Mississippi Today

Q&A with midwife Janice Scaggs

Published

1 year ago

November 30, 2023

When Janice Scaggs joined the University of Mississippi Medical Center in 2020, she became part of a growing effort by the state’s largest public hospital and academic medical center to reintroduce midwifery into Mississippi’s maternal health care.

Certified nurse-midwives like Scaggs are educated in graduate-level midwifery programs and also hold an active registered nurse credential at the time of certification.

In the last three years, Scaggs, as the hospital’s only midwife, attended a little over six percent of births at UMMC each year.

In June, a second certified nurse midwife, Kim Rickard, joined the team. As part of the nurse midwifery clinical advisory committee, she and Scaggs plan to integrate a minimum of eight new nurse midwives into UMMC hospitals and clinics to offer round-the-clock midwifery care by 2027.

Midwives advocate for autonomy and comfort over efficiency for their patients, and have been proven to decrease unnecessary interventions such as cesareans in low-risk mothers – thereby improving morbidity and mortality, as well as postpartum mental health, and lowering the overall cost per capita of care.

Doctors and OB-GYNs are experts when it comes to abnormal pregnancies, Scaggs explained, but they don’t always know how to stand back and let a normal physiological birth unfold.

“Midwives … are the experts in normal, and have always been educated on a patient-centered model of care, really advocating for the patient and family, and empowering them,” she said.

Unnecessary cesareans and their increased use in Black pregnancies are not only a large contributor of preventable maternal deaths, but also a large contributor of maternal health disparities. Maternal mortality and morbidity after emergency cesarean birth is nearly 5 times than after vaginal birth.

Midwives are proponents of simple, but successful, low-intervention practices during labor – such as mobility and intermittent auscultation, or a technique of listening to and counting fetal heartbeats for a short period of time during active labor.

Editor’s note: This interview has been edited for clarity and length.

Mississippi Today: The term “midwife” translates to “with woman.” How do you see your role as a midwife, and how does it differ from that of, say, a doctor?

Janice Scaggs: We have so many similarities that sometimes that’s a really difficult question, but then on the other hand it’s really not.

If you look at the midwifery-led model of care, it really focuses on the individual, on putting them at the center of care, midwives being advocates for their patients and families – they want to empower the woman.

We focus on normal and healthy, certainly recognizing the abnormal. I look at us as the experts of that normal (births), whether it’s OB care, birthing, or gynecologic care, as well as family planning. I would say that that differs from our physician colleagues, because they really are focused on what the abnormal is, and they are experts when things are not going right.

MT: Tell me about the evidence around midwife-led care in reducing maternal and neonatal morbidity and mortality.

Scaggs: It’s well documented in other countries where midwifery is integrated into the health care system that it improves outcomes. We now have some good evidence in the U.S. to look at those evidence-based benefits, as well, including decreasing unnecessary interventions, improving the overall outcome of health – mental health as well as physical health – and decreasing the cost of health care, as well.

We increase breastfeeding rates, decrease preterm birth rates, and then (use) that approach of not using intervention unless absolutely necessary. We end up not performing interventions that can lead to morbidity, when maybe they didn’t need to be done, such as an unnecessary primary cesarean section.

MT: So, in today’s world, more women give birth in hospitals, and around technology, than ever before. But that hasn’t necessarily led to better outcomes. We know that because of infant and maternal mortality rates, and also high cesarean rates – across the country but particularly in Mississippi. Tell me about your non-pharmacological approach to birth and your philosophy around that.

Scaggs: I look at non-pharmacologic support as being an option that can either be done on its own or can be integrated with medical technology and pharmacologic options for women, as well. So they don’t have to stand separated.

But if we’re focusing on non-pharmacologic, we know from research that mobility, upright positions in the first stage of labor, decreases the length of labor, it decreases other interventions, it decreases cesarean rate. It improves comfort for moms who are trying to cope with labor without pharmacologic methods.

So, giving women permission and opportunity to move in labor – they will and they want to. If we put them in a bed and don’t encourage them to move, they won’t, because they feel unempowered, they don’t feel like they can safely move around.

That non-pharmacologic approach to giving women options, having them understand they are safe options in most settings, and we’re talking about primarily low-risk births with midwives. And then looking at things like acupressure points can be extremely helpful, using heat and cold in different aspects can be helpful. Touch – we know that there’s therapeutic touch for all aspects of health care, and that includes in labor and birth.

Using things like birthing balls when women are either in the bed, when they may be tired, either with epidurals or without epidurals, for positioning, can be extremely helpful in opening the pelvis to its most optimal position so that the fetus can get into the most optimal position. Babies come out a lot easier if they are head down and looking down, in relation to mom’s body, as opposed to what I would call sunny side up or coming down a little bit crooked. Changing the shape of the pelvis and having mom moving, whether it’s in the bed or out of bed, does lead to better outcomes, insofar as getting baby in a good position and having a faster labor.

It als just helps mom to cope better. When you’re hurt, you want to move. And if women stay in one position and don’t move, then we know that they’re not going to cope as well. I always talk to students and moms about how part of my job is to help you recognize when you’re suffering and to help you cope and to limit suffering. We know that doing that for women in labor actually improves our mental health outcomes and in the postpartum period it decreases anxiety and depression. And we know that that is something we should all be focusing on, and we’re just beginning to see more attention to that mental health aspect of the process of labor and birth.

MT: So, midwives primarily use intermittent auscultation, as opposed to electronic fetal heart monitoring, to listen to fetal heartbeat. Can you explain the difference between the two and how EFM can increase one’s chances of an unnecessary cesarean?

Scaggs: Continuous electronic fetal heart monitoring has two small, round devices – plastic devices that fit on mom’s belly. One graphs on a computer system to show when (the mother) is having a contraction. The other one is a little ultrasound piece. It’s not an ultrasound visually; it’s for hearing. We hear the heart rate, or auscultate the heart rate. And on these monitors, you can have continuous monitoring of the fetal heart rate, as well as uterine contractions.

We introduced this thinking we were going to decrease the overall cerebral palsy rate and we didn’t quite have the evidence to support that. And we have found now, 25, 35 years later, that for high-risk women, it’s extremely advantageous to have continuous electronic fetal monitoring. But for low-risk women, who are in spontaneous labor, who don’t have risk factors, we many times actually offer or perform interventions that aren’t necessary because (the continuous electronic monitoring) really sometimes provides more information than we need to have.

If we use intermittent auscultation, which is using either a handheld little Doppler which is another ultrasound device to hear heart tones, or even the old fashioned fetoscope that looks like the ear trumpet, that we can use to listen on mom’s belly. We listen before a contraction, throughout a contraction and one minute after the contraction, and we do that every 15 minutes during labor and five minutes during active labor and every five minutes when they’re pushing. And in doing that, if we hear anything abnormal we then can transition to more continuous monitoring to find out how the fetal heart is and to assure that we actually have a healthy baby. But you’re not having to be strapped down and continuously monitored. It may be that if everything sounds good and normal, that you never have to utilize the continuous electronic fetal monitoring.

MT: Tell me more about that relationship between a traumatic birth and postpartum depression.

Scaggs: Well, I can’t define trauma for somebody else, but if I don’t ask the right questions I’m not going to know if there’s been trauma.

I’ve had women who have come to postpartum visits, who I thought had the most beautiful birth and labor experience ever, and who seemed wonderful, and I find out a couple weeks later that there was something that caused them a trauma – whether it was terminology that was used, whether it was moving forward with a plan that maybe was not clear to them.

I’ve seen women have emergency cesarean sections who really needed them who show no signs of trauma, and then women who have planned cesareans who have trauma related to that. I think there are so many small things we can do to decrease trauma for women and that’s going to be, number one, communicating and finding out what helps them the best, not necessarily ourselves.

And as a provider, of any kind, whether you’re a midwife, a physician, a nurse, you can love your job so much and impose what you think somebody else should need. Being very self aware and self reflective, having humility of the process of labor and birth, is one of the best ways I think we can eliminate severe trauma.

MT: Do you think Mississippi will ever have a birth center? Would that be helpful here?

Scaggs: I think it would be wonderful if we could have regional freestanding birth centers that are supported by nurse-midwives with, you know, appropriate consultation, collaboration and referral to OB-GYNs and maternal-fetal medicine physicians for care as needed.

It would give us a better sense of community support in places where we don’t have as good of access. It could provide prenatal care, as well as care for labor, birth and postpartum period, as well as family planning.

MT: What do you think is needed to shift the paradigm from the hospital model of birth, which relies so heavily on technology, to a model of fewer interventions for low-risk pregnancies and empowering women to give birth according to their own plan when safe?

Scaggs: That’s a big question and I think it has a multifaceted answer. I think it always comes down to: what is the culture for supporting intended vaginal birth? What is the culture for putting women in the center of care? And what the relationships are between health care providers and nurses within a hospital, and support from administration for the type of training that is needed to be able to do things like intermittent auscultation. There’s a specific way to do that. So there needs to be education for nurses to be able to learn that; there needs to be a better nurse to patient ratio. So, we have some workforce issues. There’s also financial issues, educational issues. The bottom line is it’s really difficult to change culture. It takes time.

The more we can lean into family-centered, patient-centered, care, the more we can use the evidence that we currently have around us to improve outcomes.

If Mississippi can integrate midwifery into the health care system, that’s going to be the simplest answer. Who better to change the culture than midwives, who are the experts in normal, and have always been educated on a patient-centered model of care, really advocating for the patient and family, and empowering them, as well. The more we can empower women to have these choices and to understand they have these choices is really going to help.

MT: Is there anything else you’d like to add about midwifery in Mississippi?

Scaggs: I would like to say that I have been very supported within the university and from the chair of the department (Dr. Marty Tucker), to be able to grow midwifery. He’s the one who initially reached out to me when I had moved to Mississippi and was trying to navigate and figure out where jobs were and not finding many. He believes in midwifery being integrated into our model of care.

And I think if we had more physicians and administrators who understood midwifery and were open to hearing about it and really looking at the evidence, that we would have more midwives in Mississippi. But it takes us partnering to do that. I need them, and I need for them to realize also that they need my profession in order to best care for women in the state.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Mississippi Stories Videos

Mississippi Stories: Michael May of Lazy Acres

Published

9 hours ago

January 21, 2025

Staff Editor

mississippitoday.org – rlake – 2025-01-21 14:51:00

In this episode of Mississippi Stories, Mississippi Today Editor-at-Large Marshall Ramsey takes a trip to Lazy Acres. In 1980, Lazy Acres Christmas tree farm was founded in Chunky, Mississippi by Raburn and Shirley May. Twenty-one years later, Michael and Cathy May purchased Lazy Acres. Today, the farm has grown into a multi seasonal business offering a Bunny Patch at Easter, Pumpkin Patch in the fall, Christmas trees and an spectacular Christmas light show. It’s also a masterclass in family business entrepreneurship and agricultural tourism.

For more videos, subscribe to Mississippi Today’s YouTube channel.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

Mississippi Today

On this day in 1921

Published

17 hours ago

January 21, 2025

Staff Editor

mississippitoday.org – Jerry Mitchell – 2025-01-21 07:00:00

Jan. 21, 1921

George Washington Carver Credit: Wikipedia

George Washington Carver became one of the first Black experts to testify before Congress.

His unlikely road to Washington began after his birth in Missouri, just before the Civil War ended. When he was a week old, he and his mother and his sister were kidnapped by night raiders. The slaveholder hired a man to track them down, but the only one the man could locate was George, and the slaveholder exchanged a race horse for George’s safe return. George and his brother were raised by the slaveholder and his wife.

The couple taught them to read and write. George wound up attending a school for Black children 10 miles away and later tried to attend Highland University in Kansas, only to get turned away because of the color of his skin. Then he attended Simpson College in Indianola, Iowa, before becoming the first Black student at what is now Iowa State University, where he received a Master’s of Science degree and became the first Black faculty member.

Booker T. Washington then invited Carver to head the Tuskegee Institute’s Agriculture Department, where he found new uses for peanuts, sweet potatoes, soybeans and other crops.

In the past, segregation would have barred Carver’s testimony before Congress, but white peanut farmers, desperate to convince lawmakers about the need for a tariff on peanuts because of cheap Chinese imports, believed Carver could captivate them — and captivate he did, detailing how the nut could be transformed into candy, milk, livestock feed, even ink.

“I have just begun with the peanut,” he told lawmakers.

Impressed, they passed the Fordney-McCumber Tariff of 1922.

In addition to this work, Carver promoted racial harmony. From 1923 to 1933, he traveled to white Southern colleges for the Commission on Interracial Cooperation. Time magazine referred to him as a “Black Leonardo,” and he died in 1943.

That same year, the George Washington Carver Monument complex, the first national park honoring a Black American, was founded in Joplin, Missouri.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

Mississippi Today

Legislative recap: 2025 tax cut battle has been joined

Published

2 days ago

January 20, 2025

Staff Editor

mississippitoday.org – Geoff Pender – 2025-01-20 12:00:00

After relatively brief debate and questioning given its magnitude, the state House passed the first meaningful legislation of the new session: House Bill 1, a measure that would eliminate the state income tax, trim taxes on non-prepared food and raise sales and gasoline taxes.

It would mark a sea change in state tax structure, a shift from income to consumption taxation.

“We are at a place where we can finally tell the hard-working people of Mississippi we can eliminate the tax on work,” House Ways and Means Chairman Trey Lamar, HB1’s author, told his colleagues.

The measure passed the House 88-24. It gained some Democratic support in the supermajority Republican House, with nine Democrats voting in favor, 24 against and 12 voting present.

The proposal garnered some bipartisan support because it includes at least a couple of items Democratic lawmakers have championed in the past: A gasoline tax to help fix crumbling roadways, and a reduction in the “grocery” tax, or the sales tax levied on unprepared food, of which Mississippi has the highest overall rate in the nation.

It still met with some Democratic opposition in part because it is a sea change toward more “regressive” taxation. Proponents say this is just, people should pay more for state services they use, such as roadways, and for things they buy as opposed to taxing income. Opponents say this places a proportionately higher tax burden on people of modest means.

“I would say the people hurt the most with this would be working people who have to put gas in their car to go to work or those who have to purchase materials to do a job,” House Democratic Leader Robert Johnson said.

Beyond that concern, opponents or skeptics worry that the foundation of the proposed tax overhaul would be built on shifting sands — a state economy that has been so rosy primarily from the federal government dumping billions of dollars in pandemic spending into Mississippi. With the federal spigot being cut off, some worry, the state economy could slump, and the massive tax cuts in this new plan could provide a state budget crisis, of which Mississippi has much experience, and underfunding of crucial services such as schools, roads, health care and law enforcement.

The largest hurdle Republican House leaders face in seeing their tax plan through to law is not in garnering bipartisan support. It’s internecine disagreement with the Senate Republican leadership, which still appears to harbor abovementioned concerns about overhauling tax structure in uncertain economic times and betting on growth to cover massive tax cuts.

Senate leaders have said they want to enact more tax cuts, but their plan has not yet been released. Lt. Gov. Delbert Hosemann has provided some details of what he wants to see, but it would appear he wants a more cautious approach on cuts. He has not publicly opined on the tax increases in the House plan.

Quote of the Week

“Have you ever worn a belt and suspenders, lady? It’s a belt and suspenders approach.” — Rep. Trey Lamar, R-Senatobia, to Rep. Omeria Scott, D-Laurel, during floor debate on Lamar’s bill to eliminate the state income tax and raise other taxes.

“No. I have not worn a belt and suspenders. I don’t know anyone who has worn a belt and suspenders,” Scott replied.

In Brief

House will renew push to legalize mobile sports betting

House Gaming Committee Chairman Casey Eure, R-Saucier, told Mississippi Today he plans on taking another crack at legalizing mobile sports betting in the state. In 2024, the House and Senate passed versions of legislation to permit online sports betting, but never agreed on a final proposal. Some lawmakers raised concerns that gambling platforms would have no incentive to partner with smaller casinos, and most of the money would instead flow to the Mississippi Gulf Coast’s already bustling casinos. Proponents say legalization would undercut the influence of illicit offshore sports betting platforms.

“I’ve been working on this bill for many years and I’m just trying to satisfy any concerns that the Senate may have so we can pass this and start collecting the tax dollars that the state deserves and not allowing everyone to place bets with these offshore accounts,” Eure said. “I feel like the state is losing between $40-$80 million a year in tax revenue.”

Sports wagering has been permitted in the state for years, but online betting has remained illegal amid fears the move could harm the bottom line of the state’s brick-and-mortar casinos. Mobile sports betting is legal in 30 states and Washington, D.C., according to the American Gaming Association. — Michael Goldberg

Hosemann makes Senate committee chair changes

Republican Lt. Gov. Delbert Hosemann last week named new chairmen of committees, after former state Sen. Jenifer Branning was sworn into office as a new justice on the Mississippi Supreme Court.

Sen. Chuck Younger, a Republican from Columbus, previously led the Senate Agriculture Committee and will replace Branning as chairman of the Transportation Committee. Sen. Neil Whaley, a Republican from Potts Camp, previously led the Senate Wildlife, Fisheries and Parks Committee, but will now lead the Senate Agriculture Committee.

Here are the other changes to Senate committees:

Sen. Ben Suber, a Republican from Bruce, will be the new chairman of the Senate Wildlife, Fisheries and Parks Committee

Sen. Bart Williams, a Republican from Starkville, is the new chairman of the Senate Public Property Committee

Sen. Scott DeLano, a Republican from Gulfport, will lead the Senate Technology Committee

Sen. Robin Robinson, a Republican from Laurel, will chair the Senate Labor Committee

Sen. Angela Turner Ford, a Democrat from West Point, will lead the Senate Drug Policy Committee. — Taylor Vance

What’s in a name? Democratic Rep. Scott hopes GOP majority will pass ‘Donald J. Trump Act’ bills

Perhaps tired of seeing many measures she authors ignored or shot down in flames by the Republican supermajority in the Mississippi Legislature, Democratic Rep. Omeria Scott of Laurel is trying a new strategy: naming bills after Republican President-elect Trump.

For this session, Scott has authored: House Bill 61, the “Donald J. Trump Voting Rights Restoration Act;” House Bill 62, the “Donald J. Trump Ban-The-Box Act … to prohibit public employers from using criminal history as a bar to employment;” and House Bill 249, the “Donald J. Trump Early Voting Act.” — Geoff Pender

More bills filed to criminalize abortion

Since the 2022 Dobbs Supreme Court decision overturned the constitutional right to an abortion, Mississippi lawmakers have proposed bills to criminalize workarounds to the state’s strict abortion ban – including criminalizing the abortion pill and out-of-state abortions. The 2025 legislative session is no exception.

Rep. William Tracy Arnold, R-Booneville, filed House Bill 616 that would make it a felony to manufacture or make accessible medication abortion. Anyone convicted of the crime would be subject to a fine between $1,000 and $5,000, as well as imprisonment between two and five years. Last year, about 250 Mississippians each month requested medication abortion from Aid Access, the only online telemedicine service supplying medication abortion via mail in the U.S.

Helping a minor receive an abortion would also be criminalized under House Bill 148 filed by Rep. Mark Tullos, R-Raleigh. That would include transporting a minor out of state to undergo an abortion, as well as helping a minor procure a medication abortion – both of which would be punishable by not less than 20 years in prison or a fine of not less than $50,000. — Sophia Paffenroth

By the Numbers

$1.1 billion

The estimated net annual cost of the House plan to eliminate the state income tax and raise sales taxes, once fully phased in. Proponents say economic growth would allow the state budget, currently about $7 billion a year, to absorb the cut. Eliminating the income tax would cost the state $2.2 billion in revenue, but the House plan would raise about $1.1 billion in other taxes in offset.

0

The amount of income tax Mississippians would pay after a 10-year phased in elimination of the state income tax. With previous cuts being phased in, state income taxes next year will already be reduced to 4%, among the lowest rates in the nation.

8.5 %

The new Mississippi sales tax, up from current 7%, under the House tax plan assuming most local governments would not opt out of adding a new 1.5% local sales tax.

13 cents more a gallon

The cost of the House’s proposed new 5% gasoline tax, based on last week’s average cost of gasoline in Mississippi of $2.62. The new 5% tax would be on top of the flat 18.4 cents a gallon current state excise on gasoline.

4%

The tax on unprepared food once a reduction of the current 7% would be phased in over a decade under the House plan. The state would over time reduce its sales tax on such groceries to 2.5%, but local governments would add a 1.5% sales tax to such items unless they opt out.

Full Legislative Coverage

Lawmakers must pass new legislation to improve access to prenatal care

Lawmakers will file another bill this session to help low-income pregnant women get into the doctor earlier – after the federal government rejected the program set up under last year’s law, because of discrepancies between what was written into state law and federal regulations for presumptive Medicaid eligibility. Read the story.

Proposal: eliminate income tax, add 5% tax on gas, allow cities, counties to levy local sales tax

House leaders last week unveiled a sweeping tax cut proposal that would eventually abolish the state income tax, slash taxes on groceries, increase local sales taxes and shore up funds for state and local road work. Read the story.

A new Mississippi law aims to limit jailing people awaiting mental health treatment. Is it working?

Officials say a new law to decrease the number of people being jailed solely because they need mental health treatment has led to fewer people with serious mental illness detained in jails – but the data is contradictory and incomplete. Lawmakers plan legislation to make more counties report the data. Read the story.

How soon we forget: Mississippi House push for record tax cuts revives fear of repeat budget crises

Eight years ago, from a combination of dozens of tax cuts the Legislature approved and a slumping economy, the state saw a budget crisis that resulted in severely underfunded schools, government layoffs, a near halt to building new roads and highways and problems maintaining the ones we have, too few state troopers on the highways and cuts to most major state services. Read the story.

NAACP legislative redistricting proposal pits two pairs of senators against each other

The Mississippi chapter of the ACLU has submitted a proposal to the courts to redraw the state’s legislative districts that creates two new majority-Black Senate districts and pits two pairs of incumbent senators against one another. Read the story.

Legislation to send more public money to private schools appears stalled as lawmakers consider other changes

Some top lawmakers in Mississippi’s Republican-controlled Legislature are prepared to make it easier for students to transfer between public schools but remain skeptical of sending more public money to private schools. Read the story.

House passes $1.1 billion income tax elimination-gas and sales tax increase plan in bipartisan vote

A bill that phases out the state income tax, cuts the state grocery tax and raises sales taxes and gasoline taxes passed the House of Representatives with a bipartisan vote on Thursday. Read the story.

Tate Reeves and other top Mississippi Republicans owe thanks to President Joe Biden

The tremendous cash surpluses that some state Republicans cite when defending their plan to eliminate the state’s income tax would not exist if not for the billions of dollars in federal funds that have been pumped into the state during Biden’s presidential tenure. Read the story.

Podcast: Mississippi transportation director discusses proposed new gasoline tax

Mississippi Department of Transportation Director Brad White tells Mississippi Today’s Geoff Pender and Taylor Vance he’s staying “in his lane” and out of the politics of a House tax overhaul that would eliminate the income tax and raise sales and gasoline taxes, but that he’s pleased lawmakers are trying to address the long running need for a steady new stream of money to help cover highway maintenance needs. Listen to the podcast.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.