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Updated ~ Friday December 02, 2005 19:51 

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  Newly Posted Letters

 #12    Megan Roy, July 5, 2004

 #11    Keri Claussen, July 2, 2004 

 #10   Renee S. Anker, L.M., Chair July 1, 2004

  # 9    Lilah Monger

  # 8    Kathryn Newburn, CNM -- June 30, 2004 

  # 7    Holly Mathews -- Mothers Day letter,  June 29

  # 6    CEO -- California Coordinator -- Mothers Day letter, June 28 

  # 5    On Episiotomy -- June 23 

  # 4    On Health Insurance -- Jun 17

  # 3    Sandy Caldwell -- Mothers Day letter, June 15

  # 2    Karen Ehrlich, LM, CPM -- Mothers Day letter  2004

  # 1    CCfHF/ Frank Cuny -- Mothers Day letter, May 17


Letter #1
California Citizens for Health Freedom
8048 Mamie Avenue, Oroville CA 95966-8214 ~ Phone:530.534.9758 ~ Fax:530.534.5854
              E-mail: Freedom@citizenshealth.org  ~  Website:
www.citizenshealth.org
~ -------------- ~ ----------------- ~ ------------------------------ ~ ----------------- ~ --------------- ~

Advocates for citizens’ access to the broadest safe and effective options in health/medical care…

                                              Frank Cuny, Executive Director                  

                Maria Shriver
                Office of the First Lady
                State Capital
Building
                Sacramento, CA 95814

                                                     May 17, 2000

        Dear First Lady,

This letter is on behalf of the Consortium for Evidence-base practice of Obstetrics (C.E.O.). Our citizen organization (California Citizens for Health Freedom) is a member of the C.E.O. The goal of this new consortium is to establish physiological management as the standard of care in California for all healthy women with normal pregnancies.  

The books The American Way of Birth & The Thinking Woman’s Guide  to a Better Birth  will hopefully serve as a positive introduction to why the physiological management of birth is an important issue to women and a challenge to the current view that childbirth in a healthy woman is not a normal process, but instead is a medical or surgical procedure.

Were physiological management of birth to becomes the standard of practice in California, like it is many other western nations,  C.E.O. members believe that it would :

In order to assist you in understanding this important issue we are inviting mothers to mail you letters about their positive experience of physiologically-managed labor and birth and others to recount their negative experience with the current medical model of intervention in normal birth. 

We believe that you, as a mother and an author of children’s books, will take an interest in this issue. We hope you will be open to having a representative of the CEO meet with you to share their perspective.

                     Sincerely

                     Frank Cuny
                     Executive Director

a 501-C-4 non-profit corporation specializing in  legislative advocacy


Letter #2

Karen Ehrlich, CPM, LM
11120 Oceanview Avenue

Felton, California  95018
831/335-9388 (message 425-3326)

Mother’s Day, 2004

Maria Shriver
Office of the First Lady
State Capital Building
Sacramento, CA  95814

Dear Ms. Shriver

I saw a recent appearance of yours on the Oprah Winfrey Show.  In it, you were discussing with Oprah that you aren’t sure what your mission should be as California’s First Lady.

May I suggest an incredibly important mission—one that is central to your passion for motherhood, children and family life?  That issue is how labor and birth are treated in conventional obstetrical care in California, and indeed throughout the U.S.—in ways that are not based in science, and raise the cost of childbirth care to staggering proportions of our budgets.

Medicalization of normal, healthy women is rampant in modern obstetrics.  If this medicalization improved outcomes for mothers and babies, those of us who have fought for years for a simpler approach to childbirth wouldn’t have much to make noise about.  However, the way modern obstetrics delivers maternity care does not improve outcomes for healthy women and their babies!  The United States stands a shameful 25th in the world for infant mortality.  And in recent years mortality for mothers, and in 2002 for newborns, has actually risen in our wealthy country, which pours more money into obstetrical services than any other in the world.

You will likely be receiving quite a few letters from those who, like me, are deeply concerned that the onslaught of ever-increasing medicalization is not based in science.  We hope that you will seriously consider taking on this crucial issue as intrinsic to the health of mothers and their children that you champion so fervently.

For more information on our campaign to take back normal birth, go to <http:// www.ScienceBasedBirth.com 

Sincerely

Karen Ehrlich, CPM, LM
Midwife


Letter #3

June 15, 2004

Sandy Caldwell
17 Foss Drive

Redwood City
, CA 94062-3027

Maria Shriver
Office of the
First Lady
State Capital Building

Sacramento, CA 95814

Dear First Lady Shriver,

I am the mother of three grown daughters who are all of childbearing age.  Two of my daughters were born at home and one in the hospital. I gave birth to them over 25 years ago in a normal, uncomplicated way.

Several years ago I rethought my own career as a marketing executive and determined that I wanted to do something that would have more meaning for me.  I learned about childbirth support assistance (birth doula) and happily took the necessary steps to certify with Doulas of North America.

My early experiences with supporting laboring women in a hospital setting truly opened my eyes and I was shocked by what I saw.  I saw a woman being instructed to push so hard at the moment of birth that I felt sure she would tear (she did).  I saw women restricted to certain positions for actual birth that made it hard for them to birth their children in a normal, physiological way.  I saw women scared into accepting certain procedures such as cesarean birth, because their babies showed distress signals on the monitors.  These babies were born completely healthy.  I listened as residents told women they weren’t progressing quickly enough (one centimeter an hour) and so would need Pitocin to speed things up.  This increased these women’s distress and difficulty in giving birth normally.

Needless to say, I saw that there is a prevailing fear-based environment in many of the doctor practices and local hospitals that limited options for these women.  I saw that may own daughters, should they decide to begin families in the SF Bay Area, have no optimal choices, only the lesser of bad choices if they choose to stay within the current medicalized care offered by most physicians and hospitals.

Many of my friends are local businesswomen who do not have children or whose children are grown.  In discussions with them I observe that they are unaware that women’s rights regarding their health care are being eroded by the non-scientific practice of obstetrics and by the insurance companies who seem to be the ones calling the shots on various options for pregnant and laboring women.  It’s not until a woman is pregnant that the awareness of the erosion of rights and options begins dawn in her mind.

As First Lady, I ask that you make providing evidence-based, safe and affordable wellness care for women from pre-conception through birth (and beyond!) a priority and focus of your great influence.  I ask you to support the development and integration of trained and experienced midwives (as done in many westernized countries) into our health care system to increase physiological, safe birth and the accompanying satisfaction and decrease health care costs.  Doing so has proven to lower the incidence of maternal and infant mortality in many other countries around the world.

Please go to http://www.sciencebasedbirth.com/ for more information on the current situation and how you can help.  I would appreciate your taking time to meet with the leaders of the Consortium of Evidence-based Obstetrics and California Citizens for Health Freedom by contacting Donna Russell, 530.534.9758 or info@sciencebasedbirth.com so that you can hear first-hand what’s happening and how you might best help create California as a national leader in reforming poor and common obstetrical practices, restoring physiological birth, reducing health care costs and increasing satisfaction with birth.  Doing so will aid in the development of healthy families.

With great sincerity and warm regards,

Sandy Caldwell CD (DONA)

650.261.9171


Letter # 4

17 Jun 2004

Jill Herendeen" <jherendeen@onemain.com>

Dear CEO Coordinator,
 
         I  have spent years puzzling over why health insurance companies don't care about saving money by hiring midwives.  Here is my theory--which "clicked" after I'd read an article on "tort law" and the federal judge's summary in the Lange-Kessler case, upholding the 1993 NYS PMPA, which makes independent midwifery in NY a crime. 

        Insurance companies will NEVER lose money, because they can raise their rates eternally.  If they were losing money, they would go out of business. When consumers stop buying health insurance because it's too costly, the insurance companies go whining to the government for subsidies, complaining that ordinary people can't afford health care anymore, and of course the politicians hasten to comply, wanting to be seen as being in favor of "health care" when, in fact, health INSURANCE is NOT synonymous with health CARE (and maternity care, is all too often the antithesis of CARE), though both politicians and health insurers obfuscate this fact by using the two phrases interchangeably, as if they were the same thing. I suspect that health insurers and hospitals cut deals. And besides, it is in the direct interest of health insurers that health CARE be seen as something that would not be affordable without health INSURANCE, so that people will buy health INSURANCE in the hope of getting health CARE.  If people could afford decent health care on their own, they wouldn't need to buy insurance.
 

          Most people seem to believe anything their doctor tells them, refusing to believe that the doctor would either lie to them, or withhold information which could significantly affect their health and emotional well-being.  They refuse to believe that doctors make decisions based on MONEY rather than HEALTH.  The doctors are just victims of the "Standard of Care," the need to keep their jobs and perhaps they've been lied to by the medical schools, which are also out to make money, otherwise why wouldn't they be teaching the scientific evidence?  I suspect most women WITH insurance trot complacently off to the hospitals because they have insurance and that's all it'll pay for and they don't know anything else. 

        If women are too poor to have insurance, they know that the hospital/Medicaid/state (depending on which state they're in) will pay for the birth, and they don't know anything else.  If the birthing experience turns out to be rotten, they either are suckered into believing that that's the way it necessarily is, or they curtail their childbearing.  The most effective methods of birth control are only available from OBs, so OBs stay in business either way.  Since studies have proven that c-section rates plummet when c-sections are paid for at the same low rate as vaginal births, then our obscene c-section rate is, in fact, a subsidy for hospitals and the part of the economy which depends on them.

 

         By contrast, most of the countries with the excellent birth outcomes & low c-section rates due to independent midwives as primary maternal caretakers ALSO have socialized medicine, so that cost IS a national issue.  (Maybe those countries don't have any health insurance industry, and fewer tort lawyers.)  Also--and I think Marsden Wagner mentions this in PURSING THE BIRTH MACHINE--birth is a no-fault event in those countries.  Doctors don't sweat constantly about being sued, and parents don't sweat about how they're going to pay for extra medical expenses if things go wrong.  Nobody faces the threat of living the rest of their lives in poverty due to a birth with a non-optimal outcome--which is something that nobody can guarantee won't happen, even with the best efforts on everyone's part.  Maybe simply the reduction in anxiety contributes to better birth-outcomes.
 
         Its true that the truth has only to be revealed--BUT the powers-that-be who have their hands in each others' pockets are not going to change anything regardless of how many tons of truth anyone throws at them.  I see only two possibilities for change:  A) women will become sufficiently wary and avoid hospitals in SUCH a big way that hospitals will change things, or B) the U.S. will have socialized medicine which, seeing how well Congress has been avoiding this and for how many decades, will probably require either a revolution OR complete campaign-financing for for those running for Congress, which in turn will probably also require a revolution, as Congress keeps avoiding this also.  Am I wrong?  Am I missing something?  This is supposed to be a democracy!   Naomi Wolf sort of cracked me up, going on and on about how mothers aren't cared-for, even by their nearest and dearest, much less the government, and taking it out on themselves and ACCEPTING it. 

        Maybe women should keep their pants on and DEMAND support BEFORE they have sex!  But why, in the richest (supposedly) country on earth, should this be necessary, when poorer countries manage?  (Presumably they save enough money having better outcomes to pay for some of the cost of keeping people healthy.)  People who really care about the health of women and babies should be able to vote/lobby/demonstrate/boycott enough to DEMAND change. Or, they should become rich enough to be able to pay whatever good care really costs. Or, they could work together with their families and/or neighbors and care for each other on a cooperative basis, without money changing hands at all.  I don't claim to know which solution would be best.  I think any of them would be better than what we've got now, but hey, some people might think it's better to just drift through life without being forced to use their brains, and let smarter or more aggressive people take advantage of them and define reality for them. 

 
Best wishes,
 Jill Herendeen  (Yes, by all means, e-mail me if you want to discuss this!)

Letter #5

ankara <ankara@baynet.net>

6/23/2004

Dear CEO coordinator,

The following organization in France has begun litigation for assault [episiotomy] and a campaign to ensure that all women are in control of their own bodies. It's time for the USA and Canada to get on board - to state one's refusal in writing prior to admission (an "advance directive") to any and all procedures and to ensure that laboring women are consulted rather than assaulted.

The litigation is long overdue - it will serve us all and those who follow will be armed with the right to refuse [before it's too late].

Stéphanie  St-Amant <st-amant.stephanie@courrier.uqam.ca>
Date: Thu Jun 10, 2004  9:21:49  AM America/New_York
Subject: Re: L'episiotomie est-elle une mutilation genitale?

Some ressources in english against episiotomy:
        aims.org.uk
        www.fraternet.org/afar/mdf.htm
        www.fraternet.org/afar/episiotomie-conf-beverley.pdf
        www.birthlove.com/free/rape_complimentary.html
        birthingnaturally.net/barp/episiotomy.html


Letter # 6

Consortium for the Evidence-based practice of Obstetrics
American College for Evidence-based Obstetrics
3889 Middlefield Road
Palo Alto, CA
650 / 328-8491

California First Lady Maria Shriver

Office of the First Lady
State Capital Building
Sacramento, CA 95814

Mothers’ Day 2004 Letter

RE: (1) Bringing the attention of the public and the legislature to the profoundly dysfunctional and economically wasteful nature of the current obstetrical system for healthy women

(2) Establishing a forum for public dialogue with obstetricians on the potentially harmful & unscientific practices of contemporary obstetrical care, especially as applied to healthy women

To First Lady Maria Shriver:

We’d like to introduce you to the Consortium for the Evidence-based practice of Obstetrics (CEO) and enlist your support in achieving its mission as stated above. You have publicly affirmed the important but difficult role of mothers and children in our society and expressed interest in supporting this cause. We concur and share your hopes and dreams on behalf of California families and the mothers that are so central to the wellbeing of their families.

The Consortium for the Evidence-based practice of Obstetrics is a new and broadly based organization of consumers, taxpayers and childbirth and public health professionals. Our membership is acutely aware of the many serious problems that healthy women with normal pregnancies face finding appropriate care in a dysfunctional maternity care system that fails to meet the needs of healthy childbearing women, practitioners, taxpayers or society. 

In response to these problems, CEO is committed to reforming our maternity care policy and dedicated to bringing science-based maternity care to all childbearing women. A_CEO is an affiliated group for physicians who wish to re-establish the scientific foundation of their profession and reclaim their expertise in the use of physiological management for normal birth.  

The CEO web site is www.SciencebasedBirth.com. In addition to the scientific literature cited on the CEO web site, additional scientific research confirming the assertions of CEO is published by the Maternity Center Association of NYC and available @ www.maternityWise.org.

CEO’s kick-off political activity began on Mothers’ Day 2004 and is a letter writing campaign to you as California’s First Lady. We ask that you extend your influence as First Lady to the following:

(1)   Bringing about public discourse thru legislative hearings that address the ever-climbing induction, cesarean section and maternal mortality rates, the off-label use of Cytotec for labor induction, the danger of promoting the ‘maternal choice’ cesarean as the so-called ‘ideal’ form of childbirth, lack of access to VBAC services and the physically damaging effects on the pelvic floor and pelvic organs associated with the current, medically-interventive & anti-gravitational management of vaginal birth

(2)    Facilitating passage of legislation mandating that physicians obtain true informed consent before substituting medical and surgical interventions in place of the safer, evidence-based principles of physiological management and that full information be provided about the risks of medical or surgical interventions and the mother’s consent obtained before being used during labor

Current Political Realties

 

Healthy childbearing families, post-cesarean mothers, hospital-based nurse-midwifery programs and professional midwives of all backgrounds face extremely serious problems under our highly politicalized and deeply dysfunctional obstetrical system. Interventionist obstetrics as applied to virtually all healthy women introduces artificial and unnecessary harm. At present, the obstetrical profession systematically fails in its most important job -- to preserve and protect already healthy childbearing women, which is 70% of the childbearing populations.

 

A healthcare system that over treats three-quarters of its patients is both expensive and dangerous. According to the scientific literature and vital statistics records, conventional obstetrics exposes healthy mothers and babies to unnecessary physical and mental suffering and increased rates of preventable death and disability. The medicalization of vaginal birth causes stress incontinence and other long-term problems. Another area of extreme concern is the ever-increasing Cesarean and maternal mortality rate and the issue of non-consensual obstetrical treatments and procedures and mandatory cesareans for healthy women with unusual circumstances.

 

False & Outrageous claims by A_COG
 

Recently the obstetrical profession has veered even further from common sense and science-based maternity care. The American College of Obstetricians and Gynecologists’ (A_COG) is publicly claiming that Cesarean section is safer and better for mothers and babies than normal spontaneous birth. An October 31, 2003 a press release by A_COG announced a decision by their Ethics Committee that it was now considered "ethical" for obstetricians to perform purely elective – that is, medically unnecessary or so-called “maternal choice” cesarean surgery. Substituting a euphemistic term like “maternal choice” can’t negate the danger and pain of major abdominal surgery. The obstetrical profession fails to see the connection between the routine use of drastic interventions in normal birth and damage to maternal tissue. Convinced as they are that pelvic floor dysfunction is merely the unpreventable “collateral damage” of vaginal birth, many obstetricians predict that cesarean will completely replace normal birth within the next 10 or 15 years as the official standard of care.

 

Forty percent of all childbirth services are paid for out of public funds. Interventionist obstetrics misdirects approximately 14% of our total health care budget (2.4% of GNP) to healthy women. It also systemically creates expensive, often long-term iatrogenic complications. This is a fiscal disgrace that reduces medical services to the ill, injured and elderly; the increased tax burden and inflated cost of employee health insurance also reduces job growth and the ability of California businesses to compete in the global economy.

 

Most of all, this is a crisis for our daughters, granddaughter and all young women who face the very real possibility that they will never even have the chance to have a normal vaginal birth or if they do, they will be permanently harmed as a result of the faulty understanding of normal birth by the obstetrical profession and the massive use of damaging medical and surgical interventions, episiotomy and instruments such as forceps or vacuum extraction.

 

Criticism of these serious systemic problems is not meant as a criticism of individual obstetricians, many of whom do a superhuman job under very trying conditions. Physicians too have been victims of organized medicine’s historical agenda to discredit physiologic principles. Since 1910, medical students have been taught that normal birth was a “nine month disease” that required a medical and surgical “cure”. As a result, medical educators did not teach the principles of physiological management to medical students and OB residents. As practicing physicians, obstetricians are unable to use the strategies of physiological management due to lack of training and experience and because our tort laws require physicians to do only what other physicians of the same specialty are doing. Obstetrical practice is defined by A_COG, which universally promotes a highly medicalized and interventive style as the official “standard of care”. Obstetricians who fail to intervene do so at their peril, as they are vulnerable to lawsuits and loss of their medical license for providing so-called negligent or “substandard” care.

 

Truth does not need to be defended, only revealed

Physiological management is the evidenced-based model of maternity care. It is associated with the lowest rate of maternal and perinatal mortality, is protective of the mother's pelvic floor, has the best psychological outcomes and the highest rate of breastfed babies. Use of physiological principles results in the fewest number of medical interventions, lowest rates of anesthetic use, obstetrical complications, episiotomy, instrumental deliveries, Cesarean surgery, post-operative complications, delayed and downstream complications in future pregnancies.

By comparison, conventional obstetrics as applied to healthy women is the opposite of evidence-based, physiological management. Its associated with high levels of medical intervention, obstetrical complications, anesthetic use, instrumental deliveries, Cesarean surgery and post-operative complications including emergency hysterectomy, delayed complications such as stress incontinence and pelvic organ prolapse, downstream complications in future pregnancies such as placental abnormalities and stillbirths, long-term psychological problems such as postpartum depression, lower rates of breastfeeding and increased rates of asthma in babies born by cesarean section. Conventional obstetrics for healthy women is neither safe nor cost-effective.

A long over-due, and much needed reform of our national health care policy would integrate physiological principles with the best advances in obstetrical medicine to create a single, evidence-based standard for all healthy women. Physiological management should be the foremost standard for all healthy women with normal pregnancies, used by all practitioners (physicians and midwives) and for all birth settings (home, hospital, birth center). This “social model” of normal childbirth includes the appropriate use of obstetrical intervention for complications or at the mother’s request.

The most efficient response to the dangerous disconnect between science and the obstetrical arts would be recognition by A_COG that physiological management is the evidence-based model of maternity care for healthy women and therefore, the official A_COG standard for this population. This would prompt medical schools to teach the philosophy, principles and skills of physiological management to medical students, practicing physicians to learn and use the strategies of physiological management and insurance companies to reimburse obstetricians for this safe and cost-effective care. For this to occur, we need a fundamental change in the public discourse and political dynamics between citizens, A_COG and other representatives of organized medicine.

On behalf of mothers and babies and the membership of CEO, I ask for whatever assistance you may be able to offer in this regard. I look forward to your reply.

Faith Gibson, California Coordinator, CEO / A_CEO


Letter # 7

Holly Mathews
1556 Plateau Ave. Apt #1
Los Altos Hills, CA 94024

Maria Shriver
Office of the First Lady
State Capital Building
Sacramento, CA 95814

RE:  Reforming Maternity Care,
        Holding Public Hearings about Obstetrical Excesses
 

June 29, 2004

Dear Ms. Shriver,

I am a new member of the Consortium for Evidence-based practice of Obstetrics and convinced that the way obstetrical care is provided to healthy women is a bad system. It needs to change as soon as possible. Let me tell you why.

I haven’t had children myself yet but my mom had all three of us normally, without drama or trauma. The same is true for other, older relatives. I’ve seen normal births with midwives. Now my women friends are having babies. I am appalled at the many interventions and problems that they all describe. How can every one of my healthy friends, each with a perfectly normal pregnancy, have so many problems? Out of ten new babies, not a one of them had a simple “normal” birth. Although none of them or their babies had any serious medical problems, all but one was induced. They were usually told that being induced was easier or better than waiting for labor to start naturally. Their OBs said a lot of things but a truthful description of the facts didn’t seem to be one of them.

As a long-time friend, I was with several of them in the hospital during labor and what I saw was very upsetting. Being induced seems like a really hard way to have a baby. It means having many different tubes and needles put in your body, wires strapping you down to the bed, not being allowed to get out of bed or eat or drink anything and lots of pain. For some of them, this went on for more than 2 days. After days and nights of labor, no food and no sleep, they were told to push their babies out uphill, while lying on their back. Most of my friends weren’t strong enough to do that. It seems that doctors don’t know much about the laws of gravity either.

Out of my ten friends, all had epidurals, six of them had episiotomies and stitches, three had unexpected C-sections, 2 had a vacuum or forceps used, and one of them got an infection in her stitches. One of babies broke its collar bone during the birth and was in the NICU for several days. Their hospital bills were at least $20,000 dollars and that didn’t count the C-sections or the baby with the broken bone. Maybe my friends were just unlucky but it seemed to me that the care they received made things harder and actually caused many of these problems.

I don’t know exactly how to fix this but somebody needs to do something. Obstetricians need to hear from women and explain why, after 14 years of medical school, they can’t simply deliver a baby without doing major painful stuff to the mother. I know many midwives and they do simple normal births all the time, so a woman’s pelvis must still work OK. Why can’t doctors learn how to deliver a baby normally? Let them explain that in a public hearing.

Thank you,
Holly Mathews 


Letter # 8

June 30, 2004

Dear Maria Shriver,

 
As a certified nurse midwife, I am committed to providing women safe and healthy choices in regards to their maternity care. 

 I beseech you to carefully read the research related to nurse midwives, and I hope that you will support the autonomous role midwives deserve when providing such excellent care to women and their families.

 
Sincerely,
Kathryn Newburn, RNP, CNM, PHN
Burlingame, CA

Journal of Epidemiology and Community Health, Vol 52, 310-317

Midwifery care, social and medical risk factors, and birth outcomes in the USA

MF MacDorman and GK Singh
Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, MD 20782, USA.

STUDY OBJECTIVE: To determine if there are significant differences in birth outcomes and survival for infants delivered by certified nurse midwives compared with those delivered by physicians, and whether these differences, if they exist, remain after controlling for sociodemographic and medical risk factors. DESIGN: Logistic regression models were used to examine differences between certified nurse midwife and physician delivered births in infant, neonatal, and postneonatal mortality, and risk of low birthweight after controlling for a variety of social and medical risk factors. Ordinary least squares regression models were used to examine differences in mean birthweight after controlling for the same risk factors. STUDY SETTING: United States. PATIENTS: The study included all singleton, vaginal births at 35-43 weeks gestation delivered either by physicians or certified nurse midwives in the United States in 1991. MAIN RESULTS: After controlling for social and medical risk factors, the risk of experiencing an infant death was 19% lower for certified nurse midwife attended than for physician attended births, the risk of neonatal mortality was 33% lower, and the risk of delivering a low birthweight infant 31% lower. Mean birthweight was 37 grams heavier for the certified nurse midwife attended than for physician attended births.

CONCLUSIONS: National data support the findings of previous local studies that certified nurse midwives have excellent birth outcomes. These findings are discussed in light of differences between certified nurse midwives and physicians in prenatal care and labour and delivery care practices. Certified nurse midwives provide a safe and viable alternative to maternity care in the United States, particularly for low to moderate risk women.


Letter #9

                                                                                                               Santa Clara, California 95050

June 25, 2004

Maria Shriver
Office of the First Lady
State Capital Building
Sacramento, California 95814

Dear Ms. Shriver,

I am writing on behalf of myself and all other women of childbearing age, both present and future, and on behalf of the Consortium for the Evidence-Based practice of Obstetrics to encourage you to use your considerable influence as First Lady of California to improve our current maternity care system. Physiological management of pregnancy, labor, and birth is the safest, most cost-effective, and most ethical model for our maternity care system, and I urge you to act to bring public awareness of the great need to reform our current expensive and obsolete system of maternity care to bring it in line with the science-based physiological model. 

Having experienced both medicalized delivery in a hospital setting and natural (physiological) birth at home, I can attest to the many benefits of the physiological management of pregnancy, labor, and childbirth.  I would like to share with you some of my experiences to help you understand the advantages of the physiological model of maternity care over the medical model.

My first birth went exactly by the book; each stage of my labor progressed just as the many books I read had described the typical labor.  I was confident in my body’s ability to give birth and I was eager to experience it.  I had often expressed to my obstetricians my desire to have a natural birth without any unnecessary interventions, but the medical idea of “natural” and “necessary” are unfortunately not the same as mine. It was quite upsetting to me to submit to the various “routine procedures” of the hospital - having an IV, having to lie in bed with the belt of the electronic fetal monitor strapped around my abdomen, not being allowed to eat or drink, having my water broken, giving birth flat on my back with my legs held up at a ninety-degree angle (which reduced my pelvic opening and forced me to push my baby out against the force of gravity), being directed to hold my breath and push while the doctor slowly counted to ten, being given an episiotomy and the subsequent stitches to repair it, having my baby whisked away to be cleaned and examined before getting even one touch, having my placenta tugged from my uterus instead of allowing it to be expelled naturally.  The event as a whole was very traumatic.

My dissatisfaction with that experience led me to seek midwifery care for my subsequent pregnancies.  I have received care from three midwives in three states with three legal situations regarding midwifery – first in an alegal state which had no laws governing midwifery care; second in an illegal state where the practice of non-nurse midwifery is a misdemeanor crime; and finally here in California where midwifery is licensed but the laws are written in such a way that they are impossible to abide.  Each of the three midwives was certified by the North American Registry of Midwives and was imminently qualified to provide care to a healthy woman with a normal, low-risk pregnancy. 

The care I received from each of these midwives, in my opinion, far surpasses the care I received from an obstetrician.  Each prenatal appointment with a midwife lasted an hour or more, while I was lucky to get five minutes of a busy obstetrician’s time.   The midwives treated me as a whole person, inquiring about my emotional, financial, and marital well-being as well as my physical health.  The physical assessment of my and my baby’s health was much more comprehensive than that I received during appointments with an obstetrician. I had the same access to prenatal testing and was encouraged to make my own informed opinion about which tests and procedures I would like to have performed. I appreciated being an active participant in my own prenatal care and I especially appreciated the fact that my pregnancy was considered a normal part of my lifecycle rather than a pathological condition fraught with danger which my lack of medical training left me unable to comprehend.

With each of my midwife-attended home births, I labored comfortably in my home, caring for my family and going about the normal business of the day.  I ate and drank as necessary, allowing my body to be nourished and hydrated for the strenuous work of giving birth.  I checked in periodically by phone with my midwife and decided when I was ready for her to come.  Once she arrived, she set up her equipment and performed an assessment and I continued to labor in whatever place and position I felt most comfortable.  Her periodic assessments were not intrusive and were performed in a manner that respected my needs and desires. 

I chose to labor on my feet, allowing the force of gravity to assist my labor, until my water spontaneously broke.  I gave birth upright or semi-upright supported by my husband, positions which allow much easier descent of the baby through the birth canal than a back-lying position.  I pushed with the force of each contraction – a very natural and irresistible impulse – instead of being directed to push according to someone else’s arbitrary count.  I didn’t need an episiotomy, in spite of the scar tissue left from my first birth, and I didn’t tear. 

My newborn baby was handed to me immediately, allowing my baby skin-to-skin contact with me and the comforting, familiar sound of my heartbeat.  The umbilical cord was not cut until it had stopped pulsating, allowing my baby the full benefits of the rich cord blood. My husband and I were able to examine and enjoy our baby at leisure, even before the placenta was expelled, which happened naturally with the help of a few mild contractions.  My midwife performed a thorough neonatal assessment with my baby always within reach of my touch.  She made sure everything was cleaned up and we were all settled in comfortably before she made her departure, and she returned for two home visits in the next few days to check on us and ensure our continued well-being. 

I recognize that technological interventions have their place in compromised pregnancies and am grateful that doctors have mastered techniques which allow them to save lives of mothers and babies when complications arise.  Too often, though, medical interventions are performed when there is no real need and they produce complications rather than prevent them.  Labor is called labor for a reason; it’s hard work.  The healthy female body, however, is wonderfully designed to withstand the rigors of labor and birth when events are allowed to unfold naturally, and this fact seems to be ignored or downplayed. 

True necessity for intervention in labor and birth is uncommon, yet it is even more uncommon today to experience intervention-free birth in a hospital setting.  “Normal” has become something unnatural.  The system that has allowed this situation to develop is flawed and needs to be reformed. 

In conclusion

I am asking you, as First Lady of the State of California, to make the rehabilitation of our maternity care system a priority.  The standard of care for normal, healthy mothers and babies must be made to conform to proven scientific principles that recognize the superiority of the physiological model over the medical model of maternity care.

Thank you for your consideration of this matter.

Respectfully,                                                                                                      Lilah Monger

cc:            California Citizens for Health Freedom


 

Letter # 10

 

CALIFORNIANS ADVOCATING
LICENSED MIDWIFERY

P. O. BOX 620191
Woodside, CA 94062-0191
www.calmidwifery.org


 

 

 

 

 

 

 

 

Ms. Maria Shriver
Office of the First Lady
State Capital Bldg.

Sacramento
, CA 95814

Re: Mother’s Day Initiative for the Consortium for Evidence-Based Practice of Obstetrics (C.E.O)

Dear Ms. Shriver,

We are writing to you as part of a state-wide effort to call attention to the fact that pregnant women in California are slowly having their choices and access to the full range of childbirth options taken away from them. Healthcare during the childbearing years is increasingly being dictated by malpractice concerns and the ever-increasing use of technology—all without any scientific evidence that it provides better outcomes.  This has lead to increased healthcare costs due to the inappropriate use of technology.

One example of misused technology is unnecessary c-sections. California’s Center for Health Statistics recommends a caesarean rate of no more than 15% based on research and analysis of current data. This rate provides optimal outcomes for mothers and babies, while lowering serious complications and additional healthcare costs caused by unnecessary surgery. But in obstetrics today the number of caesareans is climbing to all time highs. In the latest health statistics for California (2000) there were 124,467 c-sections recorded. This figure represents 22.7 % of all births in that year. This means that in 2000 alone, 9,584 women had surgery for no reason. That’s 26 women each and every day being exposed to the increased morbidity and mortality that accompanies major abdominal surgery!

Sadly, since 2000, caesarean rates have gone up to 26.8%. One of the most prevalent reasons for the increase is that more and more hospitals are refusing to allow women with a previous c-section to attempt a VBAC. Women’s’ choices in labor and delivery are being narrowed by those whose motivation is not the safety and care of patients. So we have increased costs from surgery and increased complications from surgery without any indication of benefits to mother or baby. In fact the only beneficiaries of unnecessary c-sections are the hospitals who are able to move more patients through labor and delivery, and the physician, who can charge more and go home rather than having to stay on the floor monitoring laboring women.

We believe that the answer to this problem, and others of a similar nature, lies in increasing consumers’ access to the midwifery model of care. Midwives offer less expensive, less interventive care, that has scientifically proven to provide equal or better outcomes in women experiencing normal healthy pregnancies (approx. 70% of the pregnant population), than the current medical model does.

How is this possible? The midwifery model of care focuses on women’s social and emotional needs, along with her medical needs. It also relies on the judicious use of technology—just because we can utilize technology doesn’t mean we should do so. In short, midwives try to see each client as an individual with individual needs and desires. By contrast the medical model has devolved into seeing the pregnant woman as separate from her uterus and baby, with machines to monitor them and each individual as a potential litigant or disaster waiting to happen.

Please note that this is not a criticism of obstetrical care for women experiencing a high-risk pregnancy or other serious complication. We welcome the advances in medicine and the skills of physicians to provide the best medical care for such situations.  However, we want to see such care reserved to treat only those who need it, rather than using it unnecessarily on the entire population of healthy patients. This approach offers the best outcomes for mothers and babies AND it has the added benefit that it will save our state money

The first step in increasing access to the midwifery model of care is to remove the many barriers to practice that exists in California.  How can we do this? We must have a system that grants midwives autonomy and replaces mandatory physician supervision with collaboration, creating mutually respectful relationships between medical personnel and midwives. No less than the World Health Organization recognizes midwifery as an autonomous profession, with midwives being the recognized experts in normal pregnancy and birth.  This will only serve the women of California by providing them with increased safety and more choices during their childbearing years.

We thank you for your support.

Sincerely,

Renee S. Anker, L.M.
Chair, CALM

 


 

7/02/04
Keri Claussen
8719 Rosewood Av
LA, CA 90048

Maria Shriver
Office of the First Lady
State Capital Building
Sacramento, CA 95814

Mothers Day 2004

Dear First Lady,

I am writing on behalf of the Consortium for the Evidence-based practice of Obstetrics (CEO). The medically-interventive, obstetrical model used routinely on healthy women causes major problems. Obstetrical intervention for healthy women is not scientifically-based. We need public dialog to bring about appropriate changes in our national maternity care policy and the reform these potentially harmful obstetrical practices.

Physiological management provides the safest and most cost-effective form of maternity care and is associated with the lowest rate of maternal and perinatal mortality and the greatest wellbeing of mother and baby. Science-based or ‘physiological’ model of childbirth should be the universal standard for healthy women with normal pregnancies for healthy populations.

Legislative hearings are necessary so childbearing families who have had negative experiences with the current system can testify on problems such as:

(1) off-label use of Cytotec for labor induction & increasing percentage of non-medical induction
(2) the ever-climbing cesarean section and maternal mortality rate that is 30th in the developed world
(3) the danger in promoting the maternal choice cesarean as an idealized form of childbirth
(4) the physically damaging effects on the pelvic floor and pelvic organs associated with medical management of vaginal birth --

Examples include: procedures or policies that keep a laboring woman confined to bed such as continuous electronic fetal monitoring, the use of artificial hormones to stimulate or accelerate labor, narcotics, epidural anesthesia, requiring the mother to labor or push in anti-gradational positions, prolonged-breathe holding, episiotomy, operative delivery, etc

The need for a new law requiring physicians to provide full information about the risks of each significant medical or surgical intervention and to obtain truly informed consent before substituting medical and surgical interventions in place of the safer, evidence-based principles of physiological management.

Thanking you in advance,
Keri Claussen


Letter # 12

July 2, 2004

Dear Ms.Shriver,

I am writing to you on behalf of the Consorteum for the Evidence Based Practice of Obstetrics. I am a midwifery student,but first and foremost, I am a mother.I have given birth to three beautiful, healthy children,two in the hospital and one out of the hospital. I would like to share my different experiences with you.

My first son was born in the hospital ten years ago.During my four hour labor with no pain medication, I was given an I.V. against my will, (even though I had been told by my doctor that I didn't have to have one.) I was kept on the electronic fetal monitoring device for my entire labor,(even though the hospital policy stated that monitoring was only required for 15 minutes of every hour.) I was not allowed to get out of the hospital bed even to urinate. When it was time to push my baby out, I wanted to be upright, but I was forced to lay back and put my feet into stirrups and I was covered with sterile drapes so I couldn't even see when my baby came out. I was given an episiotomy even though my son was small, because my baby came so fast that my doctor didn't make it.The doctor that was on call payed no attention to my birth plan or the written instructions of my doctor that were posted in my chart. I felt completely taken advantage of and powerless!

Needless to say, when I became pregnant again, even though I had no insurance, no money and Medi-Cal wouldn't pay for midwifery care,I sought out a midwife! During the course of this pregnancy I had every question answered and my midwife spent at least forty five minutes with me at every appointment. (and that is the standard in midwifery care!) I was so thrilled! She even helped me get started in my own study of the art of midwifery. When I was thirty one weeks pregnant, I had to go to the hospital to be treated for premature labor. I was released, but my second son was born two weeks later and because of the prematurity we had to go to the hospital for his birth. I was still very disappointed, but my experience was so different from the first time. My midwife accompanied me to the hospital. She was by my side the entire time I labored, keeping me smiling, keeping me hydrated and adjusting the fetal monitor. When I pushed my baby out, she kept a warm compress on my perineum to keep me from tearing (she remembered that I did not want another episiotomy!) The nurses that were present at the birth said that they were amazed, because the doctor who did the delivery always gives episiotomies and I did not get one! My baby was big for being so early, was breathing well and nursed well so he only had to stay in the hospital for a week. I was very lucky!

With my third pregnancy, I was determined to stay out of the hospital!! We had previously determined with the help of my family doctor that my second baby was premature because I had an undiagnosed liver problem. So with my doctor's go ahead, My midwife helped me find a nutritionist and I took special classes so that I could carry my baby to term. My third baby was born out of the hospital, on his due date, with only three hours of labor and weighed nine pounds! I did not tear my perineum, nor did I have an episiotomy.I was allowed to move freely during my labor, encouraged to eat and drink, I was not given an I.V. and I had the wonderful pain relief of water to help me cope with contractions. What a huge difference in the quality of care!! My midwife has such faith in the ability of a woman's body to naturally do what it is supposed to do. I do not see that in doctors and nurses in most hospitals.

Midwives are trained to help healthy women deliver healthy babies the way we have been delivering babies since the dawn of time.Midwives are also trained to recognise when someone needs care that is beyond their scope of practise,and they refer these mothers to doctors in their communities that are trained to handle illnesses or emergencies.

Most doctors treat pregnancy as a disease when it usually is the healthiest time in a woman's life.(She may eat better,quit smoking,start exercising , take vitamins, all things that tend to improve health overall!)Doctors are trained to treat disease.Pregnancy and birth is not a disease, so for the protection of those women who do not want an out of hospital birth, we need to change the policies and procedures governing pregnancy and birth. We need to change how doctors view pregnancy and birth. We need to reinstill faith in the human body of a pregnant woman so they will allow her to birth naturally and comfortably without being strapped to a bed, filled with drugs, given an episiotomy etc. We need to change hospital policies that protect the hospitals in our sue happy society instead of protecting the wellfare of the mothers and babies! We need to change the policies that allow for insurance companies to dictate to doctors and hospitals instead of providing care for clients! We need legislative hearings so that our government can hear what is happening!

Thank you for taking the time to read this letter, and please consider what I am saying. We really do have a problem with the system as it is. It is time for a change that takes into consideration the people for once!

Sincerely, Megan Roy


www.ScienceBasedBirth.com

CEO / A-CEO // Contact Information //
 California Citizens for Health Freedom
              
1- 530-534-9758         Donna Russell      info@sciencebasedbirth.com