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Monday, March 19, 2012

Day 2: midwives as primary maternity care providers and inter-professional collaborative care

yesterday was intense. it was a long day and we had powerful discussions, the day culminating in the language of racism that exists in "white neo-midwifery".

i'll talk about this concept later as it is a big topic. one that is distinct from what i see as the intention of this conference. but one that is important in order to address the disparity in maternal and neonatal mortality rates in the united states.

a discussion that leads to more questions than perhaps answers. 

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i attended two break away sessions yesterday.
take away message from both:

"the right care at the right time in the right place by the right people"

the question is - what does this look like and how do we get there?

in the two sessions, the first on midwives as primary maternity care providers, the second, collaborative care. 

Amy Romano discussed what a primary maternity care provider is and the concept of a maternity care home. These concepts are the outcomes of the 2020 Visioning and the Blueprint for Action.

some interesting distinctions that she made, which we can see happening in other countries, is the difference between midwifery care and midwife-led care. it is this concept that midwives need not necessarily be limited to low-risk women, but that midwives work with women, in a collaborative relationship with other healthcare provider to meet the individual needs of pregnant women. the midwife essentially coordinates a woman's care. 

this can work in conjunction with the concept of a maternity care home (which i discovered was not necessarily a discrete physical place - though it could be). 


Elements and features of maternity care home
-        primary maternity care providers assigned to each women
-        individualized care planning guided by
o      standardized risk screening
o      evidence-based guidelines
-        linkages with community resources
o      behavioural health services
o      mental health services
o      parenting services
-        preventative care
-        access to self-care information, reseources, and tools
-        accessto a higher level of care, as needed
-        shared decision making and clinical decision support
-        coordination of care
-        performance measurement and reporting, continuous quality imporovemnt
-        new payment models, eg. bundled payment, pay for performance (including “patient experince”)
-        community outreach to foster access to care
-        newborn care and breastfeeding support/promotion


the second part of implementing a system like this is by facilitating effective inter-professional collaborative care.

this is huge. 

Debbie Jessup talked about the MOM's for the 21st century act - HR2141 (122th)/HR5807 (111th), a large component of which involved the development of a core curriculum that is essential to providing high quality maternity care. one with a public health focus, incorporated cultural sensitivities, supports physiologic birth, and includes an interdisciplinary curriculum. 

emerging from the homebirth summit, statement six addresses the idea of interdisciplinary education. 

"effective communication and collaboration across all disciplines caring for mothers and babies are essential for optimal outcomes across all settingsto achieve this, we believe that all health profession students and practitioner who are involved in maternity and newborn care must learn about each others disciplines and about maternity can health care in all settings."

Practical application of inter-professional education (IPE) in maternity care
-  focus on expanded understanding of roles, responsibilities, skills and training or maternity care providers
-    focus on expanded understanding and appreciation for varied birth settings
-    focus on promoting more integrated approaches to supporting women across all birth settings both in selecting sites for care and in movine from one care setting to another as needed/desired


Lisa Kane Low, CNM involved in the interdisciplinary education workgroup made an important argument that the cross training can and should begin between CPM's and CNM's. that we should be welcoming each other into our practices and spaces. learning from each other, gaining knowledge from each others expertise. 

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so were does this leave us?

Day 3 - today we focus on where we want to go.

i have a lot more to say about the discussions from yesterday, and this is where i want to focus my attention. what i see as important in addressing the maternity care disparity in this country. 

we will see what emerges. 

Sunday, March 18, 2012

Day 1: Setting the Stage

millennium development goals, blueprint for action, government initiatives - strong start, AOC's, innovative awards. but how do midwives access these? how do CPM's access these? 

there has been an increase in homebirth --> amongst white, non-hispanic women. 40% of maternity care covered by medicaid. in 26 states midwifery is legal. in 14 states medicaid covers midwives. where do we go?

do midwives want to be primary maternity care providers?
what does this mean? how does this look? what does it imply?

education: skills in health promotion, public health, collaboration....

individual responsibilities of midwives to foster these relationships at a local level. don't stop fighting just because midwifery is legal. a system that requires mother to go between midwife --> family practice doc --> specialist is inefficient.

women will be lost, particularly if we are trying to mitigate the disparity that exists. 

do we as white midwives feel guilty because of the colour of our skin? most women don't seek healthcare providers. most women only see healthcare providers during their pregnancy. 

what tools do we as midwives have to meet the needs of these women?

are we turning our backs on them? do we even see these women and their needs?

do we want to be primary maternity care providers or do we want to be midwives (continuing to serve the same women we have been serving)?

i thank the midwives that came before me, that fought for the white, non-hispanic women to have the options that they do. but it's time to move forward. we need to reframe the discussion around midwifery care away from homebirth and refocus it on to what is important. serving women during their pregnancies - not only white women, but all women. 

sure birth can be a spiritual journey, but today is that what is important? when women and baby's are dying, what is important?

the above may not actually be a summary of all that came out of yesterday, but the above is how i've processed it. where i see the discussion.

Friday, March 16, 2012

lobby day

the beginning of the 2012 NACPM Symposium started with a bunch of midwives occupying capitol hill.

there were about 45 of us crowded into a small room at the health policy source office this morning, being prepped for our meetings with senators and congressmen, advocating for the mission of the MAMA campaign and HR 1054.

the bill, if passed would include CPM's in the list of providers that would be reimbursed by medicaid for out of hospital midwifery services. right now there are only about 14 of the 24 odd states where midwives are licensed that receive medicaid reimbursements.

our WA state contingent was strong, about fourteen. much of the information that we provided the representatives comes from data collected from our home state (yes, yes. i'm not from washington, but for all intensive purposes, why not).

over the next four days we will be filled with information, my aim is to try and blog throughout.

i should be proud. there are only a handful of students that are present at this symposium. i'm amongst some pretty powerful midwives and the energy is high.


Sunday, March 11, 2012

Friday, March 2, 2012

creating business plan for school is causing me to think about the future.

this semester i have two professional issues classes: business and responsibilities. lab work. pharmacology. well-woman. skills IV. plus a few seminars. and my independent research class. 

creating a business plan for school is causing me to think about the future.

this is stressing me out. 

i was so focused on staying in the present for so long because the future, what i am going to do, where i am going to go is so up in the air. i have no singular attachment. i feel as though i have no home, but know i could make one anywhere.

i left myself open to options. to be free to see where life took me. 

i'm contemplating staying in WA. this, with having to write a business plan for school is forcing me to analyze what this actually would look like, how it could be feasible. choosing a state that has no clear route for licensing midwives trained outside of their approved schools (N=1). with midwives currently waiting with their applications, piled with others, for any sort of due process.

it will take years for me to get licensed in WA after i finish school. there are groups out there that are trying to work on a way to get midwives licensed in the state, midwives trained outside the all holy bastyr/SMS system. there are two groups. philosophically opposed with each other vying for the same purpose. 

hopefully it will be sorted out by the time i finish school. how long would such a bureaucratic process take to sort out?

this is all being counterproductive to my practice of staying in the present. this is having an unhealthy side effect. 

choosing to immigrate to another country isn't an easy process. particularly when i would be giving up socialised health care. but it's worth it, right? it's good.