Pro-choice pregnancy and the politics of language

I was inspired to write my latest column for RH Reality Check because of a number of emails I’ve gotten over the years with various questions about the issue of the language we use to talk about pregnancy and it’s impact on pro-choice politics.

From the column:

As a blogger and a doula, I think about this question of language a lot. What language to use when talking with people I’m supporting during their abortions? What about when supporting someone with a miscarriage? Should I use different language in one scenario over the other? How about when I write about these issues? If we call it a baby at only eight weeks, does that compromise our right to access abortion?

For me the answer is no. The reason that abortion is a decision best left to individuals who are pregnant is because it’s a complicated ethical and personal choice that one can only make for themselves. While there may be a lot of science regarding fetal development, when hearts beat and nervous systems are developed, there is no right answer when it comes to when life begins. It’s a question and a choice that every individual person has to grapple with for themselves. The same is true for the language of pregnancy and birth.

I do my best to mirror the language of the people I’m working with. If they call it a baby, I’ll call it a baby. If they call it a pregnancy, or a fetus, or a itty-bitty bundle of joy, I’ll do the same. Nothing about these language choices denotes anything about what choices should be available to pregnant people—it simply denotes how that individual person sees themselves and their pregnancy.

Read the full piece here.

Responding to the home birth debates

My latest column for RH Reality Check is up. With some serious hesitation I decided to respond to the conversation about the safety of home birth started by Michelle Goldberg recently at the Daily Beast. It’s been really challenging to see how polarized these conversations are, how vast the divide is between what feels like two camps: the home birthers (who are assumed to hate hospitals, obstetricians and people who use either) and the hospital birthers (who are assumed to hate midwives, home birth and people who use either). It feels like the potential for debate and rational dialogue is minimized because of this polarization. Maybe I shouldn’t be surprised by any of this. Anyway, my response is excerpted below.

A recent heated dialogue between journalists Michelle Goldberg and Jennifer Block about the safety of home birth has been the latest in a recent media flurry about the rise in home births reported by the CDC in January. A New York Times Magazine profile of Ina May Gaskin, arguably our nation’s most famous home birth midwife, was just one of the most mainstream of the recent articles, and seems to have stirred up much scrutiny of the practice.

I feel compelled to dip my toe into the conversation, if only to try and steer it in a different direction. The source of the back and forth between Goldberg and Block centers on this question: “Is home birth safe?” It’s not a new question; in fact it has been debated since the beginning of obstetrics and hospital birth at the turn of the 20th century.

Unfortunately, though, it’s exactly the wrong question to which to be devoting so much air time. A scant share of all women giving birth in the United States do so at home. Despite the reported 29 percent increase in home births nationally between 2004 and 2009, fewer than one percent of births happen out of hospital. While home birth gets much scrutiny, particularly when wealthy white women are seen as forging a new trend by choosing it, the place where the majority of women give birth in the United States — the hospital — goes largely un-scrutinized.

Hospital births do get a lot of attention in birth activist circles (where I spend significant time, as part of my work at Radical Doula). Midwives and doulas will quickly recite the problems with hospital birth, e.g., why high intervention rates (c-sections, inductions) are bad for mother and baby. But outside of that arena, where it’s arguably most needed, the conversation is stalled.

Here is the reason this matters: we are in the midst of a maternity care crisis. I’ve said it before, but I’ll say it again: our maternity care system is broken. Why? Because our maternal and fetal mortality rates are worse than 40 other countries worldwide, despite the fact that we spend more money than anyone else on maternity care. And where is  almost all that care being delivered? In hospitals.

Read the rest here.

New column: Preparing for the trans baby boom

My latest column for RH Reality Check was published this week. An excerpt:

This shift in attention toward the issues facing trans and gender non-conforming pregnancy is indicative of a bigger shift overall — more and more trans and gender non-conforming people are giving birth. As Pati Garcia, a Los Angeles doula and midwife-in-training put it during our panel: “We’re on the cusp on a trans baby boom.”

Trans health as an overall field is still in its nascency. Our understanding of hormone therapies, gender reassignment surgeries, and much more is still being developed, so it’s no surprise that the field of pregnancy and parenting for trans people is also new and developing.

Within the needs of trans people in pregnancy and birth is the challenge of addressing what seems like an obvious connection: between pregnancy and femaleness. Trans people are often neglected in the arena of pregnancy and birth because of the strongly-held notion that only female-identified people experience pregnancy and birth. While not all trans people, whether they were assigned female at birth or not, can experience pregnancy (because of infertility or hysterectomy), some can and do, prompting the need for our pregnancy and birth providers to accommodate.

It’s not easy, as it’s a process that is intensely gendered. Everything from maternity clothes to the language of health care providers carries the assumption that the pregnant person identifies as female (and often that the other parent identifies as male). Language is an obvious barrier from the get-go: maternal health, pregnant women, all of the language associated with pregnancy and birth is gendered. From body parts to actors, all is coded in a way that would make a pregnant person who is not identified as a female feel uncomfortable.

Read the whole article here.

It was inspired by my panel at the Philadelphia Trans Health Conference, so big props to Pati Garcia (aka Chula Doula), Ryan Pryor, Abigail Fletcher and Lucia Leandro Gimeno, my co-panelists. It was an amazing conversation about trans and gender non-conforming centered midwifery and doula care. And the room was full! I love how many more people are focusing on these intersections, because there is much work to be done.

New column: More on maternity care and race

My second column is up at RHRC, an expansion on my thoughts about the new census numbers and maternal health.

The Center for Medicaid and Medicare Innovation just announced 43 million in funding for new approaches to prenatal care that address the problem of premature births — something that leads to much higher mortality rates, and a host of other complications for newborns. But once again it looks like midwifery will be kept out of this discovery process — the only eligible providers are those who see at least 500 births per year — something that few midwifery practices or birth centers do. These requirements are based on the desire for statistically significant findings, but they might just exclude those who can actually produce the results they are seeking.

It’s hard to imagine that a medical provider who is forced to carry a high volume of clients will be able to provide the care necessary to eliminate race-based health disparities. If Medicaid doesn’t make room for alternative, potentially life-saving maternal health models, we risk endangering the health of generations to come. The challenges are clear, what we require are the innovative solutions. Our nation’s health depends upon it.

I also owe a big thank you to Claudia Booker, who got in touch after I wrote this post, to talk with me about the challenges of making a living as a midwife who serves mostly low-income women of color. Much of our conversation didn’t make it into my column, but it’s an absolutely crucial conversation for us to have: how can midwives make a living and still serve low-income women? Medicaid, only an option in a portion of states, makes it extremely difficult to make a living and stay true to the midwifery model.

Without it, midwives have little chance of reaching women of color, and midwives who want to work exclusively with low-income populations will have to make a living through alternate means. Our providers have to make a living, and if they can’t make a living serving low-income women, we’re screwed.

Thank you Claudia, for pointing out that making midwifery accessible to communities of color also means making the midwifery profession accessible to those who want to serve communities of color. That’s going to require an innovative business model for midwifery.

One thing we talked about was having a diverse clientele–for each midwife to serve clients who can pay the full fees (either through private insurance or out of pocket) and low-income clients via Medicaid or a sliding scale.

The challenge, she said, is racism. Namely that it can be difficult for midwives of color to attract clients who can pay (who are more likely to be white), and these biases make it difficult for all midwives to have a diverse client base. She pointed out that we all want providers who look like us.

I have a lot more to say on the subject. For now, you can read my column, and stay tuned for more.

More on the resignation of midwives of color from MANA

I mentioned a bit about the news that a key group of midwives of color, who were previously involved with the Inner Council at the Midwives Alliance of North America, resigned early this week.

More has been released regarding their resignation, so I wanted to post additional information here.

I realized shortly after posting that I in fact do know quite a few of the midwives who resigned–I just hadn’t been in contact with them lately, and did not know they were so active in MANA. Jessica Roach sent me their letter of resignation, which is also posted on this blog.

The first part is a letter from MANA, seemingly in response to the resignation of the midwives of color. What follows is the resignation letter.

Again, because I am not involved in MANA, I don’t want to comment on the situation specifically, except perhaps to say that I feel much solidarity with the women who have resigned. Claudia Booker, Jennie Joseph and Michelle Peixinho I know to be really incredible midwives and passionate leaders–I trust their opinions and experiences.

Again, for me, the bottom line is this: we can no longer ignore the disproportionately high negative maternal and infant health outcomes faced by communities of color.

And it’s going to be damn hard to address those disparities if we can’t even address racism in our own organizations–especially if that racism means that providers of color choose to leave or are pushed out.

The needs of communities of color in maternity care can no longer be the topic of an interest group, or a caucus, or a breakout session. It has to be THE FOCUS. And my guess is that if we address the needs of communities of color, we’ll probably change maternity care in ways that benefit everyone.

Jessica Roach also wrote a follow-up letter about the resignation that Claudia posted on her facebook page–I’ll share it at the Radical Doula facebook page.

Holding pregnant women to a dangerous and unattainable standard

I have a new column at RH Reality Check where I’ll be posting every other week. My first column was appropriately published today, the same day that Bei Bei Shuai was released from jail.

Bei Bei hugging family upon being released from jail
Photo via National Advocates for Pregnant Women

Bei Bei Shuai is finally out of jail after 435 days. In case you don’t remember her case, the details are here.

The not-so-good news is that the Indiana Supreme Court refused to hear the appeal asking them to drop all the charges, which means she will likely have to go to trial.

My column focuses on how Bei Bei’s case is just one piece of a much larger and really dangerous trend: holding pregnant women accountable for guaranteeing a healthy pregnancy outcome.

As a society we have absorbed the myth that the right doctor and the right use of modern medicine can circumvent illness and death in pregnancy and birth. Some of the blame for this myth falls on doctors and the medical industry. Although new technologies, particularly developments in neonatal medicine, have significantly improved chances of survival for newborns, we still cannot guarantee a healthy pregnancy and birth outcome for every pregnancy.

But these expectations don’t stop with providers — they’ve now extended to women themselves, who do not have the support of insurers, or employers, to protect them when they fail to live up to these expectations. We also believe the myth that pregnant women can guarantee a healthy birth outcome.

If doctors are expected to perform heroic acts to save the lives of newborns, women are expected to do even more to make the impossible possible — often expected to put their own life and well-being on the line.

And the punishment for not achieving perfection in pregnancy and birth goes way beyond a lawsuit, a multi-million dollar settlement, or even the loss of employment. Increasingly, the punishment is imprisonment.

Read the whole thing here.

Birth politics in a “majority minority” country

There has been a lot of news lately that keeps tying back to the thread I started a while back, about how midwifery can truly be accessible to communities of color.

First, last week we had a big media splash with new census data that shows the majority of babies being born in the US today are not white. This has been true for quite some time in certain parts of the country, like California, but now it’s a national fact. Demographers have been predicting for a long time that we’re heading in this direction, so it’s not a surprise. But it does make for good headlines, and stirs the pot of zenophobia and racist panic.

It also makes extremely clear how important it is that we focus on the needs of communities of color when it comes to maternal health. It’s no longer about an interest group! It’s no longer about the minority! Dealing with race-based health disparities in maternal health is actually about the majority of births. Wow.

Feels like a game-changer to me.

Unfortunately for midwives and birth activists, women of color are still a very small minority of those accessing out of hospital birth. A bigger slice is likely accessing in hospital midwifery care (anyone know those stats?) but we’ve got a long way to go.

Then, yesterday, the news that the Midwives of Color contingent of MANA, Midwives Alliance of North America, resigned in protest. Still waiting to see a statement from MOC about what prompted this move, but MANA already acknowledged it on their facebook page:

It is with heavy hearts that the Midwives Alliance today received the resignation of several key members of the MANA Midwives of Color (MOC) Section, including the Chair. MANA is fully aware of its history of privilege and the issues related to cultural and systemic hierarchies in decision-making. We are committed to working towards a structural change in the way our organization operates in light of the repeated failures to address the needs of our midwives of color. We recognize the disproportionate impact of perinatal disparities and poor outcomes for women, infants and communities of color. MANA has an ongoing responsibility to address these issues in order to fulfill our mission of providing a professional organization for all midwives.

I’m not involved in MANA, I’m not a midwife, I haven’t talked to anyone from the MOC. (I did attend a MANA conference back in 2005/2006 in Mexico City). I don’t know the specifics of what went down, what prompted this major move.

What I do know is this: We have to center the needs of communities of color in maternal health. The disparities alone should have been enough of a reason. Black women are FOUR times more likely to die during childbirth than white women. FOUR TIMES. But of course, that’s how racism works.It perpetuates systems of oppression by marginalizing the needs of those most in need.

But now we’re no longer the minority. Now, the health of the nation very literally depends on our ability to tackle race-based health disparities, particularly in maternal health.

I personally believe that the midwifery model of care is a big piece of the puzzle when it comes to answering the problem of race-based maternal health disparities. And a big piece of the puzzle of making midwifery care accessible in communities of color? Midwives of color.

So I sincerely hope that MANA, or whatever other governing bodies exist in the midwifery world, can get their priorities straight, and do what work needs to be done.

The numbers don’t lie–and they point in a clear direction. We need to be putting all of our attention on race-based maternal health disparities. All of it. It’s a concern of the majority now.

The California Pregnant and Parenting Youth Guide

I’ve written before about the problem with teen pregnancy programming that relies on stigma.

Cover of new guide called "California Pregnant and Parenting Youth Guide"

Well here is an amazing alternative that shows what a true educational tool that provides resources looks like, the California Pregnant and Parenting Youth Guide.

Awesome! The guide is online and available in downloadable form. It’s in Spanish and English. It talks about options for pregnant teens (like abortion and adoption) without any of the scary shaming stuff about how if you choose to have a child it will end up in prison because you are a teen. It talks about resources, insurance programs, how crisis pregnancy centers are anti-choice. It talks about immigration! It’s written at a level teens can understand. It talks about legal rights for teens and parents, issues with custody, tips for parenting. There are cartoons!

Okay, obviously I’m super psyched about this. Cause I am. This is what all teens need. Keep your stigma, and provide resources instead.

The only criticism I can provide is that they don’t talk about birth options in terms of doulas or midwives. But otherwise? Incredible.

You can view the guide and download it here.

Homebirth Ryan Gosling

If you’ve been following the tumblr meme of sites that use photos of Ryan Gosling with “Hey girl” sayings, it’s excitably reached the birth activist world.

Homebirth Ryan Gosling shows us all sorts of approving statements about homebirth from America’s heart throb. One part poking fun at the birth activist community and one part legitimate support for homebirth, it’s worth checking out.

Increase in home birth leaves women of color behind

Last week, the CDC released data proving what those of us in the birth activist community have noticed for years: home birth is on the rise. They evaluated home birth numbers from 1990-2009.

After a decline from 1990 to 2004, the percentage of U.S. births that occurred at home increased by 29%, from 0.56% of births in 2004 to 0.72% in 2009.

There are many reasons for this increase, from Ricki Lake and the Business of Being Born, to studies that show serious problems with our maternal and fetal mortality rate. Also midwifery is on the rise, and CPMs have been successfully pushing for recognition at the state level.

To those of us who support the midwifery model of care and believe that leaving the hospital setting is a good idea for many low-risk births, this is great news. It’s also still disappointing that the overall percentage is so low–less than 1% of all births! Although when you look at it on a state level, there are places (like Montana and Oregon) where the rates are double the national average.

CDC graph of home births broken down by race/ethnicity

But, as we’ve come to expect, when you examine these numbers based on race and ethnicity, the picture is very different:

For non-Hispanic white women, home births increased by 36%, from 0.80% in 2004 to 1.09% in 2009. About 1 in every 90 births for non-Hispanic white women is now a home birth. Home births are less common among women of other racial or ethnic groups.

About 90% of the total increase in home births from 2004 to 2009 was due to the increase among non-Hispanic white women.

The chart above shows just how dramatic the disparity is. I addressed some of my thoughts about what’s behind this gap in this post, which generated some good discussion in the comment thread.

I think we’ll see that racial gap diminish when midwifery advocates include people of color in their work. When more midwives and doulas of color are leading these initiatives, and also when public funding for out-of-hospital birth care is addressed.

The other disparity that the CDC study points out is a geographic one, which may also mirror the racial disparities:

Map of US with percentage home births by state

The percentage of home births was generally higher in the northwestern and lower in the southeastern United States.

This Northern/Southern disparity is true for many health outcomes, and can probably be attributed to demographic differences, as well as a political climate that more favors midwifery and out of hospital birth in the Northwest. It’s clear we need more strong midwifery advocates in the South–and that would also be a place where it would make sense for people of color to take the helm.

We know that a shift as radical as bringing maternity back out of the hospital is going to take decades. It was a decades-long,  well-funded campaign that brought birth into the purview of doctors and hospitals to begin with. The good news is we are moving in the right direction, but if we leave women of color behind, we’re not going to achieve the wide-spread culture shift we’re working towards.