On How a Bill Becomes a Law: The bill that will likely become the reconciliation bill on healthcare has been posted (PDF). Ezra Klein explains what it means.

Democratic leaders say a bill will pass this week.  House Minority Leader John A. Boehner (R-Ohio) pledges obstruction, saying Republicans will do “everything we can to make it difficult for them, if not impossible, to pass the bill.”

Jen Nedeau covers the multiple threats to women’s health and reproductive rights that must be addressed, including the House anti-abortion language. You know it as the Stupak/Pitts admendment. But Richard Doerflinger, the U.S. Conference of Catholic Bishops’ point man on abortion, should have had his name in there, too. Meanwhile, Jessica Arons tries to see the world through the lens of Rep. Bart Stupak (D-Mich.).

In an editorial in Monday’s paper, The New York Times urges anti-abortion Democrats to accept the Senate’s restrictive provisions, the lesser of two evils.

Too Many Tests, Too Much Treatment: “A spate of recent reports suggests that many Americans are being overtreated. Maybe even President Barack Obama, champion of an overhaul and cost-cutting of the health care system,” reports Lindsey Tanner of the Associated Press.

“More care is not necessarily better care,” wrote cardiologist Dr. Rita Redberg, editor of Archives of Internal Medicine, commenting on Obama’srecent physical, which included prostate cancer screening and a virtual colonoscopy. The PSA isn’t recommended at any age and a colonoscopyisn’t recommended under age 50.

Over-testing may be due to a combination of what is known as “defensive medicine” — doctors ordering tests and procedures because they’re trying  protect themselves against lawsuits (or because they’ll be compensated by a fee-for-service system) — and patients insisting on tests and treatments that they’ve heard about or know is commonly prescribed. But the thinking around more care = better care may be shifting.

“This week alone,” writes Tanner, “a New England Journal of Medicine study suggested that too many patients are getting angiograms – invasive imaging tests for heart disease — who don’t really need them; and specialists convened by the National Institutes of Health said doctors are too often demanding repeat cesarean deliveries for pregnant women after a first C-section.”

Stopping the Campus Rape Crisis: Jaclyn Friedman, executive editor of Women, Action and the Media and co-editor of “Yes Means Yes,” wrote a must-read op-ed in the Washington Post on ending the silence around sexual assault on college campuses.

First, colleges can eliminate the “miscommunication” excuse that many rapists use by creating an on-campus standard that requires any party to a sexual interaction to make sure their partner is actively enthusiastic about what’s happening — not just not objecting. They can create judicial boards equipped to seriously investigate rape accusations, instead of throwing their hands up at the first sign that the accused’s testimony contradicts the accuser’s. They can defend the safety of the entire campus by permanently expelling those found guilty of sexual assault. And they can be transparent about every step of the process.

Plus: The Center for Public Integrity recently released “Sexual Assault on Campus: A Frustrating Search for Justice,” an in-depth report filled with useful data, articles and resources.

Recognition for Midwives: Granny midwife Margaret Charles Smith was inducted into the Alabama Women’s Hall of Fame at Judson College this month. Smith attended nearly 3,000 births between 1949, when she received her midwife permit, and 1981, when she attended her last birth. Her life story is told in a book Smith co-wrote with Linda Janet Holmes, “Listen to Me Good: The Life Story of an Alabama Midwife.”

Plus: Rachel previously noted that the National Library of Medicine is featuring an exhibition on African American midwives. ”Nothing To Work With But Cleanliness: African American ‘Grannies,’ Midwives & Health Reform” tells the story of “granny” midwives and the state and local training programs that educated them and succeeding generations of midwives. View a wonderful set of photos from the exhibition on Flickr.

Utah’s Controversial Law Charges Women and Girls With Murder for Miscarriages: Writing at AlterNet, Rose Aguilar breaks down the problems with Utah’s new law that makes it a criminal offense for having miscarriages caused by “intentional or knowing” acts.

“What happens to women who are in abusive relationships?” asks Planned Parenthood’s Melissa Bird. “What happens if a woman threatens to leave the abuser, falls down the stairs and loses the baby? What if the abuser beats the woman and causes a miscarriage? Could he turn her in? Who would the prosecutor believe? What happens if a drug addict who’s trying to get clean loses her baby? Will she be brought up on murder charges?”

Some critics point out the legislators erred in not considering the lack of access that young people have to comprehensive sex education, and the overall lack of contraception and health services, especially in remote parts of the state.

The Girls Who Kicked in Rock’s Door: Not exactly health related (unless you’re like me and consider loud music essential for well-being), but I am completely intrigued by the “The Runaways,” the new film about the 1970s all-girl rock band, starring Dakota Fanning and Kristen Stewart. Sia Michel writes about the story behind the film and its director, Floria Sigismondi.

Beginning today and continuing through March 10, the National Institutes of Health is hosting a “consensus development conference” on the topic of vaginal birth after cesarean section.

A free live webcast (with captioning) of the conference is being made available for those who can’t attend the Bethesda, MD event. (You may need to download an appropriate media player to watch it.)

Various experts are discussing the medical evidence on VBAC (audience discussion has been lively already!), including the following key questions:

• What are the rates and patterns of utilization of trial of labor after prior cesarean, vaginal birth after cesarean, and repeat cesarean delivery in the United States?
• Among women who attempt a trial of labor after prior cesarean, what is the vaginal delivery rate and the factors that influence it?
• What are the short- and long-term benefits and harms to the mother of attempting trial of labor after prior cesarean versus elective repeat cesarean delivery, and what factors influence benefits and harms?
• What are the short- and long-term benefits and harms to the baby of maternal attempt at trial of labor after prior cesarean versus elective repeat cesarean delivery, and what factors influence benefits and harms?
• What are the nonmedical factors that influence the patterns and utilization of trial of labor after prior cesarean?
• What are the critical gaps in the evidence for decision-making, and what are the priority investigations needed to address these gaps?

They are also expected to discuss a systematic literature review on the topic prepared under contract with the Agency for Healthcare Research and Quality (AHRQ) which will be completed and released this year and will address these same key questions. The previous AHRQ review on the topic was completed in 2003, and identified significant gaps in the literature and the problems those gaps pose for informed decision-making. A full agenda with listed presenters and sponsors is available online.

Following the conference, a panel will prepare a consensus statement addressing the key questions; you can sign up to be notified when the draft and final statements are available online and/or to receive a mailed copy of the final statement.

The Feminist Breeder is planning to have coverage of the conference on her blog and radio show, and the International Cesarean Awareness Network is planning a blog carnival on the topic of why VBAC is a viable option [hat tip to Jill at The Unnecesarean]. The hashtag #nihvbac is being used for discussion on Twitter.

The full conference will be archived at the NIH website, so if you can’t watch this week, you can view the proceedings later.

According to reports, the Mississippi bill that would make non-nurse midwives illegal in the state is dead after “a barrage of calls and e-mails on lawmakers, urging them to kill the bill” from advocates for midwifery and home birth.

We mentioned the bill in a post last week, after it passed the House and was referred to the state Senate’s Public Health and Welfare committee. Committee chair Hob Bryan has now indicated that he will not bring the bill up for a vote, saying that “This is something there’s a good bit of concern about. Several people in the committee said they had gotten calls to oppose it.”

The Big Push for Midwives, mentioned in the story, led the campaign to mobilize against this bill and issued action alerts last week encouraging midwifery supporters  to contact their State Senators regarding the bill. Campaign manager Katherine Prown explained that their opposition was not opposition to regulation of midwifery, but to the limitation of midwifery practice solely to CNMs (who typically do not provide home birth support).

“At least 26 states have laws authorizing CPMs and there’s an effort under way to get more states to license them so the practice of out-of-hospital midwifery is regulated nationwide,” Prown said. Without those laws “you end up with this buyer beware kind of climate and anyone can claim to be a midwife,” said Prown.

The Big Push campaign works to expand access to Certified Professional Midwives and out-of-hospital maternity care, including work to regulate and license CPMs in all 50 states.

A bill has passed in the Mississippi House that could effectively make  midwives who are not also trained as nurses illegal in the state. The bill states that “the practice of midwifery shall only be conducted by Certified Nurse Midwives; to provide that any person who is not a Certified Nurse Midwife who engages in the practice of midwifery shall be subject to criminal penalties and injunctive relief.”

The bill would make it illegal for Certified Professional Midwives — midwives who who are specially trained to deliver babies in out-of-hospital settings– to practice.

Right now, the Midwives Alliance of North America (MANA) categorizes the current situation in Mississippi for non-nurse midwives as “Legal by Judicial Interpretation or Statutory Inference” – in other words, interpreted to be legal but not explicitly provided for in the current law.

The organization provides some documentation from the previous MS Attorney General who concluded in 1991 that, “By its express terms, the practice of medicine as defined in Miss. Code Ann. Section 73-25-33 specifically excludes the practice of midwifery. Thus, it is the opinion of this office that those persons otherwise not licensed as nurses may engage in the practice of midwifery without licensure as a physician and for compensation.”

The current bill, which would add language to explicitly make non-CNM midwives illegal, passed the state House on February 9th and has been referred to Public Health and Welfare committee in the state Senate, whose members bill opponents are contacting. That committee consists of: Hob Bryan, Chairman; Alan Nunnelee, Vice-Chairman; Terry C. Burton; Eugene S. Clarke;Bob M. Dearing; Joey Fillingane; Hillman Terome Frazier; Billy Hewes; W. Briggs Hopson III; John Horhn; Cindy Hyde-Smith; Gary Jackson; Kenneth Wayne Jones; Tom King; Chris McDaniel; Nolan Mettetal; Willie Simmons; Bennie L. Turner; Lee Yancey. Contact information for each Senator is linked from this Senate roster.

MANA is encouraging supporters of Certified Professional Midwives who live in Mississippi to contact their state Senators. Tell them that you do NOT support making Certified Professional Midwives illegal, and ask them to vote NO on HB 695.

In other birth-related legislative news, the American Association of Birth Centers is asking supporters to contact their Senators and Representatives to support the Medicaid Birth Center Reimbursement Act (H.R. 2358 / S. 1423). For further information, see our previous post and information provided by AABC.

The American College of Nurse-Midwives has posted a new position statement on nitrous oxide for labor analgesia [PDF], stating:

“It is the position of the American College of Nurse‐Midwives that women should have access to a variety of measures to assist them in coping with the challenges of labor.”

The ACNM notes that a blend of inhaled nitrous oxide and oxygen is used for pain relief in labor in many other countries, but it not typically available in the United States, where epidural anesthesia and systemic opioids are more common.

Potential benefits of nitrous oxide are outlined in the document, including the ability for a woman to self-administer via face mask, the ability to quickly administer or discontinue the gas, and the lack of known adverse effects on the woman, fetus, or progress of labor.

Concerns about potential adverse effects, especially from occupational exposure to the gas for health workers, are also detailed and addressed in the document.

ACNM concludes:

While nitrous oxide is not without side effects and will not be agreeable to or effective for every laboring woman, it is an inexpensive, simple, reasonably safe and effective analgesic. It is important that midwives know about nitrous oxide analgesia and be able to offer it to women during labor.

See our previous related posts and companion content on the topic for more information and discussion, as well as this archived chat with the author of “Birth Day: A Pediatrician Explores the Science, the History, and the Wonder of Childbirth.”

First, Dr. Mark Sloan, author of Birth Day: A Pediatrician Explores the Science, the History, and the Wonder of Childbirth, is chatting with readers online through February 21st via the LibraryThing website.

If you don’t have a LibraryThing account (they’re free), you’ll need to sign up first if you want to post questions or comments (you can browse the discussion without signing up). After logging in, scroll down the right side to “Author Chats” and select the chat with Mark Sloan. You’ll be able to post questions and comments, which Sloan is responding to – the author indicates that “all questions, comments, birth stories, new parent experiences, and hard-earned pearls of grandparental wisdom are welcome.”

I haven’t had a chance to read “Birth Day” yet – any readers have comments/reviews to share?

Second, the Baltimore chapter of the International Cesarean Awareness Network (ICAN) is seeking submissions for an art exhibit titled “Cesarean Voices,” which will be “the first of its kind in the country and will be an exploration of the issues surrounding cesarean birth.” Deadline for submissions is April 7, 2010, and artists should contact tiffanyaverill at hotmail dot com if they are interested in submitting artwork or have any questions. From the call for submissions:

We are accepting submissions for artwork to be shown in an ongoing installation to include original paintings, drawings, computer generated art, belly casts, poetry, and tapestries. Artwork must translate to the public the experience of having a cesarean either through your own or someone else’s eyes. In addition to cesarean art, the exhibit will feature an area called the “Birth Empowerment Zone” with artwork illustrating Ten Steps of the Mother-Friendly Childbirth Initiative (http://www.motherfriendly.org/mfci.php#step1) and Lamaze’s Six Care Practices that support having a natural and healthy birth. The six guidelines can be found at http://tinyurl.com/lumqx4

The complete call for entries is available for download [.doc file].

Last week, California Watch, a new project of the Center for Investigative Reporting, released a report describing an increase in maternal mortality in the state over the past decade.

The report shows that the number of California women who died from causes directly related to pregnancy nearly tripled in the past decade.  The report’s authors confirm that this is the most significant spike in pregnancy-related deaths since the 1930s. The findings have prompted enormous concern and many questions about why this is happening.

Dr. Elliott Main, the principal investigator for the California Maternal Quality Care Collaborative, the public-private task force investigating the problem for the state, acknowledged that only a modest amount of this increase was related to factors such as obesity among mothers, advanced maternal age, and infertility treatments. He said it was hard to ignore the fact that cesarean rate has increased 50 percent in the same decade that maternal mortality increased.

While changes in reporting may be responsible for some of the apparent increase, California Watch explains:

In 1996, the maternal death rate in California was 5.6 per 100,000 live births, not far from the national goal of 4.3 per 100,000. Between 1998 and 1999, the World Health Organization changed its coding system, which may have increased reporting of deaths. The California rate was 6.7 in 1998 and 7.7 in 1999. Because the number of mothers who die is small, the rate tends to fluctuate from year to year.

In 2003, when California revised its death certificate, the rate jumped to 14.6. And in 2006, the last year for which data is available, the rate stood at 16.9.

The best estimates show that less than 30 percent of the increase is attributable to better reporting on death certificates. Even accounting for these reporting and classification changes, the maternal death rate between 1996 and 2006 has more than doubled, Main said.

Although the number of deaths is relatively small — and pregnancy and birth are safe for the vast majority of women –  it’s more dangerous to give birth in California than it is in Kuwait or Bosnia.

It is difficult to understand all the possible causes for the increasing maternal death rate without more data available. California Watch notes, though, that “The California [California Maternal Quality Care Collaborative] task force isn’t waiting to determine the ultimate cause of these deaths. It has started pilot projects to improve the way hospitals respond to hemorrhages, to better track women’s medical conditions and to reduce inductions.” (In some hospitals across the country that have already introduced stricter limits on inductions with no medical indication, there is evidence of improved outcomes.)

California Watch notes that the California Department of Public Health has failed to release a report on the trend; initial findings on the increasing maternal mortality rate were presented at a 2007 conference, but a more formal report has been under review since 2008, according to the piece. The Department’s the department’s director of public affairs has responded that “There was no effort to hold that report back. It just needed some more revisions.”

The CA Department of Public Health has released a couple of graphs of basic trend data, one showing an increase in maternal mortality in California over the last 10 years that is greater than the increase in the U.S. overall, and a second showing an increasing rate of maternal mortality for Black women (37.6 per 100,000 live births in 2002-2004) that is much higher than that for Hispanic (11.9), Asian (10.4), and White Non-Hispanic (11.9) women.

For readers around the D.C. area: the National Library of Medicine’s History of Medicine division in Bethesda, MD will run an exhibit through June of this year on the history of African American “granny” midwives. Details below:

Nothing To Work With But Cleanliness: African American “Grannies”, Midwives & Health Reform

For over three centuries, African American midwives delivered babies and practiced folk medicine in rural counties throughout the South. Midwifery came under public scrutiny in the 1910s when progressive reformers blamed the “unsanitary practices” of midwives for the higher rate of maternal and infant deaths. During the next two decades reformers campaigned unsuccessfully to eliminate the practice of midwifery. There simply were not enough skilled physicians or hospital facilities in southern rural communities. Poverty and pervasive racial discrimination also made home births more desirable than hospital deliveries to many of the African American families living in rural counties.

Training midwives was deemed the only viable solution in the South where African Americans midwives were predominate. Midwives received instruction from public health nurses during annual state-sponsored institutes and monthly local midwives clubs. Classes, which emphasized sanitary delivery practices, were taught by demonstration, songs and role playing. From the 1920s through the 1960s this next generation of midwives continued in the tradition of their “granny” predecessors with the added benefit of scientific knowledge.

Through photographs and artifacts, the exhibit tells the story of “granny” midwives and the state and local training programs that educated them and succeeding generations of midwives.

The exhibition, inside and outside the NLM History of Medicine Division Reading Room, Building 38, first floor, runs from February 2010 to June 2010. All are welcome to visit, 8:30 AM to 5:00 PM weekdays, except federal holidays.

Directions, security, parking, etc.: http://www.nlm.nih.gov/hmd/about/visitus.html

For more information: Sheena Morrison, sheena dot morrison at nih dot gov 301.402.8847

[hat tip to a LinkedIn post by Jeffrey Reznick, Deputy Chief, History of Medicine Division, US National Library of Medicine, National Institutes of Health]

Following financial struggles and a move by another hospital system to take over, St. Vincent’s Hospital in Manhattan is in danger of closing.  The proposal  has met with community protest, primarily because, as one article notes, “St. Vincent’s treats a disproportionate number of poor, homeless and uninsured patients, who could be forced to go elsewhere for emergency and inpatient care.”

The potential closure has caught the eye of birth choice advocates, as St. Vincent’s houses the The Eli & Abby Manning Birthing Center, created last year to improve birth options at the facility.

According to Choices in Childbirth, St. Vincent’s is:

…currently the only hospital in the City that we know of that is taking strides toward lowering the C-section rate and offering women the option of birthing on their own time. The head of OB, Dr. Mussalli, and his partner Dr. Worth have spent the last year turning things around at St. Vincent’s; introducing the option of birth tubs, providing a home for in-hospital midwifery practices and supporting the homebirth option by signing off on written practice agreements for many of our homebirth midwives and acting as their back-up hospital when transfer from home is necessary.

The organization provides the following suggestions for those interested in becoming involved in the issue:

How you can help:
1. Please visit the new website: www.savestvincents.com and help in whatever ways are at your disposal. Here you can share stories of what St. Vincent’s has meant to you as a parent, provider, or community member. You can also write letters to elected officials

2. Choices in Childbirth is hosting a brainstorming/strategizing meeting for concerned members of the birth community in response to the potential closing of St. Vincent’s Hospital. Drs. Mussalli and/or Worth will attend as well. If you’re interested in getting involved please come to this meeting or contact us at Choices in Childbirth if you’re unable to attend.

Tuesday, February 2
6:45 P.M.
859 Broadway, 3rd floor
@ 17th street
(trains to Union Sq)

Please RSVP to laure at choicesinchildbirth dot org

A special supplement of the journal Women’s Health Issues highlights two new reports published by Childbirth Connection:  “2020 Vision for a High Quality, High Value Maternity Care System” and “Blueprint for Action.”

The reports result from “an extensive multi-year collaboration with more than 100 maternity care leaders representing industry stakeholders – from hospitals and health plans to consumers and providers” with the purpose of “creat[ing] a framework for revamping maternity care in the US and advancing health care reform.”

Freely available online, the 2020 Vision document describes core principles and beliefs about maternity care and goals for care during pregnancy, around the time of birth, and after birth. Examples of values outlined in the document include practicing evidence-based care, supporting physiologic birth, using performance measurement, and supporting shared decision-making and choice.

The Blueprint for Action document, also freely available, provides more specific recommendations for action, including payment reform, reduction of disparities, altering the maternity care workforce composition and distribution, altered approached to liability, focus on resolving clinical controversies, conduct of comparative effectiveness research, better coordination of maternity care, and many others.

Overall, the documents provide an outline for reform of the maternity care system to support evidence, choice, cost-effectiveness, and safety, with recommendations for action and identification of key players for reform at each step, somewhat in the style of the Healthy People model for setting decade-long health system goals. The numerous specific recommendations contained in the documents are a lot to digest, so we appreciate reader responses in the comments.

Our Bodies Ourselves, like many other birth organizations and activists, has long believed that all birthing women should have access to midwives and to a midwifery model of care. A new video, “Why Choose a Midwife?” provides an overview of this model and serves as an advocacy tool for midwifery.

Our own Judy Norsigian was interviewed for the piece, and explains the Our Bodies Ourselves position on choices in childbirth:

We want to have more women having vaginal births after cesarean available in the hospital setting, we want to have more certified nurse midwives in the hospital setting, we want to have more trained, licensed midwives in the home birth setting.

She also acknowledges a woman’s right to make her own educated decisions with regard to childbirth, explaining that “women and their partners choose the risks they want to take when they choose a home birth or they choose a hospital birth.”

Other topics covered in the 12-minute film include safety, home birth, the problems with some routine hospital interventions, the attention provided by midwives, cost, and choice. Also featured are Gene DeClerq, PhD (Boston University School of Public Health) and Marcie Richardson, MD (a Massachusetts Ob/Gyn), with additional footage graciously provided by other filmmakers. A volunteer film editor, with guidance from a group of volunteers from Our Bodies Ourselves and Massachusetts Friends of Midwives, created the piece.

Although the film is somewhat focused on Massachusetts, those interested in adapting the video for their communities can contact June Tsang at junetsang23 at gmail dot com.

Technical difficulties: We apologize, but needed to take the video down at this time.

Oral arguments began this week in the Florida case of Samantha Burton, a pregnant woman who visited her doctor when she was 25 weeks pregnant with signs of a potential miscarriage. The doctor ordered bed rest, which Burton declined with the intent of seeking a second opinion, as her two job and two existing young children made bed rest a difficult prospect. The doctor then contacted the state.

According to the New York Times:

She was ordered to stay in bed at Tallahassee Memorial Hospital and to undergo “any and all medical treatments” her doctor, acting in the interests of the fetus, decided were necessary. Burton asked to switch hospitals and the request was denied by the court, which said “such a change is not in the child’s best interest at this time.” After three days of hospitalization, she had to undergo an emergency C-section and the fetus was found dead.

I am appalled. But I am not surprised.

The NY Times points to an ACLU rep’s statement at Daily Kos which neatly sums up the problem:

Don’t get me wrong — of course I want pregnant women to follow their doctor’s advice. But I do not think that pregnant women should be confined against their will if they are unwilling or unable to do so. If we allow the government to confine a pregnant woman for not following orders to remain in bed, what’s next? Will we forcibly hospitalize pregnant women for having a glass of wine with dinner? Or eating too much fast food? What if they don’t take their prenatal vitamins? Or miss their doctor’s appointments? What if a pregnant woman refuses a cesarean section? While we each may have strong opinions about such behaviors, our government cannot interfere in a woman’s personal private medical decisions. Allowing the government to make medical decisions for pregnant women means that literally every decision and every activity a pregnant woman engages in could be regulated by the state.

Of course, our government DOES interfere with a “a woman’s personal private medical decisions” — just look at abortion laws –and this case is just one more example.

The same values that lead to restricting women’s choices about following medical advice also affects the choices women have in birth. Many hospitals will not allow vaginal births after cesareans or allow women to chose whether they are continuously monitored, implying that the “only thing that matters” is getting a healthy baby at the end, and that the woman’s “experience” does not matter. In such a framework — where women’s desires are readily ignored (and made to seem trivial) –  court intervention with regards to bed rest does not seem extreme. We have already seen cases in which court-ordered cesareans have occurred.

In this case — as in abortion and birth choices –the fetus is prioritized. A woman’s bodily autonomy and preferences for how her pregnant body is treated and used are held secondary to fetal outcomes. People other than the individual woman are allowed rights to control her reproduction.

The ACLU argued in its amicus brief [PDF] on the case that such interference “invites State requests for court intervention in nearly all aspects of pregnant women’s behavior and medical judgments,” and may discourage women from seeking care. “In turn, some women will be discouraged from coming to a hospital for pregnancy care if they know that any disagreement may lead to forced medical treatment.”

Archives of the oral archives should become available soon at available at the website of the Florida 1st District Court of Appeal.

Jill at the Unnecesarean also has a couple of posts on the case. For more on issues related to the rights of pregnant women generally, see the National Advocates for Pregnant Women.

[adapted from a post at Women's Health News]

Last week, the U.S. Food and Drug Administration announced the creation of a new research program, dubbed the “Medication Exposure in Pregnancy Risk Evaluation Program” (MEPREP), to study the effects of prescription drugs used during pregnancy.

In explaining the need for such research funding and initiatives, the agency states:

About two-thirds of women who deliver a baby have taken at least one prescription medication during pregnancy according to a journal article published in the American Journal of Obstetrics and Gynecology. There are very few clinical trials that test the safety of medications in pregnancy due to concerns about the health of the mother and child.

In order to gather such information, the FDA will collaborate with researchers to analyze data on prescription drug use and pregnancy outcomes from 11 sites of the HMO Research Network Center for Education and Research in Therapeutics, Kaiser Permanente’s multiple research centers, and Vanderbilt University (this blogger’s larger workplace).

The National Women’s Health Information Center provides further information on the use of prescription and OTC medications in pregnancy, including the current labeling categories applied to prescription drugs to indicate what is known about using them during pregnancy.

In 2008, the FDA proposed a rule change that would eliminate these somewhat unhelpful letter categories (A, B, C, D, and X) in favor of adding a “Pregnancy” section to drug labels with a risk summary and more clear information about available data on use of the drug during pregnancy and breastfeeding. A public comment period was held on the proposed rule, but it does not appear to have been finalized yet.

See also: Strollerderby post on the announced drug studies; the FDA’s info for consumers on the proposed labeling change; LactMed (search for information on specific drugs and breastfeeding); fact sheets on drug exposures during pregnancy and lactation from the Organization of Teratology Information Specialists; and Motherisk’s publications on drugs in pregnancy.

Boston’s NPR news station, WBUR, recently featured a program on midwives, “Midwifery in Massachusetts” (archived online).

The almost hour-long segment, which aired on the program “Radio Boston,” addresses why some people choose home births and/or midwifery care; the ongoing discussion in Massachusetts about the regulation of midwives; and related birth issues such as malpractice insurance, c-section rates, cost and birthing centers.

A bill pending in the Massachusetts state Senate calls for the creation of a state board that would regulate and license Certified Nurse Midwives (CNMs), Certified Midwives (CMs) and Certified Professional Midwives (CPMs).

The program also features two Massachusetts commenters: Dr. Angela Aslami, an OB/GYN who does not support home births and does not believe CPMs should do deliveries, and Dr. Gene Declerq — Boston University School of Public Health professor and a technical adviser on the documentary film “The Business of Being Born” — who believes home births can be an acceptable option. Peggy Garland, a CNM who helped draft the licensing board legislation, was also a guest. The program includes listener comments and questions.

Our own Judy Norsigian, OBOS executive director, commented on the program’s website in support of expanding access to midwifery care.

“The key issues here have to do with preserving safe, optimal choices in childbirth for women and their families,” wrote Norsigian, pointing to this Choices in Childbirth statement signed by hundreds of physicians, midwives and other maternity care experts.

Norsigian also notes that OBOS is collaborating with Massachusetts Friends of Midwives (MFOM) and other groups to produce an 11-minute film  to educate Massachusetts legislators about the benefits of the proposed midwifery legislation. The DVD will be available through OBOS’s website by mid-January 2010. She concludes:

After OBOS produced our latest book (“Our Bodies, Ourselves: Pregnancy and Birth”) in March 2008, I had the unique opportunity to speak with hundreds of doctors, midwives, and community members in more than 50 cities across the country. It is exciting to see greater community activism trying to expand access to midwives in all settings. This will reduce the obscenely high cesarean section rate in this country, improve outcomes for both mothers and babies, and could also save millions of dollars now spent on inappropriate obstetrical interventions that actually worsen rather than improve outcomes.

The College of Physicians and Surgeons of British Columbia (Canada) is the licensing and regulatory body for all physicians and surgeons in the province. As such, its mission involves establishing and enforcing standards for medical practice in the region, and the College publishes resource manuals with policies and guidelines to inform and direct providers.

The College recently approved a new resource manual on planned home birth [PDF] in British Columbia. It begins:

The College supports a woman’s right to personal autonomy and decision making in obstetrical care. When a woman is considering planned home birth, physicians play an important role in providing advice and information so that it is an informed choice, considering all the benefits and potential adverse outcomes. [emphasis added]

The manual goes on to explain factors to consider, such as previous cesareans, unpredictable complications, and the availability of emergency services.  Canada requires that midwives be licensed, and the manual includes the advice that “Physicians involved in planned home births need to ensure that they have appropriate knowledge, training, equipment and understanding of the assessments necessary in planned home delivery.”

I’m still stuck on that one explicit statement, “supports a woman’s right to personal autonomy…” For contrast, see our previous discussion on the AMA’s homebirth resolution and birth choices.