Belly Tales

It’s snowing here, but here’s a little piece of news that will warm the cockles of your heart.  As we all know, there was a big stink over at Facebook awhile ago when they banned the pictures of nursing mothers, which then led to the formation of the facebook group Hey Facebook, Breastfeeding is Not Obscene, which served as an official petition and currently has 50,000+ members.  However, not content with merely joining a facebook group, breastfeeding mother Heather Farley actually organized a breastfeeding protest outside the Palo Alto headquarters of Facebook on December 28th while visiting her family in the Bay Area.  Good for her!  The world needs more nurse-ins, and this is a perfect example of an online protest moving out of the world of blogs and into the real world.

While Facebook maintains that breastfeeding photos are okay, it does have a no-nipple no-areola policy, and will remove photos that other users indicate as obscene, which is apparently what happened with the breastfeeding photos that were originally removed.  I still don’t understand how photos of teenagers clad in lingerie are acceptable while photos of breastfeeding babies are not.  While some people argue that this is for the protection of the women and babies from predators, I really think what it does is send the message that public breastfeeding is not acceptable.  It seems like any use of the breast for anything other than sexual gratification is what’s considered obscene.  In our sex-drenched culture, sexy women in lingerie won’t even make us bat an eyelash, but a baby taking sustenance from a breast….that’s obscene.  How can breastfeeding not be considered “family-friendly”?  It’s the very essence of family friendly — it’s feeding and nourishing said family.  And for the folks who wonder why people would want to even take a photo of a nursing baby in the first place…just look at all the photos taken of babies with bottles in their mouths.  It’s cute, and as a parent, I can only imagine that there’s something very satisfying and fulfilling about watching your baby eat.  Babies are born to breastfeed, and it’s not obscene.  Anyway, kudos to the lactivists of California for making their real world presence felt outside the Facebook headquarters this holiday season.

And with that, I’m off for the rest of the year.  See you next year!

Let’s face it: the economy sucks right now.  We haven’t yet hit rock bottom, and it’s going to be awhile (probably a long while) before things begin to recover.  In the midst of this harsh financial reality, companies and industries are scrambling to find ways to save money.  Birth activists have been trying for decades to convince this country of the benefits of midwifery based on its safety and track record of better outcomes, not to mention improved client satisfaction, but hey, this is America—the only thing people really pay attention to in this country is the bottom line.  So maybe midwifery has finally found the argument it needs to affect actual change.  In the midst of one of the worst recessions since the Great Depression, NOW is the time to increase access to midwifery care because it’s excellent care for a heck of a lot less than what we’re currently spending on maternity care.

In early December, shortly after the nomination of Tom Daschle as Secretary of Health and Human Services (HHS), the Big Push for Midwives launched a campaign to get Mr. Daschle to attend a community meeting on midwifery and its advantages.  Per the change.gov initiative, discussions on healthcare reform will be occurring around the country between 12/15 - 12/31, and Senator Daschle has promised to attend a few of them in person.  Thanks to the Big Push for Midwives, he was invited to several heartland discussions, including this one in Lees Summit, MO.  I haven’t been able to find any updates or reports from this meeting yet.  I’m not sure if Senator Daschle was able to attend, but it’s definitley the sort of discussion he (and the Obama administration) should be listening to. (Was anyone actually able to attend that meeting?  If so, give us an update, please!!  I’ve been searching the internet for reports on the meeting, but I haven’t found any yet.)

As this excellent recent article in the LA Times (Midwives Deliver by Jennifer Block) points out, midwives deliver much safer care for much lower cost:

The most cost-effective, health-promoting maternity care for normal, healthy women is midwife led and out of hospital. Hospitals charge from $7,000 to $16,000, depending on the type and complexity of the birth. The average birth-center fee is only $1,600 because high-tech medical intervention is rarely applied and stays are shorter. This model of care is not just cheaper; decades of medical research show that it’s better. Mother and baby are more likely to have a normal, vaginal birth; less likely to experience trauma, such as a bad vaginal tear or a surgical delivery; and more likely to breast feed. In other words, less is actually more.The Obama administration could save the country billions by overhauling the American way of birth.

It seems like instead of encouraging midwifery care, the opposite is happening.  Birth Centers around the country are closing at a rapid pace, and Medicaid has recently started to resfuse to fund birth center care:

Over the past few years, CMS (the federal agency that runs Medicaid/Medicare) has begun disallowing federal matching funds for state Medicaid payments for freestanding birth centers services. Birth centers have been recognized by CMS (and earlier, by HCFA) as a Medicaid provider type in State Medicaid Plans since 1987. Recently, however, CMS has disallowed such payment by several state Medicaid Agencies, including Alaska, South Carolina, Texas, and Washington State, claiming that it lacks clear statutory authority and direction to do so. CMS has directed its regional offices to stop federal payments to any state for birth center services.

As this article points out, this is going to cause a huge squeeze on birth centers around the country, and we’ll soon be seeing even more of them close unless something is done.  This is an urgent call to action.  The AACB has several resources on their website listing ways to contact your senators and let them know about this issue, including using this lovely flyer which lists all of the important talking points you’ll need when composing your e-mail or making your phone call (calls are preferrable, apparently, since e-mail is more likely to be lost in the midst of all the e-mails on the federal bail-out).  The reason this is so important is that Medicaid generally sets the standard for insurers.  If Medicaid stops insuring birth center care, other insurance companies will follow suit.  Birth centers are a crucial link in many communities, providing quality health care to diverse populations (including women on Medicaid - you only have to look at the work of Ruth Lubic and the Morris Heights birth center to appreciate that), and we need to keep as many of them open as possible.  Not only does it make great health sense, but it saves money too.

And here’s another great cost-saving suggestion: stop insuring preterm elective cesareans.  When I read this article I just about choked.  I can’t believe insurance companies are willing to pay for this when research has consistently shown that there are still a lot of complications with “near-term” infants (babies born between 34 - 36 wks) such as respiratory distress, jaundice, temperature instability (hypothermia), delayed brain development and feeding difficulties.  Forget the fact that a cesarean delivery is several thousands of dollars more expensive than a vaginal delivery; the real damage in this practice is caused by the increased number of preterm babies and the burden of care they demand.  Prematurity and NICU care accounts for one of the largest chunks of healthcare expenditure.  Even the March of Dimes is calling for a decrease in preterm cesareans.

I’ve always been consistently amazed that HMOs, managed care systems and Medicaid haven’t latched onto midwifery with more enthusiasm.  I wonder sometimes if this is because ACOG and the AMA are able to counteract the economic practicality of midwifery care with a tons of lobby money.  The economic angle isn’t anything new.  The Business of Being Born said the same thing in 2007, and Michel Odent, Ina May, Naomi Wolf, Suzanne Arms, Robbie Davis-Floyd etc. etc. have been saying the same thing for decades.  Maybe in the midst of the recession, the message will finally get through: midwifery care is better AND cheaper.

One week after our historic election of Barack Obama as the 44th president of the United States, here’s a very interesting article on what his presidency might mean for Women’s Health (of the non-”airquotes” variety), namely improved access to birth control and sex education (i.e. the federal government no longer funding abstinence-only programs), a reversal of the “conscience” legislation which is now allowing doctors, nurses and pharmacists to legally refuse to perform any service they morally object to, including prescribing birth control, and stopping the global gag-rule which prohibits federally-funded health clinics in foreign countries from performing abortions or even referring women to other facilities that will. It’s all good stuff, and worth checking out (with a nod to Women’s Health News who found the article in the first place).

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:

As reported by the Daily Kos, a rigorous new poll shows that Measure 11, South Dakota’s latest attempt to ban abortion, might not pass as easily as everyone originally thought.  South Dakota’s initial attempt to ban abortion in 2006 was defeated by 56% to 44%, mainly because the bill included no exceptions for victims of rape and incest, or provisions for the mother’s health.  Now, in 2008, these exceptions have been inserted into the wording of the referendum, but as the Daily Kos points out, these provisions are largely superficial, and offer no real practical exceptions.  The general idea was that as soon as this wording was inserted, the South Dakota abortion ban would pass by a landslide, but thanks to a hard, uphill battle waged mainly by the South Dakota Campaign for Healthy Families, the latest polls show that Measure 11 might be shot down again, just like its 2006 counterpart.  According to the poll, if the vote were today, 44% would vote No, and 42% would vote Yes.  Which is really exciting, encouraging news, although the race is too close for comfort.

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.

The AMA has recently issued a resolution supporting ACOG’s Statement on Homebirth which agrees that the safest place to have a baby is the hospital, of course, where obstetricians work and get paid.  What’s really awful is that they’re using Ricki Lake’s movie, The Business of Being Born, as a tool to try to pass laws that would mandate that all births occur in hospitals, since hospitals are the “safest” place to give birth.  Nevermind that in this country (at least for now) all women have the right to make their own choices about their bodies and the health care they receive, or the fact that the U.S. has one of the worst rates of neonatal and maternal mortality among developed countries and that (wow, what a surprise) 90% of all our birth occur in hospitals, or that other countries with much better mortality rates wholeheartedly support and embrace homebirth and that there is strong evidence-based research which backs this up.  Nevermind all that.  In this country, it’s money that does the talking, and money which sets the agenda and passes laws….and now, the AMA, with all its money, has unsurprisingly agreed with ACOG’s ridiculous statement.

The Huffington Post has an article up detailing all of the furor, along with a raging debate in the comments section.  Please, if you care about this even a little bit, visit the article and post a comment.  The more comments the Huffington Post receives, the higher the likelihood that they’ll move the article to their “favorites” section, which will keep the article up on their website for days.  The more comments and press this topic gest in the blogosphere and in the media, the more women will hear this message, and the more this subject will become part of our national debate.  Every comment counts!  Here’s the link again: Docs to women: Pay no attention to Ricki Lake’s homebirth

The American College of Obstetricians and Gynecologists (ACOG) recently issued a Statement on Homebirth which condemns homebirth and all those who are willing to attend homebirth (aka midwives), concluding that only “…the safest setting for labor, delivery, and the immediate postpartum period is in the hospital, or a birthing center within a hospital complex, that meets the standards jointly outlined by the American Academy of Pediatrics (AAP) and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers.”

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.

I’ve sort of fallen off of the blogging bandwagon, but what’s the point of a blog if you can’t be political with it? So, with that in mind, we now take a break from our regularly scheduled midwifery for this brief political message:

I’m voting for Barack Obama

I like the fact that he’s run a very clean campaign and refused corporate lobby money. I like the fact that he’s an idealist—people try so hard to call him naive and inexperienced because he’s idealistic and hopeful—but why should we vote for our fears rather than our hope? How deliciously refreshing to be voting for a candidate that you actually like: someone who inspires you and makes you hopeful, rather than voting for the candidate that you dislike the least! There’s an excitement and an energy in his grassroots movement which is sweeping the country right now that’s really got me excited, so much so that I’ve actually given money to his campaign. My donation was then matched by another Obama supporter in California, and we’ve since gotten into an e-mail correspondence. I like the sense that his campaign is driven by hundreds of thousands of little guys like me, and that our combined small-fry donations are actually adding up to a lot.

I think this country needs a radical change in leadership, and while I really like Hillary (I’ve voted for her twice as a Senator), she and her husband have been the darlings of the Democratic party for over 20 years now. Clinton ran on an anti-establishment platform of change in 1992, but now he and Hillary have become the establishment. It’s time for some new blood. It’s Obama, not Hillary, who’s most successfully running on Clinton’s legacy of change.

Some of our greatest presidents have had very little Washington experience. Abraham Lincoln served only one undistinguished term in the House before becoming president. “Looking at the 19 presidents since 1900, three of the greatest were among those with the fewest years in electoral politics.Teddy Roosevelt had been a governor for two years and vice president for six months; Woodrow Wilson, a governor for just two years; and Franklin Roosevelt, a governor for four years. None ever served in Congress.” [1] Even Clinton himself came in with gubernatorial experience, but not a whiff of congressional first-hand know-how.

I’m impressed by Obama’s history of being able to unite both sides of the aisle and craft true bipartisan legislation. I like his constancy and his character; when you actually look at his record (short though it might be), you quickly realize that he’s someone who sticks to his guns. I like the fact that he’s been opposed to war in Iraq from the start. I’d much rather vote for someone with good judgement and little experience than someone with lots of experience but judgement calls which they’ve since regretted. “Obama is an inner-directed man in a profession filled with insecure outer-directed ones. He was forged by the process of discovering his own identity from the scattered facts of his childhood, a process that is described in finely observed detail in “Dreams From My Father.” Once he completed that process, he has been astonishingly constant.” [2]

I think Barack Obama is more electable than Hillary Clinton. This is partly because I know many people—Republicans, Independents, and even some Democrats—who don’t just dislike Hillary….they DESPISE her. I don’t know why, I don’t understand it, but I know that it’s a very personal, deep-seated hatred, and that many people feel this way about her. My number one goal is to get a Democrat in office as the president, and I feel that a Hillary nomination will be a blessing in disguise for the Republican party. They’ll sling mud, they’ll get dirty, they’ll draw upon that strange RABID Hillary hatred, and maybe they’ll win because of it. I don’t want to give them that chance. I think that Obama has the potential to reach out and win the vote of not only Democrats, but Independents and *even* some moderate Republicans. He’s running a campaign that’s trying to beat the Red State/ Blue State mentality, which isn’t something that Hillary (who’s too firmly entrenched as a Democratic bastion) can transcend. As for the question of whether or not he can withstand the Republican mud-slinging machine….well, Hillary hasn’t exactly been kind to him, but she hasn’t been able to dig up anything on him yet. Maybe because there ISN’T anything to dig up.

Finally, I don’t think it’s possible for America to fall much lower in the esteem of the international community. We need a new face, a new message to be sending to the world to redeem our great country from the ravages and stupidity of the Bush years. I feel that Obama, as a relative unknown, is best poised to start with a clean slate in the opinion of the world. Barrack HUSSEIN Obama—fathered by a Kenyan, growing up in Hawaii and Indonesia, attending a Muslim high school—offers an opportunity to rebrand the face of America in the eyes of the world which Hillary just can’t match. [3]

I like Hillary. When this election started last year, I was pretty certain I was going to be a staunch Hillary supporter to the end. The fact that I’m voting for someone else instead really surprises me. I’m a strong feminist, and I do think the time is ripe for a female president. However, I don’t think she’s the right candidate. I think she’s more divisive than unifying in this current climate, and I think the Republicans will have a field day with her record and her history (anyone in the mood for an ugly recap of the Monica Lewinsky affair or WhiteWater? I’m certainly not!! ). I think Obama offers a new start and a new opportunity to actually get beyond the partisan divide which has been the crux of Baby Boomer politics. If Hillary ends up winning, I’d be happy to vote for her in the general election, but I think Obama is the better choice.

So there you go: that basically sums up why I’m voting for Barack Obama. I’d love to hear your thoughts on this!! Who are you voting for, and why? And if anything I’ve said helped tip your hat into the Obama ring, go give him $20 at www.barackobama.com and join his grassroots movement—you too can have your donation matched by someone in another state who is believing, just like you.

[1] NY Times Op-Ed 1/20/08

[2] NY Times Op-Ed 12/18/07

[3] The Atlantic: Goodbye To All That

The other day I discovered a postcard at my local yoga center urging women to participate in a birth survey, which instantly piqued my interest; apparently this survey has already been going on for some time, although I have only now heard about it. A little research has revealed that the Coalition for Improving Maternity Services (CIMS) has launched a new program entitled The Transparency in Maternity Care Project, which is intended to research and explore maternity care in this country, with an emphasis on improving the transparency of maternity care. Unlike other areas of medicine, hospitals and maternity care providers are still pretty cagey when it comes to being open with their numbers. What is the c-section rate for specific doctors or hospitals? What is the VBAC rate? How many providers perform episiotomies? How many elective cesareans or inductions occur annually? Hard numbers like this are always notoriously hard to come by. And of coruse, beyond the actual numbers themselves, women’s experiences with maternity care providers and services and overall satisfaction is often something which is overlooked. It seems like The Transparency in Maternity Care Project is trying to fix all of that, and is acting as a follow-up to the Listening to Mothers surveys which occurred in 2002 and 2006. Like Listening to Mothers I and II, a survey lies at the heart of The Transparency in Maternity Care Project, which can be found at the following website: www.TheBirthSurvey.com. The pilot survey is occurring in New York City right now, between July 2007 and July 2008.

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.

I got an e-mail the other day from a colleague at work who was passing on to a whole bunch of us a forwarded e-mail that she had received. Here’s the content of what the e-mail said. It was entitled “Urine Dip”:

Like a lot of folks in this state, I have a job. I work - they pay me. I pay my taxes and the government distributes my taxes as it sees fit. In order to get that paycheck, I am required to pass a random urine test with which I have no problem. What I DO have a problem with is the distribution of my taxes to people who DON’T have to pass a urine test. Shouldn’t one have to pass a urine test to get a welfare check because I have to pass one to earn it for them?

Please understand, I have no problem with helping people get back on their feet. I DO, on the other hand, have a problem with helping someone sitting on their ASS, doing drugs, while I work. Can you imagine how much money the state would save if people had to pass a urine test to get a public assistance check?

Pass this along if you agree or simply delete if you don’t. Hope you all will pass it along, though. Something has to change in this country — and soon!

My colleague hadn’t written this e-mail. It was a forwarded chain letter, and all she was doing was forwarding it to the rest of us. She did ask us what we thought about it, though. My initial desire was to dash of an immediate (and very heated) response to everyone on the recipient list. Cooler heads prevailed, however (I am still a very new employee, and I’m not sure how I feel about making enemies this early in the game), but I did want the opportunity to air my thouughts on this. So hello my delicious little annonymouse blog, aka venting-opportunity-extraordinaire.

What do I think about this? Well, I think it’s a very condescending, priviledged and uneducated point of view. It’s an excuse that people make for not having to care as much about “those people who do drugs” or “those people on welfare” or “those people who sit around on their asses doing drugs while I’m working”. While there are always a few people who are bound to take advantage of a system like welfare or medicaid, I don’t think the majority fall into this group. Ask yourself how you would feel if you were receiving welfare–would you be sitting back on your ass, taking advantage of it, and doing drugs? I think many people are embarrassed and ashamed to be on welfare, but unfortunately, the system focuses on the hand-out aspect of it, rather than on teaching and educating and empowering and giving people the tools and resources they need to get off of welfare. I think it creates a system of dependency and complacency, and I think THAT’S what needs to change.

Those of us with good jobs are privileged in so many ways we may not even recognize. How did we get those jobs? Because we have an education. How did we get that education? Because we were blessed with an attitude or an upbringing or a teacher or a mentor or a relative or a friend who believed in us and taught us that education is important, and that it matters. How did we pay for that education? Because we were blessed with scholarships or grants or friends or relatives who could help us out, or banks that had enough faith in our future potential that they were willing to loan us money, and because we were blessed with enough cultural capital to know how to ask a bank for money in the first place. Or because we were blessed with the knowledge that education is worth it, even if it takes you 7 years to pay for every cent of it yourself from your hard-earned paycheck at MacDonalds. How did we get into college? Because we were blessed enough to finish high school; because many of us we weren’t growing up with violence or drug abuse in the home, because most of us had a stable life and a roof over our heads and food to eat and time in the evenings to do homework and someone there who was going to make sure we DID our homework. Of course we had to work for it, and want it, and put in lots of our own hard-earned blood, sweat and tears, but the desire to get where we are right now is something we shouldn’t take for granted, and not something that everyone is lucky enough to have. The “well, why don’t they just get a job?” attitude is a blanket statement of privilege, which fails to acknowledge how difficult it is to obtain a good job, and all the ways that getting an education and therefore getting a good job is a learned behavior, and a cultural gift, and that not everyone is lucky enough to have that passed on to them and instilled in them, especially at a young age.

The other fallacy in this is the fact that drug use is an ADDICTION. What makes people take drugs in the first place? Depression, loneliness, feelings of helplessness and despair? A sense that they’re trapped, that there’s no way out, that life is shit and there’s nothing to do but try to enjoy what little time you’ve got on this earth in any way you can? Trying to belong to a particular group, trying to fit in, trying to feel like you’ve got a community or a family or friends? Whatever the reasons, the decision to habitually use drugs rarely stems from carefree flower-child experimentation or laziness. People who start to use drugs are driven to it because something is pretty damn bad in their life in the first place, and then, once they’ve started….they can’t stop. Hence the ADDICTION part of it.

To make it sound so easy and so simple–I have a job, I don’t use drugs, I take a urine test, so why can’t “those people” do the same?–is a very narrow-minded point of view, and fails to address any of the larger issues; it’s patronising, simplistic and judgemental, at its very core, and because we all know that the majority of people on welfare are certainly not white, it’s also racist at its core. Cutting people off from the help they need by forcing them to take a urine test before receiving public assistance will probably only make things worse, not better, and only addresses the symptom, rather than the root of the problem. The root of the problem is: what is it in this person’s life which drove them to take drugs in the first place, and how can we address that and help that? I don’t believe in free hand-outs either, but drug addiction is not something that people can just stop overnight, no matter how much they might want to (and usually if they’re deep in addiction, they don’t want to anyway), and it’s not something that people can usually do on their own. It’s so easy for the non-addicted to say to someone who’s addicted…well, just stop using, get off your lazy ass and quit doing drugs…but has that person ever stopped to consider just how HARD that is? Have you actually put yourself in the other person’s shoes, and tried to walk a mile in them? Help, compassion, non-judgement and true understanding would go a lot further, in my very humble opinion, than the “get off your lazy ass and quit abusing the government dole” attitude. Respect for “those people” would make a huge difference, too, but if you see “those people” as lazy (and if you see them as “those people” in the first place)…you’re never going to be able to respect them enough to make any kind of positive change.

Where does the midwifery come into all of this? LISTEN TO WOMEN and DON’T JUDGE. Those two lessons, all over again. The respect and the need to be able to put yourself in someone else’s shoes is inherent in that.

Now, the next question is…should I go ahead and send this back to everyone on the e-mail list? What’s it worth? Making a good impression at my new job and not pissing people off right off the bat…or speaking my mind and being upfront and honest about my beliefs, even at the expense of creating work conflict? Aargh, really tough call.

A few weeks ago, Dark Daughta over at One Tenacious Baby Mama asked me for a contribution to her new weekly series entitled Reloaded, which happens every Sunday and features old posts that are worth posting and reading a second time (oldies but goodies, as she calls them). She wanted posts that I was particularly proud of, “something that really kicks ass analytically, politically” etc., and I quickly discovered when I was combing through my old posts that I don’t really have much in the analytical/ political/ highly opinionated/ kick-ass vein. It seems that my blogging style overall tends to be of the objective-news-reporting variety, or at best the highly-researched highly-factual variety; in other words, the variety that is so factual and evidence-based that no one can really argue or disagree with what you’re saying; in other words, the risk-free variety. Which is good to know about yourself, I guess, because it then prompts a bunch of really good questions, like: WHY AREN’T YOU TAKING MORE RISKS? Why aren’t there more highly opinionated, highly political, highly analytical, highly kick-ass posts on your blog? What are you scared of? Pissing someone off? Causing controversy? But really…is there any other point to a blog than opinion? If all we’re after is the news, we’ll read newpapers and news sources, thank you very much. Blogs are supposed to comment on things. So, good to know. Note to self: enough with the reporting on things. Get commenting instead. Go out on that limb. It’s about time, don’t you think?

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.