Vaginal Breech Birth & SOCG

The Society of Obstetricians & Gynecologists of Canada (SOGC) has made a shocking announcement this week: to not only offer vaginal breech birth but to also establish training programs nationwide so physicians can once again become skilled in this lost art. From this article

Physicians should no longer automatically opt to perform a cesarean section in the case of a breech birth, according to new guidelines by the Society of Obstetricians and Gynecologists of Canada.


The new approach was prompted by a reassessment of earlier trials. It now appears that there is no difference in complication rates between vaginal and cesarean section deliveries in the case of breech births.

“The safest way to deliver has always been the natural way,” said Dr. Lalonde.

“Vaginal birth is the preferred method of having a baby because a C-section in itself has complications.”

The article goes on to cover the disadvantages of a c-section, which are so often ignored:

Cesarean sections, in which incisions are made through a mother's abdomen and uterus to deliver the baby, can lead to increased chance of bleeding and infections and can cause further complications for pregnancies later on.

“There's the idea out there in the public sometimes that having a C-section today with modern anesthesia and modern hospitals is as safe as having a normal childbirth, but we don't think so,” said Dr. Lalonde.

“It is the general principle in medicine to not make having a cesarean section trivial.”

And the true kicker that sets apart SOGC from ACOG:

The SOGC believes that if a woman is well-prepared during pregnancy, she has the innate ability to deliver vaginally.

I have to say I'm somewhat shocked at this turn of events. While eliminating universal c-sections for breech is a great strategy for reducing overall c-section rates, it's still a bit stunning to see such an organization reach the same conclusion, and then take the necessary steps to see it happen. No muss, no fuss. Simple, direct, evidence-based, effective.


I do think that last quote has quite a bit to do with it. At the heart of the matter, SOGC realizes that women can and will give birth with or without them, so it's advantangeous to them all to foster good relationships based upon respect and acknowleding their autonomy to make their own health care decisions, which means offering alternatives to automatic abdominal surgery when it's not needed.


This strikes at the heart of the differences between ACOG and SOGC - ACOG does not let evidence drive their decisions nor do they believe in womens' innate ability to deliver vaginally when well prepared. And it shows in our birth outcomes. Lucky us.

MIA

So sorry to have been MIA for so long. After 4 cases of pneumonia (1 child, 2 husband, 1 myself), 3 nasty flus (2 me, 1 child), 2 asthma attacks, and an extreme supra-chondryall fracture of the humerus requiring surgical repair (oldest child) 2 casts and 6 weeks of physical therapy, we've had more than our share of medical issues in the past 3 months.


Now, as I lay recovering from the last vestiges of my own case of pneumonia, I am trying to catch up on the dozens of posts that were started, but never posted. I do sincerely apologize for the absence and hope the summer brings better weather - and better health - for us all.

Stating the Obvious: Hospital Practices Strongly Impact Breastfeeding Rates

A new study analyzed data from Listening to Mothers II, a nationally representative survey of 1,573 mothers who had given birth in a hospital to a single infant in 2005. Mothers were asked retrospectively about their breastfeeding intentions, infant feeding practices at one week, and hospital practices.

About half (49 percent) of first-time mothers who intended to exclusively breastfeed reported that their babies were given water or formula for supplementation, while 74 percent reported being given free formula samples or offers.

Boston University (2009, March 19). Hospital Practices Strongly Impact Breastfeeding Rates. ScienceDaily. Retrieved March 20, 2009, from http://www.sciencedaily.com­ /releases/2009/03/090319161505.htm

So, this study only confirms what we already know - poor breastfeeding rates are more often caused by external factors, such as supplementation and formula offers - rather than a true inability to breastfeed.

The key to remember if you're planning a hospital birth is to state - widely and loudly - that you intend to exclusively breastfeed, and to accept all the assistance you can get, whether it be a true lactation consultant or a supportive nurse. You must remember to tell all staff that you want NO supplementation of any kind at any time - including pacifiers or glucose water.

The most vulnerable times will occur if they want to take the baby for "observation" in the nursery. While many hospitals allow 24 hour rooming-in, some still promote this archaic practice of shuttling newborns off to the nursery, where you'll have no idea if your wishes are being respected. If you aren't able to avoid this separation, for whatever reason, you can make your preferences explicitly clear beforehand or send dad to be on watch until this time period is up.

Ultimately, you may have to advocate for yourselves and your child. The best plan is to know what you're up against. Don't wait until the birth to find out if the hospital is mother-baby friendly or breastfeeding supportive. These factors can be easily assessed with a simple pre-birth tour or call to the maternity floor during your pregnancy. Don't let lack of preparation undermine your commitment to breastfeed your child.

New Product to Help with C-Section Recovery

A new product, Vitagel, is being used to assist mothers recovering from c-sections.

While I completely support minimizing recovery time and maximizing patient comfort and safety, I can't help but wonder if this new product will be used to market c-sections by downplaying the fact that c-section remains a major abdominal surgery that should be a last resort.

Only time will tell, but I can see the great potential for an increase in c-sections due to a public perception of safety and greater convenience due to a shorter, easier recovery time.

The answer isn't to take a product like this off the market, because all mothers should have access to the safest, quickest, most comfortable recovery possible, but to promote the evidence-based practices that reduce the incidence of c-sections and thus, the need for such a product.

This will be on my radar for 2009 - I'll be interested to see where it leads.

CDC Stats are In: C-Sections are Again on the Rise

Today, the CDC released preliminary birth data for 2007. While some statistics were encouraging, namely that preterm birth, the leading cause of infant mortality in the US, decreased for the first time in over 20 years, other statistics were not so encouraging:

For the 11th straight year, c-section rates continued to climb, from 31.1% in 2006 to 31.8% in 2007.

Pre-terms births, defined as infants delivered at less than 37 weeks of pregnancy, fell 1% in 2007 to 12.7% of all births. Per the March of Dimes, the improvement is largely due to a reduction in deliveries taking place before 39 weeks.

I've posted in the past on the mounting research outlining the dangers of induction and c-section before 39 weeks and the large number of pre-term births that could be prevented by doing so, which is a position also supported by the March of Dimes.

The CDC stats confirm that the efforts of the March of Dimes and other such advocacy efforts are helping to delay c-sections and inductions until closer to 40 weeks, but have as yet been unsuccessful in reducing the number of c-sections needlessly performed each year.

I find it so ironic that the key to improving birth outcomes for babies is forcing doctors to adhere more strictly to evidence-based guidelines. The incidence of pre-terms births was reduced, not by some great technical advance in medicine, but by making doctors stop performing potentially harmful procedures too soon.

In short, when doctors follow the evidence, birth outcomes improve.

The real conundrum lies in why is it so difficult to make modern maternity care practices follow what the evidence proves is best for mothers and babies...

Proposed Research Study on Social Support in Childbirth

Hazel Williams of the University of Sussex recently contacted me about a study she is conducting on the effect of social support on childbirth experiences. Details are posted below:

---

This month and next, there is an MSc Health Psychology study being run
at the University of Sussex (UK). We are carrying out research looking
at the effects of social support on experiences of childbirth. The
findings from this study will help us understand how different types
of support during birth may affect women's feelings of control and
emotions during and after childbirth.

If you are interested in taking part, the Health Psychology online
study can be found at:

http://www.sussex.ac.uk/Units/socpsy/webq/hw1/index.php

All of the information you give in the questionnaire will be treated
as strictly confidential and will be used only for the purpose of this
study.


Best wishes and thanks for your time.

Hazel Williams

---

Please consider participating to further our knowledge in this area and to support birthing mothers worldwide.

Screening of New Documentary: Birth

Some time ago, I posted about filmmaker Kathryn Mora and her forthcoming documentary entitled "BIRTH".

Kathryn contacted me to announce that the film is complete and a screening has been scheduled. I encourage everyone to attend. Details are available below:

ANNOUNCEMENT
You are all invited to the premiere screening the documentary, BIRTH on Thursday, March 19, 2009 at 7 p.m.

BIRTH, explores the benefits of natural childbirth and the dangers mothers and babies face in today’s high-tech and drug-filled maternity care environment. The mothers in the film who gave birth with drugs and medical intervention and without, compare their experiences. In addition, childbirth experts give valuable information and enlightening insights about birth. When a woman considers childbirth, education will help replace her fears with confidence and empowerment. This documentary will interest everyone because childbirth affects us all in one way or another.

The screening will be held at:
Center For Digital Imaging Arts at Boston University
274 Moody Street Studio C
Waltham, MA 02453
781-209-1700

For questions, please contact filmmaker Kathryn Mora at 518-867-7100 or via email kathrynmora@gmail.com.

Directions
From Points North/South to the CDIA Waltham Campus (274 Moody Street, Waltham, MA.)
Take Route 128/I-95 to Exit 26 (Route 20). Follow Route 20 East for 2 miles. Turn right onto Moody Street. CDIA is located 1/4 mile down on the left.

From Points East/West
Take the Mass Pike to exit 14 (Route 128/I-95). Take Route 128/I-95 to Exit 26 (Route 20). Follow Route 20 East for 2 miles. Turn right onto Moody Street. CDIA is located 1/4 mile down on the left.

PUBLIC TRANSPORTATION
Train: Fitchburg (Fitchburg Line) commuter rail to Central Square Waltham - CDIA is located two blocks up on Moody Street.
Bus: Oak Park - Dudley via Central Sq bus #170 or Cedarwood bus #70/70A

PARKING
There are two public parking lots within a short walking distance of CDIA. The Embassy Parking Lot is located two blocks down Pine Street behind the Embassy Landmark movie theatre and is located one block away from CDIA. The Crescent Street Lot is another option, located on Crescent Street between Moody and Adams. In both cases look for the parking signs when you reach Moody street.

ACOG Issues New Guidelines on Managing Stillbirth

Yesterday, ACOG released new guidelines on managing stillbirth.

Overall, it's a generally solid, informative, although very clinically-driven, piece that gives a run-down of the known stats and evidence currently available.

What really struck me was the section on Management. Stillbirth is universally devastating for new mothers and families. They've spent at least 5 months (since stillbirth is deemed to occur after 20 weeks) pregnant feeling this child grow inside them and anticipating its birth, only to have their worst fears realized.

In token appreciation to this great loss, the ACOG guidelines state:

After a stillbirth, sensitivity to the family's emotional state is important. Parents should be given the opportunity to hold their baby and perform cultural or religious activities, such as baptism.

In response to this tragedy and its overwhelming impact on the mental and emotional health of their patients, clinicians are advised in a brief, single sentence to be sensitive to the family's emotional state.

The other 3.5 paragraphs are devoted on how to get a family to agree to an autopsy or get their consent for a number of additional tests if they can't be talked into a full autopsy, citing this reasoning:

"Parents want answers when they have a stillbirth, so clinicians should not be afraid to request an autopsy. Without a thorough evaluation it will be difficult to counsel women on their risk of having another stillbirth," said Dr. Fretts.

While I agree in principle, in practice, far too many families are so emotionally blindsided, they can't see the benefit of the autopsy or testing at the time. Perhaps its due to the lip service physicians are instructed to pay to the family's emotional state, wrapped up in a single sentence with a few token activities thrown in.

Perhaps the guidelines could read, "families should be allowed to hold their babies for as long as they like, call whatever family members they wish to come support them, dress the baby and take pictures, as needed. Families should be moved to a location off the maternity floor to avoid painful contact with other families experiencing the joy of their new babies if they so wish".

It would seem to me that by truly showing empathy to the emotional needs of the family, it would be easier to broach painful topics such as autopsy and post-mortem testing.

Expanded Midwifery Care in Ireland

Here's a positive article on the expanded use of midwives in Ireland.


It's a good read that highlights many of the benefits of midwifery care. Enjoy!

Good Article on VBAC

Here's a well-written article on the soon-to-be lost option of VBAC that does a great job of highlighting the erroneous reasons hospitals and doctors report on why they don't offer VBAC.

This is one of my favorite parts:

In 1999, after several high-profile cases in which women undergoing VBAC ruptured their uterus, the American College of Obstetricians and Gynecologists (ACOG) changed its guidelines from stipulating that surgeons and anesthesiologists should be "readily available" during a VBAC to "immediately available." "Our goal wasn't to narrow the scope of patients who would be eligible, but to make it safe," says Dr. Carolyn Zelop, co-author of ACOG's most recent VBAC guidelines.

I wonder how much longer it will take before ACOG realizes that in their efforts to "make it safe", they'd caused more harm than help.

Unfortunately, I don't think it will be any time soon.

Campaign to Change Hospital Policy Against Midwifery Care

I received this email from an expectant father seeking help in changing a local hospital's policy on midwives attending births. If you live in the area (and even if you don't), please consider making a phone call or sending a letter/email to the hospital administrator to heighten awareness of the issue and hopefully change hospital policy for the benefit of mothers and babies:

My wife and I are expecting our first in September. We are eager and excited to work with a specific midwife/nurse practitioner who works in a woman's health office near our home. This office is connected with Holy Cross Hospital in Silver Spring, Maryland. For this reason, we can not work with our midwife during birth because Holy Cross does not allow midwives to help women deliver in their hospital. They are the only hospital in our region that does this horrible practice. I was hoping you could help get the word out and help me to begin a campaign with the hospital leadership.


The president of the hospital is:

CEO and President: Kevin Sexton

Holy Cross Hospital

1500 Forest Glen Rd.

Silver Spring, MD 20910

301-754-7010
E-mail Address: sextok [at] holycrosshealth.org

~~~~~~~~~~~~~~~

If you've never phoned, written or emailed such a letter, here are some sample scripts with talking points to include:

"My name is ____________________. I live in _______ near ________ hospital. I wanted to share with you how the lack of access to midwifery care at ________ hospital has affected me and other women and families in the vicinity. (List 1 or 2 examples from the list below or add your own).

• I chose to travel ____ miles rather than give birth in this hospital due to the lack of midwifery care providers


• I had to choose a provider I'm not comfortable with because of the lack of midwifery care at this hospital


• Parents have the right to choose how, where, and with whom their children will be born.


• Women deserve to have access to all the nationally certified maternity care providers that women in other states, like Wisconsin and Minnesota, can choose from -- including CPMs


• Midwives are known to do an excellent job working with under-served populations, including undocumented worker populations, who are more accustomed to midwifery care in their home countries


• With obstetricians leaving that profession, midwives can help fill the gap for normal births in a cost effective fashion


• With their unique out-of-hospital training, Certified Professional Midwives can be a vital part of emergency services in times of epidemics, natural disasters or terrorist attacks (when hospitals might be overwhelmed with actual medical emergencies), allowing obstetricians to oversee the cases that required their surgical expertise


• I want the option of midwifery care available for my children,
  when they start to have children of their own

(You should pick the talking points that make the most sense in your situation and/or best represent your point of view or comfort level.)

"I hope that in light of these factors, you will reconsider your policy and allow midwives to have privileges within this hospital to attend to birthing women and their families. Thank you for your consideration in this matter."


Please spread the word to help this and other families in the area gain full access to the care providers of their choice.

Time to Take a Page from the NHS Book...

The National Health Service (NHS) Institute for Innovation and Improvement recently released a new initiative and toolkit to "to assist maternity units in achieving low caesarean section rates while maintaining safe outcomes for mothers and babies."


According to this article, after only 18 months, c-section rates dropped from 24% in 2007 to a mere 16% in November 2008.


The idea of a 16% c-section rate is the US seems like a dream. That is half our current c-section rate and very close to the World Health Organization's (WHO) target rate of 10-15% or less.


The truly intriguing aspect of the toolkit is that it is one of introspection. The NHS created a tool to help providers and maternity care units self-evaluate their practices against evidence-based standards, to see how their actions impacted the number of cesarean births and how altering those practices could help or hinder birth outcomes.


The American College of Obstetricians & Gynecologist's (ACOG) has stated that they are "committed" to reducing the number of c-sections. However, their approach, in sharp contrast to the NHS, has been to simply blame the mother - we're too fat, too lazy, too old, too small, or even "that's what they wanted" and so on and so forth...ad nauseam...


If ACOG is truly committed to lowering c-section rates nationwide, it's time for them to take a page from the NHS's book: start implementing the necessary steps to create the change you want to see.


Namely, start practicing evidence-based medicine and the rest will follow...

Common Chemicals May Delay Pregnancy

Another recently-published study has found a link between exposure to common chemicals and the time it takes a woman to conceive as well as birth defects and growth restriction in fetuses. It's yet another example of how the expansion of technological options can have unintended side effects on our species.

The most disturbing fact is that the chemicals were known toxins in the process of being phased out. While it's encouraging that they are being removed from products, the reality is that the damage has been done; while they will no longer be present in newly-manufactured items, there presence will linger in landfills, water supplies, and our bodies for decades to come.


We must remember that our actions today force the outcomes of tomorrow. More due diligence is needed on the safety of such technologies before they are used to prevent this seemingly never-ending cycle of self-destruction through industrialization.

Understanding the Dangers of Cesarean Birth: Making Informed Decisions

Understanding the Dangers of Cesarean Birth: Making Informed Decisions, a new book by Nicette Jukelevics, MA, ICCE of the wonderful resource on vaginal birth after cesarean section, VBAC.com has just been published.


You can learn more about the book and view the table of contents at: http://www.dangersofcesareanbirth.com


I haven't had a chance to read it yet, but I'm certain it will move onto my list of recommended resources.


Buy your copy from Amazon using GoodSearch and the vendor will donate to the Coalition for Improving Maternity Services (CIMS). Go to www.goodsearch.com/goodshop.aspx, choose CIMS as your charity, then choose Amazon and enter Dangers of Cesarean Birth in the Amazon search bar.


This is a timely book I'm sure will help empower and inform mothers to help stem the tide of ever-increasing c-sections without improved outcomes for mothers and babies.


Please pass this along to all the mothers in your life.

New Research on Predicting Pre-eclampsia

Researchers at the University of Bristol have conducted a new study which may help predict which mothers are at risk of later developing pre-eclampsia.

Flaxseed Oil and Risk of Pre-term Birth

New study finds link between flaxseed oil consumption in pregnancy and pre-term birth



An interesting read....

How Different They Are...

Yesterday, I ran across this article, which details the story of a UK mother with a history of precipitous labor (labor lasting less than 3 hours), who chose a homebirth (which nearly became an unassisted birth) with her last child to avoid giving birth en route to the hospital.


She and I share commonality in that both my labors were also precipitous. My first was born in 3 hours and my second in a mere 45 minutes.


As I read further, I was struck by a seemingly small detail, but one that truly crystallizes the differences between the US and UK maternity systems:

"After Charlotte was born doctors had recommended that Hazel have a home birth if she ever fell pregnant again..."

Ummm, did I read that correctly?


In the US, homebirth would never be suggested as the solution to precipitous labor. I can personally attest to the one-and-only US answer: "medically necessary" induction.


In my case, this would mean inducing between 36-37 weeks, as both my children were also born before 38 weeks.


So, despite the fact that precipitous labor at term is typically moving so quickly because it is completely uncomplicated, because everything is going right, I would be forced, not only to undergo a decidedly unnecessary induction with all the added risks it entails, but also at the additional risk of delivering a pre-term infant, and all in the name of "preventing complications".


This is a perfect example of how overmedicalized the US system is: instead of letting labor progress normally on its own, the desire for a false sense of control makes modern obstetricians believe they must save me from myself, that only by their aggressive intervention could I be saved from the risk of birthing in my own time, in my own home.


In all probability, my next birth will be unassisted, not as an active choice, but due to the lack of one.



My choices are:


1. Plan a hospital birth

This means accepting an induction and all its ancillary interventions between 36-37 weeks. There are no birth centers in my state, so that is not an option, although even in a birth center, induction would be my only option. I have interviewed all the insurance-covered OBs in my area and this is the consensus, take it or leave it.

2. Plan a midwife-assisted homebirth

Due to the lack of support for midwifery care from the medical maternity model, the nearest midwife to my home is still over an hour away. Were my next birth to go as quickly as my second, it's highly unlikely she would arrive before the baby did. Even if we called from the very first contraction, I doubt there would be enough time for her to get to our house.

So, what to do? Most likely, I will choose a midwife, paying four times as much for her care (since my insurance won't cover midwifery care), all the while knowing she probably won't be present for the birth.



While many would baulk at the thought of an unassisted birth, I accept that, whether I want it or not, this may well be the reality of birthing again. As such, I don't spend time worrying about this fact; rather, I can focus on preparing everything needed to birth as safely as possible at home.


If modern obstetrics truly cared about making birth as safe as possible, then their focus would be on practicing evidence-based medicine and recognizing when intervention was truly necessary. Thus, the midwifery model of care would be the standard, so that women such as I could birth safely with a skilled attendant present no matter what place of birth was chosen.

Mother-Friendly Childbirth Forum to Gather in San Diego

The Coalition for Improving Maternity Services' (CIMS) 2009 Mother-Friendly Childbirth Forum and Annual Meeting will be held March 5-7, in San Diego, California. The program includes 24 sessions that will cover a broad range of issues affecting childbearing women.

The 2009 CIMS Forum will cover topics ranging from "Racial and Ethnic Disparities in Birth Outcomes," to the findings of a new national report, "New Mothers Speak Out," on the physical and mental health challenges faced by new mothers, to "The Case Against Elective Repeat Cesarean Surgery," to "Why Transparency in Maternity Care Matters."

This is sure to be an eye-opening event and one that is truly crucial to affecting change through the modern maternity machine. The key to accomplishing true change in the system is through widespread public awareness, not only of the shortcomings of the current system, but of simple ways it could be changed for the benefit of mothers and babies.

The full press release is available here.

The Pitfalls of Impatience

A new study published in the November, 2008 issue of Obstetrics and Gynecology, conducted by researchers at the University of California, San Francisco, found that over 130,000 cesareans could be avoided each year by simply waiting an extra two hours for labor to progress normally.


The study focused on the all-too-common "failure to progress" c-section. The study was longitudinal over 1991-2001 and examined outcomes for 1,014 women having their first child at the UCSF.


Current ACOG guidelines state that physicians should wait two hours once an active labor arrest, or a period of time when dilation and effacement have ceased, before moving to a c-section. However, the article states that while this is the standard of care, many physicians currently ignore the guideline and move straight to an avoidable, unnecesarean.



Currently, 1/3 of all c-sections performed each year are for "failure to progress".



The study also highlights the dangers of a primary c-section, which are so often overlooked and were well outlined by the head author:

"Cesarean delivery is associated with significantly increased risk of maternal hemorrhage, requiring a blood transfusion, and postpartum infection," Caughey said. "After a cesarean, women also have a higher risk in future pregnancies of experiencing abnormal placental location, surgical complications, and uterine rupture."

Results of the study also found that women who had c-sections had increased rates of postpartum hemorrhage, chorioamnionitis infections and endomyometritis infections.


However, no significant difference in the health outcomes of the infants was found.


The most refreshing factor about this study is that ultimately, it highlights the dangers of primary and repeat c-sections as well as highlighting the role of physician non-compliance with the outlined standard of care.


Ultimately, the study shows that if physicians follow evidence-based guidelines in their practice, maternal outcomes are improved.


Despite the fact that this is a new study, this is not new information. The two hour wait time was already the standard of care when this study was undertaken. The real issue is getting physicians to respect the evidence and stop rushing to a c-section at the earliest convenience.


I have to wonder what will have to happen before physicians start using evidence-based practice in maternity care.


Despite study after study extolling the pitfalls of procedures such as episiotomy, lithotomy position, EFM, failure to progress c-section, restricted movement and arbitrary time limits on labor, these harmful practices are still standard across much of the US.


Perhaps a punitive approach would work: fine physicians for each non evidence-based procedure: $500 for an episiotomy, $1000 for EFM, $3000 for each unnecesarean.


That, I think, would be an effective approach at gaining adherence to evidence-based medicine and focus on maximizing reimbursement for quality care, not convenience.

The MEAC Needs Your Help

Feel free to pass this along and support midwifery across the US. Donations are also tax-deductible.


October 2008

Dear Friend of the Allied Midwifery Organizations,

MEAC needs our help!

MEAC is the Midwifery Education Accreditation Council. MEAC promotes excellence in midwifery education by supporting and accrediting midwifery schools around the country that prepare midwives for national certification as CPMs. MEAC is doing exciting, groundbreaking, and vital work for our midwifery movement. Just this month, the Milbank Memorial Fund, a non-partisan institute devoted to health policy analysis, issued a new report titled, “Evidence-Based Maternity Care: What It Is and What It Can Achieve”. The report cites data from the landmark study of CPMs published in 2005 and concludes:


The low CPM rates of intervention are benchmarks for what the majority of childbearing women and babies who are in good health might achieve.


MEAC currently accredits eight free-standing institutions and two programs that reside within universities, providing excellent midwifery education for more than 500 matriculating students.


Why does MEAC need our help now?


This year, the U. S. Secretary of Education deferred a decision to extend recognition of MEAC, requesting that MEAC provide evidence of a stronger financial and volunteer base. It is ESSENTIAL that MEAC satisfies the requirements to continue its recognition by the USED. This appeal to you hopes to accomplish two things:


1. Increase the capacity of MEAC’s Reserve Fund to cover one year’s operating budget ($120,000).

2. Demonstrate to the USED that MEAC has a strong base of support that can be called upon to respond swiftly and effectively in a time of need.


Please help us in this one-time capital campaign. We have come so far in the last decade. We can’t let it slip away. Your support is crucial and so much appreciated at this time! Please give generously. Large donations of $500-$1,000 will provide significant support. Smaller donations will help, step-by-step, to achieve this goal. We can do this together- it is an investment in our future!


Sincerely Yours,

The Leadership of the Allied Midwifery Organizations


*Donations to MEAC are tax deductible!
Make checks payable to MEAC, POB 984, LaConner, WA 98257,
http://www.meacschools.org