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Submitted by Kate Gorman, Co-Director/Producer The Face of Birth Are you looking to do a fundraiser for your group or to gather all your friends and colleagues together around a new birth film? Starting March 8th International Women’s Day you can host a screening in your living room, community theater, or wherever you choose of the much anticipated Documentary,The Face of Birth Documentary (87 minutes 2012, Australia).

The Issue of Home Birth in Australia

In Australia in 2009 it nearly became illegal to have a home birth! A new government introduced maternity law reforms that required every midwife to have Public Indemnity insurance. Whilst this may be not a bad thing in itself, no insurer would cover independent midwives who attended homebirths. And at the time apart from a tiny number of hospital/home birth programs the only way to have a homebirth in Australia was with an independent midwife.

It was proposed that if a midwife continued to attend home birth without insurance she would be fined $30,000 and deregistered. If a mother paid a midwife to attend her at home she could be charged with criminal intent. How could this have happened? Australia once had close ties to the UK with historically similar health care systems, however in the UK, still to this day, a woman can chose where to give birth and a mother can chose a home birth all completely funded by the National Health Care System.

Following announcements of the proposed new laws, in September 2009 over 3,000 people, mostly mothers, prepared to march in protest on the national Parliament House. Just hours before the protest commenced the government announced it was giving independent midwives a reprieve allowing them to practice for another two years (this later was extended to three, then to five years). With this announcement came regulations that the midwife would have to collaborate with an obstetrician who would have to ‘sign off’ on the midwife being able to attend.

It was at this rally at Parliament House that filming started on the Birth Documentary The Face Of Birth. Since the film’s release in Australia in 2012 the government has again extended the exemption for independent midwives and amended the collaboration agreement allowing midwives to also collaborate with health professionals/services such as hospitals and General Practitioners. A slight improvement but in the meantime many independent midwives have given up and their numbers have dwindled across the national, especially in rural areas. Despite this the Home birth rate has nearly doubled from 2008 to 2012! It seems women want the choice despite it having become more difficult to access.

The film was taken up by various lobby groups who used it to apply additional pressure to the ‘powers that be’. Further changes followed where independent midwives can also qualify for a health insurance rebate, meaning that the mother paying the midwife can recover some costs for ante natal and post natal care (but strangely not for the actual birth).

Some of the Australian State governments have also looked for solutions. In Victoria two large hospitals started up home birth pilot programs – offering not only the option of birth at home but also continuity of care with caseload programs. The programs became incredible popular incredibly quickly.

While women in Australia are struggling and fighting for their rights, in New Zealand, Australia’s close neighbours, they have in place what US Anthropologist Robbie Davis-Floyd has declared the best maternity service in the world. Where women can choose home, hospital or birth centre birth all funded and also choose their lead maternity carer (80% of women choose a midwife). The lead maternity carer stays with the woman during the care and if the mother chooses to change place of birth, i.e. from hospital to home or birth centre to hospital, during the pregnancy even during the labour, their lead maternity carer can go with them.

While the beginnings of change are being felt in Australia, there is still there is a long way to go.

With birth choices being so limited in countries like Hungry, Croatia, Russia and the US – where it is illegal is some states to have a homebirth – films like The Face Of Birth, Freedom for Birth and Organic Birth are going a long way to help educate and create change for all the women who are yet to have their babies. It is at screenings of these films that women and families gather and share experience good and bad. Groups, rallies, websites, activism and general support for women is born from these community screenings. The human rights issue of choice for place of birth is an issue for all humanity.

To see more and have your own screening visit www.faceofbirth.com.

Submitted by Jill Wodnick, M.A., LCCE

Social Determinants on Birth: A Call for Doula Training Organizations to Address Perinatal Disparaties

The city of Newark, NJ demands our attention in the birth world. Is it the 40% of Newark mothers who received late or no prenatal care; is it the 694 (15%) mothers who were breastfeeding upon hospital discharge, or is it that the time to prove to policy makers that social determinants of health are the elephant in the room….it is time to look at the big picture and focus on eradicating & eliminating poverty and racism as the tool to improve birth.

For too many doulas, they will be able to offer words of comfort and use a rebozo, but may never have had the training to learn about perinatal disparities and social determinants on health. We know about the high cesarean birth rate, but what about perinatal disparities which impact breastfeeding rates as well as birth outcomes.

Social determinants of health is defined as factors such as income, education, occupation, employment, housing, child care, family structure, and neighborhood characteristics, which are thought to have powerful effects on health and yet are beyond the reach of medical care.

If you have not heard of how social determinants impact health, hear the words from the Association for Children of NJ, a non profit, non partisan group that just conducted their annual Kid’s Count data, consider this: ‘A baby born in Newark today will likely be born to a single mother who at best, has only a high school education and is working at a low paying job. Most of her paycheck will go to rent, leaving little left over for food….Her job is not likely to offer health benefits, so she may not receive the early prenatal care that can reduce the risk that her baby will be born premature…”

The data reveals that a disproportionate amount of young children in Newark spend their first years in poverty. Paul Tough’s new book “How Children Succeed” examines how  poverty-related stress can affect brain development, and inhibit the development of non-cognitive skills. He argues that persistence, self-control, curiosity, conscientiousness, grit and self-confidence, are more crucial than sheer brainpower to achieving success and these non cognitive skills are deeply impacted by the prenatal and infant relationships.

It seems that Newark Mayor Cory Booker had read ‘How Children Succeed.’ At the Kids Count data presentation on February 6, 2013,  he spoke of early experiences mattering, singing to 7 month babies and the impact of stress in the prenatal period. He also spoke of the impact of poverty on parenting.

But what he did not speak about, was the value of reducing barriers to promote exclusive breastfeeding as a strategy to improve children’s health. New Jersey has the highest rate of obesity among low income children, ages 2-5 since 2008. As birth professionals, we know the U.S. Surgeon General’s Call to Action documents that breastfeeding is a preventative  behavior that can reduce childhood obesity, asthma and juvinille diabetes, in addition to fostering social and emotional bonds of attachment between that mother and baby. As Newark, NJ has for this moment has a funding commitment to create a Newark Early Childhood Council from the Foundation for Newark’s Future, we must take this moment to share the evidence, science and psychology that links exclusive breastfeeding to health indicators and the multi faceted tools to reduce barriers, especially for women of color and low income mothers.

Alas, too many doulas have never been taught about perinatal disparities in birth outcomes.  It is imperative that all doula training programs have as part of their training a curriculum that examines disparities in birth outcomes and the role of social determinants on health.

Housing & Urban Development has started ‘cradle to college initiatives’ and many school districts across the country are now looking at the birth and perinatal period as formative experiences for the classroom. Doulas and birth professionals are at a pivitol crossroads right now with a myriad of public and private initiatives recognizing that birth and breastfeeding outcomes are more optimal with a trained doula or community peer educator. Yet too many doula training programs do not address the disparities in birth outcomes  nor link healthy birth and breastfeeding to life long children’s health.

I go back to the words of Paul Tough, “The part of the brain most affected by early stress is the prefrontal cortex, which is critical in self-regulatory activities of all kinds, both emotional and cognitive. As a result, children who grow up in stressful environments generally find it harder to concentrate, harder to sit still, harder to rebound from disappointments and harder to follow directions. And that has a direct effect on their performance in school. When you’re overwhelmed by uncontrollable impulses and distracted by negative feelings, it’s hard to learn the alphabet.”

The link between racism, poverty and perinatal outcomes are clear. The link between exclusive breastfeeding and children’s health indicators are clear.  The link of woman to woman support is clear. We can contribute to a more just, healthy and sustainable world by making an impact on birth and breastfeeding.  Imagine if all birth professionals learned about their role in the cradle to college pipeline and their work was put in the context of social determinants. Imagine if all the birth professionals wrote a few sentences to the Foundation for Newark’s Future asking them to fund a sustainable and innovative community based breastfeeding program with measurable goals and outcomes. One woman at a time, I pray a better world; for welcoming centers of integrative care, of respectful births, of indivisible breastfeeding support and the lullabyes for all children. Please read the poem by Ina Hughes– it reminds me of why I pray for all children and why our work in woman to woman support must continue.

Additional resources:
http://kirwaninstitute.osu.edu/research/opportunity-communities/
http://buildingblocksalamedacounty.wordpress.com/2012/10/23/kellogg-foundation-to-fund-best-babies-zone-in-alameda-county/
http://www.cpehn.org/pdfs/Achieving%20Greater%20Health%20-%20Shrimali%206-12.pdf http://www.unnaturalcauses.org/assets/uploads/file/ClosingTheGapBWBirthOutcome.pdf http://www.surgeongeneral.gov/library/calls/breastfeeding/calltoactiontosupportbreastfeeding.pdf

Sample letter you can write to Foundation for Newark’s Future:
http://foundationfornewarksfuture.org/contact/
Dear Foundation for Newark Future, as a childbirth professional, I am so excited for your commitment to improve the early experiences of infants and toddlers in the City of Newark announced at the ACNJ Kids Count Data. As you are finding programs to fund with measurable outcomes,  please consider a community breastfeeding initiative.   NJ has the highest rate of obesity among low income children ages 2-5 since 2008 and that exclusive BF is a health behavior that impacts literally reduces childhood obesity, asthma and juvinile diabetes, in addition to the social and emotional attachment and engagement of mothers and babies.  A community based BF program which has had great success in many other cities could enhance and compliment the health of all families in the city of Newark and work with linakages and collaborations.  I am happy to share resources on evidence based community breastfeeding programs, like the COPE Perinatal/JJ Way Community Lactation program from Orlando, FL or the Health Connect One breastfeeding program from Chicago in addition to social media programs like Best for Babes that focus on reducing barriers to exclusive BF.  I am happy to share my ideas and support for this initiative and would like to set a phone call to share  the science about why BF is linked to improving health outcomes and shaping the early experiences of new families in need.

(your name and number)

Submitted by: Heather Hancock RN RM PhD FRCNA FACM MAPS

I am also a voice from down under who joined the list as a midwife and in March I will be starting private practice as a Perinatal Psychologist – and will still be a midwife.