Saturday, February 24, 2007

Minnesota Doula Bill

Susan Lane, of the Childbirth Collective non profit doula group, reports that the 2007 version of the doula bill, bill 1296, has been accepted in the House of Representatives in the Minnesota Legislature.
The Senate also has a version of the bill. The goal is to include doula care coverage by Minnesotan's health maintenance organizations and state medicare.
HF 1296 includes this current wording:

A bill for an act
1.2relating to insurance; requiring coverage for doula services; requiring medical
1.3assistance to cover doula services; establishing a doula registry; ensuring in the
1.4patient bill of rights the presence of a doula if requested by a patient; amending
1.5Minnesota Statutes 2006, sections 144.651, subdivisions 9, 10; 256B.0625, by
1.6adding a subdivision; proposing coding for new law in Minnesota Statutes,
1.7chapter 62A; proposing coding for new law as Minnesota Statutes, chapter 146B.
1.8BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1. [62A.0412] COVERAGE FOR DOULA SERVICES.
1.10 Subdivision 1. Scope of coverage. This section applies to all health plans as defined
1.11in section 62A.011 that offer maternity benefits.
1.12 Subd. 2. Required coverage. Every health plan in subdivision 1 must provide
1.13coverage for doula services when provided by a nationally certified doula of the mother's
1.14choice.
1.15 Subd. 3. Special restrictions prohibited. Coverage under this section shall not be
1.16subject to any greater coinsurance, co-payment, or deductible than that applicable to any
1.17other nonpreventive service provided by the health plan.
1.18 Subd. 4. Definitions. The definitions in this subdivision apply to this section.
1.19(a) "Doula services" means emotional and physical support during pregnancy, labor,
1.20birth, and postpartum.
1.21(b) "Nationally certified doula" means an individual who has received certification
1.22to perform doula services from the International Childbirth Education Association, the
1.23Doulas of North America (DONA), the Association of Labor Assistants and Childbirth
1.24Educators (ALACE), Birthworks, Childbirth and Postpartum Professional Association
1.25(CAPPA), or Childbirth International.
2.1EFFECTIVE DATE.This section is effective July 1, 2007, and applies to coverage
2.2issued or renewed to Minnesota residents on or after that date.

The doula registry is currently described like this:
Sec. 5. [146B.02] REGISTRY.
4.13 Subdivision 1. Establishment. The commissioner of health shall maintain a registry
4.14of certified doulas who have met the requirements listed in subdivision 2.
4.15 Subd. 2. Qualifications. The commissioner shall include on the registry any
4.16individual who:
4.17(1) submits an application on a form provided by the commissioner. The form must
4.18include the applicant's name, address, and contact information;
4.19(2) maintains a current certification from one of the organizations listed in section
4.20146B.01, subdivision 3;
4.21(3) completes a criminal background check; and
4.22(4) pays the fees required under section 146B.04.
4.23 Subd. 3. Renewal. Inclusion on the registry maintained by the commissioner is
4.24valid for three years. At the end of the three-year period, the certified doula may submit a
4.25new application to remain on the doula registry by meeting the requirements described in
4.26subdivision 2.

The rest of the bill has to do with definitions and restating the responsibilities of the registry. Read the entire bill.
Congratulations, Susan, The Senate and House authors, The Collective, and other dedicated doulas and friends who have put this bill forward. Next it goes to Health and Human Services for approval.
Here is Susan's contact information.

Susan Lane, CD, LCCE
3rd Party Chair
The Childbirth Collective
salane@visi.com

Wednesday, February 21, 2007

The Tipping Point of Birth?

The book, The Tipping Point, by Macolm Gladwell reports on how small ideas grow among the right combination of people grow to marketing miracles or tragic epidemics of harmful behavior. He describes how some creative thinkers designed children's educational shows to stick in the children's head until they actually did offer an educational benefit.

Can we use the principles of The Tipping Point to improve maternity care in a significant way? In a national or world wide way?

Or will we be limited to transient local successes that fold up after the person fueling the program retires?

What can make positive maternity care behaviors "sticky?"

Read more about The Tipping Point at Malcolm Gladwell's website.

Saturday, February 17, 2007

Socialized medicine or socially engineered dis-ease?

I've been hearing that Universal Health care is a good thing for a long time. Certainly certain aspects of that would be wonderful. Like emergency care for people who now are left to suffer or die.
Here in Minnesota we have an ethic of helping each other and giving to social agencies to help those we haven't met yet and who are in need. A spot of socialism is a healthy adjunct to a well functioning free market system. I'm very proud of our county hospitals, one of which set up a payment schedule of $25 a month for a friend of mine who had bleeding tumors that needed treatment and yet had no health insurance or savings account to pay with.

Life expectancy is the same for Cuba as the US, and as odd as that may strike you, consider that Cuba's infant mortality is superior by far to ours. Since the Soviet Union's (Cuba's late sponsor) mortality rates were not as good as Cuba's I hesitate to credit the economic systems. Smaller units of socialization (communities) and traditional support systems, higher iodine intake, something else may be a more likely clue.
There may be some interesting answers to the question of how a country that spends 187. US dollars a year per person has improved survival (and literacy rates) than a wealthier country that spends about 100 times that per person per year.

Listen to some Canadians complain about health care. Limited to what and when you can get it and if it is a rare illness that's expensive to treat the treatment may not be given to a person even if it exists. I also hear the Brits worrying about national funds to pay for health care. Swedes pay close to 70% of their income on taxes.
Some universal coverage may be important, but what do we currently have for all? Immunizations? Ok, as long as I'm not forced to take 'em. Prenatal care? Really? And yet our current system is causing more and more premature babies, with higher induction rates, outdated weight and salt restrictions, and bears a large burden to our gap in the infant mortality rate. Plus these are the folks promoting cesareans without informed consent for women who don't need them--even though the maternal death rate is higher from unnecessary cesareans than for vaginal birth.
Why would a midwife demanding inferior care for all?
Why work for univeral bondage to allopathic medicine when we already see the crappy administration of big medicine in action now. Patients get 5 and 10- minute appt.s in spite of their needs just to push up the profit margin. Government control of health care just means the current corporations would get a goverment paycheck as they are kept in place as government contractors. The Fairy Godmother does not work in Washington, lobbyists do.

Parents in the 1980s worked so hard for the right to homeschool and small private and charter schools. The competition expanded options nad was a real boost for the creative teachers nad administrators among the public schools to step up school services.
Charter clinics? Yeah, we have the community clinic model now. And I'm glad for it. But how would we fight for grassroots health models when the monopoly is complete?

The FDA is already in a winning battle to restrict herbal remedies. The FDA approved breast implants; you know, those popular insertable balloons with a 100% breakage rate? Another neck exerciser for the FDA is cytotec. Why doesn't the FDA put the pressure on to stop cytotec when the uterine rupture risk includes alarming rates of mother and infant death?
I don't know, but I know some drug companies that are making more money than we can comprehend. Those are the guys that you want judging what is universally acceptable for health?

Smaller groups of people could come up with creative solutions for their locales, but a huge conglomerate of people are overwhlemed.
What else, besides subsidizing big corporations with government money would work that could provide quality care to all?

Thursday, February 15, 2007

First look

copyright 2006 Gail Tully

Morning window

As I sit at the computer and type this am, the sky is a bright winter blue. Sunlight angles low across the thin blanket of snow. The cool browns of four oaks and a basswood cast purple lines upon the lawn. Upwards, hundreds of dappled branches across the blue.

Four cardinals cluster close amidst the branches and flap apart again as the two bright males seek to overcome each other's competition for the two females. Suddenly a flutter of wings as they come beak to beak. Just as quick, they fly back to their original branches. They look at one another but I can perceive no hostility. I throw out a handful of sunflower seeds on the front walk. But they have other needs in mind.

Tuesday, February 13, 2007

Another transverse baby!

She wrote:
i just found out at my 35 week appt, my baby has its head at my right hip, and back down at my left hip.
i am a firm believer that God can do anything, and I have been praying, but i am scared to death to have a c-section, but that is all i think about. i am trying really hard to be positive, and do my exercises, and go to my chiropractor to get the webster technique done, but i guess
i need to know that it is posible for the baby to turn.
my dr made the comment that this is the worst transverse position, because the baby has to go backwards to get into position..any help would be appreciated !!! thanks

I wrote:
This is exactly, exactly the case of Emily last week! Her movie and story are on my blog.
[Feb. 9, 2007, How to do an inversion]

When you are done watching the video and reading the previous two posts go back to the regular Spinning Babies Site and search "transverse lie" using the quotation marks and then read each thing that comes up. It worked for Emily; it might workfor you.

Emily's baby was in the same position, back down and her baby slipped right down after 2-3 inversions, the Webster technique (different link here) and a prayer group praying for her. :)
Let me know!

Friday, February 9, 2007

Praise Report

"Hey, Gail, this is Maureen," the message on the phone said.
"I'm just sharing a praise report. We just got the ultrasound back and Emily's baby's head is down. And I am giving credit to God and to your hands that He used and your technique to get that head down. Thank you so much for meeting with them. She told me you were able to get some pictures and show her the technique and she did it again this morning. She said she felt a lot of movement last night. . .
Also, we prayed at church."

I have to pass this praise right along to Carol Phillips, DC for showing me how an inversion can help achieve optimal fetal positioning. Also, Emily saw the chiropractor exactly once with whom she got an adjustment of her pelvic joints and the Webster maneuver to release the round ligaments. The inversion I showed her helped the soft tissues, including the cervical ligaments. Together, these help get the womb symmetrical for the baby to drop down.

Would the baby drop down any way? Would the baby drop down with prayer alone? It may have been. Prayer has been studied by top universities and shown to improve health to a measurable degree. Most babies move head down. My feeling is that when the need for a cesarean can safely be reduced then our responsibility as parents and caregivers is to reduce that chance of surgery.
As far as the techniques being mine, they're not. I'm simply showing people how to apply the techniques and when. Maureen uses the phrase, "your hands" but she spoke metaphorically. I did not put my hands on this mother's belly. Maureen had recently palpated (felt) the baby. And Emily knew exactly where her baby was. She showed me and the shape of her belly made it clear also. It is an amazing honor to help facilitate, along with all these other wonderful people in the community, a healthier birth for families. Let's join Maureen in praising God.

Emily's baby had been transverse for about a week at 36 weeks gestation. See the earlier post this same date. A transverse lie midway through the last trimester is worrisome and not to be ignored. Fortunately, Emily was willing to do the inversion to help herself and her baby. Hopefully she and Ludvig will share a picture of their sweet baby next month!

How to do an inversion

An inversion is a technique for relaxing the lower uterine ligaments. It also helps a breech baby flip upside down. I learned the technique from Carol Phillips, a skilled chiropractor and craniosacral therapist who is knowledgeable in the birthing process.

The Spinning Babies Website lists a number of reasons a pregnant woman might do an inversion. See "Using the inversion in late pregnancy." This blog tells you how.

If you have questions about your situation, you may look at SpinningBabies.com for answers. I can't answer questions from the blog easily. You may email me, but if the answer is on the website, I will direct you there rather than answer. Thank you for considering the immense amount of time I offer to answer needs. A simple email is so much faster than a blog post to get to and to answer.


Do the inversion if you feel athletic enough. Don't do it if you have trouble breathing, with asthma, for instance. Ask your caregiver if there is any medical reason you shouldn't do this. Don't do it right after your breech baby has turned head down.

1. Have a helper to brace your shoulders so you don't come down from the couch too fast.
2. Have your knees on the edge of the couch.
3. Come down slowly.
4. Brace yourself on your forearms.
5. Relax your belly.
6. Relax your neck and head.
7. Hold the pose for 30 seconds for a head down, posterior baby, or a minute for a breech or transverse baby, if you can. Start with shorter times in the pose and work up to 30 seconds.
8. Crawl forward, bringing one knee down to the floor and then the other.
9. Come to your hands and knees.
10. Sit up, on your heels and catch your breath.
Crawl around the room helping the weight of the womb settle forward.

Watch a 2 minute movie:

Emily and Ludvig are 36 weeks pregnant (8 months) and their baby has turned sideways -- into a transverse lie. See a photo of the transverse lie fetal position earlier on this blog. Emily uses the inversion to help relax her cervical ligaments that may be tight and twisting her lower uterus. There are other reasons that a baby may lie sideways in the womb, but this is a common reason, and one that Emily can do something about. She is also seeing a chiropractor and a midwife. She may also visit a craniosacral therapist or Maya massage therapist. She'd like to have a natural birth, so it is important that the baby turn head down.

New: How can you tell if it worked?
A baby in a transverse lie is lying sideways and the mother's belly, in the last trimester of pregnancy, generally looks wider side-to-side than top-to-bottom.
When the baby does move into a vertical position the womb will look different.

Once head down, kicks will be strongest above the navel towards the ribs, and there will be suddenly more pressure in the pelvis. There may or may not be twinges in the cervix. The sides of the womb won't bulge, but one side may have a large mass of firm baby (the back) while the other MAY have limbs. Alternatively, there may be limbs on both sides and "all over" the front without such an obvious firm side when baby faces the front.
Learn more at Belly Mapping.

Changing the Earth by supporting Birth

Mothers bring forth life; medical corporations do not. Birth can be simple, powerful and loving. Fetal positioning, natural birthing and practical help for normal birth.