MotherBaby Network

advocacy and commentary with a focus on Lane County, Oregon

Category Archives: insurance

Stepping Toward A Baby-Friendlier Oregon

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The Breastfeeding Coalition of Oregon under the direction of Amelia Psmythe recently hosted its sold-out 5th annual two-day statewide conference – Stepping Toward A Baby-Friendlier Oregon. Supporters who made the conference possible include Oregon WIC, Oregon Public Health Institute, Hygeia, Limerick, and Medical International.

Anyone wanting to know what Oregon’s many infant-feeding stakeholder groups are up to should make a habit of attending. While there is still so much to be done to protect and promote breastfeeding, the following downloadable synopsis of conference presentations will give you a quick bird’s eye view of the excellent and diverse work already underway.

Oregon is fortunate to have an extraordinarily talented cadre of savvy, skilled and committed advocates for quality care. Throughout the state, these advocates promote and protect women’s health, well being and basic human rights spanning the entire arc of their reproductive lives whether at home, in the community, in the health care system, in the economy or as “subjects” of scientific research and inquiry. The BCO annual conference is a good opportunity to check in and rally for the difficult but critical work ahead to achieve breastfeeding’s full-spectrum benefits for the entire population.

Framing the discussion…Presentations and discussion were conceived of and organized to align with the Surgeon General’s Call to Action to Support Breastfeeding (SGCTA). The SGCTA is a federal tool to direct policy, fund activities and align stakeholders around important objectives outlined in Healthy People 2020. Federal, state and local grants and staffing resources are made available and prioritized based on alignment with SGCTA objectives.

The SGCTA to Support Breastfeeding is a ground-breaking document because it is a clear departure  from previous policy and political frameworks that define breastfeeding as an individual responsibility or lifestyle choice beyond the concern, responsibility and reach of government focus. Finally, breastfeeding behaviors and outcomes have been re-defined as the product of cultural norms and structures at all levels of society. Accordingly, public health workers, researchers, employers, health care systems, communities and families are “called to action” to better and more effectively support mothers and babies to breastfeed.

Presentation Synopses. Following is a list of presentations. It gives a wide-angle view of how individuals and institutions are aligning Oregon with the SGCTA. Click here for a version of this post that also includes a synopsis of each presentation.

The Role of Consumer Advocacy in Increasing E-B Infant Feeding Practices
Katharine Gallagher, MPP. Consumer advocate, blogger and independent childbirth educator.
slides
, talk

Let’s Talk! Breastfeeding Education Series Tear Sheet Project
Rachel Martinez, BA, IBCLC, RLC. New Member Training Coordinator at Nursing Mothers Counsel of Oregon, and Legacy Emmanuel Hospital lactation consultant.

The Oregon Black Women’s Birth Survey
Shafia Monroe, Midwife. Founder of the International Center for Traditional Childbearing

Supporting Families the Whole Way: Continuity Care Model
Debbie Alba, RN, IBCLC. Nurse and Lactation Consultant at Good Samaritan Regional Medical Center, currently serving as Western Region Steering Committee Chair

Angie Chisholm, CNM. Certified Nurse Midwife at Samaritan OB/GYN in Corvallis, with a long interest in lactation and evidence-based care.

Oregon WIC Peer Counseling: A Public Health Approach
Kelly Sibley, MPH, RD, IBCLC. Nutrition Consultant and Breastfeeding Coordinator with the Oregon State WIC Program. Coordinates WIC BF peer counselors.

Engaging Community Partners in Breastfeeding Support
Helen Bellanca, MD, MPH. Family physician who has worked with health policy and advocacy for four years, leading insurance collaborative and child care survey.

Lessons Learned on the Way to Baby-Friendly: Providence Newberg
Joanne Ransom, RN, IBCLC. Labor & delivery nurse and lactation consultant at Providence Newberg, former Vice-Chair of Northwest Mothers Milk Bank, new OEBIN co-lead

Redesignation with Baby-Friendly: Strategies for Success
Michelle Stevenson, RN. Perinatal Nurse and former La Leche League Leader, led two CA hospitals to Baby-Friendly designation, and now manages the Women and Newborn Care and Nursery at Kaiser Sunnyside Hospital.

Eliminating Elective Deliveries Prior to 39 Weeks Gestation: OR Challenge
Joanne Rogovoy, Executive Director of the Oregon March of Dimes, and leader of the workgroup that banned early c-sections on Portland area hospitals.

Donor human milk & Northwest Mothers Milk Bank
June Winfield, Board Chair / Director

Breaks for Nursing Mothers are Federally “Reasonable”
Amelia Psmythe, Director of the Breastfeeding Coalition of Oregon and West Region Coalition Representative to the United States Breastfeeding Committee.

Nursing Mothers Counsel Workplace Lactation Support Program
Marion Rice, Ed.D. 25 year educator, currently leads the Nursing Mothers Counsel of Oregon Worksite Lactation Support Program

What Do Women Really Want? A 21st Century Mother’s Movement
Andrea Paluso, MSW, MPH. Co-founder of Family Forward Oregon, The Mother PAC, and recent graduate of the Emerge Oregon legislative mentoring program.

Breastfeeding Outcomes in Women with a Prior History of Cesarean Section
Cathy Emeis, PhD, CNM. A nurse-midwife and researcher at OHSU, Cathy’s current research examines the impact of birth interventions and c-section on breastfeeding.

Breastfeeding Coalition of Oregon: Northwest Edge of the Wave of Change
Amelia Psmythe, Director of the Breastfeeding Coalition of Oregon and West Region Coalition Representative to the United States Breastfeeding Committee

US Breastfeeding Committee Annual Report
Robin Stanton, MA, RD, LD. USBC Past-Chair and Nutrition Consultant with OR Department of Human Services, Public Health Division

Collaboration for Collective Impact
Amelia Psmythe and Robin Stanton, MA, RD, LD

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Sacred Heart to become Baby Friendly, McKenzie-Willamette exploring designation

Since posting Project Aims to Improve OR Hospital-Based Breastfeeding Services, MotherBaby Network has received a good deal of positive feedback from individuals in healthcare, elected office, local government, the insurance industry, the non-profit sector as well as from consumers. The post describes a new statewide project (Oregon Hospitals Partnering for Evidence-Based Infant Nutrition) that support hospitals in developing the evidence-based infant feeding practices associated with increased rates of breastfeeding and better health outcomes.

MotherBaby Network received the following information from Sacred Heart Medical Center and McKenzie-Willamette Medical Center regarding plans for the Baby Friendly designation at each facility. Pursuit of this designation provides facilities with a clear pathway for developing the knowledge and effective practices to properly support breastfeeding. It is a clear signal to women and families that they can have confidence in a facility’s infant feeding services.

Sacred Heart Medical Center Intends to Become a Baby Friendly Facility

Sacred Heart Medical Center will pursue the Baby Friendly Hospital Initiative’s designation. An interdisciplinary group of L&D nurses, physicians of several specialties and administrators has been formed. A letter of intent to Baby Friendly will go out before July 1, 2011.

McKenzie-Willamette Medical Center Exploring Baby Friendly

McKenzie-Willamette Medical Center is exploring pursuit of the Baby Friendly status.

If both SHMC and MWMC were to become Baby Friendly, evidence-based infant-feeding would become a community standard. Hopefully, both hospitals will join the new collaborative, statewide hospital effort to support these efforts. Interested parties should contact Amelia Psmyth at Amelia@breastfeedingOR.org or Desiree Nelson at Desiree@breastfeedingOR.org.

These latest state and local developments around breastfeeding reform occur in a national context of growing awareness and support for improving the circumstances in which women, families and communities welcome babies. Issuing the first-ever Call to Action for breastfeeding reform, Surgeon General Regina M. Benjamin is the latest national figure to add her support. Describing the multiple, overlapping barriers in communities, healthcare systems and places of employment, Benjamin urges the nation to remove them so that women will no longer be forced to stop breastfeeding sooner than they want or discouraged from initiating breastfeeding. More information: www.surgeongeneral.gov.

Interested in what local women and families who have used evidence-based breastfeeding services have to say? Read Lane County Friends of the Birth Center’s consumer survey.

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Lane Co’s extends prenatal to women ineligible for OHP due to immigration status

Following six other counties, Lane County is implementing Oregon’s Prenatal Expansion Program to provide Oregon Health Plan (OHP) Plus Prenatal services to pregnant women who have “Citizen / Alien Waived Emergency Medical” (CAWEM) coverage.

Expansion of CAWEM coverage to include prenatal care is made possible through the federal Children’s Health Insurance Program (CHIP) that allows States to serve the unborn children of women who would be Medicaid-eligible except for immigration status. Oregonians access Medicaid through OHP.

The CAWEM Plus prenatal benefits are the same as OHP Plus with four exceptions: sterilizations, therapeutic abortions, hospice care services and death with dignity services. Maternity coverage ends at delivery, unless postpartum services are provided through a bundled (packaged) rate. The newborn will be enrolled in OHP Plus for one year of automatic eligibility.

Providers accepting OHP can now serve CAWEM Plus clients. For more information, see the Provider Alert Sheet (includes Spanish-language description) and Quick Facts. Clients can enroll at any Department of Human Services site.

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Project Aims to Improve OR Hospital-Based Breastfeeding Services

With funding support from Oregon WIC and Multnomah County Health Department, the Breastfeeding Coalition of Oregon (BCO) recently launched a new statewide project – Oregon Hospitals Partnering for Evidence-Based Infant Nutrition. This project supports hospitals in developing the evidence-based systems associated with increased rates of breastfeeding.  The project aims to promote evidence-based hospital maternity practices related to breastfeeding by offering technical assistance, convening a spring 2011 hospital summit, and supporting the formation of a hospital collaborative learning community.

Lane County’s Desiree Nelson joins the project’s four-member team:  BCO Director Amelia Psmythe, Helen Bellanca, MD, MPH, Rachel Burdon, RN, MPH, and Mary Lou Hennrich, RN and Executive Director of Oregon Public Health Institute (OPHI).  Oregon WIC allocated federal funds for increasing breastfeeding rates through outreach to hospitals. Locally, Nelson is well known for co-founding Baby Connection, a phenomenally successful live demonstration of Baby Friendly step 10:

Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

Arriving early and leaving well after closing time, families and babies consistently demonstrate the very real but unmet demand for weekly, drop-in evidence-based lactation support in the weeks and months following birth.

Key Backers

The BCO’s parent organization, the Oregon Public Health Institute recently formed an innovative working group for health insurers – the Oregon Health Insurers Partnering for Prevention (OHIPP). The first of its kind in the nation, OHIPP is a collaborative obesity prevention effort between health plans and public health policy advocates.

Currently, six health insurers participate in OHIPP – representing 65% of private insurance and 45% of Medicaid. Insurers contribute money to fund selected interventions. Because breastfeeding is increasingly associated with reduced risk of childhood obesity, OHIPP has selected increasing breastfeeding rates as its first collaborative public health intervention.

OHIPP’s direction could have a huge impact on breastfeeding practices in Oregon. Imagine, for example, the impact of a reimbursement system in which rates for births were higher for hospitals certified as evidence based by the Baby Friendly Hospital Initiative. This type of innovative intervention conveys the importance of becoming evidence based and signals growing understanding that evidence-based care is preventive and effective in the long run.  In this scenario, hospitals would be incentivized to seek support and resources like those the BCO is offering through this project.

Additional critical support for evidence-based breastfeeding services comes from the Oregon Association of Hospitals and Health Systems (OAHHS). A recent OAHHS membership survey indicates 85% of nurse managers are aware of the gold standard for evidence-based breastfeeding support systems – the Baby Friendly Hospital Initiative. 39% want technical assistance and support on Baby-Friendly 10 Steps. Plans are underway for OAHHS to partner with the BCO to co-brand educational opportunities and communicate the importance of evidence-based breastfeeding support to its membership.

Hospital Outreach

The Oregon Hospitals Partnering for Evidence-Based Infant Nutrition project is in the initial outreach phase to hospitals and health system leaders. Interested hospitals are encouraged to begin forming multi-disciplinary teams for the purpose of assessing current internal practice. Representatives from these teams will be invited to participate in a Spring 2011 summit for a day of education, group facilitation and collaboration. Participants will be encouraged to form an ongoing network of communication between their facilities, to support the path toward institutional change.  Interested hospitals should contact Amelia@breastfeedingOR.org or Desiree@breastfeedingOR.org for more information.

Lane County’s PeaceHealth Nurse Midwifery Birth Center is one of four Baby Friendly Hosptial Initiative-designated facilities in Oregon. Community and consumer support for moving the birth center from downtown Eugene to the new Sacred Heart Medical Center campus in Springfield were centrally linked to the unwavering demand for ongoing access to evidence-based breastfeeding services. Judging by the outcomes and immense demand for these services, making them available at the county’s two leading hospitals, Sacred Heart Medical Center (SHMC) and McKenzie-Willamette Medical Center would be a tremendous boon for families and communities.

Next week, Lane County Friends of the Birth Center will release results from a recent survey taken by more than 100 local women and families describing their experiences evidence-based breastfeeding services at the PeaceHealth Nurse Midwifery Birth Center. Demonstrating the connection between evidence-based services and consumer satisfaction, LaneCoFBC intends the survey to encourage all Lane County hospitals to achieve the Baby Friendly designation. For a copy of the survey, email lanecofbc@gmail.com. (Click here to access the survey.)

Progress already

Locally, there is positive discussion of SHMC RiverBend Labor and Delivery staff’s recent innovative and successful introduction of uninterrupted skin-to-skin contact immediately following birth. Providing skin-to-skin as standard care is a very positive development because it is bedrock practice for developing evidence-based breastfeeding services. Babies placed skin-to-skin with their mother are more likely to be breastfed and to breastfeed for longer.

Having SHMC Labor and Delivery staff describe how front-line practices and internal systems have been altered to bring more evidence-based care to the floor is an example of useful information that could be shared at the upcoming Spring 2011 summit hosted by the Oregon Hospitals Partnering for Evidence-Based Infant Nutrition project. Attending health professionals would return to their respective hospitals with a concrete, doable action for improving mother-baby breastfeeding outcomes.

Writing on the wall

Discussion of evidence-based breastfeeding care is a roundabout way of saying hospitals should identify ways to understand and implement Baby-Friendly practices. Savvy hospitals understand consumers, legislators, government agencies, the business community and accreditation bodies have connected hospital-based breastfeeding practices with the success mothers and babies have in the months following discharge.

Perusal of the following links demonstrates a trend toward adoption of Baby Friendly language for discussions of evidence-based care. They also demonstrate large-scale convergence around breastfeeding as a top-ranking major objective in health care.

  • The Joint Commission’s new perinatal care core measure set includes exclusive breast milk feeding

The question hospitals must answer about breastfeeding services is no long whether or not to become evidence based but (1) how to do it and (2) how to demonstrate that it is being done. Because Baby-Friendly is the established and universal standard for effective breastfeeding care, pursuing and maintaining this designation answers both questions in the most expedient manner. The project’s greatest potential value to hospitals lies in the efficiencies it can generate through developing models of collaboration for identifying and removing barriers to reform. The potential for idea sharing and cost sharing for staff training and education increases significantly with each hospital’s commitment to participate.

To learn more, contact Amelia@breastfeedingOR.org or Desiree@breastfeedingOR.org for more information.

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Considering maternal mortality in Lane County

Yesterday, I attended the UO Women’s Law Forum discussion of maternal mortality. Among the invited speakers was certified nurse midwife Hilary Prager from the PeaceHealth Birth Center.

Anyone remotely interested in or familiar with maternal and infant well being knows US rates are significantly higher than those in other developed and developing countries. Recently, Amnesty International issued a report – Deadly Delivery: The Maternal Health Care Crisis in the USAoutlining the total disconnect between US maternal health care spending (more than any other country) and maternity outcomes. Women in this country have a higher risk of dying from pregnancy-related complications than their counterparts in 40 other countries. The report also describes the extreme variations among women. Perhaps the starkest disparity is that African-American women are nearly four times more likely to die of pregnancy-related complications than white women.

I don’t know what Lane County’s maternal mortality rate is but I do know its fetal-infant mortality rate tops Oregon counties and hovers around or above national rates. Despite being home to a major university and hospital system in the developed world, Lane County’s fetal-infant mortality rate is more in line with developing world outcomes. It would be useful to know what local rates for maternal mortality are, too. At the UO Women’s Law Forum I asked if maternal and infant mortality rates tend to track similarly and was told they do not. That said, where there is a poor maternal mortality rate, there will also be a poor infant mortality rate (or vice versa). ). In other words, our maternal mortality rate probably isn’t so great.

Mother and baby mortality rates are the gold standard report card for local and national entities. They are a significant metric for overall public wellbeing because pregnancy often happens to women who otherwise would not interface with the healthcare system. As pregnancies progress, the capacity for a community to provide adequate care is revealed. Bad outcomes suggest systemic, community-wide problems made apparent by but reaching beyond women and babies. Maternal and fetal-infant mortality are among the most extreme of negative outcomes euphemistically described as the “tip of the iceberg.” They frequently occur where access to healthcare and social service systems is inadequate or limited.

According to the latest Lane County data for fetal-infant mortality, 62 women suffered a fetal or infant mortality between July 2007 and June 2009. Barely two-thirds of these women accessed prenatal care during the first trimester. Among candidates for the Oregon Health Plan, many no doubt delayed or skipped coverage due to the OHP requirement of a certified birth certificate at application time.

Bureaucratic barriers are not limited to OHP-eligible pregnant women. These kinds of barriers plus significant financial obstacles, as reported on NPR’s health blog, make it extremely difficult for pregnant women to purchase individual policies, too. At the same time, recent coverage by the Washington Post connects a healthy nation with healthy pregnancies:

“Investing in maternal health would return larger and longer-lasting dividends than almost any other comparable public health investment.”


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Latest on Midwifery Board rules / Shout Out to Midwifery Supporters

Latest development in OARS

The Oregon Board of Direct Entry Midwifery is near the end of a yearlong process of revising the Oregon Administrative Rules (draft rules) that govern licensed direct-entry midwives (LDMs). With a few exceptions, LDMs are the sole providers of home birth services in Oregon. In September, draft rules developed by the “Rules Advisory Committee” received seven-to-one support from the Midwifery Board. (Read earlier post and reference the Guide to Midwifery Credentials and Terms in Oregon)

Following a subsequent month of written public comments and an October 28 public hearing, the Oregon Health Licensing Agency (OHLA) —oversight agency for the Midwifery Board— extended the written public comment period by 30 days. OHLA cites the “high volume of public comment and diverse nature of topics” for the extension.

Consumers underrepresented at public hearing

Advocates for choice in maternity care have expressed concern over so few consumers and supporters of LDM care attending the hearing. Consumer Minna Pavulans offered the only such perspective. (Read a consensus letter Pavulans helped draft earlier this year.) The small showing contrasts with a large Spring 2010 convergence in Salem of the many women, partners and babies registering demands for continued access to LDMs.

In contrast, LDM opponents were in high attendance at the recent public hearing, achieving the strategic benefit of over-representation for their views. Requests included altering the draft rules to forbid LDMs from serving women with the following kinds of pregnancies:

  • Vaginal birth after cesarean (VBAC)
  • Breech
  • Twin.

The proposed draft rules permit LDMs to serve women with most of these kinds of pregnancies. This is a major victory for maternity choice advocates and likely an choice in care unique to Oregon. LDM opponents also asked that practicing LDMs be required to secure $1 million liability insurance. Obtaining this level of coverage is almost certainly impossible.

Within the licensed direct-entry midwifery community, a lack of basic accord on the draft rules exists. Discerning if the LDM community generally views the rules as mostly okay with a few exceptions or mostly unacceptable is difficult. In contrast to LDM opponents, it is proving hard for this constituency to convey a consistent, strong message to the Midwifery Board.

Ironically, as midwives debate the impact of the draft rules on choice in maternity care, the position of individuals and groups pushing for additional restrictions improves. For good or bad, boards respond most to constituencies with clear and consistently conveyed demands.

What does freedom of choice mean in the context of licensure?

In Oregon, direct-entry midwives may practice with or without a license. Women select licensed or unlicensed direct-entry midwives for numerous reasons. Three common reasons for selecting a licensed midwife include:

  • Insurance reimbursement. Some health insurance plans, including that of the Oregon Public Employee Benefit Board and Oregon Health Plan, reimburse for LDM care.
  • Professional standards. To gain licensure, midwives demonstrate evidence of core competencies and pass written exams.
  • Legend Drugs and Devices. LDMs legally carry and administer anti-hemorrhagics, medical oxygen, IV fluids, anaphylactic treatment and local anesthetics among other items.

In selecting a LDM, a woman opts into a model of care in which state-endorsed rules govern the terms of licensure. Rules for who midwives may serve, when additional consultations are required and consumer recourse in the event of a complaint are just a few of the many areas in which the midwife-client relationship is shaped by codified guidelines.

However a woman defines the benefits of licensed direct-entry midwifery, they are gained in the context of the rules of licensure. Rules, by their very nature, infer limits. The Midwifery Board’s most pressing task right now is to determine what those limits on scope of practice should be and how to articulate them in the new set of rules.

Support for imperfection?

Are the draft rules perfect? Must they be to garner general consumer support? The answer is “no” on both accounts.

By virtue of having been drafted by a group of individuals —each with a unique set of convictions, beliefs and biases— the rules are necessarily imperfect. This is not the same as saying they are unworthy of support. Another litmus test is to assess to what extent the divergent views have been transparently negotiated with evidence-based findings setting the standard for debate.

Consumers can also assess their personal level of support or opposition for the draft rules by asking two questions:

  1. Are the flaws fundamental enough to preclude one’s overall support?
  2. Is a better outcome possible given current political realities?

Consumers, make your thoughts known

Having dominated the public hearing, LDM opponents have everything to gain by redoubling their efforts. Despite a poor showing at the public hearing, it’s not too late for consumer feedback to stabilize what is turning out to be an unpredictable conclusion to a yearlong revision. Consumer participation earlier in the process is credited for strengthening the position of advocates for choice in maternity care. To the degree that the rules protect those choices, consumers deserve credit. To get the job done, more letters (yes, another letter!) are needed to empower the Midwifery Board to resist yielding to extreme positions.

Supporters (and opponents) of the LDM model of care have through Sunday, November 28 at 5pm to weigh in. Email or mail your letter here:

Samie Patnode, Policy Analyst
Oregon Health Licensing Agency

700 Summer St NE, Suite 320
Salem, OR 97301-1287
samie.patnode@state.or.us
Work: (503) 373-1917
Fax: (503) 585-9114

Send it to your elected representatives and post it on your personal Facebook pages. Send it to Oregon Midwifery Council at info@oregonmidwiferycouncil.org.

Invite partners, family and friends who support choice in maternity care to write letters, too. Share your letter with them to help them get started. Offer to send it in for them.

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New rules for the Oregon Midwifery Board?

Last month, the Oregon Board of Direct Entry Midwifery (Midwifery Board) voted seven to one to submit revised administrative rules to the Oregon Health Licensing Agency (OHLA).

This is the latest development in a nearly ten-month process of literature review, expert testimony and public comment. Not altered since 1993, the administrative rules regulate licensed direct entry midwifery. They include definitions for certain births that may not be attended by the state’s 65 licensed direct-entry midwives (LDM). Click here for a definition of LDM.

Proposed rules: http://www.oregon.gov/OHLA/DEM/Midwifery_Laws_Rules.shtml.

What should consumers know?

The draft rules are evidence based and serve the vast majority of practicing LDMs and Oregon women desiring their care. They identify three new types of high or absolute-risk birth that may not be attended by a LDM:

  1. Three cesarean sections unless previous successful vaginal birth
  2. Monochorionic, monoamniotic twins
  3. Breech where feet or knees are presenting and fetal hips are extended (Proposed Div 25 & 30 – p. 7)

Additionally, there is a new non-absolute risk requiring consultation with another Oregon licensed health care provider, including an LDM, with appropriate experience. Here is the new non-absolute risk:

Lack of adequate progress in vertex presentation is when there is no progress after a maximum of three hours in cases with full dilation, ruptured membranes, strong contractions and sufficient maternal effort; (Proposed Div 25 & 30 – p. 14)

Following is the definition of consultation:

For the purpose of this rule “Consultation” means a dialogue for the purpose of obtaining information or advice from an Oregon licensed health care provider who has direct experience handling complications of the risk(s) present, as well as the ability to confirm the non-absolute risk, which may include but is not limited to confirmation of a diagnosis and recommendation regarding management of a medical, obstetric, or fetal problems and condition. (Proposed Div 25 & 30 – p. 16)

Time to wrap it up

The revision process has been a long, fraught one. There are individuals and organizations that no doubt view the draft rules as granting too much or too little scope of practice for LDMs. It is critical for consumers in support of the Midwifery Board’s more than ten-month effort to balance these views by publicly supporting its recommended rules.

Consumer voices make a significant difference. Letters and public testimony make an impression on elected officials and appointees. Earlier in the revision phase, letters and public testimony demanding continued access to LDMs most certainly strengthened the position of like-minded members on the Midwifery Board. As a result of public accountability, these members were better able to counter efforts to impose unwarranted restrictions on individual choice in maternity care and to instead press for governing rules that are in step with consumer preference and evidence-base care.

Consumer power works

Earlier this year, state employees and dependents petitioned the Public Employees Benefit Board to restore access to maternity care with LDMs after it erroneously denied claims and gave incorrect benefit information to individuals desiring this benefit. And, just last month, PEBB stated it would defer to the Midwifery Board when determining coverage for LDM-attended births.

More than 140,000 Oregonian are covered by PEBB. This makes the recent decisions a significant and positive development for choice in maternity care.

Grab your pen

Write a letter of support to the Oregon Board of Direct Entry Midwifery and send it to:

Samie Patnode, Policy Analyst
700 Summer St NE, Suite 320
Salem, OR 97301-1287
samie.patnode@state.or.us
Work: (503) 373-1917
Fax: (503) 585-9114

Send it to your elected representatives and post it on your personal Facebook pages. Send it to Oregon Midwifery Council at info@oregonmidwiferycouncil.org.

Come to Salem

On October 28, 2010, the agency and the board will hold a public hearing where a contracted hearings officer will receive oral testimony. More info here.

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Congrats to Friends’ Katharine Gallagher and Midwife Cindy Hunter for Healthy Babies Awards!

Originally posted on Lane County Friends of the Birth Center‘s blog…

Congratulations to the Lane County Healthy Babies 2010 Award Recipients recognized at yesterday’s second-annual reception!

Awards were given to an individual, a practitioner and an organization in acknowledgement of their contributions toward reducing fetal-infant mortality and increasing community health in Lane County. Former KEZI news anchor Rick Dancer served as the master of ceremonies. Dancer encouraged Healthy Babies to use social media to increase its reach. Commissioner Rob Handy and Lane Co. Health and Human Services Rob Rockstroh both emphasized the critical importance of reducing Lane County’s uniquely high rates of fetal and infant mortality.

Individual. Katharine Gallagher, chair of the Lane County Friends of the Birth Center, was recognized in the individual category. Katharine touched on the importance of evidence-based mother- and baby-centered care in improving community outcomes and on the need for ongoing county support for the Healthy Babies initiative. (See Katharine’s comments below)

Katharine Gallagher and Cindy Hunter

Practitoner. Cindy Hunter, former Nurse-Midwifery Birth Center midwife and currently the Nurse Educator for Labor and Delivery at Sacred Heart, was recognized in the practitioner category. Cindy shared her inspiring story about discovering the importance of and ultimately in finding ways to ensure dignified care for women and babies. LaneCoFBC looks forward to its upcoming October 5 fireside chat with Cindy. She will be sharing her recent experiences volunteering in Haiti. (Learn more here.)

Organization. Project FEAT (Family Advocacy and Treatment) coordinators Kristin Funk and Liz Twombly reflected on the lessons learned and insights gained throughout their 5-year project funded by the Department of Health and Human Services to develop policies and procedures for addressing the special needs of substance exposed newborns. Kristin and Liz highlighted the importance of nurturing and protecting mother-child bonds and the power that this connection can have to inspire women to move beyond substance abuse.

In recent weeks, Lane County Healthy Babies, Healthy Communities received the following media attention:

Lane County State’s Top Fetal-Infant Mortality Rate: That rate is prevalent and statistically significant regardless of other factors

ALIVE AND KICKING | County’s infant death rate improves, but could it be better?

EDITORIAL: A gauge of social health | Reduction in fetal-infant death rate encouraging

Healthy Babies initiative helps (letter to the editor, scroll down)

To get involved or for more information about the Healthy Babies initiative, visit www.preventionlane.org. The next Healthy Babies meeting is on October 7 from 8:30 to 10am at Lane County Mental Health.

Following are LaneCoFBC Chair Katharine Gallagher’s comments:

Thank you very much for this award – I am honored by the acknowledgement.

Little did I know that founding Friends of the Birth Center to encourage construction of the new PeaceHealth Nurse Midwifery Birth Center would be the beginning of a genuinely rewarding endeavor. Like all worthwhile efforts, it’s been a joint one from the start.

Practically over night Friends of the Birth Center brought many, many other women, families and community members together. Families with brand new babies and families with kids graduating high school shared their stories. This evening, three founding members who now serve on the Friends’ board join me: Eleanor Vandergrift, Karen Guillemin, Kathy Lynn. Board member Renee Bailey could not attend.

Karen Guillemin, Katharine Gallagher, Kathy Lynn, Eleanor Vandegrift

And a founding Dad – my husband David Wacks as well as a Birth Center grandfather – my dad Mike Gallagher.

Originally seeking to maintain our personal preference for maternity services in a freestanding birth center, we quickly made connections between the holistic, communal and mother-baby focused approach we know so well and the local and national discussions about the power of preventive, evidence-based and cost effective care to dramatically improve maternal- and infant-wellbeing.

A strong link exists between the care we regularly access at the Birth Center and what is needed to increase community-level wellbeing. Early prenatal care regardless of insurance status, regular postpartum opportunities to meet other new parents, and ongoing breastfeeding support that really works – this is the “standard issue” package for anyone walking through the Birth Center’s doors.

As we were making these connections, the Friends group began to learn about our community’s local rates for fetal and infant mortality. We have been moved to view construction of the new Birth Center as one of great importance for the entire community. This is because it is a living laboratory of the kind of care we need to see more of in Lane County. Accordingly, we remain very grateful to PeaceHealth for making the new Birth Center a reality.

Moving forward, I look forward and I know Friends of the Birth Center does, too, to supporting the County’s initial efforts to focus our collective attention and resources on reducing fetal and infant mortality. The most recent statistics show some improvement and I believe that is a credit to the Healthy Babies, Healthy Communities initiative. If we are to continue making progress, ongoing county and community support are necessary.



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Access to Licensed Direct Entry Midwives

Two important events affecting ongoing access to Oregon’s licensed direct-entry midwives happened in September.

#1: PEBB defers to Midwifery Licensing Board on coverage

The Public Employee Benefit Board will continue to follow guidelines established by the Board of Direct Entry Midwifery when determining coverage for members accessing maternity care with licensed direct-entry midwives. The Lund Report’s coverage:

Midwives Retain Status Quo with PEBB

PEBB Looks into High Risk Births

#2: Midwifery Licensing Board completes review of administrative rules:

The Board of Direct Entry Midwifery has completed it’s initial review of the administrative rules. On September 13, 2010 the board recommended proposed administrative rules to the Oregon Health Licensing Agency (OHLA).  The agency filed proposed administrative rules with the Secretary of States Office which will be published in the Oregon Bulletin on October 1, 2010.

Public comment will close as of October 28, 2010, giving interested parties 28 days to comment.  On October 28, 2010, the agency and the board will hold a public hearing where oral testimony will be received by a contracted hearings officer.

Please send all comments to the following:
Samie Patnode, Policy Analyst
700 Summer St NE, Suite 320
Salem, OR 97301-1287
samie.patnode@state.or.us
Work: (503) 373-1917
Fax: (503) 585-9114

The Legislation and Rules Committee will meet on December 4, 2010, to review proposed administrative rules and make final recommendations to the board of December 10, 2010.  On December 10, 2010, the full board will meet to review and consider all comments and recommendations from the committee, public and hearing officer.  At this meeting the board will recommend permanent rule adoption to the agency.

Proposed rules have been filed by Division.  Division 25 and 30 have been combined to administrative purposes.  The following are Secretary of State required documents and proposed rule text. 

New PeaceHealth Nurse Midwifery Birth Center Opens

On Saturday, PeaceHealth hosted a grand opening of the new Nurse Midwifery Birth Center! More than 200 community supporters joined in the celebration.

The grand opening marks the re-opening of the Nurse Midwifery Birth Center practice in a new freestanding facility on the Sacred Heart Medical Center at RiverBend campus. The practice began more than 20 years ago and has welcomed more than 5,600 children. On May 7, Donna and Corey Templeton welcomed Faye Patience,the first baby to arrive at the new center.

Expectant parents, new parents and little ones along with extended families and friends joined the Birth Center staff, PeaceHealth leadership and Sacred Heart Medical Center Foundation to celebrate the new facility. It was a joyous affair all the more special for the glorious spring weather. (See photos of the new Birth Center here and photos of the grand opening here.)

Each program speaker emphasized the critical community partnerships that made the new birth center a reality.

  • Tom Ewing, PeaceHealth Medical Group Chief Medical Officer, described the Birth Center services as “benchmark care.”
  • Mel Pyne, PeaceHealth Oregon Region CEO spoke to the importance of community collaboration. Pyne also read a congratulatory letter from Sen. Jeff Merkley. The Senator emphasized the importance of evidence-based breastfeeding support from prenatal care through the first year of a child’s life.
  • Midwife Michele Peters-Carr shared the staff’s pleasure in resuming the special work they do and the joy they feel in seeing the old birth center‘s spirit, history and love grace the new one.
  • Bob Scheri, PeaceHealth Director of Mission and Spiritual Care Services, brought the Birth Benter staff together where all could see and honor these women for the unique role they play in attending women and families to gently birth and welcome their babies.

Lane County Friends of the Birth Center made the following comments:

Good afternoon. My name is Katharine Gallagher and I am the chair of Lane County Friends of the Birth Center. I also served on the SHMC Foundation’s capital campaign. It is a pleasure to be here – the day before Mother’s Day and forty weeks, the gestation time for a baby, after construction began. It is an honor to thank PeaceHealth for making this day possible. Forgive me; I might take a bit more time than technically appropriate – my apologies!

Going back sixteen months, the future of PeaceHealth’s out-of-hospital maternity services was uncertain. The available funds to build a new facility at the RiverBend campus were insufficient to initiate construction. Deeply concerned, a group of Birth Center families met to identify how we could collectively communicate the importance of continued access to a freestanding birth center and invite community support for the construction of a new facility.

If you haven’t, I encourage you to talk to the women and families who use the Birth Center. You will hear descriptions that seem almost magical. Don’t be fooled – the birth center model is not magic, it just feels that way. These magical descriptions of birth center midwifery are the result of receiving care in line with the highest national and international standards for evidence-based mother and baby practice. Evidence-based care follows what research tells us yields the greatest good. In essence, these standards bring women into the center of their own care where they are fully engaged in preparing for birth, giving birth and caring for a new baby.

Originally seeking to maintain a personal choice in maternity care, Friends of the Birth Center has learned to value the connection between PeaceHealth’s birth center-based midwifery and the wellbeing of the community as a whole. Though largely unknown or overlooked, Lane County struggles with an unacceptably high fetal-infant mortality rate. It is higher than the nation; higher than the state; and higher than rates in comparable counties and it affects women and babies across all socio-economic, age and ethnic groups. The individualized, holistic care women and babies need to avoid these tragic outcomes happens at the Birth Center. The earlier the prenatal care, the better the outcomes and PeaceHealth honors this by serving all women at the Birth Center, regardless of their insurance status.

Many of us discover the seemingly magical benefits of the PeaceHealth birth center after our babies arrive and we begin to breastfeed and care for them. Most of us need to learn how to breastfeed, to establish and maintain our milk supply and to incorporate breastfeeding into our lives, especially as we resume commitments in addition to mothering a newborn. The Birth Center knows birth is the middle, not the final, event of maternity care, even if most of us don’t! After we give birth, we along with our families are seamlessly ushered into a twenty-four hour lactation support system and a weekly baby clinic where we weigh our babies, ask lactation experts questions and find peer support among the many other moms, dads and grandparents who attend. We go home confident that breastfeeding works. This comprehensive postpartum support is key to seeing breastfeeding extend beyond initiation.

This lifeline -like, evidence-based breastfeeding care has a name: the Baby Friendly Hospital Initiative. As the name suggests, this initiative is not just for birth centers. Most Baby Friendly facilities in the country are hospitals. I raise this point because Lane County has very high rates of breastfeeding initiation but steep drop off rates once women go home. Ensuring all women and families receive Baby Friendly care is a goal worthy of our community and one we can accomplish. We can do this and we will be better for it.

I will close with heartfelt thanks to PeaceHealth Oregon CEO Mel Pyne for his vision and leadership and to his staff for their commitment to getting the job done. From our first overture, Friends of the Birth Center was welcomed into a productive dialogue and partnership. We are also grateful for Rueben Mayes’ leadership of the SHMC Foundation and to his staff for supporting every effort to identify all potential pathways forward. That PeaceHealth pressed forward during a wrenchingly difficult and turbulent recession speaks to its capacity and resolve to invest in the future by providing the much-loved, cost effective, prevention-oriented care that will yield excellent long-term outcomes for Lane County women, babies, families and the community.

That PeaceHealth’s investment should result in an uncommonly attractive facility in a setting of remarkable natural beauty speaks to its respect for the community – US. Friends of the Birth Center looks forward to continuing its partnership with PeaceHealth and to continuing efforts to foster connections among Birth Center families.

Thank you for the new Nurse Midwifery Birth Center – the best Mother’s Day gift ever!

Lane County Friends of the Birth Center welcomes community participation. To learn more, please read our membership letter of invitation.

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