[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.

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More Thoughts on Expanding Midwifery: Action Steps

On Sunday, I blogged about my thoughts on the ways in which National Midwifery Week is being publicized. Here’s the one sentence summary :

I love midwifery and I aspire to collaborate with other midwives to expand the midwifery model of care to be more inclusive and reflective of the communities in which I will serve. 

Since Sunday, I’ve been thinking about what I would like to see in the midwifery community. It’s been a good exercise for me to move beyond articulating the problem towards envisioning and enacting solutions.

Historically, I would argue that midwifery has been a women-centered profession. It’s in the name, for sure: “to be with woman.” It is still considered by many to be “women’s work” and often we talk about “women-centered care.” There’s the assumption that midwives are about “mamas and babies.” When we talk about the midwifery model of care, we’re generally talking about women’s reproductive health–by which we mean people who were born as females and fit into the gendered binary ideal of female. There’s also an assumption (at least here in the U.S.) that the people providing the care are also women. All of these assumptions add up to a partial truth. The whole truth is, ironically enough, is more simple than that: midwifery care is for everybody and can be provided by anybody, regardless of gender, race, sexuality, etc. Period.

As a woman of color, I think a lot about my positioning and the ways in which I am seen and not seen in the culture I live in. I am a college-educated woman with a lot of resources at my disposal…but I have to work hard to find myself reflected in the broader culture of this country. I also have to work really, really hard to find myself reflected in the world of nursing or midwifery. Because of the resources I have access to, this experience ranges from a mild inconvenience to sometimes an uncomfortable dissonance, and at times more intense frustration and anger. I don’t think I’ve ever experienced true disparity in my health care or education. Sadly, I can’t say the same is true for many of the marginalized communities in this country.

When I think about potential steps that major midwifery organizations can take to walk the talk of inclusion, I dream big, but also recognize that sometimes the small steps mean a lot. Here are a few of my ideas at this moment in time.

Show more images of diverse families.

I think many organizations are getting better about this, but images matter. They are the reflection of an organization’s values. When only certain types of families are portrayed, the underlying message says “We only serve this kind of cliente.”

Show more images of diverse midwives. 

It’s a bit of a chicken and egg question, to be sure…but the way to truly connect with a diverse clientele is to have care providers that reflect the diversity of those they seek to serve. As an Asian-American, I don’t see myself reflected anywhere in the midwifery community, as a potential parent or midwife. Likewise, where are the images of male midwives? What about queer midwives? They’re out there, doing great work! You can see it here, and here, and here. (And check out this article from Vanderbilt’s School of Nursing for more on the history of male midwives.) When we limit ourselves to the narrow mindset of midwifery = women, we’re only speaking to one community.

Make the shift in language to be more inclusive. 

My friend K wrote a short sweet post about language three years ago that I still love. Language, like images, is a powerful change agent that instantly can open or shut doors.

Speak up as an ally, loud and proud during Trans Awareness Week

At every opportunity, collaborate with ally organizations committed to anti-oppression work. There is definitely value in the quiet, behind-the-scenes work of culture change within institutions. But there is also incredible power that comes with using one’s voice, whether as an individual or as an organization, to speak up for justice.

Make real, concrete changes to the core competencies of midwifery training so that midwives graduate with the skills they need to be able to provide not just competent, but quality, skilled, compassionate care. 

This action step is especially near and dear to my heart. As a current student, I want to know that when I emerge from the cocoon that is midwifery school, I will be able to provide quality care to all my patients, no matter what their anatomy or gender identity may be. Right now, I am not convinced that midwives are getting these skills without having to pursue supplemental training outside the core curriculum.* This seems like a huge gap that needs to be narrowed before midwives can practice inclusive care.

[*Case in point: Varney’s Midwifery (fourth edition), considered by many to be the “Bible” of midwifery textbooks, includes one paragraph on transgender issues. It can be found towards the end of the 13-page chapter (of a 1,386 page text) titled “Health Issues of Lesbian and Bisexual Women.” The paragraph itself focuses on MTF transgender individuals who identify as lesbian. Two references are cited, dating back to 1996 and 1997. Obviously, not all trans people are gay or lesbian. And a lot has changed in LGBTQ health care since 1996.]

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I don’t think the process of making midwifery care will always be easy or simple. I imagine there will be some struggle and conflict and discomfort as patterns of thought shift. But the responsibility is ours and I am eager to connect with other healthcare professionals, especially midwives, who are ready to do this work together.

[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]: 11

I’ve known about Doula David for a while now…so I was super excited to read this interview he did with another doula, Sarah. I admit, when I first became a doula, it never really crossed my mind that men might be interested in doing birth work…but of course, as my friends in the LGBTQ community pointed out, there are lots of ways to create a family, and lots of room for diverse support.

And I absolutely agree.  I’m especially interested in learning more about transgender health care, because I think it’s an area that is still developing, and that many people don’t know much about.  As a future midwife, I would be thrilled to be able to support transgendered folks who are wanting to get pregnant–and equally–I want to be able to guide them to doulas that they feel comfortable with.

So here’s to all kinds of doulas–not just doulas of differing philosophies, but doulas of all ages, races, ethnicities, genders…there’s room for everybody, and in the end, we are all better off when pregnant people feel supported and nurtured.

Juicy excerpt:

Q: As a male Doula, you are working in a field that most think of as a female only profession. You are in a way, changing what we assume a Doula to be. Do you feel as though you will be able to help other men that have the desire to Doula?

A: Honestly, I had no idea that I would be the second known certified male doula. I assumed that it would be rare but not THIS rare. I imagined there would be some fellas out there who supported a partner through multiple births and who was such a great supporter that he became a doula. I know there are other men both trans and cis-gendered who are providing doula support and I imagine that there will be more to come.

I feel that the birth world is diverse in philosophy but lacks racial, ethnic, and cultural in addition to gender diversity. While I did not set out to break any boundaries, I do hope that if my presence has any effect in addition to simply providing doula support that it will help inspire more diversity. I hope that what we assume a doula to be will explode and that we will see doulas of all shapes, sizes, colors, languages, cultures and of course genders.

Read the entire interview here.

What Does Inclusive Really Mean?

As a doula, I’ve thought long and hard about this, because I am committed to making my services as inclusive and accessible as possible. I may not connect emotionally with every possible client I meet, but I want to make it clear that I believe that doula care and midwifery care should not exclude anyone on the basis of race, gender, sexuality, etc.

This was a great article to wake up and read this morning…Sharon Muza, a doula and educator in Seattle, is guest blogger today on Science and Scnsibility, and shares the experiences of Cathy Busha.  Cathy is a MSW, and she and her partner are expecting their first baby in July.  As the non-carrying parent in a lesbian couple, she has experienced all kinds of subtle and not-so-subtle hints that the childbirth ed world still hasn’t quite made the shift…and it hurts.

As I’ve explored books and blogs and birth websites, it seems the birth world, like the rest of the world, is hyper-heterosexist with rigid gender roles. Heterosexism assumes that everyone is straight: there are no pictures or stories of lesbian births on mainstream birth websites. At best, the word ‘partner’ is used, but all images, examples and stories are of straight couples.  I have grown weary of having to translate my role (non-biological mom) from mainstream books, videos and materials that assume all families are one man, one woman.

As for gender roles, on birth websites, women are portrayed with long hair, flowy white dresses, surrounded by flowers, brimming with nurturing instincts. Men, on the other hand, are described as bumbling, strong, masculine providers who may or may not know how to hold a baby or change a diaper, but patiently suffer through their wives’ crazy cravings and mood swings. I don’t identify with either of these paradigms and wondered how I would fit into the birth class we had chosen to take.

Language is important, and can make a world of difference in ways that those of us in positions of privilege would never notice. Imagine going through your entire pregnancy feeling invisible in your childbirth ed class because the language used never acknowledged, affirmed, and celebrated your presence. For any birth professional, this is a post well-worth taking five minutes to read and ponder…and then take some more time to consider simple ways that you can make your language more inclusive and affirming of families of all kinds.