In Your Voice

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.

Submitted by: Hermine Hayes-Klein

The United Nations has devoted this year’s Human Rights Day to “the rights of all people…to make their voices heard in public life and be included in political decision-making.”  What better time to acknowledge the global movement raising its voice for human rights in childbirth. As cesarean rates skyrocket around the world, and women exchange stories  of coercion and force in obstetric care, it should come as no surprise that people are organizing to demand change.

What are human rights in childbirth? Every health care system in the world faces the same essential questions. Who decides how a baby is born? Who chooses where a birth takes place? Who bears the ultimate responsibility for a birth and its outcome? What are the legal rights of birthing women? What are the responsibilities of doctors, midwives and other caregivers in childbirth? What are the rights and interests of the unborn, and who has the authority to make decisions on its behalf?

In 2010, Hungarian mother Anna Ternovszky took these questions to the European Court of Human Rights.  After the healthy, safe, and empowering birth of her firstborn, at home, with the midwife Agnes Gereb, Anna objected to the fact that her ability to hire Agnes a second time was affected by the threat of legal sanction against Agnes for attending her at home.  In the decision of Ternovszky v. Hungary, the Court held that birthing women have a fundamental human right to choose the circumstances in which they give birth. The foundations for this right include the rights to privacy, to autonomy, to control over our own bodies, and the right to make decisions for our children even as we are giving birth to them. Ternovszky is only binding on European nations, but this fundamental human right applies to all women everywhere. As a birthing woman, you have the right to meaningful choice and genuine support for your personal needs around and during childbirth, whether those needs are for planned cesarean section or undisturbed home birth with reliable medical backup.

As a birthing woman, nobody can tell you that you “must” do anything. Nobody can “let you” or “not let you” do anything. Nobody can pressure or force you into a cesarean section that you do not believe is in the interest of yourself and your baby. Nobody can cut an episiotomy if you do not consent to one. Nobody can do anything to your body or your baby without discussing it with you first and asking for your consent. You have the right to be the ultimate authority over everything that occurs around your body’s birth of your baby.

These are the fundamental human rights of the birthing woman. And yet, these rights are so commonly violated, that most women are not even aware that they have them. In both the developed and the developing world, women are too often treated with disrespect and abuse, including subjection to unnecessary, damaging, and costly surgical interventions. They are told what will happen to them, or not even asked. As women raise awareness of problems in birth care common to most modern obstetric systems, they are realizing that many of these problems could be addressed by acknowledgment of the woman’s right to make the decisions of childbirth, of her ultimate authority over the birth process.

Many disagree that pregnant women retain the fundamental human rights applicable to healthcare. In only the last month, vocal proponents of medical birth called the claim that birthing women have a human right to autonomy “unethical” and “morally grotesque.” What I find unethical and morally grotesque is the assertion that a doctor, making decisions about a patient , has more authority over an unborn baby than the woman who has grown it out of her own flesh and blood.  Especially a doctor with a 35% cesarean section rate.

In the article linked above on moral grotesquerie, media darling “Dr. Amy” revealed her opinion that physiological birth, undisturbed maternal-newborn bonding, and the right to avoid unnecessary abdominal surgery have a value equal to manicures. I disagree, and I am not alone. Women are ready to stand up for the simple right to respectful support in childbirth. Dr. Amy claims that the right to autonomy in childbirth is a wealthy, western white woman’s concern, and she will not be the last to say so. Every woman’s movement has met this charge: “There are women dying in poverty, women who can’t feed their children, and you spoiled bitches dare to make a fuss about the right to own property/ right to vote/ right to education/ right to equal work and equal pay? You obviously have too much time on your hands.” It is true that one cannot fight for more than survival, when survival is in question. But that doesn’t mean that women have a right to survival alone. As nations challenge their birth care systems to meet Millennium Development Goal 5, they can do so in a way that replicates the institutional human rights violations of Western obstetrics, or they can evolve birth care to respect the fundamental human rights of the women they aim to assist. Ask women in the developing world if they are unconcerned with disrespect and abuse in childbirth.

The idea that the doctor, and not the woman, holds authority over decision-making in childbirth is so entrenched that it will take a paradigm change to put the woman back at the center of birth care.  The momentum is building, around the world, capable of generating this transformation.  The hundreds of people energized by the 2012 Human Rights in Childbirth (HRiC) Conference  in The Hague became tens of thousands of people inspired by the 1000 global screenings of Freedom for Birth on September 20^th.  In the next week, the circle of activists will expand with the release of a 15-minute free version of Freedom for Birth and the launch of new functionalities on the HRiC website that will help people from around the world to find and join the organizations working to improve birth where they live.

If you believe Martin Luther King, Jr.  that the “arc of the moral universe is long, but it bends toward justice,” then there is reason to hope that the fundamental human right to autonomy and authority in childbirth will be recognized. But the only way this will happen will be if birthing women demand their rights. As Anna Ternovszky, the plaintiff who asked justice of the ECHR, said in Freedom for Birth, “Now is the time to let our voices be heard.”

Hermine Hayes-Klein was the organizer of the Human Rights in Childbirth Conference in the Hague on May 31-June 1st of this year.

_{About the obirth blog: The Orgasmic Birth weblog shares the opinions of Orgasmic Birth, Sunken Treasure Publishing and the obirth team as well as weblogs submitted by our readers or guest blogs that may or not be the opinion of Orgasmic Birth. Obirth believes it is time to be BOLD in sharing our thoughts and perspectives, to challenge others to think in new ways and whether we agree or disagree, hopes to have a discussion where we can look at childbirth in new and old ways.  “These are the best of times and the worst of times.”  Opportunity is here to transform maternity care practices and it will take a village. We appreciate your voice and thoughts, along with resources when possible so that together we can contribute to a larger discussion where women, men and communities are empowered to Take Back their Birth!}