birth

Have you miscarried? A research opportunity

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From Lisa Rosenzweig, a doctoral candidate in Clinical Psychology:

Research Opportunity for Women who have Miscarried

Everyone has a unique experience with miscarriage and unfortunately, little is known about women’s experiences of support and how this may affect responses to miscarriage, and so I invite you to participate in my dissertation research study examining women’s experiences following a miscarriage. Although there is no direct benefit to you, survey results may help healthcare providers better understand and meet the needs of women following miscarriage. This online survey takes approximately 15-20 minutes and is open to women who have miscarried a wanted pregnancy in the previous 6 months who are 18 years of age or older, living in the United States, and involved in a relationship with a significant other. Participants are eligible for a raffle for a $50 American Express gift certificate. For more information, please don’t hesitate to contact me.

Lisa Rosenzweig
Teachers College
lsr2106@columbia.edu

Link to the survey here!

From the clinic: How we make choices about birth providers

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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.

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

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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!

What birthing women definitely DO NOT need

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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

Lost in translation

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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.

Home birth and class

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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!

Latina immigrant who was shackled during labor now faces deportation

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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.

Home birth in the NYTimes, minus class analysis

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An article from this weekend’s NYTimes chronicles the rising trend in home births in NYC. It partially credits the recent Ricki Lake documentary, The Business of Being Born.

The article does a good job of addressing the different challenges for women giving birth in their NYC apartments. It takes about space concerns, neighbor issues, clean up and hospital transfers. The article is also accompanied by a slideshow of photos from various home births.

What the article doesn’t address is the huge class divide in these types of births. I, as a doula and general advocate of midwives and out of hospital births, am a huge supporter of home births. I think they are better for moms and babies who have low-risk pregnancies. I think moms feel more comfortable and are away from the stress and pressure of a hospital. She is on her own time line, no questions asked.

But the huge drawback to promoting home birth is that it is primarily an option for upper middle class women. Not everyone has a home that is safe to birth in. This could be because of family circumstances, overcrowding, lack of support from partners or simply lack of adequate space. There are also obvious financial barriers since most insurance companies won’t cover home births.

It’s unfortunate that an article about birth in NYC didn’t address this issue at all, seeing as it is such a diverse city, in terms of both class and race.

Also, once again an article about women’s health is marginalized, this one was placed in the Home and Garden section. At least it wasn’t in Fashion and Style this time.

Cross-posted at Feministing

Lynn Paltrow: Can There Be Justice for Pregnant Women if the Unborn Have “Human Rights?”

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From Lynn Paltrow’s piece at RH Reality Check:

This summer, the question of abortion and the rights of the unborn once again took center stage as a presidential campaign issue. In August, at the Saddleback Civil Forum, Pastor Rick Warren asked both presidential candidates: “At what point is a baby entitled to human rights?”  Senator John McCain’s answer, “at the moment of conception,” immediately established his anti-abortion bona fides.

But the right answer, as a matter of international human rights principles and simple justice, is: human rights attach at birth, not at conception.

This is the only position that ensures that upon becoming pregnant, women do not lose their human rights.

Political candidates of all persuasions should rest assured that to oppose the recognition of human rights before birth is not to deny the value of potential life as matter of religious belief, emotional conviction or personal experience. Rather, it is to recognize the value of the women who give that life.

Right on.