Documentary Film Maker and VBAC Mom Pushes for Increased Awareness About Midwife/Doctor Collaboration

2 Jun

Bridgid Maher is a tenured, associate professor of Film and Media Arts Division in the School of Communication at American University. She gave birth to her first son by cesarean and wanted to have a VBAC when she was pregnant again. Maher chose a midwifery practice with privileges at a Washington D.C. hospital and gave birth naturally to a 9 pound 10 ounce daughter.Sherpaslogo

As Maher shared her VBAC story, she realized that many women did not know about the benefits of midwifery care or that certified nurse-midwives (CNMs) and Certified Midwives (CMs) can attend their clients’ births in a hospital.

Maher wanted to let women with a prior cesarean know about the benefits of midwife/physician collaborative care and decided to direct and produce The Mama Sherpas. Evidence shows that collaborative care reduces interventions, lowers cesarean rates and improves health outcomes. A Sherpa refers to a member of a Tibetan people living on the high southern slopes of the Himalayas in Eastern Nepal known for providing support for foreign trekkers and mountain climbers.

This last year Maher has been filming three collaborative practices: in Alexandria, Virginia; Springfield, Massachusetts;  and Davis, California. The documentary film-maker is looking for financial support to cover production expenses for an additional year to complete the project. Maher hopes to raise $30,000 by July 8th through an indiegogo campaign. Maher and the production team can keep any funds that have been raised by the deadline.

Birth advocates and mothers who want to increase awareness about birth options after a cesarean can support the film-maker by making a donation to the campaign.

Birth Practices that Lead to Optimal Maternal and Newborn Outcomes

10 Apr

April is Cesarean Awareness Month. An opportunity to showcase a model of care that lowers the odds for cesarean section for healthy women and leads to optimal health outcomes for mothers and babies.

Research shows that the following birth practices lead to optimal maternal and newborn outcomes:

  • Provide women with evidence-based information regarding benefits and risks of tests and procedures so they can make informed decisions about their care.
  • Encourage continuous support (doula care) for labor and birth.
  • Provide care that respects women’s cultural, social and religious preference.
  • Allow women to walk freely and choose positions of their choice for labor and birth.
  • Allow women to eat and drink during labor.
  • Do not use the following interventions routinely, and if needed their use should be evidence-based:
  • Amniotomy (breaking the bag of waters)
  • Continuous electronic fetal monitoring
  • Use of I.V.s
  • Encourage mothers to touch, hold and breastfeed their newborns at birth.
  • Encourage skin-to-skin contact for all mothers as soon as medically safe.
  • Strive to achieve a 5% induction rate, a 10% or less cesarean rate in community hospitals and 15% or less in tertiary hospitals, a VBAC rate of 60% or more and a 5% or less episiotomy rate.

These are the recommendations of the Mother-Friendly Childbirth Initiative (MFCI) an evidence-based mother-, baby-, and family-friendly model of care which focuses on prevention and wellness as the alternatives to high-cost screening, diagnosis, and treatment programs.

In California maternal and newborn health professionals have formed the Mother-Friendly Childbirth Initiative Consortium of Los Angeles and are using the MFCI as a practice and policy tool to improve outcomes in their communities. You can download powerpoint presentations on the MFCI from the website.


Scientific evidence that supports the Ten Steps of the Mother-Friendly Childbirth Initiative can be downloaded at no cost from the Journal of Perinatal Education: Promoting Normal Birth, Winter 2007 Issue, Supplement, Coalition for Improving Maternity Services: Evidence Basis for the Ten Steps of Mother-Friendly Care.

Cesareans Are Increasingly Being Questioned

14 Mar

In a video address to the Coalition for Improving Maternity Services (CIMS) Forum participants on March 1, Michael C. Lu, MD, MS, MPH, Director of the U.S. Maternal and Child Bureau, stated, “Cesarean has its place, but given the real risks associated with cesarean it should not be performed without clear maternal, fetal or obstetrical indication…Cesarean delivery increases the risk of placenta accreta which intern increases the risk of postpartum hemorrhage and cesarean hysterectomy.“

Michael C. Lu, MD, MS, MPH, Director U.S. Maternal and Child Health Bureau

Michael C. Lu, MD, MS, MPH, Director U.S. Maternal and Child Health Bureau

In an interview with Rebecca Dekker, Ph.D., RN, of, Celeste G. Milton, MPH, BSN, of the Joint Commission expressed her concern about preventable cesareans,  “When medications are used to force labor, a first-time mom doubles her chance of having an unplanned C-section…A substantial number of unplanned C-sections are due to physicians mislabeling a woman’s labor as ‘failure to progress’- a term that research says is more aptly named ‘failure to wait.’“ The Joint Commission which accredits and certifies health care organizations wants hospitals to perform fewer early elective cesarean deliveries (before 39 weeks) and fewer cesareans on low-risk first-time mothers.

Milton stated that “physician and hospital practice patterns-not pregnant women’s conditions or their diagnoses- are the major reason for differences in C-section rates among hospitals.”  The Joint Commission has made it mandatory, as of January 2014, for hospitals with more than 1,100 births a year to publicly report on their elective cesarean rates and rates for low-risk first-time mothers.

In a recently published White Paper on cesarean section in the U.S. the California Maternal Quality Care Collaborative recently concluded:

Cesarean delivery has come to be regarded as the safer option, when in fact it has greater risks and complications than vaginal birth. Higher cesarean delivery rates have brought higher economic costs and greater health complications for mother and baby, with little demonstrable benefit for the large majority of cases. With the marked decline in vaginal births after cesarean, cesarean deliveries have become self-perpetuating; and every subsequent cesarean brings even higher risks…

Some women prefer cesarean birth, or view it as a positive experience. However, there is growing evidence that for the majority of women, having a cesarean (compared with giving birth vaginally) is associated with greater psychological distress and illness, including postpartum anxiety, depression, and post-traumatic stress disorder. Cesarean deliveries can have an adverse influence on maternal-infant contact at birth, women’s satisfaction with and feelings about the birth, their babies’ experiences, and their success with breastfeeding.

In its recent systematic review comparing harms of cesarean with vaginal birth, Childbirth Connection cautioned, “Overuse of cesarean delivery in low-risk women exposes more women and babies to potential harms of cesarean with minimal likelihood of benefit. Of particular consequence are downstream effects including childhood chronic illness and placental complications in any subsequent pregnancies. These include life-threatening complications that occur more frequently with accumulating surgeries.”

In Dr. Michael C. Lu’s video address he also emphasized that “…no woman should be subjected to unnecessary interventions and… every woman should be cared for in a system that respects her autonomy and upholds the principles of Empowerment, Do No Harm, and Responsibility (principles of the Mother-Friendly Childbirth Initiative) and be given the choice of mother-friendly maternity services…”

Caring for childbearing women according to the recommendations of the evidence-based Ten Steps of the Mother-Friendly Childbirth Initiative can effectively reduce exposure to unnecessary interventions that can lead to avoidable cesareans.





Physicians and Midwives Working Together: An Option for Mothers Seeking a Woman-Centered Birth in a Traditional Setting

4 Feb

Evidence shows that a collaborative model of care that includes physicians and midwives working together can lower interventions, the use of drugs for pain relief in labor, induction and cesarean rates and improve health outcomes for mothers and babies. Brigid Maher, a documentary filmmaker, Associate Professor of Film and Media Arts in the School of Communication at American University (Washington, D.C.) and a VBAC mother herself, wants more women to know that. In fact, in The Mama Sherpas, a full-length documentary about four physicians and nurse-midwives collaborative models of care which Maher is currently producing and directing, she seeks to educate women about birth options they may not know exist.

A Sherpa refers to a member of a Tibetan people living on the high southern slopes of the Himalayas in eastern Nepal and known for providing support for foreign trekkers and mountain climbers.

Maher’s film, scheduled to be released for festivals and broadcast in the Spring of 2015, follows the lives of several expectant mothers through the course of their pregnancies and the four different types of collaborative practices that care for them. The documentary follows expectant mothers who plan to give birth in four U.S. communities: Alexandria, Virginia; Arnold, Maryland; Springfield, Massachusetts; and the Sacramento area of California. Mothers can give birth in a hospital or a birth center.

The Mama Sherpas investigates how midwifery care, if mainstreamed into current medical practices can improve health outcomes and reduce costs. In March of 2011 the American College of Obstetrics and Gynecology and the American College of Nurse-Midwives issued a joint Collaborative Practice Statement affirming  that “quality of care is enhanced by collegial relationships characterized by mutual respect and trust, as well as professional responsibility and accountability.”

“I have two objectives for this documentary,” states Professor Maher. “The first is for general audiences who will watch the long format documentary and hopefully recognize that integrating a nurse-midwife into the prenatal experience is not and either or paradigm. You can have a collaborative experience with midwives and doctors in a hospital. What the documentary explores is what that can look like.  The second objective is for this project to be useful for care providers, NGOs and maternity care non-profits who work within a collaborative-care model or similar style of care. If for instance, a woman is going for a VBAC, what can that look like?  Following and observing a woman’s story can help women gain a better understanding of what to expect beyond a text book or a traditional info-birth video. This is where the web component- short, weekly released scenes (we have filmed) – becomes critical.”

Rather than the traditional method of releasing a trailer in advance of the completed film, Maher, Program Director of the Digital Media Skills Graduate Certificate Program at American University has chosen to begin educating women and the medical community about this collaborative model of care early on by posting weekly short scenes from what will eventually become a full-length documentary. Maher has posted scenes from the mothers they are following on vimeo.

Professor Maher has partnered with the American College of Nurse-Midwives and the Birth Options Alliance  to extend her outreach efforts. She plans to post several educational materials on the film’s website that can be used to develop a curriculum and encourage conversations to take place about the benefits of mainstreaming midwifery care into current medical practice.

To find out more about the upcoming documentary visit The Mama Sherpas  webpage  and the following social media links:


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