What’s the connection between health care reform and midwifery care?

July 8, 2009

My first article is up at The American Prospect, about Certified Professional Midwives and health care reform. I talked to some amazing advocates in reporting for the piece, including Michelle Bartlett, an Idaho midwife who helped push through licensing legislation in her state.

Michelle Bartlett is not the typical Washington high-stakes health-care player. She’s probably not on the radar of anyone in Congress or the Obama administration. Bartlett is a midwife in Idaho, but in the last few years, she’s been trying her hand at lobbying. This came after a night spent in jail for using medication during a home birth she attended in 2000. Bartlett was the second midwife to be charged for this type of practice in Idaho, and thanks to her efforts, she will be the last in her state. “I’ve done a lot of hard things in my life, and giving birth was one of them,” Bartlett says. “But giving birth to a law was really hard.”

On April 1, Gov. C.L. “Butch” Otter of Idaho signed legislation allowing certified professional midwives (CPMs) like Bartlett to administer medication during births. Unlike certified nurse midwives who are able to practice in all 50 states and generally work in hospital settings alongside obstetricians, midwives like Bartlett are referred to as “direct entry” midwives, and practice exclusively outside of hospitals, mostly in homes or birth centers. These CPMs spend three to five years training and meet the standards for certification set by the North American Registry of Midwives.

…

State licensing fights may be the first step for these midwives, but it’s not their last. Now they’re turning their attention to the federal health-care reform debate, and a look at the maternity-related health-care costs quickly explains why. Childbirth is among the top five causes for hospitalization, and the No. 1 cause for women. According to Childbirth Connection, Cesarean section is the most common operating-room procedure, and in 2009 the C-section rate hit an all-time high according to the Centers for Disease Control and Prevention, at 31.8 percent of all births. These rates account, in part, for the increasing cost of maternity care in the U.S. Maternal and newborn charges totaled $86 billion in 2006, 45 percent of which was paid for by Medicaid. The federal government is already footing a huge portion of the U.S.’ maternity-care bill, and these midwives think they can help reduce costs significantly, and not just for low-income women.

Check out the rest of the article here.

If you want to join the advocacy efforts mentioned in the article, check out The Big Push for Midwives and The MAMA Campaign.

Leave a Comment » | birth, home birth, midwives | Permalink
Posted by radicaldoula

Great article on the practice of shackling incarcerated women

July 6, 2009

Anna Clark has a great piece up at RH Reality Check about the practice of shackling incarcerated women. She delves into both the realities of the practice (horrific) and the amazing activist response that has arisen to organize against this practice (and has been successful!). Here is an excerpt:

The 2008 federal policy against shackling cued renewed hope among advocates for the humane treatment of incarcerated women. Beyond lawsuits and advocacy with individual departments, legislative campaigns to restrict shackling are finding unprecedented success-after years of falling on deaf ears.

New Mexico is the most recent state to bar shackling through a bill signed by Governor Bill Richardson this spring. New York and Texas currently have bills backed by legislative support that await the word of their governors before they become law. “For us, it’s not enough to change regulations (on shackling in particular prisons),” Saada Saar said. “To do this campaign through the legislature gives us a way to respond to violations of the policy. Through state statutes, mothers’ rights are better protected.”

“A lot of states do have corrections policies that restrict shackling, but (the policies) aren’t commonly known or understood,” Sussman said. “A law allows us to go to court; it makes it hard for others to say they didn’t know (that shackling is restricted).

“We have a strong case in Illinois because of the law there, for example. We need to bring cases to ensure enforcement,” Sussman added. “It’s a dual strategy.”

It’s a strategy that inspires diverse support. Broad coalitions are signing on to legislative and legal campaigns to transform the experience of giving birth in prisons, jails, and detention centers.

Among those backing the New York Anti-Shackling Bill are women’s health advocates, prison rights organizations, medical and public health groups, and “even fellowships and ministries that aren’t our frequent allies,” Sussman said.

Read the rest here and more from Anna Clark here.

1 Comment | activism, birth, reproductive justice | Permalink
Posted by radicaldoula

Latino’s born to midwives will no longer be denied passports

June 29, 2009

An update to this story from almost a year ago. It was reported by the NY Times that Latinos born near the border to midwives were having their citizenship challenged.

Well some good news for us on this front from the ACLU:

Pending court approval, DOS will train its staff on how to fairly weigh all the evidence provided in passport applications and how to avoid improperly subjecting people whose births were assisted by midwives in Texas and along the U.S.-Mexico border to heightened scrutiny in reviewing their passport applications.

All denials will be automatically reviewed by a three-member panel comprised of experienced DOS staff members, and if that panel also denies an application, DOS must communicate the specific reasons for the denial to the applicant. The applicant can then challenge the denial and ask DOS to reconsider its decision.

Additionally, anyone birthed by a midwife who has filed an application for a passport between April 2003 and September 15, 2008 and, with a few exceptions, whose application was not expressly “denied,” can re-apply for free. DOS will be setting up mobile units across the border on specific dates to assist those reapplying.

Via Latina Lista

1 Comment | birth, midwives, racism | Permalink
Posted by radicaldoula

Home birth in Australia may soon be illegal

June 26, 2009

New legislation in Australia that requires all midwives to be insured may make home birth illegal and inaccessible.

From News.Com.Au:

Under the draft Health Practitioner Regulation National Law, released last week, a midwife cannot be registered unless she has insurance.

But with insurance companies and the Government so far refusing to include homebirths in the indemnity scheme, midwives will face being de-registered if they attend a homebirth.

Via Citizens for Midwifery.

This is really terrible and this insurance squeeze often effectively makes midwifery illegal/inaccessible in the US too.

1 Comment | birth, midwives, news | Permalink
Posted by radicaldoula

From the clinic: How we make choices about birth providers

May 15, 2009

So I’ve been volunteering at a clinic, helping a midwife with translation (and other odd tasks) with her mostly Latina immigrant client base.

I’m really loving it, working with pregnant women again, doing direct service with latinas. I’ve missed being in a healthcare provider setting, and I miss doing doula work too. I’m working on it.

The women who come to the clinic get to decide where to give birth and with what type of provider. Her options are:

1) Hospital birth at teaching hospital with residents

2) Birth Center birth with Certified Nurse Midwives (CNMs)

3) Birth in the teaching hospital, but with care from CNMs from the birth center

This third option is really cool and not one I’d heard of previously. Most of the time, CNMs that deliver in hospitals are staff of the hospital and have a practice based there.

So the majority of the women this midwife sees choose hospital births. Now that midwives are an option in the hospital, it’s presenting a new possibility. But many of these women (like all women) have LOTS of preconceived notions about midwives. One woman who is almost due illustrates this really well:

Maria (not her real name) is from Honduras. She’s a spanish speaking immigrant and is pregnant with her third child. When we presented the possibility of having a midwife attend her birth in the hospital, she told me (after a little prodding) that her partner was really against her having a midwife. She said that he was born to a midwife at home in Honduras, and that the midwife dropped him on his head during the birth, which caused him to have a permanent eye deformity. Maria didn’t think it was worth it to fight with him about it, even though she was open to having a midwife there instead.

Ok, a few things about this. First, obviously the power dynamics between mom and partner are intense. Second, immigrants bring with them to the US all sorts of preconceived notions about how people should give birth. Some of it is based on life experience, like this, some of it is based on hearsay, feelings about class and health care models, a ton of things.

It’s very possible that her partner was delivered by a midwife at home. It’s also very possible that he was dropped at birth. It’s not necessarily true though, that it caused his eye deformity. The point is, it doesn’t matter, because this is the story he believes. And it’s informing his choices now. That’s a lot for providers here to contend with.

My main take away from all of this is that the issue of educating people about their birth options is so complex. It’s not just about what we’ve seen on tv, what we’ve heard from our families. There are layers upon layers of knowledge and preconceived notions we have to unpack to change the choices people make about how to birth. For immigrants we have to deal with a whole other cultural context, role for midwives, medical system and structure. Understanding this is the just the beginning of culturally competent care.

Leave a Comment » | birth, experiences from the clinic, immigration | Permalink
Posted by radicaldoula

Mothers Day good news: Better access to home birth in Washington State

May 9, 2009

It’s nice to have some good news to share on Mother’s Day. I recently interviewed some advocate, midwives and doulas in Washington State about out-of-hospital birth options there. It’s good news and their model is really making headway for other states and access to midwifery. I elaborate on this in a new article over at Reproductive Health Reality Check, Barriers to Home Birth Fall in Washington State:

Nationally, only a small portion of women give birth outside of hospitals (around 1%) and very few of those women are low-income. In a recent piece for RH Reality Check, The Cost of Being Born at Home, I painted a grim picture of the options afforded to low-income women around the country who are considering out-of-hospital birth. Few out-of-hospital childbirth providers are registered with Medicaid. Cost and physical space available at women’s homes are also significant prohibiting factors. And lack of knowledge of the practice, as well as lack of targeting from media and advocacy promoting home birth (such as the pro-home birth film The Business of Being Born), impact low-income women’s decisions about where to birth.

But there’s at least one exception to this national trend, brought up by the advocates I interviewed and by commenters responding to my original piece-Washington State. In fact, thanks to a history of expansive access to midwifery care and a number of big legislative gains, low-income women in Washington State now have more birthing options than most women around the country.

According to Audrey Levine, President of the Midwives Association of Washington State (MAWS), 2.3% of births statewide in 2007 were performed out-of-hospital.  While still a low percentage, that’s more than twice the national average of 1%. What is even more impressive is the number of those births that are reimbursed by Medicaid.  According to Levine, around 45% of out-of-hospital births attended by midwives in the state are Medicaid births. That mirrors the percentage of births to women on Medicaid overall in the state-also around 46-47%. (Of the 26 states that license CPMs, only 9 allow CPMs to participate in Medicaid, so this percentage is a significant departure from the situation nationally.)

Read the rest here.

Also stay tuned for details about a home birth and low-income access live chat with me and a midwife at RHRC next week!

1 Comment | birth, midwives | Permalink
Posted by radicaldoula

What birthing women definitely DO NOT need

May 4, 2009

The due date is quickly approaching…..
Everyone is eagerly waiting to see the new addition to the family. The pictures that are taken will be in the albums forever…..
but wait, who is that unrecognizable monster in a hospital gown?
NOT YOU!

Finally there is A Dressed Up Delivery!

We at Pretty Pushers believe that you deserve to look your best when you work your hardest. The enclosed five items are sure to keep you feeling fabulous until the job is done!

I’m sure you’re dying to know what these five magical items are. 1) Pink lip gloss and a mirror 2) A “delivery dress” 3) A headband 4) A lemon-water towelette 5) Heated massage oil

As a doula who has accompanied women during childbirth I can tell you that the only useful thing in the kit is the massage oil and maybe the headband. Massage can be great for pain mediation during labor, and if your hair is long you might want it out of your face. Oh, and the mirror could come in handy, because some women like to see what they are doing as they push.

Perpetuating screwed up ideas about women’s beauty is already infuriating enough, but now we need to mix it in with childbirth. If you’ve ever actually been with a woman after she’s given birth, I’d say she looks pretty damn beautiful, sweat and all.

Cross posted at Feministing.com

7 Comments | birth, stupid products | Permalink
Posted by radicaldoula

Lost in translation

March 5, 2009

My inspiration for this post.

I’m bilingual. I spoke Spanish before I spoke English because I grew up with two Cuban immigrant parents. My mom likes to joke about how she dropped me off at my preschool in my mostly White Southern town and handed the teacher a Spanish/English dictionary so she could communicate with me.

Being bilingual gives you an interesting lens on the world. Mine is particularly interesting because although I am Latina, you wouldn’t necessarily know by looking at me. I pass, most of the time, as white. That means a lot of things, some of which I may some day tackle here, but in this context it means I get to hear things, in both languages, that other people don’t.

As a doula this was particularly enlightening/challenging because I got to hear and understand everything a doctor was saying but not communicating to their patient when she didn’t speak English. I got to witness the jokes between doctors, the decisions about care that were being made without consultation, the idle chatter and conversation that they carried on in her presence. Then I had to make a decision. Do I tell her what they are saying?

I was taught that a doula shouldn’t be a translator. My doula trainer explained, with the best of intentions, that those roles should be separate. Just like a doula doesn’t replace a partner, they can’t replace a translator.

That’s great in an ideal world, where everyone has exactly what they need. But let’s remember where we live: planet not so ideal. On this planet, translators are only brought in when there is paperwork to be signed. On this planet, doctors/medical students/nurses with a working knowlege of Spanish get to communicate with the patient when and if they want to. On this planet, a Spanish speaking doula may be the only thing helping a Spanish speaking mom/family/partner feel safe.

So I had to make decisions. Constantly. Decisions about when to translate, what to translate, how to translate. Having to be a filter never felt good, even when I felt like I was protecting her from hearing something she wouldn’t want to hear.  I didn’t want to be the only one in the room who could communicate her needs/questions/concerns to her providers. I didn’t want that power.

What would my ideal world look like? Well, first of all, women would get treated exactly the same regardless of what language they spoke. Doctors/nurses/people wouldn’t talk about a patient in a language she didn’t understand in front of her. They would get consent for everything they did, before they did, and explain every step along the way. 

And that’s just the beginning.

5 Comments | birth, doulas, dreams, language, racism | Permalink
Posted by radicaldoula

Home birth and class

March 2, 2009

I’m working on an article for RH Reality Check about the lack of class perspective in the home birth debate. It seems to me that much of the discussion about home birth (and other alternative birth options) are framed in the terms of consumer choice, which doesn’t take into consideration those who can’t make that choice, or don’t have that option (for reasons of insurance, money, providers, home environment,etc). I wrote about this a while back when the NYTimes had that story about home birth that seemed to only feature wealthy white women in NYC.

I’m looking for doulas, midwives and other birth advocates/activists who have experience with home birth and thoughts on this issue.

Please email me at RadicaldoulaATgmailDOTcom.

Thanks!

4 Comments | birth, class | Permalink
Posted by radicaldoula

Latina immigrant who was shackled during labor now faces deportation

February 27, 2009

Juana Villega de la Paz made news this summer when she was detained by a police officers for driving without a license while 9 months pregnant. She was found to have no documents and ended up giving birth with in detention and was treated as a securty threat. She was shackled during parts of her labor, a practice that occurs at jails and prisons around the country but is being actively contested.

Juana was released after the birth of her child and told to report to the authorities each month. She just received news that she will be deported the next time she reports.

This story highlights a number of things: the inhumane way people are treated while incarcerated, the way undocumented immigrants are being treated like they are violent or dangerous criminals and the ahborrent state of our immigration policy.

Juana is currently using legal venues to prevent her deportaiton. She has four American citizen children.

1 Comment | birth, immigration, racism | Permalink
Posted by radicaldoula

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