she use? Has she developed a good working rapport with them?
• What kind of postpartum care does she provide? (Ask about frequency of baby checkups, assistance with breastfeeding.)

In addition to asking these questions, it is important to be clearabout what you expect from your potential midwife. Be prepared to shareyour vision of the birth and discuss any fears you may have. Tell herhow knowledgeable you are about birth at present and how informed youwould like to become.

Determine if the midwife's answers to your questions agree with yourdesires. If your heart trusts her, you have found your midwife.

5. Prenatals

Prenatal visits may take place at the midwife's home or clinic or atthe family's home. The latter is especially comforting for the family,as they are in their own surroundings and may be less hesitant to askquestions and get involved. Prenatal visits are also a time for themidwife to get to know the family and friends, neighbors or otherchildren who plan to be present at the birth. Midwives invite familymembers to ask questions and listen to the baby's heartbeat. Intimateinvolvement of the family throughout the pregnancy allows for earlybonding of the newly emerging family unit.

The midwife first interviews the pregnant woman to determine whethera high-risk situation exists. Homebirth may not be a viable option foreveryone. A high-risk woman has certain medical conditions or specialneeds. She may have diabetes or blood disorders. Women having a VBACand women carrying a baby in breech position or twins have slightlyincreased risks but need not necessarily be ruled out for a homebirth.

If the midwife and family determine that a high-risk situationexists or may develop, they decide whether a homebirth is practical.This process is especially important for families in rural areas manymiles from a hospital. As midwives have varying levels of experience,some are more comfortable than others in handling situations withhigher risk.

The midwife helps the whole family prepare for the birth. Prenatalcare for the pregnant woman commonly includes discussing nutrition,exercise and overall physical and emotional well-being, as well asoverseeing the healthy development of the fetus. The midwife and familyoften discuss the mechanics of birth. The more those involved knowwhat's going to happen, the more comfortable they will be whileawaiting the birth.

A birth plan (see Creating Your Birth Plan: The Definitive Guide to a Safe and Empowering Birth)designed at this time helps the family create a desired atmosphere.This may include special music, candles, religious or cultural rituals,individuals in attendance, which room in the home will be the birthingroom, what kind of support the mom desires, etc.

Birth is a well-designed process, and most women can give birth easily by trusting themselves and their practitioner.

6. Labor

When the mother's labor begins, she calls the midwife. The midwifemay be intimately involved right from the beginning of labor, or shemay be present in more of a peripheral sense. At homebirths, family andfriends frequently join together to provide encouragement. Husbands orpartners may be the primary source of support for the birthing mom. Themidwife can help fill this role if other support is not available.

Usually someone other than the mom or her partner assumesresponsibility for any children who are present, freeing mom to focuson birthing. Another adult may be the designated photographer.

The midwife helps calm those who are present at the birth. Tensionin a room can slow down or stop a labor. The midwife handles thesesituations so the mom and her partner can continue to focus on thebirthing process.

Because homebirth families are well prepared, the birthing processcan feel quite natural. They can let go of any fear surrounding birthand trust the process instead.

During labor the partner and family members nurture the mom. Themidwife watches for complications or signs of distress in either mom orbaby. Throughout labor, the midwife asks permission to perform anyprocedure and explains to the mom and family what she is doing and why.

The birthing process is allowed to take its own course and set itsown pace. The general philosophy is that any interventions(administering drugs or trying to hurry things along) cause more harmthan good.

In the safety and security of her own home, the mom is likely to beless inhibited about trying different labor positions and locations.She can sit on the toilet or go for a walk outside. She can eat ordrink whatever she wants. She writes her own script. When it's time todeliver, she can try whatever position she wants: on her side,squatting, sitting or kneeling.

7. Complications

Occasionally, complications occur during labor. The midwife istrained to recognize the early signs of complications and to takenecessary action. Transport to the hospital during the birthing processmay be necessary for the health of the mother or baby. To promote asmooth transition in this situation, some midwives have their pregnantmoms pre-register at a nearby hospital.

The rate of cesareans is generally very low for midwives attendinghomebirths, compared with hospital births. Part of the reason for thislow rate is the fact that most homebirths are kept low risk by goodprenatal care. Furthermore, midwives generally don't hurry the birth,which, ironically, often speeds it up. When a midwife and mother builda personal relationship, this trust helps women let go and have theirbabies more easily. Labor and childbirth are a natural process, andunless distress to the mother or baby is indicated, no one interfereswith this process through drugs, medical equipment or cesareanintervention.

8. Birth

Homebirth allows for full participation of family members. Under theguidance and assistance of the midwife, husbands or partners have anopportunity to "catch" their child as it is born. These moments can bevery powerful and transformational in the lives of the new parents.

At homebirths, babies are usually placed on the mom's stomach orbreast immediately, providing security, warmth and bonding between momand baby. In the rare case in which the baby has difficulty breathingon its own, midwives are fully trained in infant CPR. Usually, puttingthe baby right to the breast and having mom talk to her baby willencourage it to take those first breaths.

Putting the baby immediately to the breast also helps reduce anybleeding the mom may have. The sucking action stimulates the uterus andcauses it to contract. This closes off blood vessels and reducesbleeding.

After a hospital birth, things can get very busy, with bright lightsand many people carrying out procedures on the baby. This can cause ababy to shut down or shy away from people.

At home, on the other hand, there is time to be quiet, calm andpeaceful. Those first moments are sacred-baby's special bonding timewith parents. A new baby wants only love and nurturing. This earlybonding allows the baby to relax and feel secure.

The mother's milk supply usually comes on the third or fourth dayafter birth. Prior to that, the baby is drinking a substance calledcolostrum, which has many antibodies to help fight bacteria and buildup the baby's immune system. It is also rich in vitamins and protein.The midwife will offer counseling and support in getting started andcontinuing to successfully breastfeed.

Some members of the medical community have recently acknowledgedthat having a homebirth decreases the mother's and baby's chances ofcontracting an infection. The mother is used to the bacteria in her ownenvironment and has built up immunities to it. This is passed on to thebaby through the colostrum. Even when women are segregated in maternitywards, infections are much more common after hospital births thanhomebirths.

One of the benefits of homebirth is that after the birth and bondingtime, mom and baby can be tucked into their own bed to rest and sleep.The husband or partner sometimes joins them for rest and deeper bonding.

After the baby is born, the midwife is still accessible forinformation and support. This can be of great comfort during thepostpartum period when moms have questions or problems. The midwifeusually continues to check on the mother, baby and family for sixweeks, although some midwives continue to get calls for much longer.Some families and midwives form lasting friendships.

9. Resources

Many educational resources offer detailed information on birthing and homebirth. These are just a few of our favorites.

• Heartand Hands, by Elizabeth Davis, Celestial Arts, P.O. Box 7327, Berkeley, CA 94707, U.S.A.
• Midwifery Today magazine, P.O. Box 2672-350,Eugene, OR 97402, U.S. inquiries@midwiferytoday.com
• Mothering Magazine, P.O. Box 1690, Santa Fe,NM 87504, U.S.A.
• SpiritualMidwifery, by Ina May Gaskin
• Citizens for Midwifery

Jill Cohenlives in Gates, Oregon, with her husband and two of her four children.After practicing as a lay midwife for 20 years, she has now returned toschool to get a nursing degree. She has been with Midwifery Today since1990, where she is associate editor of MidwiferyToday magazine.

Editor’s Additions

• "Gracious Births," an article from MidwiferyToday, Issue 32, Winter 1994.
• "What Midwives Want From Their Clients,"an article from The Birthkit, Issue 5, Spring 1995. Must readingfor anyone considering a midwife.
• "Homebirth: What Are the Issues?" an article by Sara Wickham, MidwiferyToday, Issue 50, Summer 1999
• "Homebirth After Cesarean: The Myth and the Reality," by Amy Haas, Midwifery Today, Issue 86, Autumn 2008.

If you enjoyed this article, you'll enjoy Midwifery Today magazine!Subscribenow!

More information about homebirth:

• TheHeart and Science of Homebirth
• MidwiferyToday, Issue 50
• Midwifery Today magazine

FOR IMMEDIATE RELEASE: Monday, September 1, 2008

Number Two With a Bullet

Critical Women’s Health Issues Neglected as Physician Group Yet Again
Sets its Sites on Midwives

WASHINGTON, D.C. (September 1, 2008)—In the newest phase of its ongoing
effort to deny women the right to choose their maternity care providers
and birth settings, the American College of Obstetricians and
Gynecologists (ACOG) has announced that eliminating access to midwives
who specialize in out-of-hospital birth is now the second most
important issue on its state legislative agenda. This move puts
restricting access to trained midwives ahead of such critical issues as
contraceptive equity, ensuring access to emergency contraception, and
the prevention and treatment of perinatal HIV/AIDS.

“ACOG claims to be an advocate of women’s health and choice, but when
it comes to the right to choose to deliver your baby in the privacy of
your own home with a Certified Professional Midwife (CPM) who is
specifically trained to provide the safest care possible, ACOG’s
paternalistic colors bleed through,” said Susan M. Jenkins, Legal
Counsel for the Big Push for Midwives Campaign. “It is astonishing that
an organization that purports to be a champion of women’s healthcare
would
put a petty turf battle that affects less than one percent of the
nation’s childbearing women ahead of pressing issues that have an
impact on nearly every woman in this country. If this is not
dereliction of duty, I can’t imagine what is.”

In recent years, ACOG has led a well-financed campaign to fight
legislative reforms that would license and regulate CPMs and has now
teamed up with the American Medical Association (AMA) to promote
legislation that would prevent families from choosing to give birth at
home. Despite these joint efforts, the groups have not been successful
in defeating the groundswell of grassroots activism in support of full
access to a comprehensive range of maternity care options that meet the
needs of all families.

“Wisconsin is a good example of what ACOG and the AMA are up against,”
said Jane Crawford Peterson, CPM, Advocacy Trainer for The Big Push.
“Our bipartisan grassroots coalition of everyday people from across the
state managed to defeat the most powerful and well-financed special
interest groups in Wisconsin, all on an expenses-only budget of $3000
during a legislative session in which $47 million was spent on
lobbying. When you try to deny women the fundamental and very personal
right to choose where and how to give birth, they will get organized
and they will let their elected officials know that restrictions on
those rights cannot st
and.”

Noting these successes, ACOG has recently launched its own grassroots
organizing effort, calling on member physicians to recruit their
patients to participate in its “Who Will Deliver My Baby?” medical
liability reform campaign.

“ACOG itself admits that we’re facing a critical shortage of maternity
care providers,” said Steff Hedenkamp, Communications Coordinator for
the Big Push. “They certainly realize that medical liability reform is
nothing more than a band aid and that increasing access to midwives and
birth settings is critical to fixing our maternity care system and
ensuring that rural, low-income and uninsured women don’t fall through
the cracks. Midwives represent an essential growth segment of the U.S.
pool of maternity care providers, but instead of putting the healthcare
needs of women first, ACOG would rather devote its considerable
lobbying budget to a last-ditch attempt to protect its own bottom line.
This is not a happy Labor Day for our nation’s mothers and babies.”

The Big Push for Midwives (_http://www.TheBigPu http://www. Thehtt_
(http://www.thebigpu shformidwives. org/) ) is a
nationally coordinated campaign organized to advocate for regulation
and licensure of Certified Professional Midwives (CPMs) in all 50
states, the District of Columbia and Puerto Rico, and to push back
against the attempts of the American Medical Association and the
American College of Obstetricians and G
ynecologists to deny American
families access to safe and legal midwifery care. The campaign plays a
critical role in building a new model of U.S. maternity care delivery
at the local and regional levels, at the heart of which is the Midwives
Model of Care, based on the fact that pregnancy and birth are normal
life processes. Media inquiries: Steff Hedenkamp (816) 506-4630,
_steff@thebigpushfo rsteff@theste_ (mailto:steff@thebigpushfor midwives. org) .

#####

The Big Push for Midwives Campaign is fiscally sponsored by Sustainable
Markets Foundation, a not-for-profit organization recognized as
tax-exempt under Internal Revenue Code section 501(c)(3). The mission
of the Big Push for Midwives is to build winning, state-level advocacy
campaigns towards successful regulation and licensure of Certified
Professional Midwives (CPMs) in all 50 states, the District of
Columbia, and Puerto Rico.

Visit the Big Push for Midwives Campaign on the Web at
www.TheBigPushforMi www.TheBigP

Sustainable Markets Foundation | 80 Broad Street, Suite 1600 | New
York, NY 10004-2248

The Big Push for Midwives Campaign | 2300 M Street, N.W., Suite 800
| Washington, D.C. 20037-1434

************ **It's only a deal if it's where you want to go. Find your travel
deal here.
(http://information. travel.aol. com/deals? ncid=aoltrv00050 000000047)

[Non-text portions of this message have been removed]

“The Business of Being Born” chronicles Ricki Lake’s choice to home birth her second son in 2001. The AMA is offering up plenty of criticism about using midwives and having babies at home, versus traditional hospital births.

Ricki Lake responded to AMA’s criticism, saying, “It feels like a personal attack. I can’t imagine they are scared everyone will have a home birth because I did. The message of the film is about having all the choices in birth, it’s about getting information and being empowered. The documentary is a point of view. Home birth is not for everyone.”

The AMA supports the American College of Obstetricians and Gynecologists’ official recommendation that “the safest setting for labor, deilvery, and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex, that meets standards jointly outlined by the American Academy of Pediatrics and ACOG.”

POSITIVE STEPS FOR THE HEALTH OF OUR CHILDREN

Effective Legislation Curbs the Use of Known Toxins in Chidrens Toys and Products

    A handful of states have recently passed laws curbing the use of dangerous toxins commonly found in children's toys and other children's products.  The handy website below, developed by the Ecology Center in collaboration with the Washington Toxics Coalition, explains more. This site gives you information about toxic toys and their dangers.  And it provides a great search tool for evaluating specific toys and products that may already be in your home or that you are considering for purchase.    Click on this link to read more:    www.healthytoys.org

1. Inspect foam items and replace any with ripped covers or misshapen/breaking-down foam
2. Use a vacuum with a HEPA filter
3. Don't reupholster foam furniture in homes where children or pregnant women live  
   

The Midwife On A Mission

CBS Evening News: Can A Simple, Caring Approach Reverse The High U.S. Infant Mortality Rate?

nvironmental Health Reports

Search• RSS Feed

Toxic Baby Furniture: The Latest Case for Making Products Safe from the Start 2008-05-06 Toxic-Baby-Furniture.pdf News Release

Executive Summary

Furnishingscontaining formaldehyde – a toxic chemical linked with allergies, asthma, andcancer – can contaminate indoor air within California homes. Babies and young childrenare particularly vulnerable to harm.

To evaluate the potential dangers children face, EnvironmentCalifornia Research & Policy Centerpurchased 21 products intended for use in a baby’s nursery and hired aprofessional laboratory to test them. We found that six of the productsproduced high levels of formaldehyde vapor. In particular, several brands ofcribs and changing tables emit formaldehyde at levels linked with increasedrisk of developing allergies or asthma.

To protect children from formaldehyde and other chemicalhazards, Californiashould adopt a new approach to chemical regulation, encouraging manufacturersto design products that are safe from the start.

Many baby nursery furnishings emit formaldehyde.

• Of the products tested, the Child Craft Oak Cribemitted the largest amount of formaldehyde. The crib includes a drawer madefrom composite wood, which is often manufactured using formaldehyde-based glue.
• Other products with high formaldehyde emissionsincluded the Bridget 4-in-1 Crib by Delta, the Kayla II Changing Table byStorkcraft, the Berkley Changing Table by Jardine Enterprises, the CountryStyle Changing Table by South Shore Furniture, and the Rochester Cognac Crib byStorkcraft.
• The remaining 15 products tested – including theOlympia Single Crib by Jardine Enterprises; several wastebaskets, lamps, andshelves made with composite wood; and several window valances and wall hangings– emitted relatively low amounts of formaldehyde.

A baby sleeping in a nursery furnished with a high-emissioncrib and changing table may face an increased risk of developing allergiesand/or asthma.

• A new single-family home furnished with only aChild Craft Oak Crib and a Storkcraft Kayla II Changing Table would have indoorformaldehyde levels of about 30 ppb on average throughout the whole house. Aless spacious unit in a new apartment building would have indoor formaldehydelevels as high as 52 ppb. (See Table ES-1.) These estimates exclude anyadditional formaldehyde emissions from building materials or other pieces offurniture within the home.
• Studies have shown that chronic exposure toformaldehyde at levels greater than 16 ppb in indoor air is linked with anincreased likelihood of respiratory symptoms (such as coughing) and/or allergicsensitization in children. Indoor formaldehyde levels greater than 50 ppb havebeen associated with an increased risk of diagnosed asthma.
• Formaldehyde appears to have a large impact onchildren’s respiratory health. For example, in one study, 16 percent ofchildren in homes with formaldehyde levels less than 16 ppb had diagnosedasthma, while 44 percent had asthma in homes with indoor formaldehydeconcentrations greater than 40 ppb.
• Moreover, contamination levels could be higherclose to the source of emissions. For example, in a lightly ventilated nurseryfurnished with a Child Craft Oak Crib, formaldehyde levels could be as high as75 ppb. Formaldehyde exposure could be even higher for an infant actuallysleeping in the crib, very close to the source of emissions.

Formaldehyde exposure can cause cancer in the long term.

• The State of California and the International Agency forResearch on Cancer classify formaldehyde as a known humancarcinogen.
• Under Proposition 65, California has determined that exposure toformaldehyde at 40 micrograms per day (equivalent to an indoor concentration ofabout 2 ppb) results in a 1 in 100,000 lifetime risk of cancer. Individually,the Child Craft Oak Crib, the Bridget 4-in-1 Crib, the Kayla II Changing Table,the Berkley Changing Table, the Country Style Changing Table, and the RochesterCognac Crib each contain enough formaldehyde to contaminate an entire home withlevels of formaldehyde greater than this threshold.

Formaldehyde is just one example of how the chemicalregulatory system fails to protect children from health hazards

• Inadequate resources and legal authority oftenprevent regulatory agencies from taking protective action – even wheresignificant evidence of harm to public health already exists. For example,federal regulators first became aware of links between formaldehyde vapor andrespiratory health problems more than 30 years ago. However, stiff resistancefrom the chemical industry in the early 1980s largely thwarted new rules onformaldehyde emissions. Moreover, Californiadeclared formaldehyde to be a toxic air contaminant in 1992 – yet 16 yearspassed before the state successfully issued a regulation to limit emissionsfrom composite wood.
• In addition to formaldehyde, about 1,400chemicals on the market today have known or suspected links to cancer, birthdefects, and other health problems. And tens of thousands more have not beenadequately tested for health impacts.

To better protect children, California should reform its system ofchemical regulation through the Green Chemistry Initiative. This programshould:

• Require chemical manufacturers to prove thateach chemical they market is safe.
• Empower regulatory agencies to restrict or banthe manufacture and use of chemicals that pose potential dangers, erring on theside of protecting human health and the environment.
• Ensure public access to information on chemicalsand their uses through mandatory reporting requirements.

How We EstimatedIndoor Air Pollution Levels.

Environment California Research & Policy Centerhired Berkeley Analytical Associates, LLC to test the formaldehyde emissions ofselected baby nursery furnishings. Laboratory staff placed each product in anenvironmental chamber and measured the amount of formaldehyde vapor that thatwas released to air. We then extrapolated the results to estimate how much eachproduct would contribute to the formaldehyde air concentrations within atypical home. (For technical details, see the Methodology section on page 26.)

For Parents Seekingto Minimize Children’s Exposure to Formaldehyde

• Ask about the formaldehyde emissions offurniture and building products before you purchase and install them in yourhome.
• If such information is unavailable, avoidproducts with components made of raw medium density fiberboard or other typesof composite wood.
• Ensure adequate ventilation within your home.Maintain moderate temperatures and humidity levels.
• Place pollution-absorbing plants, such as spiderplants, Bostonferns, dwarf date palms, pot mums, or peace lilies, in your home.