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New report takes maternal mortality concerns to the UN

August 28, 2014

It’s a problem we all know about, and one that just keeps getting worse. A new shadow report, written for the United Nations International Convention on the Elimination of Racial Discrimination, examines the ongoing crisis of maternal mortality for African-American women, which I wrote about in my latest article for Colorlines.

“Over the last 40 years, the rate of black women dying in childbirth has been three to four times the rate of their white counterparts. For example, in Fulton County, Georgia, which includes Atlanta, there are 94 maternal deaths per 100,000 live births for black women—three times the national average. The white maternal mortality rate in the same county is essentially zero—too insignificant to report. In Chicksaw County, Mississippi, the maternal mortality rate is higher than those in countries of Sub-Saharan Africa, including Kenya and Rwanda.”

It’s so upsetting to see this crisis worsen, and wonder whether there is any political will to really address it. The report also includes anecdotal evidence from two focus groups conducted in Mississippi and Georgia by Sistersong, where black women shared their experiences with health care. Unsurprisingly, there were many accounts of racism, miseducation and disrespect experienced.

One woman from Jackson, Mississippi, shared that her doctor had assumed she wouldn’t be able to use birth control effectively: “After I had the baby, and I went back for my checkup…[the doctor] told me, ‘I’ll see you in six weeks.’ I said, ‘Why?’ He said I’d be pregnant again.” Others described prenatal and labor experiences where they didn’t feel their providers adequately informed them of their options. Another woman from Jackson had this to say: “We really don’t have a lot of good experiences when it comes to having childbirth, especially because we’re poor…Why are all these women having caesareans? Was it really necessary for me?…You have more black women having caesareans. Now I’m questioning.”

I didn’t include this in the article, but Monica Raye Simpson, Executive Director of Sistersong, told me that doulas and midwives were brought up in both focus groups. While we may not be able to solve maternal mortality on our own, we may be able to improve individual women’s health care experiences by providing support and resources.

The report also addressed lack of access to health care because of immigration status for Latina women living in South Texas.

My only hope is that the more we raise the alarm about this problem, the more likely we are to see steps taken to address it.

Read the full article here, and the full report here.

 

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NYTimes: Abortion and Birth, Together

June 25, 2014

In case you missed this article from two weeks ago, I was interviewed by journalist Alissa Quart for an article about full spectrum reproductive justice work.

These doulas partner with clinics directly and accompany women to their operations, helping to alleviate pain through techniques like massage, acupressure and breathing. One of them is Ms. Pérez. When I met her in a Lower Manhattan cafe, she explained how she and others like her volunteered for years at hospitals and clinics, accompanying many women whom they met in waiting rooms for their abortions. Ms. Pérez speaks Spanish, and sometimes she would translate as well. “I want to push back against the idea that birth is over here in this corner and abortion is over there in that one,” she says.

This is by no means the first article I’ve been interviewed for over the years, and not even the first that was maybe going to be in the NYTimes. That kind of media coverage comes with the territory of being easily found by googling “abortion doula”–mostly a product of how long this blog has been around (7.5 years!). Also in the interest of full disclosure on how the media world works, Alissa and I have a mutual friend who also suggested she talk to me.

But it’s clear that the work of full spectrum doulas is gaining some momentum, and some media recognition. This NYT article is a big one, simply because of the level of visibility that such a publication has. And I won’t lie, there was a thrill in picking up an actual physical newspaper and seeing my name, and quote, in print.

Just a few days after the NYT article went live, another article about abortion doulas, this one featuring the work of Lauren Mitchell, a co-founder of the NYC Doula Project, was published.

And there are more to come (I’ve already gotten another interview request from a journalist wanting to write about the topic). I always offer additional suggestions of people in this work to talk to, usually suggesting other doulas of color, and I’ll continue to do that. This movement has been fueled by the labor (pun intended) of many, and it’s important to me that my blog, and writing, don’t overshadow the many people who’ve contributed and led this work.

It’s exciting to see the fruits of so many years of work from so many of you turning it to legitimate attention. I do think the connections between abortion and birth highlighted in the NYT article are radical and affirming and have the potential to counter a really damaging political environment that tries to drive a wedge between experiences that are part of our lives.

I got one question from a midwife after the article was published, in reference to this quote:

“Midwives didn’t talk about abortion, really,” says Miriam Zoila Pérez, a doula and author of “The Radical Doula Guide.” And, she said, “some people in the midwife community are anti-choice.”

She wrote to ask if I was misquoted, and talked about the many midwives (herself included) who are indeed pro-choice. I know, and am really happy to know, that there are many in the midwifery community who are supportive of all reproductive choices, including abortion. Midwives are abortion providers in many places of the world, including in California now that legislation allowing midwives to provide some abortions passed last year.

What the first half of my quote was referencing was my experience in the birth activist community, particularly in 2005-2009, where I never heard abortion referenced overtly, particularly in birth activist writings or at the MANA conference I attended in 2005 or 2006. While the political orientation of midwives when it comes to abortion varies widely, there has been a history of silence on the topic, I assume in an effort to avoid conflict and focus on common ground between politically disparate groups. There is a contingency of midwives and doulas with strong religious views that are anti-choice. I in no means want to minimize the amazing work of pro-choice and full-spectrum midwives, but much of what lead me to start this blog was that silence on issues like abortion (as well as race, sexuality, immigration, gender and more).

I’m excited to see these topics being addressed in a more overt fashion across the birth activist world, and hope we’re moving closer to providing truly comprehensive and non-judgmental support to folks throughout their reproductive lives.

 


Ten things to consider when choosing a birth doula

May 6, 2014

I often get questions from friends or readers who are looking for a doula, and unsure of how to go about finding and choosing one. So here are a few things to consider.

1) What kind of support are you looking for? You may not know exactly, but it is important to envision your ideal pregnancy and birth experience, and think about what role you see a doula playing. While there are certain things that doulas cannot do (anything medically-related to the pregnancy, for example) there is a lot of flexibility when it comes to the doula’s role, and what you might want to look for when it comes to choosing the doula. For example, if you’re really interested in massage as a technique for relieving contractions, you’d want to look for a doula who has experience with those techniques. Or maybe you have a really engaged partner, and you want a doula who is experienced at working with partners to help them be involved in the birth process. Do your best to envision what kind of support you might want, and then ask questions of the doulas you meet that are specific to those things. You’ll likely change your mind along the course of the pregnancy, or during the birth itself, but it’s a good starting point and helps evaluate the skills of the doula you choose.

2) I think the most important thing, above all the details about a particular doula, is chemistry. Do you feel comfortable with this person? Do you feel at ease? Do you have any connection with them, do you get along? Do you feel comfortable communicating openly and honestly with them? These characteristics are less tangible than other factors you might consider, but I think it’s the most important, and why I recommend meeting potential doulas in person (you might consider a phone call first with a few potential doulas, and then meeting in person with the top one or two). Some doula collaboratives have regular meet and greets where you can talk to a number of potential doulas at once–another good option that is also less time-consuming than one on one outreach.

3) Ask for referrals from friends. There are lots of places to find potential doulas, but I think referrals are the best place to start. If you know people who’ve worked with doulas before, ask them for recommendations. It’s likely you may even have doulas in your social or professional network. I wouldn’t pick someone solely because of another’s positive recommendation because what one person needs in terms of birth support is really different than another, but it’s a great place to start, and then you can explore more in depth with others.

4) Check out local birth and baby expos or fairs. Another place you can meet a number of potential doulas at once, which can be a great way to explore options. Bonus: you might meet prenatal massage therapists or birth photographers as well!

5) What’s your budget? The vast majority of doulas are paid for by the clients, out of pocket. A few insurance companies are starting to reimburse, but it’s rare. The doula you work with may be able to give you more information about potential insurance reimbursement, but it’s a good idea to be prepared to pay out of pocket. What can you afford? Doula services range widely in terms of cost–anywhere from free or barter if a doula is in training, or has a sliding scale for low-income clients–to up to $3000 for a really experienced doula in an expensive metropolitan area like NYC. The fees also depend on what services the doula offers. Consider your budget and what you’re able to afford when exploring potential doulas.

6) How important is it to you to have a doula whose identity or experiences mirror your own? While diversity in the doula community is still a struggle, there’s a growing number of doulas from diverse backgrounds. Does it feel really important to work with a queer doula, a doula whose race or ethnic background matches yours, a doula of color, a doula who is an immigrant, who speaks a language other than English? There are two things to consider here: whether it’s important that they come from the same community as you, or that they simply have experience working with people from that community. You may find that having a straight doula is fine even if you are queer, as long as they have experience working with other queer clients.

7) Do you have any specific pregnancy or birth experiences you want the doula to have experience or expertise in? For example, if you’re pregnant with multiples, it might be important to find a doula who has worked with other clients with twins before. Or if you’re having a second birth, and your first was a c-section, maybe you want a doula who has worked with a VBAC client before (vaginal birth after cesarean). If you’re considering an epidural, you may want a doula who has worked with epidurals before. Or if you’re giving birth at a birth center, or at home, you may want to ask potential doulas if they have worked with people in those settings.

8) Is political alignment important? Do you want a doula whose political perspectives or values match your own? If you’re a solidly pro-choice atheist, for example, would you be okay working with a doula who was very religious and pro-life? Many doulas wouldn’t let their personal beliefs interfere with their doula work, but it’s worth considering how you feel, and assessing this when you meet with potential doulas.

9) Ask for references. Just like when considering hiring anyone, you might want to ask for references of other people who’ve worked with that doula. It can give you a sense of what they are like in practice, and give you an opportunity to ask questions of someone who worked with them.

10) A few other places to look for doulas: I have many radical doula profiles you can browse here (with the caveat that these are not endorsements, simply a series for anyone who self-identifies as a radical doula), and you can also look at any number of doula training organizations for doula listings in your area (DONA for example has a directory of doulas by location). You can also use google to browse doulas with their own websites, or find doula collaboratives. Also consider asking your provider (OB, midwife, primary care provider, massage therapist, etc) for recommendations.

Other doulas or people who’ve worked with doulas, are there things you would add to this list? Add them in the comments.


Remarks from SQUATfest: Birth activism as part of the movement for reproductive justice

September 3, 2013

In early August I had the honor of speaking at the SQUATfest conference. It was a first of its kind gathering that brought together doulas, midwives and other birth activists interested in radical politics. It didn’t have a central theme, but I knew that it was going to be a unique space.

I gave the talk below to the attendees on the morning of the second day. I have a lot more to say about the gathering, and the topics I addressed below, which I’ll do in follow up posts. Makeda Kamara gave an absolutely earth-shattering and life-altering keynote address the following day. I don’t believe that it was recorded, but if you ever have a chance to read Makeda’s writing or see her speak, you have to do it. She has incredible wisdom about midwifery, as well as racial justice movements in the US and abroad.

The gathering was inspiring, but it was also another reminder that there is much work left to do, even within the “radical” parts of our movement, particularly around questions of racial justice and dealing with white privilege.

—————–

The reason I started my blog, Radical Doula, in 2007, was because I couldn’t imagine a room like this one existing. I had been a doula for a few years, and as my own identity and politics developed, I looked around me and felt alone.

I felt alone as a queer and genderqueer person. I felt alone as a Cuban-American, a Latina, a child of immigrants. I felt alone as a reproductive justice activist and someone who supported access to abortion as well as access to homebirth and midwives. I felt alone as someone who approached my work as a doula as social justice activism.

I remember one of the first, possibly the very first, conversation I had with another doula who felt similarly. Christy Hall, who is here today, and I met at a reproductive justice conference, and the memory of crouching in the corner with her, infant in arms, talking about being doulas with radical politics is seared in my brain.

So very much has changed since that first conversation all those years ago. The fact that this gathering is happening at all is a major testament to that change.

Needless to say, I no longer feel alone. Instead I’m in awe of the incredible growth in the doula movement, and particularly in the movement of doulas who see their work as part of a broader social justice vision. For so many of us, this work isn’t just about improving a few select people’s experiences with pregnancy and birth–it’s about changing the systems altogether.

This is no easy task. And while the growth and expansion of the doula movement is really good news in many ways, it also presents its own unique challenges.

What I wanted to talk about today is how I see our work as birth activists as part of the broader reproductive justice movement.

For those of you who aren’t familiar, reproductive justice is a movement that was established by women of color in the reproductive rights movement who wanted a framework through which to see their organizing that better mirrored the lives of the people in their communities. It’s an intersectional framework that acknowledges the complexity of people’s lives and the many issues that affects them.

One way I describe it is building a world where everyone has what they need to create the family that they want to create.

While abortion still tends to most of the attention in this work, I think birth workers, are also perfectly suited to be part of this movement and to utilize the framework to support our own efforts.

So what does it really mean to understand our work as doulas, or midwives, or birth activists, as part of the movement for reproductive justice?

First it means we put at the center of our work those who face the most challenges.

Read the rest of this entry »


Pregnancy After Transitioning Study

July 26, 2013

I’ve written before about the increase in information, resources and stories about trans pregnancy. While we know a lot more now than just a few years ago because trans folks having babies are getting together to share info, there is still a lot to learn about the experience. 

A provider who is queer, doula and midwife friendly asked me to share this call for participates in a survey about transmasculine pregnancy experiences. If you’re interested in participating, see below. 

Pregnancy After Transitioning Study (PATS)

PATS Anonymous Survey – Online Information Sheet

We are doing a pilot study about transgender men’s’ experiences with pregnancy.  This study aims to better understand how to best assist female-to-male transgender individuals who may want to become pregnant as well as how to counsel about pregnancy and possible birth outcomes. The data collected in this initial unfunded pilot study will offer some guidance to transgender men, and their healthcare providers, who are pregnant or interested in becoming pregnant.  The results from this study will support and guide the development of future outcome-oriented clinical research in this area of intense growing interest and importance

This study is an anonymous online survey of people who identify as transgender men (assigned female at birth with a transmasculine/ transmale/ female-to-male gender identity) and have been pregnant and delivered a baby.  If you self-identify with this population, then we would like to invite you to participate in this study.

If you choose to be in the study, you will complete a survey. This survey will help us learn more about transgender men (assigned female at birth with a transmasculine/transmale/female-to-male gender identity) who have been pregnant and completed the pregnancy.  The survey will take about 20 minutes to complete.  The questions will relate to your experience with fertility, conception, pregnancy, and birth.   To be eligible for the study you must be over 18 years old and have completed a pregnancy within the past 10 years.  You can skip questions that you do not want to answer or stop the survey at any time. The survey is anonymous, and no one will be able to link your answers back to you. Please do not include your name or other information that could be used to identify you in the survey responses.

All study results will be made available to the community through the Center of Excellence for Transgender Health at the University of California, San Francisco. The mission of the Center of Excellence for Transgender Health is to increase access to comprehensive, effective, and affirming health care services for trans and gender-variant communities.  More information can be found at http://transhealth.ucsf.edu

Questions? Please contact the study coordinator Lexi Light (415-206-6453LightA@obgyn.ucsf.edu).  If you have questions or concerns about your rights as a research participant, you can call the UCSF Committee on Human Research at 415-476-1814.

Being in this study is optional. If you want to participate, click this link to start the survey: http://bit.ly/PATStudy

Additionally, the researchers at the Center of Excellence for Transgender Health (CoE) at UCSF are doing research that is designed to lead to better programs for transgender people. They want to know if you wish to learn more about their research studies or if you may wish to participate in any of the studies that may be appropriate for you. By clicking this second link & filling in your contact information, you will allow qualified professional people on the staff of the CoE to contact you in the future to ask if you want to participate in any studies.  You will be entering your contact information into a different survey, completely separated from the above anonymous survey.  You have no obligation to actually participate in any study.

By providing your information, if a study on transgender people needs subjects, you may be contacted to ask if you want to participate. You do not have to participate. You may withdraw permission to be contacted at any time by contacting the CoE.  If you do not provide your information, there will be no penalty or loss of benefits to which you are otherwise entitled. 

Participation in research may involve some loss of privacy. However, your contact information will be handled as confidentially as possible. Access will be limited to the data manager and the researcher organizing the study and will require a password. No information will be used for research without additional permission. Your contact information will not be shared with anyone outside the CoE.

There will be no cost or payment to you if you sign this form.   If you have questions now or later, you can talk with the study researcher about any questions, concerns or complaints you have about this study.  Contact the study researcher(s) Dr. Jae Sevelius at 415-597-9183.

If you wish to ask questions about the study or your rights as a research participant to someone other than the researchers or if you wish to voice any problems or concerns you may have about the study, please call the Office of the Committee on Human Research at 415-476-1814  

If you agree to be contacted in the future, please indicate your preferred contact information on the following form https://redcap.ucsfopenresearch.org/surveys/?s=sHwkt3

 


Review: What Makes a Baby

June 11, 2013

What Makes a Baby Book Trailer from Cory Silverberg on Vimeo.

A few months back I got a lovely email from Cory Silverberg telling me about a new book that he authored: What Makes a Baby. After a very delayed email exchange (I’ll admit I am often sloooowwww to respond) I received a copy of this lovely book in the mail.

The promises made in the trailer above definitely deliver. It’s an amazing specific yet unspecific story that helps tell the tale of where babies come from—all the modern and queer possibilities included. It does an incredible job of being inclusive of all genders and bodies. It also tells a birth story that includes the possibilities of a c-section and a vaginal birth, of midwives and doctors.

I’m not an expert on kids books, or what works when teaching kids about sensitive subjects like this one, but I’m happy to have this on my shelf for future use with family and friends.

The book is now available for purchase. A readers guide and more are available here.


ACOG says labor should begin naturally—When will medical practice change?

May 9, 2013

In my latest column at RH Reality Check I talk about new guidelines issued by ACOG regarding scheduled c-sections. They were addressing the practice of scheduled c-sections that have been producing pre-term deliveries, with a particular push-back on the  reasoning of a baby being too large to be born vaginally.

For those of us who’ve been tuned into the maternity care debate, these kinds of change of practice or philosophy from a group like ACOG seem like a huge turn around. So huge, that at first I thought the whole thing was a hoax.

But, thankfully, it’s not. ACOG is actually urging providers to “let nature take it’s course.” Similarly, they just released new findings regarding the impact (potentially negative) of pitocin use on newborns.

For those of use who’ve been pushing back against rising c-section rates and pitocin use for a long time, this is a victory. But the challenge remains that history tells us it will likely take a long time for these recommendations to actually influence medical practice. In my column I use the example of episiotomy to illustrate this lag:

Unfortunately, it could take years for these changes to go into effect. Just look at the history of episiotomies. In the 1950s and ’60s, episiotomies, a cut in the perineum (the region between the anus and vagina), were recommended as routine practice during labor. At the time it was believed that an episiotomy was preferable to the natural tearing that is very common during vaginal delivery, and that the straight incision of an episiotomy was easier to repair. A 2012 Huffington Post article outlines this history, and how the practice came to dominate by the 1980s, occurring in more than 60 percent of deliveries.

It was only then that clinical trials were conducted to examine the impacts of episiotomy in comparison to natural tearing, and the results were staggering:

Clinical trials conducted in the ’80s and ’90s found that episiotomy cuts can, in fact, turn into even deeper lacerations during delivery, damaging the area around the rectum. Then, in 2005, a sweeping review published in the Journal of the American Medical Association found no benefits to routine episiotomy. A year later, the American Congress of Obstetricians and Gynecologists issued new guidelines, saying that episiotomy during labor should be restricted because doctors had previously underestimated the risk of bad outcomes later on, such as painful sex and possible incontinence.

Decades after those clinical trials, and seven years after the new ACOG recommendations, it’s unclear exactly how the new recommendations regarding episiotomy are being implemented. In 2005, the year before the ACOG recommendations, a study in the Journal of the American Medical Association (referenced in the Huffington Post article) estimated that 25 to 30 percent of vaginal deliveries still involved episiotomy. The 2010 National Hospital Discharge Survey reported that roughly 320,000 episiotomies were performed in the United States that year.

So this is both good news, and a call to action for all of us. As consumers, advocates and doulas our efforts have contributed to these recommendations, and we must remain vigilant to ensure that they get implemented. We can share these recommendations, coming from the Association tasked with governing Obstetricians, with providers who may be reluctant. And we can keep the pressure on. It’s a long battle, but I’m heartened by these incremental signs of progress.

Read the full column here.


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