Source: International MotherBaby Organization
Dear Friends of IMBCO,
March 8th marked the annual International Women's Day, celebrating the incredible achievements,
past, present and future, of women all over the world. Additionally, the global celebration on May
15th highlighted the importance of family on the International Day of Families.
At IMBCO, we are working hard to improve the lives of women and families and we have made
significant progress over the last few months. We are so excited to report the news to our invaluable
supporters and sponsors. Highlighted in this issue you will find the opening of the first freestanding
birth center in Uruguay, changes to the medical curriculum in Brazil, hope for greater women's rights in
Israel, and exciting news from India, Slovenia, Australia, Cameroon, Bangladesh, Mexico, and the
Thank you to all of our Country Representatives for your contributions to moving IMBCO's goals
forward, and to you for helping to make these accomplishments possible!
Examples of Vertical Birthing In Austria and Canada:
IMBCO is pleased to welcome Healthy Mother Wellness & Care of India as its ninth member of the global MotherBaby Network (MBNet). Healthy Mother Wellness & Care was selected to join MBNet as it leads India in comprehensive maternal and newborn care based in the midwifery model. IMBCO board member Robbie Davis-Floyd commends Healthy Mother for its approach, stating that they "represent the global vanguard of compassionate, humanistic, and evidence-based care in childbirth and constitute a model we hope many others will replicate." Since its opening in June, 2009, Healthy Mother Wellness & Care has maintained normal birth rates of nearly 85%, which are among the highest in India.
Healthy Mother Wellness & Care operates two sites, one in Hyderabad and Bangalore, and provides Lamaze-certified childbirth education classes, certified Lamaze teacher training workshops, breastfeeding support, and postnatal return to fitness programs. They also operate the Santcum, or natural birthing center, where "women have access to a full range of services from prenatal checkups to labor support, support for natural birthing, and postpartum care, assisted by a team of midwives, doulas, nurses and backup OB/GYNs" (Sakotal, 2011).
According to a recent Lancet article, India experiences the "world's greatest burden of maternal, newborn, and child deaths. In 2008, 1.8 million children [under 5 years], including 1 million neonates died, and 68,000 mothers died" (Paual, Sachdev, Mavalankar, Ramachandran 2011...p.332). It is IMBCO's hope that the high-quality care executed at Healthy Mother Wellness & Care will demonstrate the potential to improve maternal and infant health services for families in India through providing high-quality, cost effective, and midwifery-based care. IMBCO looks forward to Healthy Mother's future contributions to MBNet and to the women, babies, and families of India.
Flavia Previtali cutting the ribbon with First Lady Lucia Topolansky
Centro de Maternidad Montevideo, the first freestanding birth center in Uruguay, was inaugurated on April 1st. First lady of Uruguay, Lucia Topolansky and Lamaze board member and program director at Universidad Anahuac in Mexico City, Elena Carillo, as well as many other important national and international figures, were there to support the mission and center.
Elena Carillo states "I'm very happy for women in Uruguay. I'm sure the birthing center will be a major contribution to improve the quality of infant maternal care in this country and I see a promising future for many other countries in Latin America that will surely follow this venture." Following the inauguration, an international birthing seminar, "Birth and Quality of Life," was held on April 2nd and 3rd, where Flavia Previtali presented the components and importance of the International MotherBaby Childbirth Initiative.
Centro de Maternidad Montevideo
The birth center is already welcoming an influx of pregnant women for birthing classes and prenatal care in addition to starting an International Volunteer Opportunity Program (IVOP), which invites health professionals to visit and work on-site. If you are interested in the IVOP program, please contact Flavia Previtali, the IMBCI regional representative for the Americas at firstname.lastname@example.org. Stay tuned for more information on the important changes taking place in Uruguay for women and families through the Centro de Maternidad Montevideo!
SAO PAULO, BRAZIL UPDATE
On April 5th, 2011, Daphne Rattner, member of the board of directors of IMBCO, presented "Humanized Childbirth as a Reproductive Right of the Woman" to the course on Obstetric Pathology at the School of Medicine of Botucatu - University of the State of São Paulo - UNESP, Brazil.
In addition, she presented the 10 Steps for Optimal MotherBaby Maternity Services to medical students, OB/Gyn residents, Family Medicine residents, graduate students, nurses, undergraduate nursing students, and public services physicians.
Based on these events, the Department of Obstetrics and Gynecology of the School of Medicine of Botucatu is adopting Humanized and Evidence Based Childbirth Care as its official policy, with promising future perspectives!
2010 was an exciting year for Slovenia in relationship to improving birthing services. In the beginning of 2010 Slovenia's Ministry of Health announced plans to allow women to give birth outside of hospitals. Currently, most women give birth in one of fourteen maternity hospitals; freestanding birth centers do not yet exist. This legislation would allow autonomous midwifery practices to be formed, create protocols for homebirths and a professional organization for homebirth practitioners, as well as expand options for birthing services.
Within the established maternity hospitals in Slovenia, one facility has begun piloting a "midwifery house." Recently opened, the midwifery house allows women to have natural childbirths with a midwife for an out-of-pocket fee. Slovenia's IMBCI country representative is hopeful that the new "midwifery house" will enable the midwifery paradigm to be further implemented around the country. Finally, the Natural Beginnings Society, (locally known as Mama Zofa), which operates as the sole national NGO in Slovenia dedicated to improving maternity care, celebrated its tenth year in 2010. In August, 2010, this NGO created a document entitled, "Our Common Goal: Excellent Maternity Care in Slovenia."
Despite these advances, there remains much to change. Slovenian women are only permitted one companion in labor, and children are prohibited as it is considered an "unacceptable practice" by Slovenian health care practitioners. This limits the possibility of both doula and the patient's partner to be present, as well as children. Additionally, discussions are circulating about the possibility to completely centralize maternity units, thereby closing units with fewer 1,000 births per year on the grounds of being unsafe. While the medical establishment supports this measure, women and local citizens' representatives are largely opposed. Closures of small units would also limit access to medical back-up for freestanding birth centers and homebirths in less populated areas
MEXICO CITY, MEXICO UPDATE
Authorities of the Health Department of Mexico City have recently developed guidelines that promote vertical birth and discourage the promotion of positioning women flat on their backs in the pushing phase of labor. A specifically designed birthing bed has been installed in both public and private hospitals all over Mexico City, one of the largest cities in the world. In addition, through the work of Elena Carillo and her team in Mexico City, many private hospitals and clinics are implementing the IMBCI, adopting the midwifery model of care, and even offering water births at their facilities.
Australia's country representative wishes to report that the past few years have been a "time of change for maternity care in Australia." The federal government recognized that the established maternity care system was not serving women well, and thus implemented far-reaching changes. In 2010, Australia established a national registration board for registered midwives (RMs). The national registry allows clients to directly access private, eligible midwives for the full spectrum of midwifery care (i.e. antenatal, intrapartum, and postnatal services). Additionally, pregnant women may now be attended by private RMs in either the public or private sector. RMs are required to demonstrate "collaborate arrangements" to comply with the new requirements, and it remains unclear as to how these relationships with facilities and colleagues will be implemented. There is also concern that the new requirements will render certain RMs ineligible to provide care in rural areas and in tertiary hospitals. Nevertheless, Liz Wilkes, president of the Australian Private Midwives Association and founder of Midwives Australia, summarizes the changes with the following statement, declaring that midwives "have been given an important opportunity - while it is certainly not perfect, it is a starting point for furthering [midwives'] scope of practice and enhancing the types of care Australian women receive."
In Israel, women continue to confront limited options when giving birth. According to IMBCO's country representative, expanded birthing options are a possibility in certain facilities, and only for those who can pay out-of-pocket. Private pay allows women to give birth in special birthing rooms without IVs, and with freedom of movement, intermittent monitoring and respect for their wishes. Additionally, most public hospitals do not utilize midwives or obstetricians; this care is limited to private facilities.
While women are legally allowed to give birth outside of the hospital, they are only allowed to do so at home as independent birth centers remain illegal in Israel. The proportion of home births is small; a mere 500-700 babies out of 161,000 in 2009 occurred at home. While birth centers remain forbidden under law, independent centers have been opened. Most of these are run by midwives, but must operate outside the insurance system at personal cost to families.
To further the goals of IMBCO, Israel's country representatives are working to publish a IMBCO/IMBCI journal article in the Israeli medical journal, HAREFUA. In 2012, the Perinatal Society of Israel had planned to dedicate an entire meeting to natural birth and related issues; however this meeting has been postponed indefinitely. Finally, the chief of a central hospital has been changed, and work is being made to introduce the IMBCI initiatives.
Israel's statistics stand at the following for 2009 (the most recent year for which data is available):
National caesarean rate: 19.7%
Trial of labor after primary caesarean: 67.4%;
Vaginal birth after primary caesarean: 61.5%
Trial of labor after secondary caesarean: 29.6%
Vaginal birth after secondary caesarean: 16.7%
Caesarean on demand: 2.3%
Vaginal birth of breech presentation: 8%
Induction of labor: 17%
Instrumental delivery: 5.1%
Perinatal mortality: 7.9/1,000 live births
Claudette Akemche and Dr. Asomba
Cameroon's country representative wishes to report that there is much progress to be made for the women of Cameroon. Women still lack proper emotional support in childbirth, and continue to ask for greater choices while giving birth. Cameroon's chapter of IMBCO is working with the White Ribbon Alliance, which strives to ensure that all women across the world have access to safe pregnancy and childbearing services, to continue improving care for women.
Claudette Akemche, the second runner-up for Miss Cameroon UK and midwifery scholar in the UK, visited Cite Verte District Hospital Yaounde and Bonadikombo maternity Limbe with Dr Asomba, the IMBCO Cameroon country representative. Claudette is committed to maternal health in Cameroon - her visit was very important for her country.
Mixed messages and scrutiny are themes in Bangladesh with respect to a woman's right to breastfeed. In January of this year, the government passed a law mandating that women receive 6 months of paid time off in order to have the choice to exclusively breastfeed their newborns. This seems like a clear enough message from the government, but employees have their doubts that this law will actually come to fruition. Additionally, health experts are concerned that this law will in fact contribute to discouraging breastfeeding in the country of Bangladesh.
Sadly, despite fact that 2 million infants suffer from severe malnutrition, of which 15 percent die annually, the government has announced that they will close the National Nutrition Program, which provides nutritional support in both rural and urban settings. The country representative in Bangladesh reports concern that all of these changes are negatively impacting women's and families' rights and access to quality care and choices and calls for IMBCO's support.
A CALL FOR SUPPORT FROM URUGUAY & BRAZIL
Natural Beginnings Soceity is requesting that interested parties sign their petition and support their mission by visiting their website at http://www.mamazofa.org/peticija/en/vsebina/maternity-care-initiative.
Brazil has a cesarean birth rate of roughly 48% in the public sector and between 70% and 90% in the private sector with maternal morbidity and mortality needing much improvement. In response to these alarming statistics, The University of Sao Paulo developed a curriculum based on the midwifery model of care and implemented this program in 2005. However, ever since its opening, it has faced many bureaucratic and political challenges. One such challenge has peaked, and regulatory agencies of Brazil are threatening to suspend the entrance exam, which in turn threatens not only the extinction of the midwifery program in Sao Paolo but the profession of midwifery as a whole. Representatives from Brazil and IMBCO are asking you to please read the following call for help and offer your support. Thank you!
To sign the petition calling for the maintenance of the direct entry midwifery course in Brazil:
In Spanish click here
In English [click here](https://docs.google.com/viewer?a=v&pid=explorer&chrome=true&srcid=0Bzov72etAUiGMThmNTcyOTAtY2QzMy00ODhlLWEwMzEtNDg3MzAwMWRlOTY5&hl=en
IMBCO International Day October 18, 2011 Bad Wildbad, Germany
IMBCO International Day Strasbourg, France 2010
Join Debra Pascali-Bonaro and Robbie Davis-Floyd at the IMBCO International Day October 18, 2011 at the Midwifery Today Conference in Bad Wildbad, Germany. Discover what other countries are doing to implement the IMBCI and network with incredible people that strive for optimal MotherBaby care everywhere!