May 7, 1999
Volume 1, Issue 19
Midwifery Today E-News
“Coalition for Improving Maternity Services (CIMS)”
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In This Week's Issue:

1) Quote of the Week
2) The Art of Midwifery
3) News Flashes
4) CIMS Mission Statement
5) What is the Mother-Friendly Childbirth Initiative?
6) Mother-Friendly Childbirth Initiative
7) ACNM Annual Meeting Workshop
8) CIMS Slide Presentation
9) Ten Questions
10) Question of the Week
11) Switchboard
12) Coming E-News Themes

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1) Quote of the Week:

"Education means drawing out a person's latent capacities for understanding and living, not stuffing a passive person full of preconceived knowledge."

- Stephen Nachmanovitch in "Free Play"

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2) The Art of Midwifery

Floating and Walking
For a woman whose baby is posterior: If you have access to a swimming pool, float the woman belly down with the help of a flotation device for hours, if possible. Follow with one hour of walking. Repeat this every day for several days. The baby should turn and the mother can deliver easily.

- Midwifery Today West Coast conference Tricks of the Trade circle attendee

Keep Them Smiling
Even a forced smile releases endorphins, the body's natural pain medicine that is similar to morphine. When we are with a birthing woman who is in pain, it may help to tell some good jokes--or even some not so good ones, especially in early labor. Carry a joke book in your birth bag!

- Marianne Manely, in Midwifery Today Issue 47

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3) News Flashes

Antioxidants and Placental Calcification

A study of 1,500 pregnant women examined the effects of antioxidants beta-carotene and vitamins E and C on the calcification of placental tissue caused by smoking. The amount of daily antioxidants each woman consumed was calculated using the results of interviews with nutritionists. For each dietary unit of vitamin E there was an approximate 47 percent reduction in the risk of placental calcification. A similar trend was seen for vitamin C and beta-carotene, but this finding was limited to African-American women.

A diet rich in antioxidants may also be important for pregnant nonsmokers whose placentas may be at increased risk of damage due to pregnancy-induced high blood pressure or exposure to environmental pollutants.

- American Journal of Epidemiology, 1998; 147

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4) CIMS Mission Statement

The Coalition for Improving Maternity Services (CIMS) is a coalition of individuals and national organizations with concern for the care of and well-being of mothers, babies, and families. Our mission is to promote a wellness model of maternity care that will improve birth outcomes and substantially reduce costs. This evidence-based, mother-, baby- and family-friendly model focuses on prevention and wellness as the alternative to high-cost screening, diagnosis, and treatment programs.

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5) What is the Mother-Friendly Childbirth Initiative?

The Coalition for Improving Maternity Services (CIMS) is a collaboration of maternity service professionals including midwives, physicians, nurses, childbirth educators, labor support providers, lactation consultants, postpartum care providers and consumer advocates. In 1996, after two years of meetings, the organization produced a consensus statement regarding childbirth practices in the United States. The Mother-Friendly Childbirth Initiative (MFCI) is an evidence-based document that provides guidelines for identifying and designating mother-friendly birth sites including hospitals, birth centers and homebirth services. The initiative outlines ten steps for mother-friendly care and includes a requirement for birth sites to also qualify as baby-friendly according to World Health Organization guidelines.

The MFCI has generated interest both at a national level and abroad.
Adaptability was designed into the document, and organizations in many other countries are translating and disseminating the information or adapting it to their own needs.

CIMS is now focusing on a variety of methods for putting the MFCI to work.
For more information about CIMS, visit their website at http://www.healthy.net/cims or write them at 2120 L St., Suite 400, Washington, DC 20037; telephone number is 202-478-6138.-excerpted from Quickening, March-April 1999

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6) Mother-Friendly Childbirth Initiative (paraphrased and condensed)

Principles:

- Normalcy of the Birthing Process: Women and babies have the inherent wisdom to birth; babies are aware, sensitive human beings and should be treated as such; breastfeeding provides optimum nourishment; birth can safely take place in hospitals, birth centers and homes; midwifery model of care is the most appropriate for the majority of women.

- Empowerment: A woman's confidence and ability to give birth and care for her baby are enhanced or diminished by those who give her care and by the birth environment; a mother and baby's interconnectedness must be respected; the childbearing period is a milestone event that profoundly affects its participants and in the long run, society.

- Autonomy: Every woman should have the opportunity to: have a healthy and joyous birth experience; give birth as she wishes; have access to the full range of options for pregnancy, birth and the nurturance of her baby; receive accurate and up to date information about the benefits and risks of all procedures during the childbearing year, with the right to informed consent; receive support for making informed choices.

- Do No Harm: Interventions should not be applied routinely during the childbearing year; medical treatments should be evidence-based.

- Responsibility: Each caregiver is responsible for the quality of care given; care should be based on the needs of the mother and child; hospitals and birth centers are responsible for periodic review and evaluation based on current scientific evidence; society is responsible for ensuring access to quality maternity services for all women; individuals are ultimately responsible for making informed choices about the healthcare they and their babies receive.

(For the full version of the Initiative, check the website at http://www.healthy.net/cims Be sure to read the sidebar entitled Help Circulate This Initiative. To obtain paper copies of the Initiative, write to CIMS at 2120 L Street, Suite 1202, Washington, DC 20036 to request that a copy be mailed or faxed to you. Please include $3 US to defray costs ($4 Canada/Mexico, $5 all others).

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7) ACNM Annual Meeting Workshop

Learn more about mother-friendly care at this year's ACNM Annual Meeting in Orlando, Florida. On Saturday May 29 from 12:45 to 4:30 p.m. participants in an interactive workshop titled Making Mother Friendly Care a Reality:
Birth Professionals as Agents of Change will receive in depth education on the development of the document, the scientific evidence for each of the ten steps, options for utilization of the document in specific work settings, an overview on the dynamics of change theory and an opportunity to interact and network with other birthing professionals. The workshop will feature Peggy O'Mara, editor of Mothering magazine; midwife and author Ina May Gaskin; Joy Grohar, past president of AWHONN; Pat Turner, past president of ICEA and Mayri Sagady, current chair of CIMS. Cost of the workshop is $45. For more information or to receive a registration form, contact: Donna Haegele at dhaegele@acnm.org or call 202-728-9860.

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8) CIMS Slide Presentation

Work on the new CIMS slide presentation continues. A pilot presentation has been completed and is available for showing to interested groups. This slide presentation describes the creation and mission of CIMS, the development of the Mother-Friendly Childbirth Initiative, the philosophy behind the 10 steps, and the steps themselves, illustrating each point with powerful images. Every slide is accompanied by text (in some cases, that consists of a suggestion for silence while a particular slide is shown).
The slides are numbered to match the text. Those who present this slide show can simply read the text that goes with each slide, and/or elaborate with their own comments and perspectives. We recommend that you hand out copies of the MFCI prior to presenting this show. If you stick to the text, the show will take about 40 minutes from start to finish.

The CIMS slide show has been prepared by Robbie Davis-Floyd, Mayri Sagady, Roberta Scaer, Jan Tritten, Henci Goer, and Peggy O'Mara. Slides have been donated by all of the above, as well as by Harriet Hartigan, Rae Davies, Barbara Hotelling, Sondra Bardsley, Kip Kozlowski, and Linda Smith.

This slide presentation is proving to be a powerful educational tool. It is designed to educate childbirth groups and organizations about the MFCI, and it can also be used to educate the public about the problems with American birthways and their possible solutions.

Because the CIMS slide presentation is still in a pilot stage of
development, we ask anyone interested in showing it to gather feedback from the audience about how it might be improved, and send these suggestions to us when the slides are returned.

If you wish to present this slide show, contact Robbie Davis-Floyd, 804 Crystal Creek Drive, Austin Texas 78746 (home and office: 512-263-2212;
mobile/voice-mail: 512-426-8969;
davis-floyd@mail.utexas.edu
She will send you a notebook containing the slides and the written text that accompanies them. Since only two copies of the show exist at present, you must agree to return the copy you are sent within a week of its receipt.

Finalization of the CIMS slide presentation awaits our obtaining a few more images. If you have slides of any of the following, please send them to Robbie Davis-Floyd at the above address:

  • a woman moving around on a birth ball during labor - external fetal monitoring, clearly showing the belts and the machine (has to be recent)
  • the internal monitor either in place or being inserted
  • a childbirth education class in progress
  • gloved hands doing perineal support as head emerges (showing no or very little blood)
  • a breech birth (showing no or very little blood)
  • a vacuum extractor delivery (showing no or very little blood)
  • kangaroo care
  • a stitched episiotomy to show the results

- a circumcision in progress

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9) Ten Questions

CIMS has produced a very effective brochure entitled What to Ask When Deciding Where to Have Your Baby. It lists ten questions to ask if you are going to have a baby, and provides information about the issues the questions raise. The questions are stated in values-neutral wording to not antagonize mother-unfriendly birthing services. The text that accompanies the questions is brief and to the point, clear, and potentially very empowering. The Ten Questions are:

  1. Who can be with me during labor and birth?
  2. What happens during a normal labor and birth in your setting?
  3. How do you allow for differences in culture and beliefs?
  4. Can I walk and move around during labor?
  5. How do you make sure everything goes smoothly when my nurse, doctor, midwife or agency need to work with each other?
  6. What things do you normally do to a woman in labor?
  7. How do you help mothers stay as comfortable as they can be? Besides drugs, how do you help mothers relieve the pain of labor?
  8. What if my baby is born early or has special problems?
  9. Do you circumcise baby boys?
  10. How do you help mothers who want to breastfeed?

For a copy of the brochure together with the Mother-Friendly Childbirth Initiative, send $3 US ($4 Canada/Mexico, $5 all other) to CIMS, 2120 L St. NW, S-400, Washington, DC 20037.

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Learn more from these Midwifery Today issues:
No. 14, How to Keep Midwifery Alive and Growing (Regular price $7.00)
No. 35, Educating the Public (Regular price: $7.00)
No. 42, Autonomy (Regular price: $7.00)
No. 49, Bridging the Gap (Regular price: $12.50)
Save $1.00 on each of these back issues! Call 800-743-0974 to order today!
Mention code 940 and save $1 per issue.
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10) Question of the Week (repeated from last week): How and why do you induce labor? Send your response to: mtensubmit@midwiferytoday.com

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Missouri Birth Center needs help! Looking for CNM willing to work part time working into full time. Rural practice, full scope, benefits available. Great schools, recreation includes lakes and outdoors to local music, crafts, and Branson entertainment. Call Diane Barnes, 417 272-8845 office, 417-338-5431 home.

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11) Switchboard

I have enjoyed your magazine for about 3 years. I subscribed to E-News a month ago and want to tell you how much I enjoy it. It is a great way to keep current and I look forward to it each week!

A special thanks to Jill Cohen for her commentary on apprenticeship [Issue 17]. As a student, it was helpful to be reminded to take things slowly and one step at a time. Too often I find myself looking at how much I don't yet know and becoming overwhelmed. Thanks Jill!

In the same issue, Jan Tritten mentioned that many women suffer from post traumatic shock syndrome after birth. Having recently heard about a women who appeared to be in shock for several days after giving birth in a local hospital, I had a couple of questions:

  • Is post traumatic shock the same as post traumatic stress disorder?
  • Would standard trauma debriefing procedures be beneficial to these moms?
  • Any recommendations for further reading to learn more about signs, symptoms and care for women suffering from post traumatic shock?

Lastly, I noticed that drugs in labor will be a topic in the near future. I recently read the articles on cytotec inductions in Midwifery Today Issue 49, and have also seen this mentioned elsewhere recently. I was curious if there is any information available on possible side effects on the baby both during labor and after the birth.

- Per Wilson

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I put every issue of E-News in a large 3-ring binder I call my Childbirth Binder. Then others can look at my information. I am in the process of getting certified as a childbirth educator with a non-profit Christian organization called Apple Tree Ministries. I like that one of the main messages of the program is that God meant for childbirth to be a blessing, not a curse! In two of their books, Bible passages concerning "pains" in childbirth are discussed. One soon sees that the word has been misinterpreted through the years (and cultures). It was wonderful for me, as a mom with a horrible hospital birth experience, to know giving birth did not have to be an experience to dread, but instead look forward to.

I'm also writing because I have been reading some of the readers' replies and I have some resources that might be helpful for anyone who might be interested. I have viewed two videotapes of a presentation given by a doctor of chiropractic named Carol Philips. She specializes in the entire birth process and breastfeeding, etc. Included is incredible information concerning, among other things, bedrest, back labor, labor that doesn't progress, heartburn, and sciatica. She shows many other things a partner or midwife can do for the pregnant or laboring woman. If readers want further information, email me at tinkyl@excite.com

- Tina Zimmermann, Marshfield, Wisconsin

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I am presently a nursing student in Canada. My career path is to work with pregnant mothers, births and postnatal care. Can anyone suggest midwife or nurse-midwife schools in the United States, particularly in Oregon? I am also an American citizen. Any feedback would be helpful in determining exactly how my future career path will be accomplished.

- Samantha Gorrell, University of Victoria nursing student

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Thinking about becoming a midwife? PATHS TO BECOMING A MIDWIFE: GETTING AN EDUCATION is the book for you!
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12) Coming E-News Themes

Coming issues of Midwifery Today E-News will carry the following themes. You are enthusiastically invited to write articles, make comments, tell stories, send techniques, ask questions, write letters or news items related to these themes:

- drugs in labor (May 14)
- premature rupture of membranes (May 21)
- doulas (May 28)
- induction (June 4)
- educating the public (June 11)
- Group B Strep (July 9)
- episiotomy
- epidurals
- breastfeeding
- waterbirth
- breech birth
- nutrition
- homebirth

We look forward to hearing from you very soon! Send your submissions to mtensubmit@midwiferytoday.com. Some themes will be duplicated over time, so your submission may be filed for later use.


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This publication is presented by Midwifery Today, Inc., for the sole purpose of disseminating general health information for public benefit. The information contained in or provided through this publication is intended for general consumer understanding and education only and is not intended to be, and is not provided as, a substitute for professional medical advice, diagnosis or treatment.

Midwifery Today, Inc., does not assume liability for the use of this information in any jurisdiction or for the contents of any external Internet sites referenced, nor does it endorse any commercial product or service mentioned or advertised in this publication. Always seek the advice of your midwife, physician, nurse or other qualified health care provider before you undergo any treatment or for answers to any questions you may have regarding any medical condition.

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