On Mon, Dec 8, 2014 at 5:31 PM, PushGirl #2,135 wrote:

"This study–published in Pediatrics Jan 2015–looked at 2 million kids, and found that children delivered by cesarean delivery had significantly increased risk of asthma, systemic connective tissue disorders, juvenile arthritis, inflammatory bowel disease, immune deficiencies, and leukemia.

"I’d call that some evidence."

On Tue, Dec 9, 2014 at 6:52 PM, PushGirl #4,933 wrote:

"Why isn't this in the news...?"

Birth activists were all pretty happy this week reading about the new U.K. National Health Service NICE guidelines recommending birth at home with a midwife, or in a midwife-unit for first-time mothers. (And again when seeing the ripple headlines here and here and here.)

"The UK gets it right," we posted on The Big Push for Midwives Campaign Facebook page. But, positive as this development may be, it is clear it will take far more than British sanity about birth for US policymakers or the US maternity care system to likewise "get it right" or even to "get it."

As one commenter quickly noted, opponents will quickly hog-tie the new UK policy to British midwifery education, or the integration of home and hospital in that country ... the usual rhetorical smoke-and-mirror tricks used to deflect attention from the fact that US home birth midwives, CPMs, are experts in out-of-hospital care, the gold standard, educated specifically to excel as providers of home and other out-of-hospital maternity care. The casual reader, who does not yet know those facts about CPMs, will then fail to realize that the NICE recommendations hold true also for American women who, like their British sisters, are female mammals (smoke and mirrors be damned).

The good news is that The New York Times journalists saw instantly the real basis for the differences in care between the US and the UK. Read it here. Notice, in the 11th paragraph, right after the obligatory recitation of ACOG's standard rote objection to home birth ("we do not believe" home birth is safe), the article points out:

"If such a recommendation were made in the United States, doctors might worry about losing patients to midwives."

There it is, folks, in a nutshell, laid right out in the open.

The New York Times gets it, it understands that ACOG's opposition to home birth isn't really about safety, or education, or models or care, or liking CNMs better. It is all about competition, losing patients to another type of provider, about money. '

The article continues: "That concern is absent in Britain's taxpayer-funded system. There are no financial incentives in the U.K. for doctors to deliver in a particular setting (that is, hospitals) because there is no personal gain."

Shazam. It is thrilling to read that in (news) print! Yes, the percentage of home births in the US is relatively low, but for heaven's sake, it increased by 29% from 1990 to 2009, and it has continued to rise in an upward trajectory. Consumer choice is a powerful thing.

'ACOG and the hospitals can read these reports too, and they understand the implications for their bottom lines. When MacDorman, Mathews, and Declercq write, in their 2014 Data Brief on 2012 place-of-birth data exactly what those implications are: "If this increase continues, it has the potential to affect facility usage, clinician training, as well as resource allocation," the OBs and hospitals know what is being written on the wall – and we do too.

Add to that the intriguing responses regarding future birth sites provided by the representative sample of women who had given birth in a hospital in 2012-2013 and who responded to Childbirth Connection's 2013 Listening to Mothers III: New Mothers Speak Out Surveys and Reports. Asked how open she might be to a future birth at home, an amazing 11% indicated that they would definitely want to give birth at home, while another 18% said they would consider a home birth. Likewise, 25% of survey participants would definitely want to use a freestanding birth center! Another 39% said they would consider a birth center.

This is huge, friends.

At the present time, the statistics gathered and published by Childbirth Connection reveal that, in 2012, 23% of all hospitalizations were for childbirth and newborn care, and that maternity care is the "single most common" cause for hospitalization in the US.

So, if one owned a hospital, or if one medically managed all of one's patient deliveries at a hospital, how would one feel about handing off 10% or 25% of those families to midwives and birth centers? And not in some distant 20-years-from-now future, but as soon as those Mothers stop speaking out long enough to get pregnant again? Well, if present-day monopolies are any indicator, one would fight tooth and nail to maintain one's market share of the $111 billion one billed for maternity care facility charges alone in 2010.

"First they ignore you, then they laugh at you, then they fight you, then you win."  

~Mahatma Ghandi

Many birth activists understand that the out-of-hospital birth movement in the US is in the next-to-last stage of this lifecycle. "They" are fighting against sanity, reality, and consumer choice. Hard. And when their junk science isn't sticking, they are trotting out the bigwigs at ACNM and ACOG shouting that CPMs need more education in more structured institutions, because those bigwigs have a very long history of taking away existing traditional educational paths and intentionally closing off and slowing down production of their competition (King Bigwig himself Abraham Flexner did it exceedingly well in 1914).

Sadly, it gets even worse when "they" sense the ship isn't sailing solely in their $111 billion direction. Bigwigs like those of Delaware ACOG come out from the bowels of the boat with last-ditch, cut-throat tactics to snatch away legislative victory from mothers and families fighting for increased access to CPMs and more out-of-hospital birth options. And when they slink back below deck, Lady Justice rightly asks why do "they" do it? Are "they" truly concerned for patient safety, or only about throwing all the midwife competitors overboard (or nearly as bad, down into the physician-oversight slave galleys)?

As the Listening to Mothers III: New Mothers Speak Out and the latest CDC Data Brief tell the story, The Big Push for Midwives Campaign (and the whole PushNation) is getting the message across. Women are hearing the true facts, and informing and educating themselves. They are beginning to make new choices.

Dearest birth activists, amazing Pushers, and Salty Dogs, we are all seaworthy!

Don't give up the fight now and don't reach uncomfortable compromises.

Do not even be discouraged, all hands on deck!

We are in the fighting stage to turn this battleship around, and the data point toward the absolute bearing of our winning.

Thank you SO much all you amazing Pushers fighting to remove barriers that deny mothers, babies, and families access to high-quality, safe, and cost-effective midwifery care and increased access to Certified Professional Midwives (CPMs), who specialize in out-of-hospital maternity care. http://j.mp/BigPushTY2014

The federal Centers for Medicare and Medicaid Services (CMS) released on April 9 the Medicare billing information for physician providers after decades of litigation by the American Medical Association (AMA) seeking to block the release. [http://www.reuters.com/article/2014/04/09/us-usa-medicare-data-idUSBREA3809H20140409] Some of the dollar figures for federal moneys paid to individual physicians have been shocking, but those of us who have studied the economics of maternity care should not be surprised. It is basic economics that markets in which consumer access to information is blocked, and also where real competition has been suppressed, will be characterized by high prices.

The Big Push for Midwives Campaign supports the release of provider billing information because it benefits women and their families. Consumers should have access to information that could affect decisions about their healthcare, including the choice of provider and the cost of a provider's services. An informed public is better equipped to exercise not only health care choices, but also political speech, especially now that private health plans are required to provide maternity coverage. This kind of data educates both citizens and policymakers about the direct and indirect costs related to healthcare and allows better informed decision making.

Why did the AMA fight to suppress this information for so long? The assumption that consumers are ignorant and need to be protected from information goes back to early American court cases from the 1700s. Back then even physicians did not understand what diseases were and how they spread. Most people could not read and had very limited education. Even if they could read, the information was stuck in books in far-off universities. This remained true even during much of the last century.

Today, most people can read and have access medical and health care information on the internet. They could have had access to this cost-related information if the AMA had not impeded access. Women and their families should have access to whatever information they need that could affect their health care decisions, including relative costs, so they can make intelligent decisions based on the evidence.

The heart of midwifery is educating women and their families so that they make informed decisions instead of keeping them ignorant and dependent on providers. Releasing information like this is a good first step. We need to make this information user-friendly and to educate both citizens and policymakers to compare many factors – costs, outcomes, consumer satisfaction – so they can understand and use the information effectively. Consumers need this information for health care decision, and policy makers should be looking at and comparing what the federal government pays for physician services versus the services of other health professionals, such as midwives.

For those playing along at home, as soon as The Big Push for Midwives announced the "Largest US Study to Date Finds Home Birth to Be a Safe Option for Most Women" based on newly released research (here and here), Big Medicine played a card from its dark deck.

Goliath reached up its sleeve to flip the Ace of Scaremongering at millions of mothers, families, and babies across the US, in its desperate attempt to try to shut/shout down the truth, citing numbers that are neither published nor peer reviewed, and based on birth certificate data.

The good news is that the truth about the safety of out-of-hospital birth as published in the Journal of Midwifery & Women's Health is still available even if Goliath is teetering from the stone that hit his exposed forehead.

While it is beyond pathetic to see the turf war that Big Medicine continues is waging, it is sadly not surprising. Goliath doesn't seem to care that:

• Rural, uninsured, and underinsured women need more maternity care options.
• States need to remove barriers that deny mothers, families, and babies access to high-quality, safe, and cost-effective midwifery care.
• The US needs to get it in gear to significantly reduce rates of prematurity and low-birth weigh that are critical to reducing racial and economic disparities in birth outcomes, and reducing unnecessary costs to our health care system.
• The US has one of the highest rates of both infant and maternal death among industrialized countries, and frankly, the US maternity care system is broken. Maternal and fetal mortality rates are worse than 40 other countries worldwide, and we spend more money than anyone else on maternity care. Where is almost all that care being delivered? The answer Goliath doesn't want you to see through his 30%-c-section-tinted glasses is HOSPITALS. 

Big Medicine is NOT doing so great at birth in America, and Big Medicine's problem with out-of-hospital birth is not that it isn't safe. Rather, it's that it is a safe option for most women and thus presents a threat to the Big Medicine status quo and the trade associations and state medical societies who control it. Goliath is deeply dependent on maintaining the status quo … so dependent that Big Medicine will sometimes tell bald-faced lies about out-of-hospital birth research on national television and in other media outlets and hope that no one notices. Here are some other sensible voices on the matter:

• Here's an impressive statement from the American College of Nurse Midwives (ACNM)
• Here's a piece where Missy Cheyney refutes these new scaremongering numbers.
• Here's an item that points out more on the flaws in birth certificate data.
• Here's the response of the Reddit community to a recent diatribe from Big Medicine's biggest shill.
• Here's a commentary by sociologist Barbara Katz Rothman on "Home Birth In a Risk Society."
• Here's a Facebook post by Rebecca Dekker, PhD, RN, APRN of EvidenceBasedBirth.com.
• Here's a Throwback Thursday treat by Wendy Gordon, CPM, LM, MPH, MANA Division of Research, Assistant Professor, Bastyr University Dept of Midwifery in Science & Sensibility.
• Here's another Throwback Thursday treat by Miriam Pérez of radicaldoula.com published in RH Reality Check.

Here at The Big Push for Midwives, we are ALL IN to knocking Goliath down. The powerful and strong are not always what they seem. David had only a stone and a slingshot to bring down the greatest warrior of his time. The Big Push has only the truth, courage, faith, and the amazing grassroots uprising of the PushStates who fight the good fight every day from where they are with what they have. To see more on these dueling studies, visit the PushHeadlines page today.

Submit your question to the Big Push.

QUESTION #1: The American Medical Association (AMA) (along with other doctor trade organizations) has taken a stance diametrically opposed to home birth and Certified Professional Midwives (CPMs). Activist midwives and consumers who are involved in statewide legislative efforts across the US have cited the AMA's stance as a main motivator in their activism: they want to get legislation passed before the anti home birth lobby can. To what degree is the Big Push for Midwives a reaction to the stance of the AMA and other doctor's groups at the state and national levels?

ANSWER: When it comes to Resolutions the AMA passes in opposition to home birth, these are adopted in response to the growing success of the grassroots movement in support of expanding access to Certified Professional Midwives and out-of-hospital maternity care. Since midwifery activists began organizing across states in 2005—an effort that culminated in the launch of the Big Push for Midwives Campaign in 2007—UT, VA, WI, MO, ME, ID, and IN passed laws authorizing legal practice for Certified Professional Midwives, while bills that had been effectively dead for many years in states such as IL, NC, MA, AL, SD, and AL suddenly began to make significant progress.

Once such item, Resolution 205, was brought to the AMA on behalf of the American College of Obstetricians and Gynecologists (ACOG), which had issued alerts to its members about the Big Push’s legislative successes and the need to increase the resources dedicated to fighting CPM legislation (these alerts are titled "ACOG 2007 Midwifery Year In Review" and "ACOG 2008 Midwifery Year In Review").

So clearly they are concerned about the progress we’ve been making and they've made defeating our bills their second most urgent state legislative priority, ahead of issues such as medical liability reform, access to contraception, and reducing perinatal HIV.

Another such item, Resolution 814, sought to limit the scope of practice for allied health care providers, though it predates the Big Push and doesn't specifically mention Certified Professional Midwives (which physician groups love to try to malign by using the oxymoron, "lay midwives"), it was brought to the table by the Texas Association of Anesthesiologists, which had fought quite forcefully, though unsuccessfully, to repeal their state law authorizing CPMs to practice. (If you're interested in learning more about that battle, we can put you in touch with the lobbyist who helped the Texas midwives defeat the TAA, but it’s a safe bet that it was one of the primary catalysts for Resolution 814.)

..so let's say we get out there and do more in 2014

There's still time to donate

We're getting close to our target goal to help keep on the lights here in 2014 at The Big Push for Midwives with the New Year here upon us. On Friday, Jan. 24, 2014, we will celebrate our 6th PushDay and another trip around the sun aimed at expanding access to Certified Professional Midwives and out-of-hospital maternity care. But CPMs and the families who choose them still need your help! Let's make this year's goal. If you've been meaning to make a contribution, now's the time.

What Have You Done for Me Lately:
The Big Push 2013 Roundup

To help push harder in 2014, the Big Push for Midwives Campaign doubled down just lately to gather resources, provide strategic planning and message development, outreach proactively with news media, and create new tools and helpful services for state consumer and midwife groups that are actively working on legislation to license CPMs, envisioning the day when CPMs are licensed in all 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, and Guam.

2013 saw the Big Push lose and regain its PushMediaMachine powered by Vocus and the Big Push Steering Committee. From the early days on the campaign in 2007 and 2008 to the headlines we see in the media today, there is so much to be grateful for across the good PushNation of tens of thousands of people. If you are left wanting for more:

• Review the latest PushHeadlines.
• See all the news that's fit to push in the Newsroom.
• Get inspired by just how much your donation means.

The Big Push for Midwives Campaign is not a top-down organization, rather, the essence of grassroots. The Big Push has always been the work of a coalition of the PushStates groups, and the collective focus has always been to create a mutual-help project for all the consumers and midwives pushing in the statehouses and sharing ideas, strategies, successes, and setbacks to create efficiencies and interconnectivity.

Thank you!

We really can't say it enough - so we'll say it again here. Thank you. We have the best group of members and supporters that we could ask for, and it's because of you that we have been able to keep going.

How far do we have to go?

We're just 50 monthly donors (at $10/mo) away from hitting our goal and ringing the bell on making our 2014 target goal - but why stop there? Let's see if we can beat our record. In addition to donations, we could use your help spreading the word to your friends and family (and clients if you are a professional) to expand the circle of the birth activist community.

In commemoration of Labor Day 2013, The Big Push for Midwives Campaign has launched the Honor Your Midwife for Labor Day fundraising project, which will give thousands of families across the United States the opportunity to honor their midwife and support our media campaign to raise public awareness about the benefits of midwives and out-of-hospital maternity care.

Your tax-deductible donations will go directly to reserving a space on the Honor Your Midwife for Labor Day wall on The Big Push for Midwives Campaign website, where you can express your appreciation and gratitude for your midwife.

In addition to honoring the midwives working to preserve birth options for families seeking an alternative to hospital birth, Honor Your Midwife for Labor Day will fund the technological and professional resources needed to support The Big Push for Midwives Public Relations and Social Media team. We are the only national organization providing professionally developed, proactive and pro-midwife Public Relations and Media Relations services, including customized media lists, to states with active grassroots campaigns in support of expanding access to midwives and out-of-hospital maternity care.

The Big Push for Midwives Campaign's professional communications team has a proven track record of honoring the midwifery profession by placing positive stories about the many benefits associated with midwives and out-of-hospital maternity care in local, state, national, and international media outlets.

The sad truth is that midwives rarely get the honor they deserve for providing families with the full range of birth options, improving birth outcomes, and saving millions of dollars in health care costs each year. The Honor Your Midwife for Labor Day gives people the opportunity to both honor their midwife at the personal level and support the campaign to honor the profession of midwifery itself at a much broader level, through the media, and slowly change the many negative cultural attitudes about birth.

Please donate and help spread the word to raise public awareness of the personal, social, and economic benefits associated with midwives and out-of-hospital maternity care and fight back against anti-midwife, anti-home birth propaganda that continues to find its way into the media.

At its November 2005 Interim Meeting, the American Medical Association (AMA) House of Delegates adopted Resolution 814 titled, “Limited Licensure Health Care Provider Training and Certification Standards.” The resolution states:

RESOLVED, That our AMA, through the Scope of Practice Partnership, immediately embark on a campaign to identify and have elected or appointed to state medical boards physicians (MDs or DOs) who are committed to asserting and exercising their full authority to regulate the practice of medicine by all persons within a state notwithstanding efforts by boards of nursing or other entities that seek to unilaterally redefine their scope of practice into areas that are true medical practice. (Directive to Take Action)

Resolution 814 emerged from the Scope of Practice Partnership (SOPP), which was formed by the leadership of the AMA and other physician trade organizations to obstruct expansion and to restrict the licensed scope of practice of other healthcare professionals. These actions by organized medicine limit access to providers who have the education, expertise and experience to offer safe, quality health care services to the public, particularly for rural, uninsured and other underserved populations.

The Big Push for Midwives Campaign objects to the misleading and divisive language used in the AMA SOPP resolution, which needlessly pits medical doctors against other healthcare professionals at a time when the American public is faced with unprecedented healthcare shortages and millions of uninsured children and adults. The healthcare professionals that have been targeted by SOPP, which include nurse practitioners, physician assistants, podiatrists, optometrists, psychologists, chiropractors, and midwives, are the solution to this crisis, not the problem. The erroneous claim that SOPP can or should determine what is best for the patients of other healthcare professionals represents an outdated and patronizing line of thinking that cannot possibly serve the needs of today's patients—particularly childbearing women and their babies. Therefore, The Big Push for Midwives opposes SOPP and its efforts to restrict the scope of practice of our allied healthcare partners and to obstruct legislative initiatives that would increase access to licensed Certified Professional Midwives.

Father Knows Best Meets Big Brother Is Watching:

"The SOPP also is overseeing the completion of the AMA Scope of Practice Data Series, a compendium of information and resources for medical associations on 10 non-physician providers, and the creation of a geographic mapping tool that will allow Federation partners the ability to map, on a state-by-state basis and by specialty, the practice location of not only allopathic and osteopathic physicians but also various non-physician providers."

"From the President" by Ronald M. Davis, MD http://elephantcircle.net/?p=429

Following this AMA directive, several state medical boards have targeted more than a dozen midwives in states where CPM licensure is not yet available, leaving hundreds of pregnant women without care.  

The Big Push for Midwives collaborated with the California Families for Access to Midwives (CFAM) to get out this latest news release in California. CFAM is a social justice organization dedicated to removing barriers that deny California citizens access to licensed midwife care.

It looks like the "Free Our Midwives!" rally on July 1 at the Capitol in Sacramento, CA, was a great success, with 375 parents, babies, and midwife supporters converging on the Capitol in support of efforts to remove from California law a repressive and outdated provision that is threatening the future of legal midwifery in California, and perpetuating racial and economic disparities in birth outcomes.

Assemblywoman Susan A. Bonilla told the crowd at the rally that "You have made an impact here today." In addition, Assemblywoman Bonilla did two important things to help remove physician supervision:

1. She removed language from the bill (AB1308) that restated and outlined a plan for implementing California’s famously ill-conceived and unobtainable requirement of physician supervision of licensed midwives.
2. She also verbally committed to amending the existing law to take physician supervision completely off the books. PLEASE THANK HER (using old fashioned pen and paper! No calls for now!) for her support.

Resulting PushHeadlines:

• The Modesto Bee  |  July 8, 2013
• The Sacramento Bee (photo gallery)  |  July 8, 2013
• Point Reyes Light  | July 3, 2013
• LAFamily.com  |  June 2013