The Big Picture: Disparities in Maternal Health in the US

This will be a short post…I accidentally cut my finger while chopping onions for dinner last night, and typing with a bandaged finger is not super compatible with long posts.

Things I’m thinking about:

The Importance of Understanding and Reversing Disparities in Maternal Health Outcomes

This is a great overview article by  Christine Morton, PhD,  a medical sociologist who has researched, worked and written about disparities in maternal health for many years. Read the whole thing over at Science and Sensibility.

She starts with a shocker:

Maternal mortality is associated with the widest and most persistent disparity (inequality) in all of public health.  African American women have a three to four-fold greater chance of dying as a result of pregnancy than women in any other racial-ethnic group.1The gap between maternal mortality in African American women and women of other racial-ethnic groups is greater today than it was in the 1940s.2

And this:

Some suggestive work in this area was published by Tucker and colleagues from the CDC (2007), who examined the prevalence of five conditions considered major causes of mortality occurring during hospitalization for labor, birth and postpartum. They found that African-American women did not have a higher prevalence of these conditions (preeclampsia, eclampsia, abruption placentae, placenta previa and postpartum hemorrhage) compared to other racial/ethnic groups, but were more likely to die from them, suggesting either a possible difference in the severity of the disease or the quality of care provided during hospitalization.

Which is why I’m supporting this:

“I promise, I will do something this time”: Scholarships for ICTC’s Black Midwives and Healers Conference 2012

And if you need any more inspiration to contribute to this fund…please read my friend K. Heron VIehmann’s powerful words from her graduation speech, given earlier this summer from Birthwise Midwifery School. In fact, you should read the whole blog anyway. It has the best name ever (Bloody Show!) and as she describes it, it explores the intersections of health and race, class, sex, gender, sexuality and disability.

We need more midwives who are willing to tackle the unconscionable disparities in birth outcomes in this country. I’ve been so inspired by her journey, and look forward to walking that path and someday calling her colleague as we work to find creative solutions to improving maternal and infant health care in this country.

Letter of Support for Midwives of Color

I’m reposting this letter of support, drafted by AROM (Anti-Racism and Anti-Oppression Work in Midwifery).

This letter was drafted by midwives and student midwives who strongly believe that the recent resignation of the Midwives of Color Inner Council of MANA provides a unique opportunity to step up and take personal and collective responsibility for the ways in which midwives of color have been marginalized in this country.

It is worth taking the time to read in its entirety…but here is one excerpt that I think captures our anger, frustration, and deep desire to create radical change in the midwifery community for the sake of improving maternal and child health in this country:

We acknowledge the injustice of the fact that the white-dominated midwifery community continues to regard the health impacts of racism and colonialism as a special interest issue. This is a reflection of cultural dominance and a denial of basic human dignity. We bear witness to the fact that this has isolated midwives of color. It is unjust to expect midwives of color to bear the burden of addressing the problems of racial disparities in maternal and perinatal outcomes. We acknowledge that the dramatically higher rates of infant and maternal mortality for African American and Native American women in the US represent violence against women and children, and we are all responsible for addressing this. Denying the reality of these differences, disputing the causes, and withholding our full attention and energy from the problem constitute acts of gross negligence as midwives. We recognize the need to universalize an understanding of these concepts and integrate them into a shared world-view.

Read the entire letter here.

[Friday Wrap Up]: 10

Wow, it’s been a busy week…both personally and in the broader midwifery community.

Since the resignation of the MOC Inner Council, I’ve been following the conversation over on MANA’s Facebook page closely. There’s been a lot of hurt over the years that needs healing…but I’m also impressed by some of the depth of heart and intention in moving forward.

I’m particularly interested in the efforts of the Future Midwives Alliance in drafting a Midwifery Student Bill of Rights.  Having several friends who are pursuing or finishing apprenticeships for direct-entry midwifery, I’ve learned a lot about the pitfalls of apprenticeship. As a future nurse-midwifery student, my hands-on clinical training will take a different path (namely, I’ll be doing most if not all of my clinical work under the preceptorship of hospital-based nurse-midwives), but I fully support my sisters who are pursuing midwifery by traditional apprenticeship. Further, I would really like to see more support and better guidelines and protocols to help protect these student midwives from being taken advantage of during such a formative period of their training.

Reading and Pondering:

…This blog post exploring the often dichotomous views of adoption and abortion…as an adoptee and self-described pro-choice advocate, there’s a lot there resonated for me here.

…How sad I feel that it took until 2012 for Wisconsin to have its first licensed midwife of color. Tehmina Islam sounds like an amazing midwife…but really, we need more midwives of color, everywhere.

…This webinar on racial disparities of breast cancer outcomes by Breast Cancer Action on my own time…and looking forward to seeing Pink Ribbon, Inc. when it comes to theaters here in Portland.

…The depiction of nurses and teachers as “pink collar” workers in the NYT article earlier this week about men moving into jobs traditionally held by women.

…Also, really, really wishing I could be in Philly at the end of the month for this awesome workshop on full spectrum midwifery/doula care at the Philadelphia Trans-Health Conference. I’ve heard and read about the work of Miriam Perez and Pati Garcia for a while now…so I have no doubt this will be an amazing workshop.

When not reading and pondering, I’m delving into the final three weeks of A&P…we’ll be focused on the cardiovascular and pulmonary systems–blood and blood vessels, the heart and lungs.  Although it is definitely complex, it’s also more directly applicable to my future work as a clinician…so it feels less like hum-drum memorization. Today in lab we dissect a pig’s heart–it was huge!

Oh, and I’m on-call for two mamas due any day.  Can’t get much more exciting than that!

Midwives of Color

Just after MANA posted its third video, the entire MOC Inner Council resigned, en masse, in response to persistent struggles with the MANA board. This is an important moment for MANA, and for midwifery in America.

It’s no secret or surprise that health disparities are a major concern in this country, nor is it news that health care providers of color have long struggled for respect from their white colleagues.  This is as true of doctors and nurses as it is of midwives.  Particularly within the midwifery community, though, there’s been a long history of oppression, racism, and misunderstanding that has undermined the efforts of midwives of color in feeling supported as they advocate for their communities.

The conversations on Facebook have been heated and passionate, and I’m hopeful that this big change will bring in a new wave of energy and commitment from MANA to more pro-actively address the long-standing concerns of midwives of color.  The health disparities are too great, and the need for more midwives of color too strong to get bogged down in blame games.  We need both action and healing if we are to move forward as a united midwifery community serving the best interests of women who seek midwifery care.

I am a Midwife, part III

This is the third video in MANA’s I am a Midwife series, and definitely my favorite so far.  It explores the issues of racial disparities in maternal health care…and how midwives are really uniquely situated to address these unacceptable inequities.

This video really highlights for me both the magnitude of the problems in our current health care system, and why I believe so passionately that midwives will be at the forefront of positive change.  For so many people, prenatal care may be their first, or only interface with the health care system.  As a future midwife, I want to be doing all I can to provide appropriate care that addresses the full spectrum of health care needs…and also help shape policy and protocols to ensure that everyone has access to the same level of care.

As Geraldine Simkin says,

“It’s not acceptable that African American women, regardless of their educational and economic background, still have a four times greater chance of dying in the childbearing year than their white counterparts… It’s not acceptable that three to four times more Native American and African American babies die than their infant white counterparts.”

[Friday Wrap Up]: 6

Whoa, Nelly!  Things are starting to wind down this term (what?! when did that happen?!), and I’m starting to feel the pinch.  Our final lab practical is next Thursday–it will cover all the bones and muscles we’ve learned in the last three weeks.  One more week of lecture, covering the spinal cord and cranial nerves, and then lecture final is Tuesday the 20th. On the 23rd, I head to CA for a few days with a dear friend expecting her first baby in early April.

And although I should probably be studying for finals on my non-class day, I’m opting instead to attend a workshop on infant adoption for nursing students.  Although I’m not a nursing student yet, I have friends in a local nursing program who are involved in their school’s Reproductive Justice/Nursing Students for Choice chapter.  They’re putting on this workshop, along with some staff from the local Boys and Girls Aid, and I’m super interested in how this will be presented….and to get a sense of how nursing students are prepared to support women who may be planning to place for adoption. More next week.

Other random bits that have crossed my mind in between cramming more muscles into my already full brain:

  • Where are all the Asian and Asian-American midwives?  As a Korean-American adoptee, I keep my eyes peeled for anyone who looks like me in the world of midwifery.  I know of one student who’s also Asian-American…but have yet to meet either a CNM or CPM who identifies as A/AA/PI. There’s this midwife whose site I stumbled upon…but we don’t live on the same coast!
  • Guess I’m not the only future midwife who worked in education first…like me, Makeda got her MEd first, then went into midwifery.  Maybe someday I’ll get to meet her–sounds like she does fabulous work in global maternal health.
  • I really want to see this film, which chronicles the experience of several midwifery students at Maternidad la Luz, down in El Paso…hopefully the doulas and midwives in my community can come together to host a screening this summer.
  • May have stayed up too late last night reading just one more page of this book, recommended to me by a friend. I agree with a lot of it (ie, our health care system is in dire need of major overhaul)…and yet other parts are a reminder of why I feel called to midwifery as opposed to pediatrics or obstetrics. It’s well-written though, and a great insider’s look into the how it’s becoming harder to just practice good, common-sense medicine in an age of managed health care and absurd malpractice lawsuits.