Below is the letter from Geradine Simkins, president of MANA.
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Dear Friends,
I’d like to address some of the comments about the upcoming Homebirth Summit. First of all, this is an idea that has been brewing for at least two years, some might say for two decades. No one really “owns” the idea of putting together a gathering of multiple stakeholders to have a frank and productive conversation about how to best support and care for women who chose homebirth. But after lots of conversation—the decisive one being at the ACNM Homebirth Section meeting two years ago—we decided to pursue this “project” in earnest.
Many of you may be familiar with the type of process we chose. It is not unlike what Childbirth Connection chose to use when they initiated the process for creating their seminal work, “Transforming Maternity Care: A Blueprint for Action”. They convened a Vision Team of experts in the fields of maternity care and health systems, worked in specific stakeholder groups, and developed concrete solutions to some of the most pressing issues facing the U.S. maternity care system. The result is a group of actionable strategies to improve maternity care quality and value.
It was not a conference; it was an invited work team. The Homebirth Summit will also not be a conference. Here are some details about the process and the participants:
- In order to get representatives to the table who are in any way involved with homebirth, 72-80 delegates have been identified to be evenly balanced across 9 stakeholder groups (listed below).
- The invitation selection process has been an iterative process with many rounds of vetting, internally and externally.
- Short lists were created by subcommittees chaired by those who knew those stakeholders.
- Each subcommittee of the MULTIDISCIPLINARY planning group went through a detailed vetting and weighing process and considered the balance of perspectives, ethnicities, gender, age, geography, and other factors.
- After serious consideration, we hired consultants from Future Search because of their success with consensus building among groups with very disparate (and often conflicting) ideas, values and principles.
- We are using Future Search Methodology, which prioritizes including participants who had authority, information, expertise, need, and resources.
- We also prioritized those who were likely to respect the process by fully engaging in the Future Search methodology and open-minded dialogue.
- The stakeholders are NOT ANY ORGANIZATION but rather are individuals who are defined as belonging in these nine stakeholder groups:
- Consumers (from a variety of perspectives)
- Consumer advocates (doulas, childbirth educators, childbirth and women’s healthcare activist)
- Home Birth midwives (CPM, CNM, LM, Amish, traditional, whatever)
- Obstetricians and OB family practice
- Collaborating MCH providers (nursing: L&D, neonatal, pediatrics; CNMs who provide backup)
- Health insurers and liability insurers
- Health policy, legislators, legal, ethics
- Research and education: Public Health, epidemiology
- Health models, systems, administrators
In this way, the WHOLE SYSTEM is at the table. Otherwise, we will not be able to seriously come to consensus.
The point is not to debate the “right or wrongness” of homebirth, or even the safety. The goal is to establish what the whole system can do to support those who choose homebirth, and provide the care, safety net, consultation, collaboration and referral necessary to make homebirth the safest and most positive experience for all involved—moms, babies, families, communities, health care workers, hospital personnel, administrators, payors, and so on.
We have been meticulous and intentional about our process. Nonetheless, not everyone will agree with our process. With only 72-81 spots to make this a functional process, not everyone will be happy with those that are selected, and specifically, if they were not selected.
I would ask you to consider that we are working very hard and with the firm intention of making the process, the event and the outcome as optimal for mothers and infants as possible, and for the benefit of midwives serving homebirth clients.
In solidarity,
Geradine
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Geradine Simkins, CNM, MSN
President & Interim Executive Director
Midwives Alliance of North America
president@mana.org
executivedirector@mana.org
geradines@gmail.com
275 Cemetery Rd.
Maple City, MI 49664
231.228.5857
This is reassuring not in the slightest. The greatest number of seats at the table are reserved for those without a dog in the fight. Actual mothers, who have to live with this, are sadly underrepresented. The vast number of people in this "consensus" not only have no business being involved, but have very very little actual knowledge of home birth.
ReplyDeleteBirth belongs to mothers, not to a bunch of governing bodies. Are you telling me that some random OB vetted by other OBs knows better than I how I can choose a safe birth? Really?
And in another email Geradine sent, the usual birth types were thrown under the bus in unnecessary and early compromise. Breech? Twins? Forgetaboutit, you get your high-risk self straight to the hospital, no home birth option for you. This fails to inspire confidence.
I can't just trust them. Not until any of them behave in something resembling a trustworthy fashion. How about they work on bringing down the cesarean rate, something that is *clearly* within their perview, and *then* extend their reach into a realm they have less expertise in?
I think this sounds well thought out - if it was just a meeting of mothers and midwives what would that serve to accomplish?
ReplyDeleteI agree with Laureen. The concept is well intentioned, but if the purpose is to improve integration of care then there need to be a LOT more consumers at the table. Janie is also correct that just talking to ourselves would be unproductive and meaningless. But it seems to me that the stakeholders should be more evenly distributed between in-hospital and out-of-hospital.
ReplyDeleteLaureen is correct in noting that the hospital providers have more than 50% of the representative slots. If this was required to get them to the table then you have to question if it is worth it. Gera's post also does not address the original idea that this was to be a consensus process. Now it has become a Summit and the purpose is a friendly chat. I find it hard to believe that all these people are giving up their time to just chat, with no intention of arriving at a statement.
The Childbirth Connection process produced a useful document because the stakeholder list was fully representational. There are too many of the major stakeholders that have been excluded from this list.
As for inviting individuals instead of representatives from organizations, this is very difficult to do. For example, no matter protests to the contrary, when Gera speaks in public she has a fiduciary responsibility to MANA to speak on behalf of the organization. Ditto for all of the people on the steering committee. They are attending to support and promote the concerns and issues of the organizations they represent. What is the point of anyone attending if they are not speaking on behalf of a stakeholder group.
Great idea to get everyone at the table, but the fact that so many people are complaining so early in the process should be a clue to the organizers that the stakeholder list is not appropriately representative
The fact that the insurance industry has more seats at the table than CPMs is pretty appalling. Also, doulas and childbirth educators are birth workers, not consumer advocates, who are also woefully underrepresented here. What gives?
ReplyDeleteAll good points. I'm still *chewing* on Simkin's message. Hoping more people will respond here.
ReplyDeleteThanks Rixa for the additional info.
Aren't these the exact people we want dialogue with and change from? So in that regard I am ok with them representing more than 50 percent
ReplyDeleteI wrote to ACNM months ago asking to be considered as a participant in the Homebirth Summit. I felt I could bring something to the table as I am a consumer (in a sense - I supported my daughter in her 2 homebirths), I am a "consumer advocate" as a doula, and I was previously a L&D nurse. I support midwifery of all types including unlicensed and traditional, homebirth, a woman's right to make her own choices surrounding her birth, and I recognize that rarely medicine and technology do play integral and necessary roles in labor and birth.
ReplyDeleteI have written back a few times since March for an update about when the participants were expected to be chosen (I was told April) and if they had yet been chosen (I have not received a response back to this question). Does anyone know if the 72 - 80 delegates have already been chosen or are they still in the process of choosing them?
When I read this by Geraldine it concerned me: "Short lists were created by subcommittees chaired by those who knew those stakeholders." That doesn't sound like a balanced representation to me if they are just choosing people "they" know. That is pretty "safe" of them to not get a true consumer/mother perspective on the struggles of everyday women surrounding homebirth or was I misunderstanding this statement?
I know I read somewhere that they do not want outliers sabotaging the whole process from moving forward, but are real, everyday mothers and the people who support them in homebirth really the outliers in the conversation regarding their lack of options, their treatment by the medical establishment, lack of insurance coverage, and choices surrounding their right/choice to homebirth? I think not. Maybe as a MCH provider in the past and someone who lived through the struggles surrounding homebirth via her daughter I can relay some of those thoughts and struggles.
I am hoping they are still choosing participants and that I might still have a shot at participating. Geraldine are you reading this? I am open minded, dedicated to making the outcome as optimal for mothers and infants as possible, and feel like I have a unique perspective that I hope I can share at the summit. Crossing my fingers here in Maine that there is still a chance I will be chosen to participate.
Lisa O'Rourke Goulet RN, IBCLC
Lisa, that is the real gist of my concern as well. Who determines "who" is an outlier? And if they only want comfortable opinions at the table, doesn't that mean that they aren't really including stakeholders that also have different viewpoints?
ReplyDeleteI live in a licensure state that has caused me to have serious concerns about further education in midwifery because of very real possibility of either having to turn away women who are capable of birthing and smart enough to understand risk and at the same time, very likely to be reported and investigated more than once. If I tried to have a homebirth in my state, I face the very real possibility of having someone else (a care provider) make that decision FOR me or going unassisted. Many women in my state are facing these kinds of options or return to hospital systems for cesareans.
I'm concerned that these types of opinions and real concerns need to be heard and not simply from the perspective of care providers but also from the very real people this impacts, the women. And even then, women from licensure states and women from non-licensure states can have very different perspectives even though both their midwives face prosecution or other consequences in a birth gone wrong. How are their choices impacted? I guess that this summit idea being an invitation-only concerns me because its once again a place where freedom of VOICE for women isn't really being heard. Where is the open forum for women to bring UP their concerns? Do we need to create one? I'm certainly thinking about it.
Shannon,
ReplyDeleteThe more forums on homebirth the better!! Go for it!
Lisa
You know, I think it's a GOOD thing that insurers and policy people and hospital-based OBs have a place at the table. If homebirth is going to become a viable, economical, safe option, these groups HAVE to be on board with it. I also think it's evenly split between homebirth advocates (consumers, advocates, and attendants), hospital-based providers (OBs/FP, collaborating nurses/peds, and administrators), and policy people (public health, health policy, and insurance).
ReplyDeleteI work in public health, and I have seen talks by hospital executives and CEOs of HMOs and managed care organizations. They do actually care a lot about patient safety, quality of care, and cost-effective care delivery. If homebirth advocates and providers can demonstrate that homebirth is a safe option that is less expensive and provides better care than hospital birth, you could find healtcare executives and insurance companies to be advocates for it, or at least find them willing to cover homebirth costs. Hospital administrators might just need to think outside the box about how they can still make maternity care a winner - maybe they need to offer midwifery services with the option for homebirth attendance - maybe there's no reason they couldn't except that they haven't thought about it yet. Maybe Medicaid could be a leader in employing OOH midwives to attend low-income women. What can we imagine that will be win-win?
Policy people need to be at the table if legislators are ever to be convinced to change existing laws about home birth attendants, physician back-up agreements, and make midwifery legal and above-board nationwide. It would be great if access was equal all over the country, rather than the mishmash we have now.
OBs and MDs need to be at the table to TALK to midwives and homebirthing parents, to find out what actually goes on when there ISN'T a transfer. It will demystify the experience, give them new perspective, give them confidence to consider coming around the the position of saying, "OK, I will be your back-up and work collaboratively with you to support your clients if they need to be transferred to a hospital." We can also find out what THEY need in order to be comfortable with collaboration.
It seems to me good to think not only about what message consumers and homebirth supporters want to be heard, but maybe also what we need to hear from these other groups. Women and homebirth supporters are 1/3 of the puzzle and we ARE represented. It is true already that people who really want homebirth are going to get it one way or another. But if more women are to have it as an option, if it is truly to become part of mainstream medical care options for birthing moms, we can't just have a bunch of advocates who refuse to budge on things like levels of acceptable risk, or who refuse to look at the numbers from 'the establishment's' multiple perspectives. What evidence do the insurance policy dudes and the family practice doctors and hospital administrators need to consider how they can integrate homebirth into women's options as a matter of routine? What hard numbers do they need, what research will be the right "language" to convince them to expand support (financial, legal, logistical, moral) for homebirth for more women? Would expanding homebirth support mean that maybe the homebirth contingent makes compromises on acceptable training, or risking out certain women? Maybe, but what if those compromises actually expanded care options for large numbers of women? There is nothing to lose by sitting down and talking, and possibly much to gain.
I applaud this effort at dialogue and hope it will bear fruit not just in terms of providing support for the minority who currently birth at home, but will actually be one step in expanding maternal choice. Can you imagine if more than 1% of American women could choose homebirth because it's integrated into models of care?