October 14, 2009
Volume 11, Issue 21
Midwifery Today E-News
“Business of Midwifery”
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Midwifery Today Conferences

Ina May Gaskin ~ Michel Odent ~ Elizabeth Davis

These are just three of the teachers you'll learn from at our conference in Philadelphia, April 2010. Other confirmed teachers include Gail Hart, Marsden Wagner, Naolí Vinaver, Carol Gautschi and Elaine Stillerman. Plan now to attend!

Learn more about the Philly 2010 conference and get a complete program.


Robbie Davis-Floyd ~ Michel Odent ~ Harriette Hartigan

Learn about birth from these great teachers when you attend our conference in Strasbourg, France, 29 September – 3 October 2010. Planned classes include Prolonged Pregnancy, Prolonged Labor, Managing Hemorrhage, Posterior Position and Preventing and Managing Birth Complications at Home.

Learn more about the Strasbourg 2010 conference. To receive a printed program by mail when it becomes available, please e-mail admin@midwiferytoday.com with your name and postal address.

In This Week’s Issue:


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Quote of the Week

"$13 to $20 billion a year could be saved in health care costs by demedicalizing childbirth, developing midwifery, and encouraging breastfeeding."

Frank Oski, MD


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The Art of Midwifery

When potential midwifery clients come to you, have a list of satisfied past clients ready for them to contact. [Editor's Note: Of course, you will have procured these moms' permission first.] Be sure to include the name of someone who had a long or difficult birth, because this is where your true nature and competency will really be evident.

Sarah, Midwifery Today Forums
Excerpted from "Tricks of the Trade," Midwifery Today, Issue 66
View table of contents / Order the back issue


ALL BIRTH PRACTITIONERS: The techniques you've perfected over months and years of practice are valuable lessons for others to learn! Share them with E-News readers by sending them to mtensubmit@midwiferytoday.com.


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Research

A German study published in the American Academy of Pediatrics' journal found that breastfeeding protects infants from Sudden Infant Death Syndrome (SIDS). Any amount of breastfeeding was found to be protective. The study included 333 cases of SIDS and 998 age-matched controls from 1998-2001.

Researchers adjusted for the confounding effect of socioeconomic status (less likelihood of engaging in smoking or intoxicated co-sleeping), to meet criticism of prior studies. They speculated that because maternal acquired immunoglobulin G is low in early infancy and the baby does not yet produce large amounts of its own immunoglobulin, breast milk (which contains immunoglobulin and cytokines) may help prevent infections that are believed to contribute to SIDS. In addition, breastfed babies are more easily aroused than those fed formula.

The researchers recommended that all SIDS-prevention campaigns include promotion of breastfeeding for the first six months of life. The full study can be found at: http://pediatrics.aappublications.org/cgi/content/full/123/3/e406

Pediatrics 123(3): e406-10


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Fees for Midwifery Services

How does a midwife know what to charge for her services? This is always a difficult question, especially for the new midwife. She wants to be competitive, yet she certainly doesn't want to undercut herself. Becoming a midwife involves a lot of time, commitment, hard work...and money. Midwives are worth their weight in gold; unfortunately, many midwives only ask a pittance for their services. There is a reliable way to get a benchmark on a reasonable rate for your geographical area. Medicare has their fee schedule on their Web site. You can log on, type in any code and bring up the Medicare allowable amount for your area. Most midwives never, ever deal with them (count your blessings!), but Medicare sets the example for everyone else in the country—what Medicare does, the other insurance carriers will do, too. Let's take a quick look at what Medicare reimburses for the global maternity code (59400) in different corners of the country:

  • Seattle, Washington: $1695.80
  • San Francisco, California: $1870.24
  • Topeka, Kansas: $1545.01
  • Salt Lake City, Utah: $1651.31
  • Providence, Rhode Island: $1753.95
  • Miami, Florida: $2161.96

So what does this mean for you? First, you should make sure that your fees are never below Medicare rates. That's right, never. Medicare is considered the absolute lowest reimbursement rate that could even possibly be considered fair. You do not want to devalue yourself and the midwifery profession by having fees lower than Medicare. Your fees should be set to an amount between 150–200% of the Medicare rates—this is still a competitive rate, especially considering the superior care midwives give their clients.

Second, if you accept insurance reimbursement, the allowable amount should not be below Medicare rates (if they are, an appeal needs to be filed). If you are contracted, you can use these fees to negotiate your contract to be sure you are being fairly reimbursed. Again, a commercial insurance company should be allowing at least 150% of the Medicare fee schedule for your area.

For directions on how to access the Medicare Web site and a few codes you can look up, please see our article "Setting Your Midwifery Fees" in our Resource Center, under Business Topics, at: www.midwifebilling.com

Kelli Sugihara, Certified Professional Medical Biller

Kelli Sugihara has been billing for midwives since 1997 when her mother asked for her help with insurance claims. She is also the business instructor at Midwives College of Utah. She lives in the Seattle, Washington area with her husband (a twin born at home), their three children (all born with midwives) and two cats (also born at home). She is the director of Midwife Billing & Business, LLC, and can be reached at: info@midwifebilling.com


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Want the whole story?

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Midwifery Today Magazine Issue 68

Learn Tricks from Expert Midwives
Sharing Midwifery Knowledge

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Placenta rituals, remedies and recipes…

Placenta: The Gift of Life

…are what you'll find in Placenta: The Gift of Life. Read this book to discover the various ways placentas have been used by people around the world and throughout the ages. You'll also find 15 recipes that will show you how to use the placenta in ointments, essences and other remedies for a variety of ailments. Placenta: The Gift of Life is a book from Motherbaby Press, an imprint of Midwifery Today. Get the book.



Web Site Update

Read this editorial by Jan Tritten from the brand-new issue of Midwifery Today, Autumn 2009:

  • Traditional Midwifery
    “We are losing the knowledge and wisdom of traditional midwifery as fast as we are losing the rainforest. Just as we are discovering this incredible knowledge base, it is disappearing. We can do better, and in some places we are. Much is being lost to our own arrogant medical imperialism and belief that we know what is best. Instead of extending a helping hand…we often come in with our ideas, taking over another culture with our medicalized one. Respect is a keyword here.”

Read this article excerpt from the most recent issue of Midwifery Today newly posted to our Web site:

  • Am I a Traditional Midwife?—by Brandi Wood
    “Recently a knowledgeable friend and I were discussing traditional midwifery. She challenged my foundational views about this subject, made valid points and even raised the question for me: Am I a traditional midwife? I have often considered myself a modern direct entry midwife. I decided I needed to do more research on what a traditional midwife was and is.”

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Question of the Week

Q: Has the state of the economy affected your practice? If so, has it had a positive or negative impact?

— Midwifery Today E-News staff


SEND YOUR RESPONSE to mtensubmit@midwiferytoday.com with "Question of the Week" in the subject line. Please indicate the topic of discussion *and the E-News issue number* in the message.


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Learn about midwifery education!

Are you an aspiring midwife who's looking for the right school? Are you a practicing midwife who would like learn more? Visit our Education Opportunities page to discover ways to start or continue your education.



Question of the Week Responses

Q: What changes have you noticed in midwifery and birth practices in the past ten years?

— Midwifery Today E-News staff

A:

  1. Older moms;
  2. Older dads;
  3. Less interest in childbirth education (CBE) classes;
  4. Less prepared moms, who may have taken a class at a hospital where information was controlled by doctors;
  5. Less interest in non-medicated birthing;
  6. Acceptance of epidurals as a part of all labors;
  7. [Fewer] referrals from doctors to private classes;
  8. Bigger classes;
  9. Less follow-up from teachers of the above bigger classes...make that none.

— Linda B. Jenkins, RN
jenxl@aol.com, www.birthprep.com

A: My 21-year-old daughter has been advised to have a LEEP (loop electrosurgical excision procedure) for moderate dysplasia due to HPV. I know this may leave scarring on the cervix or possibly pose a small risk of preterm labor when she becomes pregnant. My midwife said she would be put on a preterm labor protocol. What experiences have midwives had with this situation?

Have you seen cervical scarring or preterm labor after a LEEP? Does scarring lead to slower dilation or "stalls" in dilation? Does she have any alternatives for treatment other than the LEEP? What is your advice regarding pregnancy? Would this preclude her from using a midwife?

— Michelle


Q: I had a LEEP procedure and went on to have two vaginal births. The first was long, but she was big and in an occiput posterior (OP) position with the cord wrapped twice around her neck; the second was the easiest day of that child's life for me...and she is now 41. My oldest daughter had a LEEP procedure and she had a very statistically average first birth (12 hours) with a vaginal delivery...also with the cord wrapped around the baby's neck twice. For the second delivery her husband (an OB) and I were the only ones with her, she delivered so fast. The third was unintentionally born in water; she felt pushy so the midwife said to push. Out came her third child—2 lbs larger than either of the preceding two. My advice is that it may be worth just what is being paid for it...take one day at a time...if she needs the LEEP procedure now, do it.

— Linda B. Jenkins, RN
jenxl@aol.com, www.birthprep.com


Q: I have a friend who has been trying to get pregnant for at least two years now, probably three, without success. She is a powerful, healthy, active, spiritual woman. Her husband is a wonderful African dancer and has an individual providing spiritual guidance from Africa who has promised them that the baby will come someday. I am an RN and know the medical definition of infertility. I try to have hope for them but it is hard for me. My friend has had all the infertility tests run and has been told all is okay with her. I do not know about her husband. They cannot afford in vitro fertilization.

My friend has great faith and has, incredibly, not lost hope but I wish I had some information to give her besides the normal medical research on things that could help her get pregnant. I know this is a struggle so many other women deal with too. Any ideas?

— Maira

A: My advice is to tell your friend that you are here to listen any time and as often as needed. Please don't offer advice or stories about how "a friend of mine finally adopted, gave up, got drunk, took a vacation or whatever and got pregnant." Those things do happen, but the stories are told because they are so rare.

After three years it is unlikely, although not impossible, for your friend to get pregnant on her own. I hope she will find a way to deal with the financial side of fertility treatments (which have their own set of stresses), but either way she needs friends right now—friends who are willing to listen to her grief and sorrow again and again if necessary. If your friend seems distant, reach out to her. It is easy to pull away from friends who can not or will not understand the cycles of grief and hope that come with trying to conceive. It is often easier to isolate oneself from the more "fertile" world than to deal with pregnancy announcements, baby stories and advice that trivializes instead of validating her experience.

You may also want to read some books (or blogs—try "Stirrup Queens" at stirrup-queens.blogspot.com/) to further understand what your friend may be going through. Even try asking her how she is doing or what it is like. If she doesn't want to talk about it, let it go. If she does, it may be just what she needs.

Thank you for wanting to support your friend during what may be the most trying time of her life.

— Camilla Kane


Responses to any Question of the Week may be sent to E-News at any time. Write to mtensubmit@midwiferytoday.com. Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.


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Think about It

We are hearing much about health care these days, and electronic medical records (EMRs), along with anything else electronic, are being very much discussed. What are EMRs, and can they be implemented in a midwifery practice?

EMRs are usually part of an electronic Practice Management (PM) program. There are several good PM programs available that would work well with a midwifery practice and a very few excellent programs. These programs allow you to input client demographics and medical history; the very good programs will let you input birth outcomes, complications and track statistics. Web-based programs are also becoming more and more popular for their ease of use and efficiency. If you use a laptop or PDA, use a billing service, have an office outside of your home, or more than one midwife in the practice, a Web-based program can be a real asset. The information is not stored on your computer; rather it is stored on the company's server. You log onto the server with your user name and password and can access your clients' information wherever there is an Internet connection. Having all the data on a server also adds a layer of protection. Even if your computer crashes, your laptop is stolen or you lose your PDA, your clients' information is not compromised.

Along with the PM program, many companies offer add-ons. These usually include insurance billing, cash invoicing, inventory management, online scheduling, document storage, online insurance verification, direct deposit of insurance reimbursement, credit/debit card processing, patient portal, e-prescribing and EMRs. EMRs offer a format for doing all of your charting on the computer, with the option of offices being linked together and with local hospitals. From what is being shared in online groups, most EMRs are still getting the bugs worked out. Thinking of midwives and EMRs, it might be difficult for a homebirth midwife to access a computer during a birth, although a laptop is a possibility. Hand-held EMR devices are still quite expensive (although they continue to drop in price) and are not waterproof (think waterbirth). For OB-specific EMRs, the price becomes prohibitive for most midwives, and many companies have agreements with ACOG that they will only use their charting format. There are a few smaller programs that show potential, however, and we continue our quest for midwife-friendly EMRs.

The medical community is moving more and more towards electronic solutions to the business aspects of their practices. A few well-chosen technologies can save considerable time and money and can also increase the efficiency—and profitability—of your midwifery practice.

Kelli Sugihara, Certified Professional Medical Biller

Kelli Sugihara has been billing for midwives since 1997 when her mother asked for her help with insurance claims. She is also the business instructor at Midwives College of Utah. She lives in the Seattle, Washington area with her husband (a twin born at home), their three children (all born with midwives) and two cats (also born at home). She is the director of Midwife Billing & Business, LLC, and can be reached at: info@midwifebilling.com


Letters

The Mid-Atlantic Conference on Birth and Primal Health
Las Palmas de Gran Canaria, February 26–28, 2010

From the conference Web site:

What is the future of a world born by caesarean? This is the question we need to ask now that, thanks in particular to the work of Michael Stark, the c-section has become easier, faster, and safer than ever before. In this conference we will not only focus on technical advances, though.... We will also constantly make reference to recent scientific advances which suggest we should apply new criteria in order to evaluate practices within midwifery and obstetrics. For example, thanks to a large amount of data provided by developing disciplines as diverse as ethology, bacteriology, epidemiology and hormonology, it has recently been possible to confirm scientifically that...a human newborn baby needs his or her mother. After thousands of years of beliefs and rituals which have disturbed or prevented first mother-newborn interaction, modern science now has the power to reverse our deep-rooted conditioning.

We welcome all of you, participants from the five continents. We want to thank Prof. Garcia Hernandez and our friends in Las Palmas for suggesting the Canary Islands Convention Centre as a venue for this conference held under the auspices of the Goddess of Love...the Goddess born from the foam of the waves.

Dr. Michel Odent, President, and Heloisa Lessa, Executive Secretary

For more information and to register: www.wombecology.com/conference


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This publication is presented by Midwifery Today, Inc., for the sole purpose of disseminating general health information for public benefit. The information contained in or provided through this publication is intended for general consumer understanding and education only and is not intended to be, and is not provided as, a substitute for professional medical advice, diagnosis or treatment.

Midwifery Today, Inc., does not assume liability for the use of this information in any jurisdiction or for the contents of any external Internet sites referenced, nor does it endorse any commercial product or service mentioned or advertised in this publication. Always seek the advice of your midwife, physician, nurse or other qualified health care provider before you undergo any treatment or for answers to any questions you may have regarding any medical condition.

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