According to this press release by the ACLU, the Florida District Court of Appeals ruled in favor of Samantha Burton, and in favor of the “right of pregnant women to make their own medical choices.”

Or did it?

As a reminder for those of us who aren’t courtwatchers, here’s the recap: In March of last year, Samantha Burton, a mother of two experiencing a complicated pregnancy,* was told by her doctor that she should go on bed rest. When she told her doctor that she could not or would not go on bed rest for the remaining 15+ weeks of her pregnancy, she was slapped with a court order by the Circuit Court of Leon County. The order stated that, in order to effectuate the best interest of the child, Ms. Burton had to report to Tallahassee Memorial Hospital for bed rest and any other treatment deemed necessary (including cesarean section). After several days, with Ms. Burton still under court order, a stillborn baby was delivered by cesarean section.

The exact blow-by-blow is unclear, but from the dissenting opinions it appears that Ms. Burton had no lawyer during any hearing that might have taken place prior to her surgery. In August of 2009, the ACLU of Florida filed an amicus brief (PDF) in state court on Ms. Burton’s behalf. The brief argued, among other things, that the lower court had improperly applied the “best interest of the child” standard, which is reserved for juvenile court situations where there are—you know—actual children at issue (as opposed to fetuses). In the decision handed down today (PDF), the court reversed the order, which is great in a posthumous victory sort of way. But watch carefully. Says the court:

A patient’s fundamental constitutional right to refuse medical intervention “can only be overcome if the state has a compelling state interest great enough to override this constitutional right.” Thus, the threshold issue in this situation is whether the state established a compelling state interest sufficient to trigger the court’s consideration and balance of that interest against the appellant’s right to refuse to submit to the medical intervention the obstetrician prescribed. The state’s interest in the potentiality of life of an unborn fetus becomes compelling “at the point in time when the fetus becomes viable,” defined as “the time at which the fetus becomes capable of meaningful life outside the womb, albeit with artificial aid.” (citations omitted)

Did you catch that? The court agreed that the “interest of the child” standard was improper, but posits an alternative framework for which the threshold issue is viability, and the court never made a finding of viability of Ms. Burton’s fetus. According to this reasoning, it stands to reason that if the fetus had been viable, they would have moved on to a balancing of the state’s “compelling interest” in the “potentiality” human life with Ms. Burtons’s right to medical autonomy and bodily integrity. If you’re thinking that this is some pretty convoluted language, it’s because it is a quotation. I unfairly hid the ball with my “citations omitted” – this language is cribbed from Roe v. Wade. Confused? You’re not alone.

In fact, while the court plucks the standard for when the state’s interest becomes “compelling” from Roe, the actual holding of the case suggests no such usage. What the actual opinion says is that:

If the State is interested in protecting fetal life after viability, it may go so far as to proscribe abortion during that period, except when it is necessary to preserve the life or health of the mother. (emphasis added)

Nothing about the total confinement, nothing about forced surgery. Now there is a definite possibility that the court could stack the “potentiality of life” against the right to medical refusal and Ms. Burton would emerge victorious, particularly where the court follows with the 1-2 punch of the requirement that the imposition of state power be “narrowly tailored in the least intrusive manner.”** But I have a pretty good hunch that this would not be the case.

Enter Laura Pemberton, who in 1996 was dragged from her home to the very same hospital for a court-ordered cesarean section. When she filed an affirmative federal suit (PDF) for damages for the deprivation of her rights, the court ruled that “Ms. Pemberton’s constitutional rights were not violated” using Roe as its justification. According to the court in Pemberton:

The Court [granting the order] concluded that by the point of viability—roughly the third trimester of pregnancy—the state’s interest in preserving the life of the fetus outweighs the mother’s own constitutional interest in determining whether she will bear a child. The balance tips far more strongly in favor of the state in the case at bar, because here the full-term baby’s birth was imminent, and more importantly, here the mother sought only to avoid a particular procedure for giving birth, not to avoid giving birth altogether. Bearing an unwanted child is surely a greater intrusion on the mother’s constitutional interests than undergoing a caesarean section to deliver a child that the mother affirmatively desires to deliver. (citations omitted)

Translation: if you want that baby, surely you want it by any means necessary. This may indeed be the case, but is that really something that the court should decide?

The court in Burton was not bound to follow Pemberton, but I am not surprised that it went down the same path. The first indication that led me to worry that this might be the case came in footnote 6 of the ACLU amicus brief.

Before I give it to you in its entirety, I should note that before law school, footnotes were so much detritus at the bottom of the page – the flotsam and jetsam of the law that let me turn the pages in my casebook that much quicker. Then I took Constitutional Law with an inscrutable prof who was master of the takedown. Woe betide me, it turns out that most of constitutional jurisprudence as we know it stems from a footnote on a case about evaporated milk. Yeah, footnotes matter. So here’s what the ACLU has to say:

For reasons discussed infra Part III, this is not an otherwise “exceptional” case, and thus is completely distinguishable from Pemberton, in which a federal district court held that a court-ordered cesarean section did not violate the federal Constitution. In that case, the patient was “at full term and actively in labor [for more than a full day]”. “[And i]t was clear that one way or the other, a baby would be born (or stillborn) very soon, certainly within hours.” Indeed, in Pemberton, the court echoed the analysis in In re A.C., cautioning: “Medicine is not an exact science. . . . In anything other than an extraordinary and overwhelming case, the right to decide [on the course of medical treatment] would surely rest with the mother, not with the state.” Based on the unique and exigent facts and “clear and uncontradicted evidence,” it ultimately held that Ms. Pemberton’s case was “thus markedly different” from the situation in In re A.C., and thus extraordinary. However, because the federal court did not consider Ms. Pemberton’s right to refuse medical treatment under the Florida Constitution and because the facts of Ms. Burton’s case do not even begin to approach the facts in Pemberton, that decision does not support, let alone require, a similar determination in this case. (citations omitted)

Instead of giving the court a foothold to reject the idiosyncratic reading of Roe in Pemberton, the ACLU distinguishes Pemberton predominantly on the facts. This leaves open the possibility that if the factual situation were different, Pemberton might “support [or] require a similar determination.” I shudder to think which factor might tip the balance for any particular woman, but my gut tells me that the ringer would most likely be a full-term pregnancy in labor. That is, virtually any women who attempts an “unauthorized” VBAC, any woman who checks herself out of the hospital against medical advice, or any woman who gets the 39-week macrosomia bait-n-switch.

So congratulations to Samantha Burton and to the ACLU. To the rest of us of childbearing years, maybe it’s best to steer clear out of Florida.

*or, as the court puts it, “the appellant had failed to follow the doctor’s instructions and recommendations, rendering her pregnancy ‘high-risk.’” What are the implications of this framing for obese women? What if it’s true that gestational diabetes and preeclampsia are caused by diet and lack of exercise?

**although, let’s be real, when was the last time an OB told a woman in this sort of situation that her baby would probably be just fine if she had that vaginal breech birth? Or is it more like “if you do not lay down on this table for a cesarean right now, you, your baby, and probably your neighbors will die!!!”

Forever 21 recently announced that it will be adding a maternity line, Love 21. Media have jumped on this, claiming that the line is being targeted to states with high teen pregnancy rates. One site asks readers whether they are “offended” by the addition of the new line. Offended? Not any more offended than I am that Old Navy only sells the jeans that fit me online.

The theory is, of course, that by making non-hideous maternity wear, the store is encouraging pregnancy in the segment of its clientele that is Not Yet 21. A number of responses expose the flap as bunk and un-news, mostly circulating around the theme of “I am over 21 and I shop there!” or “that ‘correlation’ is really reaching.” Indeed, there is probably some unknown, unrelated 3rd variable that makes the states with high teen pregnancy rates coincidentally good test markets for the line (like number of malls, age distribution of population, popularity of that style of fashion, etc.). With all the stigma that we heap on teen mothers, the fact that they can only dress in tents and sails is the least of the factors that makes teen motherhood a less-than-compelling option. And anyway, are pregnant teenagers more likely to be shopping at Forever 21, or at less expensive stores like WalMart or Target that already carry “fashion conscious” maternity lines (i.e. not giant t-shirts that say “Bun in the Oven”)? Far more interesting than the clothing line underlying the controversy is the fact that this would be considered even possibly controversial.

This reminds me of a recurring theme in my inbox: the C-Panty. The C-Panty is underwear created specifically for use post-cesarean. I can’t tell you how many times this underwear technology in its million incarnations has been forwarded to me with some sort of “ugh! I can’t believe this exists!” note attached. Honestly, I’m not crazy about the idea of elective cesareans without medical indication either, but if someone had told me that such undergarments existed when I was recovering from my surgery, I would have kissed their feet. Every pair of underwear I owned cut into the incision, and it was a year before the nauseating “hurty-numb” feeling of nerve damage dissipated and I could sit with my jeans buttoned.

Something about both of these controversies similarly rubs me the wrong way. Don’t get me wrong, I wish I could always be wearing elastic-waisted jeans, but can we really say with a straight face that teens are thinking about those wonderful elastic waists on stylish boot cut pants when they’re conceiving their babies? It’s not about incentives, it’s about the idea that clothing that fits = comfort. We’re grudgingly willing to accept that women act in ways we don’t approve of (assuming of course that the C-Panty is about maternal request cesareans–a stretch), but if they have the audacity to be comfortable, we just can’t abide it.

In my mind, this evokes the hair shirt, a garment worn in Biblical times and the Middle Ages to show penance through constant discomfort. Saints and martyrs literally dressed themselves in atonement.

What I want to know is what if there were a line of clothing just for teen mothers, something trendy to make them feel a little less like lepers among their peers. As it stands, many people see parenthood as the punishment for the transgressive act of unwed female sexuality (lest we forget, it’s not the age of motherhood moving back, it’s the age of marriage moving forward).  Are ugly clothing simply the wages of sin, a modern scarlet letter? Is having to throw out all your underwear the punishment for vanity, or how one “proves” that a cesarean was against her wishes? The message seems to be that mass-produced clothing is made for people who are “normal” and therefore creating mass-produced clothing for teen moms and cesarean moms is “normalizing” something we don’t want to be considered normal. Aside from having some weird ableist undertones fundamentally incompatible with the spectrum of human bodies, this seems to be singling out and picking on people who already have enough to deal with.

Food for thought: note the lack of moral panic when American Apparel introduced its maternity line*. Everybody knows that only Olympic gymnasts can fit into their lilliputian fashions – is the difference that Forever 21 has a not-too-parenty age in its name?  Or is it that gold lamé maternity unitards are per se punishment?

*Granted I don’t think this counts as an actual maternity line if the items aren’t specially cut for pregnant bodies. C’mon, people, haven’t there been enough visible celebrity pregnancies for us to be past the whole “just buy it in XXL” strategy?

(h/t Momotics)

Two years ago today, I became a mother … to a blog.

I was sitting at a summer job when the tagline (Liberté. Egalité. Maternité.) popped into my head and would let go, and it suddenly occurred to me that I should start a blog about being a mother in law school, because it’s such a trippy experience that I figured it was worth documenting. I think I settled on “Courtroom Mama” because in my head it was a clever play on “courtroom drama,” and because everything else was taken.

As it turned out, the experience of being a mother in law school is one that is simply not conducive to sitting around and blogging. It suddenly made sense that all the law school blogs by mothers went silent within the first six weeks of starting school: if you have time to blog, there’s probably something else you should be doing. So I didn’t really start to write ’til I was out of school.

It took me a little while to decide what I wanted to write about–in fact, I’m still working that out–but I’m very grateful to have this tiny bit of internet property from which to preach the gospel of feminist mothering and empowered birth.

My goals at this point are simple: (1) get into something of a schedule that keeps me thinking but won’t make me resent blogging, (2) continue to deserve my readership by writing from the heart and the head (and maybe sometimes the hip), (3) pretty up my space a little.

So, if you’re reading this, thanks a lot! Have a cupcake!

Let me be straight up. I’ve never been a fan of Lisa Belkin’s “Mother Lode” blog.  She’s written some pretty tone deaf patriarchy apologia on what she terms the “opt out revolution” (since pretty thoroughly debunked by the Center for Work Life Law (pdf)) and has always more or less struck me as someone striving to be an “Edgy Mommy Blogger.” Remember, “[w]hy don’t women run the world? Maybe it’s because they don’t want to.”? Ho, ho! How very above it all she must be!

So it shouldn’t have come as a surprise when she trotted out the just-won’t-die trope of “childbirth as a sporting event with gold medals.” But in this case, I really just had to say fuck you. No seriously.

Imagine the mock incredulity: “aren’t women past the burdensome fiction that there is an ideal way to give birth?” Well I do declare! Isn’t sexism finished already?! Fiddle-dee-dee. As evidence for the fact that women just aren’t “over” birth already, she perches on a post on Babble by Denise Schipani in which she discusses her lingering pain over the fact that her births didn’t go the way that she had hoped and admitting that she was “scared to death” during her precipitous delivery that unceremoniously ended during the pushing phase.

Way to kick someone while she’s down, Lisa. Shame on you!

Here’s what I find to be a “burdensome fiction”: the idea that just because someone is ambivalent about their birth experience, that means that they think that everyone MUST give birth in a certain way. This is horseshit.

In a comment that I fully expect will never be published, I pointed out that in every other circumstance, the pain and trauma of “what ifs” around life experiences is treated gently. You did everything you could! It all came out okay in the end!

But when it comes to childbirth, wanting anything beyond merely making it out alive is the height of indulgence. Being frightened or disappointed or any of the other million permutations of emotion other than perfect maternal bliss and gratitude? Suck it up, cupcake, this isn’t the Olympics.

Not like cesarean surgery isn’t a SURGERY, an incision of metal into skin and through flesh and fat and organs that then get stitched and stapled together, requiring narcotic pain medication. Not like you’re not awake for it while you’re being cut open. For some reason, to Lisa Belkin, when babies are born their mothers-subjects are temporarily replaced with mother-objects. Everything that happens happens not to her, but to her. On her. Around her.

Tut-tut!, the commenters cry, “Babies, and not the mother’s experience, should be at the center of attention here!” How much more “center of attention” can you get than literally having the mother draped off, a room full of people standing at her splayed cunt or guts waiting to catch a baby. She’s probably lucky if anyone remembers she’s there because, lo!, here comes innocent life. Frankly, I don’t see how one can view the experience of becoming a mother this way without viewing the experience of being a mother in a similar light: Every moment of motherhood is supposed to be about self-denial, eyes firmly on the prize of NOT fucking up and destroying society by having a child who comes out average.

Here’s a bit of nuance that I think will be lost on Belkin: there is an ideal way to give birth, but not a right procedure. The right way is the way that leaves the mother feeling at peace with the birth. If she’s at peace with her elective cesarean or her epidural or her water birth, that is the right way. If she’s left feeling disempowered, scared, unsure, this is the wrong way.

Hell, this doesn’t mean that everything went according to plan. I know lots of mothers who wanted to have an unmedicated vaginal birth, and after pushing for five hours or sudden decels or whatever, ended up having to have a cesarean. From the feelings that most of them shared with me, they were not crazy about having had a cesarean, but were at peace with it because they knew it was how it had to be. But the story that Schipani tells, one of wanting a VBAC but having a labor that progresses unexpectedly—with a doctor who doesn’t really support her—that ends, almost inevitably, in a repeat cesarean section, is the wrong way, and it’s something I wish nobody had to experience. It sounds like she was robbed of the feeling that she did everything that she could, which is another thing entirely to saying that anyone else isn’t doing what she should.

Sometimes I hold out hope that maybe “they” are right, and the Mommy Wars are just a fabrication, and we can all hold hands and run through fields of lilies together (or at least join arm-in-arm as a unified movement of mothers creating a better world for ourselves and our babies). Retrograde trauma-bashing like this makes me realize that it’s probably a pipe dream.

This post was written by Amy Romano for RH Reality Check as part of the “Crisis in the Crib” Blog Carnival.

Courtroom Mama, blogging at The Unnecesarean has issued a long-overdue challenge to the birth advocacy community to take off our “birth blinders” and see the infant mortality crisis in the United States for what it is: one of the most shameful examples of health disparities in our country. Reflecting on Crisis in the Crib, a documentary released last year by The Office of Minority Health, she writes,

I care so much about unnecessary interventions and evidence-based care that it’s tempting to look at our flagging position in rank for maternal and infant health and say, “see! It’s the unnecesareans and the pitocin and the EFM!” But the truth, as the documentary shows, is more complicated…we live in a nation where the legacy of slavery and segregation is a permanent invisible underclass.

She’s right, and the statistics are astounding. One in six black babies are born preterm, and one in 25 are born very preterm (before 32 weeks). According to the March of Dimes,

In 2004, 4.1% of black infants were born very preterm, compared to 1.8% of Hispanic infants, 1.6% of white infants, 2.2% of Native American infants and 1.5% of Asian infants. Very preterm infants face the highest risk for death and serious lifelong disabilities.

The theory that has emerged to explain disparities in preterm birth states that factors such as intergenerational poverty, racism, and social isolation cause chronic stress that triggers changes in women’s immune and vascular systems, making them more vulnerable to having a baby that is born too soon and too small. When the problem runs this deep, is it any wonder that essentially nothing that doctors and midwives do to women – whether it’s medications, bed rest, ultrasounds, or fetal fibronectin tests – has any meaningful impact on preterm birth rates? With no effective tools in their toolbox, maternity care providers work in vain to prevent babies from filling up costly, high-tech neonatal intensive care units, fighting for their lives.

But what if we changed the tools and the toolbox? Maybe prenatal care – totally reimagined, could help women counteract or manage the stress and prevent its devastating physiological, emotional, and behavioral effects.

It turns out it can. CenteringPregnancy is the first innovation in prenatal care in approximately 100 years. This redesign brings women out of the exam room into a group setting where they receive basic prenatal checkups, build community with other women, and gain knowledge and skills in pregnancy, childbirth and parenting. Two healthcare providers facilitate groups of 8-12 women of similar gestational ages. Instead of short visits alone with a provider, CenteringPregnancy has ten 120-minute sessions from about week 14 of pregnancy through one-month postpartum. That is, 20 hours of prenatal care across pregnancy, compared to about 2 hours – at no additional cost.

A large, multi-center randomized controlled trial documented a 33% reduction in preterm birth for women in Centering groups conducted in two public clinics. The benefit was pronounced among African American women, who experienced a 41% reduction in preterm birth (10% vs. 16%). Other outcomes include improvement in breastfeeding rates, satisfaction with care, return for postpartum visits, and pregnancy spacing.

Many of us who come to birth advocacy through positive, empowering experiences, treasure the prenatal care we received. For those of us who had home births, hour-long (or longer) appointments are the norm, and it’s time spent forming meaningful relationships based on mutual trust and shared responsibility with our midwives. My own midwives for my first pregnancy spent time to help me problem-solve and plan so I could improve my nutrition, avoid overexhaustion at work, and prepare for birth and motherhood. They checked in with me often to make sure I had adequate support from my partner, my family, and my community. I could ask questions not just about my back soreness or fatigue, but the big questions like “What do people mean when they say having a baby changes everything?” and “How will I be able to go back to work and still nurse and mother my child the way I want to?” and my midwives shared their wisdom from their own journeys as mothers and from the thousands of families they collectively had cared for before me. I made informed decisions with their guidance, and I entered labor feeling confident in my body, my choices, and my care providers.

THIS is how prenatal care should be. Right? Well, not necessarily. Unless and until there is a major upheaval in healthcare financing and staffing patterns, having this kind of prenatal care is a privilege. And I don’t mean privilege like “I’m so lucky.” I mean privilege in the sense that I can’t have that kind of care unless others are deprived of it.

If everyone woke up tomorrow and realized that they deserved to have every question answered, every fear and concern explored, every test/procedure/diagnosis explained, we would quickly run out of midwives to provide that care. That is, if our solution was to provide one-to-one care on the traditional prenatal schedule. In short, that kind of prenatal care, however great it is, is not scalable to levels that could benefit all women and babies.

The Centering model of prenatal care has been implemented in more than 300 sites throughout the U.S., Canada and other countries and is highly replicable. A hospital or provider practice that decides today to start Centering could be enrolling women in their first groups in just a matter of months. It is appropriate for all prenatal populations – whether teens, military, community health centers, private practices, Indian Health Services and so on. It has also been adapted to provide well-woman and well-baby care throughout the baby’s first year of life, a stark contrast to the traditional fragmented mother-baby care that drops women’s wellbeing out of the picture after the 6 week postpartum visit. (A randomized controlled trial of this adaptation is in progress.)

If the birth advocacy community is serious about making childbearing safe, healthy, transformative, and joyful, and connecting mothers in a network of supporting community, we need to broaden our view of what constitutes optimal care. Yes, there are critical problems with how labor and birth are “managed” in this country, and we need to continue to work on that front. But how can we justify not fighting for the widespread implementation of programs that are proven to avert preterm births and close the gap between blacks and whites?

Thank you, Courtroom Mama, for pushing us all out of our comfort zones a little to talk about the bigger reality about birth in this country. I want to issue a challenge to my fellow birth advocates to look at the models of prenatal care, not just birth care, and rally behind those that are effective and empowering.

Conflict of Interest Disclosure: I do social media consulting for the Centering Healthcare Institute, including administering both their Facebook and Twitter profiles.

I woke up this morning to find this hair-raising headline in my Google Alerts from my nerdily beloved BBC:

Should There Be a Limit on Cesareans? The World Health Organization has dropped its recommendation that fewer births be carried out by Caesarean section, saying there was no evidence for a limit.

HOLY WTF, BATMAN! Courtroom Mama’s on the case!

I immediately wondered what they were citing, so using my trusty sidekick, Google, I discovered that the significant language (“there is no empirical evidence for an optimum percentage”) came, not from some new statement, but from the WHO’s 2009 handbook Monitoring Emergency Obstetric Care (pdf here).

Wait a second, that seems familiar…

Isn’t that the same report that says:

Pending further research, users of this handbook might want to continue to use a range of 5–15% or set their own standards… [t]here is no empirical evidence for an optimum percentage or range of percentages, despite a growing body of research that shows a negative effect of high rates. It should be noted that the proposed upper limit of 15% is not a target to be achieved but rather a threshold not to be exceeded.

And don’t forget

Many observers consider that we are experiencing a worldwide epidemic of overuse of caesarean section and that the rates will continue to rise, in view of practitioners’ and administrators’ fear of litigation, local hospital culture and practitioner style as well as increasing pressure from women in highly industrialized countries to undergo caesarean sections for non-medical reasons. At the same time, evidence for the negative consequences of caesarean section is increasing: recent studies in countries with high rates suggest that caesarean section carries increased risks for maternal and neonatal morbidity and mortality.

That’s a pretty far cry from Target to reduce caesareans scrapped as experts demolish ‘myth’ that they are more harmful.

Mystery solved. Does that mean I get to call it?

CODE MEC! CODE MEC!

Shame on the press for putting this through the echo chamber.  Jill at the Unnecesarean has a nifty angry letter you can send as a bit of Mother-Sized Activism.

I hope all of you mamas are having a wonderful day, and that the people in your life are celebrating the motherwork that you do, whether that’s gestating, nurturing, striving for a better world, and any of the infinite permutations of mothering. My hat is off to you. And so is Mr. T’s.*

And a special Happy Mother’s Day to Jessica Valenti of Feministing who just announced her pregnancy (and thanks to Mom’s Tinfoil Hat for tipping me off, because apparently I live under a rock). Welcome to the the path to the “other side”** — we’re cheering for you and wishing you an easy pregnancy and birthing.

*You’ll notice his endorsement of unmedicated birth (“M is moan an miserable groan from the pain that she felt when I was born”). So maybe not hypnobabies approved, but definitely favoring vocalization as a coping technique. ;)

** To clarify, this isn’t a reference to like “Team Edward” or “Team Jacob.” A childbirth educator once told me about a culture’s belief that there is a sort of chasm that separates mothers from women who are not mothers, and that childbirth is a rickety and sometimes scary bridge between the two that the woman must cross. It’s so narrow that only one person may cross at a time, so people can lend her support and cheer her along, but no matter what, the journey is hers alone. I like this metaphor a lot.

What do you say about a 160 year old hospital that died? That it treated survivors from both the Titanic and 9/11? That it practiced according to Catholic ethics (i.e. no abortions, emergency contraception, or procedures that would create unused human embryos)? That it was midwife-friendly and its obstetrical director prided himself on “minimally-invasive obstetrics?”

The full impact of the closure of St. Vincent’s Hospital in Manhattan on birthing women hadn’t really occurred to me until I read Miriam’s post about it on Radical Doula. New York City has a vibrant home birth midwifery community, put into the spotlight by The Business of Being Born. That community is now under threat because the hospital that served as the backup for the home birth midwives has gone belly-up.

According to Choices in Childbirth, the moment of truth is here. At midnight tonight, the majority of the NYC homebirth midwives will no longer be able to practice legally. From a CIC email bulletin forwarded to me by an NYC birth activist:

Unless immediate action is taken by the Governor and the NYS Department of Health the women that these midwives serve will be denied access to a home birth with their chosen provider and these providers will no longer be able to practice legally in NYS.

This means that everyone—from the women who have just discovered that they are pregnant to the ones due yesterday—are going to be forced to either switch providers or have a “back alley birth.” Provided, of course, that the midwives are willing to stake their licenses to continue to provide services.

I’m not just mourning a hospital I never met. I’m pissed. I see this as a bellwether, just a highly visible part of a disaster that is happening in slow-motion. After all, St. Vincent’s had the advantages of a storied past and being in the same neck of the woods as the New York Times, automatically giving it a much wider audience than the hundreds of other hospitals that quietly close down or change their VBAC policies, leaving pregnant women high and dry. If the biggest city in the U.S. will throw its home birthing families to the wolves, what in the world are the rest of us to hope for?

To the midwives of New York City, for what it’s worth, we’re standing here across the internet, fists in the air, shouting “FREE OUR MIDWIVES!”

For anyone who is in NYC, here is the advice from Choices in Childbirth:

YOU MUST ACT NOW to save the home birth option for New York Women:

Call:

• 311
• Wendy Saunders, Executive Deputy Commissioner for the NY State Department of Health, appointed by Governor Paterson. 518-474-8390
• Larry Mokhiber, he Secretary of the Board of Midwifery (518-474-3817, extension 130)

And say….

With the closing of St. Vincent’s Hospital, half of the licensed, highly trained home birth midwives serving NYC have lost their Written Practice Agreement (WPA).   St Vincent’s was the only Hospital in the city supportive of a woman’s right to choose a home birth and willing to sign a WPA.  In the weeks since it’s announced closure, these midwives have reached out to hospitals and obstetricians all across the city looking for support, with no success.  Please help us to save the homebirth option in New York.

People can also email the Governor using this contact form. You can also sign a petition supporting the Midwifery Modernization Act, which will remove WPA from the midwifery law effectively removing this barrier to accessing midwifery care. See NYSALM’s fact sheet about what the Midwifery Modernization Act Means for You.

This piece is cross-posted to RH Reality Check.

According to this NPR segment on the biology of trust (mp3 here), both of them require oxytocin to happen.

As a women’s health advocate, I know a little thing or two about oxytocin and its role in labor. I know about oxytocin release in orgasms and milk letdown (which nobody tells you about for that first postpartum sex ¡SURPRISE!). I know that oxytocin contributes significantly to bonding, hence much ado about keeping the mother/baby dyad together in the minutes after birth. I know that adrenaline is antagonistic to oxytocin, which is why all of the above are nigh impossible when a person is frightened or stressed.

What I didn’t know was that oxytocin is the magic responsible for trust as well. The segment describes the role of oxytocin in trust formation through the story of a little girl with Williams Disease, a congenital neurological problem that impairs the body’s regulation of oxytocin. It just keeps churning it out, and consequently she is, well, pathologically guileless. She trusts absolutely everyone like they were her best friend. Poetic, but evolutionarily disadvantageous.

This isn’t how things are supposed to be. The article points out that “oxytocin is generated only after some concrete event or action”; once a person does something to show that they are not a threat, the body creates oxytocin. From a ground-level perspective, this makes sense: someone is nice to you, you form a little bond. I think that this has an interesting implication for birth: if the birth attendant does something to make a woman feel that she or he is not a threat (e.g. treating a woman with respect, listening to her, comforting her…), she will create more oxytocin as a result, which will in turn help labor along.

As for big government? Professor Paul Zak, a neuroscientist and economist (how do you like those credentials!), discovered that administering oxytocin to people makes them more generous and trusting of others, thereby making them more trusting of the government as well. This micro-to-macro model of social cohesion is outlined in Robert Putnam’s Bowling Alone (which, for those of you who were following along as I tweeted the 2010 CIMS Forum, went on my #booklist hashtag when it was referenced by Raymond Devries by way of explaining our American Exceptionalism in birth): people connect with those around them on the community scale–church groups, bowling leagues–and are show greater solidarity on a societal level. Which is to say, if we have more tea parties (or good birthing experiences?!), we’ll have fewer Tea Partiers. However, the economic crisis has caused massive amounts of stress, which in turn has hampered trust-cum-oxytocin, and voila! widespread distrust of government.

Apart from being totally fascinating in a really geeky way, this is the ultimate justification for progressives to participate in the Birthquake proposed by Jill at The Unnecesarean; after all, oxytocin production is at its apogee just after birth. Although I guess if you think about it, Boobquake will do, as long as there is lactation or orgasms involved…

When I posted yesterday, I considered talking a little bit about how environmentalism is a reproductive justice issue. I eventually decided against it but, conveniently, the National Women’s Law Center took it on for me. I’m not really talking about ecofeminism, a particularly essentialist form of feminism that I generally can’t even read about because my eyes are too busy rolling uncontrollably (although I’m willing to try if someone can provide me with a primer that doesn’t use the words “earth” and “mother” within two words of each other). Rather, I’m talking about the intersection between Environmental Justice and Reproductive Justice, beautifully articulated by this factsheet from NWLC and the Law Students for Reproductive Justice. The basic thesis is this: if you care about reproduction, you also have to care about the effects of the environment on our ability to prevent pregnancy and bear and raise children.

Thanks in part to the ouster of the flat earth mentality that concern about the mutual effects between humans and the environment is “speculative” or “alarmist,” this is an issue that has been gaining an increasing amount of attention. As the primary carers and sole gestators of children, bio-women are particularly impacted by certain environmental issues, and uniquely burdened by reproductive policies intended to curb environmental depletion.

Some of these things, I think most mothers have already considered as they worriedly pause before popping a tupperware into a microwave; for example, an an op-ed by Nicholas Kristof asks whether exposing developing brains to toxins causes autism. Assuming, of course, that they have the privilege of owning a microwave, much less worrying about tupperware instead of the Superfund site next to which they are supposed to be raising their kids. Other issues, such as NAPAWF’S work on the National Healthy Nail Salon Alliance to protect the reproductive health of women in the beauty industry, or Sharon Astyk’s prolific writings on how peak oil is a women’s issue, are so far beyond my ken that I had to do a double take. I’m not anything that could be mistaken for granola, but having kids has definitely increased my sense of urgency about not leaving a scorched and salted earth behind me when I leave this planet.

So in the continuing spirit of making “every day Earth Day,” I hope you brilliant folks will consider the ways in which the ways we affect our environment affect us.