But there's at least one exception to this national trend, brought up by the advocates I interviewed and by commenters responding to my original piece-Washington State. In fact, thanks to a history of expansive access to midwifery care and a number of big legislative gains, low-income women in Washington State now have more birthing options than most women around the country.
According to Audrey Levine, President of the Midwives Association of Washington State (MAWS), 2.3% of births statewide in 2007 were performed out-of-hospital. While still a low percentage, that's more than twice the national average of 1%. What is even more impressive is the number of those births that are reimbursed by Medicaid. According to Levine, around 45% of out-of-hospital births attended by midwives in the state are Medicaid births. That mirrors the percentage of births to women on Medicaid overall in the state-also around 46-47%. (Of the 26 states that license CPMs, only 9 allow CPMs to participate in Medicaid, so this percentage is a significant departure from the situation nationally.)
Washington State has long been at the forefront of the midwifery movement, which helps explain some of the huge leaps forward they've made in access to midwifery care. In the early 1970s, Seattle Midwifery School co-founder Suzy Myers was already practicing midwifery in Washington. She and a group of midwives were training by apprenticeship and getting clients by word of mouth in conjunction with a feminist health center in Seattle. This was not uncommon around the US, and there is a history of midwives practicing in similar fashion, quietly and under the radar. The legal status of their practices has been debated in the courts, with the overall conclusion that unless a state has a specific law on the books licensing midwives, midwives are practicing advanced nursing without a license. In the 1970s, however, this was unclear to many midwives and advocates, a number of whom believed that since midwives were not mentioned in the law in many states, they could practice as they saw fit. Some also chose to practice regardless of their legal status.
In the mid-70s, Myers and her cohort of midwives were approached by the Department of Licensing (DOL, now the Department of Health) about their practice. "We were asked to explain our illegal midwifery practice. We went to that meeting with the director of DOL and a representative of the Attorney General," Myers remembers. "We were expecting to be reprimanded and what we found instead was Roz Woodhouse, the only African American woman to be appointed a cabinet position in Washington State. The first thing she said was ‘How can I help you?'"
From that meeting, the midwives learned that there was already a law on the books in Washington that would allow them to practice midwifery with a license - all they needed was a degree from an accredited school in good standing. The law dated back to 1918, and according to Myers, was probably written to accommodate foreign-trained midwives coming to work in Japanese immigrant communities in the state.
So began the Seattle Midwifery School (SMS), co-founded by Myers and Marge Mansfield, which just celebrated its thirtieth anniversary last year. SMS trains direct-entry midwives who can practice in a number of states, depending on the licensing there. Direct-entry midwives are not nurses (the other main path to practicing midwifery in the US is as a Certified Nurse Midwife-CNM) and instead train in independent schools that develop their own curricula which are accredited by a national accrediting body, through the Midwifery Accreditation Advisory Council.
The founding of the school provided a mechanism for licensing midwives with the state. Licensing is an important step, because not only does licensure often legalize midwives' practice, it also opens up the possibility of inclusion in insurance coverage. According to Myers, Medicaid coverage had technically always been an option for midwives, but was blocked by the qualification that the birth had to take place in a licensed facility. By the 1990s legislation was passed providing that all births in Washington state, regardless of location or provider, could be covered by all insurance policies based in the state, including Medicaid.
What doesn't seem to be so different in Washington State are the demographics of the women having out-of-hospital births. Michelle Sarju, the first African-American midwife to graduate from the Seattle Midwifery School and Clinical Director at Open Arms Perinatal Services, explained that women of color are still only a small portion of her clients. "The majority of my Medicaid clients were white women who were educated. [Out-of-hospital birth] is accessible-the question is do women know about it."
Other advocates in the state readily admit this shortcoming, and point to a lack of diversity among midwives as a part of the problem. Myers, the current Midwifery Education Chair at SMS, addresses this through her work in midwifery education: "I'm trying to do everything I can to make midwifery education accessible to women from underserved communities. The best thing is to make our midwifery profession reflect the women. It doesn't right now. We don't have enough women of color in the profession."
According to Sarju, some of the same social barriers that were mentioned by midwives and doulas in my original article hold true in Washington as well. "Women of color don't know about midwives," she reiterated. "And what they do know doesn't lead them to make that decision." Sheila Capestany, a doula and home birth mom explained, "There are some cultural beliefs about home birth, [and] hospital care is equated with the gold standard of care." Despite the fact that out-of-hospital birth is more common, there are still knowledge gaps in particular communities about birth options. "There is a lot of misinformation about midwifery care," Capestany emphasized. "I had my babies out of hospital - a lot of people asked me if it was legal." The potential for this to change, however, seems ripe, as shown by Sarju's experience with the newer immigrant communities. One of her clients, a Somali woman, recently discovered that home birth was an option in Washington. "Now that she is choosing an out of hospital birth, it's spreading like wildfire," Sarju explained.
The best news for advocates of the midwifery model of care is the recent data coming from Washington State about the cost benefits of out-of-hospital birth. According to the Midwives Association of Washington State, "Washington Department of Health cost benefit analysis showed that licensed midwifery care saves the state $3.1 million per biennium in cost-offsets to Medicaid when low-risk women give birth with licensed midwives instead of in the hospital." This is probably the most compelling argument for promoting licensed midwifery practice and inclusion of LMs in public and private insurance policies. Legislators are beginning to hear this message as well, and not just in Washington State. Three weeks ago, Idaho became the 26th state to pass legislation licensing Certified Professional Midwives, and other states are considering similar legislation. The proof, however, is in the budget negotiations from this past session. Levine explained, "When we went to the legislature this year, and even though so many services are being cut, we hung on because licensed midwifery is a bargain." In a climate where cost-cutting is a top health care reform priority, this may prove the right moment for expansion of midwifery care nationwide.
]]>Join us on Thursday, May 14th at 9am Eastern/12 noon Pacific for Making "My Birth, My Choice" A Reality For All Women - a livechat with Miriam Perez and JayVon Muhammad, certified professional midwife. Join in on a fascinating, in depth discussion about the reality of access to homebirth in the United States for all women! Ask your questions about or share your experiences with out-of-hospital birthing, midwifery and doula services for all women regardless of income level. Visit the site on Thursday, May 14th at 9am Eastern and join the conversation!
One
mother laboring with her midwife on the roof of her Cobble Hill penthouse,
gorgeous Manhattan skyline in the background. Another holding her newborn
on her living room couch, exposed brick and high ceilings behind her.
These are just two of the scenes from the November New York Times article and slideshow about the growing interest among New York
City women in birthing at home. These images paint a very specific picture
of homebirth--all the women were pictured in spacious, nicely decorated
apartments and, with the exception of one African-American woman, all
were white. Watch the popular Ricki Lake documentary The Business of
Being Born, released
last year, and you get a similar story: Lake and her interviewees
were all financially well off and could afford to choose to birth at
home. Neither the Times article nor Lake's film touched on one
thing that all these women seemed to have in common--money.
Despite The Business of Being
Born's relative
popularity, the film only reaches and speaks to a limited audience.
"The Business of Being Born is fabulous, but low-income women
are not seeing it," says JayVon Muhammad, an African American Certified
Professional Midwife (CPM) in Sacramento "The midwives that
are promoting it don't typically have low-income women in their client
base...[Even when low income women see the film, they] don't see women
that look like them, economically and ethnically, they can't see themselves.
They think that only ‘those' women do that."
Upwardly-mobile
moms in New York City may finally be catching on to the benefits of midwifery
and homebirth, but low-income women are still firmly planted in the
hospital most often with medicalized births overseen by doctors. Current
efforts to transform birth - offering women more options and preserving
their decision-making - are not reaching low-income women. Birth activism
draws attention to the ubiquitous media portrayal of highly interventionist
births, the normalization of c-sections, and the lack of choice afforded to women by their doctors, whose hands, in turn, are tied by hospital
policy and malpractice fears. The criticisms made by birth activists
are accurate yet incomplete. Missing from these conversations is how
low-income women - who suffer the worst outcomes for their babies,
including lower
birth weights and higher infant mortality rates
- are making decisions about where and how to give birth.
The maternity reform movement's frame of consumer choice (exemplified by the name of one of the primary advocacy organizations, Choices in Childbirth) may be at least partially to blame. This frame neglects the reality that many women can't make a choice at all. "I work in a (very) low-income Medicaid clinic in Sacramento, and the women all have Medicaid or Family Pact as insurance," Muhammad explains. "Medicaid doesn't cover homebirth, so even if women choose to have homebirth, they are not covered, leaving no choice at all. As a result, when women show an interest, and very few do, they don't have a choice. They are forced (due to lack of money, and insurance) to deliver in the hospital."
There are a number of barriers to low-income women giving birth out of hospital. As Muhammad highlighted, Medicaid is the first. Medicaid and other state health insurance programs generally do not cover out-of-hospital births. According to Steff Hedenkamp, Communications Coordinator at The Big Push for Midwives, only in nine states can CPMs (who account for the majority of homebirth practitioners) register as Medicaid providers. Even in those states, very few CPMs go through the process because of bureaucratic red tape. Yet even if a woman has private insurance, she often faces similar barriers when trying to choose out-of-hospital birth. The estimated $4000 that a homebirth costs without insurance coverage might not be an impossible hurdle to cross for a middle class family, but is a near impossibility for low-income women.
Medicaid
policy may be the most significant logistical barrier, but it isn't
the only one standing in the way of low-income women delivering outside
the hospital. Doulas and midwives who work in low-income communities
of color see the barriers as being social in addition to financial. Muhammad explains: "In low-income black communities, which I am a product
of, we don't learn about natural birth, or birthing choices."
Claudia Booker, an African American doula in Washington, DC, agrees. She explains that women in low-income communities of color stopped giving birth outside of hospitals at least three generations ago. There is also a sense, she noted, that giving birth at home is "what poor people do and [that homebirth] was something we did because we had no option." This history reflects a larger transition among US women giving birth at home to hospital birth, which happened in the 1920s. Low-income communities, and particularly African American ones, took longer to make this transition because of poverty, racism and lack of access to hospitals. Now the paradigm has shifted and hospitals are where low-income people get most of their health care.
Another barrier to home birth for low-income women is concern over birth certificates for their babies. In recent years, particularly since 9/11, obtaining passports and other citizenship documentation has become increasingly difficult. The crackdown has focused on people born to midwives at home. Immigration authorities have begun questioning the validity of documents from these midwives and holding those individuals to a much higher burden of proof. This has had a disproportionate impact on Latinos and other immigrants, requiring them to go to great lengths to obtain passports and other documentation. Claudia Booker thinks this fear of citizenship being questioned may keep low-income people from leaving the hospital to give birth.
The media depictions of home birth moms are not far off from the demographics of those at the helm of the maternity reform movement. This small collection of organizations and individuals, primarily made up of midwives, doulas and mothers, is predominantly white and middle class. Steff Hedenkamp from the Big Push for Midwives readily admits these shortcomings. "You could say we're not doing enough to reach out and engage with lower income women, and it's probably true. We're not doing enough on every level." It's difficult to say whether it's merely a demographic issue, or reflective of something larger, but it's clear that the demands of the maternity reform movement are not promoting the needs of low-income women. Even if the Medicaid barrier were to be eliminated, the education provided by films like The Business of Being Born need to be geared specifically toward low-income women or they aren't going to leave the hospitals anytime soon. "My clients don't know a thing about homebirth, nor do they understand why they would even consider such a thing," explains Muhammad. "They are not educated about the benefits of birthing out of the hospital or birthing without interventions. Many of them think the elective c-sections are okay, and can't wait to schedule theirs, as they have friends that have."
One thing that all these advocates can agree on is that the current health care crisis may provide an opportunity for real maternity reform. During such shaky economic times for the health care industry, cost cutting is a definite priority. Steff thinks birth might be the perfect target for savings, as midwives cost less than obstetricians, and vaginal birth less than a c-section. "If anyone is doing real healthcare reform, they have to look at the cost of maternity care. A thirty-percent c-section rate and rising? It's not sustainable. No way." These reforms may have a chance of reaching low-income women, particularly if lower cost birth options, like midwives, homebirth and birthing centers become part of a universal health care package.
Muhammad put it plainly: "If Medicaid doesn't start covering homebirth, any positive changes toward homebirth will not benefit poor women. They will have to choose between homebirth and food, and food will win every time."
]]>When the media covers the rising rate of c-section, it's often ready to lay the blame at the feet of a woman we're come to know well over the last few years -- the busy career mom scheduling her delivery between important business deals, penciling in labor and delivery the way she pencils in a client meeting. As criticism of surgical birth mounts, the idea that mother-initiated c-sections are spurring an overall increase in the practice has only become more popular.
In mid-April (coincidentally also Cesarean Awareness Month), Time Magazine claimed that Choosy Mothers Choose Cesareans. Euna Chung, a child psychiatrist in Los Angeles, told Alice Park that she planned her c-section before she was even pregnant. Park wrote of Chung, "a combination of having watched traumatic vaginal deliveries in medical school and hearing about her mother's difficult emergency caesarean experience after trying to deliver vaginally helped make up her mind." Chung told Time, "I had a fear of going through labor and ending up with an emergency C-section anyway. I know that's rare, but I didn't want to deal with it." A recent Today show segment picked up on this supposed phenomenon, referring to the trend as "babies on demand." Dr. Judith Reichman, the expert obstetrician on the show reported National Institutes of Health Statistics that approximately 2% of all c-sections nationwide can be considered "cesarean deliveries on maternal request."
While the media likes to use these stories of maternal demand as attention-grabbing hooks for their reporting on the rise in c-section rates, other birth advocates and birthing rights organizations take issue with the "mother's choice" frame. Our Bodies Ourselves' recently released book "Pregnancy and Birth" explains that the studies which produce data like what Dr. Reichman referenced is flawed and not at all conclusive:
Although some studies describe an increase in caesareans without any medical indication, the authors of these studies are clear that these may not represent real ‘maternal request.' The studies, based on birth certificates or hospital billing records, have no way of documenting whether the caesarean was initially sought by the mother, whether it was based on physician advice or pressure, or whether there was simply poor record keeping.
These advocates argue that while there invariably are some women who are choosing casareans without medical reasons, they do not represent a significant enough percentage to account for huge increase in c-sections in the last decade. In other words, some moms may be requesting surgical birth, but that has little to do with the overall increase in c-section rates. Childbirth Connection's most recent survey Listening to Mothers survey reports that just one woman in 1600 actually reported having a first c-section because she chose and planned it ahead of time without any medical reason - a rate far lower than the 2% suggested by Dr. Reichman on the Today Show.
Does it do any harm when the media, doctors and others point to mother's choice as the reason behind higher c-section rates? These advocates argue that it takes away attention from the how decisions related to pregnancy and childbirth are really made: often, under intense pressure from the woman's physician. Childbirth Connection explains, "There is a change in practice standards that reflects an increasing willingness on the part of professionals to follow the cesarean path under all conditions. In fact, one quarter of the Listening to Mothers survey participants who had cesareans reported that they had experienced pressure from a health professional to have a cesarean." Even if women are reporting a choice for cesarean, Childbirth Connection and others argue that women aren't making decisions about their mode of delivery in a vacuum; rather, they are deeply impacted by the opinions and guidance of their providers. Lamaze International explains, "What women hear from obstetricians powerfully influences what they think. Some obstetricians think so little of the risks, pain, and recovery of cesarean surgery that they feel that ‘convenience,' ‘certainty of delivering practitioner,' and ‘[labor] pain' justify performing this major operation on healthy women." When physicians talk up convenience and don't give air time to possible complications resulting from c-section, it's no wonder women make decisions in the same terms.
What makes these advocates the angriest, though, is the implication that doctors who support a woman's right to elect a c-section do so because they believe in supporting all of women's choices around how they want to give birth. Quite the opposite, says Lamaze International:
]]>Obstetricians champion a woman's right to choose elective surgery on grounds of ‘patient autonomy' but deny her right to refuse one. Access to vaginal birth after cesarean (VBAC) has declined precipitously in recent years and is currently unobtainable in whole regions of the United States...Until such time as obstetricians support a woman's right to refuse as well as choose surgery, the promotion of ‘maternal request' cesarean must be viewed with extreme suspicion.
For some women, the need for emotional support during pregnancy termination is high. Erin explained, "Even though I was very clear in my heart and mind that the abortion was exactly the right thing to do for me at that point in my life, it was nonetheless a very frightening experience. The medical staff at the hospital were not kind to me and there was no discussion about what was happening to my body, it was just a procedure that they were doing to me as coldly and clinically as possible." As the number of providers decreases (it has dropped 37% since 1982) and the number of women having abortions continues to go up, clinics and abortion providers are overextended and under-resourced. Not only are many providers not well equipped to provide adequate support, but the procedure itself can also be a painful one, during which many women are fully or at least partially conscious. Raquel Valentin, Practice Manager for the Family Planning Division at Beth Israel Hospital explained, "Many first trimester abortions are being done with local and moderate sedation. This means that the women are still awake and emotional." The decision to use moderate sedation is based on both the women's choices and the higher risks associated with full anesthesia but can result in an experience that can be both frightening and, at times, painful.
In at least one abortion provider setting, a group of women is looking to provide additional support to women during pregnancy termination. The Birth Sisters, an existing doula program at Boston Medical Center (BMC), is in the process of adding abortion to their already comprehensive list of support services offered. The program, fully funded by the hospital, provides women with support from the early stages of their pregnancy through the postpartum period, often from doulas who can provide culturally competent services to the burgeoning Latino immigrant population served by the Medical Center.
Within the Birth Sisters program, the doulas have developed specialties, which are accompanied by further training in a particular area. Some of the Birth Sisters have specialties in domestic violence, others in breastfeeding. In an effort to meet the needs of women having abortions, the program is looking to expand the program to include compañeras, doulas who would provide this abortion support. The idea is currently in the research stages, and the members of the program have developed a needs assessment that will provide data on what kind of support women who are terminating their pregnancies at BMC need. They plan on having the compañeras meet with the women before the abortion, accompany them during the procedure and then meet with them at periodic increments afterwards as well (two weeks, two months, four months, etc). This mimics the role of a birth doula, who frequently meets with women before and after the birth, and goes beyond the support that most abortion providers currently offer. Dr. Nilda Moreno, an OB/GYN and member of the Birth Sisters program, explained, "We don't only want to provide emotional support but also contraceptive support. We want them to have all the information to prevent unintended pregnancies." Dr. Moreno also explained that the training will be similar to what counselors at Planned Parenthood receive, but with a special focus on emotional support. In addition, they also plan on providing support to women having medication abortions, who usually go home and pass the pregnancy on their own.
The idea of providing a support person to women during pregnancy termination is not a new one. Planned Parenthoods, other abortion clinics and feminist health centers have a history of trying to provide support to women having abortions, in the form of options counseling and also with accompaniment during the procedure. Other abortion settings provide similar support in the form of specially trained counselors, or patient advocates. When these programs are already providing models for supporting women during abortion procedures, why doulas?
Erin explained why she would have wanted a doula at her abortion: "I feel that a doula would have helped me understand what was happening to my newly pregnant body, the process of the abortion, and the after care for my body." Doulas employ a variety of techniques with women in labor, some that help prepare her mentally for the labor, others that mediate pain, and others that focus on relaxation. Many of these techniques could have useful applications in the support of women during pregnancy terminations, as Erin describes. Explaining how the abortion procedure works is similar to visualization used by doulas during labor, when the doula helps the woman to visualize the baby moving down into the birth canal with the strength of each contraction. These visualizations can help the woman better cope with the pain of labor by enhancing her understanding of the purpose and cause of the pain she is feeling. In addition, pain mediation techniques, like massage, acupressure and breathing could all be helpful for some women during these abortion procedures.
Central to the concept of doula care for abortions is the follow up component. This is where most clinics and providers are unable to provide the longer-term support that a doula could. "I would also have welcomed their support in confirming that my body would, in the future, be ready and able to make a baby and that I would be a good mother when the time was right," Erin says. An important component of birth doula work, this follow-up allows the doula to check in with the woman throughout the months following her abortion, when additional concerns and issues may arise.
Susan Yanow, supporter of the Birth Sisters project and former director of the Abortion Access Project, explained that she sees abortion care as just another service that doulas can provide, in addition to the other areas where they already provide support. "I don't want to carve out abortion in any way that minimizes or maximizes it," she explained. Instead of implying that women who have abortions need a lot of support, this is simply another opportunity to help women within the broader context of doula care. To her it's important that women do not feel that abortion is being stigmatized and that women are not being sent the message that they need support during their abortion. "For some women," Susan reminded me, "all they feel after their abortion is relief."
"The reasons a woman decides to have an abortion are complicated, and her feelings are really complicated. We need to take care of all of it." Susan explained that what she doesn't want to do is send the message that all women need support; and she worries that it will simply add to the stigma that women already feel around abortion. Some women have social networks, family members and friend who will be there for her; some don't need any special attention at all. But for the women who do need it, Susan agrees that it should be available to them. At the Birth Sisters program, a large majority of the women they serve are immigrants from Latin America, many of who are terminating pregnancies that they acquired while crossing the US-Mexico border. These pregnancies can be a result of rapes that are not an uncommon occurrence for immigrants who come into the United States without documents.
For many in the midwifery and doula community, the idea of a doula offering her services to a woman terminating a pregnancy is controversial. Abortion is a topic that is rarely breached at midwifery and doula meetings and conferences, and in many ways has become the elephant in the room of the birthing rights movement. The reasons for this are varied, from a strong religious contingent within doula and midwifery communities to women who feel strongly that they are working on behalf of mothers and babies. A thread in reaction to an article I wrote for Campus Progress about being a radical doula on the site Alldoulas.com provoked an interesting discussion about this issue. One poster explained, "I am an advocate for moms and babies. Aborting babies is totally opposite from that in my view. As much as I believe in a mothers right to choose how she will give birth, I also strongly believe in the baby's right to live. When I was new in this doula work, I started out assuming that most in the childbirth field would naturally be pro-life. It was very hard for me to comprehend how doulas and midwives could be pro-abortion."
One woman and advocate who is working to force abortion advocates and birth activists to dialogue with one another is Lynn Paltrow. Executive Director of the National Advocates for Pregnant Women (NAPW), Lynn has been advocating on behalf of pregnant women for most of her career. Last Spring, Lynn and NAPW hosted the Summit for Health and Humanity of Pregnant and Birthing Women in Atlanta, Georgia. What transpired was a gathering of abortion advocates, reproductive rights activists, midwives, doulas and birthing rights academics. Not everyone in the room was in support of abortion. Not everyone in the room understood the benefits of natural childbirth. Lynn explained in her article on TomPaine.com, "Participants moved beyond the divisive abortion debate to find common ground in the experiences of pregnancy and the increasing limitations to care and support that all pregnant and birthing women face." The Birth Sister's Compañera project, along with two other similar abortion doula projects (one in New York City and another in Washington State) arose from conversations that began at the summit.
In the last few years, we have seen the abortion climate in the United States become increasingly hostile. The current administration, including its newly appointed Supreme Court, seems adamant about limiting women's access to abortion procedures. Medical students aren't being trained to do the procedure, yet the need for abortion services remains steady. Some women make the decision to have an abortion within a supportive and loving environment, and they are able to cope well with the emotions that can come along with terminating a pregnancy. But other women make the decision alone, or without the support of a partner or families. It's these women who will benefit the most from having a doula at her side-someone who has no investment in her pregnancy, and simply wants to hold her hand, distract her, make her laugh or explain the procedure to her. But it's also about more than just helping a woman survive that one procedure, it's also about trying to mediate the impact it has on the rest of her reproductive life. "I had a hard first labor," Erin recounted. "I wonder if I had trouble connecting to my birthing body as a result of the abortion experience. Once I worked with a doula for the birth of my two very much wanted and planned children, I could imagine what it would have been like to have a doula at the abortion."
]]>Lisa, a first time mother, touchingly recounts her story to a stand-alone camera, her image projected onto the wall behind the stage. The other seven cast members sit in two rows of chairs facing one another, alternately playing the roles of support people, mothers, nurses and obstetricians. Lisa's story is one of eight told in Birth, a play by Karen Brody, written in the style of the Vagina Monologues and based on her experiences interviewing women across the United States about their birth stories. The play is being performed around the world this month (from small towns in Arizona to as far away as Uganda) in honor of Labor Day and the BOLD (Birth On Labor Day) campaign. BOLD's mission is to use theatre as a vehicle for social change, and is part of "a global movement to make maternity care mother friendly."
The run in New York City includes three performances in the month of September and will raise funds for the Friends of the Birth Center, a group trying to open a Birthing Center in Manhattan since the close of the Elizabeth Seton Childbearing Center in 2003. Heidi Miami Marshall, director of the New York performance, recruited doulas to attend each rehearsal in the final week, to insure that an "expert" could give the actresses feedback. They asked questions about noises (have you ever heard a woman wahoo?), signs of nervousness in a birthing mother, and more complex questions about the political context of birth. The play touches on the many facets of maternity care in the United States today, from elective cesarean sections to home births and everything in between. Its conversational tone invites you in to experience each woman's story and feel the pain, joy, excitement and fear along with her as she deals with the cacophony of emotions surrounding childbirth and pregnancy.
At the opening New York performance at a small sold-out theatre in the West Village, the pre-play audience chatter was not your typical theatre conversation. In an audience with a higher than usual proportion of midwives, doulas and childbirth educators, the conversations instead tuned in on relevant issues like hospitals, inductions, epidurals and birth stories. As the play began, a black screen on the stage posed the question, "Do you know your birth story?" The actresses launch into their stories, through which the play made an obvious attempt not to make any woman's choice,(even an elective cesarean section), seem wrong. Instead each woman grapples with the consequences of her decision, her struggle to get what she wanted from her birth and how these decisions were affected by the people around her.
In a panel following the play, audience members hit on the difficult issues at hand-how do you know when to trust a woman's intuition and when to trust her medical provider? What about low-income women and immigrants, whose voices were absent from the play? What is a normal birth anyway? Each performance this month is followed by a Talk Back-a way for the audience to engage with the issues brought up by the play and it provides a forum for members of the local birth community.
Karen Brody's innovative play will continue to open up the dialogue about women's birthing environments, in the United States and abroad, encouraging women to process their own experiences and share their stories. As the author herself explains on the BOLD website, "One woman dies every minute throughout the world from a pregnancy or childbirth-related cause. As a writer I wondered, why are we not telling this story? And as an activist I wondered, how can we tell this story in a way that will make a difference, that will shift the model of maternity care for women to the mother's needs?"
]]>As a queer Latina working for an abortion rights organization, I can attest to that fact that Kirchick is wrong—and the only thing divisive about LGBT groups and reproductive rights advocacy is the insistence on keeping them apart. Kirchick implies that abortion should not be a concern of LGBT organizations because "'Oops babies' are simply not a phenomenon common to gay life." The ignorance behind this statement is vast, but to sum up a few of the things this author neglects:
LGBT people come to the community from a diversity of backgrounds including, for many, significant time spent in the closet, and very often partnering with folks of the opposite sex. Sexual assault and rape are unfortunately still a reality, both for heterosexual women and queer women. Kirchick is also obviously leaving out the "B" and "T" in his discussion, because bisexual and transgender members of our community are by no means excluded from the possibilities of pregnancy.
Regardless of all of these exceptions to the crux of his argument—that abortion is not an issue that affects the LGBT community—the most important evidence that I have to the contrary are the activists that I work with. At the National Latina Institute for Reproductive Health, we bring together groups of like-minded Latina/os with a passion for reproductive justice through our Latinas Organizing for Leadership and Advocacy trainings. A large number of these men and women identify with queer communities, and this isn't a coincidence. Even though our work does not focus explicitly on LGBT issues, these activists see the connections clearly and resonantly enough to devote a significant portion of their time to reproductive justice activism and advocacy.
As a member of the steering committee of Causes in Common, a coalition that works to make the connection between LGBT and reproductive justice movements and build cross-movement collaboration, I see how these connections can be fostered and put to good use. People of color, particularly women of color, are familiar with the tensions that arise when one segment of an oppressed group's interests are seen to be at odds with the agenda of the group as a whole. In the past, women of color have been at odds over feminist struggles within their national and ethnic movements. The lesson learned from this history? Solidarity is the only thing that can really bring about widespread change.
Reproductive justice is not just about one's ability to reproduce. It's about autonomy, its about respect, its about shared principles based in the human right to health and a desire for real social change. If members of the LGBT community can't understand this, how can we expect to find allies in other movements? This isn't about feminists versus abortion advocates versus queer people; this is about building a movement within which we can all find a space. The other side has mastered this. It only takes a quick look at the common denominator between anti-choice and anti-gay legislators and activists to see it. They are one in the same. We need to be as well.
]]>