Wednesday, April 8, 2009

Hope and History

A report to the Allied Midwifery Organizations on the Home Birth Consensus Conference planning meeting held March 21-22, 2009 in San Francisco
Tanya Khemet – ICTC Board
Diane Holzer & Maria Iorillo – MANA Board
Suzy Myers – NACPM Board

Planning has begun for a multi-stakeholder Future Search conference entitled,
“The Future of Homebirth in the United States: Addressing Shared Responsibility.”

In June 2008, the ACNM Board approved a resolution/request by their Home Birth Section members, led by Saraswathi Vedam, to convene a multidisciplinary consensus conference with key stakeholders on the provision of planned home birth services with appropriate infrastructure and support.

A Steering Group was formed to initiate a planning process, with members from ACNM, MANA, and University of California at San Francisco (UCSF), who donated space and personnel for the first planning meeting. Together they invited several key stakeholder groups and identified high profile facilitators from Future Search. In the ensuing months senior members from ACOG, AAP, ACNM, MANA, ICTC, NACPM, AWHONN, Lamaze International and UCSF committed to participating in a multi-disciplinary planning meeting for a national consensus conference. (Childbirth Connection, APHA, the CDC and others have indicated support and interest but were unable to send representatives to this meeting).

Each organization nominated one or two senior representatives to attend; all of the organizations supported the travel and lodging for their representatives. Grants from the Foundation for Advancement of Midwifery (FAM), and the boards of ACNM, MANA, ICTC and NACPM were used to support the costs of the planning meeting and facilitators.

This first planning meeting was held March 21-22, 2009 in San Francisco. We met for a day and a half in a UCSF boardroom with a lovely view. The meeting was collegial, focused, and productive. In attendance were:

Hal Lawrence, VP of ACOG, John Kattwinkel of AAP, Suzy Myers representing NACPM, Diane Holzer and Maria Iorillo representing MANA, Cathy Collins-Fulea and Saras Vedam representing ACNM, Judith Lothian from Lamaze International (wearing the consumer advocacy hat as well), Naomi Stotland (OB) and Leslie Cragin (CNM) from UCSF, Tanya Khemet, representing ICTC, and Ocean Berg, representing AWHONN, along with two lead facilitators from Future Search, Sandra Janoff and Richard Aronson.

This report summarizes the planning meeting.

Future Search
We will use the Future Search model (www.futuresearch. net). A Future Search Conference is a structured two and a half day meeting based on a set of principles that tap into the capacity for people from diverse perspectives to work together on complex tough issues. Future Search is internationally renowned for brokering lasting agreements and shared initiatives in highly volatile and polarized settings, around a variety of issues related to poverty, health care access, regional and ethnic conflict, and education.

A Future Search conference is typically a gathering of 60-80 individuals and organizations that have agreed to discuss ways to create conditions that will improve and change whole systems. Participants must include those with “authority, resources, expertise, information and need”. To ensure success we must have the key components of the whole system in the room so that we are not just talking to “ourselves” but giving voice to each piece of the system.

The hope is that the eventual consensus conference will be organized in a way that is most likely to foster the dialogue needed to find common ground and spark constructive action that will ultimately benefit all, regardless of whether women choose home or hospital birth.

The planning meeting
Our first day together, from noon to 5 PM, was spent on introductions and a presentation by the facilitators about Future Search: it’s history, methodology and examples of the work they have done with other groups seeking to solve problems and find common ground

A large and important part of the second day was to brainstorm and consider what stakeholder groups needed to be represented and who would actually represent them. We collectively identified 72 potential individual participants or stakeholder groups to be invited from a variety of sectors including:

Consumers & their advocates
Health policy analysts and regulators
Research and public health experts
Payors and liability insurers
Hospital staff and systems administrators
Other maternity care providers and educators

The Future Search conference uses structured activities involving the whole group as well as work in small groups. Sitting at round tables together, each table must have a sufficient mix of key stakeholders. Given the limitation of numbers – we have decided to limit our conference size to 72 individuals -- it was pointed out that our goals would be best served by inviting people who can represent varied interests, experience and viewpoints, in other words, wear multiple hats. Additionally, after much discussion, it was agreed that each table must have one home birth provider.

We also agreed that the major midwifery organizations participating in planning the conference would choose their home birth representatives as follows:
MANA - three representatives
NACPM - two representatives
ACNM - one representative
ICTC - one representative

Additionally, it was agreed to be sure a student midwife is included because we want our future represented. We were able to secure one representative for NARM in the regulatory category, as well as a seat for the MANA DOR in the research category. All representatives will be carefully selected to reflect expertise, diversity and commitment to cooperative dialog.
What’s next?
The next step will be to prepare grant applications for funding with a goal of convening the meeting in spring, 2010. Projected costs for this Future Search conference will be approximately $150,000. Expenses include: facilitator salaries, travel and lodging for approximately twenty participants (prioritizing need), venue rental, catering, supplies, and materials. In addition, we still have $7000 in outstanding expenses for the planning meeting.

So that is our current task -- to find the money!

We have three identified potential funders whose grant applications will be due June-September. We can use any assistance anyone can provide to prepare these grant applications.

On the advice of the facilitators, we are seeking a venue with natural light, and an ambience that will promote a feeling of wellness and willingness to dialogue (perhaps a retreat center). It also must be easily accessible from various locations. Tanya Khemet has agreed to head up the venue search. We would be grateful for suggestions.

We will continue to refine the list of appropriate stakeholder representatives with the advice of our respective organizations and colleagues. We have committed to regular monthly conference calls as a planning group, and have invited ACOG and AAP to nominate one additional planning group member from their organizations. (They felt that the planning committee was overly representative of the homebirth viewpoint, which was true). Once the draft invitee list is finalized we may engage in a wider vetting process through our respective organizations, and with some advice from our colleagues at Childbirth Connection who have recently identified key stakeholders from multidisciplinary perspectives for their Symposium.

Change is a slow and steady process that begins with common ground and hope for a better future.
Please direct any suggestions regarding venues or funders, as well as your comments to any of us:
Diane Holzer:
Maria Iorillo:
Tanya Khemet:
Suzy Myers:

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