Home Births
Mamas of Color Rising: Advocating for Mother Friendly Births For Mamas of Color in Texas
January 11th, 2011Prior to 1989, Midwives practiced freely in Texas. Many Texas children were born via midwife assisted births and many of these births took place outside of the hospital. In 1989, The Texas Midwifery Act was amended to include mandatory basic and continuing education requirements which took effect in September, 1993. The law was further amended in 1997 when new rules were written to assist the Midwifery Board in implementing the law through disciplinary actions which could include removal of documentation and administrative penalties.
In 2002, midwives ceased to practice in hospitals in Austin.
Since that time, access to mother friendly childbirth practices has been essentially non-existent for low income women and women of color in the Greater Austin Area. These women have been at the whim of whatever Medicaid would cover and whatever treatments the obstetricians who accept Medicaid reimbursement are willing to provide. To say the least, low cost, high quality, minimally invasive care has been scarce.
Mams of Color rising, is a collective of mamas of color in the Greater Austin area fighting for birth rights for all mamas. Here is how they describe themselves:
“Mamas of Color Rising is a collective of working class and poor mothers of color based in and around Austin, TX. We are interested in organizing ourselves and other women/mamas of color around issues with accessing needs like food, housing, education and safety, finding out together what our larger ideal community looks like and building it together.”
Currently the main objectives of Mamas of Color Rising is to gain equal access to “Mother Friendly Birth Practices” for low income mothers of color. Their goals are:
- To Create a volunteer doula project for low-income women of color in Austin. This project will begin with 20 women of color being trained as doulas March 2011.
- To Work in collaboration with pro-midwifery lawyers and other organizations and to get Medicaid to cover Midwifery care in Texas
- To Start free pre-natal midwifery care in Austin with volunteer midwives. This will serve as as a pilot for a Medicare Proposal.
To that end, Mamas of Color Rising is working to train 20 women of color as doulas in the greater Austin TX area to serve the Austin Mamas of Color in need. These women will be trained this coming March, 2011. Mamas of Color Rising is raising funds to cover the cost of training for these women. This training will be the first step in launching a culturally based volunteer doula project for low-income women of color in Austin.
Currently, Mamas of Color Rising has raised $933 of the $2000 needed to train the doulas. If you are so moved, please consider donating to Mamas of Color Rising in support of the Doula Training Program. You can make a donation directly on their website mamasofcolorrising.wordpress.com via PayPal.
As Mamas of Color Rising has so aptly pointed out:
“Our vision of organizing around motherhood is not a biological one, it’s not just about biological moms, or even just moms, but about all of those members of a community who share in the often undervalued and invisible work of care-taking and parenting. It’s not just symbolic either, because unfortunately right now its mothers and other women who do the vast majority of the work of taking care of children, elders, and sick folks who cannot take care of themselves.(all unpaid!)
As Mamas of Color Rising, we want to present these issues for public conversation and struggle. We see this work as a way to challenge the patriarchal and isolating model of nuclear family units AND as a way of creating social justice for everyone because a society is only as good/strong/just, as how it treats its (women) children and elders.
If you agree, please support Mamas of Color Rising.
References:
: Addendum to Federal Trade Commission Department of Justice Hearings on Healthcare Competition
Mamas on Bedrest: Some Things Just Stink!
November 10th, 2010Some things just stink. I have wrestled with this blog post for over a week trying to find a tactful way to address the battle waging between obstetricians and midwives. I have looked at several articles and commentaries and have come to the conclusion that the tactics that the American Medical Association (AMA) and The American Congress of Obstetricians and Gynecologists (ACOG) are using to limit in some cases, and frankly ban in others, midwives from attending home births and other births just plain stink.
As previously stated in the blog post A Plea From Mama to OB’s and Midwives, the primary focus should always be what is in the best interest of mothers and babies. Unfortunately, the AMA and ACOG both have not only adopted adversarial stances against midwifery practice, they have gone so far as to use faulty study data to support their claims and to push for legislation to limit or ban midwives from practice. And while midwives have offered their fair share of negative assaults on obstetrical practice one has to admit that midwives have never sought to limit, ban or outright erase obstetrical practice. This is the unfortunate tenor that the AMA and ACOG have taken and why this battle has turned so ugly.
But don’t believe me. Let’s look at what the major issues are. Maternity care in the United States is subpar at best. If you are insured, you fare quite a bit better, but women are still subject to far too many interventions and unnecessary procedures that have lead to a cesarean section rate of 32% nationally. According to Amnesty International’s Report Deadly Delivery: The Maternal Health Care Crisis in the USA, 2 women (or more) die each day from pregnancy related complications. A woman is 5 times more likely to die in childbirth in the US than in Greece, 4 times more likely than in Germany and 3 times more likely than in Spain. Our maternal mortality rate has more than doubled from 6.6 maternal deaths per 100,000 in 1987 to 13.3 maternal deaths per 100,000 in 2006 and these rates are higher in women of color (Black women are 4 times more likely to die from pregnancy related causes than white women). Amnesty estimates that these rates may actually be low because there is no federal requirement to report these outcomes. Amnesty International also notes numerous barriers to maternity care, noting that poverty is a major factor, but even insured women have difficulty obtaining safe, effective, low intervention maternity care. The US’s own Healthy People 2010 has documented benchmarks to improve maternity care-none of which the current model of obstetrical care has been able to meet. And the World Health Organization reported that despite the large amount of money spent on health care in the United States, The US still ranks 37th out of 191 assessed countries in health care delivery and accessibility, far behind many other industrialized nations. What we are doing is not working and as they saying goes, “The definition of insanity is to continue doing what you are doing while expecting a different outcome.”
Several organizations including The World Health Organization and Amnesty International are advocating for increased use of “more woman-centered, physiologic care provided by family-practice physicians and midwives”. Yet ACOG and the AMA have balked and have launched aggressive anti-midwife campaigns. Amy Tuteur, MD, in her blog post Midwives and the Assault on Scientific Evidence, repeatedly states that midwifery practice is not based on science and that many practices are based more on ideology. She cites numerous articles and books published by midwives, yet never names specific practices used by midwives that are harmful to mothers or babies. In contrast, there is well established evidence that restricting a woman to bed while laboring, labor induction and cesarean sections increase labor and delivery complications and all are common practices in obstetrics. Dr. Tuteur’s claims are well refuted by the 107 comments to her post, many with reputable citations.
Joseph Wax, MD was the next physician to attack midwifery and home birth in his article, Maternal and Newborn Outcomes in Planned Home Births vs. Planned Hospital Births: A Meta analysis. His meta analysis concluded that home births attended by midwives resulted in a three fold increase of neonatal death versus birth in a hospital or birthing center housed within a hospital. While Dr. Wax’s analysis was praised by the main physician medical societies, using minimal scrutiny his conclusions were found to be flawed and based on study data known to be insufficient, inconclusive or just plain wrong. Yet, even before the study was officially published in the September issue of the American Journal of Obstetrics and Gynecology, it was “leaked” to the media during the summer-just in time to be read as legal decisions were being deliberated in New York and Massachusetts regarding midwifery practice and home births.
Both of these publications and others like them have the full backing of the AMA, which has been waging its own battle against midwives. In resolutions drafted in April of 2008, The AMA has voted to back legislation that will prohibit home births, AMA Resolution 205-1 and severely limit the scope of midwifery practice, AMA Resolution 204 Midwifery. While the legalese of these documents is sound, the resolutions themselves ignore the scientific evidence, stated by Amnesty International, The World Health Organization, The Cochrane Review and others that all state that midwife assisted homebirths, in uncomplicated pregnancies, are as safe as hospital deliveries. Additionally, midwife attended births result in lower rates of interventions, lower cesarean section rates, lower rates of complications, lower rates of infants being admitted to the NICU and lower rates of maternal and neonatal death. (See Transforming Maternity Care, in the supplement to the January 2010 issue of Women’s Health Issues, the official publication of the Jacob’s Institute of Women’s Health, George Washington University.)
It’s okay for physicians to oppose midwifery care, in fact it’s somewhat understandable. In their eyes they have a lot to lose; revenue, patients and their status as “top” health care providers. Many obstetricians resent having to “clean up the messes” that occur when a home birth goes bad. But in the face of the evidence in support of midwifery care and the dire maternity statistics that arise out of the current US hospital based, physician driven maternity health care system it’s hard to believe that they are not willing to do more to bring affordable, effective, safe, low intervention care to all women of America. Holding onto this notion that the only providers able to provide quality maternity care is obstetricians in the hospital setting is not only bull-headed but unethical and is completely contrary to the line in the Hippocratic oath that states, “First do no harm.” (Yes, withholding care does as much harm as rendering poor care.) But to go so far as to bar others, who are trained and qualified to provide maternity care from doing so -especially to low income women who so desperately need quality, compassionate maternity care-while at the same time disparaging the work that they do is not only unethical, it just plain stinks.
“Baggage Check” An Essay on Releasing Expectations
October 27th, 2010Baggage Check By Angela Quinn
This article originally appeared on The Unnecesarean Wanna know a little secret? Not all homebirthers are free-spirit, hippie-types who run barefoot and bra-less through life without a care in the world. Some are (and I’m totally jealous) but a good many of us are really type-A, compulsive, control freaks. I wanted to have a homebirth for a number of reasons: lack of confidence in the non-evidence-based medical model of labor and delivery, lack of desire to fight policy and procedure during contractions, and mostly because I wanted to be in control of my own birth process. But I also wanted to be able let go at any time without feeling like someone was right there hovering over my shoulder waiting to take that control from me.
So there it was in a nutshell – why I chose homebirth. On July 29th, 2010, I had a “successful” HBAC and brought my beautiful little girl into the world to join our family. However, I’ve struggled for the past couple months with why I have felt cheated, dissatisfied and disappointed. After all, healthy mom, healthy baby – that’s all that matters, right?
Recently I realized that I am suffering from the loss of my expectations. I thought that I could control the whole process of birth. If asked, before the birth, I would have smiled serenely and said things like, “I don’t know what to expect, we’ll just wait and see,” or, “I’m just going to let things play out and see how they go,” or, “I’ll just go with the flow.”
But inside, I just knew. This birth, maybe my last baby, was going to be the most awe-inspiring-amazing-empowering-healing-example-setting-I-am-woman-hear-me-roar example of childbirth EVER. Here’s how it would go, I imagined. I would realize I was in labor, I mean, having surges, and I would immediately put on my Hypnobabies CD and go into hypnosis. I would recognize the surges for what they were, functional and opening my cervix like a flower. I would light some candles, send my husband out for Rita’s Italian Ice, read a book, and get into my nice warm birth tub where I would labor in stoic silence, a pillar of strength, telling my midwife and doula that they could rest and I’d let them know when the baby was born. I would push for a few minutes, because (this time) my baby would be in an optimal position since I’d done everything right during this pregnancy (I exercised, ate well, saw a chiropractor, sat on my birth ball for work, watched my posture, did pelvic tilts, visualized). I would have a waterbirth. The Hallelujah chorus would play as I reached down to feel the baby crowning and usher her into this world into calm, loving, peaceful surroundings. I would immediately place her on my chest. She would crawl up to my breast, just like the videos, and latch on by herself. And, cut! Fade to black with mother and baby happily bonding and music from a Summer’s Eve commercial playing in the background.
My mom says I’ve always been like that, expecting things to go the way I plan them. When I was 9 or 10 years old, I’d write these skits that my younger siblings and I would put on for my parents. Somehow I expected Broadway, and was always surprised and disappointed by the reality of 5 little kids who forgot their lines and had safety-pinned towels and paper hats for costumes. In preparing for this birth, I thought I was just visualizing and being positive, but what I had really done was written my birth story ahead of time. Well, guess what? It didn’t follow the script.
In reality, I went into labor in the morning and worked through the first 6 hours or so finishing up stuff for my boss and sending emails. Then I went to a scheduled appointment at my midwife’s office (an hour away), dropped off the kids at my mom’s, run some errands, and threw up in the car. The Hypnobabies stuff worked in the beginning, but once it got harder, damn, that woman’s voice got annoying. Surges, my ass! How about hot knives being shoved into my lower back. I had excruciating back labor (again!) because, despite my best efforts, I had another occiput posterior baby. I didn’t like the birth tub after a couple hours and got out. I whined and moaned…a lot. I considered transfer to a hospital since I really thought she wasn’t coming out at one point, but the only reason I didn’t transfer is because I was so wimpy that I knew I wouldn’t be able to handle my contractions (or the back pain in between) in the car. I never felt the urge to push since she was face up, but I pushed for over 2 hours, painfully, and she finally came out once my tailbone broke (again!). She didn’t crawl to my breast by herself, because she wasn’t breathing and didn’t breathe until after about 5 minutes of resuscitation attempts. It was the scariest few minutes of my life, and I’ll never be able to think about her birth without remembering that heart-stopping, throat-constricting fear. Fear that we would become a statistic, that this whole thing had gone horribly wrong. After this birth, I knew I didn’t want to have any more children.
This wasn’t how it was supposed to go. This birth was supposed to be healing. I was supposed to overcome the physical and mental obstacles of the birth process through sheer determination and feel so powerful afterwards. My education and knowledge was supposed to carry me through any tough times. I was supposed to have a wonderful, idyllic story to tell to those considering homebirth. I was going to be an example to others of how the female body is made to birth naturally and effortlessly. My birth was to be a statement about what’s broken in maternity care today. I don’t know about you, but I’m thinking that’s a pretty freakin’ huge burden to put on one vagina. That’s a hell of a lot of baggage to hang on the shoulders of one tiny little baby.
That’s not to say that I’m not allowed to be disappointed. Or grieve the loss of the perfect birth story that lived in my imagination. Or to feel betrayed by my body once again. I’m allowed to be sad about it sometimes. But I think I would have been less so if I had not decided ahead of time that my birth story would be defined by what it could DO for me. Assigning a value to the birth process based on a pre-determined “yes or no” outcome is exactly what frustrates us so much sometimes about the “quit whining you have a healthy baby” attitude of society. So why do we do that to ourselves with the other outcomes of a birth?
I wrote down my actual my birth story a couple days afterwards, and it had a lot of grief and anger and sadness in it. I could barely see to type it up because I was crying so much while I wrote it. It was only later, when I started looking through my camera to add pictures to the story, that I began to see the details that I had been missing because I had so many pre-conceived ideas that were clouding my perspective.
As I saw the pictures taken around my house, I remembered that there were times of peace during the process and that I was comfortable in my surroundings, allowing me to focus on what I needed to do. I can say without a doubt that had I not been at home I would have had another cesarean. The picture of my doula putting a wet washcloth on my forehead and pouring warm water on my back made me realize that I did need to rely on others around me and that it is OK to ask for help. Seeing how often my husband’s hands were in the pictures as I leaned on him for support made me realize how much he was there for me. Our relationship has been on the rocks for the past few years, and I even said to him that it didn’t matter to me if he was present for the birth. I didn’t need him or anyone else. I prided myself on my independence. But I did need him, surprising both of us just how much. He felt needed and I felt taken care of. It’s quite possibly the first time in 11 years of being together that I have ever relied on him to that extent, and it changed something subtle in the dynamic of our marriage, for the better. When I saw the picture of my husband cutting the cord and the one of her lying on my chest afterwards, I was grateful for the decisions I made leading up to and immediately after her birth. I remembered that I was smart enough to choose a competent, knowledgeable midwife who understood the benefits of natural birthing, delayed cord clamping, skin-to-skin contact and the power of the human body. My faith in my instincts as a mother returned as I looked at the picture of her nursing for the first time, strong, alert, and healthy. And when I looked at the pictures of myself laboring in different positions, my muscles straining, my face a mask of determination, I realized that I was not a wimp. I am strong. Not with the kind of strength that wills away the presence of obstacles altogether, but with the strength that allowed me to overcome and to persevere despite the unexpected difficulties and challenges I faced.
We can do our research; we can prepare our minds and bodies; we can make sure that we are healthy and ready. But we can’t define our birth story ahead of time. We can’t go into it assuming it will be healing or empowering or a message or a political statement. When we do that, we risk that we will not see our birth for what it is – a beautiful, amazing process that helps define us as women and mothers in ways we may not expect. It may not be pretty. It may not live up to our standards of perfection. Sometimes birth just….is.
And now, cheesy as it may seem, I have to close this post with this quote. Ask not what your birth can do for you…nah, just kidding. Worse, a Beatles song. It’s been going through my head since I started writing, so I guess it has to make it in here somewhere: “Let it be, let it be, let it be-ee, let it be. Whisper words of wisdom, let it be.” There, now it’s in your head too.
Thanks so much for that reminder, Angela!
