A new investigative report released by California Watch reports that maternal mortality rates in California have seen a spike in recent years, almost tripling in the last ten years.

To me, there is one clear cause of this kind of increase, and that’s the c-section rate, which according to California Watch have increased 50% in the same decade in CA.

The World Health Organization recommends a c-section rate of about 10%. We currently have a national average of 30%. In some hospitals it’s as high as 90%.

C-sections are major abdominal surgery. There are risks involved, and with so many c-sections, you’re going to start having deaths as a result.

We need less c-sections. Period.

The other thing this report revealed was that there was significant increase in maternal mortality among non-Hispanic whites, a group traditionally excluded from maternal mortality and low infant birth weights. Well again, this is probably because of the c-section rates, which might even be higher among this group than women of color.

The idea that increases in technology use could actually harm women, rather than help them, is impossible to believe for the OB-GYN community:

When researchers unveiled their initial findings to a conference of the American College of Obstetricians and Gynecologists in 2007, there were gasps from the audience, according to participants at the San Diego event. The idea that California was moving backward even in an era of high-tech birthing was implausible to some.

This is exactly the point. Overusing technology it’s just as harmful as under-utilizing it. The bottom line is that OB-GYNs are trained as surgeons, and their dominance of maternity care is proof of that–they are performing more and more surgeries than ever.

We need practitioners who are trained to care for women birthing without technology, namely midwives. Technology has a role, but it should be the exception not the rule. And let’s be clear here. It’s not just c-sections that are to blame. It’s also increasing induction rates, epidurals and other medical interventions that disrupt the process and are more likely to cause interventions.

“For every maternal death, there are 10 near misses; for every near miss, there are 10 severe morbidity cases (such as hysterectomy, hemorrhage, or infection), and for every severe morbidity case, there is another 10 morbidity cases related to childbirth,” Camacho wrote in an e-mail.

Chally of Zero at the Bone included a post from Radical Doula (about the shackling of incarcerated pregnant women in PA) in the latest Carnival of Feminists.

Go check it out! It’s an awesome thematic round-up of some of the best feminist blogging out there.

There is a great article up at RH Reality Check, written by Mary Mahoney, one of the founders of The Doula Project. I’ve written about the NYC-based Doula Project before, and am honored to have been one of the founders.

All the credit for what the project has become goes to co-founders Mary and Lauren, who took some very early stage ideas about providing doula care to folks having abortions and turned it into this amazing project which supports people throughout all stages of reproductive life, including abortion, fetal anomalies, miscarriages, adoption and birth.

I think this project takes doula care to its natural end–we’re there to support pregnant folks, through any and all decisions.

The Doula Project has served over 500 pregnant people since the fall of 2008, guided by the mission of providing free compassionate care and emotional, physical and informational support to people facing birth, abortion, fetal anomaly, or miscarriage. The foundation of our project is built on meeting pregnant people where they are, something I’ve taken with me from working four years in the reproductive justice movement. This connects to our belief that pregnant people should be trusted to make the choices that are best for them and that their experiences and the memories of those experiences should be honored.

Doulas hold a unique position in health care as non-medical lay people who are there solely for the pregnant person. The birth doula movement has certainly grown over the past few years, and innovative and radical projects have expanded care for pregnant people who might otherwise not receive it, such as young mothers and women in prison. During this time, The Doula Project has been building on a new model of doula care: one that supports pregnant people having abortions and choosing adoption.

Read the whole article here and check out the Doula Project here.

UPDATE: There is another great article about the Doula Project in the Brooklyn Link.

More news on the shackling front. The good news is that this horrific practice is finally getting some much needed media attention. The bad news is that it still happens, despite policy changes that are meant to eradicate the practice.

Philadelphia Weekly has an in-depth article about one woman’s experience being shackled during labor for over 17 hours. She even has scars on her ankles to prove it.

I was happy to see that she had a doula with her, who tried to get the shackles taken off, to no avail.

The descriptions of Torres’ experience are really horrific. I admire her courage for telling her story, with the hope that it will never happen again.

Being shackled during labor was just one of many dehumanizing moments Torres says she endured: When she was transported outside of the prison, a chain was wrapped two times around her body, just below her breasts and above her stomach, and then placed into a lockbox where her wrists were secured with handcuffs. A confident and careful speaker, Torres intermittently pauses to reflect on her story’s implications. “The squatting and the coughing [to search for hidden drugs and weapons]… I did even at nine months pregnant.”

These stories just further reveal a truth that many of us ignore–the dehumanizing and unjust practices of the criminal justice system. It isn’t just pregnant women who need to be treated better in prison.

In reaction to stories like these, a PA legislator, Senator David Leach, has introduced legislation to ban the practice.

The article also highlights the amazing work of three doulas working at Riverside Correctional Facility. I’ve been seeing an increasing number of doulas looking to work with incarcerated women as folks reveal the conditions that women often labor under. This program is even staffed by paid doulas–the other programs I know are volunteer.

Danyell Williams sleeps with her cell phone like a doctor with her omnipresent pager. The 37-year-old Philadelphia native and her three staff members—all trained doulas—are each on call for two weeks every other month, rushing to the hospital when they get word of an impending birth. Over last year’s Fourth of July weekend, Williams worked through 23 sleepless hours of labor.

MOMobile’s program at Riverside is groundbreaking. “We’re one of the only ones in the country,” says Williams. Since the beginning of the doula program in November 2006, MOMobile has attended 42 births.

The doulas are the only intimate human contact that jailed women have while giving birth. “When you’re incarcerated, the only people allowed in are security staff and MOMobile,” says Williams.

The good news of all of this is that there has been little opposition to legislation looking to ban the practice. The challenge comes with the bureaucracy of the prisons and the chain of command that often ignores legislation and procedural changes.

Read the whole piece here.

Thanks to New Voices Pittsburgh and La’Tasha Mayes for the link.

Today is blog for choice day, a chance for the blog world to commemorate the anniversary of Roe vs. Wade–on it’s 37th year!

Each year, I find myself unable to write about choice without talking about why I want it to be justice instead.

As I’ve talked about before, choice isn’t enough.

Choice doesn’t recognize that we don’t all have a choice. That often times our choices are impacted by what others want, by what we can afford, by what we will allow ourselves to do.

Our choices are mediated by politicians, religious figures, our paycheck this month. Our choices are limited by our family members, our lovers, what we see on TV and who is close to us when we have to make a decision.

Our choices are determined by the color of our skin, the language that rolls off our tongues, the restrictions of our bodies, the gender we identify with and the people we love.

Our choices aren’t just about abortion, they’re also about how we live, how we create family, how we interact with our bodies, with society, and with the world.

So I’m going to spend today, instead of thinking about choice, thinking about justice.

Although this is new to me, it’s news from October. CAPPA announced that certified doulas will now be able to apply for insurance reimbursement through Medicaid and other third party insurance companies.

According to CAPPA, certified doulas can register for an NPI (national provider identification number) under the heading of “Nursing Service Related Providers Type.” (NOTE: According to CAPPA, you do not need to be a nurse).

Their post about this doesn’t explain which certifications count (DONA? CAPPA? toLabor?) or what the reimbursement might actually be.

These steps are really important for expanding access to doula care to those without the means, but who might have private insurance or Medicaid. The downside is that inclusion in insurance programs also usually mean stricter regulation of doulas, usually via certification. Right now, certification is just an administrative (and financial) hurdle doulas have to cross, but it’s possible that it could get harder as the role of the doula becomes more professionalized.

Will it be harder to be a radical doula in a super-professionalized doula world? It’s possible. (For more on why I’m not certified, go here).

Professionalization has also been a struggle for midwives. It’s meant more rigorous standards for education (and only certain types of education count), training and even malpractice insurance. It’s a double-bind, since for low-income women to have access to doula and midwifery care, we need insurance inclusion, but insurance inclusion means tighter regulation and restrictions on how we practice.

Anyone have experience getting reimbursed by insurance companies or Medicaid for their doula services?

The Superintendent of the Corrections Center for Women (the only one in WA state that houses pregnant women) said 30% of women are shackled during labor in a recent MSNBC article.

Only 30%?! Wow, how nice of them.

Bills have been introduced in the Washington State House and Senate that would outlaw the inhumane practice of shackling incarcerated pregnant women during labor and delivery. The laws would prevent the use of any types of restraints on pregnant women who are incarcerated.

Let’s hope this law passes, so 30% can become zero.

Thanks to Peggy at Open Arms for the heads up!

Part of what sustains my blogging is speaking. Getting to talk directly with folks, have conversations and hear about the work of other activists is one of my favorite parts of this work.

I’ve done events at campuses and conferences around the country, on topics like reproductive justice, gender non-conformity and feminism, the connections between birth activism and reproductive rights, Latinas in the US.

I’m happy to discuss pretty much anything I’ve written about!

I’m currently booking events for the spring, so email me if you’re interested in bringing me to your campus, conference or organization.

More info about previous events I’ve done is here.

A fellow doula emailed to inquire about volunteer doula programs in New Jersey–she’s particularly interested in Northern New Jersey.

She’s interested in getting one together if there isn’t one already. If you know of any, leave them info in comments or email me.

The complete list of volunteer doula programs is here, and feel free to send info about any other programs I don’t have listed.

The title comes from Lynn Paltrow, of the National Advocates for Pregnant Women, on this segment of GRITtv. Also on the segment is Silvia Henriquez, Executive Director of National Latina Institute for Reproductive Health.

Video after the jump.