by Ellen Shaffer and Judy Norsigian

This week, we all learned a lot about Susan G. Komen for the Cure, and Planned Parenthood, and breast cancer. Now that Komen has caved (sort of; Planned Parenthood’s response), we might start to learn what it will take to mobilize an outcry to really stop the attacks on women’s health.

As Komen was committing a huge PR failure, it became clear via Facebook, Twitter and a new Tumblr site, Planned Parenthood Saved Me, that many women value and rely on Planned Parenthood for breast cancer exams and other preventive health services. A slam-dunk week for Planned Parenthood.

We need to make it a slam-dunk month. What Komen, and the evangelicals, and Republican Rep. Cliff Stearns, who launched the pointless political inquiry, and the U.S. Conference of Catholic Bishops are really mad at Planned Parenthood about is this:

Part of what they do is help people plan. Parenthood. You know. They support birth control. In some cases, they provide it. Like your corner drugstore, but better.

And this week, the bishops are howling about it because the Obama administration refused to grant a broad religious exemption to contraception coverage.

Never mind that virtually all Catholics use birth control, that the Church itself only began to oppose it in 1968, that the Pope recently conceded that condoms are useful, and approved condom use for stopping the transmission of AIDS.

Never mind that most Catholic-affiliated hospitals, schools and charities cover birth control in their health plans — health plans that come out of the wages employees earn themselves.

Never mind that undergraduate and graduate students are fighting for coverage — and are still being denied, even for medical reasons.

Close to every cent the Church has not spent settling lawsuits against priests who sexually molested children has gone into this week’s media campaign to rile up opposition to covering birth control.

So far they’re doing a pretty effective job of it. The Obama administration is standing firm, but Congress is still on the warpath.

You can send a message that you stand against attacks on birth control and with Planned Parenthood. The organization just launched a TV ad campaign in support of contraception coverage (watch below).

And learn more about the men behind the war on women. They’re not going away anytime soon.

Ellen Shaffer is co-director of the Trust Women/Silver Ribbon Campaign, a project of the Center for Policy Analysis. Judy Norsigian is co-founder and executive director of Our Bodies Ourselves.

At an historic Home Birth Consensus Summit in Virginia last month on “The Future of Home Birth in the United States: Addressing Shared Responsibility,” a group of 68 national and international experts developed nine key common ground statements that provide a foundation for continued dialogue and collaboration across sectors in the maternity care field.

The statements were posted this week at homebirthsummit.org, along with comment about the scope and context of the meeting. The site also includes information about why the summit was necessary and the process involved in reaching consensus. Action plans relating to these statements will be posted soon.

As one of the participants in the three-day summit, I was impressed with our collective commitment — despite different perspectives and areas of disagreement about out-of-hospital birth — to a common goal of improving maternal and newborn care for families choosing to give birth at home or in freestanding birth centers.

Mark Sloan, a pediatrician and writer who attended the summit, briefly explains the history of home birth in United States, offering context for why the summit marks a significant moment: “The representatives of all the major midwifery organizations — MANA (Midwives Alliance of North America) and ACNM (American College of Nurse-Midwives) — as well as ACOG (American College of Obstetricians and Gynecologists), FIGO (International Federation of Gynecology and Obstetrics), and the AAP (American Academy of Pediatrics) sat together in the same room to discuss home birth for probably the first time in history.”

One of the agreed-upon statements emphasized our belief that “collaboration within an integrated maternity care system is essential for optimal mother-baby outcomes. All women and families planning a home or birth center birth have a right to respectful, safe, and seamless consultation, referral, transport and transfer of care when necessary. When ongoing inter-professional dialogue and cooperation occur, everyone benefits.”

The ninth and last statement reads: “We recognize and affirm the value of physiologic birth for women, babies, families and society and the value of appropriate interventions based on the best available evidence to achieve optimal outcomes for mothers and babies.”

Other statements address improving the current liability system, the licensure of maternity care professionals, increased participation by consumers in multi-stakeholder initiatives, and the creation of an equitable maternity care system without disparities in access, delivery of care, or outcomes. See below for the full list.

The remarkable collegiality and constructive dialogue among the stakeholders present enabled the group to develop these nine core principles as well as commit to a variety of future collaborations. This is an important first step towards achieving improved outcomes for childbearing women and their families in this country.

As Saraswathi Vedam, director of the Division of Midwifery at the University of British Columbia and chair of the Home Birth Consensus Summit Steering Committee, noted: “When you have an issue as controversial as home birth, there are always going to be differences of opinion among various types of providers, policy-makers and even among consumers. But all of us recognize that for women who choose home birth, it’s our shared responsibility to work toward policies that will make that choice as safe as possible.”

Summit participants included obstetricians, family physicians and midwives, non-professionals serving in advocacy roles, insurers, attorneys, ethicists, administrators, policy makers, researchers, and others with expertise in epidemiology, public health, midwifery, obstetrics, pediatrics, nursing, sociology, medical anthropology, law, and health policy research.

We invite your comments on the statements below.

STATEMENT 1
We uphold the autonomy of all childbearing women.

All childbearing women, in all maternity care settings, should receive respectful, woman-centered care. This care should include opportunities for a shared decision-making process to help each woman make the choices that are right for her. Shared decision making includes mutual sharing of information about benefits and harms of the range of care options, respect for the woman’s autonomy to make decisions in accordance with her values and preferences, and freedom from coercion or punishment for her choices.

STATEMENT 2
We believe that collaboration within an integrated maternity care system is essential for optimal mother-baby outcomes. All women and families planning a home or birth center birth have a right to respectful, safe, and seamless consultation, referral, transport and transfer of care when necessary. When ongoing inter-professional dialogue and cooperation occur, everyone benefits.

STATEMENT 3
We are committed to an equitable maternity care system without disparities in access, delivery of care, or outcomes. This system provides culturally appropriate and affordable care in all settings, in a manner that is acceptable to all communities.

We are committed to an equitable educational system without disparities in access to affordable, culturally appropriate, and acceptable maternity care provider education for all communities.

STATEMENT 4
It is our goal that all health professionals who provide maternity care in home and birth center settings have a license that is based on national certification that includes defined competencies and standards for education and practice.

We believe that guidelines should:

allow for independent practice
facilitate communication between providers and across care settings
encourage professional responsibility and accountability, and
include mechanisms for risk assessment.

STATEMENT 5
We believe that increased participation by consumers in multi-stakeholder initiatives is essential to improving maternity care, including the development of high quality home birth services within an integrated maternity care system.

STATEMENT 6
Effective communication and collaboration across all disciplines caring for mothers and babies are essential for optimal outcomes across all settings.

To achieve this, we believe that all health professional students and practitioners who are involved in maternity and newborn care must learn about each other’s disciplines, and about maternity and health care in all settings.

STATEMENT 7
We are committed to improving the current medical liability system, which fails to justly serve society, families, and health care providers and contributes to:

inadequate resources to support birth injured children and mothers;
unsustainable healthcare and litigation costs paid by all;
a hostile healthcare work environment;
inadequate access to home birth and birth center birth within an integrated health care system, and;
restricted choices in pregnancy and birth.

STATEMENT 8
We envision a compulsory process for the collection of patient (individual) level data on key process and outcome measures in all birth settings. These data would be linked to other data systems, used to inform quality improvement, and would thus enhance the evidence basis for care.

STATEMENT 9
We recognize and affirm the value of physiologic birth for women, babies, families and society and the value of appropriate interventions based on the best available evidence to achieve optimal outcomes for mothers and babies.

Our Bodies Ourselves recently received a wonderful picture of pre-teen girls watching one of their moms get a pelvic exam, complete with mirror and flashlight, along with a note about how the nurse-practitioner conducting the exam explained everything that was being done in simple, straightforward language.

As a way to underscore how much young women across the country are able to learn about their bodies through such critically important show-and-tell learning, we are inviting women to share with us (anonymously is fine) stories of how nurse-practitioners and other ob-gyn clinicians (including nurse-midwives, family physicians and obstetrician-gynecologists) have taken the time to teach them more about their bodies through use of speculums (some with flashlights built in!) and mirrors, participation in the “whiff” tests, and other approaches that directly engage women in the learning process.

In an era where the “yuck” factor is used to inappropriately encourage risky douching practices and use of scent-filled vaginal products that may be harmful to overall vaginal health, it is important to remember how valuable this kind of education during a clinical pelvic exam can be.

Moreover, clinicians who incorporate these recommended educational practices are helping to offset a conservative trend toward restricting information about women’s reproductive and sexual health. Access to books like “Our Bodies, Ourselves” is denied in some schools and libraries; self-knowledge is considered shameful or even dangerous.

Please share with us your stories as clinicians who provide such exams or as women who may have benefited from them. You can either add your story in the comments below, or email office@bwhbc.org. And feel free to share and re-post this call

We plan to post these anonymously on the Our Bodies Ourselves website so that young women will be encouraged to respond with a “Yes” the next time their ob-gyn clinician might offer them the option of seeing their own cervix or learning more about their vaginal secretions.

We would also welcome emails and letters from ob-gyn clinicians who might be able to cite articles in the medical literature that point to the benefits of this kind of education. Our mailing address is available here.

Thank you for taking part in this discussion!

If you’re in Massachusetts, please ask your state representative to urge House Speaker Robert DeLeo to bring an important midwifery bill to a vote. Text of the bill — House 4810: An Act Relative to Certified Professional Midwives and Enhancing the Practice of Nurse-Midwives – can be found here.

The bill was just released from the House Policy and Steering Committee and is now in Third Reading, chaired by Rep. Vincent Pedone of Worcester.  The legislative session closes on Saturday, July 31. If it’s not voted on by then, the bill would die and have to be reintroduced in the next legislative session.

If you’re able to discuss the bill with your legislator or a staff member, please be aware that some legislators have misinformation about the midwifery bill’s content, especially regarding the items below. Here’s some background:

1. The Massachusetts Medical Society strongly objects to CNMs functioning without direct MD supervision, yet has articulated no sound basis for this objection. Nationally, ACOG already supports the elimination of direct supervision of CNMs by physicians, acknowledging that it is not required for safe practice, and 44 other states no longer have such requirements.

2. Some legislators incorrectly think that the bill would provide new prescription-writing privileges for nurse-midwives — this is not really the case. Nurse-midwives already have prescription-writing privileges but can now exercise these privileges only if an MD is technically providing supervision, which amounts merely to a review of sample prescriptions on a quarterly basis.

Because of hospital accrediting rules, this clause prevents CNMs from admitting patients in labor under the midwives’ own names; prevents CNMs from serving on hospital committees that determine maternity care policies; and bars them from control of their own practice environment. This undermines the ability of CNMs to provide the most effective care. (CNMs already have independent prescription authority in most other states, including New Mexico, New Hampshire, Washington, Arkansas and Oregon, and the District of Washington.)

3. Although the legislation has already been rewritten to accommodate concerns about the age at which a midwife could begin training (it was changed from 18 to 21), legislators are still being misled about this fact. There are, by the way, no such age requirements that we have been able to find in the Massachusetts statutes with respect to the education of nurses.

4. Another objection is that the bill does not require a midwife to carry malpractice insurance. In almost all states, malpractice insurance is not required by statute, and it would be unfair to single out one professional group in this regard. Some would argue that such a requirement would violate equal protection clauses.

Because the “risk pool” of homebirth midwives across the country is small, malpractice insurance has never been available for homebirth midwives, despite the concerted efforts of national and local organizations over several decades. Requiring CPMs to adhere to a standard that is impossible is another mechanism to restrain trade and prevent access to home birth midwives.

Childbearing women who want to be protected by malpractice insurance have the option of delivery in facilities, where such insurance coverage is required. Moreover, the Massachusetts legislature could follow a few other states in making disclosure of this absence of malpractice insurance coverage part of a required informed consent procedure. The malpractice insurance issue is not a credible objection to this bill.

Please share this news, and thanks for taking the time to take action on this important piece of legislation!

As an Our Bodies, Our Blog reader, you know that the specific interests of women and health are intricately connected to broader issues of social change. For just this reason, OBOS has been a proud, longtime member of Community Works, a cooperative fundraising effort involving more than 30 Massachussetts social justice organizations.

Community Works is currently offering a special incentive that I wanted to share with our Massachusetts friends. You might be able to directly support OBOS’s work without even making a donation yourself.

Community Works receives donations largely through the convenience of payroll deductions at 52 private, public and nonprofit employers in the greater Boston area, representing more than120,000 employees. Such payroll deduction contributions to Community Works help to support the work of member organizations such as OBOS.

Any member group that enlists a new workplace that will offer Community Works as one of its employee charitable giving options will receive half of the proceeds of the first year’s campaign. So if you help OBOS enlist a new employer, you will help raise valuable funds for OBOS in the coming year.

The set-up is simple: Visit the Community Works website to see where campaigns are already underway. Then contact your friends in workplaces that don’t already offer Community Works as a charitable option. If you know anyone who can help bring Community Works to their workplace, please email me: judy (at) bwhbc (dot) org

If we are successful in securing the workplace you suggest, OBOS co-founders (myself included) will send inscribed copies of any of OBOS’s books to the person or institution of your choice.

This is a wonderful opportunity for those of you who value what OBOS does to provide concrete support to both our organization and the other social change groups that are part of Community Works. Whether working to address environmental justice, sexual assault, youth and community violence or health care access, each Community Works member operates within a framework of equality, justice and peace.

Remember, it takes a village and more to sustain the work of public interest organizations like ours. Take a look at the current employer partner list and let us know who’s missing. Your help with this effort is much appreciated!

Judy Norsigian is executive director of Our Bodies Ourselves.

It is with heavy heart that so many of us receive the news of Sen. Ted Kennedy’s death. Although I have been anticipating this moment for weeks now, the reality is still such a shock.

I know that for so many women’s health activists, Kennedy’s passing will only strengthen our resolve to continue his valiant fight for meaningful health care reform. I have started writing letters to several more liberal Republicans, beseeching them to honor his memory by breaking ranks with the Republican Party and its current efforts to eliminate the public health insurance option from any bill coming out of Congress.

As a tribute to this tireless advocate for the millions who had no political power, each of us can think of one gesture we can carry out in the coming weeks.

In 2002, I testified before the Senate HELP Committee on the topic of somatic cell nuclear transfer (which involves creating cloned human embryos to serve as a source of embryonic stem cells for scientific research; it poses health risks for women who provide eggs for such research). Kennedy, who was co-chairing that particular HELP Committee hearing, was ever so gracious, even though I knew he did not agree with the position of Our Bodies Ourselves at that time.

And when my late husband, Irving Kenneth Zola, died in 1994, shortly after he was appointed to the National Council on Disability, Kennedy’s remarks at a special memorial service for Irv in Washington, D.C., brought tears to everyone’s eyes. His compassion, tenacity and commitment to the needs of all remain an inspiration to me both personally and professionally.

We will miss you terribly, Ted, and we will all fight even harder for the causes you championed for more decades than some of us have even been alive.

Judy Norsigian is executive director of Our Bodies Ourselves.

Dr. George Tiller’s murder offers us all an opportunity to reflect upon and honor the work of so many women’s health care professionals who continue to offer abortion services despite ongoing threats to themselves and their families.

That such a kind and dedicated human being could be attacked and killed like this sends all of us reeling once again. How is it that those who purport to care about life can spew forth the kind of hateful rhetoric that foments destructive passions in already unstable individuals like Dr. Tiller’s attacker?

I think about a few physicians I know who have had to walk around their communities wearing bullet-proof vests. Even though there has not been a shooting like this one in some years, they are well aware of the recent increase of harassment and violent incidents related to abortion clinics in this country.

Terrorist behavior like this is designed to deter other women’s health care practitioners from providing abortion services. And it is precisely because of this that we must all be outspoken in our support of all physicians willing to provide such services — and of the women who seek these services.

Widespread community resolve and solidarity will be key to our ability to restore a civil society in which such acts of violence will not be met with so many cheers by those who would use any means to stop women from having abortions. We now need to find more ways to honor and support women’s health providers like Dr. Tiller.

This week I re-read the moving speech of Dr. Garson Romalis, an obstetrician-gynecologist in Vancouver, British Columbia, who was attacked twice (in 1994 and again in 2000). He spoke last January at a University of Toronto Law School symposium marking the 20th anniversary of R. vs. Morgentaler about why he continued to provide abortions despite two attempts upon his life. It is a speech I think that all of us need to read again.

His courage, commitment and resolve will help inspire many of us to keep working toward a world in which women are respected and supported in their times of need. One concrete action we can all take is to support the George Tiller Memorial Fund, established by the National Network of Abortion Funds to provide assistance to the same women Dr. Tiller served, or any of a number of groups now working to preserve women’s access to comprehensive reproductive health services. Here’s more info (pdf) about the fund.

- Judy Norsigian, Our Bodies Ourselves Executive Director

by Judy Norsigian
Our Bodies Ourselves executive director

Last year, the American Association of Birth Centers (AABC) filed a petition with the federal Centers for Medicare and Medicaid Services (CMS) to intervene in a hearing regarding CMS’ disallowance of Medicaid payment for a birth center.

According to AABC:

The federal Medicaid law lists the types of providers and services that are eligible for payment. Hospitals, clinics, nurse-midwives are listed, but birth centers are not. Until recently, some states paid birth center charges above and beyond the midwife’s professional fee, but did so based upon an interpretation of the Medicaid law.

However, as a result of the judge’s recent ruling:

CMS top officials … have a new interpretation, which leaves out birth centers, and no longer accept the former interpretation.  This means that if the birth center is to get paid for the facility, the birth center must to be added to the Act as a distinct category of provider, like hospitals or clinics.  And, the ONLY WAY this can be done is by passing a bill through Congress to amend the Medicaid law.

Birth centers have an outstanding record of providing safe, women-centered births and all women should have access to them, regardless of their income status. In addition, the ruling could easily lead to denial of other insurance payments to birthing centers, as other payers often follow the lead of CMS.

Our Bodies Ourselves believes that CMS must be directed to cover birthing centers, and we ask our supporters to take the following steps:

• Sign this petition in support of Medicaid funding to birth centers. (And tell your friends and colleagues to do so as well!) We need to collect 10,000 signatures in the next week or so.
• Contact your senators and representative to support a new bill to be introduced by Rep. Susan Davis (D- CA). This bill will include birth centers as eligible providers for Medicaid payment.

The AABC  has additional background information on the issue, as well as a letter for physicians to sign. You can keep up with the progress of the campaign on the AABC’s Facebook page.