Book Review: Pushing for Midwives

Book Review: Pushing for Midwives: Homebirth Mothers and the Reproductive Rights Movement
by Christa Craven
Paperback: 232 pages
Publisher: Temple University Press; 1 edition (October 28, 2010)
ISBN-13: 978-1439902202

Reviewed by Molly Remer, Talk Birth

Mainstream feminist groups have been slow to recognize the right to reproduce along with the right to be free from reproducing. A focus of the second-wave women’s movement was shaking off motherhood as what solely defined womanhood. So perhaps there has been a reluctance to watch over the process that makes women mothers. –Jennifer Block quoted in Pushing for Midwives

Framed as a health policy concern, Pushing for Midwives assesses the homebirth movement and midwifery activism in the context of the reproductive rights movement. The focus of the book is on legislation in Virginia, but is still of relevance and interest to activists from other states. Craven also tackles complicated topics that are often ignored in homebirth and midwifery texts, addressing issues of race, privilege, and socioeconomic status and the impact on access to care. She also takes a solid look at issues of political and religious diversity within the homebirth activist community.

Written in a densely academic style evocative of a dissertation, Pushing for Midwives, became tedious and dry in places and took a long time to finish reading. The very narrow focus on Virginia, while still applicable to other states, became tiresome by the final chapters.

I particularly enjoyed Craven’s exploration of the history of consumer activism in midwifery as well as the consideration of homebirth in the larger context of women’s health activism. I appreciated her exploration of the feminist movement and how it has historically neglected issues of birth advocacy and reform, while also looking the current relationship between feminism and midwifery activism, particularly how birth advocates choose to self-identify. Women’s health activists and midwifery advocates will likely find a lot of food for thought in the pages of Pushing for Midwives.

–
Disclosures: I received a complimentary copy of this book for review purposes.
Amazon affiliate links included in book title and image.

I am a Midwife Campaign

MANA has a great educational campaign going on right now called I am a Midwife. The campaign involves a series of short videos released once a week about a variety of topics. More than just a general education campaign, each video includes a variety of different women--midwives, mothers, public health activists, maternity care activists, authors---speaking out on important topics in maternity care. Each woman also identifies, "I am a Midwife." This week's video is about health disparities in maternity care, which is a very important and too-often ignored topic. It raises the concern that African American women and their babies are more likely to die than their Caucasian counterparts even when other variables are equalized (i.e. same socioeconomic status, same education, etc.) and moves into wider discussions about racism and the treatment of minority group members. It then focuses on the value and role of midwifery care in addressing these concerns.


As MANA states in relationship to this campaign: "For midwives, sharing is daring. We dare to challenge the status quo. We dare to speak up for women's innate wisdom in pregnancy and birth. We dare to assert that there is a better way for our babies to be born. And we dare to insist that birth belongs to families."

Absolutely! The I am a Midwife public education campaign is extremely powerful. I have to confess that when it originally launched, I didn't personally make time to watch the videos right away, somehow assuming that they were "generic" videos with a "rah, midwives!" type of message. Don't make the same mistake I did. These are quality videos with important messages, powerful voices, and essential education and information. You will definitely learn something from watching them!

--
Molly
CfM Blogger

International Women's Day---Guest Post: Wake Up Campaign

Today is International Women’s Day, an occasion to celebrate women and girls’ remarkable potential, inherent worth and vital contributions to our communities. It’s also a day to recognize that millions of women and girls still confront threats to their safety, their health, their livelihoods and their dignity - and to advocate for solutions that can improve their lives.

Are you concerned with these issues? Then join the International Rescue Committee (IRC)’s Wake Up campaign. At rescue.org/wakeup, you can read stories of real women facing crisis – like Fatuma, whose daughter was assaulted on the daily trek for clean water in Somalia; Francine, who is working to overcome the wounds of sexual slavery in Congo; and Angele, a Cameroonian asylee who fled political turmoil in her home country and is slowly rebuilding her life in the United States. You can sign a pledge affirming your support for women and girls like these all over the world who are fighting for survival and struggling to endure. When you do, you’ll join the ranks of such notables as IRC Voice and “The Walking Dead” star Sarah Wayne Callies and actresses Téa Leoni, Alyssa Milano and Morena Baccarin. And you can use the tools in the IRC’s handy social action kit to share the pledge and raise awareness about what can be done to help – which makes you a part of the solution.

The IRC works to protect and empower women and girls in more than 40 countries and 22 U.S. cities, from Burundi to Baltimore. We’re joining with them on this special day, to take a stand for women and girls. We hope that you will, too. Sign the Wake Up pledge and pass it on!
---
Article provided by Ruth Fertig of International Rescue Committee

In photo:
Lay Htoo, 20, looks at her newborn daughter Di Lay, born a few hours earlier in Tham Hin refugee camp’s maternity ward. Each year, 15 midwives trained by the International Rescue Committee (IRC) examine and support hundreds of women and children in the camp, which is near the Thailand-Myanmar border. (Photo: Peter Biro/IRC).

Book Review: Arms Wide Open: A Midwife’s Journey

Book Review: Arms Wide Open: A Midwife’s Journey

By Patricia Harman
Beacon Press, 2011
ISBN: 978-0807001387
324 pages, paperback, $16.47 (Amazon)
http://www.beacon.org

Reviewed by Molly Remer, MSW, ICCE, CCCE
http://talkbirth.wordpress.com

I very much enjoyed Patricia Harman’s first book, The Blue Cotton Gown, and was delighted to learn about her new memoir, Arms Wide Open which is, in a sense, both a prequel and sequel to her first memoir. The first half of Arms Wide Open chronicles Patsy’s experiences with homesteading and communal living as a young hippie mother in the 1970’s. It also explores her thoughts and experiences with peace activism and her passion for an eco-friendly life. During this time, she attends her first birth and dives into her midwifery journey and eventually becomes a CNM practicing with her hippie-farmer-turned-OB/GYN husband in West Virginia. Her experiences with their years in a joint women’s health practice are described in The Blue Cotton Gown. Readers who, like me, wondered what happened where The Blue Cotton Gown left off, can find out in the second half of Arms Wide Open, which is a narrative of Patsy’s ongoing work with women through 2009 and includes her emotional painful moments in her marriage, as her husband struggles with fears of another lawsuit as well as with chronic pelvic pain patients who abuse his trust (chronic pelvic pain is a specialty of their practice).

I did feel as if there was a large chunk of story missing as the book somewhat abruptly skips from 1978 to 2008. We miss learning about any of Patsy’s experiences in nurse-midwifery school, nor do we learn much about her practice when she was a CNM attending births. The book transitions from her years as a self-taught midwife considering going to school to become a CNM, straight to her present-day years as a CNM in a private women’s health practice.

Harman’s writing style is lyrical and engaging as well as candid. The book is based on personal journals and reading it feels like eavesdropping on someone’s very private thoughts and feelings. The book is much more of a look at a woman’s feelings about her life, than it is a “manifesto” about birth or about the practice of midwifery. In this manner, I feel like you receive a much more complete picture of a midwife’s life and journey, rather than reading a sequence of birth stories. Patsy has a lot of life in addition to birth. While definitely not a “feel good” book, Arms Wide Open is a deeply touching and very honest exploration of one woman’s personal journey in life, love, motherhood, and midwifery.

--

Disclosure: I received a complimentary copy of this book for review purposes.

International Women's Day

"If ever the world sees a time when women shall come together purely and simply for the benefit of humanity it will be a power such as the world has never known." --Matthew Arnold

"I long to speak out the intense inspiration that comes to me from the lives of strong women." –Ruth Benedict

Tomorrow is the 100th anniversary of the first International Women's Day. For more information about celebrating check out the International Women's Day website. Or, visit the Imagine a Woman website to read this blog post or to check out this handout about 50 things to do to celebrate International Women's Day, Women's History Month, yourself, and the women who inspire you.

To bring it back to birth, you might also enjoy watching these helpful midwifery/birth videos from strong women on the Midwifery Today youtube channel.

“I believe that these circles of women around us weave invisible nets of love that carry us when we're weak and sing with us when we're strong.” --SARK, Succulent Wild Woman

"Loving, knowing, and respecting our bodies is a powerful and invincible act of rebellion in this society." --Inga Muscio

In honor of International Women's Day---and every day---let us celebrate our bodies, honor our mothers, and trust in the nets of love woven around us by a multitude of remarkable, powerful, everyday women.

--
Molly
CfM Blogger
(photo from my blessingway in January 2011, 38 weeks pregnant with my baby girl!)

Legislative Alert from AABC

Passing along a legislative alert from the American Association of Birth Centers:

Women and Children Lose in Budget Cuts: We need your help!

It always is a shock to me that Women and Children's Programs are at the top of Federal and State budget cuts. Republicans in the U.S. House of Representatives have passed large cuts in health services to women, infants, and children (H.R.1):

Hundreds of millions from WIC (Women, Infants, and Children):
WIC provides Federal grants to States for supplemental food, health care referrals, and nutrition education for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children up to age five who are found to be at nutritional risk.

Hundreds of millions from Maternal and Child Health Block Grants:
This Block Grant referred to as Title V is a public health program that reaches across economic lines to improve the health of all mothers and children, train providers and support services for children with special healthcare needs, offers newborn screening and genetic services, lead poisoning and injury prevention, and health and safety promotion in child care settings.

More than a billion from Community Health Centers:
Community Health Centers are key partners for many Birth Centers. They exist to fill the void in underserved communities and vulnerable populations by assuring access to comprehensive, culturally competent, quality primary care services.

This federal quandary is shared by many states: Demand for health services is growing and states are cutting Medicaid budgets for the poor and disabled. Medicaid accounts for approximately 25 percent of state spending when federal matching dollars are included according to the National Association of State Budget Officers.

PLEASE DO NOT SIT BACK AND DO NOTHING. WOMAN AND CHILDREN NEED OUR HELP NOW. This is not a Republican, Democrat, or Independent position. This is the moral and ethical action to take now.
ACTION STEPS
1. Call your U.S. Senators -( U.S. Capitol Switchboard: 202-224-3121).
Ask to speak to your Senator's health legislative aide.
2. Call your State Governor, Senators and Representatives
3. Tell them you are NOT in support of cuts to women and children's health! The deficit can be reduced by cutting waste in other areas.
4. Please let Karen Fennell (AABC's lobbyist) know of your contacts with legislators.
Tell her who you talked with and any comments or additional information requested. Call Karen at 301-830-3910; Send email to fennell.karen.s@gmail.com

Suggested Talking Points

WIC Program: This is one of the most efficient programs to improve child nutrition. The program gives expectant mothers with very small children important education on how to eat healthy during their pregnancy and how to feed their children healthy meals. And it provides them with coupons to incentivize them to purchase the best foods for their children. Research shows that without this intervention the nutritional intake of these children would be higher in fats, salts and sugars, according to a recent U.S. Food and Nutrition Services study. Instead if spending $1,400 a month in extra medical care for an obese child, for just $41 per month this program shifts these mothers and children into healthy eating patterns, says the Centers for Disease Control and Prevention. Clearly, the WIC approach is a useful and relatively cheap way to stem the rising tide of childhood obesity and a healthy pregnancy.

Maternal and Child Health Block Program: The program has been cut by 30%. This program is the safety-net care for women and children. The block grant pays for child immunizations and prenatal care for tens of thousands women and children. It is obvious that without access to immunizations more dollars will have to be spent to care for kids sick with easily preventable illnesses. Reducing access to prenatal care is both life-threatening and costly. A preemie baby's health costs are 10 times higher than a full-term, healthy-weight child, according to the March of Dimes. It makes no sense to cut a program that has a proven track record of delivering health to babies and driving down America's health care costs.

Community Health Centers: Funding for community health centers will be cut in half. Senator Orrin Hatch (R-UT), who was a cosponsor of the legislation responding to President George W. Bush's call to expand funding for these centers in 2008, says that "since 2001, additional funding has allowed health centers in more than 750 communities nationwide to provide care to about four million new patients. These centers provide affordable and quality care to at-risk Americans who otherwise might have to might have to do without." As state by the Center for American Progress, "No health care costs will be avoided by cutting this $1 billion out of the budget because the absence of care doesn't stop you from getting sick. It simply means you get sicker and you turn up at the emergency room or hospitals when your illness has progressed to the point that you care needs are exorbitantly expensive.

State Medicaid Cuts: Most States have budget proposals to cut funding for Medicaid. Talk to staff about what you know best - health and costs implications of a lack of prenatal and newborn care. A useful resource is the article Ten Myths About Medicaid published by The Kaiser Commission on Medicaid and the Uninsured.
--

Jill Alliman, CNM, MSN

Chair, Legislative Committee

American Association of Birth Centers

Women's Equality Day

It was on August 26, 1920, that women finally obtained the right to vote with passage in the U.S. Congress of the 19th Amendment!

According to the website of the National Women's History Project:

"The observance of Women's Equality Day not only commemorates the passage of the 19th Amendment, but also calls attention to women's continuing efforts toward full equality. Workplaces, libraries, organizations, and public facilities now participate with Women's Equality Day programs, displays, video showings, or other activities."

You've probably guessed what I'm going to say, but I would love to see all women have equal access to to quality birth care--that would include the Midwives Model of Care (equally applicable in hospital settings as well), the Six Healthy Birth Practices (Lamaze) as the standard of care, and simple respect of women's voices about their wishes in birth. As it is now, women are limited in this equal access by geographic region, insurance coverage, financial need, legal restrictions, VBAC bans, and lack of available midwives to name a few. Some people take a, "where there's a will there's a way approach--I'd do anything it took to pay for my midwife and have my baby at home," but I believe it is much more complicated and multifaceted than that.

As I think about Women's Equality Day, I also think about this quote from Raven Lang in her 1972 classic, Birth Book:

“Birth has not only reached the absurdity of having to be relearned, it also has the absurdity of becoming a criminal offense if we are to go ahead with our ideals and do things the way we desire. And so, because of the system, midwifery as practiced in this book is against the law. It has become political. We didn’t make it that way. For us it is a beautiful, personal, spiritual, sexual experience. And for us to have that, we become criminals.”

I shared this quote on the CfM Facebook page and several people commented that not much has changed today...

--
Molly
CfM Blogger

Medical Control as Acceptable

Still going through my saved-things-to-blog-about and want to share these thoughts from the book Brought to Bed: Childbearing in America 1750-1950 in the epilogue:

Many of birthing women's successes in increasing their powers over childbirth procedures have depended upon women reeducating themselves about childbirth. The enormous proliferation in recent decades of popular literature about giving birth, much of which advocates decreasing routine medical interventions, is evidence of women's attempts to reclaim knowledge previously more commonly held within women's world. When birth moved to the hospital and became dominated by technical interventions, women lost their understanding and familiarity with the processes of labor and delivery. Many women, realizing that their lack of knowledge distances them from their own bodies, are trying tor recover some of that lost knowledge through self-education in normal functions...

In addition to the women who completely challenge medical authority and those who want to find ways to work in cooperation with it, there is a third group of American women today who find medical control of childbirth as practiced in most hospitals perfectly acceptable. They find the prospect of delivering babies frightening or uninteresting, and they wish to experience as little of it as possible. They want to be assured of a healthy outcome, but they do not feel the need to participate actively in bringing it about. They, like many women of the 1920's and 1930's, eagerly turn over their decision-making power to their doctors, who, in turn, readily accept it. The women hope that medicine can provide a streamlined and easy experience and that they will not have to suffer too much either in the process of labor and delivery or in its aftermath. Many women enter the hospital and emerge from it with their babies without having given the experience itself very much thought. (emphasis mine)

This third group (as discussed in the second paragraph) is a conundrum to me and I think it is the main reason why the birth culture in the U.S. ISN'T changing rapidly in response to evidence-based information, great books, informative publications and websites, helpful doulas, awesome childbirth classes, etc. How do you reach women who just don't care? And, why as advocates, do we care if they don't? :( And, is it any of our business if a large subset of the population finds medical control of birth perfectly acceptable and even desirable?

I'd like to explore why I think it is our business in a later post, but first I have to clarify why exactly that is...

--
Molly
CfM Blogger

Grassroots Network: NIH VBAC Consensus Conference Information

Dear Friends,

The National Institutes of Health are holding a “consensus development conference” on the issue of VBAC in early March. You can attend in person but there is also the option of registering for the Webcast, where registrants will also be able to submit questions on-line.

The announcement below includes brief background, but you can find more extensive background, plus a listing of the entire program, at: http://consensus.nih.gov/2010/vbac.htm. There is also detailed information about the venue, transportation, etc.

On the web page above, there is a menu choice of “get involved”. The very last item is “contact us with questions or comments”. Given our experience with the consensus conference on “maternal choice cesarean section” a few years ago, the NIH definitely needs to hear from many people, from both inside and outside the hospital walls, for there to be any chance of a fair or meaningful “consensus” to be reached.

It is worth reading through the program topics and who is speaking on them. Almost all of the speakers are OBs. It is interesting that no mention is made of the use of drugs to stimulate or augment labor as an issue in the safety of VBAC –hopefully that will be addressed… There appears to be virtually no consideration about the manner in which VBAC is undertaken (support? Use of drugs? Attitude of provider? Type of provider? Etc.) which seems like a pretty important topic related to frequency, success and risks. There is a section for “mothers’ stories” – by a USA Today medical reporter, the next to last speaker on the program. Does anyone know her? And, of course, there is no listed topic addressing the high and increasing rate of cesarean section, an underlying factor.

We know consumers and others made a difference by attending, commenting and speaking up at the “maternal choice cesarean” NIH conference. So, let’s make use of this opportunity to make our voices heard in whatever way we can regarding VBAC.

Sincerely,

Susan Hodges, “gatekeeper”

===================================================

Join the National Institutes of Health's Consensus Development Conference on Vaginal Birth After Cesarean: New Insights

March 8-10, 2010
Natcher Conference Center | NIH Campus | Bethesda, Maryland
http://www.consensus.nih.gov

For most of the 20th century, clinicians believed that once a woman had undergone a cesarean, all of her future pregnancies required delivery by that procedure as well. In the 1980s, vaginal birth after cesarean (VBAC) also began to be considered a viable option for these women. Since 1996, however, VBAC rates in the United States have consistently declined, while cesarean delivery rates have been steadily rising.

What accounts for these changing practice patterns? Frequently cited concerns about VBAC include the possibility of uterine rupture during labor, infection, and other complications. However, repeat cesarean delivery carries risks for both mother and baby, and may impact future pregnancies.

Be part of pivotal discussions that will help answer critical questions related to vaginal birth after cesarean. The conference is free and open to the public. Your input is valuable. Please join us!

Information and Registration: http://consensus.nih.gov | 1-888-644-2667

Can't attend?
Webcast registration: http://consensus.nih.gov/vbacvideocast.htm -- there will be the ability to ask questions online.
Pre-order statement: http://consensus.nih.gov/vbacstmt.htm

Continuing Education for this activity is pending. Please see the final announcement for details.

Medical Care is a Consumer Issue

From the book Women and Doctors some good reminders that medical care is a consumer issue (and a business!):

"Keep in mind that health care is a business. Doctors would like to have you see them as thorough professionals, unsullied by such crass considerations as income and market share. Don't believe it! Not only are genuinely unethical and mercenary doctors actively marketing their operations, but well-intentioned doctors are doing it as well. In fact, the health-care system as a whole is actively pursuing you as a patient through the same techniques that everyone with a product is using to get you to be a customer. The danger lies in your failing to understand that. Be a smart and wary consumer, and keep the entire health-care system in the same perspective that you probably already have placed car dealers, insurance salesmen, and makers of food products."

And on a related note, here are some stats from the recent US Maternity Care Facts from Childbirth Connection:

In 2006, combined facility charges billed for "mother's pregnancy and delivery" and "newborn infants" ($86 billion) far exceeded charges for any other hospital condition in the United States.

In 2006, 42% of all maternal childbirth-related hospital stays were billed to Medicaid. The two most common conditions billed to Medicaid as the primary payer in 2007 were pregnancy and childbirth (28%) and newborns (26%), which together comprised 53% of discharges billed to Medicaid.

"Mother's pregnancy and delivery" and "newborn infants" were the first and third most expensive conditions billed to private insurance in 2006, involving 14% of hospital charges to private insurers, or $41 billion.

--
Molly
CfM Blogger

Birth Survey at CIMS Forum

Results of The Birth Survey to be featured prominently at the 2010 CIMS Forum!

Plus... Don’t Miss Ricki Lake , Judy Norsigian, Rima Jolivet, Penny Simkin, and many more!

Where do we begin? We have a spectacular line-up planned for the 2010 Mother-Friendly Childbirth Forum and Annual Meeting, Feb. 26-27, in Austin , Texas . Start planning now to attend this important conference--learn more at www.motherfriendly.org.

CIMS proudly announces that acclaimed actress, filmmaker, family advocate and author Ricki Lake , along with 15 distinguished faculty, will address attendees at the 2010 Mother-Friendly Childbirth Forum and Annual Meeting. Lake, an integral figure in the birthing community since the 2007 debut of the documentary The Business of Being Born and subsequent projects that encourage childbearing women to become informed maternity care consumers, has traveled tirelessly around the United States to discuss the state of the birthing “industry” in an effort to demonstrate how all parents-to-be can benefit from taking a more active role in their birth experiences.

CIMS' [and CfM's] own Nasima Pfaffl will present an important session titled "Thank You for Listening to Me: Trends and Patterns in the Results of The Birth Survey." As you know, The Birth Survey has been collecting national data on women’s birth experiences for the last 18 months. This presentation will provide information on the patterns and trends in the data captured through The Birth Survey. Questions such as, how do different provider types compare; do women who had a c-section or an induction report feeling pressure to have these procedures; patterns of responses about midwifery care; and how women have reported they feel about the quality of the care they have received. Data will be presented that is not available via the public website!!

Online registration to open soon. Please visit www.motherfriendly.org for additional program details, travel/lodging information, and to sign-up for our electronic newsletter.

Hope to see you there!

Articles of Interest

I have a lot of projects going on lately that are taking precedence over blogging here in a frequent or creative way (I am pregnant with my third baby and recently started teaching college classes. I also teach birth classes on a regular basis, homeschool my two boys, etc., etc., etc.). Bear with me and in January I should have more blog-time again!

So, this week I wanted to share some links to articles I read recently:

Three Minute Interview with Ginger Garner (yoga therapist) from the National Association of Mothers' Centers focusing on "Childbirth in America: Why it Needs to Change."

A quote I enjoyed from the article: "Birth is valuable. It gives rise to our entire future. There is power in our ability to give birth to the future of our planet. We need to reclaim that power."

Pregnant Prisoners article. In one residential parenting program mentioned in the article, "Another perk for pregnant women at the prison is access to a volunteer doula program. A non-profit group called The Birth Attendants offers monthly prenatal care, labor and delivery assistance, postpartum services, and family planning education courses."

Also getting a lot of attention in birth activism blogs are the new international infant mortality rankings.

Available at: http://www.cdc.gov/nchs/

Or directly from: http://www.cdc.gov/nchs/data/databriefs/db23.htm

Key findings

Infant mortality rates for preterm (less than 37 weeks of gestation) infants are lower in the United States than in most European countries; however, infant mortality rates for infants born at 37 weeks of gestation or more are higher in the United States than in most European countries.

One in 8 births in the United States were born preterm, compared with 1 in 18 births in Ireland and Finland.

If the United States had Sweden’s distribution of births by gestational age, nearly 8,000 infant deaths would be averted each year and the U.S. infant mortality rate would be one-third lower.

The main cause of the United States’ high infant mortality rate when compared with Europe is the very high percentage of preterm births in the United States.

--
Molly
CfM Blogger

Pit to Distress

There has been a lot of chatter on the internet recently about the "pit to distress" phenomenon apparently practiced in some hospitals. The phrase referred to the administration of Pitocin until the baby goes into distress and a cesarean can be performed. The Unnecesarean blog (as well as others) covered the topic in such depth, I don't have much to add! See this post and this post for her thoughts and quotes from a variety of sources. She quotes Keyboard Revolutionary (who I believe started the whole blog-flurry) as saying, “'OBs, do you still think women are choosing not to birth at your hospitals because Ricki Lake said homebirths are cool? Do you still think we are only out for a 'good experience?'"

Nursing Birth also has an excellent post on the subject.

All these posts and the "pit to distress" subject keeps making me think of the quote that opens Henci Goer's Obstetric Myths vs. Research Realities book: "Facts can be disproved, and theories based on them will yield in time to rational arguments and proof that they don't work. But myth has its own furious, inherent reason-to-be because it is tied to desire. Prove it false a hundred times, and it will still endure because it is true as an expression of feeling...It is illogical--or at least, pre-logical; but from this very fact it gains a certain strength: logic may disprove it, but it will not kill it."

This, to me, explains the essence of why harmful maternity care practices continue to persist in hospital settings.

--

Molly

CfM Blogger

Physicians & Birth

A few weeks ago, I read an older book titled Woman-Centered Pregnancy and Birth. I marked the following quote to share because I thought it succinctly summed up one of the primary issues in maternity care:

"The major problem which arose almost as soon as physicians started attending women in birth is the same problem which exists today in obstetrics: physicians use their medical techniques when they are not really necessary and their technology and practices often create more problems than they solve. It is possible to appropriately apply this criticism to nearly every form of technology which has been used by physicians on women in birth from the 1500's to the present."

I also noted an observation from the book Birth Tides: Turning Towards Homebirth: "To these people, it seems as thought the medical system has been reduced to a form of social control. [Another woman] makes the point, however, that controlling women has always been an intrinsic part of antenatal care."

I think the recent AMA resolutions I've posted about and the situation with private midwifery in Australia lend credence to the idea that the medical system is a form of social control!

--
Molly
CfM Blogger

Grassroots Network: Health Care Reform Kick Off Events

Dear Friends,

Organizing for America, a website run by the Democratic Party, is working to get more people involved with Health Care Reform efforts. The activity is to have gatherings or house parties—Kick Off events -- on June 6 (yes, in just a couple of days!). You can host an event, or you can find one already scheduled in your town just by entering your zip code (see link below).

These gatherings do not have to be big and fancy, but they can focus attention on the importance of Maternity Care in health care reform, and in particular on Midwives, especially Certified Professional Midwives, as an important part of the solution.

President Obama has stated that real reform must uphold three core principles -- it must reduce costs, guarantee choice, and ensure quality care for every American.

Federal recognition of Certified Professional Midwives, so that they are eligible for Medicaid reimbursement, would address all three goals without costing anyone any additional money, and would actually save us all a lot of money.

Below are suggestions for participating in these Kick-Off events. Whether you host one or participate in one, you can talk about maternity care, midwifery and especially the financial and health benefits of increasing access to out of hospital birth with Certified Professional Midwives.

For additional useful facts and information:

CfM’s letter to Obama “Maternity Care: A Priority for Health Care Reform”

“State of American Childbirth”

“Out-of-Hospital Midwifery Care: Much Lower Rates of Cesarean Sections for Low-Risk Women"

“CPM Issue Brief - Certified Professional Midwives in the United States”

Additional factual information here (scroll down home page for Childbirth Connection’s “Health Care Reform Priorities for High Quality, High Value Maternity Care” and the Milbank Report on Evidence-based Maternity Care).

How to Participate in the Health Care Reform Kick Off Parties

1) Go to the Organizing for America website that is run the Democratic National Committee

2) Register if you do not already have a user name and password.

3) Click on "Host or Attend a Health Care Organizing Kick off"

4) Create your event, entitled, "Midwifery and Health Care Reform – (Your Town)." We would like all of the events to have the same name so that we will be more noticeable.

5) Follow the instructions to create your event, including inviting as many people as you can think of. Here is a description that you can use for your event:

"This 2 hour event will be designed to inform consumers and health care practitioners about the value of including midwifery in the upcoming Health Care Reform bills. We will discuss how everyone can get involved. Light refreshments will be served."

You can, however, say whatever you would like and plan whatever you would like.

6) Download or at least read online the instructions on how to host a Kick Off event. It will give you a little sense of what they are looking for. Our events will be more specific to midwifery. At some point during your event, you can have attendees log on to the Organizing for America site and write their stories. If you don’t want to host an event, attend one that is already scheduled and speak up about CPMs and home birth.

7) These kick offs are designed to mobilize people around spreading the word about health care reform. We want to mobilize people around spreading the word about how midwifery can be included in health care reform. Brainstorm ideas for talking to key legislators and policy makers in your area.

8) These kick offs are also wanting to inspire folks to do Health Care Service projects on June 27, 2009. Brainstorm how your group might “show off” how wonderful midwives are and could be in your community. How about collecting baby clothes donations for the homeless or low-income families. What about offering a free day of prenatal visits, massage and yoga. Be creative, be fun, be visible.

So…. Let’s be part of the national debate. We need to be concise, consistent and VISIBLE!! Have fun and let us know what happened!!

Sincerely,

Susan Hodges, “gatekeeper”

Susan Hodges is a Women's Health Hero Nominee!

As a follow-up to my previous post, Citizens for Midwifery President Susan Hodges has been nominated for a "Women's Health Hero" Award. You can view the nomination here.

From OBOS:

"One winner will be chosen by the staff and Our Bodies Ourselves' Board of Directors, while the other winner will be determined by the public through a ratings system located on the contest website. Public voting ends May 8, 2009 and the entry that receives the highest overall ranking will receive the Audience Choice Award. So don't forget to ask friends, family and co-workers to rate your entry. "

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Molly
CfM Blogger

OBOS Women's Health Heroes

Our Bodies, Ourselves is seeking nominations for their "Women's Health Heroes" contest. I can think of many women I'd like to nominate and hope to have a chance to do so soon. Here is some more information about the contest from OBOS:

When you hear the words "Women’s Health Hero," who comes to mind? Your 9th grade health teacher who taught you about sexually transmitted infections? The midwife who sat with you through 15 hours of labor? The young Nigerian activist you read about who’s working to end gender discrimination in her country? Or maybe the neighbor who counter-protests at the abortion clinic every Saturday morning?

Whoever your heroes are, we want to know about them! We’ve created the Our Bodies Ourselves Women’s Health Heroes awards to honor those who make significant contributions to the health and well-being of women. It’s a great way to publicly recognize people who make a difference in your life or the lives of others.

Nominations are now being accepted. Please visit http://www.ourbodiesourselves.org/heroes.asp for more information.

Contact Wendy Brovold, Communications and Marketing Manager at wendy@bwhbc.org or 617-245-0200x13 with questions.

Violence, Women, & Birth

Edited to say that I made a mistake with the posting dates on my posts this week and International Women's Day was Sunday, March 8th.

Today is International Women's Day. The United Nations theme this year is "Women and men united to end violence against women and girls." As I've referenced before, domestic violence was the first cause in which I became deeply invested. Though I do not work in shelters any more and my focus has shifted to birth work, I continue to pay special attention to matters concerning violence against women. So, this theme naturally made me think about violence against women in the birth place. In 2002, Susan Hodges wrote an article for CfM News called "Medical Model Maternity Care and 'Violence Against Women'" and I wanted to share some thoughts from that article today.

Susan wrote:

I recently read an article from The Lancet that put “what’s wrong” into language that made me sit up and take notice. In Violence against women in health-care institutions: an emerging problem by A. F.P.L. d’Oliveira, S.G. Diniz and L. B. Schraiber (The Lancet, Vol. 359. May 11, 2002) the women authors looked at documentation of violence against women in health institutions worldwide, focusing “on four types of violence: neglect; verbal violence, including rough treatment, threats, scolding, shouting, and intentional humiliation; physical violence, including denial of pain relief when technically indicated; and sexual violence.” In other words: emotional, physical and sexual abuse. The authors go on to specifically mention violence against women in reproductive health services: “These forms include excessive or inappropriate medical treatments in childbirth, such as doctors doing cesarean sections for reasons related to their social or work schedules or financial incentives; or adhering to obstetric practices that are known to be unpleasant, sometimes harmful, and not evidence based, including shaving pubic hair, giving enemas, routine episiotomy, routine induction of labour, and preventing women having companions in labour.”

In other words, our work is about stopping violence against women in the birthplace – we just haven’t been calling it that. I am not saying that everything that happens in hospitals is bad, or that even the abusive aspects of hospital maternity care is necessarily equivalent to being raped or beaten. However, abuse is abuse, from relatively mild to severe, and just because it is not extreme does not negate the fact of abuse or violence against women. In particular, we are talking about government-regulated health care being provided to women having babies – we should expect and demand that every aspect of that care is the opposite of abusive, that the care is respectful of us in every way.

Think about the stories you have heard, or seen on TV, or just read in the newspaper. Here we are, healthy women giving birth, but the doctor or hospital does or does not “allow” us to walk, eat, drink, have a doula, or whatever! Think of all the times women have been threatened “if you don’t progress to x-centimeters by such-and-such a time, you’ll have to have a c-section,” or told to shut up during labor, or coerced into interventions, or berated for complaining, or yelled at to PUSH. Think of all the times vaginal exams and other interventions have been conducted without asking the woman’s permission, and sometimes by strangers. Not to mention all the invasive interventions (drugs, IVs, episiotomies, etc.) that are commonly imposed without informed consent, or women who are persuaded to acquiesce by means of lies about their necessity and lack of information about risks. Etc. etc. etc. We have known these things are wrong and very disturbing, but most of us have not called them acts of “violence against women.” Under any other circumstances, many of the actions and behaviors visited upon women laboring in hospitals would be completely unacceptable as verbal abuse or, in many cases, could warrant legal action for assault and battery. They certainly include acts that are in violation of professional conduct and standards of care as delineated in state laws. Violence against women is about abuse of power, whether on the street or in the hospital. So let’s start calling the disrespect, violations of privacy, loss of freedom, unnecessary interventions, intimidation, etc. what they are: Violence Against Women.

Speaking of hospital care and women, there is another good article from CfM News available online called Effects of Hospital Economics on Maternity Care.

And, this post by Gloria Lemay has been making the rounds lately and I think it is also fitting for today: Are You a Good Candidate for Hospital Birth?

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Molly
CfM Blogger

International Women's Day

International Women's Day is coming up on March 8th. This holiday has been celebrated since the early 1900's, particularly in European countries. You can read about the history and purpose and watch a quick video here (the video is from Russia and so only addresses the holiday there and its connection to socialism). I did a quick search of the International Women's Day site for "midwifery" and "midwives" and came up with ZERO results. Then, I searched for "birth" and "childbirth" and came up with next to nothing. There is a section on the site where you can submit your own stories for publication on the site. I'm envisioning several people contributing thoughtful articles about midwifery care and maternal health in time to honor the 2009 International Women's Day. If you contribute something, please be sure to let me know!

Here is a press release I received about how some birth activists are planning to recognize International Women's Day:

FOR IMMEDIATE RELEASE
A celebration of International Women’s Day is planned on Sunday, March 8 at the Coudersport Public Library, highlighted by a screening of “Singing The Bones,”
a full-length movie that tells the story of three generations of women brought together by a single birth.

The celebration is the brainchild of longtime childbirth educator Donna Batterson, who is the coordinator of the Healthy Beginnings Plus program for Charles Cole Memorial Hospital. She brought the idea to Freda Fultz of A Way Out and Jane Metzger, a Coudersport Library trustee, who enthusiastically agreed to collaborate on this special celebration.

“We wanted to offer a time for women of all generations to join in celebration of this special day,” says Batterson. “We envision it as a time for mothers, daughters and grandmothers to spend time together celebrating our womanhood.”
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Perhaps there are other such events planned across the country--or, perhaps you could organize a recognition of your own! If not this year, maybe start planning for 2010.

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Molly Remer
CfM Blogger