This meta-analysis (Maternal and newborn outcomes in planned home birth v. planned hospital birth: a metaanalysis) by Wax et. al. (also known simply as the ‘Wax study”) is not new.  It came out last September in the American Journal of Obstetrics and Gynecology (AJOG), but the reverberations of this controversial study are still being felt in the birthing community today.  As mentioned above, the flaws in this study have been discussed on numerous blogs and in numerous articles, so there’s no need to re-hash the entire argument here. (For further reading on this, though, check out the following links: Science and Sensibility, Our Bodies Our Blog, Science Based Medicine, Nature, ACNM’s response, Midwifery Today’s response).  To sum it all up, though, I quote from Michal et. al., Planned Homebirth v. Hospital Birth: A Meta-analysis Gone Wrong:

The statistical analysis upon which [the Wax meta-analysis'] conclusion was based was deeply flawed, containing many numerical errors, improper inclusion and exclusion of studies, mischaracterization of cited works, and logical impossibilities. In addition, the software tool used for nearly two thirds of the meta-analysis calculations contains serious errors that can dramatically underestimate confidence intervals (CIs), and this resulted in at least 1 spuriously statistically significant result. Despite the publication of statements and commentaries querying the reliability of the findings, this faulty study now forms the evidentiary basis for an American College of Obstetricians and Gynecologists Committee Opinion, meaning that its results are being presented to expectant parents as the state-of-the-art in home birth safety research.

And that’s really the crux of the issue right there: ACOG has based their most recent home birth committee opinion paper on the Wax findings, despite the fact that the Wax study is so controversial, and has been so loudly contested.  ACOG seems to take the Wax study as gospel truth: “Published medical evidence shows [home birth] does carry a two- to three-fold increase in the risk of newborn death compared with planned hospital births.” (i.e. the Wax findings).  But as you can see above, the Wax findings are anything but conclusive. Couple this with the fact that a recent study in the current issue of Obstetrics & Gynecology (ACOG’s very own publication, aka the Green Journal) found that two-thirds of all of ACOG’s practice guidelines have no basis in science, and we have a very serious cause for alarm.  As one of the letters to the Editor at AJOG pointed out in regards to the Wax Study,  this is the dangerous practice of communicating bad science to the public.  To quote liberally from this letter to the Editor:

These practices are unethical, causing harm through unfounded confusion and fear, and misleading policymakers and the public. The Singapore statement on research integrity represents the first international effort to unify policies, guidelines, and codes of conduct for researchers worldwide.⁴   Accordingly, the AJOG publication would fail on 2 counts: (1) poor quality of the study; and (2) author recommendations made beyond what the data support and outside of their professional expertise. Obstetricians are not the leading professional group in home birth and midwifery-led care, and should not reach policy conclusions in isolation. It is essential to use appropriate subject peer reviewers: in this case midwife and epidemiology experts in studies examining midwifery care and birth setting.

Obstetricians have never been the experts on home birth.  In my own personal experience, I cannot think of a single obstetrician who has even seen a home birth.  Nevertheless, as Melissa Cheyney writes in the  Huffington Post (Why Home Births Are Worth Considering), the Wax study is only serving to fan the flames between the obstetrical/ medical community and the home birth community (I purposely refrain from saying the homebirth/ midwifery community, because I feel like midwives can and do and SHOULD straddle the gap between the home birth community and medicine, offering high-touch, low-tech intervention as we do, and advocating for all women, everywhere, regardless of their birth choices or location of birth).  When home birth is seen as more dangerous than hospital birth by obstetrical “experts”, what then happens to the women and families who still choose to have a home birth?  Are they considered crackpots and lunatics endangering the lives of their babies?  What happens if they need to transfer to a hospital?  What happens if they need to transfer to a hospital but the midwife is reluctant to make the transfer based on the stigma and ostracizing treatment she and the family will receive in the hospital setting?  Will the barriers to midwives choosing to attend home births continue to rise so high that ultimately they can no longer provide this service? And if that happens, where does that leave the women who will still choose to have a home birth anyway, without any medical provider available to attend them?

So long as ACOG’s opinion on home birth continues to be based on poor science, we’ll continue to move further and further away from what this country truly needs: an integrated model of care, where women who choose home births and the midwives who serve those women are backed up by obstetricians and the medical model of care, allowing for safe transfers when needed without stigma, judgement or blame.

“[Rep. Mike] Pence [R-Ind.] has acknowledged that health centers use Title X money to perform valuable services that he supports, but he contends that the funds are also being used to support abortions indirectly by covering operating costs and other related expenses for Planned Parenthood and other abortion providers.

“Eliminating Title X funding has never been my goal,” he said on the floor Thursday. “My focus has and will remain on denying taxpayer dollars to Planned Parenthood or any organization that provides or promotes abortion as a means of birth control.”

My argument with this is that once again, abortion and birth control are getting mixed up, and they are two totally different things.  This frustrates me no end.  Family planning and birth control helps to avoid abortions!  If our country is so strongly anti-abortion, this is EXACTLY the type of organization we should be supp orting, not defunding.  I have personally used Planned Parenthood before as a student in order to obtain birth control, and as a midwife I personally send many of my patients to their clinics since 1) they accept medicaid (and all of my patients are medicaid-only recipients) and 2) they have the Mirena IUD and are willing to insert it into medicaid-only patients (my hospital unfortunately only has the copper-T IUD on offer, so patients seeking the Mirena need to go elsewhere; the Mirena, of course, is a form of BIRTH CONTROL).

Planned Parenthood is now currently trying to raise money and defend itself in the Senate against further legislative attacks.  Luckily, I seriously doubt that the Senate will approve the same level of draconian cuts to Title X funding, and even if they do, President Obama has vowed to veto such a bill.  Nevertheless, Planned Parenthood NEEDS YOUR HELP! With the anti-woman climate in Washington right now, it is very naive to sit back on our heels and assume that the Senate will automatically turn this aside.  Write a letter to your Senator, call or speak with your Senator, or sign PP’s Open Letter to Congress.  Or, if you’re in  the NYC area, attend the Planned Parenthood New York’s Rally at Foley Square at 1:00 pm this Sat. 2/26.

“The bill in South Dakota is an invitation to murder abortion providers,” says Vicki Saporta, the president of the National Abortion Federation, the professional association of abortion providers. Since 1993, eight doctors have been assassinated at the hands of anti-abortion extremists, and another 17 have been the victims of murder attempts. Some of the perpetrators of those crimes have tried to use the justifiable homicide defense at their trials. “This is not an abstract bill,” Saporta says. The measure could have major implications if a “misguided extremist invokes this ‘self-defense’ statute to justify the murder of a doctor, nurse or volunteer,” the South Dakota Campaign for Healthy Families warned in a message to supporters last week.

Thankfully, for the moment, due to a national media outcry against H1171, the bill has been momentarily shelved, while Representative Phil Jensen, the bill’s sponsor, decides to either include language to protect abortion providers,or  cancels the bill altogether, since South Dakota law already includes an “unborn child” in the definition of “person”, and Rep. Jensen admits there may not be a need for a separate bill.  The NY Times also has the article here. There is supposed to be a further decision made on whether to go forward with H1171 today, so I will try to update this as the news arrives.

Even if the justifiable homicide aspect is dropped in H1171, there is still another bill pending in the South Dakota legislature which proposes to make getting an abortion in SD even more arduous.  This bill, H1217, would require women to undergo counseling at a Crisis Pregnancy Center (CPC) before being allowed to go forward with an abortion.  As it stands right now, the requirements to get an abortion in SD are already nearly insurmountable.  There is only one clinic in the state which provides abortions, the doctor who does them is flown in from a neighboring state only one day a week, and women are forced to see a sonogram of the fetus and are read from a script emphasizing that the baby is a living, separate entity and that they are connected, before going forward with the procedure.  Adding a visit to a Crisis Pregnancy Center, which are often run by religious/ pro-life organizations, throws up yet another obstacle.  H1217 also proposes adding a mandatory 72 hour wait time between counseling at the CPC and the actual procedure itself.

The 2006 CDC Waxman report has already noted that CPC’s are notorious for providing false and misleading information, and that the majority of counselors are pro-life activists, not trained healthcare professionals.  RH Reality Check has a great article on this.  Mother Jone’s also wrote extensively about the Waxman report and the false information provided by Crisis Pregnancy Centers.  Here are a few other links to blogs discussing H1217:

Our Bodies Our Blog

The Curvature

Blog For Choice

While our focus is caught up on the Federal level and the House’s swift and drastic attack on women’s reproductive rights (more on this to come), it’s easy to lose sight of the smaller state battles which can do a lot to set precedent and undermine Federal laws in the first place. If you’re looking to directly support the women of South Dakota, here is a good place to start: South Dakota Campaign for Healthy Families.

Related links:

The Daily Kos: an account from an abortion clinic escort

Belly Tales: post from 2008 on the eve of the 2nd SD referendum vote (which didn’t pass)

South Dakota’s Measure 11 was soundly defeated: “South Dakotans have affirmed by their votes tonight that no vague law can account for every individual circumstance. And that is precisely why women and families, not the government, should make these personal healthcare decisions,” said Sarah Stoesz, President and CEO of Planned Parenthood Minnesota, North Dakota, South Dakota.

The New York Times, in the midst of all the election craziness, published an article on new links between depression and premature delivery which have been recently reported in the Journal of Human Reproduction. The study interviewed 791 women and ultimately gave them scores based on how many depressive symtoms they exhibited–the higher the score, the worse the depression. The study found that the higher the score, the greater the risk of preterm delivery, even after controlling for prior preterm deliveries, miscarriage, socioeconomic status, education and other variables. This is particularly fascinating considering that so little is known about how depression affects pregnancy, and vitally important since depression during pregnancy (and the mental health of women during pregnancy in general) are so often overlooked in prenatal care.

The New Space for Women’s Health (formerly Friends of the Birth Center) is having a fundraiser on November 18th at Babeland called Women Come First. The event, which is co-sponsored by Ricki Lake and The Business of Being Born, offers an opportunity to not only raise money for the new free-standing women’s health and birth center in New York City but an exclusive cocktail party and shopping opportunity. Sounds like a lot of fun! I’d be there if I wasn’t already working that day…

Finally, I’m sure this is going the rounds on the internet, but I think everyone, everyone, needs to watch Keith Olbermann’s special comment on Proposition 8:

Even so, none of this changes the fact that women trying to access reproductive health care in South Dakota face a really tough challenge.  There is only one clinic in South Dakota which performs abortions, and they are done by a rotating staff of doctors who are flown in from neighboring states.  And again, as the Daily Kos has pointed out, the hoops that women in SD have to jump through before actually having the procedure done are incredibly daunting:

The woman must receive state-mandated “counseling.”

The woman must wait at least 24 hours after the state-mandated “counseling” before procedure may be provided.

If the patient is a minor, a parent or guardian of the patient must be notified.

The doctor must offer the woman an opportunity to view a sonogram, and must then record any responses in her permanent medical records.

The doctor must deliver a government-dictated script to women designed to intimidate her and discourage her decision. The mandatory language includes statements of fact which are contrary to all available medical research.

Usually by the time a woman is sitting across from me (a midwife) for her initial prenatal visit, she’s already made up her mind to keep her baby.  But every now and then I come across a woman who’s still conflicted, and we usually have a frank and very difficult discussion about whether she really wants this pregnancy or not, and everything that keeping this pregnancy entails.  This is a hard decision to make in a hospital like mine, sitting across from a provider like me who is resoundingly pro-choice, and is not at all judgemental or discouraging of the woman’s thoughts or decision.  These women are often young, alone, and already scared and intimidated, but if they really don’t feel like they can keep this pregnancy (for whatever reason–and we do talk about the reasons, but only to make sure that she’s thought everything through), I gently refer them to the termination of pregnancy clinic, with compassion and support.  No one is judging them.  Judgement is the LAST thing you should find in your health care provider’s office.

Now, imagine this were South Dakota.  Imagine how much harder it would be to make such a decision if I were legally required to read these women a script containing statements which are medically false and which do nothing but make the woman feel even more intimidated and guilty about her decision.  If I were forced by state regulations to make it very clear that I think abortion is a terrible idea, it would take a very staunch woman indeed to be able to stand up to something like that (and this is not because I’m so terribly persuasive, but only because the power of the white coat is astounding: people automatically trust you a little bit more and believe you’re speaking the truth, just because you’ve got a white coat on.  If you tell them that they need to eat more iron-rich foods because they’re anemic, they generally listen to you.  If you tell them that what they’re doing is wrong, they listen to you too).  And then, to top it off, I’d have to offer these women a sonogram, just so they can see that heart beating some more, and feel even more like a monster for doing what they feel they have to do.  The cruelty of it makes my skin crawl.

In any case, the reproductive rights of the women of South Dakota hang in the balance (and by proxy, the women of the rest of this country too, because if this referendum passes in South Dakota, it’s just opening the door for every other state).  And do not be fooled: the inclusion of exceptions into the wording of the bill in no way changes the fact that this referendum will basically make all abortions in South Dakota illegal, because there is absolutely no practical way to carry out these exceptions, and no doctor willing to test it.  So, what can we do about it?  We can donate money to the South Dakota Campaign for Healthy Families, and we can…(to put a rather neo-conservative spin on it)…pray.

Many other websites have covered this topic in exhaustive detail, so I’ll refer you to them in just a moment, but first a few comments of my own. As Rixa rightly pointed out on her blog The True Face of Birth, ACOG’s sudden acceptance of out-of-hospital birth facilities (i.e. freestanding birth centers) flies directly in the face of their earlier November, 2006 Statement on the subject, where they were adamant that the hospital “is the safest setting for labor, delivery, and the immediate postpartum period,” and that “ACOG strongly opposes out-of-hospital births.” I wonder what caused the sudden change of heart? If you recall, during the time, ACOG and the American Association of Birth Centers (AABC) were not on such buddy-buddy terms. In fact, the AACB wrote a scathing denouncement of ACOG’s statement. Opposing out of hospital birth included births that occurred in freestanding birth centers as well as in homes. I guess in deciding to attack homebirth directly, maybe ACOG decided that it would be better off having the AACB as an ally rather than an enemy, and included freestanding birth centers in its list of “acceptable birthing places” this time around. Who knows. There has got to be so much back-room wheeling and dealing and politics involved in all of this that one can only wonder at the motives. But crucially, why must support of freestanding birth centers be at the expense of homebirth?

It’s also interesting to note that the ACNM has yet to issue a response to this. Is that because they’re partly mollified by ACOG’s acceptance of certified nurse-midwives to the exclusion of all other midwives? From the ACOG statement: “For women who choose a midwife to help deliver their baby, it is critical that they choose only ACNM-certified or AMCB-certified midwives that collaborate with a physician to deliver their baby in a hospital, hospital-based birthing center, or properly accredited freestanding birth center.” Making distinctions like that among midwives in our country (CNMs v. CPMs) only hurts our profession as a whole and is going to get the overall profession of midwifery absolutely no where, but I’ve already written about this ad nauseum. And what about the hundreds of Certified-Nurse Midwives/ Certified Midwives who attend homebirths? Dear ACNM: Just because the majority fo CNMs/CMs work in hospitals doesn’t mean that those who work in homes don’t need a response statement from you. You’re still the professional organization for ALL Certified Nurse Midwives and Certified Midwives—even those who perform homebirth. If you won’t stand up for a woman’s right to give birth in a home, at least stand up for the midwives you represent who deliver in homes….even if it means butting heads with your beloved ACOG.

As Rixa conjectured, maybe all of this is indeed in response to Ricki Lake and Abby Epstein’s documentary The Business of Being Born, which has done a terrific job of raising awareness regarding homebirth. The real question we need to continue to ask ourselves is this: Why is it that America, with all of it’s insistence on hospital birth and safety, still has one of the highest rates of neonatal and maternal mortality among developed countries? That question lies at the heart of The Business of Being Born, and clearly, the American way of doing birth, for all its emphasis on hospitals and safety, has not adequately addressed this. What we need is a statement from ACOG more along the lines of the Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Midwives (RCM), which both jointly support homebirth, in sharp contrast to what ACOG has churned out (kudos to Rixa for finding and posting this in its entirety). Just read the first few lines of the document:

The Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG) support home birth for women with uncomplicated pregnancies. There is no reason why home birth should not be offered to women at low risk of complications and it may confer considerable benefits for them and their families. There is ample evidence showing that labouring at home increases a woman’s likelihood of a birth that is both satisfying and safe, with implications for her health and that of her baby.^1–3

What a refreshingly different point of view. Surely American women aren’t that different from British women? Surely our healthcare systems are not that different? Why can homebirth be safe on one side of the pond, and unsafe on the other? Yeah, you guessed it: one side is actually basing its policy on research and fact, while the other is pandering in fear, uncertainty and doubt. And don’t forget the economics at work here. ACOG is a professional organization supporting and marketing the services of its members: obstetricians. In other words, a lobby. Again as the Business of Being Born points out, the bottom line is always the bottom line. If we had a national healthcare system like the NHS, where homebirth actually translates to increased savings, rather than a competitive profit-driven healthcare system and a surplus of obstetricians, we’d probably be seeing a lot more governtment-funded support for homebirth.

This is the line that really sticks in my craw: “The main goal should be a healthy and safe outcome for both mother and baby. Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby.” You selfish, selfish mothers, trying to enjoy your relaxing, all-natural births at the expense of your babies! The mother and the baby have become hopelessly estranged in the minds of American medicine, and the emphasis (and increasingly, the legal rights) of the baby are always seen as more important than those of the mother. Rather than motherbaby, where the two are linked and the health and wellbeing (physical, mental and emotional) of one is dependent on the other, we have fetal rights outstripping maternal rights, in courts as well as in hospitals. Why can’t modern medicine seem to get it through its skull: what’s good for the mother is ALSO GOOD FOR THE BABY. The two are not diametrically opposed. When a woman feels safe, supported and relaxed, she’s able to sink into her labor and allow her birth to unfold in the manner that’s best for the baby, without all of the stress hormones and cortisol, without all of the fear….and more often than not, with stunningly good outcomes.

In any case, you should go read the rest of Rixa’s post on The True Face of Birth ASAP: 10 Responses to ACOG’s statement on homebirth, as well as the other responses cropping up around the blogosphere.

There were many reasons to choose New York City as our pilot site.

First: New York is a large, high profile city offering a wide variety of birth options.

It is a densely populated and well-networked urban center. There is easy access to multiple press/media outlets. Approximately 125,000 births occur in NYC per year. Forty-four hospitals provide maternity care services. The majority of the country’s obstetricians are trained in NYC. Two Free-standing Birth Centers are in operation. An established homebirth community thrives. Nearly 10% of births in NY are attended by midwives.

Second: The Grassroots Advocates Committee will be piloting the project in partnership with Choices in Childbirth (CIC), an active grassroots organization based in NYC.

CIC is well connected with the NYC birth community. CIC publishes The New York Guide to a Healthy Birth – in 2007, 20,000 copies advertising The Birth Survey will be distributed free to the public. A member of the GAC and CIC is based in NYC and will be engaged in the day-to-day oversight of the pilot.

Third: New York State is one of only two states with a Maternity Information Act.

The MIA provides the public with legal access to intervention rates at the facility level. Choices in Childbirth is connected with the NYS Department of Health and has already collected the intervention rates for all New York hospitals.

So, if you live in NYC and have given birth in NYC, here’s your chance to discuss your experience and provide valuable information and feedback about birth in our country. Please participate in the birth survey ASAP. As for the rest of the country, the project plans to unveil a national survey next summer, but if you’re super motivated, you can provide feedback about your birth experience at www.drscore.com.

Anyway, I sent Dark Daughta a few posts. One on the Keeper (still one of my proudest feminist and environmentalist statements), one on the UK’s new birth agenda (Maternity Matters), and two on female circumcision (Circumcision or Mutiliation? and Further Thoughts on FGM).

I was curious to see what Dark Daughta would think of them. Leave it to Dark Daughta to not only think about them, but to write an explosive 1000 word treatise as well. She picked my posts on female circumcision, of course, and then ran with them. Ran is a polite word for what she did. More like smacked the posts upside down, flipped them inside out, and then shook all of the loose change out of their pockets. She took everything I had thought after my first encounter with a circumcised woman, and all of the conclusions I had come to at that time (and this had involved a lot of thinking back then, trust me), and managed to turn all of those thoughts, all of those culminations of thought, absolutely, irrevocably, upside down. In the space of just one post. Leave it to Dark Daughta to challenge the hell out of you.

Just a few highlights, here:

Dear Student Midwife:I’m glad that you’re asking yourself questions about how best to proceed. …Maybe examining the culturally based and biased and ofttimes downright racist, response of many privileged feminists who were not born into cultures where genital circumcision is practiced might offer some much needed space inside which there might be less emotionally and politically charged room for a true examination of the issues.There is a power relation here. Are parents in western societies hunted down and denied access to safe male circumcision? Why is the WHO advocating for this procedure when there is a fast growing segment of the male population that is crying out against it?

When male circumcision of babies who can’t make the choice for themselves is enshrined as a part of at least major world religion, are health care practitioners strategizing about how best to stigmatize grown men who present penises that are mutilated? Are feminists of conscience refusing to sleep with men who are circumcized? Are we looking on them with pity and defining them as mutilated? Are we strategizing about how best to divest them of custodianship of their sons so that we can keep them safe from circumcision? Is anyone noticing that the actual side effects of male circumcision…besides those that go horribly wrong…are minimal because these surgeries are done by skilled practitioners in sterile settings?

I don’t agree with either kind of circumcision. But I can’t fail to notice that one is filled with shame and stigma heaped on those who experience it, while the other is thought of as a throwback that should be done away with but is still tolerated and executed in hospitals.

Being useful is definitely not going to include making any circumcized wimmin feel uncomfortable and on the spot about the decisions of their parents. So, labeling a woman’s cuts “mutilations” without checking to see what if anything she says about her own genitalia will go a long way to making a practitioner seem like a judge and not as someone a woman can potentially confide in or turn to.

Because really, the shock and the unfamiliarity with the view below is ours, not theirs. If we’re gonna pay lipservice to accepting the anatomy of the vulva, we’re going to need to work at really understanding and respecting that wimmin come in all sorts of configurations for all sorts of reasons.

This “who is civilized” and “who is babaric and uncivilized” binary split that serves the west/the north, giving our cultures a much needed oppressive ego boost needs to GO!

Yowsa. And those are just the highlights. I’d highly reccommend that you go and read the rest of the post, because she writes with so much passion and conviction, and has this incredible way of phrasing things in ways that I would never, ever think of.

Now, how do you respond to a post like that? I didn’t even know where to start. First I had to do a lot more thinking on the subject, which I’ve been doing for the past several days and nights. I wrote an e-mail response to her, which she published in last Sunday’s Reloaded V which started to flesh out some of my thoughts. And now I find myself here again, having done yet another 180 on the subject (my apologies for repeating some parts of my e-mail, but this is pretty much where my thinking is at right now).

I think Dark Daughta is right on a lot of counts. There is indeed an inherent racism/ oppression in a viewpoint which has decided to call one form of ritual cutting “mutilation” while at the same time leting so many other types of cutting fall under the category of “circumcision” or some other word, and therefore under the umbrella of cultural acceptability (male circumcision, labioplasty, clitoral hood piercing, episiotomy etc.). I can see how that is indeed our culture (and by that I mean western culture) taking its own viewpoint on what constitutes a healthy vulva and setting it forth as “right” and “correct” and that anyone else who does anything different to their vulva (especially something brutal or harmful and something we as a culture don’t fully understand) is therefore wrong and backwards and oppressed and brutalized by their own culture…and that this “mutilation” is therefore a form of violence against women. This viewpoint then lays the groundwork for our invasion of their culture; in other words, this viewpoint basically gives us permission to enter their culture and tell them what’s right and wrong, and that they have to stop this cultural practice. And many huge, big name organizations like UNICEF, the World Health Organization, the US Dept. of State, Amnesty International, USAID etc. etc. have all issued policies and statements which call for an end to this practice, and have programs or policies in place which exist to help educate and save these women from their fate.

Calling something “mutilation” implies, by its very nature, that those who are “mutilated” need to be saved. That makes sense, and I see that now, but I had never before thought of it in those terms. So further thinking on this is prompting me to start to refer to this ritual as “circumcision” again rather than “mutilation”. I do appreciate that my view of what constitutes a healthy vulva is certainly not everyone’s view, and who am I (or who are we?) to decide what is or is not the right kind of vulva? Why is labioplasty or clitoral hood piercing okay, while female circumcision is not? And what would happen if circumcision was done well, by medically-trained people using sterile instruments, sharp instruments, making clean, hygienic cuts? So many of the problems inherent in this practice comes from the scarring and infection which is secondary to the cuts themselves. If there was no scarring, if there was no infection, would the damage be less? As Dark Daughta pointed out, female sexuality stems from a lot more than the tiny nub of flesh which is the clitoris. If the clitoris is removed, but in a clean and precise manner, using sharp, sterilized instruments (rather than a rusty tin can or a piece of glass etc.), would women be able to retain a higher level of sexual functioning? I never, ever would have thought that an underground feminist movement to provide clean, hygienic, medically-trained female circumcisions is not that far off from what feminists were doing in the 70s with their underground abortion clinics to provide clean, hygienic, medically-trained abortions, but yeah, I do see the similarity.

I wrote in a comment on my first post that “I undrstand that there are a lot of cultural and personal reasons involved in choosing [male] circumcision, and I don’t feel like it’s my place to say.” So if I can so graciously back out of the debate when it comes to males, why can’t I do the same with females? To say that these girls aren’t educated about the pros and cons of the procedure, that they’re forced into it by their parents and their culture at a young and vulnerable age (usually at puberty), and that they therefore aren’t making informed consent doesn’t hold up, either, because the same can be said of male circumcision. Baby boys are absolutely, positively NOT making an informed decision when it comes to having their penises cut or not. It’s a decision that their parents are making for them for many different reasons, just as it’s a decision that the culture/ parents are making for the girls who are receiving female circumcision. And I ask again: what right do I have to step in to this decision-making process and tell someone that they’re wrong, or that this decision is wrong? I have no right whatsoever.

Now, before someone comes along and rips into me, let me just make this very very clear: I am not advocating female circumcision, nor am I advocating male circumcision. I am not condoning either practice, nor am I saying that they’re both fine and acceptable, and that they should continue unhindered. All I am saying is that it’s not my place to judge these practices, and it’s not my place to make these decisions. Since I’m not a member of a culture that practices female circumcision, the rich cultural context with which this practice resides is lost on me. The shame or humiliation someone of that culture might feel by not being circumcized and therefore not being a full participant of their culture is something I’m never going to be able to empathize with. And I am questioning whether it is right for our culture (Western culture) to go on huge “Stop Violence Against Women” campaigns in cultures which are not ours, in contexts which we don’t fully understand (and probably can never fully understand).

I do think that these practices need to stop. But I don’t think that the impetus for changing this is going to come from us (from the West), and I don’t think it should. If it’s going to change, it needs to come from within; from women and advocates who are of these cultures, who understand the context, who can see the patriarchy at work in such acts, and who want to rise up against it. And when they do, we as Westerners can and should support them with all of the resources our rich, privileged cultures afford us.

I guess the only sticking point I still have at this point is the following: if you’re a member of a culture, and if it’s all you know, and if you’re never exposed to anything else, you will never have the objectivity necessary to ever question or rise up against these practices that you have seen and been a part of since birth? And maybe that is where an organization can step in and offer education to members of these cultures; ideally, the education should come from members of the culture themselves. I think the folks over at RAINBO are on the right track, and if we as Westerners want to support the education of women (and therefore indirectly the hope that eventually these practices might stop), we can do this by supporting organizations like this.

As far as being a practitioner, the take-home lesson here is once again very simple, and very difficult to fully learn: LISTEN TO WOMEN, and DON’T JUDGE. How is it that I can see this so clearly on issues like abortion, where I absolutely, 100% feel that it is not my place to say, and that since I’m not carrying her baby or walking in her shoes, I have no right to judge at all….and yet issues like female circumcision still bring about huge, heaping amounts of judgement? As a white woman from a privileged background, I’ve been trying for awhile to own my privilege, and see the way that this affects my point of view on everything. This is a difficult, never-ending task, and while I feel that I’ve managed to own this on several more obvious issues, this is an issue I hadn’t even picked up on. I guess the ultimate, life-long goal for every evolving human soul is to continue to move towards a state of less and less judgement. To become as close to non-judgemental as you can possibly be. I say possibly, and “close to” because I think being non-judgemental is an impossible goal. Our psyche, our sense of self, our identities, our culture, our experiences and background and upbringing, everything we use to know ourselves as who we are–all of this is based on judgements which we have formed through living, judgements which we have consciously or unconsciously absorbed, and I think it’s impossible to seperate yourself from them. I am not using this as an excuse. Moving towards a more non-judgemental state requires very close and painful examination of those life experiences and background and upbringing and culture. It requires seeing the ways that your life experiences and culture has potentially prejudiced you, seeing the ways you are privileged, seeing the ways that power affects your identity–power you have, or don’t have, or have in some areas but not others. It requires seeing where you come from, seeing the way that this has formed your world view, and then seeing the way that this outlook affects how you see others. That’s a huge part of becoming less judgemental.

The LISTEN TO WOMEN and DON’T JUDGE take-home message means that all future encounters with women who have been circumcized will involve calling it circumcision, following her cues, and letting her talk or not talk about it, as she desires.

Anyway, those are my thoughts on this subject at this moment in time. Granted, I will continue to think, and I’m sure my thoughts will continue to evolve. I’d be really interested to hear what others think about this as well. It is a very sticky subject, and it’s not about to get any more clear any time soon.

First, Verizon Wireless, the cellphone megagiant, has gotten itself into a heap of trouble by initially refusing to allow NARAL Pro-Choice America to host a text messaging service on its network. Verizon initially claimedthat company policy allows it to refuse “highly controversial” and potentially “unsavory” messages from being distributed on its network. NARAL quickly shot back with an action alert and Verizon was flooded with thousands of e-mails and text messages from angry subscribers, and several anti-censorship groups also joined the fray. Quickly realizing it had made a huge mistake (especially when it discovered that other cellphone networks like Sprint and AT&T had approved the NARAL text messaging service without a whiff of protest), Verizon reversed its position, allowing the NARAL text service to go forward, and issued a statement in the press, but NARAL is still hounding Verizon to put its new public policy in writing. Interstingly, since the issue dealt with text messaging and shortcodes, the story was picked up not only by pro-choice and anti-censorship news carriers and blogs, but by sites like Ars Technica and Slashdot.

Sticking to the technology theme, the website Facebook recently started banning pictures of women breastfeeding from user accounts, and in some instances has banned specific users altogether (for example, Karen Speed from Australia, who has chronicled the entire event on her blog, One Small Step for Breastfeeding). Facebook banned certain pictures on account of their “obscene content” and asserted its right to remove pictures as a violation of its terms of use policy, but as the Sydney Morning Herald points out, it’s not exactly clear what constitues an “exposed breast”, which is the specific violation, and Facebook hasn’t provided any further. clarification. Right. So, breastfeeding is obscene, and women aren’t allowed to post their own pictures of themselves breastfeeding on their own facebook accounts. If this bothers you as much as it bothered me, go join the new facebook group entitled Hey, Facebook, breastfeeding is not obscene!

In other news, a 43 year old Russian woman has recently given birth to a 17 lb. baby, her 12th baby to date. Wow!!

Finally, this is a quick reminder to local folks that the 5th annual Miles for Midwives will be occurring this weekend, Oct. 6th, at Prospect Park. The 5K run/walk helps to raise awareness for midwifery, as well as raise money for the ACNM local NYC chapter, and Friends of the Birth Center. My beloved boy and I will both be there, of course, running and sweating in the sunshine. Race time is 10:00 am, rain or shine. If you’re interested in joining the race, you can register at Active.com.

Finally, the long-awaited SUNY Downstate Gala will be occurring this coming weekend, celebrating 75 years of continuous midwifery education. SUNY Downstate is actually the oldest and longest running midwifery program in the country, and is commerorating the event by a day-long educational symposium featuring speakers such as well-known author Barbara Katz Rothman and keynote speaker Joyce Thompson, CNM, followed by a dinner-dance. Sounds amazing! Go Downstate!