The Whiteness of Homebirth

USA Today published an article this week about the 20% rise in homebirths between 2004 and 2008. What struck me most, though, was not the fact that homebirth has been on the rise, but that USA Today focused in so much on the racial disparities amongst women choosing (and in many places having access to) homebirth. I feel like it’s something I am constantly talking about and working towards remedying. It’s a bit surprising and surreal to see this angle of the story picked up by the mainstream press.

Fewer than 1% of U.S. births occur at home. But the proportion is clearly going up, study by researchers at the Centers for Disease Control and Prevention found. The new figures are for 2004 to 2008. Home births had been declining from 1990 to 2004.

The increase was driven by white women — 1 in 98 had their babies at home in 2008, the most recent year for which the statistics were available.

Only about 1 in 357 black women give birth at home, and just 1 in 500 Hispanic women do.

“I think there’s more of a natural birth subculture going on with white women — an interest in a low-intervention birth in a familiar setting,” said the lead author, Marian MacDorman of the CDC’s National Center for Health Statistics.

For all races combined, about 1 in 143 births were at home in 2008, up from 1 in 179 in 2004.

Read the whole article here: Home births up 20%, driven by natural birth subculture – USATODAY.com.

My hope in all of this is that those statistics are changing, that midwives and clients are working together to change the face and make up of people who choose and can access homebirth. I feel really pleased to be working in a practice right now that is incredibly diverse as homebirth midwifery practices go. I’ve been here just over a month and I’ve met clients from nearly every racial background, lesbian clients, clients of many different nationalities and countries of origin. Interracial relationships are commonplace in this practice and our clients are all over the board in terms of class background. This practice has a thriving community in their midst and the midwives work very hard to ensure that this community continues to grow and develop as clients meet each other, network, become friends, and help each other through pregnancy and early motherhood.

Is everything perfect? Certainly not. We have a long way to go in Austin in terms of increasing diversity, especially amongst birth workers. And I definitely know that I am fortunate to be working for one of the most diverse practices in town. But it’s made me start to think long and hard about where I want to practice in the future. It’s helpful that Austin itself is a diverse locale and the sort of place where homebirth is a popular and accepted choice. Working with this practice and here in Austin makes me question on a deep level whether I’m willing to work long-term as a midwife in a less-diverse locale where there is less opportunity to co-create this beautiful, rich and diverse birthing community. Northern New England and central Texas and vastly different places and it shows in the practices I have been involved with. There is a palpable difference from a practitioner standpoint. And while I know that the individual practitioner has a profound effect on how diverse, inclusive, and accessible their practice is, so does the locale.

Deadly Delivery Update for 2011

Did you see that Amnesty International updated their publication Deadly Delivery? Things continue to not look very good. The US now ranks 50th instead of 41st in terms of worldwide maternal mortality. We continue to fail women of color and women living in low-income areas. And, for the 13th year in a row, our rates of cesarean birth have risen and now are at an all time high of 32.9% (as of 2009). Fully one third of all babies in the US are born via surgical incision instead of the time-tested vaginal route.

Da Midwif at Midwives of Color gives a poignant overview here.

Access Intimacy: The Missing Link (via Leaving Evidence)

Mia Mingus gives a name to a set of experiences in my life that I didn’t know could have a name. This is a beautiful, brave, and painfully honest piece about Mingus’ experiences with access intimacy. She says it much better than I ever could – make sure you make time for yourself to read her blog post and soak up her eloquent words.

Access Intimacy: The Missing Link There are many ways to describe intimacy.  For example, there’s physical intimacy, emotional intimacy, intellectual, political, familial or sexual intimacy.  But, as a physically disabled woman, there is another kind of intimacy I have been struggling to name and describe, what I have been calling “access intimacy.” I have begun using the term loosely and am still realizing different aspects of it.  This is in no way a complete describing of it, … Read More

via Leaving Evidence

Catching Our Babies: Open Arms and Michelle Sarju

There should be a beautiful and stunning film right here to start this post off. For some reason, I cannot get the video to embed properly. Watch it here instead.

I grew up in western Washington and lived in Seattle for a year. I definitely have mixed feelings about the birth scene in the Seattle area, but this film highlights what I think is absolutely working there.

A beautiful piece about serving women of color and low income women in Seattle. The doula service featured in this film, Open Arms, is pretty incredible. Run primarily by women of color, as you can see in the film, Open Arms provides doula services to any woman who desires a doula, basically. As far as I understand, they use grants to pay their doulas when individual clients cannot which really is a win-win situation for everyone involved. It’s a model I highly respect, think is working well, and would love to see replicated  many, many times across the country.

Michelle Sarju is also worth a mention in her own right. She currently works for Open Arms and I don’t know if she does much midwifery work anymore. She has been a tireless advocate for women of color in the midwifery scene in Seattle. A former Seattle Midwifery School (SMS) student, she has shown up time and time again as a voice advocating for better and more inclusive midwifery education, better treatment for students of color at SMS (now Bastyr), and a staunch supporter of a fundamental change in the midwifery culture and education in Seattle – one that embraces anti-oppression work at its core. Michelle Sarju has worked hard and long in what has been largely an uphill battle. It is really fantastic to see her shining in this beautiful and well-made film.

HT to Christy Tashjian for sharing this film in her blog.

Anti-Choice Legislation and Birth Work

Perez over at Radical Doula just wrote a post I think all birth workers need to read. The connection between abortion and birth work is one I’ve seen for awhile, but is so important right now with the Republican attempts to severely limit access to abortions.

But I realize that folks who read this blog may think that the reason I care about this legislation is because I work with women having abortions. What we often don’t talk about is how legislation that attempts to restrict abortion by emphasizing the “rights” of the fetus (or, as Lynn Paltrow want us to call it, fetal separatism) have big impacts on the rights of pregnant women who actually carry their pregnancies to term.

That’s right: anti-choice laws don’t just impact women seeking abortions, they impact birthing women as well.

Read the whole post here: Why birth activists should care about anti-abortion laws.

The Power of Disability Justice

Well said, Mia Mingus.

As a queer, disabled woman of color, disability justice feels like a political home for me, a place where I can engage in conversations about disability and race and gender and queerness and capitalism and more.

I tried to look to the disability rights movement, but I saw very few leaders who reflected me, and I found that, for the most part, disability was being talked about as an isolated single issue. Having been involved with racial justice, queer liberation, reproductive justice and feminist movements most of my life, I have rarely encountered spaces that addressed disability or connected it with other issues.

What does it mean to not have the luxuries of deciding when to use the bathroom in the place where you live, having alone time or going to visit a loved one in their home? How do we re-imagine relationships that center interdependency? How do able-bodied people move from simply “supportive allies” to political comrades who are actively incorporating a disability justice understanding into their work and lives?

We cannot fight for liberation without a deep, clear understanding of disability, ableism and disability justice. The bodies of our communities are under siege by forces that leverage violence and ableism at every turn. Ableism is connected to all of our struggles because it undergirds notions of whose bodies are considered valuable, desirable and disposable. How do we build across our communities and movements so that we are able to fight for each other without leveraging ableism?

I imagine a world where our organizing and activism is less segregated, where our movements and communities are accessible and don’t participate in the isolation of disabled communities. I imagine places where we fight for whole and connected people, families and communities.

Read the whole thing here: Changing the Framework: Disability Justice.

The next part of the discussion that I want to have is how do we promote and help co-create disability justice in a homebirth context, both for parents and parents-to-be with disabilities and then also for parents who give birth to children with disabilities.

Infant Mortality and Racial Disparities in Milwaukee

Milwaukee has one of the highest infant mortality rates in the nation and the numbers are particularly staggering for black women in the city.

Income and education fail to account for the racial disparity in Milwaukee’s infant mortality rates.

Blacks across the socioeconomic spectrum have higher infant mortality rates than whites.

The infant mortality rate for a child born to a black woman in the highest tier is about the same as the rate for a child born to a white woman in the lowest tier.

The infant mortality rate for babies born to a black woman in the middle tier is three times the rate for babies born to white women in the same tier.

It is not clear why.

“I’ve been working on this for 20 years,” Mason said, “and just when you think you’ve figured it out – whoosh! – it’s gone.”

A growing field of research suggests that the chronic stress of living in poverty or with barriers associated with low educational attainment increases the risk of the leading cause of infant mortality: preterm birth and low birth weight.

Research also shows that the experience of racial or ethnic discrimination deepens stress and further increases the risk of preterm or low birth weight.

A novel study published in 2006 vividly illustrates this theory.

Diane S. Lauderdale, a professor of epidemiology at the University of Chicago, wanted to know whether poor birth outcomes increased for women of Arab-origin after the terrorist attacks of Sept. 11, 2001.

Lauderdale looked at all California birth certificates for 2001, 2002 and 2003. She identified more than 15,000 mothers with Arabic last names.

Prior to 9-11, she discovered, women with Arabic last names had the same low birth weight rate as non-Hispanic white women.

But in the six months after 9-11, the chances of having a low birth weight child increased 34%.

The risk of bearing low birth weight babies, she found, did not increase for any other ethnic group.

Read the whole thing here: For Milwaukee’s children, an early grave.

Unexpected Birth Outcomes

When he was a week old, we got a call that his metabolic screening panel came back positive for congenital hypothyroid. I think this call, this first pronouncement, was from our midwife, but I don’t remember her calming tones, her everything-will-work out demeanor: I remember the blood in my ears, the grip around my perfect child tightening, the irregular shape of the bricks outlining our empty fireplace.

From Congenital Hypothyroidism: The Past

One of the births I attended in the past year was at that of a baby born with a previously undetected congenital defect. In the ensuring 12 hours or so, I had the profoundly humbling experience of watching a family’s understanding of their lives, plans, and realities change forever. Irrevocably.

It was something I had assumed I would encounter eventually, but isn’t that true with all complications of labor and birth? Some day I might see that. Not now. Not so soon, so early in my training. But there I was helping a family navigate suddenly the difficult world of grief, readjustment, hospitals, specialists, tests, etc. and ad nauseam after their beautiful homebirth. Trying to serve the needs of both parents who dealt with this information very differently, and trying to make this experience as holistic, loving, informed, and as close to the midwifery care they received before birth as possible.

Which is why I was deeply touched that Arwyn chose to share her story of discovering that her son had congenital hypothyroidsim on her blog Raising My Boychick. She talks about how it transformed her son’s babyhood and how her feelings about it have changed now that he’s older and now that she’s pregnant again. It’s a moving account, an apt commentary on ableism and disability activism, and in general an important read for birth workers.

You can read the whole story (in two parts) here: Congenital Hypothyroidism: The Past and Congenital Hypothyroidism: The Future.

Social Justice = Love

Dr. Cornel West:

For me, justice is what love looks like in public. When you love folk, you hate the fact that they’re being treated unjustly. You loathe the fact that they’re being treated unfairly. And if you don’t do something the rocks are going to cry out because when you talk about justice, you’re not talking about some abstract notion, you’re talking about something you feel deep in your soul – the way you would if you heard Curtis Mayfield play his guitar. You gotta feel.

Via the brilliant Cripchick’s Blog.

Augusta Anderson

My grandmother’s grandmother (which makes her my great great grandmother?), Augusta Natalie Nelson Anderson, was a midwife. She was born in born in Sweden we think in 1860, and died in Clear Lake Minnesota at the age of 95. When Augusta was 18, she moved to Stockholm to become a midwife at the local hospital. At this time her childhood sweetheart moved to Cleveland, Ohio. She saved her money and then followed him to the United States and married him. She took a job working in a hospital, although was barred from working as a midwife due to the fact that she didn’t speak English yet as well as the myriad of laws preventing women in this era from practicing as midwives (for more information on this, read Judith Pence Rooks’ incredibly informative book Midwifery & Childbirth in America).

Six years later she married Charlie Larson and had three children with him in Eau Claire, Wisconsin. Her youngest died from pneumonia and Charlie died in an unfortunate and horrific train accident. Augusta then married Lars Anderson and had 5 children with him in Clear Lake, Minnesota. They all continued to live in Minnesota until the dust bowl struck and Lars and his sons (the stories I could tell you about those bootleggers) drank all of their money away and they lost the family farm. The sons piled their families into two Model A Fords and drove to Montana where they resettled. Augusta, Lars, and their daughter Alma remained behind in Minnesota until their deaths although Lars and Augusta went to visit their children and grandchildren in Montana often.

If I remember correctly, Augusta’s spinning wheel is still in the family somewhere and makes its appearance at periodic family reunions.

I didn’t even know that I had an ancestor who was a midwife until my father’s cousin (the unofficial family historian) sat me down to tell me the whole family history. Augusta is fascinating to me in part because of her employment history, but in part because there’s so much we don’t know about her. There is a story about her grandfather who was a general under Napoleon. While he was living in France, he fell in love with and married his housekeeper, which was unheard of for someone of his rank. He was promptly dismissed from the army and returned to Sweden with his new wife and had a happy family. I was told that there may have been some controversy around this housekeeper as well because she may have been Jewish (this was told to me with great solemnity and not a little bit of embarrassment and would-be denial, thank you deep-seated familial racism and anti-semitism). Truthfully, we have no idea her ethnic heritage and it is interesting to me that Augusta looks so different from my other very Swedish-looking relatives on this side of the family. She has a much darker complexion and a much more square face than any of the other Andersons. Unfortunately due to the passage of time (and likely her grandmother’s status as a lower-class woman), I will probably never know the truth behind this story. Regardless, we do know that this grandmother’s name was Natalia and the name was passed down as Augusta’s middle name and the name of her first daughter who went by Nettie. I’ve also been told that although Augusta was born in Sweden (we think), her ancestry is Bohemian and her family came from the area that is now the Czech Republic.

Sometimes I stare at these pictures of her and wonder what this woman was like, whose hands caught babies once upon a time in a hospital in Stockholm.