Episode 30 (Epilogue): Born in Withdrawal

Here is a list of resources that were mentioned by tonight's guests:

----------------------------------------------

The Healthy Start Coalition of Sarasota County (941) 373-7070

Substance Exposed Newborn Committee (941) 373-7070

The Florida Center for Childhood Development (941) 371-8820

Healthy Families  (941) 371-8820

Florida FASD Clinic (941) 371-8820

Sarasota Memorial Hospital Neonatal Intensive Care Unit (941) 917-6530

Child'Space (941) 362-0944

First Step of Sarasota Mothers and Infants (941) 366-5333

Sarasota Department of Children and Families (877) 595-0384

Family Partnership Center (941) 756-3007

Sarasota County Prescription Drug Take Back

Camp Mariposa

National Acupuncture Detoxification Association

----------------------------------------------

American Academy of Pediatrics Recommendations: 

1. Screening for maternal substance abuse should involve multiple forms, including maternal history, maternal urine testing, and testing of newborn urine and newborn meconium specimens.

2. Drug withdrawal should be considered as a diagnosis in infants in whom compatible signs develop.

3. Drug withdrawal should be scored using an appropriate scoring tool.

4. Pharmacologic therapy of withdrawal-associated seizures is indicated.

5. Vomiting, diarrhea, or both, associated with dehydration and poor weight gain, in the absence of other diagnoses, are relative indications for treatment, even in the absence of high total withdrawal scores.

6. Drug selection should match the type of agent causing withdrawal.

7. Physicians should be aware that the severity of withdrawal signs, including seizures, has not been proven to be associated with differences in long-term outcome after intrauterine drug exposure.

8. The use of naloxone in the delivery room is contraindicated in infants whose mothers are known to be opioid-dependent. However, in the absence of a specific history of opioid abuse, naloxone treatment remains a reasonable option in the delivery room management of a depressed infant whose mother recently received a narcotic.

Episode 30: Born in Withdrawal

Join The Conversation tonight, 4/24 at 6pm as Laura and Ryan look at the devastating crisis of addiction in pregnant women and newborn babies in our community. We will welcome Debbie Harman, RNC, Clinical Manager of the Neonatal Intensive Care Unit at Sarasota Memorial Hospital; Kathryn Shea, CEO of The Florida Center; and Jennifer Highland, Executive Director of The Healthy Start Coalition of Sarasota County, in preparation for Born in Withdrawal, an upcoming public forum to raise awareness about substance exposed newborns in Sarasota County.

Tune into WSLR 96.5 LPFM or online at www.wslr.org tonight, Tuesday, April 24th at 6:00pm.  The program will also available later in the evening via podcast at maternallyyoursradio.podomatic.com.

For more information, please contact the hostesses of Maternally Yours at MaternallyYoursRadio@gmail.com, or on our facebook page at facebook.com/maternallyyours.

Maternally Yours,
Cheryl, Carmela, Ryan and Laura

From NOW Co-Founder Sonia Pressman Fuentes

One of our guests last night, NOW co-founder Sonia Pressman Fuentes, wrote this article on Pregnancy Leave, Parental Care Leave, and the Law, which details the three periods involved: pregnancy, delivery, and post-delivery, and about whether the employee is seeking the equivalent of sick or temporary disability leave or annual/personal leave and how that is to be calculated. 


Following last night's program, Ms. Fuentes made the following recommendations:

I would say that the three most important agenda items for people interested in this area are:

1. Federal legislation providing for paid family leave in connection with pregnancy, childbirth, and post-delivery.
2. Legislation providing for paid sick leave (federal? State?)
3. Dissemination of the EEOC’s Fact Sheet on Pregnancy Discrimination (which does not, however, deal with men’s rights when their wives or significant others are pregnant or give birth) and other information explaining the legal rights of women and men in the US vis-à-vis pregnancy, childbirth, and post-childbirth. In this connection, it appears the nursing-on-the-job issue may be on the cutting edge.

Episode 29 (Epilogue): Motherhood and the Workplace

Tonight, we discussed pregnancy and motherhood in the workplace with Sonia Pressman Fuentes, co-founder of the National Organization for Women; Kevin Sanderson, Sarasota employment attorney; and Kristin Rowe-Finkbeiner, CEO of MomsRising.org.

The Collective relied heavily on the following resources to prepare for tonight's Conversation.

Maternity Leave in the United States (or lack thereof):
Source: MomsRising.org

• Having a baby is a leading cause of "poverty spells" in the U.S. -- when income dips below what's needed for basic living expenses.
• In the U.S., 49% of mothers cobble together paid leave following childbirth by using sick days, vacation days, disability leave, and maternity leave.
• 51% of new mothers lack any paid leave -- so some take unpaid leave, some quit, some even lose their jobs.
• The U.S is one of only 4 countries that doesn't offer paid leave to new mothers -- the others are Papua New Guinea, Swaziland, and Lesotho.
• Paid family leave has been shown to reduce infant mortality by as much as 20% (and the U.S. ranks a low 37th of all countries in infant mortality).
• Four out of fifty states (Connecticut, Hawaii, Washington, and Wisconsin) have laws guaranteeing the flexible use of accrued paid sick or other leave days to care for a new child.

The Motherhood Penalty:
Source: Getting a job: Is there a motherhood penalty? by SJ Correll

• Mothers experience disadvantages in the workplace in addition to those commonly associated with gender.
• 2/3 of employed mothers suffer a per child wage penalty of approx. 5%
• for those under age 35, the pay gap between mothers and non-mothers is larger than the pay gap between men and women
• Mothers are more often evaluated as less competent than non-mothers
• Visibly pregnant managers are often evaluated as less committed and dependable, more emotional and irrational than equal female managers who are not visibly pregnant

Pregnancy Discrimination Act of 1978:
Source: EEOC

• Federal law that protects women who are pregnant or affected by pregnancy-related conditions from being treated differently from other applicants or employees with similar abilities or limitations. The Pregnancy Discrimination Act of 1978 amended Title VII of the Civil Rights Act of 1964.  The application of Title VII is generally limited to employers, including state and local governments, with 15 or more employees (including part-time and temporary workers).
• Hiring: An employer may not refuse to hire a pregnant woman because she is pregnant or has a pregnancy-related condition, or because of the prejudices of co-workers, clients, or customers.
• Pregnancy and Maternity Leave: An employer may not require pregnant employees to submit to special procedures in order to determine their ability to work. If an employer has a policy that is applicable to all employees, however, it need not exclude pregnant women from the required procedure. For instance, if an employer requires its employees to submit a doctor's statement concerning their inability to work prior to granting leave, it may also require pregnant employees to submit such statements. Likewise, an employer must treat pregnant employees who cannot perform their job due to a pregnancy-related condition the same way it treats temporarily disabled employees.
• Pregnant employees must be permitted to work as long as they are able to perform their jobs. In addition, an employer may not prohibit a woman from returning to work after giving birth.
• Employers must hold open a job for a pregnancy-related absence for the same length of time positions are held open for employees on sick or disability leave.
• Health Insurance: Any employer-provided health insurance plan must treat pregnancy-related conditions the same as other medical conditions. Further, pregnant employees cannot be required to pay a larger health insurance deductible than other employees pay.
• Other Benefits: If an employer provides any benefits to employees on leave, the employer must offer the same benefits for those on leave for pregnancy-related conditions, including vacation, pay increases, temporary disability benefits, and calculation of seniority.
• According to the EEOC, pregnancy discrimination is one of the fastest growing forms of discrimination in the workplace. According to the United States Department of Labor, in 2008, women comprised 46.5 % of the total U.S. Labor force and are projected to account for 49% of the increase in the total labor force growth between 2006 and 2016. In 2006, the EEOC handled 6,196 pregnancy discrimination claims with eventual monetary pay-outs that totaled $16.8 million.

The Family Medical Leave Act:
Source: Thomson Reuters

• The FMLA only applies to employers with 50 or more employees within a 75-mile radius of the workplace.
• The FMLA provides up to 12 weeks of unpaid, job-protected leave in any 12-month period for the birth or adoption of a child.
• Eligible employees must work at least 25 hours a week and have worked for the current employer for at least one year.
• New fathers who are eligible employees are also entitled to FMLA leave. If the same company employs both new parents, however, the spouses will only be entitled to a combined total of 12 weeks of leave.

Section 4207 of the Patient Protection and Affordable Care Act :
Source: USBreastfeeding.org 

• Section 4207 of the Patient Protection and Affordable Care Act ("PPACA", aka “Health Care Reform”, aka “Obamacare”), signed into law on March 23, 2010, amends Section 7 of the Fair Labor Standards Act to require employers to make accommodations for nursing mothers during the one year following a child's birth.
• Specifically, employers are required to provide nursing employees with: (1) reasonable break time to express breast milk each time such need arises; and (2) a space for pumping breast milk "other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public."
• The new provision does not quantify what is a reasonable length of time for a nursing-mother break, but employers are not required to compensate an employee for the break time.
• There is a small employer exception for employers of less than 50 individuals. Such employers are not subject to the requirements of Section 4207 if it would impose an undue hardship in relation to the size, financial resources, nature or structure of the employer's business.

Source: The Womanly Art of Breastfeeding

• Mothers who return to work at 16 weeks postpartum or later typically nurse longer than those who return sooner perhaps because milk supplies are established and motherbaby pairs have sufficient experience/practice.
• Women who are able to express milk regularly at work (typically every 3 hours but at least every time their baby would normally nurse) nursed longer than those who are unable.
• 82-percent of mothers surveyed said they would again choose to combine breastfeeding and working; only 18-percent said they would choose nursing over work by giving up work entirely, delaying their re-entry to the workforce or reducing their work hours.

Sarasota Memorial Hospital Introduces OB Hospitalist Program

At yesterday's Sarasota Memorial Healthcare System Public Hospital Board meeting, Dr. John Sullivan and Dr. Greg Damery presented the new obstetric hospitalist model, instituted at Sarasota Memorial Hospital two weeks ago.

According to the American College of Obstetrics and Gynecology, an OB hospitalist, sometimes called a laborist, is employed by a hospital to care for laboring patients and to manage obstetric emergencies. At SMH, this new system will provide for an Obstetric Emergency Department, whereby a pregnant patient admitting to the hospital at 18 weeks gestation or greater is seen by the OB hospitalist rather than triaged through the traditional Emergency Room. Hospitalists will also provide backup to patients' private OB's, and treat patients who are unassigned as well as (assumedly) those who transfer from out-of-hospital care. There will be eight hospitalists on staff at SMH, rotating in 24 hour shifts. They will be paid on an hourly basis, rather than on a fee-for-service basis; proponents of this model, like Dr. Sullivan, say that this will eliminate any bias based on a woman's payment abilities or insurance plan.

The major benefits of the model, according to Dr. Sullivan and Dr. Damery, are improved patient safety and satisfaction, 24/7 OB/GYN physician coverage, reduced patient wait times / overflows, consistent care for unassigned and indigent patients, and rapid response for emergency care. Additionally, hospital proponents say that the service pays for itself, and that hospitalists implement measures which generate additional revenue. We are exploring that facet of the model. Other benefits to the system from a physician's point of view are relief from the pressures of private practice (for those practicing solely as a hospitalist), more predictable schedules, competitive compensation, paid benefits, and guaranteed time off. Cited benefits to the hospital include enhancement of patient safety and an increased level of nursing satisfaction because a health care provider is always present and available.

One possible disadvantage of this system is the potential interruption of the already somewhat limited continuity of care the obstetric model provides. The labor process is greatly facilitated by sharing it with a care provider that a woman knows and trusts. ACOG suggests that obstetricians should inform patients that hospitalists are part of the team that may provide their care. Because of the potentiality of a handoff from private OB to hospitalist (and several nurses in between), clear communication between providers is paramount.

This new model fulfills the ACOG requirement of a physician on the premises during the entire trial of labor for a candidate for vaginal birth after cesarean (VBAC). Because SMH "allows" VBAC and ACOG recommends VBAC for most women with one previous cesarean delivery with a low transverse incision, there is potential for presence of a hospitalist to increase VBAC rates significantly, thereby decreasing the hospital's 42% cesarean section rate.

Listen for updates on the specifics and efficacy of this new model in the coming weeks on Maternally Yours.

Episode 29: Motherhood and the Workplace

With nearly two-thirds of first time mothers working through their pregnancies, it's important that women understand their rights and responsibilities regarding employment, maternity leave, and returning to work after having a baby.

Join The Conversation tonight, 4/17 at 6pm as Ryan and Laura look at the myriad of issues facing pregnant women and mothers in the workplace. They will be joined by Sonia Pressman Fuentes, co-founder of NOW and author of the EEOC's first Guidelines on Pregnancy and Childbirth, as well as Kevin Sanderson, a local employment attorney and advocate for womens' rights. Also joining us by phone will be Kristin Rowe-Finkbeiner, Executive Director and CEO of MomsRising, a consumer group advocating for paid family leave.

Tune into WSLR 96.5 LPFM or online at www.wslr.org tonight, Tuesday, April 17th at 6:00pm.  The program will also available later in the evening via podcast at maternallyyoursradio.podomatic.com.

For more information, please contact the hostesses of Maternally Yours at MaternallyYoursRadio@gmail.com, or on our facebook page at facebook.com/maternallyyours.

Maternally Yours,
Cheryl, Carmela, Ryan and Laura

Letter to the Editor: Dignity at Birth

Thank you to the Sarasota Herald Tribune for publishing this letter today, written by one of our Collective. 

Recently, Gov. Rick Scott signed the Healthy Pregnancies for Incarcerated Women Act (SB 524) into law. I applaud Sen. Arthenia Joyner, Rep. Betty Reed, Gov. Scott, and all who championed this legislation.

The practice of shackling incarcerated pregnant women (the overwhelming majority of which were arrested for nonviolent crimes) is barbaric, inhumane, and dangerous to the health of the mother and the baby. It interferes with the work of her health care provider, and makes the labor process more painful and more difficult than necessary. It increases trauma, and subsequent post-traumatic stress and post-partum depression, both of which increase rates of recidivism, drug use, and suicide. Conversely, when a woman gives birth with dignity and compassion, attachment to her baby is facilitated, giving that baby the greatest chance of physiological and emotional success in those first critical hours of life.

I strongly encourage the Florida Legislature to examine a prison nursery system, much like the ones in place in New York, Nebraska, California, Washington, Ohio and Indiana. Healthy maternal infant bonding strengthens a healthy society.

Laura Gilkey, Sarasota
Gilkey is the co-hostess of "Maternally Yours" on WSLR 96.5.

Maternally Yours Presents: An Afternoon in Bali

Sarasota, Florida (April 12, 2012) – Local community radio station WSLR 96.5 LPFM will celebrate International Day of the Midwife by bringing Bali to Sarasota on May 5th from 3:00 to 6:00pm. An Afternoon in Bali, produced by WSLR weekly radio program Maternally Yours, will begin with authentic Balinese dance from the Purnama Sari Balinese Dance Company, followed by an exclusive screening of documentary Guerrilla Midwife, featuring 2011 CNN Hero of the Year (and Maternally Yours guest) Robin Lim. A discussion will follow the film as well as authentic Indonesian fare from Curry Creek Cafe.

Tickets are $15 in advance and $20 at the door. Advance tickets are available at Rosemary Birthing Home and Birthways Family Birth Center, and online at wslr.org.  All proceeds benefit WSLR and Yayasan Bumi Sehat, Robin Lim's non-profit healthy birth clinic in Bali.

For more information, please contact WSLR at (941) 894-6469, or contact the hostesses of Maternally Yours at MaternallyYoursRadio@gmail.com.

About Bumi Sehat: Founded in 1995, Bumi Sehat is a non-profit, village-based organization that runs two by-donation community health centers in Bali and Aceh, Indonesia. We provide over 17,000 health consultations for both children and adults per year. Midwifery services to ensure gentle births is at the heart of Bumi Sehat and our clinics welcome approximately 600 new babies into the world each year. For more information, please visit www.balibumisehat.org. 

Episode 28 (Epilogue): Consumer Advocacy

On Tuesday, we welcomed Amy Romano of Childbirth Connection to discuss the path from consumer to advocate. Amy is the director of the Transforming Maternity Care Project, a division of Childbirth Connection. This is what they're all about:

Childbirth Connection has developed a 2020 Vision for a High-Quality, High-Value Maternity Care System, and followed that through with a Blueprint for Action. If you are a consumer that wants to make positive change in the field of maternal child healthcare, start with these two initiatives.

Amy recommended we heed the words of former IHI CEO Don Berwick, who explains a vision for a better health care system here:

...as well as in this essay.

Amy also told us about the partnership between Childbirth Connection and the Informed Medical Decisions Foundation, who are working together to create a website to support informed decision making in maternity care.

We then discussed the "Reinventing the Wheel" syndrome, whereby well-intended maternity care reform activists develop new initiatives that are essentially outlining the same tenets as established initiatives, effectively dividing our efforts. In the spirit of joining forces, these are the Maternally Yours Collective's selection of forward-moving organizations, each with their own unique missions:

MISSION: Improving Maternity Care Systemically / Holistically
ORGANIZATIONS: Childbirth Connection, Lamaze International

MISSION: Cesarean Awareness / VBAC Access
ORGANIZATION: International Cesarean Awareness Network (ICAN)

MISSION: Legal Recognition of Certified Professional Midwives
ORGANIZATIONS: The Big Push for Midwives, The MAMA Campaign

MISSION: Consumer Awareness of Midwives Model of Care
ORGANIZATIONS: Citizens for Midwifery, Where's My Midwife?

MISSION: Breastfeeding Support and Awareness
ORGANIZATION: La Leche League International

MISSION: Reducing American Maternal Mortality
ORGANIZATION: The Safe Motherhood Quilt Project

MISSION: Legislative Action for Women's and Mother's Rights
ORGANIZATIONS: National Organization for Women, MOMSRising

MISSION: Local Outreach for Pregnant Women, Infants and Young Children
ORGANIZATION: Healthy Start Coalition 

MISSION: Doula Support for Military Mothers
ORGANIZATION: Operation Special Delivery

MISSION: Doula Support for Incarcerated Women
ORGANIZATION: Birth Behind Bars

Finally, we talked with Amy Romano about the much-anticipated book she has co-authored with Henci Goer called Optimal Care in Childbirth: The Case for a Physiologic Approach. The book, hitting shelves in June, was written for those who want to practice according to the best evidence, assist women in making informed decisions, or advocate for maternity care reforms. Optimal Care in Childbirth provides an in-depth analysis of the evidence basis for physiologic care as the standard of care. With specific examination of cesarean surgery, VBAC, walking and position changes in labor, episiotomy, cord clamping, epidurals, the second stage of labor, eating and drinking in labor, and home and birth center birth, this is the most thorough analysis of evidence-based recommendation we have seen to date.

“Without a doubt, being a change-maker is likely to be frustrating and difficult, but when the health and wellbeing of childbearing women, babies, and society is at stake, no effort is too great, no accomplishment that forwards that goal too small.” -Amy Romano