Midwifery: April 2007 Archives

news item about CNMs

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Department of Labor
Good as far as it goes, but it totally ignores the Certified Professional Midwife credential.

A Concord Monitor Article

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Evidence Basis
It is amazing how simple some of this seems, and how difficult to actually implement. There are profound social, financial, and cultural barriers to doing what, on the face of it, seems right.

In Turnabout, Infant Deaths Climb in South

One of the big puzzles of modern life is the association between poverty and obesity. One would think that being poor would mean having less food available, and hence being underweight. But one of the 'miracles' of modern intensive factory farming is the availability of cheap sources of calories that do not contribute much to health at all. For example, high fructose corn syrup, found in almost everything.

My maternal grandmother was often poor. But in those days, the kind of food help given to the poor was in the form of actual food. They got beans, canned meat, government cheese, oatmeal, canned fruits and vegetables, etc. It wasn't the world's best, but it provided a base for home cooked food. And the packages had recipes, too. Now we provide food stamps or the equivalent in an electronic benefit card. And so people can make the same sad food choices that the Standard American Diet provides - chicken nuggets, cheap packaged dinners, twinkies and ho-hos, and so on. We have a couple of generations who just don't know how to cook and who eat based on what is cheap, convenient, and loaded with 'taste-good' chemicals.

Another contributor to infant mortality is babies that are born to moms who, though they may really want to do the best by their babies, just don't have the resources. A single teen mom can be a good mom but it is darned hard when the FOB just isn't there. Marriage, even shotgun marriage, used to protect the moms and babies to some extent. But that just isn't happening anymore. And we have so disassociated sexual activity from procreation in our culture that many young girls (and boys, too, for that matter) are just stunned to learn that they are pregnant. Chastity and marriage, it seems to me, might also help decrease the infant mortality rate.

Prenatal care is also important, but there is an interesting qualitative difference between the care given by the average OB and the average midwife (CNM or CPM). Medical training is based on a model of early detection of problems and early intervention via technology. Midwifery training is based on a model of primary prevention of problems through education, nutrition, social support, and referral to the medical model where appropriate. In the 1970s, there was an interesting natural experiment in Madera County CA. The infant mortality rate was higher than it should have been, because moms were not coming in for prenatal care and they were presenting to the hospital with advanced cases of many preventable problems. There were not enough OB physicians in the community to provide all the needed care, at least partially because the rate of reimbursement from the state was not even enough to meet the cost of doing business. So the state brought in some CNMs to provide the care, and the infant mortality rate went down. After a while, the state decided to increase the rates of reimbursement for maternity services, and the docs came back, got rid of the midwives, and guess what! the infant mortality rates went right back up.

I don't think that it would be possible to solve all the problems cited in this NYT report just by bringing in midwives and making them part of the system. But I think that it would be a good starting point. Local clinics with accessible hours, staffed by midwives and nurses, would really make a difference. Too bad the local politics will probably totally block such an intervention.

rest in peace

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Dr. John Billings Founder of Billings Ovulation Method

died at 7:50 AM April 1. No arrangements have been announced as yet. We thank God for his and his wife's courage and contributions to NFP over more than 50 years.
His death was not unexpected, and the family have deep faith.. so let us pray with and for them.

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About this Archive

This page is a archive of entries in the Midwifery category from April 2007.

Midwifery: March 2007 is the previous archive.

Midwifery: May 2007 is the next archive.

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