How can midwifery truly be made accessible to communities of color?

Right as 2011 was wrapping up two articles were posted about home birth and midwifery revivals in communities of color. Having written about the question of race in the home birth movement back in 2009 for RH Reality Check in these two articles, I’m excited when new outlets pick up the story. There is much movement in this arena, and also much more than can be done to make sure US midwifery is accessible to people of color.

In New America Media, Valeria Fernandez writes about efforts to revive Mexican midwifery in Arizona:

Marinah Valenzuela Farrell is one of only a few licensed midwives in Arizona. Though it isn’t a profitable venture, helping mothers bring their newborn children into this world is for Farrell a calling deeply rooted in her native Mexican tradition.

“It is really hard to be a midwife,” said the 41-year-old. “You don’t sleep, and you don’t make money. People think you’re crazy because you’re doing homebirths.”

A majority of Farrell’s clients are middle class and white, though as a Latina she aims to make midwifery accessible to low-income women in dire need of prenatal services but too afraid to seek them out in a state virulently hostile to undocumented immigrants.

“I think they don’t know that we exist,” she said. “I think the more the community knows that there’s a midwife who will come and visit them at home and do a homebirth… [attitudes] will change and shift.”

I spoke to the author while she was working on the piece, and a quote of mine is included toward the end.

In The Grio, Chika Oduah writes about black women and home birth. The article includes a video, which is a good primer of the issues at hand with home birth. It also references my Colorlines article about the possible connection between maternal health in communities of color and access to midwifery care.

What is clear from the research about this issue is that women of color are less likely to receive midwifery care, and that disparity is larger than the population numbers would suggest. I think this dynamic is complicated by global sociopolitical historical factors. For example I experienced resistance from Latina immigrant women to midwifery care because of the stigma toward parteras (midwives) in their home countries. In many places in Latin America, midwives and home birth are seen as the option used by women who can’t afford to go to hospital for birth–basically an option only for those who have no other option.

That creates class and race stigma on home birth and midwifery care.

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Update: Mississippi Personhood initiative fails

Update: It failed! Big victory for health and autonomy. Also proof that even those with more moderate or conservative politics are skeptical of such far reaching legislation. The fight is far from over though, as these efforts are bound to continue.

It’s a scary time for women’s health and autonomy. The political movement to limit access to abortion, as well as pregnant people’s rights to make decisions about their bodies and medical choices, is stronger than ever.

In the absence of any strategies to address the actual problems plaguing our economy (unemployment, for example) the ultra right wing in control of many of our state governments (and the House of Reps too) have decided to focus instead on debilitating budget cuts and bills that damage women and pregnant people’s health and human rights.

As I’ve said over and over on this blog–bills that limit access to abortion also limit the choices of pregnant people who want to parent. NAPW has a video explaining exactly what is at stake with Prop 26:

Irin Carmon, reporting for Salon, wrote about how this initiative would limit access to even birth control. These efforts are serious, and want to turn back the clock on reproductive health almost fifty years. All of these extreme efforts are poised to take judicial challenges all the way to the Supreme Court.

The vote on the initiative could go either way, which is even more frightening. Polling shows voters split evenly.

If you’re in Mississippi, please make it out to the polls tomorrow and vote NO on 26. This is serious.

California Governor vetoes bill limiting use of restraints on pregnant incarcerated women

California Governor Brown vetoed a bill yesterday that would have limited the use of restraints on pregnant incarcerated women during transport. A ban on using restraints during labor already exists. The bill passed the legislature with overwhelming support, and likely received a veto because the California State Sheriff’s Association decided to push heavily against the bill.

From the Governor’s veto message:

At first blush, I was inclined to sign this bill because it certainly seems inapprpriate to shackle a pregnant inmate unless absolutely necessary. Hovwever, the language of this measure goes too far, prhohibiting no only hsackling, but also the use of handcuffs or restraints of any kind except under ill-defined circumstances.

Let’s be clear. Inmates, whether pregnant or not, need to be transported in a manner that is safe for them and others. The restrictive criteria set forth in this bill go beyond what is necessary to protect the health and dignity or pregnant inmates and will only serve to sow confusion and invite lawsuits.

This is really disappointing news, and further proof that the health and safety of pregnant incarcerated women is not a priority. The fact that he attempted to say that the use of handcuffs or restraints could actually be needed to “be transported in a manner that is safe for them” is appalling.

In my article for Colorlines last week, I talked to Marianne Bullock, a prison doula and co-founder of the Prison Birth Project. She had this to say about the danger of restraints during transport:

Marianne Bullock, cofounder of the Massachusetts-based Prison Birth Project, offers an anecdote from across the country illustrating why shackling during transport is an acute problem. As a doula who has been working within a Springfield prison for the last four years, Bullock and the other members of the Prison Birth Project see exactly how incarcerated pregnant women are treated. Even though their facility doesn’t shackle women during childbirth, shackles are still used during transport, especially postpartum. Bullock recounts one woman that she supported during labor who ended up with a full episiotomy (an incision to widen the vaginal opening) to deal with her baby’s shoulder dystocia.

“Twenty-four hours later she was shackled foot-to-foot and walked out of the hospital,” she remembered. “It’s so dangerous to have a woman walking shackled, with who knows how many stitches.”

Congrats to everyone in California for such an impressive push getting this bill through, and here is to hoping that it gets through next time.

Lawyer to shackle herself during childbirth to protest shackling of incarcerated women

In my latest article for Colorlines Magazine, I write about the efforts to prevent prisons and jails (and detention centers) from shackling incarcerated pregnant women. What inspired me to write about this issue, which has been covered pretty extensively by the progressive media in the past, were Rebecca Brodie’s plans to shackle herself during her own birth as a protest of the practice. From the article:

Rebecca Brodie sits in her suburban Massachusetts home, talking on the phone with me while her family member sits nearby, filming the interview. The oldest female correctional facility in the United States, MCI-Framingham, is just a short eight-minute drive away. “When I conceived my third child earlier this year, it really hit home for me because everywhere I go I pass the prison,” Brodie explained. “I have all these choices and opportunities: who do I want in the room with me, do I want a water birth, or a home birth? Obviously the incarcerated women can’t make these choices.”

The proximity of the women’s prison and Brodie’s pro-bono legal work with incarcerated women is what inspired the protest she’s planning for December, when her third child is born. If all goes according to plan, she’ll be laboring and delivering her baby in metal restraints that restrict her arms and legs. She’s planning to simulate the same conditions that many incarcerated pregnant women face when delivering in state prisons and jails, including some of the women housed at the prison right by her home.

I’m still not sure what I think about Brodie’s plans. It’s an extreme form of protest, one that involves much spectacle (and a documentary to boot). But what it was clear everyone I talked to cares about the most is bringing attention to this horrific practice in hopes of ending it.

Only 14 states specifically ban the practice, and even those states don’t necessarily ban the use of shackles during transport. Governor Brown in California has a bill waiting on his desk for signature that would ban the practice during transport as well. The more work I do in the field of social justice the more I believe that the practices of our criminal justice system are some of the most dire issues we face today. We incarcerate more people than any other country in the world, and the treatment of people on the inside brings up many, many human rights questions.

I’m glad I was able to talk to one of the founders of volunteer doula program that I seriously admire, Marianne Bullock from the Prison Birth Project, for this article. Marianne and the other PBP folks work at a prison in Massachusetts, trying to address the myriad challenges moms on the inside face, including shackling.

Read the full article here.

Erykah Badu is planning on becoming a midwife

Erykah Badu wearing a tall white hatI used to write a lot more about celebrities and birth (hello Caroline in the City post from 2007!) but have since gotten sidetracked with other things.

But this was too good not to post! Erykah Badu, who has been a doula for years, is now training to become a midwife.

This is was the best part:

Badu, who provides all of her services for free, has since become a spokeswoman for the International Center for Traditional Childbearing and she is now aiming to get her professional certification so she can open birthing centres in inner cities in the future.

She reveals patients call her “Erykah Badoula” and insists “nothing gives me more pleasure” than assisting in anaesthesia-free births.

Erykah Badoula! Love it.

Via Toronto Sun

Home births up 20% since 2004

Yay!

The New York Times reported that although home births still represent a small majority of overall deliveries, by the 2008 numbers they are up 20% since 2004. I’m sure we will see an even bigger increase once we get 2011 numbers.

This demonstrates that people are really getting the message that there are safe and viable alternatives to hospital birth.

You can share your home birth story in their comments section.

Failure to progress?

I often use the example of bowel movements when talking about why it makes little sense that women are forced to labor on their backs. Imagine taking a s–t lying down?! I say for emphasis. (Gravity, of course, is the missing element).

Well this new short film from the folks at the Future of Birth demonstrates how that analogy goes even further.

“Failure to progress” is one of the more common reasons cited for c-sections. It’s a vague diagnosis, and one based on a time table for birth that is overly standardized and limited. Pressure to progress, coupled with hospital environments that don’t encourage relaxation (think lots of staff in and out, harsh lights and machinery) can have serious impacts on the labor itself.

I’ve seen this first hand with women whose labor is progressing fine at home, but once they get to the hospital, survive the intake process and are settled into a room, stop having contractions altogether. What follows is usually lots of interventions and often a c-section.

We need to challenge these practices and highlight how they themselves interrupt the flow and progression of birth.

Interview with Ina May Gaskin about women of color and birth

I had the unique pleasure of interviewing midwife and birth activist Ina May Gaskin (via email) for my latest Colorlines feature.

Ina May graciously allowed me to post the full text of our interview since only a few snippets made it into the Colorlines piece. She had a lot of wisdom about this issue (not surprisingly!). It really is worth the read–Ina May displays a really comprehensive understanding of the issues facing women of color when it comes to out-of-hospital birth care.

Here’s Ina May:

RD: You mention briefly in Birth Matters that when obstetricians were trying to bring birth to the hospital (and learn how to care for birth), one doctor in Chicago paid immigrant women to give birth there. I’ve also understood that initially, particularly black women weren’t allowed access to hospital birth because of segregation/racism and class issues as well.

IM: That’s true. In general, low-income women in urban areas were initially brought into hospitals so that doctors in training could practice on them. That how they “paid” for their care.

RD: Can you tell me a little more about the history of particularly women of color in the US when it came to birthing in the hospital? Did they have a different experience than white women in terms of when they made the transition from home birth to hospital birth?

IM: Yes. For the most part, women of color who lived in the rural south didn’t go into the hospital until the 1970s and 80s. Alabama, Mississippi, Arkansas, Florida, and Georgia still had midwives who assisted women giving birth at home right through the 1970s. When doctors could count on Medicaid reimbursement for the first time, that situation quickly changed, and the midwives who were so needed before were forced to retire. Farther north, the pattern was somewhat different, because midwifery was outlawed in many states. Everyone was pushed into the hospital when this happened, regardless of the color of their skin. Women of color and poor white women were both used as teaching material in the teaching hospitals throughout the country. For this reason, the shift from home birth to hospital birth took place much earlier among urban women of color than it did for those in rural areas of the south.

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Maternal mortality is on the rise in the US. What can we do about it?

My latest article is up at Colorlines, about the issue of maternal mortality in the United States, particularly for women of color.

The United States spending more money per capita than any other country in the world on health care, but we rank behind 40 other countries when it comes to maternal mortality. Ina May Gaskin, in her new book (review to come!) says that women today are two times more likely to die from childbirth than their mothers were.

A report recently released by the New York City Department of Health examining maternal mortality in the city between 2001 and 2005 found striking disparities for women like Eady: black, non-Hispanic women were more than seven times more likely to die from pregnancy-related causes than white, non-Hispanic women. Such disparities recur nationally. In a March 2010 report entitled “Deadly Deliveries,” Amnesty International explained, “African-American women are nearly four times more likely to die of pregnancy-related complications than white women. These rates and disparities have not improved in more than 20 years.”

But as Rita Henley Jensen explains, the New York report also points to something more than the usual indicators for maternal mortality—poverty, lack of prenatal care and preexisting conditions. Maternal mortality is not just restricted to women of color; we’re actually seeing a rise in maternal and fetal mortality rates overall. California has reported a near tripling of their maternal mortality rate in just the 10 years between 1996 and 2006. The U.S. ranks behind 40 other countries in terms of maternal mortality rates, despite spending the most money per capita on health care.

So how have we created the world’s most expensive maternity care system while still putting women and babies at risk? The answer lies in two of our culture’s biggest influences: money and technology. And now, even as Republican legislators aim to gut the Medicaid program that millions of women depend upon, a movement is growing to make maternity care both cheaper and safer by giving poor women greater access to home births.

I have to say I didn’t like the title of the piece (determined by the editors) because it isn’t just about home birth–it’s about normalizing midwifery care, and particularly expanding access to out of hospital birth, which includes birth centers as well as hospitals. It also includes midwife-provided prenatal care, even if women eventually birth in hospitals.

Home birth is still a dirty word in this country. It’s considered backwards, it’s considered unsafe, it’s considered what someone does when they have no option. This ideology is part of a calculated campaign on behalf of doctors to convince women to give birth with them in the hospital, something that actually killed more women than home births in the initial decades of hospital birth.

Home birth isn’t the problem, and never has been. The problem is making sure all women have access to skilled attendants who know how to care for pregnant women, know how to detect problems, know when to transport to a hospital or when someone might need an obstetrician–someone who is trained specifically to deal with the minority of cases that need specialized medical attention.

Women in the United States are dying in spite of having access to hospital-based maternity care (98%).

That means that women in the US are dying because of hospital-based maternity care.

Either that care is inadequate (like Akira Eady, who I wrote about in the piece, who died from a complication after being released from the hospital postpartum ), or it’s simply too reliant on interventions and surgeries that are harmful. A 33% c-section rate is simply too high. Mothers are dying because they are getting too many surgeries, too many interventions, too many inductions.

We know clearly what isn’t working. The status quo. The 98% hospital birth, the only 9% midwifery care. My article tries to explain how we got here, and what might just help us go in a different direction–back toward patient-centered care that minimizes the use of technology rather than emphasizing it. That only employs tools like c-section when they are really necessary, not just when they are convenient or used to preemptively prevent litigation.

I can’t say definitively that a move back to midwifery care (or home birth) would eliminate disparities. It probably wouldn’t–because racism and classism still exist and still effect our health outcomes. But out-of-hospital midwifery care has some pretty amazing successes both in the US and abroad in terms of reducing maternal mortality. Let’s give it a shot–see if we might not be able to improve these statistics instead of seeing them get worse and worse and worse.

Midwifery under attack in North Carolina and other big birth news

There has been a lot going on these past few weeks in the birth world that I have been watching, but not had the chance to blog about. Here are a few of the highlights and things you can do to be involved with promoting access to midwifery nationwide.

North Carolina:

A midwife in North Carolina (my home state!) was arrested in February. Via Birth and Bloom and North Carolina Friends of Midwives:

On February 19, a Certified Professional Midwife who would be licensed and regulated in neighboring states was arrested for performing the duties for which she is trained. Charged with practicing midwifery without a license, her practice is in jeopardy. Should it close, dozens of pregnant women will face a crisis of care. “Our focus is on the mothers,” says a fellow Certified Professional Midwife. “This is an unfortunate day for mothers in North Carolina.” It is also an unfortunate day for the taxpayers of North Carolina, as they face the potential for a huge bill as the case winds its way through the criminal courts.

At the root of this case is the struggle to further legalize and license Certified Professional Midwives across the country. I’ve written about this struggle before, and how the opposition to the practice of CPMs (who are trained, although not as nurses, to practice primarily home birth) is mostly a fight about who gets to provide birth care. While those in opposition tout all sorts of research about why they think home birth is unsafe, what’s really at stake is the desire for doctors and the American Medical Association to keep tight their monopoly on birth care.

Twenty six states have successfully fought the medical lobby to legalize the practice of CPMs, a hugely important step toward expanding access to a wide variety of birth care both in and out of the hospital. North Carolina is not one of them, which is why this midwife was subjected to arrest and possibly prosecution.

For more information about the situation in North Carolina and how to get involved, go here. There is also a petition you can sign here.

CPM legislation introduced in Congress:

Congresswoman Chellie Pingree, a Democrat from Maine has introduced legislation into the House of Representatives that would allow women in Medicaid access to coverage for CPM birth care. The bill, Access to Certified Professional Midwives Act of 2011, and has two other co-sponsors.

While the battle to get this kind of legislation through Congress will be a serious one (that’s going to take years of advocacy) it’s a really important first step. I’m also glad to see that the focus of the legislation is access to midwifery care for low-income women. I have a feeling this would also impact the ability of CPMs to practice even in states where it isn’t specifically allowed, but I need to corroborate that. If you know more, leave details in comments!