Community Wellness Through Improved Maternity Practices By Drs Jose Gorrin and Ana Parilla. Given at the Puerto Rican Cultural Center in September of 2003

1. Community Wellness Through Improved Maternity Practices José J. Gorrín, MD, MPH, FACOG Professor and Director Ana M. Parrilla, MD, MPH, FABM Associate Professor Maternal and Child Health Program Graduate School of Public Health University of Puerto Rico

4. Percent of Live Births Attended by CNMs in the USA 1989-2000. Vaginal Total Declercq E. Births Attended by CNMs in the US. Journal of Midwifery & Women’s Health 2003, 48, 83-4.

9. Tendency of Episiotomy Use in USA % 2000 National Hospital Discharge survey: Annual Summary with detailed diagnosis and procedure data, Vital Health Statistics 13(153), 2002

12. Tendencies in Cesarean Section rates in Puerto Rico & USA National Vital Statistics Reports 49(13), 2001 %

13. Tendency of VBAC rates in Puerto Rico and USA National Vital Statistics Reports 49(13), 2001 %

19. Coalition for Improving Maternity Services (CIMS)

26. CIMS Principles

42. Ten Steps of the Mother-Friendly Childbirth Initiative For Mother-Friendly Hospitals, Birth Centers, and Home Birth Services

62. “ The episiotomy is a ritual of genital mutilation in western obstetrics”

83. “ Routine circumcision is not a medical or social issue. It is a sexual principle and a human rights principle. " Frederick Hodges

84. Male and female circumcision should be aggressively attacked as an act of mutilation and sexual violence against boys and girls.

86. Ideals vs. Reality in USA & PR Births Programa de Salud de la Madre y el Niño, Escuela Graduada de Salud Pública, Recinto de Ciencias Médicas, Universidad de Puerto Rico 2003. Modified from : Ideals vs. Reality in US Births . BirthNet 2001. Not available 80% Only for complications Not routine Drugs in Labor 78% (in 1997) 84.8% (3.3 million) Not routine Not routine Electronic Fetal Monitoring Hospitals 99.7% Hospitals 99.1% (3.9 million) Where mother prefers Out of Hospital preferred Place of birth Physicians 99.8% Physicians 91.4% (3.6 million) Access to professional midwifery care Midwives for normal pregnancy & birth Birth Attendants PR 2001 (57,000) USA 2001 (4 million) CIMS Suggestions WHO Recommendations

87. Ideals vs. Reality in USA & PR Births continuation Programa de Salud de la Madre y el Niño, Escuela Graduada de Salud Pública, Recinto de Ciencias Médicas, Universidad de Puerto Rico 2003. Modified from : Ideals vs. Reality in US Births . BirthNet 2001. 54.3% During hospital stay not necessarily immediately 68.4% During hospital stay not necessarily immediately Within an hour of birth Immediately Breastfeeding after birth 42% 24.4% (978,000) 10-15% 10-15% Cesarean Rate 79.3% 32.7% (944,000) 20% or less, with a goal of 5% or less Systematic use not justified Episiotomies 16.6% (in 1997) 17.5% (702,000) 10% or less Not mentioned Stimulation of Labor 6.6% (in 1997) 20.5% (819,000) 10% or less 10% or less Induction of Labor PR 2001 (57,000) USA 2001 (4 million) CIMS Suggestions WHO Recommendations

88. It’s time to get some respect for mommy and for me! … HUM!

89. I am not an advocate for frequent changes in laws and constitutions. But laws and institutions must go hand in hand with the progress of the human mind as that becomes more developed, more enlightened, as new discoveries are made, new truths discovered and manners and opinions change. With the change of circumstances, institutions must advance also to keep pace with the times. We might as well require a man to wear still the coat which fitted him when a boy as civilized society to remain ever under the regimen of their barbarous ancestors. Thomas Jefferson Author of the Declaration of Independence of the United States of America

90. “ La mujer es la fragua, la unidad de la raza, la unidad de una civilización, la unidad de un pueblo.” Don Pedro Albizu Campos

91. Hanna Ana Sofía Marla Pedro Alberto Cristina

92. Las tetas – Salinas, Puerto Rico