My project for childbirth advocacy requires that I define a platform for resistance and/or protest in my chosen social change area. So, I have been meditating on what kind of action can be taken for childbirth advocacy. Do I post signs or make buttons for women to wear? Do I organize a protest in Washington D.C.? What would make a difference and what is needed to promote change?
It immediately occurred to me that what needs to change is each individual woman's experience when discussing birth with other women. Isn't this, after all, the most potent source of discouragement for women who are otherwise powerful and independent, but who somehow feel disempowered when it comes to their births? As a childbirth educator and birth professional, I hear daily that women are disproportionately told birth "horror" stories over birth "success" stories, and encouraged to give over their power to medical intervention ("Oh, just get the epidural honey") rather than pursue the most natural, physiological experience possible.
My message for resistance/protest is this: If you are female and someone tells you the story of their baby's birth, request that they tell you how you can be most empowered by their story and in your own future experience...
"EMPOWER ME!"
If a group of women gathers and starts sharing stories of pain, medications, side effects, blue babies, fear, doubt, etc....
"EMPOWER ME!"
If another women tells you to just get the epidural, to schedule the induction or the c-section, to not be a hero or a mortar in the birth process...
"EMPOWER ME...With your stories about birth!"
Don't stand for the continuation of fear and passivity in passing on birth stories from one generation to the next. DEMAND that others' experience EMPOWER you to be as INDEPENDENT and POWERFUL as you are in every other area of your life!
Gain power from others' experience! Learn from them!
And then go out, with the strength (and blood, sweat and tears) of the women who have gone before you, and demand a quality experience in birth--for both you and your baby!
Say: "EMPOWER ME!!"
Wednesday, October 27, 2010
Video: Panel on Advancing Women's Health
Childbirth advocacy blends together with many areas of women's reproductive health and combines experts in many areas (medical, public health, legal, political, domestic violence, etc., all across the world). Judy Norsigian, of Our Bodies, Ourselves, begins this panel on the topic of advancing women's health in urban settings.
Elan V. McAllister & Choices in Childbirth
Here are two clips from an interview with Elan V. McAllister, actress and theater producer, who is the President of the advocacy organization Choices in Childbirth. Elan talks about how she moved into birth advocacy.
As you watch, ask yourself: What excuse do I have to not be involved in helping women to attain a better birth experience, even if what I currently do seems to have nothing to do with birth??!
As you watch, ask yourself: What excuse do I have to not be involved in helping women to attain a better birth experience, even if what I currently do seems to have nothing to do with birth??!
Wednesday, October 20, 2010
Midwifery Legislation
In current news, my home state (Illinois) is in the midst of a long, bitter battle to enable the licensing of certified midwives--a type of legislation that exists in 21 other states at the time of this writing. Homebirth has been shown in multiple studies to be safe for low-risk women, but politics and profit are limiting the choice of women to have a safe birth at home. This is because there are very, very few nurse-midwives (the only legal midwives in Illinois, who mostly practice in hospitals) and/or doctors who attend homebirth in Illinois--between 5-10 in the Chicago area (a city of almost 3 million residents). Licensing midwives will enable highly trained attendants, skilled in homebirth care, to provide alternatives for women who wish to have a low-intervention birth at home.
This is important, because it's not that doctors or nurse-midwives are incapable of attending a homebirth. It's because malpractice insurance is impractically high for doctors who attend births at home, and laws inhibit the practice of nurse-midwives, thanks to the requirement of a written collaborative agreement.
According to this press release by The Big Push for Midwives, there is a clear COST issue in the politics of censoring homebirth. In fact, Consumer Reports, citing a well-circulated publication by Sakala & Corry via Childbirth Connection, often referred to as the Milbank Report ("Evidence-Based Maternity Care: What It Is and What It Can Achieve") stated that induction of labor, use of epidural anesthesia, excessive cesarean surgery, use of electronic fetal monitors (which have never been shown to improve outcomes in any valid study), rupturing membranes, and episiotomy are being used too often, to the detriment of womens' and babies' health!
To learn more about midwifery, including the distinctions of the different classes of midwives and how they are different, see: http://cfmidwifery.org/midwifery/faq.aspx .
Please find out if midwifery is legislated in your state. If not, urge your state legislators to support it, if they would like to get your vote in November.
This is important, because it's not that doctors or nurse-midwives are incapable of attending a homebirth. It's because malpractice insurance is impractically high for doctors who attend births at home, and laws inhibit the practice of nurse-midwives, thanks to the requirement of a written collaborative agreement.
According to this press release by The Big Push for Midwives, there is a clear COST issue in the politics of censoring homebirth. In fact, Consumer Reports, citing a well-circulated publication by Sakala & Corry via Childbirth Connection, often referred to as the Milbank Report ("Evidence-Based Maternity Care: What It Is and What It Can Achieve") stated that induction of labor, use of epidural anesthesia, excessive cesarean surgery, use of electronic fetal monitors (which have never been shown to improve outcomes in any valid study), rupturing membranes, and episiotomy are being used too often, to the detriment of womens' and babies' health!
"The reasons for this overuse might have more to do with profit and liability issues than with optimal care, the report points out. Hospitals and care providers can increase their insurance reimbursements by administering costly high-tech interventions rather than just watching, waiting, and shepherding the natural process of childbirth."According to the same Consumer reports article, underused and higher-touch modalities such as vitamins, use of midwife or family physician (not an obstetrician), continuous support in labor, use of various positions (and general mobility) in labor, increased availability of VBAC (vaginal birth after cesarean, rather than a repeat cesarean), and immediate skin-to-skin contact of mother and newborn are effective in improving outcomes.
To learn more about midwifery, including the distinctions of the different classes of midwives and how they are different, see: http://cfmidwifery.org/midwifery/faq.aspx .
Please find out if midwifery is legislated in your state. If not, urge your state legislators to support it, if they would like to get your vote in November.
Thursday, October 7, 2010
Action Ideas & Reflection on Past/Current Action
This project involves, ultimately, a plan for action that will serve to inform and educate all Americans about the importance of prompt change in maternity care. Some of the changes that will need to be made include proper informed consent, transparency of care, and a focus on mother-friendly care versus profit-making or convenience care, among others.
To define what such changes would look like in the real world, I will pause here to explain the three main foci that were just listed. First, informed consent means giving a patient of medical care (in this case, maternity care during labor and birth) full disclosure of information about the possible procedures that are offered or recommended, explaining all risks and benefits of said procedure(s), and giving the patient the uninfluenced option to accept or refuse care. Second, transparency of care refers to the full disclosure of what procedures are being performed by hospitals and medical providers, as well as outcomes of medical care--this includes an easily accessible, public display of intervention (cesarean section, induction of labor, epidural/analgesia, other surgical procedure, etc.) rates for each hospital, birthing center, medical practice, and individual medical provider. The purpose of such a disclosure is for the public to be able to make a decision about hiring a provider based on the knowledge of their practice standards. Third, a focus on mother-friendly care would place the highest priority of care on the best possible outcome for the mother and newborn baby, rather than focusing on what is best for profits and/or timing of the hospital or medical provider. For example, a mother in labor may be pressured to stay in the hospital to be induced into labor if her labor is not progressed sufficiently and there is inadequate space to care for her for the 24-48 hours required for her labor to progress naturally--this is an example of a decision that is made in the interest of profit and convenience.
There are certainly other categories of change that can be pursued in the matter of maternity care during labor and childbirth, but these three are prominent.
Examples of past and current action addressing these three prominent areas of need include these organizations and their actions:
Coalition for Improving Maternity Services (CIMS; www.motherfriendly.org): CIMS is an organization that promotes mother-friendly care through grassroots advocacy and education. The organization has done the following:
To define what such changes would look like in the real world, I will pause here to explain the three main foci that were just listed. First, informed consent means giving a patient of medical care (in this case, maternity care during labor and birth) full disclosure of information about the possible procedures that are offered or recommended, explaining all risks and benefits of said procedure(s), and giving the patient the uninfluenced option to accept or refuse care. Second, transparency of care refers to the full disclosure of what procedures are being performed by hospitals and medical providers, as well as outcomes of medical care--this includes an easily accessible, public display of intervention (cesarean section, induction of labor, epidural/analgesia, other surgical procedure, etc.) rates for each hospital, birthing center, medical practice, and individual medical provider. The purpose of such a disclosure is for the public to be able to make a decision about hiring a provider based on the knowledge of their practice standards. Third, a focus on mother-friendly care would place the highest priority of care on the best possible outcome for the mother and newborn baby, rather than focusing on what is best for profits and/or timing of the hospital or medical provider. For example, a mother in labor may be pressured to stay in the hospital to be induced into labor if her labor is not progressed sufficiently and there is inadequate space to care for her for the 24-48 hours required for her labor to progress naturally--this is an example of a decision that is made in the interest of profit and convenience.
There are certainly other categories of change that can be pursued in the matter of maternity care during labor and childbirth, but these three are prominent.
Examples of past and current action addressing these three prominent areas of need include these organizations and their actions:
Coalition for Improving Maternity Services (CIMS; www.motherfriendly.org): CIMS is an organization that promotes mother-friendly care through grassroots advocacy and education. The organization has done the following:
- Established a website with links to educational resources for mothers.
- Created a community of supporting professional that ratify and promote mother-friendly care.
- Hosts a yearly conference with speakers who are prominent in the field and roundtables for promoting ideas within the advocacy of the organization.
- Supports the Birth Survey, which is a project that promotes transparency in maternity care by collecting data from mothers about care providers and environments in order to share it with other expectant mothers via the internet.
- The organization maintains a website with links to informative articles and resources for pregnant women.
- Lamaze publishes the Journal of Perinatal Education, a peer-reviewed publication that reports on research related to mother-friendly care (such as this collection of evidence-based information co-produced with CIMS).
- Lamaze has established and publicized its
- Lamaze presents multiple national seminars, conventions, webinars, and educational trainings for childbirth professionals throughout the year.
- Lamaze has established itself as a leader in childbirth advocacy with Position Papers, promoting mother-friendly birth.
- Lamaze has an intricate network of online communities, including bloggers, Twitter pages, Facebook groups, and discussion boards (such as Henci Goer's forum) to help connect the community in cyberspace.
- Most prominently, Lamaze has established its Six Lamaze Healthy Birth Practices that outline the basis for evidence-based, mother-friendly care during labor and birth.
- A network of local chapters that meet in each community to promote the practice of mother-friendly care in each area.
- Fund-raising and awareness events, such as the Red Tent Event, that are encouraged and promoted through the national organization in individual communities.
- Created a template for birth activism ideas, with both national and local support to help initiate them, that can actually be implemented at the grassroots level.
Tuesday, October 5, 2010
Context
The need for birth advocacy is based on the knowledge that current standard practice in American maternity care is not evidence-based and often denies the right to informed consent. During labor and childbirth, women are often (subtly or not-so-subtly) encouraged to act in ways that have not been proven the safest or most effective in medical research. For example, according to Henci Goer (1995), in such cases medical evidence may be "solidly, often unequivocally, against whatever 'the doctor said,' without access to that evidence the pregnant woman is quite reasonably going to believe her doctor, who she presumes is the expert" (p. 1). The entire childbirth experience, then, becomes one of myth propagated by those who should know better, in their own interest based on fear, time, tradition, or antiquated training practices. As a result, women come to believe that they are in danger during their birth, but helpless to have any power over the decisions that govern their care.
One of the most common myths surrounding women in childbirth involves the cesarean section procedure. This life-saving procedure is surrounded by fear, with many myths concerning its use--namely, that obstetricians only perform the procedure when it is medically necessary and that the procedure is necessary in the 30% of births where it is performed (Goer, 1995; CIMS, 2010). In fact, there are many misunderstandings about cesarean section, including increased risks for both mother and baby, maternal-infant attachment, and future pregnancies (CIMS, 2010). Goer (1995) reports that many cases of cesarean section are due to factors unrelated to medical indication, such as obstetric management of labor, provider philosophy, convenience, the patient's socioeconomic status, and fear of litigation, among others. Even more worrisome, this procedure, which is purported to prevent morbidity and mortality, actually causes more problems than it solves at such high rates; evidence and education have not changed these practices, either (Goer, 1995).
Cesarean section is major abdominal surgery that can be the culmination of a cascading sequence of medical interventions (many of which are medically unnecessary) during the labors of women under the care of medically aggressive practitioners--this is known as obstetric management. As alluded to by Goer (1995), socioeconomic status (SES) has an effect on this process, but not in ways that are usually seen in American culture. Since there are profit motives and need for streamlined service in healthcare, the women who hold high-priced insurance plans often hire high-risk obstetricians to oversee their labors, which makes waiting for nature a long (and therefore, expensive) process. To streamline the process, drugs are used to start or speed up labor according to convenient schedules and to provide comfort for women in understaffed labor wards. Electronic fetal monitoring, which has never been shown to improve outcomes (Goer, 1995), is used to allow nurses to monitor women from one central location. Since drugs and monitoring interfere with the natural progress of a woman's labor, women of higher SES are often found facing an authoritative obstetrician who describes a potentially dangerous situation if labor continues for a longer period of time. Since her labor may not be progressing well or her fetus may be in distress due to the introduction of drugs, such women will gladly heed the doctor's warning and proceed with a "necessary" procedure that will save them from unknown consequences of such a long and arduous journey. Meanwhile, their well-paid doctor will complete a fast and relatively easy procedure that will assure a good night's rest, and freedom from litigation from failing to do everything they could to save the unborn child.
Interestingly, women of a lower socioeconomic status do not often suffer such a fate. When it comes to the birth itself, such women are often in the care of midwives who cost less and who are trained to wait for nature to proceed. Since they are not billing an expensive insurance policy, drugs and expensive procedures are less likely to be introduced, and in a freestanding birth center or homebirth, they are simply unavailable. Women with lower means, therefore, may not experience the disadvantage of a lucrative insurance policy--and here we see the irony.
This social change project will seek to develop a framework to continue to inform women of the realities of obstetric management and lack of evidence-based care, particularly in the hospital birth setting. This project will build upon the work that is being done by organizations such as the Coalition for Improving Maternity Services (CIMS; www.motherfriendly.org) and Birth Network National (BNN; www.birthnetwork.org), among others.
References:
Coalition for Improving Maternity Services (CIMS) (2010). The Risks of Cesarean Section: A Coalition for Improving Maternity Services Fact Sheet. Retrieved 10/5/10 from http://www.motherfriendly.org/pdf/TheRisksofCesareanSectionFebruary2010.pdf.
Goer, H. (1995). Obstetric Myths Versus Research Realities: A Guide to the Medical Literature. Westport, CT: Bergin & Garvey.
One of the most common myths surrounding women in childbirth involves the cesarean section procedure. This life-saving procedure is surrounded by fear, with many myths concerning its use--namely, that obstetricians only perform the procedure when it is medically necessary and that the procedure is necessary in the 30% of births where it is performed (Goer, 1995; CIMS, 2010). In fact, there are many misunderstandings about cesarean section, including increased risks for both mother and baby, maternal-infant attachment, and future pregnancies (CIMS, 2010). Goer (1995) reports that many cases of cesarean section are due to factors unrelated to medical indication, such as obstetric management of labor, provider philosophy, convenience, the patient's socioeconomic status, and fear of litigation, among others. Even more worrisome, this procedure, which is purported to prevent morbidity and mortality, actually causes more problems than it solves at such high rates; evidence and education have not changed these practices, either (Goer, 1995).
Cesarean section is major abdominal surgery that can be the culmination of a cascading sequence of medical interventions (many of which are medically unnecessary) during the labors of women under the care of medically aggressive practitioners--this is known as obstetric management. As alluded to by Goer (1995), socioeconomic status (SES) has an effect on this process, but not in ways that are usually seen in American culture. Since there are profit motives and need for streamlined service in healthcare, the women who hold high-priced insurance plans often hire high-risk obstetricians to oversee their labors, which makes waiting for nature a long (and therefore, expensive) process. To streamline the process, drugs are used to start or speed up labor according to convenient schedules and to provide comfort for women in understaffed labor wards. Electronic fetal monitoring, which has never been shown to improve outcomes (Goer, 1995), is used to allow nurses to monitor women from one central location. Since drugs and monitoring interfere with the natural progress of a woman's labor, women of higher SES are often found facing an authoritative obstetrician who describes a potentially dangerous situation if labor continues for a longer period of time. Since her labor may not be progressing well or her fetus may be in distress due to the introduction of drugs, such women will gladly heed the doctor's warning and proceed with a "necessary" procedure that will save them from unknown consequences of such a long and arduous journey. Meanwhile, their well-paid doctor will complete a fast and relatively easy procedure that will assure a good night's rest, and freedom from litigation from failing to do everything they could to save the unborn child.
Interestingly, women of a lower socioeconomic status do not often suffer such a fate. When it comes to the birth itself, such women are often in the care of midwives who cost less and who are trained to wait for nature to proceed. Since they are not billing an expensive insurance policy, drugs and expensive procedures are less likely to be introduced, and in a freestanding birth center or homebirth, they are simply unavailable. Women with lower means, therefore, may not experience the disadvantage of a lucrative insurance policy--and here we see the irony.
This social change project will seek to develop a framework to continue to inform women of the realities of obstetric management and lack of evidence-based care, particularly in the hospital birth setting. This project will build upon the work that is being done by organizations such as the Coalition for Improving Maternity Services (CIMS; www.motherfriendly.org) and Birth Network National (BNN; www.birthnetwork.org), among others.
References:
Coalition for Improving Maternity Services (CIMS) (2010). The Risks of Cesarean Section: A Coalition for Improving Maternity Services Fact Sheet. Retrieved 10/5/10 from http://www.motherfriendly.org/pdf/TheRisksofCesareanSectionFebruary2010.pdf.
Goer, H. (1995). Obstetric Myths Versus Research Realities: A Guide to the Medical Literature. Westport, CT: Bergin & Garvey.
Introduction
This blog is a web-based presentation for a project I am pursuing in a course for Women's Studies at Western Kentucky University. I am a graduate student in the Women's Studies Graduate Certificate Program, a program that is delivered in a distance-learning (online) format, and for which I am in the process of completing my 5th course, out of a total of 6.
This project is a Social Change Project, one which will help to develop a series of actions based upon a feminist issue that I feel is important. Since I have been a childbirth professional for 5 years, working as a doula and childbirth educator, I have seen the unfortunate disadvantages of a system that denies women basic rights to informed consent and bodily autonomy during the births of their babies. I have always been a feminist, and in fact I am pro-choice in a wide variety of ways, so I believe that women know what is best for them and have the right to decide what to do with their bodies (and those of their babies). In the arena of childbirth, this issue has become particularly prominent to me, as I struggle to help women to feel empowered by the choices they make while they often experience patronizing dictation over what actually happens to them during this vulnerable time.
I have also noticed that the population of women that is most vulnerable to this type of patronization is the population that is often overlooked--women of a higher socioeconomic status, often Caucasian, relatively more educated, and who are generally more involved in the decision-making process in their lives. This is ironic, because feminist focus usually focuses on those who are disadvantaged, while the "privileged" are overlooked. As part of this project, I hope to help illuminate why this is so--the brief summary is, however, that profit and acculturation to respecting authority are prominent in this cycle of vulnerability during childbirth.
In full disclosure, I am an independent birth professional, having never been employed by any organization for this work. I am not a doctor, a nurse, or a midwife, although I have completed some independent study in the field of midwifery. I am certified as a childbirth educator through Lamaze International and the HypnoBirthing Institute. I am also certified as a Massage Doula by the Institute of Somatic Therapy. I have recently joined the board of directors for Birth Network National, as a regional representative and (hopefully) blog contributor. My current graduate studies are mainly in the field of clinical psychology, where I have an interest in biological responses to stress, as well as depression, anxiety, and postpartum mental health.
This project is a Social Change Project, one which will help to develop a series of actions based upon a feminist issue that I feel is important. Since I have been a childbirth professional for 5 years, working as a doula and childbirth educator, I have seen the unfortunate disadvantages of a system that denies women basic rights to informed consent and bodily autonomy during the births of their babies. I have always been a feminist, and in fact I am pro-choice in a wide variety of ways, so I believe that women know what is best for them and have the right to decide what to do with their bodies (and those of their babies). In the arena of childbirth, this issue has become particularly prominent to me, as I struggle to help women to feel empowered by the choices they make while they often experience patronizing dictation over what actually happens to them during this vulnerable time.
I have also noticed that the population of women that is most vulnerable to this type of patronization is the population that is often overlooked--women of a higher socioeconomic status, often Caucasian, relatively more educated, and who are generally more involved in the decision-making process in their lives. This is ironic, because feminist focus usually focuses on those who are disadvantaged, while the "privileged" are overlooked. As part of this project, I hope to help illuminate why this is so--the brief summary is, however, that profit and acculturation to respecting authority are prominent in this cycle of vulnerability during childbirth.
In full disclosure, I am an independent birth professional, having never been employed by any organization for this work. I am not a doctor, a nurse, or a midwife, although I have completed some independent study in the field of midwifery. I am certified as a childbirth educator through Lamaze International and the HypnoBirthing Institute. I am also certified as a Massage Doula by the Institute of Somatic Therapy. I have recently joined the board of directors for Birth Network National, as a regional representative and (hopefully) blog contributor. My current graduate studies are mainly in the field of clinical psychology, where I have an interest in biological responses to stress, as well as depression, anxiety, and postpartum mental health.
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