Labor Repose

Labor Repose
LaborPayne during her 6th homebirth (9th baby) at age 44

Tuesday, March 15, 2011

CIMS- Day Two

Day two of CIMS started with a session titled, "Building a Woman and Family Centered Medical Home" I was enthralled by this presentation given by Warren Newton MD and Adam Zolotor MD, two family physicians offering evidence-based, humanized care with a practice model that most midwives would find enviable. They described a practice that included a midwife/lactation consultant, a second nurse practitioner, a social worker and a centering prenatal model. They provided ample proof of why we need more primary care physicians and fewer specialists.

Michele Laura MD, presented on the consequences of Near Term Birth. I can't get enough of this topic. It is so critical to get the word out that near term is not term. These babies look fine but they aren't fine. Healthcare consumers need to know the true risks of medically induced preterm delivery. The talk was followed by the viewing of a video created to warn moms of the risks of preterm delivery. I thought great, here is a teaching tool I can use. The video was well made but left me with an uneasy feeling. It featured two moms who went into preterm labor through no fault of their own, who ended up with babies in the NICU. This is not quite the same as moms electing induction without a medical reason. It felt a little preachy to hear on OB telling women to stay pregnant for at least 39 week (why not 40?) especially since physicians started this whole thing by selling women on inductions and making them think there were little to no risks involved. You can view it and judge for yourself: Even with my reservations, this might be an adequate tool for those trying to stem the tide of social inductions. We have to start somewhere.

The next session was one I had been waiting for: Michigan Health and Hospital Association's Keystone OB by Morgan Martin, and Tami Michele, DO. The Keystone project is an obstetrics collaborative piloted in 16 hospitals in Michigan intiated by physicians to prevent preterm birth, lower c/s rates, introduce low dose pit, and other measures of decreased perinatal morbidity. I love physician driven models as they appear to be the ones that work. Since this model of practice change is initiated by physician champions and backed by administrative policy changes, it presents some real hope to the problem of harmful obstetrical practices. Tami Michele is a midwife in physician's clothing and a hero to our cause. She used to practice here in my city but relocated to her home state: our loss is Michigan's gain...

I was excited to hear Robbie Davis Floyd's presentation on MotherBaby Childbirth Initiative (IMBCI) in which she described her upcoming demonstration projects in Quebec, Brazil, Austia, and Mozambique to introduce mother-friendly concepts into current practice. Robbie never disappoints.

Representations of breastfeeding was an interesting presentation featured three mini presentations on how long term breastfeeding and breastfeeding of older children has been featured in the media, the public perception of lactation consultants, and replacing negative frameworks with positive ones. All very interesting stuff and good food for thought.

Saturday, March 12, 2011

CIMS- Day One

Yesterday was the first full day of the Coalition to Improve Maternity Services conference, here in Chapel Hill North Carolina. This is my first CIMS conference. I was recently elected to become a member of CIMS Leadership Team. I am honored to sit among such esteemed grey heads and not so grey heads of the movement as Michelle Kendell, Barbara Hotelling, Tami Michele, Victoria Macioce-Stumpf and Ruth Wilf. We had a day of board meetings on Thursday followed by a birthday party for Ruth Wilf to celebrate her 80th birthday! (That does it, I'm staying young and vibrant by keeping active and involved in my work- Ruth is my model for aging well. At 80 she is vibrant and engaging and shows no signs of slowing down. She still works as a midwife!) Last night I enjoyed a lovely Thai dinner with Robbie Davis Floyd, author of 'Birth as an American Right of Passage' and many other anthropological books on birth and midwifery. Its been great rubbing elbows with leaders in the field of maternal infant health and lactation advocacy.

For those who are unfamiliar with CIMS, it is a coalition of MCH groups that work toward the standard of 'mother-friendly' care here in the United States and abroad. If you don't know what that is, pop over to the website and check it out at This is the standard of care for childbearing women that we all should be striving towards. It will serve as the undergirding philosophy of care in my own birth center some day.

Yesterday I attended the following workshops:

Eugene Declercq, PhD, MBA, Professor and Assistant Dean for Doctoral Education, Boston University
Dr. Declercq spoke about improvements in maternity care initiatives over the past year. He talked a lot about all the good things happening with lactation and how we can apply some of the things the breastfeeding folks have done to maternity care. He spoke of the importance of having a unified message and being united among all our groups. He presented lots of research findings such as the uptick in homebirths, the decrease in VBACs, the increase in cesareans, and how childbirth is invisible in public policy. Overall, his presentation gave us some good news, some bad news, some ideas for improvement, and the importance of engagement- a good overall view and a nice start to the conference.

Lori Dorfman, DrPH, Director of Berkeley Media Studies Group
Dr. Dorfman spoke on how breastfeeding is currently framed and how those frames limit conceptions of what needs to change in soiciety to support breastfeeding. She basically says that telling women about the health benefits of lactation won't increase rates, but rather we need to systematically remove barriers that in hospitals, home, work, school, indeed in society that keep women from being succesful in lactation continuing for as long as they wish. She also framed lactation as a health equity problem. This lady was so right on. Her talk made me proud of my work on my local health commission where we tackle these exact types of barriers within healthcare systems and on a policy making level within city government.

Danielle Riggs and Bettina Lauf Forbes, from Best for Babes spoke on giving breastfeeding a makeover and showed examples and images from their breastfeeding PR campaign to make lactation more socially acceptable. They had some interesting ideas. I'm not sure if this is the makeover lactation is looking for or not. (Very slick, polished, model thin, body beautiful images, and slogans all nicely done, but appear to me to add to myths and misconceptions about women's bodies.) However all great deal of thier campaign is dedicated to many things Dr. Dorfman spoke about in removing institutional barriers which they call, 'beating the booby traps.' Check it out and decide for yourself at

Barbara Morrison, RN, CNM, FNP, PhD Professor, Frances payne Bolton School of Nursing, Case Western Reserve University- Kangaroo Care for all and all for Kangaroo Care
Barb did a great job standing in for Susan Ludington when she discussed the benefits of skin to skin for term babies. I actually bumped into Barb the day before the conference when we rode in on the same airport shuttle. We discussed all things skin to skin (to the chagrin of our driver, I'm sure.) This was an informative session especially since folks tend to link Kangaroo Care with preemie care.

Geredine Simkins, CNM, MSN, President Midwives Alliance of North America
What Matters to Women, Matters to Midwives
This session was such a treat! We got a sneak peak at a soon to be published anthology published by one of my favorite people in the birth movement. This book is a collection of stories from 25 seasoned midwives. If the standing ovation Gera received at the end of her talk is any indication, this is going to be a fantastic read. Written in beautiful prose, Gera weaves the stories through such themes as courage, compassion, activism, and self-determination. Order an advance copy (like I intend to) at

Hot Topics: Turning it Around
This session was a hodge podge of new developments in maternity care advocacy. Topics included legislative efforts for MOMS for the 21st Century Act homebirth promotion at the state level via the MAMA (Mother and Midwives in Action) campaign We heard from Choices in Childbirth and The Big Push for Midwives

All in all this was a jam-packed day with so much good information I could hardly process it all. I so wanted to sneak away for an hour's nap but each session just seemed so tempting to pass up.