Monday, August 11, 2008

Miami Dade College Letter

Dear Board of Trustees:

Miami Dade College (MDC) was the only institute of higher education to offer direct-entry midwifery at the undergraduate level. In a historical context, MDC has always been a pioneer, beginning when it opened its doors during the heightened Civil Right’s Era of the 1960s. It was the first integrated junior college in Florida, founded on the idea that “anyone with a desire to get a college degree should be given that opportunity.”

The question has been posed as to whether or not a public institution should offer a heavily politicized and potentially litigative field such as midwifery? Our answer must be in the affirmative. If Florida is to be recognized as a state committed to ensuring equal access to healthcare (options) and improving maternity outcomes, and Miami Dade College is to exemplify the standards and continue to be regarded as a leading, innovative institution of higher learning, the Midwifery Program must main intact.

It is the legislative declaration in Florida for a “person to have the freedom to choose the manner, cost, and setting for giving birth.” Furthermore, it is recognized that “access to prenatal care and delivery services is limited by the inadequate number of providers of such services and that the regulated practice of midwifery may help reduce this shortage.” However, even though Florida Legislature set a goal to “intend midwives to be the care providers for 50% of all normal, healthy pregnant women by the year 2000,” we continue to fall short of this achievement. As of 2007, there were only 115 licensed midwives in this state.

We must ask the question, Why is midwifery so important and how does it concern Florida? Let me provide a glimpse of the current status of maternity care:

As of the 2008 estimates in The World Factbook by the CIA, the United States ranks 42nd on the infant mortality list. With 6.3 deaths per 1000 live births, the U.S. trails behind Canada and most of Europe. Yet, we have the most technologically advanced and medicalized healthcare system in the world. According to the Department of Health, infant mortality is often considered the primary indicator that reflects the health of a nation due to its association with a variety of factors such as maternal health, quality and access to medical care, socioeconomic conditions and public health practices.

In 2004, maternity care in Florida’s hospitals cost $2.1 billion. Florida Medicaid pays for half of all maternity care received in our State. Our rate of caesarian sections is one-third of all deliveries, which accounts for $1 billion of the expenditures. Of the ten hospitals with the highest cesarean rates, six are located in Miami-Dade County; thus, at 43.6%, Miami-Dade County had the highest cesarean rate of any region.

Hispanic and African-American women have the worst birth outcomes (as evidenced by SB 2120/HB 1269). African-American women are the most likely to receive no prenatal care, while teenagers are not likely to receive timely care. In addition, Miami-Dade County teens ages 15-19 rate significantly higher in repeat births.

Pregnant women are afflicted by intimate partner violence in a disproportionate amount. The Center for Disease Control found that pregnant women are 60.6% more likely to be victims than women who are not pregnant. The prevailing HIV cases steadily rising in women are likely to aggravate the gender violence. Florida ranks second in the nation for reported HIV cases.

As malpractice insurance costs rise, obstetricians are fleeing their practices leaving pregnant women with perceived fewer options for safe, effective healthcare. Low-income patients are thrust into overcrowded health departments which provide them with little sense of individuality and importance. Routine appointments become devalued and socioeconomic factors hinder progress.

Midwives step in to provide low-cost maternity care to low-risk women. Patients are afforded breastfeeding support, nutrition counseling, reproductive education, and continuity of care. The prevalence of nosocomial infections is not a concern in non-hospital births--neither are the long-term effects of medical interventions such as analgesics and labor-inducing drugs--as they are not utilized by midwives. Women are empowered through midwifery as they learn to take control of their bodies.

The Miami Dade College Midwifery Program students were informed earlier this summer that we had to pay our malpractice insurance upfront. Mistakenly, we believed that financial aid would cover this expense. However the $3000 required of us was due by August 1; and even if we secured private students loans the loans could not be initiated because we are not students of the program until the insurance is paid and we are subsequently enrolled in classes. We are not aware of any other program within the College that has this stipulation.

Midwifery is a calling. To offer us the option of furthering our education through the pursuit of vocational programs or Opticianry (August 8th “next steps” meeting) is an insult. We have not worked for years on our prerequisites, squeezed out money and time, and relocated our families for our College to disregard the hardships that have now been imposed on us. Midwifery is ablaze in our hearts and spitting in the fire does not extinguish it. We prepared for it and it is our only option.

The Midwifery Program students represent the marginalized communities that we will return to serve, without prejudice and with compassion and a unique understanding of the multidimensional needs affecting the areas of the inner-city, rural, migrant, and Native-American reservations. In addition, we are privy to knowledge outside of the academic research arena because we have a vested interest in elevating the status of the people that we represent.

We do not want to attend school out of state. Florida is replete with resources and the solutions we need to accomplish our goals. With a profound cultural atmosphere, Miami Dade College can be an international health model, lending experiences of inter-cultural activities and dynamics, within the borders of the continental United States.

Miami Dade College continues to dominate the educational industry as the largest college in the United States. It awards the most associate degrees in the nation to minorities, among whom the majority are women and non-traditional students. Many students are economically disadvantaged and first generation college attendees. We are those students and we deserve a fair chance.

If Florida International University (FIU) can implement a new medical program, which, as reported in the Miami Herald, is a 28 million-dollar public funding commitment, surely Miami Dade College can enlist the support of the community to keep the Midwifery Program in place. The total cost of in-state tuition for a midwifery student is below $5K.

Midwifery must remain in a public institution of higher learning in Florida, not to discredit private educational establishments, but to bring Midwifery to the forefront of alleviating Florida's problems, and the nation's problems. This permits the study of midwifery to involve academics, with the potential for on-going research, at the university level, among scholars; and we want to align ourselves as practitioners to be a part of that study.

Enlisting and mobilizing prospective and current midwives will help alleviate the disparities in maternal care and fetal outcomes; additionally, it can augment the services already offered by other agencies. Midwifery is only political and litigative insofar as it advances the rights of women as competent health care practitioners and as wholly-informed patients.

Our fight will continue. Your options are to act as an obstacle to the future of midwifery in Florida, or to facilitate this matter and allow us to begin our fall 2008 class on August 27. I hope that you will choose the latter.