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I don’t write about race issues, because, well, I’m white. What the hell do I know? Nearly nothing. When Navelgazing Midwife and Sagefemme asked on their blogs about the lack of midwives of color, they didn’t get much response…because there aren’t a lot of midwives of color, and all us lily-white types felt we didn’t have much to say. At least, I didn’t, other than regret that it should be this way.

Midwifery came back into the US as part of the second wave of feminism in the 70s, a wave that had many powerful women of color in it but is still symbolized, in white America’s eyes, by Gloria Steinem and women who looked like her. The third wave is still ongoing, is definitely more racially mixed, but has a lower profile in the media, and so doesn’t really have a lot of highly-visible leaders…except for a few older, mostly white, women.

So, although I have not had time to read it much yet, I did want to add Minority Midwifery Student to my blogroll, so that I can learn, and not be tempted to see midwifery as some sort of fancy-dancy white woman thing, which, frankly, it still tends to be in this country.

At any rate, I think all the midwives I linked above get into this issue much more intelligently than I can. Mostly I wanted to introduce another new link, the Black Breastfeeding Blog, because I think it’s an excellent example of personal=political. Breastfeeding, as intensely personal as it is, is increasingly a political act, much like birth, but more visible and less fraught with medical drama. The rights to breastfeed may even now be becoming a wedge to pry open a whole host of changes in the workplace, to make it reflect the needs of a workforce that is composed of many many people who gestate, birth, and nurse children as well as coming to work 40 hours a week. At least, I hope it will.

At any rate, while it takes time and lots of advocacy to get white women and women of color to change their minds about what makes a good birth, breastfeeding is a simple and powerful way to introduce women to their rights as gestating, birthing, breastfeeding human beings. Or rather, to what their rights should be. Women can stand behind unassailable, un-arguable medical evidence about the value of breastfeeding to demand more rights for women in general–among them, the right not to be hassled by Bill Maher, Barbara Walters, or any other ignorant types who think a breastfeeding woman should be locked away in a dark room until her child is weaned.

The recent protests at Applebee’s restaurants and today’s victory for a medical student who wanted time to pump breast milk (and thereby avoid severe pain and possible infection) during a nine-hour exam have kept this issue in the spotlight. And that benefits all women.

Of course, I’ve talking mostly about African American women, and when I say “women of color” I have to mention that Latina women face a different set of challenges for birth, midwifery, and breastfeeding, none of which I feel equipped to talk about intelligently from my small perspective. So if you see any good Latina (or any other nonwhite) midwifery, birth rights, etc. blogs out there…send ‘em my way.

I read this post by a new mom, which I stumbled on while Googling midwife stuff.

This is the part that struck me;

Jonathon called my mom several times to come over and help with me. Not the baby, me. I didn’t even care. I felt like when she was there, I could go on. When I was alone, I couldn’t cope.

This panic feeling, for new moms and dads, is so, so common. We joke about it afterwards, even, but the sick feeling of falling, of doom hanging over your head, of even the simplest tasks looking impossible…I think most new parents must feel this. And every one of us want others around, to help us learn and cope, but we are mostly afraid to ask.

We are afraid because we are supposed to feel shame about wanting this help, as though we are trying to push off the responsibility of parenting on our own parents. And certainly that does happen. But is handing the baby over to the anxious couple and sending them home alone the best option? Is there some middle ground between dumping your baby on your parents and lying in bed with your heart pounding in complete terror, wishing there were someone, anyone, to help you learn how to keep this incredibly demanding fragile new life alive and healthy?

Tara had PPD, but even before she got any anti-depressants, she knew that she felt better with her own mom around. Was that part of her depression, or just a natural fear of the unknown, of overwhelming responsibility?

The nuclear family as an isolated unit is a strange way for humans to live; cut off from support, advice, and extra hands, two people are supposed to be everything to each other and sufficient to raise their own children without any help whatsoever.

This is not a slam at grandparents, by the way, or anyone else. Grandparents mostly have work of their own, or responsibiliies far away from their children, that don’t let them pitch in even as much as they’d like. And a better setup wouldn’t just be them, but a wider community of friends and extended family too. Yes, a village. I know. It’s a cliche. But oh, how I dreamed about that village when Nathan was tiny and I was desperately wishing for someone to talk to while I struggled with breastfeeding, someone I could swap babysitting with when one of us needed a nap, someone to help with dinner and housework, someone to tell me it was going to be ok. Our families did what they could, but we didn’t want to look like bad parents by asking too much (and we did ask a lot, anyway) and our support network was stretched too thin and far away to be there for us like that.

We got through, like most parents do, because it does get easier, and you do stop being terrified at some point. Because there was no alternative, and we just kept going on. And all the other parents that do the same, assume that this is the way it must be. But that just seems wrong to me. There’s going to be some suffering and fear and mistakes no matter what, as part of being a parent. But does it have to be so bad, does it have to push you so close to an edge that you’re afraid to look at directly, for fear you’ll fall over?

I think that’s a question worth asking.

I had to give a brief response when joining a local ICAN chapter about who I was and why I wanted to join. I thought what I ended up with was a nice succinct guide to my birth history and radicalization. Enjoy.

My name is emjaybee, my husband’s name is Matthew, and my son Nathan is nearly 2.

Birth story: water broke at 42 weeks. “Midwives” did not let me labor naturally, insisted on pitocin (because I was 42 weeks and it was “policy”)–and I didn’t know my rights, so I went along. Needed an epidural after 6 hours of pain, no shower allowed (because of monitor) no food allowed (because of stupidity). Progress halted at 8 cm for an hour, that was considered bad enough to c/sec.

Surgery was extremely traumatic. Hospital was filthy, cruel, and treated me like dirt, and I felt lucky to get out of there alive. I suffered with depression and trauma, and frequent thoughts of suicide, for a whole year and more. Breast milk never came in, and I had to formula feed.

I had a hemorrhage 10 days postpartum that no one could explain (because it’s “impossible” for a surgeon to leave any tissue inside; apparently the blood gushing between my legs was somehow imaginary), but I must have passed the tissue and only spent one night in the hospital before I felt like I wasn’t going to die. This did not help my recovery. I was a mess, because I trusted people in a system which did not care about me or my son.

Not surprisingly, I’m radicalized, and will homebirth if I ever birth again. I also finally found the courage to admit I want to be a CPM, and am planning towards that goal.

I am not a midwife. I’m not even a midwife in training, yet. I’m not a birth educator, nurse, or EMT. I am only someone with an obsessive interest in birth and birth rights, and access to Teh Internets.

I just feel the need to post that here, to remind myself, not to go out on limbs and diagnose other women, pre- or post-partum. Sometimes I get into Internet discussions, where the ignorance and need for knowledge is so profound, and no one else is answering the woman’s confusion. And I just want to leap right in like Superman and tell her what she needs to do. And I have had to learn to take a deep breath, provide links to actual midwives, like the ones on my blogroll, and qualify everything I say.

I think, so far, I’ve kept on the right side of the line, but I don’t want to cross it and give someone unqualified advice. I don’t want a woman’s question to go unanswered either, because I know how agonizing it is to be pregnant and be confused because whatever you’re going through isn’t in the books. And no one you know who’s had kids seems to remember or have paid attention to stuff like that, and tells you to leave it all up to your doctor. Who is vague, and who may not be being entirely honest with you. It makes you feel crazy, especially considering all the hormones you’re also dealing with. Not fun.

It’s hard to pick and choose what I say, not to be flattered when women actually ask for my input, because…I am not not NOT an expert. What I don’t know FAR exceeds what I do. It’s a sad commentary on the lack of knowledge most of us women have about our own damn bodies that someone like me can even be regarded that way. I shouldn’t be. Most of what I know now should be common knowledge, taught in health class, talked about frankly on TV, movies, in books. Every woman who will birth, which is about 80% of women, should know what it looks like in its natural state, what it feels like, how it affects our bodies, long before we ever get pregnant. It’s one of the biggest experiences in a woman’s life, and it’s completely ignored unless it’s being used as a lame plot device in a sitcom or movie. That hobbyhorse of “real literature”, the First Sexual Experience, pales in comparison, to tell you the truth. You don’t usually have to face your fear of imminent death during that one, for one thing.

I blame the patriarchy, as I so often do, that this life-altering experience gets less attention in our culture than some teenager’s first time Doing It, because birth only happens to women, and is therefore Not Worth Discussing, or worse, Icky.

At any rate, I have miles to go before I certify, and while I really love telling women the things that OBs and books don’t about birth and their bodies, I don’t want to run their lives or diagnose their problems. I want to point them in the right general direction and then refer them to those who’ve already traveled that path and understood in detail the things I that I kinda-sorta-not really understand.

…remember that part of your medical training about “do no harm”? Might be time to take a refresher course, okay?

The maternal mortality rate in the U.S. is the highest it has been in decades, according to statistics released this week by CDC’s National Center for Health Statistics.

According to the figures, the U.S. maternal mortality rate was 13 deaths per 100,000 live births in 2004. The rate was 12 deaths per 100,000 live births in 2003 — the first year the maternal death rate was more than 10 since 1977 (Stobbe, AP/Washington Post, 8/24). A total of 540 women were reported to have died of maternal causes in 2004, 45 more than were reported in 2003, according to the report (NCHS report, 8/21).

A rise in the number of caesarean sections — which now account for 29% of all births — could be a factor in the increased maternal mortality rate, some experts said. According to a review of maternal deaths in New York, excessive bleeding is one of the primary causes of pregnancy-related death, and women who have undergone several previous c-sections are at particularly high risk of death.

Now while the rising c/section rate and the risks it brings are one of my favorite rants, the other factors mentioned in the article are appalling. African American women are THREE TIMES as likely to die from childbirth as white women. That’s an astonishing statistic. And a sad one. Lack of care pre-and -post partum can be deadly.

Obesity (possibly) and improved reporting may also have increased the stats, which lets OBs off the hook a little bit, but our pitiful health care system not at all.

Universal care cannot possibly come too soon. It won’t take the morbidity rate down to zero, but it will allow us to keep women of childbearing age in a system of care, so that lack of access to care during pregnancy will not be a contributing factor. If how deaths related to pregnancy are reported vary so much now that it’s affecting our stats, then our stats still aren’t good; we need a national system to truly determine the effectiveness of care and the pinpoint the problems. How many of those women who died had no care at all until they showed up in labor, maybe with undiagnosed complications that could have been treated? How many were malnourished (which you can be while being obese), had low-grade infections (even an infected gum can cause premature births), had any number of problems that may not have been fatal if caught early?

Of course, I could say the same about all health issues, which is why I’m a universal care proponent. Preventative care is critical to everyone, but under our current system, will always be sacrificed by people without a lot of ready cash. People die from lack of preventative care every day; I’d be willing to bet a great many of the mothers in this study fall into this category.

So maybe it’s not the OBs I should be hollering at, per se, but a government run by people with lots of money who will always have access to care, but who take every chance they get to deny that access to their fellow citizens. Fellow citizens who work just as hard, who pay their taxes, but who are allowed to die for the sin of being too poor to buy their healthcare.

I am so much a newbie and a bit-player in the whole birth-rights movement, but I still get so angry and riled up when I read stories like this one (warning; original link has some birth pictures, not gory, but nekkid).

The forces arrayed against women who want to have control of their own births seem so large and powerful. We trust doctors to tell us what to do, how to take care of ourselves and our children, how to be healthy and stay safe. We lionize them in shows like House , ER, St. Elsewhere, even MASH . Saintly, all-knowing doctors abound in our imagination. They may have messy personal lives, but you hardly ever see actual practices being confronted; just the occasional Bad Doctor, or lazy doctor, or drug-addicted doctor, whatever. Probably because the shows’ writers know how to write good soap opera, but only know what their consultants tell them about hospital practice.

Anyway, Sagefemme’s post echoes the frustration of people like myself and midwives in particular, who remain powerless to stop their clients from being abused and hurt by aggressive, hostile, and ultimately harmful practices.

I’m not talking natural vs medicated. I’m talking unhindered vs interfered-with birth. I’m talking about barely making it out without being cut one way or another. About your baby being handled roughly. About silence and intimacy not being a piece of your baby’s birth. There are even some homebirth midwives that don’t get the idea of unhindered birth. Really, it’s my new platform. It’s the reason why I’m so angry. We can’t keep bringing the hospital into the home! We have to do this radically different - ways that honor a woman’s physiological process of birth. We have to step back and ask if we’re doing things to really help a mamababy or are we just doing things to cover our ass in case we’re looked at by someone? Is this evidence-based or are we doing it because it’s what our peers believe is necessary?

There’s this mis-perception that the safest birth is the one with the most instruments, procedures, people, and processes involved. But every bit of interference in natural birth–from restricting the mother’s movements and ability to get protein and hydrate herself to dictating her positions to push and whether she has to use drugs–comes with its own risk.

Let’s take another natural process–say, eating. Now eating does have risks; we’ve all nearly choked to death on something, or eaten something that made us sick, or gave us an allergic reaction. At least some of those risks could be mitigated if we received all our nutrition via IV and feeding tubes, the way comatose people are fed. But of course, this would restrict our movements, introduce risks of infection and malnourishment, and be painful and psychologically damaging. It would rob us of our freedom in the name of protecting us from bodily mishaps.

Now let’s assume that for the convenience of the doctors observing them, those who wished to eat were required to lie on a table with their feet tilted higher than their head, being questioned and monitored constantly by anxious medical personnel, while trying to eat a ham sandwich, potato chips, and a coke. What are the chances, now, that the patient will have trouble swallowing, and may even start to choke? And what if every time this happened, the surgeons rushed into to install a “safer” feeding tube “saving” the patient’s life?

Birth is no different. The muscles in a woman’s uterus that handle birth are just as capable as the muscles in her throat and gut that digest her food. But being pressured “for her own good” by people she trusts in white coats, to lie down and push on her back, to be prevented from moving because she’s attached to cables and monitors, to have strangers hovering over her frowning as they check her machine readouts and dilation, has a physiological and psychological effect. She doubts herself, she feels afraid and threatened, and her body reacts by tensing and slowing down.

In rushes the surgeon with the scalpel, ready to save her from the emergency that might not have existed if she’d just been left the hell alone.

This model has got to go. It’s harmful, it’s degrading, it’s disrespectful, and it’s bad practice. It’s sexist, because it assumes women’s bodies are inherently broken and incapable, and they need someone to save them from their inability to birth. Practices that separate and interrupt mother and baby bonding postpartum disrupt a key psychological event in the relationship of a mother and child, and their loved ones, in the name of control and hospital convenience. There are no good medical reasons to drag a normal health baby off to a nursery for observation. Leave him in his mother’s arms and observe him there, where he’s safest and she’s most at peace.

Women are people, not pieces of meat, and they deserve that personhood at all times, especially as they do the hard work of bringing new life into the world. They are not born broken, but they are being broken by a system that doesn’t care about them or their babies. And more of them are realizing it all the time.

..is to compare giving birth to climbing Everest.

But I think marathon running is a good analogy too:

A few weeks later, Ann’s training was going well. She had missed a few days, but usually accomplished her daily goals. While the running itself was sometimes tedious and uncomfortable, she loved how she felt afterwards. Ann mentioned to a friend that she was training for a marathon and was surprised when her friend told several horror stories of marathon runners who suffered lifelong injuries—even one about a runner who drank so much water that he died during the race. Ann replied that she had carefully researched both common and rare injuries and that she was sure that she could either prevent them, treat them herself, or seek help if something serious arose. Her friend said, “But how can you be sure? You might die of a heart attack while you are running—you’d have no way to know it’s going to happen until it is too late. It’s just not worth the risk.”

Ann’s family thought she was crazy. Shouldn’t she be doing something more useful with her time? What if something went wrong? What if during the race she is in too much pain and can’t finish—then how would she feel? Anne told her family that she had done her research and that it was an important goal. She asked that they either speak positively about her upcoming race, or that they refrain from saying anything at all.

Ann noticed that the media always focused on the sensational stories of marathon running turned ugly. When TV crews covered races, they showed runners limping along, looking like death warmed over. They usually interviewed runners who had to drop out, giving them several minutes to tell their stories. Then, almost as an afterthought, they would give 30 seconds to a successful runner who looked exhilarated, if a bit tired and sweaty. Of course, after that runner was done speaking, the TV host would remind the audience that most people cannot complete marathons and that it was best not to get your hopes up. Good grief, Ann thought. I know plenty of people who have completed the race without dying or breaking a leg or permanently injuring themselves.

According to this link, Public Advocate for NYC Betsy Gotbaum is giving local hospitals heat for their lack of transparency:

The Maternity Information Act requires that hospitals provide site-specific statistics on delivery procedures to all incoming maternity patients and all members of the public upon request. In 2005, the Office of the Public Advocate determined that none of the 44 hospitals providing labor and delivery services in New York City were in compliance with the MIA; most did not provide any information, and the one hospital that did attempt to comply provided a pamphlet containing information that was eight years old.

Well isn’t that interesting. I birthed in Brooklyn, and I can assure you, they didn’t give me any of those stats either. Here’s something that also surprises me not at all:

The Office of the Public Advocate further determined that the cesarean section rates among hospitals in New York City were striking. Overall, public hospitals had lower cesarean rates than privately operated facilities; however, with the exception of New York University Downtown Hospital, all hospitals had cesarean rates well above the 15 percent maximum rate recommended by the World Health Organization….The report also noted, In 2004, the average cesarean rate in New York City was 28.6 percent, a 2 percent increase over 2003, when the rate was 26.6 percent. Many New York City hospitals now have a c-section rate over 30 percent.

I’ll bet it’s closer to 35% by now.

Transparency is a huge issue in all aspects of healthcare. It can be impossible to find out how different hospitals compare in terms of outcomes and quality of care, and the hospitals themselves do everything in their power to resist giving out that info. Which is especially galling under an American system that constantly tells us we are “consumers” with the right to choose how we get our healthcare. Right to choose is meaningless if you don’t have accurate information about what you have to choose from.

Thankfully, the Lamaze organization is partnering with the Coalition for Improving Maternity Services to try to create some more transparency for pregnant women seeking maternity care:

An incredible group of grassroots advocates with leadership from Sandra Bitonti Stewart and Elan McAllister (under the umbrella of and with the accolades of the Coalition for Improving Maternity Services and with support from Lamaze International among others) will officially launch the Transparency in Maternity Care Project in New York City on July 21, 2007. In the meantime the Grassroots Advocacy Committee has been collecting hospital data on hospital care practices and interventions and have developed a birth survey that will be used to gather women’s personal stories of their birth experiences. In the future women will be able to go to the website and find information about hospitals and providers…not just intervention rates but, just as important (if not more so), women’s personal experiences.

Oh man. I can’t WAIT to add my personal experiences at Brooklyn Methodist. Whoo doggie. That’s going to be a fun entry on their website. Vengeance is mine, sayeth the mom.