Getting Medicaid Reimbursement for Birth Centers

What do the Birth Center Bill and the Tour de France have in common?

Just like the Tour de France has 20 stages in the race and is a test of endurance, passage of the Medicaid Birth Center Reimbursement Act (H.R.2358/S.1423) requires endurance and perseverance at many stages.

To date we have accomplished much:

• Medicaid Birth Center Reimbursement Act introduced in the House (H.R.2358) and the Senate (S.1423)
• List of bill co-sponsors continues to grow.
• In Health Care Reform our bill is included in passage of 3 House Committees and the Senate Finance Committee.

The Health Care Reform Process

In the Senate

• The Senate Finance Committee has jurisdiction over Medicaid programs and has included our legislation in their bill.
• The Health, Education, Labor and Pension (HELP) Committee did not take action on our bill because they have no jurisdiction over the Medicaid program.
• The leadership of both Committees is working to combine their bills into one package for a vote on the Senate floor.

In the House

• The Rules Committee is in the process of combining all three of the Committee actions into one bill for a vote on the House floor.

CRITICAL NEXT STEPS

Educate your Senator on the HELP Committee to support inclusion of S.1423 "The Birth Center Medicaid Reimbursement Act" in the Senate package.

Call your U.S. Senators. Click here for directions on how to contact your Senators' health care legislative assistants.

Download "Medicaid - Why guarantee payment to birth centers?" for talking points and to give to your Senators.

After you have made your calls, please call or email AABC's lobbyist Karen Fennell and tell her who you talked with and any comments or additional information requested. Call Karen at 301-830-3910; Send email to karenfennell50@yahoo.com. This report to Karen is important so that she can follow-up.

Breaking News

Best Practices: Community-Based Postpartum Depression Screening: Results From the CARE Study -- Horowitz et al. 60 (11): 1432 -- Psychiatr Serv

 

June Andrews Horowitz, Ph.D., R.N., Christine A. Murphy, Ph.D., R.N., Katherine E. Gregory, Ph.D., R.N. and Joanne Wojcik, M.S., R.N.

The authors are affiliated with the W. F. Connell School of Nursing, Boston College, 140 Commonwealth Ave., Chestnut Hill, MA 02467 (e-mail: horowitz@bc.edu ). William M. Glazer, M.D., is editor of this column.

This column describes findings and best-practice recommendations from CARE (Communicating and Relating Effectively), a prospective randomized study in which 5,169 mothers were screened for postpartum depression. The prevalence rate was 13%. Results support use of the Edinburgh Postnatal Depression Screening Scale and a diagnostic assessment for those who screen positive. Of the 674 mothers with positive screens, 26% were not asked about their emotional state by clinicians. Screening must be linked to treatment options via referral and follow-up. Best-practice strategies for implementing screening include educating clinicians and postpartum women.

Best Practices: Community-Based Postpartum Depression Screening: Results From the CARE Study -- Horowitz et al. 60 (11): 1432 -- Psychiatr Serv

e-CIMS News October 29, 2009

Don't Miss Ricki Lake, Judy Norsigian, Rima Jolivet, and Penny Simkin at the 2010 Mother-Friendly Childbirth Forum
Start planning now to attend the 2010 CIMS Forum in Austin, Texas, Feb. 26-27.

CIMS proudly announces that acclaimed actress, filmmaker, family advocate and author Ricki Lake, along with 15 distinguished faculty, will address attendees at the 2010 Mother-Friendly Childbirth Forum and Annual Meeting.  Lake, an integral figure in the birthing community since the 2007 debut of the documentary The Business of Being Born and subsequent projects that encourage childbearing women to become informed maternity care consumers, has traveled tirelessly around the United States to discuss the state of the birthing "industry" in an effort to demonstrate how all parents-to-be can benefit from taking a more active role in their birth experiences.

Each year, the CIMS Forum attracts expert faculty from prestigious universities and the nation's leading childbirth advocacy organizations who present the most up-to-date maternity care research to healthcare providers, maternal-child health leaders, and passionate childbirth advocates who are eager to bring evidence-based maternity care practices back to their communities.  The information that Forum attendees gain provides an invaluable boost to their efforts to promote healthy birth practices across the nation.  The 2010 Forum Program features:

• Hear it first at the 2010 CIMS Forum! Rima Jolivet, CNM, MSN, MPH, symposium project director, Transforming Maternity Care: A High Value Proposition, will present recommendations for achieving a"2020 Vision for a High Quality, High Value Maternity Care System" from Childbirth Connection's 90th Anniversary Symposium's Blueprint for Action. This was developed through concerted multi-stakeholder efforts to provide actionable recommendations for improvement in 11 critical focus areas in order to answer the fundamental question, "Who needs to do what, to, for, and with whom to improve the quality of maternity care over the next five years?"
• Author and Executive Director of Our Bodies Ourselves (OBOS), Judy Norsigian, BA.  A renowned leader in efforts to improve women's health, Norsigian has lectured across the country in support of the newest OBOS publication, Our Bodies, Ourselves: Pregnancy and Birth and has taken an active role in the recent legislative efforts to improve healthcare for women and families.
• The iconic Penny Simkin, PT, whose contributions to the childbirth literature, including Pregnancy, Childbirth and the Newborn: The Complete Guide, When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women, and A Simple Guide to Having a Baby, have guided and inspired countless childbearing women and maternity care providers.
• Nancy Lowe, CNM, PhD, FACNM, FAAN, editor of AWHONN's Journal of Obstetric, Gynecologic, & Neonatal Nursing.  Lowe will present a U.S. perspective on maternity care that explores the opportunity for fundamental change through national healthcare reform initiatives.
• Kathleen Kendall-Tackett, Michael Klein, Raymond De Vries, Henci Goer, Amy Romano, Susan Jenkins, Lisa Summers, and many more!

This program is approved by the International Childbirth Education Association (ICEA) for 13.75 contact hours of continuing education.

Nursing contact hours have been applied for through the Texas Nurses Association, an accredited approver of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

To learn more about the CIMS Forum, including program details and travel/lodging information, visit the CIMS website.

To learn more about Ricki Lake and her birth advocacy work, please visit www.TheBusinessOfBeingBorn.com and/or www.MyBestBirth.com.

Are Home Birth Mamas 'Hedonists'?
CIMS takes a stand for patient choice.

In response to a biased and sensationalized segment featured on NBC's The Today Show, CIMS, along with 44 co-signing organizations, reiterated their support for informed patient decision-making in a strong statement that cites the research evidence regarding the safe choices of home birth and midwifery care.
The segment, "The Perils of Midwifery" (later renamed "The Perils of Home Birth" online), which aired on Sept. 11, inaccurately implied that hospitals are the safest place for low-risk women to give birth and mischaracterized women who choose home birth as 'hedonists,' going so far as to suggest that these women are putting their birth experiences above the safety of their babies.  Neither could be further from the truth.
Read the full correspondence, including the research citations, in

CIMS' One Voice Response to The Today Show.

Take Action:

• Endorse The Mother-Friendly Childbirth Initiative (MFCI), the nation's first and only consensus document on U.S. maternity care.
• Join us in Austin, Texas, for the 2010 Mother-Friendly Childbirth Forum & Annual Meeting and hear from Dr. Michael Klein, co-author of a new study on home birth.  Additional program details available online at www.motherfriendly.org.

Maternity Care Is an Ideal Arena for the Adoption of Participatory Health Care Tools

With all eyes focused on healthcare reform, Amy Romano's recent blog post, A Lifetime of Participatory Medicine Can Start With Maternity Care

, gives a boost to maternity care issues at this crucial time with a message that resonates soundly with The Mother-Friendly Childbirth Initiative.  Transforming the way in which childbearing women participate in their care has the potential to substantially reduce overall healthcare costs, while also improving the health and well-being of millions of new mothers and babies each year.  The article demonstrates how women's involvement in making informed maternity care decisions can pay big dividends in terms of public health impact, quality improvement, prevention of chronic disease, cost containment, and improved health literacy.  Amy, who serves on the CIMS Grassroots Advocates Committee, adds, "Childbearing women are also an ideal population to adopt innovative participatory health care tools, because they're already online and highly connected in social networks."  The Sept. 30 post was featured on e-Patients.net--a blog about Participatory Medicine that is attracting an influential readership.

CIMS' The Birth Survey: Fall Webinar Schedule

The following Transparency in Maternity Care Project: The Birth Survey Ambassador Training Webinars are planned for October 2009 -January 2010.  We are seeking an experienced volunteer to present The Birth Survey Marketing Trainings. Please contact

admin@thebirthsurvey.com if you are interested in serving as a The Birth Survey webinar trainer.
GACSTAT Transparency Project Ambassador Training: Demystifying and Collecting the Data:

• Monday, Nov. 16, 2009, 8:30 pm - 10:30 pm (Eastern)
• Monday, Dec. 7, 2009, 8:30 pm - 10:30 pm (Eastern)
• Thursday, Jan. 7, 2010, 8:30 pm - 10:30 pm (Eastern)

Great

Rate!

Share the research! For a limited time, CIMS' "Evidence Basis For The Ten Steps of Mother-Friendly Care" (Journal of Perinatal Education Supplement, Winter 2007) is available for the great rate of $50/case (48 copies)!  Share this valuable resource with hospital maternity units, your childbirth educator classes, nursing and midwifery students, and legislators. Get this great rate AND FREE SHIPPING when you order by Nov. 30, 2009. Order form available at www.motherfriendly.org.

$50/case plus free shipping offer expires: Nov. 30, 2009.

For Expectant Families

Choosing the right provider and birth facility can impact your opportunity for a successful VBAC
Many expectant mothers are considering laboring for a vaginal birth after cesarean-section (VBAC) but are not sure how to findor evaluate providers and birth facilities in their communities to maximize their opportunity for a successful VBAC.  In 1996, 28% of women with a prior cesarean delivery had a VBAC (vaginal birth after cesarean).  This birth option dropped 72% between 1996 and 2005 although 3 out of 4 women who plan a VBAC go on to have a successful vaginal birth.
Providers and facilities in the US are increasingly denying women the right to choose VBAC, stating that they are not equipped to provide an emergency cesarean in case of complications.  But, researchers argue that hospitals which are not safe for VBAC based on this premise are not safe for any mother in labor since

an emergency cesarean may be needed for other common unpredictable complications that may arise. 
All birthing women have a right to make informed decisions about their care.  The following resources are available to help you determine if VBAC is right for you and, if so, find facilities that support VBAC and compare VBAC success rates across the US.

• Vaginal Birth After Cesarean (VBAC) or Repeat Cesarean Section?
  Our Bodies Ourselves
• Birth Choices After Cesarean (PDF)
  The Vermont/New Hampshire VBAC Project (now the Northern New England Perinatal Quality Improvement Network)
• Trial of Labor After Cesarean: A Shared Patient-Physician Decision Tool (PDF)
  American Academy of Family Physicians
• Vaginal Birth After Cesarean Section
  Society of Obstetricians and Gynaecologists of Canada
• Find A Birth Center
  American Association of Birth Centers

Honor Birth!

Because pregnancy, birth, and the postpartum period are milestone events in the continuum of life...

Honor Birth was created as a way for you to honor a mother, her baby, her family, and anyone who gave her strength in her amazing journey to motherhood. Who inspires your passion for Mother-Friendly Care? 

About Us
You are receiving this e-CIMS News to keep you up to date on CIMS' activities, research, policy issues, and conferences that may be of interest to you. If you have suggestions on what resources or information you would like to see in upcoming editions of e-CIMS News, please e-mail us at info@motherfriendly.org.

CIMS is a not-for-profit organization recognized as tax-exempt under Internal Revenue Code section 501(c)(3). Our mission is to promote a wellness model of maternity care that will improve birth outcomes and substantially reduce costs.

Midwifery Today E-News 11:22 - Massage and Touch/H1N1 Prevention

 

In This Week’s Issue:

• Quote of the Week
• The Art of Midwifery: Preventing the Flu with a Healthy Immune System
• Research: Homeopathy and the H1N1 Virus
• Back Labor
• Featured Products
• Web Site Update
• Advertising Opportunities
• Question of the Week: Preventing Postpartum Hemorrhage
• Question of the Week Responses: Obama Health Care Plan/Uterine Prolapse
• Think about It
• Letters
• Classified Advertising

E-News 11:22 - Massage and Touch/H1N1 Prevention

Elevated Corticotropin-Releasing Hormone in Human Pregnancy Increases the Risk of Postpartum Depressive Symptoms

 

Ilona S. Yim, PhD, Laura M. Glynn, PhD, Christine Dunkel Schetter, PhD, Calvin J. Hobel, MD, Aleksandra Chicz-DeMet, PhD, and Curt A. Sandman, PhD

Departments of Psychology and Social Behavior (Dr Yim), and Psychiatry and Human Behavior (Drs Glynn, Chicz-DeMet, and Sandman), University of California, Irvine; Department of Psychology, University of California, Los Angeles (Dr Dunkel Schetter); and Miriam Jacobs Chair, Division of Maternal-Fetal Medicine, Cedars-Sinai Medical Center, Los Angeles, California (Dr Hobel).

Corresponding Author: Ilona S. Yim, Department of Psychology and Social Behavior, 3340 Social Ecology II, Irvine, CA 92697−7085, USA; Email: ifederen@uci.edu ; phone: 949−824−0130; fax: 949−824−3002.

The publisher's final edited version of this article is available at Arch Gen Psychiatry.

See commentary "Premature recommendation of corticotropin-releasing hormone as screen for postpartum depression." in Arch Gen Psychiatry, volume 66 on page 917.

Abstract

Context

Postpartum depression (PPD) is common and has serious implications for the mother and her newborn. A possible link between placental corticotropin-releasing hormone (pCRH) and PPD incidence has been discussed, but there is a lack of empirical evidence.

Objective

To determine whether accelerated pCRH increases throughout pregnancy are associated with PPD symptoms.

Design

Pregnant women were recruited into this longitudinal cohort study. Blood samples were obtained at 15, 19, 25, 31 and 37 weeks gestational age (GA) for assessment of pCRH, cortisol and ACTH. Depressive symptoms were assessed with a standardized questionnaire at the last four pregnancy visits and postpartum.

Setting

Subjects were recruited from two Southern California Medical Centers, and visits were conducted in university research laboratories.

Participants

100 adult women with a singleton pregnancy.

Main Outcome Measure

PPD symptoms were assessed 8.7 weeks (SD = 2.94 wks) after delivery with the Edinburgh Postnatal Depression Scale.

Results

Sixteen women developed PPD symptoms. At 25 weeks GA, pCRH was a strong predictor of PPD symptoms (R² = .21, β = .46, p < .001), an effect that remained significant after controlling for prenatal depressive symptoms. No significant associations were found for cortisol and ACTH. Receiver Operating Characteristic curve analyses revealed that pCRH at 25 weeks GA is a useful diagnostic test (area under the curve = .78, p = .001). Sensitivity (.75) and specificity (.74) at the ideal cut-off point (56.86 pg/ml pCRH) were high. Growth curve analyses indicated that pCRH trajectories in women with PPD symptoms are significantly accelerated between 23 and 26 weeks GA.

Conclusion

There is a critical period in mid-pregnancy during which pCRH is a sensitive and specific early diagnostic test for PPD symptoms. If replicated, these results have implications for identification and treatment of pregnant women at risk of PPD.

Elevated Corticotropin-Releasing Hormone in Human Pregnancy Increases the Risk of Postpartum Depressive Symptoms

Actions to Support CPMs and Out of Hospital Birth!

Dear Friends,
As the Senate and House are in the final weeks and days of
preparing their Health Reform bills for floor debate, THIS IS THE
TIME to write letters and anything else you can do to make sure
your Senators and Representatives in Washington, DC, know that
you want CPMs included at the federal level!
This e-mail includes three things to as soon as possible!
1. The MAMA Campaign continues working in DC to have Certified
Professional Midwives included on the federal list of Medicaid
Providers. Please write a brief letter to your Senators and
Representatives today! They need to hear from their constituents!
Even if you think your Congress people have already decided not
to vote for any health reform bill, write to them anyway about
CPMs. You can find all the needed information (including sample
letter language and links for finding who your representative and
senators are and how to contact them) at the Take Action page of
the MAMA Campaign website:
http://www.mamacampaign.org/contact-your-legislator/
2. The National Women’s Law Center has produced a brief video
“A Woman Is Not a Preexisting Condition!” that you can
see at: http://awomanisnotapreexistingcondition.com/
They have an email setup right on that page to send emails to
Congress about this issue, which has a section to add your own
words. This is a great opportunity to add some sentences about
CPMs, birth centers, and out of hospital birth in general.
Thanks to Susan Jenkins for sending this information!
3. The Big Push for Midwives is encouraging everyone to sign
their petition supporting CPMs and out-of-hospital birth. This is
easy to do, and you are encouraged to forward this request to
others. The petition sign-up is at:
http://tinyurl.com/Support-CPMs-Petition. Find the full text
of the Big Push notice at the end of this message.
This is our chance! Let’s make sure Congress “gets
it” about Certified Professional Midwives!
Sincerely,
Susan Hodges, “gatekeeper”
=======================================================
SHARE WITH OTHERS IN YOUR AREA!
Feel free to forward the Grassroots Network messages to others
who might be interested!
SEND US NEWS!
If you find news, resources, or other valuable information that
you think should be posted on the Grassroots Network, please send
it to info@cfmidwifery. org... with "For the grassroots network"
in the subject line. We will definitely consider using them!
HOW TO JOIN THE GRASSROOTS NETWORK LIST
Visit the Citizens for Midwifery website at http://www.cfmidwifery.org/.
Scroll to the bottom of the page and enter your e-mail address.
It's that simple!
LEARN ABOUT CfM!
Check out our website at http://www.cfmidwifery.org/.
Check out our blog at cfmidwifery.blogspot.com
Find our Group and Cause pages on Facebook
Find us on My Space
JOIN Citizens for Midwifery!
Membership starts at only $10 to become a "Citizen" for Midwifery
Upgrade and receive the CfM News starting at $30 ($20 for
students)
Easy to join on-line with a credit card go to http://cfmidwifery.org/join
GET INVOLVED!
Are you interested in volunteering with some dynamic women in a
supportive environment?
Help CfM promote the Midwives Model of Care!
We have many ways to get more involved.
Get in touch with us!
===============================================================
From The Big Push:
Push the Petition! We’re Almost 10,000 Strong!
Please take a minute to sign your name in support
of Certified Professional Midwives and out-of-hospital birth
today!
http://tinyurl.com/Support-CPMs-Petition
We need to reach our goal of 10,000 names this week, as Congress
moves closer to taking final action on health care reform
legislation. All members of Congress need to know that support
for CPMs and out-of-hospital birth in their state is strong!
Be sure to forward this message far and wide and ask your family
and friends to lend their support to the cause.
Midwives, it is especially important for you to let your clients
know that we need them to speak up!
If you live in one of the following states, we really need you to
act. We can’t allow Delaware’s Congressional delegation
to believe that only 11 people in the entire state support
midwives and home birth! If you live in Delaware, spread the word
NOW!
Or Utah, South Dakota, Vermont, New Hampshire, West Virginia and
Wyoming! Surely there are at least 100 people in each of these
states who can let their elected officials in DC know how much
they support access to midwifery care!
Most states have hundreds of signatures, some close to 1000. But
if you live President Obama’s home state of Hawaii, or in
Senator McCaskill’s home state, Missouri, or in her neighbor
state, Kansas, Congress needs to hear your voices today!
We can’t afford to allow any members of Congress to think
that there are fewer than 100 midwifery supporters in ANY state!
If you have family or friends in any of the states mentioned,
please reach out to them.
Those are states with fewer than 100 signatures but we need ALL
the states to give the petition one more Push over the top so we
can reach our goal and put Congress on notice that we want access
to CPMs now!
http://tinyurl.com/Support-CPMs-Petition

Thanks!
Stephanie Beck Borden
Grassroots Organizer, The Big Push For Midwives Campaign

A quick thank you and a new PPD survey

 

Dear Colleagues,
Last week we asked you to take a short survey regarding a university-based study on non-pharmacological treatments for PPD. Thank you for your strong response; the information we received is invaluable.
Now MedEdPPD is conducting another survey on behalf of a psychiatric research team that is planning a study to compare several treatments for women with PPD. There are two versions of this survey, one for you (the provider) and one for your patients. As before, participation is completely anonymous and we will not collect your personal information.
The research team wants to know which treatment options would not be acceptable to you as a provider and to your patients. Once acceptable treatments are determined, study participants will be randomly assigned a treatment, which will be administered for 8 weeks. Women whose PPD symptoms improve would be provided treatment for an additional 6 months.
Please assist us by taking this survey and also by forwarding it to your colleagues and patients.
Click here to take the survey.
http://www.mededppd.org/treatment_survey.asp
Pass this link to your patients.
http://www.mededppd.org/mothers/treatment_survey_mothers.asp
Thank you again for your time and in assisting us in conducting this survey.

Depression Often Goes Untreated in Working Moms: MedlinePlus

 

Health insurance, employee assistance could help mothers get treatment, researchers say

HealthDay
By Robert Preidt
Tuesday, October 27, 2009

TUESDAY, Oct. 27 (HealthDay News) -- More than 65 percent of U.S. mothers with depression don't receive adequate treatment, a new study has found.

Black, Hispanic and other minority mothers are least likely to receive adequate treatment. Mothers with health insurance are three times more likely to receive adequate treatment than those without insurance, wrote the researchers at the University of Wisconsin-Madison School of Medicine and Public Health.

"Health insurance facilitates access to adequate treatment for maternal depression. Expanding health insurance coverage to mothers with depression is a critical step in helping them get the care that they need," study author Dr. Whitney P. Witt, an assistant professor of population health sciences, said in a news release from the university.

The analysis of national data on 2,130 mothers with depression also found that working mothers were less likely to receive adequate treatment, possibly because long work hours make it difficult for them to find time to seek treatment. This means that workplaces could prove a useful location for depression intervention.

"Services like employee-assistance programs can help these mothers get screened and treated, even if they are unable to visit a provider or a mental health professional in the health-care setting," co-author Kristin Litzelman, a population health sciences doctoral student, said in the release. "Since healthy employees are productive employees, it's often a win-win for employers to offer benefits that support employee mental health."

Depression in mothers can have a major impact on the entire family, especially on the health and well-being of their children, the researchers noted. Treating depression in mothers can improve the long-term health of their families.

Health-care providers need to understand the racial, ethnic and educational disparities that affect treatment of mothers with depression in order to intervene and help these patients get the care they need, the study authors noted.

The study was released online in advance of publication in an upcoming print issue of the Journal of Behavioral Health Services and Research.

SOURCE: University of Wisconsin, news release, Oct. 19, 2009

HealthDay

Depression Often Goes Untreated in Working Moms: MedlinePlus

Planning for a C-Section - Tonic

 

By Kirk Bromley | Friday, October 23, 2009 4:00 PM ET

Whether your C-section is announced after laboring for 48 hours or you schedule one with your doctor, you want the healing process from the surgery to go as smoothly as possible.

One thing that can prevent proper healing is internal adhesions. As a result of the natural healing process after surgery, internal scars called adhesions may form on or between internal organs and/or body tissue. The occurrence of C-section adhesions can be painful and debilitating, and more of a health issue than visible Cesarean scars on the outside of your body. These internal scars may also cause complications with future C-sections and other surgeries.

Now, one company — CSectionHealing.com — offers a product that can prevent this. It's called Seprafilm. It's a clear piece of film that is applied during surgery. It sticks to your internal tissues and separates your organs to help prevent them from attaching to one another as they heal during your C-section recovery. Seprafilm is made up of chemically modified sugars, some of which occur naturally in the human body. Once placed inside the body, Seprafilm becomes a gel that contours to your internal anatomy, and you will not feel its presence. You can ask your doctor to use Seprafilm during surgery.

Here's a great video on how the procedure works.

CSectionHealing.com also offers a free C-Section Information Kit that tells you all about the procedure and gives you a list of questions you should ask your doctor. Planning ahead for your C-Section is the best way to make sure you heal properly, leaving more time for you and your baby.

Photo via CSectionHealing.com.

Planning for a C-Section - Tonic

Framing Health Care Debate As Battle Of Sexes » NPR

By Liz Halloran

Published October 22, 2009 7:01 AM

Get Sterilized, Get Coverage?

During a recent Senate hearing on women and health care, Dr. Gerald Joseph of the American College of Obstetricians and Gynecologists characterized the insurance coverage issues faced by women as "one of the most glaring reasons why we need health reform."

Not only are women charged higher premiums for individual coverage during their child-bearing years, but they also are typically required to purchase expensive riders for maternity coverage.

And there is a body of evidence that shows women have been denied coverage by insurance companies citing "pre-existing conditions" that range from having previously given birth by cesarean section to having been a victim of domestic abuse.

At the recent Senate hearing, led by Democratic Sen. Barbara Mikulski of Maryland, Peggy Robertson, a Colorado mother of two, testified that she was rejected by an insurance company that determined her previous cesarean constituted a pre-existing condition. Delivering a baby by surgical procedure increases a woman's chances of needing it again in future pregnancies.

The Golden Rule Insurance Co. told Robertson, 39, that if she had been sterilized, the coverage would have been hers. (Read part of a letter the insurer sent her.) Her story is now being featured in ads by the liberal advocacy group Americans United for Change…

wbur.org » NPR

A Woman Is Not A Pre-Existing Condition

 

Tell Congress to pass health care legislation that meets the needs of women and our families.

A Woman Is Not A Pre-Existing Condition

Expert on post-partum depression featured in one-day workshop Nov. 13 > Indiana State University: Newsroom

 

October 21 2009

The Continuing Nursing Education Program at Indiana State University's College of Nursing, Health, and Human Services will present "In the Eye of the Beholder" on Nov. 13.

The presentation will be held from 8 a.m. to 4:30 p.m. at the Landsbaum Center for Health Education, 1433 North 6 ½ St. in Terre Haute.

Even though most mothers view birth as a joyful experience, a mood or anxiety disorder may alter a mother's perception. The goal of this program is to explore ways to promote healthy outcomes for mothers and babies. The content is appropriate for physicians, residents, advanced practical nurses, registered nurses, licensed practical nurses, nurse midwives, social workers, advocacy groups and students in allied health professions.

The event features Cheryl Tatano Beck, a professor at the University of Connecticut, School of Nursing and a certified nurse-midwife. She received her doctorate of nursing science from Boston University and her certificate in nurse-midwifery from Yale University. Tatano Beck is a fellow in the American Academy of Nursing and serves on the editorial boards of several nursing research and education journals.

Throughout the past 20 years, Tatano Beck's research has focused on postpartum mood and anxiety disorders. Her research led her to develop the Postpartum Depression Screening Scale published by Western Psychological Services.

Registration is open to 150 registrants and is $90, or $20 for undergraduate students with a valid student ID. Registration must be completed in advance of the event no later than Oct. 30.

To register, or for more information, contact Leslie Krockenberger at 812-237-3696 or by e-mail at leslie.krockenberger@indstate.edu.

-30-

Contact: Leslie Krockenberger, Sycamore Nursing Center, ISU College of Nursing, Health, and Human Services at 812-237-3696 or leslie.krockenberger@indstate.edu.

Writer: Rachel Wedding McClelland, assistant director of media relations, Communications and Marketing, Indiana State University at 812-237-3790 or rachel.mcclelland@indstate.edu.

Indiana State University: Newsroom

Petition in support of The Melanie Blocker Stokes MOTHERS Act continues to grow! « Perinatal Pro Weekly Blog

 

…Meanwhile, your signature on the national petition endorses the programs, services and outreach needed to eradicate these disorders along with your support for the The Melanie Blocker Stokes MOTHERS Act! New organizational or individual endorsements are welcome!  Just email me susanstonelcsw@aol.com with your name, (organization) state and affiliation. Visit the growing list of supporters at www.perinatalpro.com

The crucial stakeholders including mothers, families, advocates and healthcare providers have been awakened to the devastation of untreated perinatal depression and the tide irreversibly turned as our mission is now shared  by many powerful allies able to shape our healthcare response to maternal depression in the decades to come…

Petition in support of The Melanie Blocker Stokes MOTHERS Act continues to grow! « Perinatal Pro Weekly Blog

A MedEdPPD Survey

 

Dear Colleague,
MedEdPPD is conducting a short survey to gauge interest in a potential university-based study of women of childbearing age who have a history of depression. We are asking for your help in recruiting appropriate patients from your practice to take a few moments and fill out the survey. Participation is completely anonymous and requires no personal information.
The aim of this study will be to prevent, without antidepressant medication, a recurrence of depression in women with a history of depression. Women in this program who are on antidepressant medication would taper off of it before trying to become pregnant. Clinicians will monitor study participants during pregnancy and after birth for signs of depression, and participants will be helped with selecting a non-pharmacological treatment if they become depressed. This study will begin in the clinic but continue over the Internet to maximize convenience for the busy mothers and mothers to be.
Please pass this link on to your patients or clients who you feel may have interest in such a study.

Click Here to Take the Survey

Thank you for your time and in assisting us in conducting this survey.

Developed with the support of NIMH SBIR contract # HHSN278200554096C.
© 2009 MediSpin Inc. All rights reserved.

Arizona Mom Fights VBAC Rules at Local Hospital | Our Bodies Our Blog

 

Posted by Christine C.

An Arizona woman’s dispute with her local hospital over its refusal to allow a VBAC (vaginal birth after cesarean), even though she has already undergone a VBAC at the same hospital, has caught the attention of CNN, which featured the story on its homepage today.

Joy Szabo, 32, told CNN she is grateful for the c-section performed during her second delivery, when doctors feared the baby wasn’t getting enough oxygen, but her third son was a vaginal birth and she thought this delivery would be, too (assuming there were no complications). Page Hospital has since changed its policy and no longer allows VBACs…

Arizona Mom Fights VBAC Rules at Local Hospital | Our Bodies Our Blog

ICAN eNews

In the news

Acupuncture May Help Prevent Cesareans

Acupuncture during pregnancy can help decrease the chances of a cesarean. Among the other benefits of acupuncture during pregnancy, an increased chance of spontaneous labor is cited. Read Full Article.

Chew Your Way to Faster Post-Cesarean Healing

Researchers say that chewing gum can help the body heal after a cesarean. "Of most interest, the women in the gum-chewing group were discharged from the hospital an average of 9.7 hours before the women in traditional management group." Read Full Article.

Cesareans for First Time Moms Highest Among African Americans

The percentage of primary cesareans is highest among African Americans. The lead author of a Kaiser Permanente study states that this phenomenon, "cannot be explained by education, smoking during pregnancy, when prenatal care began or maternal age at delivery." Read Full Article.

In the research

Treating diabetes shows benefit to babies

A recent study shows that the treatment of even mild gestational diabetes reduces the risk of a cesarean. Study participants that received treatment had about a 7% reduced rate of cesareans than those who were left untreated. Read Full Article.

Rising trend and indications of caesareans at the university of Maiduguri teaching hospital, Nigeria.

A Nigerian study of the rising rate of cesareans at a teaching hospital explains that although the rate of cesareans increased over five years, perinatal outcomes did not improve. Read Full Article.

Pregestational Diabetes: A Risk Factor for Vaginal Birth after Cesarean Failure?

A University of Pennsylvania study indicates that women with pregestational diabetes have an increased risk of VBAC "failure" than women without pregestational diabetes.  Read Full Article.

From the women of ICAN

Arizona Mom Fighting VBAC Ban

An alarming story of a woman fighting against a VBAC ban has hit the news and the ICAN blog. 

Read the story here and post a comment.

Online Support Meeting - VBAC: The Courage to Try Again

Do you live in an area without an ICAN Chapter? Are you interested in finding even more support? You can now attend an online support meeting! The first live online meeting will take place on Monday, October 19th from 9:00-11:00 pm EDT.

Read More and Register.

ICAN Calendars are Here!

Filled with photos of those touched by ICAN, the calendar is a beautiful daily reminder of ICAN's mission. Order yours now.

Get active!

Mother-Sized Activism: Page Hospital VBAC Ban

A new addition to ICAN blogs, "Mother-Sized Activism" finds an issue and suggests "mother-sized" ways we can all help. Currently, Mother-Sized Activism has taken up the VBAC ban at Page Hospital in Arizona. With just a few minutes of your time you can make a difference today!

Get Active!

Controversies in Childbirth Conference

Tampa, Florida February 19-21, 2010
www.BirthConference.org

You Requested to be Updated on Conference Developments

This update is going out to all email list subscribers, whether or not you've already registered for the upcoming conference in Tampa. February 19-21, 2010.

We are excited that computer geek and birth activist, Laureen Hudson is teaching a pre-conference workshop on Thursday, February 18^th entitled: Hands-O Tech for Birth Care Professionals. This is a bring the laptop and work on websites, blogs, Facebook, Twitter, Linkedin and other social media. Laureen's seminar on Marketing to Millennials was a favorite in Fort Worth.

Also, Robbie Davis-Floyd, PhD will offer her own workshop on Thursday, entitled, "An Afternoon With Robbie Davis-Floyd." This is an intimate, freewheeling session where Robbie will discuss her career studying birth and midwives, as well as links between birth and culture.

You can register for the conference and the pre-conference workshops at: www.birthconference.org

We have some new seminars that are about to be added to the website (not on there yet). and we want to give YOU, first look.

A) Holly Kennedy PhD, CNM, FACNM, FAAN President-elect of a ACNM will discuss Whether changes to improve maternity care that were successful in UK hospitals can be successfully implemented in the United States.

B) Rixa Freeze, , PhD , will examine whether physician and hospital refusals to give women the birth options that they desire, can lead them to have dangerous, unassisted homebirth.

C) Patrick Hauser, author of the "Fathers to Be Handbook" will discuss the interaction between fathers and the various birth care professionals. You may be surprised at how much business your practice loses because of how the fathers to be were treated.

Also, become a follower of our birth issues blog at: www.birthissues.blogspot.com , where we ask the questions that no one else is asking

MedEdPPD.org October 2009 Newsletter

October 2009

Dear Colleague,
The American Psychiatric Association and American College of Obstetricians and Gynecologists has released joint recommendations for weighing the risks and benefits of treatment options for women with perinatal depression. This summary report is intended in part to act as a guideline for Ob-Gyns and to encourage them to take an active role in diagnosing and treating depression in their patients. In short, the authors state that many patients with mild or moderate depression may be effectively treated using psychotherapy alone, but patients with severe mental illness (eg, bipolar disorder or a history of severe depression) should be referred to a psychiatrist for treatment during pregnancy. The authors also note that existing research on antidepressant exposure in pregnancy fails to control for adverse outcomes due to other health factors or pregnancy complications, including the effects of untreated depression.
For patients who need or prefer antidepressant therapy, scientists continue to plumb the data in search of information about the effects of antidepressants during pregnancy. The British Medical Journal recently published a paper by Danish researchers who looked at possible major teratogenic effects from exposure to SSRIs in pregnancy. Using birth and prescription data from Danish registries, they found a significant increase in septal heart defects when two types of SSRIs—sertraline and citalopram—were taken in the first trimester, with the highest prevalence in babies of women who were prescribed two or more SSRIs concurrently. Paroxetine and fluoxetine were not found to be associated with any major birth defects.
To learn more about SSRI use during pregnancy, please view Dr. Shari Lusskin's presentation, SSRIs and Pregnancy.

Medical Updates
Identification of postpartum depression.
Sit DK, Wisner KL.
Clin Obstet Gynecol. 2009 Sep;52(3):456-68.
This study reviewed the diagnostic criteria, clinical risk factors, and screening tools for PPD as well as how to manage patients who screen positive for postpartum depressive disorders.
Antidepressant medication use during breastfeeding.
Lanza di Scalea T, Wisner KL. Clin Obstet Gynecol. 2009 Sep;52(3):483-97.
This review of 31 empirical papers identified the most evidence-based medications for use during breastfeeding.
The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists.
Yonkers KA, Wisner KL, Stewart DE, Oberlander TF, Dell DL, Stotland N, Ramin S, Chaudron L, Lockwood C. Gen Hosp Psychiatry. 2009 Sep-Oct;31(5):403-13.
Using Medline searches, researches evaluated studies of antidepressant exposure during pregnancy to determine the risks of depression and antidepressant exposure in pregnancy. Few of the studies controlled for possible effects of depressive disorder.
View More»
In The News
Margaret Trudeau speaks in Regina at the Unmasking Postpartum Depression conference
Regina Leader-Post, September 30, 2009
Canada's former first lady delivered the keynote address at the opening of the Unmasking Postpartum Depression conference, describing her experience with PPD and her lifelong struggle with bipolar disorder.
Antidepressants Linked to Heart Defects in Newborns
Atlanta Journal Constitution, September 24, 2009
Danish researchers found that septal heart defects were common among women taking antidepressants in the first trimester.
Predicting Postpartum Depression May Be Possible
US News and World Report, September 23, 2009
Spanish researchers have devised a method that they claim can detect or predict up to 80% of PPD cases within a few weeks postpartum.
View More»
Events Calendar
Reproductive Health 2009
When: September 30-October 3 Where: Los Angeles, CA
12th Annual NPWH Premier Women's HealthCare Conference
When:October 14-October 17
Where: Providence, RI
9th Annual Social Work Conference: The Changing Face of Mental Health
When: October 22
Where: Charleston, SC
Med Ed Resources
American Psychiatric Association
The APA, which represents nearly 36,000 psychiatrists worldwide, supports the diagnosis, treatment, and prevention of mental illnesses.
Motherisk
Motherisk provides evidence-based information and guidance about the safety or risk to the developing fetus or infant of maternal exposure to drugs, chemicals, diseases, radiation, and environmental agents.
National Center for Complementary and Alternative Medicine
The National Institute on Alcohol Abuse and Alcoholism provides leadership in the national effort to reduce alcohol-related problems.
This Month's Poll
As a health care provider, are you in favor of a public insurance option as part of national health care reform?
To participate in this month's poll click HERE.

Spread The Word
Click here to tell a colleague.
MedEdPPD.org Newsletter Archives
Missed last month's newsletter? Click here for a list of our previous newsletters.

Developed with the support of NIMH SBIR contract # HHSN278200554096C.
© 2009 MediSpin Inc. All rights reserved.

1 million premature babies die each year, report finds - USATODAY.com

By Liz Szabo, USA TODAY

The preterm birth rate in the USA is especially high: 12.7% of all babies are born early, according to the March of Dimes. That rate has increased 36% in the past 25 years, partly because of an increase in elective cesarean section, an increase in older mothers and the growing use of assisted reproduction, which increases the risk of twins, triples and higher-order multiple births, the report says…

1 million premature babies die each year, report finds - USATODAY.com

Jenny's Light Newsletter - Special Edition

Jenny's Quote of the Month:

Imagination is the highest kite one can fly.

~ Lauren Bacall

October Is National Depression Awareness Month

Depression is more than just feeling "down in the dumps" or "blue" for a few days. Depression is a serious illness that involves the body, mood, and thoughts and can last weeks, months or even years. It is not a sign of personal weakness or a condition that can be willed or wished away. People with depression cannot merely "pull themselves together" and get better.
However, with appropriate treatment most depression is alleviated. The following is a list of depressive symptoms. Not everyone who is depressed experiences every symptom. Some people experience a few symptoms and others many. Additionally,
having one symptom does not mean you are depressed.
Depression Symptoms
• Persistent sad, anxious, or "empty" mood
• Feelings of hopelessness, pessimism
• Feelings of guilt, worthlessness, helplessness
• Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
• Decreased energy, fatigue, being "slowed down"
• Difficulty concentrating, remembering, making decisions
• Insomnia, early-morning awakening, or oversleeping
• Appetite and/or weight loss or overeating and weight gain
• Thoughts of death or suicide; suicide attempts
(Please call your EAP or other mental health professional immediately for assistance)
• Restlessness, irritability
• Persistent physical symptoms that do not respond to treatment, such as headaches,
digestive disorders, and chronic pain
The above list may have you wondering about yourself or someone close to you. There is no need to suffer when help is only a phone call away. Please contact your Employee Assistance Program at 800-451-1834 for information about or assistance with depression.
Additional Depression Resources:

www.nimh.nih.gov/publicat/depression.cfm
www.stress-anxiety-depression.org/depression
www.healingwell.com/depression/
www.depression.about.com
Resource: National Institute for Mental Health

October 8th is National Depression Screening Day
Screening for Mental Health, Inc., (SMH) first introduced the concept of large-scale mental health screenings with National Depression Screening Day^® in 1991. SMH programs now include both in-person and online programs for depression, bipolar disorder, generalized anxiety disorder, post-traumatic stress disorder, eating disorders, alcohol problems, and suicide prevention.  Programs are implemented by local clinicians at mental health facilities, hospitals, primary care offices, social service agencies, colleges/ universities, workplaces, schools and the military.

Click Here to find a screening site near you or someone you love.

Concord Monitor - Defensive medicine takes a financial toll

By Dr. OGLESBY YOUNG For the Monitor

…Look no further than my specialty of obstetrics for a good example of defensive medicine. Our country's cesarean section rate in 1970 was 5 percent. Today more than 30 percent of births are by cesarean section. Babies have not grown that much bigger! And, remarkably, the incidence of cerebral palsy has not changed during the 35 years of increasing cesarean section rates. Good science has shown that less than 10 percent of cerebral palsy has anything to do with events during labor and delivery. Regrettably, obstetricians have learned that our liability for the outcome of a birth is markedly reduced by performing a c-section. As one of my colleagues said, "We are never sued for the cesarean section we have done, but when we are sued it is often for the c-section we did not perform."

Calculating the actual costs of defensive medicine is difficult. Physicians have a hard time saying how much any given decision is driven by liability concerns. Doctors do get sued for failure to diagnose when not ordering tests, but our decisions are mixed with the desire to provide patients with the "best" evaluation and to please patients who want to feel that treatment is comprehensive. And in some cases, doctors increase their income by ordering more tests.

Many factors influence the amount of health care that is provided. Still, defensive medicine alone is estimated to contribute 15-30 percent to the total U.S. health bill. Defensive testing can lead to unnecessary, expensive and serious medical intervention. These hidden costs of our medical malpractice system are an important piece of the puzzle in our country, where health costs per capita are twice that of any other developed nation, despite worse outcomes than most other developed countries…

Concord Monitor - Defensive medicine takes a financial toll

Midwife gives hope to new mums in Africa (From Craven Herald)

 

Midwife Shona Featherstone working with the Living Hope charity in Nigeria

…Common problems during childbirth include breach deliveries and obstructed or prolonged labour; complications that would lead to a caesarean operation in this country.

“Even the women who survive a traumatic labour can suffer a ruptured uterus or haemorrhaging, and there are no blood transfusion facilities in the villages,” says Shona. “When I was there, we needed to do a caesarean section and the charity had to pay for oxygen on the black market.

“Some birth complications lead men to leave their wives, so the women become socially isolated.” …

Midwife gives hope to new mums in Africa (From Craven Herald)

Mothers-to-be turn to 'doulas' in midwife shortage | Life and style | The Observer

 Denis Campbell

…Research has shown that the presence of a doula can help to shorten a woman's labour, reduce the amount of pain relief she is given, make a caesarean section less likely and give fathers more confidence in supporting the mother. Most women say they find their doula a soothing, beneficial presence during what can be a traumatic experience.

Midwives are divided as to whether doulas threaten or complement their key role. "My concern is that women are perhaps using doulas because the maternity services are struggling to provide one-to-one care and that midwives, who are not just trained clinical experts but are also skilled in emotional support, are currently finding it hard to provide continuity of care," said Mervi Jokinen of the Royal College of Midwives. "It is also sad that some women may feel anxious that their concerns will not be heard by health professionals and therefore look to an external advocate such as a doula."

The Department of Health has given £270,000 to help establish volunteer doula services around England.

Mothers-to-be turn to 'doulas' in midwife shortage | Life and style | The Observer

Program boosts new mums' mental health

By Edwina Scott

…Women with no history of mental illness who participated in the program reported less than half the incidence of depression, anxiety and adjustment disorders in the first six months after giving birth compared to women who received only "standard" care, including access to a maternal health nurse…

Program boosts new mums' mental health

ICAN eNews

In the news

Almost half of obstetricians back C-section by request

Findings from a Canadian survey show that 42% of obstetricians believe women have a right to choose a cesarean section even when there is no medical indication for the surgery. However, only 21% of this group believes that a cesarean section is as safe as vaginal delivery.  Read Full Article.

VBAC now uncommon in Australia

The number of VBAC attempts in Australia has dropped to 19% and "unwarranted fears" are likely to blame.  Read Full Article.

Early periods linked to Caesareans

A study indicates that early onset of menarche puts women at a higher risk for a cesarean delivery. Longer exposure to estrogen and progesterone may " the function of the uterus in labour." Read Full Article.

In the research

Serial Membrane Sweeping at Term in Planned Vaginal Birth After Cesarean: A Randomized Controlled Trial

The practice of sweeping the membranes weekly has no significant impact on labor and delivery for women planning a VBAC.  Read Full Article.

Vaginal birth after two caesarean sections (VBAC-2)-a systematic review with meta-analysis of success rate and adverse outcomes of VBAC-2 versus VBAC-1 and repeat (third) caesarean sections.

Study focuses on the risks of a VB2C compared to a VBAC. The Leeds, UK research group notes a VB2C success rate of 71.1% as well as "comparative maternal morbidity" to a third cesarean. Read Full Article.

Effects of acupressure at the Sanyinjiao point (SP6) on the process of active phase of labor in nulliparas women.

The comfort measure of applying pressure at the Sanyinjiao point on the ankle reduces the severity of pain and decreases the rate of cesarean section. Read Full Article.

From the women of ICAN

Michelle Obama: Cesarean as a preexisting condition is "gender discrimination"

ICAN blogger comments on the recent statement made by First Lady Michelle Obama. Read Full Article.

Violating Women's Rights

ICAN's "Connecticutdoula" explores what should really be the issue in the so-called "Home Birth Debate." She argues that the discussion should focus on how to "reduce the maternal and infant mortality rates in the United States, as well as make all birthing options available."  Read Full Article.

ICAN Calendars are Here!

Filled with photos of those touched by ICAN, the calendar is a beautiful daily reminder of ICAN's mission. "  Order yours now.

Get active!

Upcoming Webinar: Journey to VBAC

Fathers have a role in preventing cesareans too! Part 2 of the webinar series "Journey to VBAC" focuses on how fathers can prepare for labor and the impact they have on the laboring mother. Rose St. John will host this webinar on October 4th at 9:00 pm EDT. This event is free to ICAN subscribers! Read Full Article.