Grand Rounds

Paul Levy is hosting this week's Grand Rounds at his blog Running a Hospital ('cause that's what he does). The topic is "when things go awry".

Is VBAC illegal? Is homebirth illegal?

The VBAC Facts blog has a great explanation of the legalities of VBACs and homebirth. To summarize, VBAC is legal everywhere in the US. Homebirth (whether VBAC or not) is legal everywhere in the US. The only legal restrictions are placed on providers, what they may do and where they may do it.

You may also be interested in my previous blog post, Is it legal for Florida midwives to do VBACs?

Oh, and if you haven't read it yet, don't miss Time magazine's article The Trouble With Repeat Cesarians in conjunction with ICAN's recently-released report on the organization's hospital survey. I especially liked this quote from the Time article:

But while many obstetricians say fewer patients are requesting VBACs, others counter that the medical profession has been too discouraging of them. Dr. Stuart Fischbein, an ob-gyn whose Camarillo, Calif., hospital won't allow the procedure, is concerned that women are getting "skewed" information about the risks of a VBAC "that leads them down the path that the doctor or hospital wants them to follow, as opposed to medical information that helps them make the best decision." According to a nationwide survey by Childbirth Connection, a 91-year-old maternal-care advocacy group based in New York City, 57% of C-section veterans who gave birth in 2005 were interested in a VBAC but were denied the option of having one.

Hm. Why give patients information about a "procedure" that is not offered by you or allowed by your hospital?

Midwifery Care in Canada

Mazely writes about A Midwife Crisis: Maternity Care in Canada:

The practice of midwifery in Canada is regulated by provincial and territorial authorities. Midwives can only legally practice their profession if they are registered with these authorities, but only seven provinces and territories have regulatory systems in place. This means that midwifery is essentially illegal in the rest of Canada. Further compounding the problem is the fact that even where midwifery is legal, it isn’t always funded or covered by health care. A two-tier system of care has been established, where the standard of maternal care changes depending on your geographic location. Midwives are only available to some women, in some parts of the country, and only some of those women can afford their services.

In addition to giving a brief history of midwifery in Canada, Mazley links to the Canadian Midwifery Regulators Consortium's chart of the legal status of midwives in Canadian territories and provinces.

Traveling mothers still "face hurdles"

Traveling mothers still face hurdles in pumping breastmilk, reports the New York Times' business section, despite updated TSA rules regarding the carrying of expressed milk on airplanes. There is encouraging news, though:

Ernst & Young, the New York City financial services company, provides free travel kits so that women on business trips can ship milk home to their babies. And the Boston Consulting Group, a management consulting firm based in Boston, helps women bring their babies on business trips by covering travel expenses for the infant and a baby sitter.

Ms. [Suzanne] Riss [editor-in-chief of Working Mother magazine] called such programs “very cutting edge” and noted that they “go a long way” toward creating loyal employees. “But they’re still the exception, not the rule,” she added.

Top 'Lawyer Mom' Blogs

I recently discovered that in December Darling Hill (a blog which I had never heard of but plan to keep an eye on!) named The Mommy Blawg one of the Top 'Lawyer Mom' Blogs of 2008.

Check out the other blogs on the list - there are some good ones. And you can find a wealth of information at Darling Hill, which is "the blog that’s devoted to that place where life and flexible lawyering meet. A 100% lawyer-parent friendly legal niche."

FDA raids Miami birth center; Placentas, medical records confiscated

On Christmas Eve, federal, state, and local authorities executed a search warrant on the Miami Maternity Center following a 10-month joint investigation by the Florida Department of Health, the US Food and Drug Administration, and Miami Dade Police Department’s Medical Crimes Unit. Birth center staff were allegedly dehydrating and encapsulating placentas in a process that resulted in placentas from various birth mothers becoming commingled. Midwife Shari Daniels denies the allegations, according to news reports:

"They charged in here as if I were making crack cocaine," Daniels complained. "They could have sent one person and we should have shown them everything." She suggested that the raid might have been caused by angry obstetricians, who charge several times what she does to deliver a baby. "The local docs are screaming their heads off.''

Jodi Selander, owner of Placenta Benefits, a placenta encapsulation service, writes on her blog:

I am (obviously) a huge proponent of placenta encapsulation. However, I can not in any way condone this type of activity. I created the Training & Certification program specifically to avoid these types of situations.

As an advocate for the movement toward legitimizing the use of placenta for its natural purpose, this story is absolutely outrageous. People who operate with such a total lack of regard for the gravity of the process and who apparently do not realize that the FDA is not on our side, set the movement back and make it harder for the rest of us who are being safe and working toward legitimacy.

Please, people - don’t think that you can find free instructions for drying placentas on the internet and just set up shop. This is serious. You need to comply with government standards and regulations. Get some training. Work with us. Together we can do it. But not when people like this are operating out there.

White Collar Crime News blogger Jef Henninger has a lawyer's take on the situation:

I hate to see good people get caught up in criminal cases when the entire problem could have been easily avoided if a good attorney got in there and essentially performed an audit on the entire business....I don’t know enough about the facts of this case to really figure out what the situation is here, but I see no indication that anyone was harmed. At the most, it seems like they had sloppy business practices while they performed a service that the people wanted; but the FDA does not agree with. This seems like it would be a good case for a lawyer to argue that this is a technical violation of civil law and not a criminal violation as no one was actually harmed.

And, as I have mentioned before, I would love to have an expert's opinion about the HIPAA implications of confiscation of medical records. What happens to a person's right to his or her own medical records when those records become evidence? I assume that HIPAA exempts healthcare providers from liability when complying with a legitimate court order or other legal process, but do the police, prosecutors, and court personnel have the same duty as healthcare providers do to keep protected health information confidential? What if the health of a woman and her baby are compromised because her prenatal records are unavailable? Is there liability? Is anyone but me asking these questions?


Update 1/08/2008: For more information and continuing updates, please visit The Placenta Blog.

Midwife Sued

Midwife in the Clouds discusses being sued here and here - for allegedly misrepresenting the fact that she was an "in-network" provider:

Obstetrics in America is filled with stories of birth workers who can no longer have loving relationships with their patients because they are scared to death of lawsuits. The only people who suffer from these lawsuits are the mothers and babies because it becomes harder and harder to get the care you want when your caregiver is scared or limited by malpractice insurance.

Thankfully, this case was not about my ability as a midwife or my care of the mother and baby but a question of contracts, insurance, and money. I am so grateful to have learned what I did without anyone being seriously hurt - my heart goes out to midwives who are charged with an unwarrented medical lawsuit.

ABA Journal Blawg 100

The American Bar Association Journal has published a list of this year's 100 best legal blogs. I didn't make the list. Neither did Blawg Review, though, so I'm in good company.

NaBloPoMo

Poland debates paying for childbirth pain meds

From Anna Wilkowska-Landowska ("Poland Says No to Pain-Free Childbirth"), the Polish health system no longer plans to pay for childbirth drugs. The Ministry of Health Director suggested (in an article in a Polish newspaper) that not only can the state budget not afford to ensure free anesthetization during childbirth to all Polish women, but that there are not enough anesthesiologists in Poland. Says Wilkowska-Landowska:

In Western European countries, as well as in Poland's neighboring countries, childbirth anesthetization is considered a standard service provided to women. The question becomes, then, why do Polish women have to pay for it? This situation divides the Polish women into two groups: those who can afford to pay for anesthetization and those who cannot afford to pay for something to which they are entitled.

The article also mentions that since the Polish government is encouraging families to have more children, the Minister's statements only make the decision to have a baby more difficult for women.

Well, I guess it's another strike against socialized medicine.

NaBloPoMo - almost there!

Well, twenty-nine straight days of blogging, and I've run out of steam. Tomorrow we'll celebrate (it's also my birthday), but for now I'm going to get some sleep.

Thanksgiving

Happy Thanksgiving, everyone! I'm thankful for the fact that it's NaBloPoMo and I'm still technically in the game.

From Thanksgivings past, I bring you What To Do With Leftover Turkey and Leftovers (or, a Tale of two grandmas). Don't forget to watch the Thanksgiving Day Parade!

Birth Center Grand Opening - Cleburne, Texas

If you live near the Dallas/Ft. Worth metroplex - particularly the southwesternmost portion - you might want to check out the newest birth center:

We are thrilled to announce the Grand Opening Celebration of Edenway's Cleburne Birthing Center on Saturday, December 6, 2008 from 11am to 4 pm at 805 N Main, Cleburne, Texas 76033. Come see how we can help you achieve the birth you desire. Meet our staff! Tour our facility! Bring the whole family for FREE refreshments! FREE pregnancy testing! FREE chair massages! Door prizes! Kids' jump house! Free info about natural childbirth, waterbirth, fertility health, baby slings, massage, herbs, birth photography, and chiropractic care in pregnancy… This will be a fun event for the entire family! Visit us at www.cleburnebirthingcenter.com or call 817-558-BABY for more information.

New ABA Poll on the job market and the economy

The ABA Journal is surveying lawyers about the job market and the current state of the economy. Results will be published in the January edition of the Journal.

Links for Midwives and others

Thanks to Citizens for Midwifery for posting a link to USPharmD.com's list of 100+ Essential Online Resources for Midwives.

Homeschooling and Vaccinations under the Obama administration

I guess this is the sort of question that everyone is asking these days. Yesterday I received a flyer in the mail advertising a seminar for estate planning professionals on how to advise their clients in light of the incoming administration. Of particular interest to my readers is how the Obama presidency will impact home schoolers and "mandatory" immunization programs. (If you have any input or links regarding midwifery, homebirth, or breastfeeding, please feel free to post in the comments; however, they tend to be state issues and I haven't heard any buzz about these topics).

Homeschooling - The Home School Legal Defense Association (HSLDA) recently sent out an e-lert on the subject of what to expect under an Obama administration. It states, "Despite HSLDA's efforts prior to the election to get an official statement from the Obama campaign regarding their position on homeschooling, we received no response." It goes on to mention the Democratic Party's support of the National Education Association (NEA) and public education in general, but asserts that the Federal government has no constitutional authority over home education. Of greater concern, perhaps, is the possibility that the United States under Obama will ratify the United Nations Convention on the Rights of the Child, a move which HSLDA opposes.

The blogger at Obama States of America has done quite a bit of research. Rational Jenn critiques the HSLDA position. And then there are Homeschoolers for Obama ("because there is no such thing as 'the homeschool vote'").

Vaccinations - Before the election, Autism activist Becky Estepp contacted the Obama and McCain campaigns regarding the candidates' positions on the issue of vaccine safety. The McCain campaign responded with a statement that "John McCain believes in the right for individuals and in the case of children, parents, to make informed health care decisions, and does not support pre-empting these prerogatives." Obama, however, responded only with a general letter about autism which did not address the issue of vaccine safety or parental choice. However, according to New Jersey mom Claudine Liss who asked Obama point-blank about his stance, Obama replied, "I am not for selective vaccination. I believe it will bring back deadly diseases, like polio." More details are available from Age of Autism (McCain Addresses Vaccine Safety, Obama Silent, McCain Senior Policy Advisor Responds To Autism Questionnaire, and McCain or Obama: Who Will Reform Vaccine Safety?); Inside Autism (The autism election and McCain supports vaccine choice) and the Oct. 23, 2008 press release.

While the issue of mandatory immunizations and exemptions are currently a matter of state law, the federal government does have a role to play in funding vaccine safety research, enacting legislation exempting vaccine manufacturers from tort liability, the availability of military exemptions, and so forth. In addition, there are Constitutional issues involved in religious exemptions (the Equal Protection clause) and the reach of state vaccination requirements, for example to private schools which do not receive government funding, which could be decided by presidentially-appointed federal judges.

For my part, just because we have elected a president who does not appear to share my views on issues that I am passionate about (namely, the right of citizens to make healthcare and educational decisions on behalf of themselves and their children without government interference) does not mean that The End is upon us. Of course, we must be eternaly vigilant in guarding our precious rights and liberties. Fortunately - in this case at least - government is a slow-moving beast, and I have come to the conclusion that one man cannot screw things up so bad that we cannot get it fixed four or even two years from now.

Baby, You're Home

The New York Times published a piece on homebirth this week ("Baby, You're Home") which is getting good reviews in my normal-birth circles, though it was inexplicably placed in the "Home & Garden" section of the paper. It seems that while homebirths are up all over the country, the biggest surge seems to be in New York, according to local midwives and sellers of birth tubs. according to the article, this may be due, in part, to the impact of last year's documentary The Business of Being Born, which was filmed in New York City. Actual statistics on this won't be available for several more years, though.

Doctors 'in denial' about safe home births

Australian doctors are "in denial"about safe home births, according to an article in the Australia and New Zealand Journal of Obstetrics and Gynaecology:

And in the absence of publicly funded homebirthing programs, women who cannot afford private midwives are increasingly opting for unassisted homebirths, says Lareen Newman, a researcher in the department of public health at Flinders in Adelaide... When obstetricians point out the real risks of this trend, women may believe they are ‘crying wolf’ because of their unfounded opposition to safe homebirths, she writes.

She calls on RANZCOG [the Royal Australian and New Zealand College of Obstetrics and Gynaecology] to acknowledge the evidence for homebirths and support public homebirth programs in its revised statement expected next month.

Good luck with that.

Midwives who Blog

Infomidwife discusses legal considerations for Australian midwife-bloggers in Cyber Talk and Midwives.

Farm-to-Consumer Legal Defense Fund

If you are interested in topics such as consumers' access to raw milk and other farm-fresh products, and the regulation of small farms in general, check out the Farm-to-Consumer Legal Defense Fund and related organizations, the Farm-to-Consumer Foundation and the Farm and Ranch Freedom Alliance.

Minimum Length of Hospital Stays

The Raising Women's Voices blog notes that new federal regulations take effect January 1, 2009 for group health plans and health issuers concerning minimum length of hospital stays for mothers and newborns following childbirth. The regulations can be found here: 73 FR 62410 (.pdf).

NaBloPoMo

I am, once again, making an attempt at National Blog Posting Month. As before, since I have three blogs, I intend to post to only one of the three every day:

The Mommy Blawg
The Baby Blawg
The Book Blawg

I may or may not mirror posts on the NaBloPoMo website; I have in the past but it is a bit time-consuming.

Happy Reformation Day

My husband found the Reformation Day Symposium, sort of a blog carnival of reformation day posts.

Midwifery and the Law

This week's Midwifery Today E-news is on the topic of Midwifery and the Law.

Guess what! I have an email address!

If you will kindly turn your attention to the right-hand sidebar, you will see the word "Email". Directly under that word is something that looks like this: mommyblawger AT gmail DOT com. It is, in fact, my email address. It is in a format which obscures it from the view of evil email address-gathering spambots. If you simply replace the word "AT" with the "@" sign and the word "DOT" with a period, and close up the empty spaces, you will have my email address. You can send me an email and I will get it. I might even write you back - eventually.