[Friday Wrap Up]: 30

So many articles this week! Some of the highlights: exciting news for APC’s in California, one woman’s experience of a later-term abortion, new trends in prenatal screening, a call to action to end the shameful shackling of laboring patients in prisons, and an awesome, awesome story about transgender parenting from Canada. Read on!

California Expands Abortion Access!

Gov. Jerry Brown on Wednesday expanded access to abortion in California, signing a bill to allow nurse practitioners, midwives and physician assistants to perform a common type of the procedure, an aspiration abortion, during the first trimester.

Oregon, Montana, Vermont and New Hampshire allow nurse practitioners to perform such abortions, which use a tube and suction, while several other states, including California, permit nonphysicians to provide drugs to terminate pregnancy.

But the new California law goes further, allowing a wider range of nonphysician practitioners to perform surgical abortions. While other states have passed a tide of laws restricting abortion access, California has gone against the political tide.

It Happened to Me: My Late-Term Abortion Was a Nightmare, But It Didn’t Have to Be

Stories like this break my heart…and make me angry. As an aspiring abortion provider, I can’t fathom how anyone involved in abortion care would let personal judgment get in the way of providing compassionate care for their patients, especially in situations like this. I want to believe that all health care providers bring good intentions to their work…but experiences like this remind me that we have a long ways to go.

Was I expecting too much, some special treatment because I wanted my baby, because I felt like my situation was particularly emotionally fraught? Maybe I expected the clinic to feel sorry for me, and they treated me like any other woman having a “regular” abortion. Except no abortion is a “regular” abortion, and no woman having an abortion should be treated with suspicion and disrespect. Every woman having an abortion for any reason deserves a little kindness and warmth. It could make a world of difference.

Breakthroughs in Prenatal Screening

“Breakthroughs”…but with a lot of nearly impossible ethical dilemmas to ponder. I so admire the work of thoughtful genetic counselors–it’s not an easy job and the growing number of tests makes this one of the more dynamic professions in health care today. Unfortunately, this article doesn’t really delve into the ethical questions of what it means to have more testing available, however, it does touch on some of the financial aspects of testing–which really, is another ethical dilemma of its own.

In the nearly four decades since amniocentesis became widely accepted, new techniques have gradually improved the safety and accuracy of prenatal diagnosis. Prenatal tests for more than 800 genetic disorders have been developed. And the number of women who must undergo amniocentesis or C.V.S. has been greatly reduced.

We Need to Stop Shackling Women in Prison–Now

The headline says it all.

One of the first women who shared her story with Birthing Behind Bars was Linda Rosa. She learned that she was pregnant with twins after entering jail in 2008. Linda Rosa recalled being shackled each time she was taken to see the doctor: “They used to shackle my hands and my legs. I would have to walk with the shackles on my legs, which would leave cuts on the back of my ankles.” Linda had to undergo a C-section and was shackled while recovering in the hospital. She recalled having stitches and staples from her c-section and shackles on her wrists and ankles when she visited her newborn babies in the ICU. “Everywhere I had to go, I had to wear shackles,” she said.

Transgender Pregnancy: The last frontier in assisted reproductive technology

Loved. This. SO. Much. We need to hear more stories like this. It’s so important.

It took nine rounds of intrauterine insemination for Heller to become pregnant. The first four experiences at a Montreal fertility clinic had been quick and impersonal. But their fifth try was worse than usual. The doctor rushed in, never said hello or gave his name, never looked at the women. He asked “insemination?” and they said “yes.” He was quick and rough, Heller recalled, and she bled afterward, something she’d never experienced. He left the lamp on between her legs as he rushed out of the room, they say.

[Friday Wrap Up]: 29

A quickie this week, as it’s been a busy first week of the fall term!

Does the Hospital “Admission Strip” Conducted on Women in Labor Work as Hoped?

A Science and Sensibility post by Henci Goer explores the evidence on that typical 20 minutes of fetal monitoring that most women are subject to upon admission.

The crucial question, though, is whether increased monitoring and surgical deliveries produced better perinatal outcomes. To that, the answer is “no.” Combined fetal and neonatal death rates in infants free of congenital anomalies were identical at 1 per 1000 in both groups (4 trials, 11,339 babies). The reviewers acknowledge that their meta-analysis of over 11,000 babies is still “underpowered,” i.e., too small to detect a difference in outcomes. However, they continue, the event is so rare in low-risk women that no trial or meta-analysis would likely be big enough to do so.

I Don’t Have Language With Which to Celebrate Women’s Pregnancies Without Undermining My Pro-Choice Beliefs

I saw this headline and was hopeful that it would be a thoughtful exploration of language and the complexity of pregnancy experiences…but it somehow fell flat for me. I think my work with Backline has instilled in me a deep trust that a so-called singular experience can have multiple layers of reality and language and meaning…and that we don’t have to be tied to the either-or feeling that Alana describes:

But the issue I’ve come across recently is what to call what a pregnant woman is carrying without betraying some very strongly held beliefs about reproductive health and rights and what I truly believe makes something a baby or a child. And when I hear someone very early in pregnancy refer to “the child growing inside of me,” or similar, a red flag goes off in my head about the way we discuss women’s bodies, pregnancies, and babies.

So how do I celebrate the women who will become mothers without implying to those that terminate that they destroyed a child? I considered using irreverent terms like “the bean” or “the little critter” so that I don’t have to say “baby” but that seems like a cop-out. It also reminds me of those amazing children’s books about that goofy character, so aptly named Little Critter. I’ve thought about referring exclusively to “your pregnancy,” but that’s so cold and medical.

My first thought upon reading this was to think…”Why don’t you just ask the pregnant person what they want you to call it?” Is that really so hard? I don’t know, maybe I’m missing something.

The One Key Question That All Doctors Should Ask

An interesting campaign. As a future midwife and current pregnancy options counselor, this question makes sense to me…but I wonder what other questions might come up for those of us not in midwifery care or women’s health.

The Oregon Foundation for Reproductive Health is pushing primary care doctors to ask every woman one extra question when they see her for a regular checkup: “Do you want to become pregnant in the next year?”

Unlike the questions, “Are you sexually active?” or “Do you need birth control?” the wording of the question “Do you want to become pregnant in the next year?” allows a conversation to start with doctors and women who both do and do not want to become pregnant. For women who answer yes, doctors can give them preconception counseling and talk about staying healthy during pregnancy. For women who answer no, doctors can talk with them about contraceptive options.

Why Ethnic Elders Forgo Hospice and Palliative Care, Part 2.

This term of nursing school is focused on chronic and end of life care. I have more thoughts coming on what this means to me in the context of my future work as a midwife…but the first thought that comes to mind is that end of life care is not all that much different in my mind than midwifery. Different situations and populations yes, but similar needs for compassion, choices, informed consent and attention to disparities.

Among hospice patients in the United States 83 percent were white, while merely 8.5 percent are African-American, 6 percent were Hispanic and less than 3 percent were Asians and all other minority categories, according to a 2012 report of the National Hospice and Palliative Care Organization (NHPCO).

Yet enrollment in hospice care has grown since Medicare first began offering hospice benefits in 1983, with nearly 1.7 million patients receiving services in 2011 — roughly 45 percent of all deaths in the U.S., according to the NHPCO. Barriers for African Americans, Latinos This comes as no surprise to Virginia Jackson, chief of chaplaincy at the Palo Alto Veteran’s Administration Medical Center Palliative Care Clinic.
“With African-Americans, because of trust and fear issues, we take care of our relatives at home,” she said. “The issue of trust–not being listened to, not being important–is a big issue with the African-American community. There is a lot of fear around trusting a physician around medication; fear of becoming addicted or fear that it may take them out.”
It’s coming up next week! I’ve got some fun posts planned to celebrate midwifery care (if nothing else, it will help keep me focused on why I’m here in nursing school–it’s to become a midwife!)

[Friday Wrap Up]: 28

This week: a lovely photo essay and video telling stories about abortion experiences, a reframing of abortion beyond “women’s rights,” questioning the (dreaded) pelvic exam, a new continuing ed opportunity from Evidence Based Birth, revolutionary NICU care, and more on full spectrum doulas from a new blogger!

Abortion: After the Decision

Love this photo essay:

I was surprised when I started talking openly with my friends and colleagues about abortion how many of them had had one themselves. I hadn’t known that 40 percent of American women will have an abortion during their lifetimes. While it’s a personal and private experience, there are 45 million women in America who share in it, and it shouldn’t be a shameful secret. The silence creates a stigma that prevents a meaningful discussion and understanding in the national debate and dialogue.

Not Everyone Who Has an Abortion is a Woman: How to Frame the Abortion Rights Issue

I missed this when it first came out, but was happy to come across it recently. There’s a lot of good stuff here that directly speaks to the kind of inclusive environment of care I hope to create as a nurse-midwife.

We must acknowledge and come to terms with the implicit cissexism in assuming that only women have abortions. Trans men have abortions. People who do not identify as women have abortions. They deserve to be represented in our advocacy and activist framework. Honestly, I am guilty of perpetuating that harmful myth, both in my rhetoric and framing. I often frame abortion restrictions as misogynistic attacks meant to control women’s reproductive lives, and that is true. But abortion restrictions also affect the lives of people who aren’t women, and they hinder trans men and gender-non-conforming people and others who were Designated Female at Birth (DFAB) from accessing abortion care, as well.

Questioning the Pelvic Exam

I know I’m not alone in wondering what the heck the point of this annual exam is…in fact, I was thrilled last year to read Feminist Midwife’s questions about it, too. This week, the NYT’s Jane Brody writes about a growing number of gynecologists who are starting to question the purpose of this exam.

These experts say that for women who are well, a routine bimanual exam is not supported by medical evidence, increases the costs of medical care and discourages some women, especially adolescents, from seeking needed care.

Moreover, the exam sometimes reveals benign conditions that lead to follow-up procedures, including surgery, that do not improve a woman’s health but instead cause anxiety, lost time from work, potential complications and unnecessary costs.

And even more stunning, yet not surprising:

How important is this exam to a doctor’s income? Slightly more than half of those surveyed ranked “ensuring adequate compensation” as very important or moderately important.

One of the most vexing problems in medicine today is the fact that doctors get paid only for performing procedures, not for the time they spend talking with patients to discuss issues of possible medical importance.

Giving Birth Based on Best Evidence

Rebecca Dekker, PhD, RN, APRN, over at Evidence Based Birth, is starting an online continuing Ed series, beginning with a class on “Big Babies.” Be sure to check the giveaway!!

NICU program that gives parents charge of baby’s care cuts stress

This is an awesome, awesome new movement in NICU care: giving parents more responsibility in the care of their newborns.

“With family integrated care, we have done something quite different,” explains Dr. Shoo Lee, pediatrician-in-chief and director of the Maternal-Infant Care Research Centre.

“What we’ve done is to say that for all babies in the NICU, the parents should be the primary caregivers, not the nurses. And the nurses are really teachers to the parents.”

The program was instituted following a 2011-2012 pilot project in which the parents of 40 newborns were asked to spend a minimum of eight hours a day in the NICU and tasked with the overall management of their child’s care.

That included bathing and changing diapers, monitoring the infant’s vital signs, and recording feedings and weight gain on their medical chart. Nurses were responsible for the medical side of care — looking after feeding tubes, adjusting ventilation apparatus and administering medications.

The babies’ progress was compared with those whose care was primarily provided by nurses, and Lee says “the results were phenomenal.”

Full Spectrum Doulaa new blog!

A friend and fellow doula has started this awesome blog about full spectrum doula work…here’s an excerpt from her first post, The Politics of Pain, Part 1

I am very much in favor of a movement that reclaims abortion as a complex matter of the heart, just like birth. Birth and Abortion are the yin and yang of reproductive power. I know that abortion will never be a happy event in the way that birth usually is… but I know it is a powerful experience and I think even in our most “pro-choice” enclaves, we are still blowing it. We are often working to hard to “rescue” people from their circumstances, thereby failing to embrace the growth and change that come with going through something.

[Friday Wrap Up, Part II!]: 26.5

So I did a new thing this week, which was to write my [Friday Wrap Up] before Friday…gaspI know! But there were so many things already, I felt I had enough for a post.

Then I found a bunch of new things…so I’m back, to share a few more pieces.

Related to the theme of changing narratives around adoption…Reuters has blown it out of the ballpark with this stunning, heartbreaking series that investigates the underground “re-homing” scene. 

Through Yahoo and Facebook groups, parents and others advertise the unwanted children and then pass them to strangers with little or no government scrutiny, sometimes illegally, a Reuters investigation has found. It is a largely lawless marketplace. Often, the children are treated as chattel, and the needs of parents are put ahead of the welfare of the orphans they brought to America.

The practice is called “private re-homing,” a term typically used by owners seeking new homes for their pets. Based on solicitations posted on one of eight similar online bulletin boards, the parallels are striking.

I don’t know which is more sad to me, the fact that this is happening at all…or the fact that it’s been happening for years and only now are people starting to get it. Some people might argue that articles like this will deter “good, well-intentioned” people from considering adoption, increasing the number of children in a broken system. This argument fails to do justice to the fact that it’s a broken system…and the only way we can start changing that system is by shining a strong light on it, exposing the dark side and that has gone unexamined.

The Adoption Policy and Reform Collaborative has issued an official statement in response:

The APRC is acutely aware of the unethical and dangerous “rehoming”* practices that have occurred for more than a decade. We have expressed our concerns with alarm. We look forward to collaborating, from the perspective of adult adopted persons, with other powerful change agents to fully, appropriately, and ethically address adoption disruptions and dissolutions.

*Please note: while the APRC recognizes “disruption,” “dissolution,” “displacement” and “re-homing” as industry terms, APRC members regard these terms as sanitized and rationalizing practices terminating the parent/child relationship. While using industry vernacular in this statement we do not endorse their usage for the reasons indicated.

 The ‘Pullout Generation’ is Here. What Do Sex Educators Think?

In response to this New York Magazine article, RH Reality Check’s Martha Kempner offers this follow-up on the idea of “pulling out”, or coitus interruptus, as a method of birth control. Kempner focuses in on research around efficacy of withdrawal, condoms, and other contraceptives, pointing out the obvious, which is withdrawal, when practiced by someone who really knows their body well and has good self-control, is still better than no contraception at all.  Kempner quotes Deb Hauser, president of Advocates for Youth:

“I believe that young people should be given honest, accurate information. They have the right to all of the information and when empowered with that information are more able to take agency over their sexual health. That means we should teach youth about withdrawal as an option when they don’t have anything else with them. Withdrawal is much more effective at preventing pregnancy than using nothing. To withhold that information is misguided.”

On the theme of health disparities, this is probably not new news…but still, glad to see folks are bringing it up:

‘Baby-Friendly Hospitals’ Bypass Black Communities

A Women’s eNews analysis finds that 45 percent of U.S. Baby-Friendly hospitals are in cities and towns that have African American populations of 3 percent or less.

A full 83 percent of U.S. Baby-Friendly hospitals are in communities where the African American portion of the population is 13 percent or less.

This geographic segregation of breastfeeding care and support may play a significant role in the lower breastfeeding rates among African American mothers, which in turn means the mothers and the infants do not enjoy the health benefits of breastfeeding.

And finally, this infographic on the geography of unintended pregnancy from Huffington Post, which really speaks for itself:

[Friday Wrap up]: 25

Some highlights from this week:

Providing Culturally Sensitive Care to LGBTQ Families in the Childbearing Cycle

Oh, my beating heart! Someday, I’ll get to one of Kristin Kali’s trainings. In the meantime, I’m going to be breathlessly awaiting a report from my friend K, who will be attending.

Midwifery Benefits? Improved Outcomes For Moms Who See Midwives, Review Finds

You know, just in case you were wondering…

The reviewers looked at 13 trials of more than 16,000 women who saw a small team of midwives throughout their pregnancy, or one primary midwife. Eight of the trials included women who were at low-risk for complications during pregnancy and birth, while five included higher-risk women. All of the midwives were licensed in their respective countries, and none of the trials looked at home births.

On the whole, women who saw midwives throughout their pregnancy were less likely to have an epidural painkiller, an episiotomy (an incision made from the vagina to anus during delivery), or a delivery using instruments, such as a vacuum or forceps. There were no differences in Cesarean birth rates.

‘Mixed Race Kids Are Always So Beautiful’

As a trans-racial/trans-national adoptee, this piece struck home for me. I don’t have kids, but many of my fellow adult adoptee friends do, and this is a common topic of conversation. I’m so, so glad to see it in the NYTimes (despite the awful comments. I make it a point to never read the comments, especially on Motherlode. It’s bad for my blood pressure.)

Still, it never fails to throw me when anyone demands to know my daughters’ precise ethnic makeup, praises them by singling out their light hair or large eyes, or asks whether such white-looking children really do belong to me. Such comments often bring back memories of my own white-by-default upbringing with my adoptive parents and the many unwanted conversations we were drawn into as a multiracial family in a very white town.

Fertility Diary: Childless as Opposed to Child-free

Amy Klein’s guest post on Motherlode is a counterpoint to Time Magazine’s recent The Childfree Life: When Having It All Means Not Having Children.

The concept of the maternal instinct is as ingrained in our culture as the falling-in-love myth, i.e. immediately “just knowing he’s the one,” like in the movies. But is the maternal instinct necessary to being a good parent? Is it necessary at all?

I didn’t “just know” I wanted to have children. I didn’t just know I didn’t either. I did a lot of soul-searching to figure it out.

Despite my uncertainty, without that innate maternal instinct of “just knowing,” I decided to take the plunge anyway. And later, when I felt the baby growing inside of me and saw its heartbeat, I knew I had made the right choice for me, even though that pregnancy did not work out.

I appreciate the distinction Klein makes between childless and child-free…they are very different experiences…yet she grounds her piece in a desire to avoid dichotomies between the two. This isn’t about having and not having, it’s about the spectrum of feelings, desires, and the ambiguities of whatever choices we make.

Why The Pro-Choice Movement Needs to Talk About Children

Yet in large part, the mainstream pro-choice movement seems to have moved away from this focus on the family in favor of concentrating on the arenas of courtrooms and state houses. While the urgency of fighting increasingly severe challenges to abortion care is hard to understate, this shift in attention, messaging, and resources means that the anti-choice movement has been able to make the idea of family, specifically unborn children, central to its emotional power and success. As a result, the pro-choice movement has been left open to charges that it is anti-child and anti-family.

As a future midwife, I think about this a lot, because I know that I am going to face a lot of opposition among other midwives who feel strongly that midwifery is about bringing babies into the world. I see my role quite differently: it’s about support an individual’s needs and desires for their health and wellness. In my mind, this includes if, when, and how to grow their families. I so appreciate this perspective, though, because I think one of the challenges within the pro-choice movement has been acknowledging that a decision to terminate a pregnancy is not always about choice, or the legal freedom to make that choice.

Sarah sums it up well:

Talking about family planning also places abortion care firmly on a larger continuum, along with contraception, access to good prenatal care, and the right of any woman to have a child. This also allows abortion to be correctly discussed as one part of the larger issue of reproductive rights and justice, rather than as an exotic medical procedure deserving of judgment and stigma.

“No Thank You”: A Guide to Informed Decision-Making

This might be one of the most helpful clarifications of coercion, implied consent, and disregard of consent that I’ve seen in a while.

The involuntary sterilisation of children with disabilities should be challenged

When I was four years old, a doctor advised my parents that I should undergo a “routine” hysterectomy. It was recommended, the doctor said, to prevent the future inconvenience of menstruation. My parents, thankfully, were horrified and high-tailed it out of there, taking me and my four year old uterus with them.

I learnt of this story as a teenager, after meeting another woman with the same genetic condition as me who had undergone a hysterectomy at the recommendation of a doctor and the consent of her parents. She experienced ongoing physical and mental health issues throughout her adult life as a result of the procedure.

New Jewish Rituals Offer Comfort to Women Who Have Had Abortions

I love this…we don’t see enough in the media about religious communities that offer space for healing within their traditions.

Not being able to process it [abortion] religiously makes it a very hard experience,” Marx said. “We thought it’s important to give it a voice.”

Germany to become first European state to allow ‘third gender’ birth certificates

Um, yeah. That headline just made my week.

…and finally, for my readers who are map-lovers as much as I am (yeah, geography majors!)

A Strangely Beautiful Map of Race in America

image by Dustin Cable

[Friday Wrap Up]: 24

…delivered on Saturday.

Among the pieces I enjoyed this week:

I’m figuring out where I fit into the life of my partner’s child:

Moving beyond gender binaries in parenting…I’m trying so hard to keep this perspective front and center in the midst of being in a nursing program where the institution still favors the assumption that a pregnant person identifies as female/woman/mother. 

“I wasn’t raised with a narrative that allowed me to see any possibility for myself outside of “mother” or “Child-Free,” and I couldn’t see myself as a mother, so I embraced a Child-Free identity with the fervor of the convert. My closest friends throughout college all more or less shared my attitude — having kids was a fool’s game. My cisgender straight or straight-ish boyfriends got vasectomies as soon as they could pay for them.

But after transitioning to male, I found I could let my guard down. No one was pressuring me to be a mom. No one was giving me knowing looks or saying “You’ll change your mind” or asking when I was due if I happened to be knitting myself a hat. In fact since I entered a friend circle of mostly LGBT folks, few people seemed to care what my opinion on kids was at all. And in a profession that like it or not seemed to involve a high degree of kid contact, I suddenly caught myself in a sea of kindergartners giving me snotty hugs goodbye, feeling… kind of wistful.”

The Opt-Out Generation Wants Back In:

A follow-up ten years later of three mother who left high-paying jobs to stay home and raise their kids. The biggest critique I’ve seen so far to this piece is how simplistic it is. A decade later and we’re still eye-ball deep in the Mommy Wars of the privileged. 

“But most people don’t make life decisions based on statistics or the collective good. And not a single woman I spoke with said she wished that she could return to her old, pre-opting-out job — no matter what price she paid for her decision to stop working. What I heard instead were some regrets for what, in an ideal world, might have been — more time with their children combined with some sort of intellectually stimulating, respectably paying, advancement-permitting part-time work — but none for the high-powered professional lives that these women had led.”

15 Weeks:

An amazing reflection by a college friend integrating her pregnancy and impending parenthood into her identity, while recognizing the many ways in which parenthood is a privileged status in our culture. As a student nurse/nurse-midwife, former doula and teacher, and still undecided about whether I will pursue parenthood, this piece resonated strongly.

“A few days ago, a TSA agent in rural Alaska asked me how many weeks along I was. This was a first. Most of the time people can’t tell I’m pregnant or they are embarassed to ask in case I’m not. It was nice. I felt seen, and I would be dishonest not to admit that this is something I have longed for–to be seen and welcomed as part of the parenthood clan of humankind.

That this longing to be part of the parenthood clan was a painful one arose both from the very personal and simple and timeless struggle of wanting children and not yet having them, and also from a frustration with our cultural rhetoric around parenthood and the inclusion/exclusion it creates. We have all heard countless times phrases such as: “There is nothing as meaningful as being a parent” or “you can’t know love until you are a parent” or “you don’t know anything about kids until you become a parent.” I have heard these things through my lens of living a life in which, since I was eight years old, I have been dedicated to ending child abuse and interpersonal violence. I have heard these phrases as a schoolteacher working 80 hour workweeks for my struggling students; as a sexual violence educator for kids and a victim advocate; as a social worker/epidemiologist specializing in interpersonal violence, child trauma, and healthy child and youth development; and as the person at the party who is super happy playing games with the six-year-olds.  I have always loved children and felt completed by having them in my life and making a difference in their lives–whether as a professional or auntie. And I know I am not alone.

There are countless aunties and uncles–of the blood and non-blood type–and adopted grandmas and grandpas, foster parents, step-parents or partners, teachers, social workers, policy-makers, pediatricians, and so many others who DO have wisdom about children and who DO have meaningful connections with and love for kids, and who live lives rich with meaning. (Not to mention people whose lives are rich with others kinds of meaning as well, such as great social or scientific innovations, community-building, etc.) Some of these people never become parents. Some won’t become parents for a while. I reject a discourse that says that these people’s work and love is less important than those who biologically bear children.

Abortion Stigma Webinar Summary:

A joint venture between ANSIRH and Ipas, exploring the elements of stigma in abortion care, mental health and clinical experiences. Participants hailed from around the world with a range of goals for gathering together virtually to discuss this topic:

  • To learn how to reduce shame and stigma with young people seeking reproductive healthcare services
  • To discover new ideas on how to combat anti-abortion legislative initiatives and media attacks
  • To explore tools to develop a stronger evidence base for advocacy
  • To gain inspiration for research topics
  • To understand strategies and language use around abortion

End of Life, at Birth:

A heart-felt reflection from a neonatologist on the ethical landscape of decision-making around micro-preemies–those babies born before 28 weeks. This is perhaps one of the more challenging aspects I anticipate in my future work as a midwife…navigating the conversations around how to move forward when we know that there are severe anomalies that will impact the life and health of an infant. I am so glad that we are talking more and more about this in the mainstream media. These conversations, like so many others around stigmatized pregnancy experiences, need to come out in the light. It’s an incredible burden for parents to have to face alone.

“Sometimes, I think we doctors need to do more than inform. On occasion, I’ve offered to make a life-or-death decision for parents. If they agree, they are essentially making the decision, but are shifting the burden to me. It’s harder for parents to say, “I unplugged my baby,” than to let the doctor do it.

This Is Not Just a Story About Prostitution:

This is how the story opens:

“First, a word of warning: This story features photos about prostitution. But under the surface, it’s more than that. It’s a story about photographic access, and how a friendship led to an intimate portrayal of a taboo subject. These are not just photos about prostitution; they’re photos about a woman who goes by the name Eden. Taken by Alicia. Her friend.”

Check out the photos. They’re marvelous.

[Friday Wrap Up]: 23

I’ve been keeping a window saved for this week, full of tabs of interesting tidbits. I don’t always have a chance to read through everything as I save it, but I think Friday afternoons will be my time to catch up on the world. At least for this term, my clinical is done at 11:30am, which means I’m home in time for lunch!

So here’s some Friday afternoon reading for ya:

My mother’s abortionI don’t think that anyone should have to speak about any personal experience if they don’t want to…but I also think that the reason why so many don’t speak and share is because of the level of stigma around abortion.

Recently, I heard my mother reveal her experience to four friends who are devoted to protecting women’s right to choose. Strikingly, two of them revealed that they had had an abortion, and the other two had close friends who’d had an abortion. None had told my mother before.

What the movement for reproductive rights needs is for the faces of freedom to emerge from the captivity of shame. To my mother’s generation, I ask: Speak openly about the choices you have made. To all women: ask your mothers, grandmothers, godmothers, aunts, sisters, daughters and partners about their reproductive histories. Show that abortion has myriad faces: those of women we love, respect and cherish.

Coercive sterilization is not a thing of the pastMiriam Perez, over at Radical Doula, reviews the recent conversation around forced sterilization of nearly 150 incarcerated women in CA state prisons. The take home?

I increasingly get more and more infuriated about how little attention in the reproductive rights arena goes to the struggles of low-income, people of color trying to maintain their right to pregnancy, parenting and bodily autonomy. If you are truly doing reproductive justice work, than this issue should get as much attention as any abortion rights fight.

 What Does Birth Cost? Hard to Tell: A follow-up to last week’s NYTimes article on the high cost of birth in U.S. hospitals.

Last month, Senator Charles E. Grassley, Republican of Iowa, and Senator Ron Wyden, Democrat of Oregon, introduced a measure to make Medicare reveal what it pays providers for every service. Mr. Wyden said the uninsured could use the data to negotiate, as could people with health care savings accounts. A searchable list of Medicare payments should be a fundamental service, Mr. Wyden said.

“Every single person in government tells people, ‘Oh, you’ve got to make good choices,’ ” he said in an interview. “But patients have their hands tied. They can’t get costs and they can’t find out about quality.”

Study Finds Benefits in Delaying Severing of Umbilical CordGeeze, about dang time, is what I have to say on this!

Newborns with later clamping had higher hemoglobin levels 24 to 48 hours postpartum and were less likely to be iron-deficient three to six months after birth, compared with term babies who had early cord clamping, the analysis found. Birth weight also was significantly higher on average in the late clamping group, in part because babies received more blood from their mothers.

A Masculine SilhouetteEver since reading this post by my friend k.emvee over at Bloody Show, I’ve been more mindful of the ways in which I’m privileged as a cis-gendered woman. I don’t have to worry about whether the clothes I wear match the way I express my gender identity. I don’t have to worry that my future clients might get upset or confused that my name doesn’t “match” my presentation. I don’t have to worry about getting weird looks when I walk into a dressing room. In fact, people often praise my small-frame as an asset to my identity as a woman. So, I get super excited when I see articles like this in mainstream media.

So, my question is, when will we start seeing “maternity” clothes that reflect the diversity of gender expression, too? Cuz I’m pretty sure this is not appealing for everyone:


First Annual NSfC Activist SummitI don’t normally say it, but OMG! I’m so excited for this. Not only is it in MN (my home state!), but there are going to be some kick azz speakers! If you’re a nurse or nursing student, you should definitely check it out!

The conference will provide a space for nursing students to learn more about reproductive justice issues, obtain clinical skills, and acquire tools for advocacy work. Clinicians will offer hands-on training in IUD insertion and manual vacuum uterine aspiration. Panels of reproductive health activists will speak about current issues and the nursing perspective in abortion care, as well as organizing for curriculum change. The conference will provide educational resources and interactive exercises, so participants leave with skills they can utilize in the clinical setting, along with a national network of support.

Are you excited yet?!

Last but not least…

Twins and in the caul homebirthThis may be one of the most amazing series of birth photos I’ve seen in a long time (and yes, the mama did give permission to the photographer, Leilani Rogers to share these!). See more photos and hear the photographer’s thoughts here.

[Friday Wrap Up]: 22

So many interesting items in the news, it’s hard to keep up with it all. Here’s what I’ve been saving:

American Way of Birth, Costliest in the World

When she became pregnant, Ms. Martin called her local hospital inquiring about the price of maternity care; the finance office at first said it did not know, and then gave her a range of $4,000 to $45,000. “It was unreal,” Ms. Martin said. “I was like, How could you not know this? You’re a hospital.”

Like Ms. Martin, plenty of other pregnant women are getting sticker shock in the United States, where charges for delivery have about tripled since 1996, according to an analysis done for The New York Times by Truven Health Analytics. Childbirth in the United States is uniquely expensive, and maternity and newborn care constitute thesingle biggest category of hospital payouts for most commercial insurers and state Medicaid programs. The cumulative costs of approximately four million annual births is well over $50 billion.

How Long Can You Wait to Have a Baby? I’m sure this is somewhere in the minds of many of the midwifery students out there in the world…

The widely cited statistic that one in three women ages 35 to 39 will not be pregnant after a year of trying, for instance, is based on an article published in 2004 in the journal Human Reproduction. Rarely mentioned is the source of the data: French birth records from 1670 to 1830. The chance of remaining childless—30 percent—was also calculated based on historical populations.

In other words, millions of women are being told when to get pregnant based on statistics from a time before electricity, antibiotics, or fertility treatment. Most people assume these numbers are based on large, well-conducted studies of modern women, but they are not. When I mention this to friends and associates, by far the most common reaction is: “No … No way. Really?

Getting Men to Want to Use Condoms I would love to think that some new creative condom will help increase use of contraception…but honestly…I think it’s gonna take more than condoms, no matter how cool.

Profiting from Pain This is mostly a placeholder for me to remember, once we get to opioids in pharmacology.

Disabled People Say They, Too, Want a Sex Life, and Seek Help Attaining It

But many disabled people, including Ms. Rebord, believe that they have a right to sexual assistance, a psychological and physical means to overcome their inhibitions and empower them to find love.

Marcel Nuss, a severely disabled father of two who breathes with an artificial respirator, is the author of “I Want to Make Love.” The book describes his personal fulfillment through love with his former wife and a sex life with escorts. His experiences, he said, persuaded him to support the use of sexual surrogates.

Institute for Healthcare Improvement’s Open School: as if I need more reading…but still!

[Friday Wrap Up]: 21

To be completely honest, I’m not sure how consistently I’ll be able to continue this series…but I keep reading amazing articles that I want to share…so maybe it will turn into an every other Friday Wrap Up.

What is the Evidence for Induction or C-Section of a Big Baby

I’ve been a fan of this blog for a while now, but Dekker really hit it out of the ballpark with this post. She thoroughly examines the current research around outcomes for “big babies,” starting with how they’re defined and the challenges of being able to accurately predict birth size in utero. There have been so many times as a doula when I wanted to shout out “but what PROOF do you have that this is a big baby?!”…but obviously, this wasn’t really my place.

Here’s the take home…but you should really do yourself a favor and read through this. Give yourself time.

In summary, evidence does not support elective C-sections for all suspected big babies, especially among non-diabetic women. There have been no randomized, controlled trials testing this intervention. It is likely that for most non-diabetic women, the potential harms of an elective C-section for a big baby outweigh the potential benefits.

What Happens to Women Who are Denied an Abortion?

This NYTimes Magazine article explores the current data coming from ANSIRH’s Turnaway Study. It’s the first study to compare what happens to women who receive abortions and what happens to those who are denied abortions.

Most studies on the effects of abortion compare women who have abortions with those who choose to carry their pregnancies to term. It is like comparing people who are divorced with people who stay married, instead of people who get the divorce they want with the people who don’t. Foster saw this as a fundamental flaw. By choosing the right comparison groups — women who obtain abortions just before the gestational deadline versus women who miss that deadline and are turned away — Foster hoped to paint a more accurate picture. Do the physical, psychological and socioeconomic outcomes for these two groups of women differ? Which is safer for them, abortion or childbirth? Which causes more depression and anxiety? “I tried to measure all the ways in which I thought having a baby might make you worse off,” Foster says, “and the ways in which having a baby might make you better off, and the same with having an abortion.”

I had the opportunity to hear the lead study author, Diane Foster Greene, earlier this spring, and all of us in the audience were fascinated by the data she was collecting. As the NYTimes article notes, there is a dearth of well-designed studies looking at outcomes like this. As a future midwife, these are things I think are important for us to be talking about. Having a clearer picture of what pregnant people are experiencing allows us to better counsel and support our patients.

Men Choose Abortion Too

I really appreciate that this piece came right before Father’s Day…this is a piece of conversation that we don’t talk about a lot, but as the author notes, men make choices around parenting and abortion, too.

Being a parent is about more than buying prenatal vitamins and diapers. It is about having the ability to support a person for the rest of your life. And when I decide to become a parent, I want to make sure that I am in a place where I am ready to do that. And I want to do it with a partner who is ready to respect our children, our family, and me. What Live Action doesn’t understand is that supporting someone through an abortion is a form of love as well. It’s a deep respect for all of life’s complexities. And I believe that most men, and fathers, understand that too.

Speaking of Father’s Day…

Celebrate Papa’s Day 2013 with Strong Families!

Many will recognize Strong Families from their previous Mama’s Day campaigns…this year, they’re also offering free e-cards for Papa’s Day as well! I love looking through these diverse images of families…they encourage us all to re-imagine gender roles in families, to re-think how we define the role of mother and father. The accompanying blog post series is full of thoughtful articles on the meaning of fatherhood in our culture. I particularly enjoyed this one by Dominic Cinnamon Bradley, who identifies as a “Black gender non-conforming, ‘crip and sick’ multidisciplinary artist from the Dirty South”. The piece is titled Four Chambers: Holding my Family of Destination.

It has been a patient labor both to release my dad and name and claim my own desire to parent—though my heart leaps to my throat to admit it. I look wistfully after expectant mothers and into the faces of tiny, blinking children and can imagine a fetus kick. I want to tell my doctors they can shove their pills for the next nine months. I want to relish the confusion as others’ eyes slide off my pregnant form and their ears catch on my pronoun. I want to birth attended by a midwife in my own home surrounded by my closest friends and chosen family. I want us to drum and dance and sing and eat and float my baby out of me on a raft of laughter. I want to cut my own cord, take a bite of my placenta, and shout to the world how tickled I am to occupy this new role. I gaze into my baby’s eyes and confer her carefully chosen name. I once told my friend that I am committed to healing my trauma, so I don’t pass it on to my child. More than anything, I want to live in alignment with that statement.

Finally, there’s this gem:

A Beautiful Body

When he finished there was a moment of silence. I imagined Eleanor internalizing, at such a young age, this deeply important lesson about all that she, in her body (the very body that she has and not one that she thinks she should have), is capable of and at that moment I couldn’t remember the last time I was so moved.

It is both difficult and easy for me to imagine how people can move through life feeling shame and stigma about their bodies…difficult because I feel lucky that somehow I managed to avoid the worst of the messaging around what a girl is supposed to look like, bu easy because I’ve watched friends struggle with body image for years. Around pregnancy and birth, in particular, I see this struggle emerge–feeling ugly and “fat” even when carrying new life into the world.

This little piece about a father affirming his daughter’s inherent beauty and strength made me tear up a little. If only everyone, regardless of gender, had parents and community members affirming their beauty.

[Friday Wrap Up]: 20

This week my heart has been full and mind swirling with thoughts about midwifery and access.

I had the great pleasure of getting to hear Jennie Joseph speak for a fundraiser for Open Arms Perinatal Services. She’s a CPM in Florida and runs a birth center and “easy access clinic”–a model of prenatal care she developed to increase care for low-income and uninsured folks in her community. The basic idea is that one day a week, her clinic is open to everyone–doesn’t matter how much money you have, or whether you have insurance or not. You walk in the door, you get prenatal care. Given the high rates of pre-term birth and low-birth weight babies in the African-American community, this is huge. Her clinic has astounding results.

It was really exciting to participate in the smaller focus group after the lunch and hear the passion and excitement of the Seattle midwifery community to replicate this model in the Seattle area. It also reaffirmed for me that my passion and drive to become a midwife is truly fueled by my desire to increase access to quality reproductive health care and improve maternal health outcomes. One of the things that really struck me was Jennie’s plea for midwives to let go of their egos a bit, in order to truly serve those that need us most. It’s not about midwives getting all the credit: it’s about collaborating in powerful ways to do what we need to do to improve maternal health.

Another interesting piece that crossed my feeds this week is an NPR article on the trend of group medical care.

Group medical appointments can work for all kinds of routine care — from post-surgical joint replacement follow-up to chronic conditions, such as diabetes or heart disease. In 2010, about 13 percent of family physicians reported conducting group visits, more than double the 6 percent that did so in 2005, according to the American Academy of Family Physicians.

In a typical group visit, a doctor, often helped by a nurse, sits down with as many as a dozen patients for up to two hours. Each patient gets a chance to ask questions and listen to others’ concerns. The doctor facilitates the discussion.

This has been happening in the world of midwifery for a while–it’s called Centering Pregnancy, and there’s quite a bit of evidence to support this model for group prenatal care. I know for many people, the idea of group care of any kind sounds horrible–issues of privacy come up, of course. But I can’t help feeling like there’s a lot be gained by connecting individuals with a community that’s going through a similar experience. Group care seems like it has a lot of potential to decrease the stigmatization of many experiences.