Current Maternity Care Legislation Supports the Principles of the Mother-Friendly Childbirth Initiative

 This month at Blossom Birth we are highlighting Mother Friendly Childbirth Initiative (developed by the Coalition for Improving Maternity Services (CIMS),  an evidence-based, wellness model of maternity care that is a comprehensive response to birth advocates' analysis of the serious gaps in maternity care services of the time. The information below is taken from the latest CIMS e-newsletter- it is a comprehensive summary of the current and upcoming key health care legislation, a great way for us to follow the progress of these very important bills and encourage our Senators and House Representatives to support them. After more than a decade birth advocates are finally seeing maternity care legislation that promises to address the health needs of mothers and infants.

Started in July 1996,  31 individuals and 26 organizations representing over 90,000 members ratified the Mother-Friendly Childbirth Initiative (MFCI).  The MFCI outlined several areas that still need improvement today: higher perinatal morbidity and mortality and a higher maternal mortality rate than many other industrialized countries; disparities in access to care and health outcomes; high rates of cesareans and inductions of labor; lack of access to midwifery care; the routine use of non-evidence based birth practices which expose mothers and newborns to avoidable harms; increased use of technology which undermined womens confidence in their innate ability to give birth; lack of support for breastfeeding and birth practices that met providers needs rather than womens needs.

Current health care law and forthcoming legislation is now addressing the very issues highlighted for change in the MFCI. CIMS is proud that many of our organization members are actively involved in developing and promoting pending maternity care legislation. They include AABC, ACNM, Birth Matters Virginia, Childbirth Connection, Citizens for Midwifery, AWHONN, MANA, NACPM, NARM and The Tatia Oden French Memorial Foundation. 

Patient Protection and Affordable Care Act (HR 3590) On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act into law. This bill includes major provisions to increase women's access to healthcare insurance, evidence-based care and maternity care providers of their choice. The far-reaching bill eliminates health insurance practices that discriminate against women and recognizes the importance of focusing specifically on women's health needs by creating and funding federal offices of women's health. In addition, the bill does away with several Medicaid and Medicare reimbursement inequalities against midwives and birth centers across the country. Included in H.R. 3590 are these key provisions: Women will have direct access to the obstetrician/gynecologist, certified nurse midwife or certified midwife of their choice;  Women will have access to insurance coverage before, during and between pregnancies; Women will no longer be denied health coverage due to pre-existing conditions such as being pregnant, having had a cesarean section, or being a victim of domestic violence; Low-income women and their children can now benefit from prenatal and postpartum nurse home visits; Employers with over 50 hourly-wage employees now have to provide nursing mothers the opportunity to take unpaid breaks to pump breast milk in an appropriate and private place on location; Women will be covered for a range of preventive services including screening for diabetes and heart disease as well as mammograms;  Freestanding birth centers in all 50 states will be reimbursed for providing care to women covered by Medicaid; All licensed caregivers who provide services in licensed birth centers for women with Medicaid will be reimbursed; As of January 1, 2011, the Medicare Part B reimbursement rate for Certified Nurse Midwives increased from 65% to 100% of the fee schedule.  Funds will be made available to cover screening, education, treatment and support for postpartum depression; To ensure that women's particular health needs are addressed in all Federal health initiatives Women's Health Offices will be created in five Federal agencies: the Agency for Healthcare Research and Quality, the Health Resources and Services Administration, the Centers for Disease Control and Prevention, and the Food and Drug Administration.  For a summary of the bill see OpenCongress.          For a comprehensive assessment of the impact of this bill read U.S. Health Care Reform Legislation Offers Major New Benefits to Childbearing Women and Newborns by Carol Sakala, PhD, MSPH on Childbirth Connections new website, Transforming Maternity Care.  Partnering to Improve Maternity Care Quality Act of 2010 (HR 6437)  This bill, introduced by Representative Eliot Engel (D-NY) in November of 2010 is being amended and has not yet been reintroduced in the 2011 session of Congress. This legislation is designed to promote optimal maternity outcomes by making evidence-based maternity care a national priority.  If passed it would:  Ensure the development of national, evidence-based quality measures for maternity care in Medicaid, as well as a process to collect this data; Create and implement a national patient survey of women to assess their experience of maternal care Establish a demonstration project to develop effective alternative payment models aimed at simultaneously improving health outcomes and reducing costs; Authorize an Institute of Medicine report to identify a package of essential evidence-based services for childbearing women and newborns.  This bill includes many key provisions recommended in two Childbirth Connection reports: Evidence-Based Maternity Care: What It Is and What It Can Achieve  andBlueprint for Action: Steps Toward a High-Quality, High-Value Maternity Care System.   Follow the progress of this bill on OpenCongress.         MOMS for the 21st Century Act (H.R. 5807)  Introduced by Congresswoman Lucille Roybal-Allard, the Maximizing Optimal Maternity Services for the 21st Century Act places a national focus on evidence-based maternity care practices to help achieve the best possible maternity outcomes for mothers and babies.  This bill would:  Expand federal research on best maternity care practices; Authorize a public awareness media campaign to educate the public about the best proven maternity care practices; Pinpoint areas with shortages of maternity care providers and create incentives for providers to fill those gaps; Improve the maternity care workforce by developing interdisciplinary core curriculum for training and increasing workforce diversity.  Follow this bill on OpenCongress. For additional information see Amnesty International,Deadly Delivery: The Maternal Health Care Crisis in the U.S.A.: One Year Update  Maternity Care Improvement Act of 2010 (H.R.6318) Representative Lois Capps (D-CA) introduced this bill. If passed it would:  Increase government accountability and coordination of efforts related to maternal health by designating a national coordinator of programs related to maternal health; Create a national registry of maternal and infant health data, and ensure that data is collected in a way that is standardized and disaggregated by race; Improve the maternity care workforce by enhancing education and training for nurses, creating an interdisciplinary maternity care core curriculum to promote best practices in evidence based, woman-centered, culturally competent, collaborative care that will prevent complications and reduce disparities; Improve the diversity of the maternity care workforce by awarding grants to increase recruitment of underrepresented minorities into the maternity care workforce.  For additional information see Amnesty International, Deadly Delivery: The Maternal Health Care Crisis in the U.S.A.: One Year Update  Maternal Health Accountability Act of 2011 (H.R.894)  This legislation was introduced by Representative John Conyers (D-MI) on March 11, 2011 and referred to a subcommittee on health on March 11.  If passed the bill would:  Provide funds for States to establish Maternal Mortality Review Committees, to collect data on pregnancy-related and pregnancy-associated deaths; Identify ways to lower maternal mortality rates Require that states reduce or eliminate disparities in maternal health outcomes; Health professionals and facilities would be required to report pregnancy-related deaths; A national definition of severe maternal complications would be developed; Each maternal death would be investigated All findings and recommendations would be disseminated. Follow this bill on OpenCongress. You can also join MomsRising in writing to Congress in support of the Maternal Health Accountability Act.  For additional information stream Childbirth Connection's Webinar, Disparities in Maternity Care   Access to Certified Professional Midwives Act of 2011 (H.R. 1054) Introduced on March 10, 2011 by Representative Chellie Pingree (D-MN), the bill provides access and reimbursement to certified professional midwives (CPMs) for services provided to women enrolled in the Medicaid program. Congressman Rodney Alexander (R-LA) will be the first Republican to cosponsor this important Medicaid payment legislation. This bill adds the services provided by Certified Professional Midwives as a new category of mandated health service under the federal-state Medicaid program. If passed, it would: Require all states that license, register, or legally authorize CPM practice to make CPM services available to all pregnant women who receive Medicaid; Add the services of a Certified Professional Midwife as a new category to the existing categories of providers (such as hospitals, nurse practitioners, certified nurse midwives and birth centers) eligible for Medicaid payment. Only CPMs who practice in a state where their services are "legally authorized by State law" would be eligible for Medicaid payment. Licensed or registered direct-entry midwives who are not CPMs would not be eligible. Follow this bill on OpenCongress. The PREEMIE Act of 2006  The PREEMIE Act was signed into law on December 22, 2006 and will expire at the end of 2011. It is designed to reauthorize P.L. 109-450 and expand research, education and intervention activities related to reducing preterm birth - the number one killer of newborns. If reintroduced in 2011 and passed the specific provisions of the bill would: Expand and coordinate federal research related to preterm labor and delivery, and the care and treatment of preterm infants; Require the development of a Preterm Birth Research, Education and Intervention Programs Action Plan for the Department of Health and Human Services; Authorize demonstration projects to test promising preterm birth prevention and treatment interventions; Establish a National Educational Media Campaign to promote healthy pregnancies and help prevent preterm birth. The Senate champion of the PREEMIE Act is Lamar Alexander (R-TN) and the House champion is Anna Eshoo (D-CA). Take Action Take action to help pass the legislation that you support. Contact your senator and your congressman or congresswoman in the House of Representatives to encourage them to pass these important bills.

Report published on increasing Maternal mortality rates in California and the U.S

Last month, as part of the Blossom's Achieving Quality Maternal Care Lecture Series we had Christine Morton, PhD join us to talk about the work of California Maternal Quality Care Collaborative (CMQCC) and the rising rate of Maternal Mortality and Morbidity in California. The report of the study that she and her colllegues have been involved in is now out! Also, join us this Saturday May 30 at 6:30pm for the next talk in our series by Henci Goer, Limits of Evidence Based Care

The California Pregnancy-Associated Mortality Review (CA-PAMR): Report from 2002 and 2003 Maternal Death Reviews. 

Read the report online.

The California Pregnancy-Associated Mortality Review (CA-PAMR) is a project of the California Department of Public Health (CDPH), Maternal, Child and Adolescent Health (MCAH) Program in collaboration with the California Maternal Quality Care Collaborative (CMQCC), the University of California, San Francisco (UCSF) Institute for Health and Aging (IHA), and the Public Health Institute (PHI). CDPH/MCAH and the CA-PAMR project are fortunate to have the voluntary service of the CA-PAMR Committee, a statewide, multidisciplinary Committee comprised of leading clinical experts in maternal and perinatal health and public health. The CA-PAMR Committee serves to determine the causes of maternal mortality and to make recommendations concerning quality improvement opportunities in maternity care and public health strategies to prevent maternal deaths in California. Funding for CA-PAMR is provided by the Federal Title V Maternal and Child Health (MCH) Block Grant Funds.

Mothering with Mindfulness Yoga

After the birth of my son, when my daughter was just 22 months old, the days were a mixture of elation and exhaustion. The physical and mental challenges of keeping up with the routine while attempting to adopt “best” practices in diapering, sleep routines, communication, potty training, etc., etc., were overwhelming. Navigating the myriad of choices and philosophies during the first years felt complicated and annoying to me. I yearned for something that felt solid, old, and normal, for something reliable and familiar, something that was the total opposite of the universe that I had entered.

Through the practice of mindfulness, I found huge freedom from the “shoulds” and gained access to a vast reservoir of inner wisdom, intuition, truth and clarity. As a long-time yoga teacher and practitioner, I wanted to share this source of freedom and contentment with other moms and created “Mindful Mama Yoga.”

In the Mothering with Mindfulness Yoga session at Blossom's Mother's Day Celebration on May 7, we explore what it means to cultivate mindfulness and how to open to the wisdom that allows us to deepen our connection to our children, our families, ourselves and our community. The class is a blend of yoga, pranayama (breathing exercises) and meditation focused on opening the energy channels of the body to better access the insight, inspiration and guidance that is available to us in any given moment.
Now my children are 3 and 5 years old and the mindfulness practice continues to be my guiding light. I walk a crooked path; but I have a reliable radar to come back to over and over again. When I start to stray, I remember this lovely quote by Thich Nhat Hahn that grounds me and brings me back to center. He says, “The most precious gift we can offer others is our presence. When mindfulness embraces those we love, they will bloom like flowers.”

Grace Kendrick
Mindful Mama Yoga and Ayurveda, Founder
www.mindfulmamayoga.com

Over the coming weeks we are featuring articles about the inspiring, rejuvenating and relaxing offerings at our Mother's Day Pampering Celebration on Saturday, May 7, 9am onwards. Come join us- sign up for a massage with Verde Touch, enjoy a great self portrait by professional photographer Rosalinda, participate in our workshops and celebrate a fun evening of music with Rockin'Moms! It is a double win: all funds from the event support Blossom's work with new and expectant families and you get to have a fun day celebrating being a mom or mom-to-be! RSVP today!

Eight Steps to a stronger back and better posture!

Hi, my name is Esther Gokhale, and I am the author of 8 Steps to a Pain-Free Back and creator of the Gokhale Method, which provides life-long tools for healthy, pain-free posture. The Method was the culmination of my long journey from constant pain and the threat of surgery, to an active life without pain or physical limitation. After undergoing back surgery after my first pregnancy, I hoped my back troubles were at an end. In spite of following the advice I was given, I had a relapse of unbearable sciatic pain that made sitting and lying down for extended periods impossible. Doctors advised both a second surgery and that I refrain from having any more children. Determined to find an alternative path, I set out to understand and address the root causes of back pain. 

One of the foundations of my work involved studying cultures around the world in which back pain is virtually non-existent. I also studied the transformation of posture through the last century and before, through art and photos. I was also fortunate to work with experts in posture, movement and physiology. These elements led to the development of the Gokhale Method, which has successfully guided thousands of people away from back pain, neck pain, sciatica, repetitive stress injury and other musculoskeletal ailments that plague our modern world.

I am especially happy to be participating in this year’s Mother’s Day Celebration at Blossom Birth on May 7, because mothers can have a huge influence on the posture of their children. The most important thing in carrying your child is to periodically lengthen the child’s spine and to support a healthy forward-tipped (not tucked) pelvic position. Babies are born with excellent posture and fantastic instincts. In fact, we can learn a lot from simply watching the way they sit, sleep and move. Unfortunately, the beds, stroller, bouncy chairs and backpacks we carry them in often distort their natural good posture. Umbrella strollers are an excellent example of this. Their rounded shape forces the baby’s spine into a C-shape, encouraging the head to drop onto the chest, reducing circulation throughout the body and compressing the lungs.

Another helpful technique for mothers is to engage the inner corset--the abdominal and back muscles closest to the spine. The inner corset is a natural way for pregnant women to tone their abs and will be invaluable for carrying your baby.

I will also answer your questions about healthy posture-- including how to hold your baby, selecting baby furniture, and other ways to stay vital during your pregnancy.

See you soon!

Esther

My youngest daughter, Monisha, sitting with a stacked spine and a healthy, anteverted pelvis.

Over the coming weeks we are featuring articles about the inspiring, rejuvenating and relaxing offerings at our Mother's Day Pampering Celebration on Saturday, May 7, 9am onwards. Come join us- sign up for a massage with Verde Touch, enjoy a great self portrait by professional photographer Rosalinda, participate in our workshops and celebrate a fun evening of music with Rockin'Moms! It is a double win: all funds from the event support Blossom's work with new and expectant families and you get to have a fun day celebrating being a mom or mom-to-be! RSVP today!

Get Your Body Back, Get Your Self Back

If you're a mother, then you probably know how it feels to surrender your body, your time, and your life after you've brought a child into the world. Things like sleeping, taking a shower or brushing your teeth become variables rather than constants in your day. After giving birth and breast-feeding you've also given up your waistline and even your breasts. They're not just for you anymore...they are part of your child's basic needs.

Your body and your life have gone through massive shifts, and you may be left wondering, “How do I take care of myself after baby?” Here are the top three ways for new moms to get nurturing they need.

1) Get support.
You’ve heard the saying, “it takes a village” – and it certainly does! This new phase of your life is truly magical but it can be depleting, too. Getting the support you need in this time of change is crucial. Ask how can you create a team of friends, healers, or coaches to assist you. Who could help you stay calm, relaxed, grounded and at ease? Find ways to be replenished, revived, and ready to take on the tasks of being a parent.

2) Create structure and establish routine.
Make sure that “you time” is part of your routine. Even a few minutes makes all the difference.

Clients in my mind body boot camp say that one of the greatest things about the work is having designated time just for them. It's something they can count on. In boot camp we meet on a weekly basis for 1-4 months. It's incredible what can happen with a little structure and designated “you time.”

3) Heal & align your body.
Mind and Body are connected. After you have a baby your posture and body has changed. The low back automatically pulls forward with the weight of baby. The pelvis has expanded and contracted. If your body is off and out of alignment, it's only natural that you will feel off. Taking care of your body brings you back into balance and alignment in all areas of your life.

Bodywork and the habits of the physical body are critical in the work I do. We release tension and tightness to restore the body's natural posture. Join us to discover what’s happening with your alignment and try sample alignment exercises at Blossom's Mother's Day Pampering Celebration on May 7th. You’ll come away feeling relaxed and inspired about being a parent and about being YOU.

Be well,
Rebecca

Rebecca hosts a mind body boot camp to address the physical, mental and energetic needs of women. She creates structure and accountability and paves the way for profound shifts--leaving clients inspired and powerful as an individual, spouse or parent. Rebecca uses a unique blend of coaching, bodywork, & energy work to clear away blocks, balance and align clients on all levels. http://www.aligntheself.com/



Over the coming weeks we are featuring articles about the inspiring, rejuvenating and relaxing offerings at our Mother's Day Pampering Celebration on Saturday, May 7, 9am onwards. Come join us- sign up for a massage with Verde Touch, enjoy a great self portrait by professional photographer Rosalinda, participate in our workshops and celebrate a fun evening of music with Rockin'Moms! It is a double win: all funds from the event support Blossom's work with new and expectant families and you get to have a fun day celebrating being a mom or mom-to-be! RSVP today!

Ina May Gaskin on maternal healthcare in the US

This recent post in Babble.com has a wonderful article by Ina May Gaskin who shares 8 ways in which she believes maternal healthcare in America needs to change:
http://www.babble.com/pregnancy/giving-birth/maternal-health-care-midwives-birth-ina-may-gaskin/

Breast Pumps and Taxes: good news!

Taxes - they are often a subject to avoid and fear - however today, thanks to some great pro breastfeeding advocates in our national legislature, the IRS has reversed its previous decision and is now allowing breast pumps to be reimbursable expenses on FSA and tax returns. 

This is great news - the majority of women in the US return to work after giving birth and the breast pump has become an essential part of that equation.  Breastfeeding is recommended by the American Academy of Pediatrics and the World Health Organization for all children under six months. Quality, efficient pumps for working moms range form $200 - $350 - this expense is now reimbursable.  Formula will cost the typical American family $3500 per year, the breast pump enables moms to provide a superior product and now the cost of doing so will be reimbursable - very proactive and good for us all - delighted to see this in the news today.

Currently, twenty-four states, the District of Columbia and Puerto Rico have laws related to breastfeeding in the workplace; fully 43 states and the District of Columbia and the Virgin Islands have laws which allow women to breastfeed in any public or private location.

Work place laws paired with reimbursable breast pumps - it's getting better all the time!

--
Wendy Wright, MBA, IBCLC (Blossom Board)
Lactation Navigation, LLC
wendy@workplacenursing.com
650-868-5318
www.workplacenursing.com

Call to Action to Support Breastfeeding

Yesterday, the Surgeon General, Regina Benjamin released a significant policy document that will hopefully have far reaching effects for the support for breastfeeding.

The Call to Action to Support Breastfeeding outlines the barriers to breastfeeding and steps to eliminate them in the United States. 

Highlights of the press release include: 

- Communities should expand and improve programs that provide mother-to-mother support and peer counseling.
-Health care systems should ensure that maternity care practices provide education and counseling on breastfeeding.  Hospitals should become more “baby-friendly,” by taking steps like those recommended by the UNICEF/WHO’s Baby-Friendly Hospital Initiative.

- Clinicians should ensure that they are trained to properly care for breastfeeding mothers and babies.  They should promote breastfeeding to their pregnant patients and make sure that mothers receive the best advice on how to breastfeed.

- Employers should work toward establishing paid maternity leave and high-quality lactation -support programs.  Employers should expand the use of programs that allow nursing mothers to have their babies close by so they can feed them during the day.  They should also provide women with break time and private space to express breast milk.
- Families should give mothers the support and encouragement they need to breastfeed.

According to the “Call to Action,” breastfeeding protects babies from infections and illnesses that include diarrhea, ear infections, and pneumonia. Breastfed babies are also less likely to develop asthma, and those who are breastfed for six months are less likely to become obese.  Mothers themselves who breastfeed have a decreased risk of breast and ovarian cancers.

A study published last year in the journal Pediatrics estimated that the nation would save $13 billion per year in health care and other costs if 90 percent of U.S. babies were exclusively breastfed for six months. Dr. Benjamin added that, by providing accommodations for nursing mothers, employers can reduce their company’s health care costs and lower their absenteeism and turnover rates.

“I believe that we as a nation are beginning to see a shift in how we think and talk about breastfeeding,” said Dr. Benjamin.  “With this ‘Call to Action,’ I am urging everyone to help make breastfeeding easier.”

Blossom is committed to supporting moms and their partners in their breastfeeding journey. In addition to being a welcoming space to come relax and take care of baby, Blossom also offers the following resources: 

Breastfeeding Basics: A three hour workshop offered frequently at Blossom to prepare pregnant moms and their partners for breastfeeding. Participants receive practical information and support to enhance their breastfeeding experience and help them anticipate and overcome common stumbling blocks that new nursing mothers often encounter. ($69/couple)

Blossom Breastfeeding Support Group

Wednesdays, 1:30-3:00pm |$15, drop-in rate; or purchase a Parent-Baby Group pass for $105: 3-months unlimited; $195: 6-months unlimited

Returning to Work: preparing yourself for the next step

One 3-hour class, Sunday, Feb 6 2:00- 5:00pm ($59/couple)

Blossom Lactation Consultations

Blossom Birth provides comprehensive lactation support, offering individual lactation appointments, phone and email support. We provide care and support in the full range of lactation issues, including proper latching and positioning, milk supply, weight gains/losses, pumping, supplementation, alternative feeding methods. We also offer breastpump rentals and basic supplies. Lactation appointments and support are provided by our lactation consultants, with appointments available at a variety of times most Tuesdays, Wednesdays, Thursdays, Fridays, and Sundays, and some Saturdays and Mondays. Rates range from $99 to $179, depending on length of the appointment and whether you meet our lactation consultant at Blossom or in your home.

To contact Blossom's Lactation Department, please email blossomlactationsupport@gmail.com or call our general office line at 650-321-2326. Our office is open Monday through Friday from 10:00am- 1:00pm and we check messages daily at 7:00pm. Most calls are returned within 24 hours. If you have an urgent matter, please let us know- we will do our best to return your call by 9:00pm on the day we receive it.


Contributed by: Wendy Wright, IBCLC (Blossom Board Member) and Co-founder of Lactation Navigation. 

In Lieu of a Blog Post!

It is my dream to be able to have the time to actually write someday.  I'd love to be one of those moms that can write a story about their day, or an experience they had in relationship to what they're feeling or thinking.... the words are continually moving through my mind, but alas, not enough time to really sit down and write..... hmmm... maybe a 2012 goal to work towards!

By then, my little guy will be 3 and maybe a little more manageable, my oldest will be 6.5 and only have 1st grade homework to deal with..... one can only dream about what extra time I may have ; )

In the meantime, I wanted to share with the Blossom folks, some of the most inspiring blogs that I've been reading the past year.

Birthing From Within Creatress Pam England: A place for parents and birth people to meet for conversations.  Currently she is exploring 50 ways to change birth in our culture and it has led to some fabulous conversations

http://www.birthpeeps.blogspot.com/

The Happiness Project: One Woman's quest for happiness without perfection.  

Written by Charity Terry Lorenzo (first ever Blossom Office Assistant)

http://imperfecthappiness.wordpress.com/

Breathing in this life... Support for Women and Mothers: Fit and Fearless Living: Currently she listed her most favorite posts for the year.

http://www.gingergarner.blogspot.com 

I  hope you are inspired as much as I am by these women and their stories.

Mendy Thijssen

Blossom Volunteer and Instructor