Urgent Notice for TEXAS students and midwives:

Written by Beth Overton

Monday a letter to Texas Midwives and some proposed rules were posted on the Texas Midwifery Board's website. These proposed new rules are specifically for the regulation of students and preceptors in Texas. Please go to the Midwifery Board website athttp://www.dshs.state.tx.us/midwife/mw_new.shtm to read this information.

Personally, I don't have a problem with why new rules are being proposed but I do have problems with the exact wording they are proposing for these new rules. I'd like to share my observations and comments with you because if my observations are correct, it will be very important for the State of Texas to hear from a lot more people than just me about the concerns.

My comments are below. Please refer to the documents on the Midwifery Board website as needed.

I would welcome a list discussion on this topic but I'm not sure if everyone would welcome that since it about Texas only. So, if anyone would prefer to discuss this with me in more detail off list, please feel free to write me personally.

Sincerely,
Beth Overton, CPM
Corpus Christi, TX

PS These comments may be difficult to read if don't receive your email in html and therefore can't see the formatting. Please let me know you need me to send them as an attachment and I will be glad to do so.

My Comments ....

6. An apprentice/student is practicing midwifery without a license when s/he:

a. Exceeds the limits of practice set by his/her supervisor

b. Advertises themselves as a midwife unless they advertise as an apprentice/student midwife with the approval of the supervising midwife. The advertisement must include the name of the supervising midwife.

c. Accept a fee for midwifery services from a client.

d. Have their own clients.

The wording of this point alternates in form between the singular and the plural. The introductory clause is cast in the singular, "An apprentice student...s/he". Sub-point 6.a. follows the singular form: "Exceeds...his/her..." Thereafter, the grammatical form is plural: 6.b. "themselves...they"; 6.c. "Accept"; 6.d. "their".

Sub-point 6.d. needs clarification. I would propose the following change for this sub-point:

6. An apprentice/student is practicing midwifery without a license when s/he:

d. Have their own clients. . has a client of her own that is not also under the care of a supervising midwife.

Explanation:

I believe it is vital for all midwifery students to have the experience of acting as primary care providers for a few clients while they are under the appropriate supervision of their preceptors. This gives apprentices a much better opportunity to develop the skills necessary to think for themselves and figure out the individual needs of individual clients.

Just as doctors work as interns, I believe that student midwives should be given the opportunity to work under supervision as a primary care provider for clients as a part of their training. Without this kind of experience we risk releasing new midwives to work on their own who lack the ability to think like a primary care provider because they were not allowed to do so during their training.

NARM recognizes the value of this kind of experience. That is why they require it as a part of the PEP process. One of the requirements for the PEP process is “A minimum of three (3) births with women for whom you have provided primary care during at least four (4) prenatal visits, birth, newborn exam, and one (1) postpartum exam.”

Please reword 6. d. so that it does not prohibit students from using the PEP process and so that it does not hinder all students from having experience working as primary care providers while still under supervision.

10. If a complaint is filed against a supervising midwife with the Texas Midwifery Board or any other professional, licensing, or certification board or agency related to midwifery, the supervising midwife shall immediately inform each of his/her apprentices/students in any course in which the students are enrolled in writing of the following information:

a. the nature of the complaint filed against him/her;

b. the name, address and phone number of the Texas Midwifery Board or the other professional, licensing, or certification board or agency; and

c. the nature of any action proposed and/or taken against him/her as a result of the complaint.

I have problems with #10 as it is written. Therefore, I would like to propose the following revisions which I have also divided into two points instead of one:

10. If a complaint is filed against a supervising midwife with the Texas Midwifery Board or any other professional, licensing, or certification board or agency related to midwifery, and if the complaint originated from patient care in which a student was directly involved, the supervising midwife shall immediately inform in writing each of his/her apprentices/students in any course in which the students are enrolled who participated in the care, providing the following information:

a. the nature of the complaint filed against him/her;

b. the name, address and phone number of the Texas Midwifery Board or the other professional, licensing, or certification board or agency; and

c. the nature of any action proposed and/or taken against him/her as a result of the complaint.

10.11. If a complaint is filed against a supervising midwife which results in a disciplinary action by the Texas Midwifery Board or any other professional, licensing, or certification board or agency related to midwifery, the supervising midwife shall immediately inform in writing each of his/her apprentices/students in any course in which the students are enrolled , providing the following information:

a. the nature of the complaint filed against him/her violation in which s/he was found guilty;

b. the name, address and phone number of the Texas Midwifery Board or the other professional, licensing, or certification board or agency; and

c. the nature of any action proposed and/or taken against him/her as a result of the complaint violation.

Explanation:

I removed the words “in any course in which the students are enrolled” because this statement is completely unnecessary. It does not clarify anything that is not already presumed without the statement included and including it could cause some confusion because not all students will be enrolled in a course.

The current wording of this rule does not take into consideration a midwife’s right to be presumed innocent nor does it take into consideration her right to anonymity. Therefore I believe it should be re-written in order to avoid a violation of these rights.

When a complaint is filed with the Midwifery Board, the midwife is assigned a case number and her name is not permitted to be used during the hearing process. The reasons for these practices is to protect the midwife’s privacy and anonymity. The midwife does not even have to attend her own hearing. Her anonymity is protected, as it should be, because she is also presumed innocent.

If a student participated in the care of a client and was directly involved in a situation which resulted in a complaint, she has a right to know about the complaint but not because the midwife should be presumed guilty but because of her own involvement in the situation. However, if the student was not involved in the situation, she has no more right to know about the complaint against the midwife than anyone else because the midwife still has the right to be presumed innocent and the right to anonymity.

Only if the midwife is found in violation of a rule or act or if the student was involved in the situation which resulted in a complaint should it be required for the midwife to inform the student.

I would also like to propose one change to the following:

11. 12. If a complaint is filed against a supervising midwife is found in violation of a midwifery rule or act, the Texas Midwifery Board’s Complaint Review Committee shall consider and may propose a restriction or prohibition on the supervision of apprentices/students in accordance with 22 Texas Administrative Code §831.169 Disciplinary Action

(a)(3).

Explanation:

Again, the midwife is presumed innocent. Therefore the Midwifery Board’s Complaint Review Committee should not consider or propose any restriction or prohibition on the supervision of apprentices or students before she is found in violation of the rules or act.

Comments Regarding the “Supervising Midwife/Apprentice Complaint Disclosure form”:

In light of my comments listed above, I would also like to make the following proposed changes for the “Supervising Midwife/Apprentice Complaint Disclosure form”:

On the front page I would recommend that the first paragraph in the second box be amended to read as follows:

As a supervising midwife, it is my responsibility to disclose information to the apprentice regarding any past or current complaints that have resulted in any disciplinary action, and any complaints that develop during the student’s clinical training which directly involved the student.

Regarding the back side of this form I would like to make one more observation and add a comment concerning my observation. The second sentence in the next to last paragraph reads,

“It is important for you to be aware of any complaints that originate from patient care in which you participated.”emphasis mine

I wish to point out that I agree with this statement completely. Please note that this wording is a part of your own proposal. I agree that it is important for students to be aware of complaints which “originate from a patient care in which [they] participated.”

I would encourage you to make the rest of this document consistent with this same line of reasoning but to otherwise protect the midwife’s right to be presumed innocent.

Beth Overton, CPM,.LM
Gentle Beginnings
www.texas-midwife.com
Every baby deserves a gentle beginning!

NIH Consensus Development Conference: Vaginal Birth After Cesarean: New Insights

This webcast can be streamed right to our homes here in South Texas!

The NIH is holding a conference on VBAC in March. Please pass this along to
any moms, doulas or midwives groups. VBAC moms and birth professionals who
can come and join in on the discussion groups is appreciated.

http://icanofdc.blogspot.com/

NIH Conference site:

http://consensus.nih.gov/2010/vbac.htm

ICAN is also looking for some VBAC moms to help them with their own stories
about insurance, etc. Please

http://ican-online.org/

Thank you C for passing on the info!

How to file a complaint against a doctor, midwife or hospital in the Corpus Christi area:

Here's some good info I thought would be important to have archived on the blog:

If you feel that you received birth care or treatment that did not meet standards or was unacceptable in any way, you have access to a complaint process. Remember that taking action when you have been treated in an inappropriate manner can help to prevent others from being harmed in the future.

PHYSICIANS

Please visit the website for more detailed information.

http://www.dshs.state.tx.us?HFP/complain_HFlicensing.shtm

http://www.tmb.state.tx.us/consumers/complain/complain.php

Complain Hotline: 1-800-201-9353

Mail complaints to the following address. You must call the Complaint Hotline to request the appropriate form.

Texas State Board of Medical Examiners

Investigations Department, MC-263

P.O. Box 2018

Austin, TX 78768-2018

HOSPITALS

Please visit the website for more detailed information.

http://www.hospitalcomplaint.com/

Mail or Fax Complaints to the following address:

Health Facility Licensing and Compliance Division

Texas Department of Health

1100 West 49th St.

Austin, TX 78756

FAX (512) 834-6653

COMPLAINT HOTLINE (888) 973-0022

NURSES

http://www.bne.state.tx.us/about/complaint.html

MIDWIVES

The following information is taken from

http://www.dshs.state.tx.us/midwife/mw_complaint.shtm

"An individual who wishes to file a complaint against a licensed midwife, or a person who is practicing midwifery in Texas without a license, may write to:

Complaints Management and Investigative Section
P.O. Box 141369
Austin, Texas 78714-1369

or call 1-800-942-5540 to request the appropriate form or obtain more information. This number is for complaints only. Please direct routine calls and correspondence to the phone number and address on the "Contact Us" page."

You can also find more information at the North American Registry of Midwives:

http://www.narm.org/peerreview.htm#Grievance

For help in writing a formal complaint letter, please visit:

http://www.birthnetwork.org/Content/Documents/Document.ashx?DocId=20673

For more support or help in dealing with this process, please feel free to contact

southtexasbirthadvocates@gmail.com

STBA group meeting!

This week Friday at 1:30pm in CC.

Email me for details

www.southtexasbirthadvocates.gmail.com

Maternity Care in the Rio Grande Valley-From one Mother to Another

Maternity Care in the Rio Grande Valley-From one Mother to Another

I am Nicole Hoff but I am better known as "Mommy", "The Birth Lady," or "The Boob Lady." I have my Bachelors in Maternal and Child Health, am a Certified Doula (a certified professional that assists mothers during pregnancy, childbirth, and the postpartum period), a Certified Childbirth Educator, an International Board Certified Lactation Consultant, and a Midwife Apprentice. As a mother and healthcare professional in private practice in Harlingen, I have helped families from all walks of life, from each end of the Valley, during a special time in their life.

Despite good-hearted intentions of many dedicated and educated health professionals, the maternity care system across the US, including the Rio Grande Valley of South Texas, has many shortcomings. A recent report by Childbirth Connection and The Milbank Memorial Fund, called "Evidence-Based Maternity Care: What It Is and What It Can Achieve," explains why the state of maternity care in the U.S. is worrisome. The care practices that have been proven to make childbirth easier and safer are underused, and the many interventions that may increase risks to mothers and babies are routinely overused. The report points to the "perinatal paradox" of doing more, but accomplishing less. I have witnessed this first hand in the Valley and I am truly worried.

Every year Valley women are suffering in silence from birth trauma that results from their treatment during labor and delivery of their child. The feelings of their negative experiences are overwhelming, and sometimes so much so that they suffer from major depression afterwards. Some women consider it "birth rape", especially if they had instruments or hands placed inside them without their consent. Because of my education and experience, I feel that I know misinformation, maltreatment, and abuse in this field when I see it. I have had the honor of attending many amazingly beautiful births here, but I think some of my "birth stories" at local hospitals would surprise you and many would just sicken you. I wish I could forget each and every demoralizing abuse these mothers and babies faced, but some were just so shocking they will always linger in my memory.

I want to put these following phrases I have heard over the years out there in the open so our community can know what is taking place. I think everyone involved in birth needs to read these, so that they can be more attuned to what they are saying and what type of care they are providing. These are just a few phrases from the many well-intentioned nurses, doctors, staff, breastfeeding "helpers", and childbirth "educators" I have heard but I will never repeat. While some of these phrases could have the correct time and place to be said and may really hold true for a mother, there have been more times that I have heard them said when it was inappropriate or not factual than when really necessary. Mothers have been mistreated, lied to, given incorrect information, coerced, manipulated or deceived so that one will be obedient and go along with treatments, and have had procedures done when there was no reason or consent to perform them. Different locations, different staff, same ABUSE.

From their lips, to my ears, to my typing fingers:

Was this a planned baby or just a mistake?
I'm a rough doctor, but I know what I am doing.
You don't need labor support.
No one can birth naturally.
C-sections don't hurt.
Wow, you're huge, you need to get that baby out now!
You're too small for this big baby!
You're seriously pregnant again?
Be quiet. Hush. Shhh. You're too loud!
Our hospital is best- even with over 50% c-section rate.
Your spouse/mom/doula can't come in with you.
We throw away birth plans.
We laugh at birth plans.
You're too sick/weak/tired for birthing your baby.
OB: I only come to catch the baby.
Give up and go with the c-section.
You can't have a VBAC (vaginal birth after c-section).
That won't work!
You can't...
Since you have medicaid...
I only speak English, this is America!
You're worrying me, stop that.
I have to do this to you because...
That's not important. Forget about it.
I don't have time. I've got other patients.
That's normal. I see that all the time.
You're wearing me out
I'm not here for you, it's just my job.
Good girl.
C-sections are safer and better for you and baby.
You're not strong enough.
That's in the past, move on.
Don't move.
I can't help it if you don't understand.
Oh relax!
You're fine!
Hold your pee and poop!
You can't get up!
No time to explain this to you.
Oh gross!
Sit still. Lay still. Be still.
Why would you want that?
Well that's a first!
You ask too many questions!
You have to do what I say.
I know your body better than you do.
Only 1 person allowed in room.
I'm cutting you open.
Push now even if not ready.
It doesn't matter what you need.
Oops! We....
Your epidural didn't work because you....
Let's induce now at 37-38 weeks.
Hurry up!
Start pitocin she's not progressing.
You have to be alone for 2 hrs.
I'm taking your baby away for 4 hrs.
You have no choice.
Even if you say no, I must...
Ob:Plan a c-section or induction for when I'm in town.
Ob:I know what's best, not you! Who is the doctor here?
You're here so I can't let you leave.
Just get pain meds already!
You can't do this anymore!
You're not pushing right!
Spread your legs! Wider!
Lay flat even if it hurts.
Did you pay your deductible yet?
I cut you even though you didn't want it.
You will hurt your baby unless...
Emergency c-section was you're fault.
I forgot to wear gloves.
Your baby needs a bath, it may have swine flu.
Your baby is dirty.
The doctor decides...
Your baby needs more than your breastmilk.
Your breasts won't work.
I have to hurt you.
I forgot and fed your baby for you.
Formula is better.
You need a catheter!
You need pain meds!
You need an IV!
You need pitocin!
You need monitoring!
You need to just chill out!
Your baby doesn't like that.
You can't go to the nursery.
You're not dilating fast enough.
I got you too drugged up to hold baby.
The baby needs the nursery more than he needs you.
Epidurals have no side effects.
You're not breathing right.
We can't do that for you.
We do this because it works for us.
Your doctor won't be here for you after all.
Follow our rules.
We have policies and protocols.

Now you know why video cameras are not allowed in labor rooms! They would be too embarrassed to let this get out, and honestly I am embarrassed for them. This list doesn't even include the sighing, eye rolling, storming out, finger pointing, paper waving, bribing, rough handling, withholding, lack of privacy, lack of respect, and other abuses. Because such practice and sayings have become routine, few maternity providers consider them abusive or inherently inappropriate.

It needs to stop... but I fear it won't.

Still, someone needs to speak up for these moms and babies and I hope someone out there cares. No local maternity professionals or hospitals have responded yet to my plea to contact me about ways to end this system of poor care. And no one has apologized to these mothers or babies-many who feel traumatized by past births. I would like to apologize for them and my apologies go out to the mothers that have had this abuse, and my hope for you is that you find healing and closure.

I will get some harsh feedback from this letter and some will deny the existence this abuse to mothers or believe that I am exaggerating, but this is because misconduct is rarely reported. I know that, sure, some births go "fine" and there are a handful of "good" staff out there, and hospitals are "working hard to accommodate mothers". I have seen that too, just not often enough to right a passionate letter about it. Maybe someone will respond wanting to know how to help make the birth experience better? The answer is easy! Birth professionals need to empower women to prevent birth trauma. Give her control through education, support, and your time. Don't make decisions for her, make them with her. Show her that she is valued and that you will give her your all to give her the best birth for her. Treat her with respect and give her privacy. Ask permission anytime you are performing an intervention, treatment, or even touching her. If she asks you to stop, do so immediately, and always explain what you are doing in detail. Above all, listen to her, and show her that you care about her AND her baby. No one deserves to be treated any differently than this, especially when in pain, when in need, and at a precious event in life.

Attention-RGV Families: You're not free from serious risks at Valley hospitals when giving birth. You will hear many of these phrases above, whether you believe it or not, it is a sad fact. The c-section rate is high in our area. You risk so many interventions that can lead to a c-section or a sick mom and baby. You face the risk of unnecessary induction, which can turn out to be too early or fail and lead to a c-section. It is a fact that you will receive care from some, if not all staff, that have amazing skills but lack natural/ normal childbirth and breastfeeding education. I have seen this at about every Valley hospital location. You will probably be made to do what they say and not what you need or want. You become their property and your baby becomes their responsibility!

There is an alternative. Escape from this abuse. There are a number of different ways for you to have a safe, happy, and healthy birth. Here are the four most common:

* With an "enlightened" doctor at a hospital
* With an "enlightened" midwife at a hospital
* With a midwife at a birthing center. Locally: Holy Family Birth Center in Weslaco.
* With a midwife at home. Locally: Beth Overton, CPM who does all prenatal care and home birth.

Seek many options, weigh the risks and benefits, and choose the birth plan that works best for you. If you are considering a natural childbirth, you should definitely educate yourself, consider taking a childbirth class not associated with a hospital or similar natural childbirth class. You really can have a beautiful birth experience even if you have your baby in a hospital, but you need to find a doctor or midwife and doula who will support you in your point of view, and you need some training to help you prepare yourself.

Attention-Doctors, staff, hospitals: If you think this isn't happening in your birth facility or practice? Prove me wrong. Show me your true support of these women and babies. Hire me as a Doula to be on staff and respected at your birth facility or clinic for 1 month. Allow video cameras into your center and take evaluations from your patients. Not brave enough for that? Show me the information on how these phrases and this type of "care" you are providing helps mothers and babies. Are you that "enlightened" doctor or midwife out there that can help Valley families, then contact me and let me know and I would be happy to share that information.

For now I, as a Valley mother and maternal and child health professional, will continue to advocate and support Valley families, and I hope that I will no longer continue to see and hear mothers and babies being abused at what should be the most joyous time of their life.

Contact me for more information.
www.BlessedBirthDay.com
nicole@blessedbirthday.com
956-245-1787

Nicole: We hear you! I love this letter and I will bring it to the attention of our group- again and again! Thank you for sharing your time and talent with us and for advocating for our honored, birthing mothers.

-Carrie

A call for stories

We believe that the birth process is a monumental experience in which a mother should be honored, valued, respected and revered. And yet, we continue to hear stories that express a number of grievances encountered by Moms during their births. Some mothers experience unfair treatment, cause for complaint, disrespect and even abuse during their birth process.

Because a birth may be a rare or even a solitary experience for one woman, she may not pursue official reprimand for any injustice she suffers. However, this choice of inaction proffers a disservice to the women who come after her and encounter similar unregulated affronts.

So we make a call for stories. Stories that explain the grievances you or others may have experienced throughout a mother's pregnancy or birth experience; stories that necessitate action for a higher level of respect and ethical practice among our medical care givers.

We hope that by gathering a collection of stories, we may better unite as one voice. Though we may not be able to change what we have experienced in the past, we may be able to create better, safer circumstances for our sisters that follow us into their time of delivery and initiation into motherhood. This is an open invitation to all mothers, fathers, family members, doulas, medical caretakers or anyone involved in the birth process who wishes to better honor or better advocate for the birthing mothers of our community.

Please email SouthTexasBirthAdvocates@gmail.com

"Maternal mortality across the world"

Thanks Beth, for bringing this article to our attention!

The video and full text can be seen at

http://news.bbc.co.uk/2/hi/americas/8325685.stm

Maybe we should consider this information as we look at the rates of c-sections in our own South Texas area. Is a c-section always the safest option?

Important Notice: We have an STBA meeting TOMORROW at 11am. If anyone is interested in attending this meeting or future meetings, pleaseemail southtexasbirthadvocates@gmail.com

"The US spends more money on mothers' health than any other nation in the world, yet women in America are more likely to die during childbirth than they are in most other developed countries, according to the OECD and WHO. The BBC's Laura Trevelyan has been trying to find out why.

Four million American women give birth every year, and about 500 die during childbirth or from pregnancy-related complications.

In the richest nation in the world, giving birth is more risky than you would think.

"No American woman should die from childbirth in 2009, we can definitely do a lot better," says Dr Michael Lu, Associate Professor of Obstetrics at the University of California, Los Angeles (UCLA).

In New Jersey, Jim Scythes is bringing up his two-year-old daughter Isabella on his own.

His wife, Valerie, died from blood clots shortly after giving birth to Isabella by Caesarean section.

Jim still cannot believe that Valerie died after giving birth, here in America.

"When Isabella walked for the first time, I sat on the floor and cried, because Valerie should have been there. I believe this could have been prevented and now my daughter will never know her mother."

MATERNAL MORTALITY One woman dies every minute during childbirth, yet almost all of these deaths are preventable. In 2001, the UN set itself the goal of slashing maternal mortality by 75% by 2015, but it is nowhere near meeting that target. Health ministers from around the world are meeting in Ethiopia to work out how to make up for lost ground. The BBC is publishing a series of reports to mark the occasion.

So why are women in America more likely to die during childbirth than they are in most other developed nations?

The answers are complex. A healthcare system which leaves what Dr Lu estimates are 17 million women of child-bearing age without health insurance could be one factor.

Obesity, poverty and the high rate of C-sections in America all play a part.

Dr Lu says about half of American women are entering pregnancy overweight. "Obesity is a major risk factor for pregnancy-related complications.

"First we need to improve the health of women before they get pregnant, and second we need to improve the quality of maternal care in America."

Shocking story

The Centres for Disease Control (CDC) in Atlanta is the US government agency that collects national statistics on the numbers of women dying during childbirth.

Dr Bill Callaghan of the CDC says the latest maternal mortality data suggests one in four to one in five women who die have heart disease, or diseased blood vessels.

To the extent that we don't explain racial disparity in pregnancy-related mortality, we're going to have difficulty making headway into it Dr Bill Callaghan Centers for Disease Control

Could that be due to women being overweight? I asked. "It could be," replies Dr Callaghan, "the obesity epidemic has not spared women of reproductive age."

Dr Bill McCool, at the University of Pennsylvania's School of Nursing, points out that America is far above the World Health Organization's goal of a 15% C-section rate.

"Surgery of any kind has risk," he says, and a C-section is, "still the riskiest way to have a baby.

"In the US, almost one third of women have that procedure for delivery of their baby."

...

the full text of the article can be found at

http://news.bbc.co.uk/2/hi/americas/8325685.stm