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Wednesday, February 18, 2009
Midwives Deliver
Midwives deliver
America needs better birth care, and midwives can deliver it.
By Jennifer Block
December 24, 2008
Some healthcare trivia: In the United States, what is the No. 1 reason people are admitted to the hospital? Not diabetes, not heart attack, not stroke. The answer is something that isn't even a disease: childbirth.
Not only is childbirth the most common reason for a hospital stay -- more than 4 million American women give birth each year -- it costs the country far more than any other health condition. Six of the 15 most frequent hospital procedures billed to private insurers and Medicaid are maternity-related. The nation's maternity bill totaled $86 billion in 2006, nearly half of which was picked up by taxpayers. But cost hasn't translated into quality. We spend more than double per capita on childbirth than other industrialized countries, yet our rates of pre-term birth, newborn death and maternal death rank us dismally in comparison. Last month, the March of Dimes gave the country a "D" on its prematurity report card; California got a "C," but 18 other states and the District of Columbia, where 15.9% of babies are born too early, failed entirely.
The U.S. ranks 41st among industrialized nations in maternal mortality. And there are unconscionable racial disparities: African American mothers are three times more likely to die in childbirth than white mothers. In short, we are overspending and under-serving women and families. If the United States is serious about health reform, we need to begin, well, at the beginning.
The problem is not access to care; it is the care itself. As a new joint report by the Milbank Memorial Fund, the Reforming States Group and Childbirth Connection makes clear, American maternity wards are not following evidence-based best practices. They are inducing and speeding up far too many labors and reaching too quickly for the scalpel: Nearly one-third of births are now by caesarean section, more than twice what the World Health Organization has documented is a safe rate. In fact, the report found that the most common billable maternity procedures -- continuous electronic fetal monitoring, for instance -- have no clear benefit when used routinely.
The most cost-effective, health-promoting maternity care for normal, healthy women is midwife led and out of hospital. Hospitals charge from $7,000 to $16,000, depending on the type and complexity of the birth. The average birth-center fee is only $1,600 because high-tech medical intervention is rarely applied and stays are shorter. This model of care is not just cheaper; decades of medical research show that it's better. Mother and baby are more likely to have a normal, vaginal birth; less likely to experience trauma, such as a bad vaginal tear or a surgical delivery; and more likely to breast feed. In other words, less is actually more.
The Obama administration could save the country billions by overhauling the American way of birth.
Consider Washington, where a state review of licensed midwives (just 100 in practice) found that they saved the state an estimated $2.7 million over two years. One reason for the savings is that midwives prevent costly caesarean surgeries: 11.9% of midwifery patients in Wash- ington ended up with C-sections, compared with 24% of low-risk women in traditional obstetric care.
Currently, just 1% of women nationwide get midwife-led care outside a hospital setting. Imagine the savings if that number jumped to 10% or even 30%. Imagine if hospitals started promoting best practices: giving women one-on-one, continuous support, promoting movement and water immersion for pain relief, and reducing the use of labor stimulants and labor induction. The C-section rate would plummet, as would related infections, hemorrhages, neonatal intensive care admissions and deaths. And the country could save some serious cash. The joint Milbank report conservatively estimates savings of $2.5 billion a year if the caesarean rate were brought down to 15%.
To be frank, the U.S. maternity care system needs to be turned upside down. Midwives should be caring for the majority of pregnant women, and physicians should continue to handle high-risk cases, complications and emergencies. This is the division of labor, so to speak, that you find in the countries that spend less but get more.
In those countries, a persistent public health concern is a midwife shortage. In the U.S., we don't have similar regard for midwives or their model of care. Hospitals frequently shut down nurse-midwifery practices because they don't bring in enough revenue. And although certified nurse midwives are eligible providers under federal Medicaid law and mandated for reimbursement, certified professional midwives -- who are trained in out-of-hospital birth care -- are not. In several state legislatures, they are fighting simply to be licensed, legal healthcare providers. (Californians are lucky -- certified professional midwives are licensed, and Medi-Cal covers out-of-hospital birth.)
Barack Obama could be, among so many other firsts, the first birth-friendly president. How about a Midwife Corps to recruit and train the thousands of new midwives we'll need? How about federal funding to create hundreds of new birth centers? How about an ad campaign to educate women about optimal birth?
America needs better birth care, and midwives can deliver it.
Jennifer Block is the author of "Pushed: The Painful Truth About Childbirth and Modern Maternity Care."
http://www.latimes.com/news/opinion/la-oe-block24-2008dec24,0,2046506.story
America needs better birth care, and midwives can deliver it.
By Jennifer Block
December 24, 2008
Some healthcare trivia: In the United States, what is the No. 1 reason people are admitted to the hospital? Not diabetes, not heart attack, not stroke. The answer is something that isn't even a disease: childbirth.
Not only is childbirth the most common reason for a hospital stay -- more than 4 million American women give birth each year -- it costs the country far more than any other health condition. Six of the 15 most frequent hospital procedures billed to private insurers and Medicaid are maternity-related. The nation's maternity bill totaled $86 billion in 2006, nearly half of which was picked up by taxpayers. But cost hasn't translated into quality. We spend more than double per capita on childbirth than other industrialized countries, yet our rates of pre-term birth, newborn death and maternal death rank us dismally in comparison. Last month, the March of Dimes gave the country a "D" on its prematurity report card; California got a "C," but 18 other states and the District of Columbia, where 15.9% of babies are born too early, failed entirely.
The U.S. ranks 41st among industrialized nations in maternal mortality. And there are unconscionable racial disparities: African American mothers are three times more likely to die in childbirth than white mothers. In short, we are overspending and under-serving women and families. If the United States is serious about health reform, we need to begin, well, at the beginning.
The problem is not access to care; it is the care itself. As a new joint report by the Milbank Memorial Fund, the Reforming States Group and Childbirth Connection makes clear, American maternity wards are not following evidence-based best practices. They are inducing and speeding up far too many labors and reaching too quickly for the scalpel: Nearly one-third of births are now by caesarean section, more than twice what the World Health Organization has documented is a safe rate. In fact, the report found that the most common billable maternity procedures -- continuous electronic fetal monitoring, for instance -- have no clear benefit when used routinely.
The most cost-effective, health-promoting maternity care for normal, healthy women is midwife led and out of hospital. Hospitals charge from $7,000 to $16,000, depending on the type and complexity of the birth. The average birth-center fee is only $1,600 because high-tech medical intervention is rarely applied and stays are shorter. This model of care is not just cheaper; decades of medical research show that it's better. Mother and baby are more likely to have a normal, vaginal birth; less likely to experience trauma, such as a bad vaginal tear or a surgical delivery; and more likely to breast feed. In other words, less is actually more.
The Obama administration could save the country billions by overhauling the American way of birth.
Consider Washington, where a state review of licensed midwives (just 100 in practice) found that they saved the state an estimated $2.7 million over two years. One reason for the savings is that midwives prevent costly caesarean surgeries: 11.9% of midwifery patients in Wash- ington ended up with C-sections, compared with 24% of low-risk women in traditional obstetric care.
Currently, just 1% of women nationwide get midwife-led care outside a hospital setting. Imagine the savings if that number jumped to 10% or even 30%. Imagine if hospitals started promoting best practices: giving women one-on-one, continuous support, promoting movement and water immersion for pain relief, and reducing the use of labor stimulants and labor induction. The C-section rate would plummet, as would related infections, hemorrhages, neonatal intensive care admissions and deaths. And the country could save some serious cash. The joint Milbank report conservatively estimates savings of $2.5 billion a year if the caesarean rate were brought down to 15%.
To be frank, the U.S. maternity care system needs to be turned upside down. Midwives should be caring for the majority of pregnant women, and physicians should continue to handle high-risk cases, complications and emergencies. This is the division of labor, so to speak, that you find in the countries that spend less but get more.
In those countries, a persistent public health concern is a midwife shortage. In the U.S., we don't have similar regard for midwives or their model of care. Hospitals frequently shut down nurse-midwifery practices because they don't bring in enough revenue. And although certified nurse midwives are eligible providers under federal Medicaid law and mandated for reimbursement, certified professional midwives -- who are trained in out-of-hospital birth care -- are not. In several state legislatures, they are fighting simply to be licensed, legal healthcare providers. (Californians are lucky -- certified professional midwives are licensed, and Medi-Cal covers out-of-hospital birth.)
Barack Obama could be, among so many other firsts, the first birth-friendly president. How about a Midwife Corps to recruit and train the thousands of new midwives we'll need? How about federal funding to create hundreds of new birth centers? How about an ad campaign to educate women about optimal birth?
America needs better birth care, and midwives can deliver it.
Jennifer Block is the author of "Pushed: The Painful Truth About Childbirth and Modern Maternity Care."
http://www.latimes.com/news/opinion/la-oe-block24-2008dec24,0,2046506.story
Monday, February 9, 2009
Beautiful Cervix
If you are interested in what your cervix looks like than you gotta check out this website. A girl took a picture of her cervix ever day for one whole cycle and it show's all of the changes that our bodies go through,very interesting...I think that we as women need to know as much as we can about how our bodies operate and this girl has a good start. Of course view at your own discretion because these are bodily photo's... Click here to check it out!
Sunday, February 8, 2009
Obsessed or What?...
I could spend all day long reading blogs,reading websites,articles,books,magazines,or talking about anything that has to do with babies,birth or breastfeeding. All of it just intrigues me and even more so,AMAZES me. The human body,a woman's body is so fearfully and wonderfully made,made to make babies! I think the whole pregnancy/birth process is my favorite but how wonderful is a newborn baby and all that comes along with it!
Growing up I never seen myself going to college and starting some fancy career. I always knew that I was meant to grow up,get married,have babies (lot's and lot's of babies! Ok,maybe not lot's but a few) and raise a family. It wasn't until I became pregnant and had my son that I really felt inspired to go back to school and pro sue a career in the birth field. My first step in that direction is to become a Doula so that I can support woman during & after labor,get my birth fix,and also explore all of my options and decide what I want to do when I go back to school. I might end up just being a Doula and that's all or I might become even more obsessed and go full force into the world of Midwifery! I'm excited and nervous about the future!
Growing up I never seen myself going to college and starting some fancy career. I always knew that I was meant to grow up,get married,have babies (lot's and lot's of babies! Ok,maybe not lot's but a few) and raise a family. It wasn't until I became pregnant and had my son that I really felt inspired to go back to school and pro sue a career in the birth field. My first step in that direction is to become a Doula so that I can support woman during & after labor,get my birth fix,and also explore all of my options and decide what I want to do when I go back to school. I might end up just being a Doula and that's all or I might become even more obsessed and go full force into the world of Midwifery! I'm excited and nervous about the future!
Friday, February 6, 2009
Chasing My Dream
The first time that I heard the word Doula,I was only 2 months pregnant and a friend was telling me that I should hire one to assist me at the birth of my first baby.
The second time that I heard the word Doula was at my first prenatal appointment where I met my midwives for the first time and the nurse on staff, who I knew right away would make the perfect Doula for me. Throughout my pregnancy I did a a lot of research about my birth options and the more reading that I did,the more I began to realize that there was so much more to giving birth and the birth process than what I had always heard about growing up...I knew that I needed a Doula with me during my labor & delivery as an extra support person,an extra comfort measure,an extra friend,and extra set of eyes and ears. I could have never imagined that my decision to have such a person would be so wonderful. My labor & delivery was very fast,but I still cherish having my Doula with me for that short amount of time-she made all the difference for me,my husband,and my family. She has inspired me to chase after my dream of becoming the very best Doula that I can be. She has inspired me to be a support system,a comfort measure,a friend,a blessing to woman who are in the midst of the most amazing moments in their lives-bringing that very special blessing into the world!
I want to make a difference in the birth world. I want to be the voice for the women who deserve to have the very best birth possible and to know that whatever happens during that time is okay,that they were made to give birth and that they can make it the most beautiful experience of their lives.
So this blog is a place for me to write about my new journey into the world of birth,oh how I love it! I hope to find the courage to share from my heart how I feel about some current issues in the birth world,but not to prove a point to people,just to educate and help others to think with a more open mind.
I am not a Doula as of yet...I am currently saving up money to start my training to become certified,and hope be on my way sooner rather than later in this year. Please feel free to comment,suggest and chat with me here!
Happy Birthing
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