Birth Justice

In my last post, I mentioned that I was listening to this radio broadcast talking about homebirth and midwifery in communities of color both in Miami and internationally. The broadcast features Tamika Middleton a doula who is also a co-founder of Black Women Birthing Resistance and the two midwives from the brand new nonprofit Mobile Midwife, Jamara Amani and Anjali Sardeshmukh. The entire program is worth a listen, but I transcribed a few pieces that I found to be particularly interesting dealing with race and birth outcomes. I’ve been talking and thinking about this topic for awhile, but I think these women said it particularly eloquently. (Emphasis below is mine.)

Jamara Amani: Locally here in Miami Dade county one of the things that we’re really concerned about, and it is a problem across the nation, is the high rates of maternal and infant mortality. And it really does impact Black communities disproportionately. There’s huge disparities. Black women are four times as likely as White women to die in childbirth or in a cause related to childbirth, and Black babies are twice as likely to die in the first year of life as White babies. And there’s several factors that are involved in that. Tamika talked about the generational trauma around birth, around raising our babies. You know, there’s lack of access to resources, there’s the stress of living in a racialized society, there’s economic injustice, lack of access to healthcare, and one of the major issues that we’re raising is lack of access to midwifery care. And we know from research and studies that have been done that midwives can help to greatly reduce these disparities by helping women to stay healthy during their pregnancies, to work through some of those traumas, to develop a relationship with trust and a rapport that is individualized for that particular woman’s experience, to provide her with education that she needs to have a healthy outcome, and then to provide birth support that is natural, that is not full of unnecessary interventions that happen in hospitals such as medications and surgeries. And so what we’re working to do is to raise awareness about midwifery as a solution to these glaring health disparirites…

Anjali Sardeshmukh: Midwives do provide a lot of care afterwards too, and that’s a really important time. So when Muhammed talked about this isolation that happens I think one of the gems of midwifery care is that it really does look at … who is this person and who is in her community and where is she from and to honor that too…

And finally:

Jamara: I want to just say too that some folks may feel like, “Well, this issue doesn’t really apply to me ’cause I’m not pregnant or I don’t have kids or I’m a man or I’m too old to have kids” or whatever reasons but this is really a community issue. It’s an issue of justice. If you were born, then this affects you so it affects all of us. And healthy mothers and healthy babies are everybody’s business. Because at the end of the day if we want to have a healthy community, we really have to take care of our moms and babies and this is an issue of justice, of liberation. Because how we birth has a lot to do with how we live …where do we enter. And there’s a saying that a lot of midwives like to say which is “peace on earth begins with birth.” So if you have a peaceful, gentle birth experience where your mother feels empowered, feels like she can do anything, feels like … her rights are being respected, then how does that affect how she mothers you? How does that affect how you’re raised? How does that affect how she interacts with, you know, other aspects of mothering? I think it’s just … such a initiation point and a transformation point for women … entering motherhood. It’s a place where I feel like we have to have justice.

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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.

Recent Race and Birth Posts

So, funny how this small project of mine called school has taken over my life. I have a few blog posts in the works, but I have been noticing how quiet Bloody Show has been lately. It makes me a little sad. So until I get a few moments to finish the posts I have started, here’s a little light reading for the meantime. Over at The Unecessarean, there’s a lively discussion going on:

Baby Catcher by Peggy Vincent

One of the books we need to read before arriving at school is Baby Catcher: Chronicles of a Modern Midwife by Peggy Vincent. It’s a book I read before and had mixed feelings about. My school encourages us to read it because it will inspire and engage us for the coming year.

This second time through, I have to say that I liked the book better. Most of Vincent’s stories in the book are inspiring, many of them riveting. When she talks about the baby who wouldn’t start breathing until she began mouth to mouth resuscitation, or the birth her 6 year old daughter observed and fell in love with I find myself moved, no question about it. She is clearly an experienced midwife with plenty of seniority in the Bay Area midwifery and obstetrical communities.

However, I am also less willing, this second time around, to overlook some pretty hefty faux pas on Vincent’s part. When it comes to race, class, sexuality, and gender identity, I can confidently say that Vincent does not quite get it. Let me state here that I am, at heart, an incredibly black and white thinker. Any shades of gray I have added to my mental capacities have come from hard work and lots of sweat on my part. I’d like to think that at this point I’m pretty decent at seeing and understanding nuances and non-clear cut categories, but it hasn’t always been easy. So on this second read I’m not ready to throw the baby out with the bathwater. There are definitely many merits to this book, but there are enough areas that give me pause that I would not recommend it as an all around inspiring, introductory read for a midwifery program.

Vincent loves using metaphors to describe situations, and typically uses these metaphors appropriately. For example:

When I awakened the day before my second child careened into the world, I waltzed around the house to songs from My Fair Lady. I could have danced all night, but by noon I’d decided that pregnancy was not at all my cup of tea. Pour the dregs down the drain, wash the cup, and put it away.

And then there are those times when the metaphors she uses to describe things that are entirely inappropriate, such as in this passage:

Nadine’s little fellow nursed happily, and then each child took a turn holding him while their dad used up a whole role of film. The baby showed admirable patience as they shifted him from one small pair of arms to another. Finally Sandi laid out her supplies for baby evaluation: tape measure, scale, thermometer, stethoscope. I unwrapped the baby from his cocoon of blankets – and laughed.

Nadine’s son had pooped so copiously that it squished between his toes. Wriggling around inside his flannel nest, he’d smeared the stuff so far up his back that it soiled the hair at the back of his head. In front, slimy meconium – the medical term for the bowel movement of fetuses and newborns – completely covered his genitals, legs, and feet. This little boy had viscous, black meconium plastered absolutely everywhere. I could have obtained a perfect footprint without using an inkpad.

He didn’t care at all, but his three older siblings screamed and fell on the floor laughing. His four-year-old sister, the oldest child in this close-knit family, declared, “Oooh, that’s yucky! We need to give him a bath right now.” I agreed. Leaving Sandi to supervise Nadine’s shower, I said “I’ll take this little tar baby into the kitchen.”

Tar baby? Really Peggy Vincent? You could say poopy baby, sticky baby, mucky baby, or dirty baby, but you chose to use a racially loaded term to describe this (probably white) meconium-covered infant? Really?

Ready to tackle a mess of sex, gender, and race with me? Read on:

… behaving calmly in the presence of San Fancisco’s flamboyant patient population often put an extra twist in my knickers.

When Vinnie and Rosebud waltzed into the exam room, I blinked rapidly and grabbed a blank chart to give me something to focus on. Vinnie seemed to sense my discomposure.

“Honey, you’re not in Kansas any more,” he said, his fuchsia boa nearly slapping me in the face as he tossed it over his left shoulder… I’m sure my astonishment glowed as brightly as Dorothy’s yellow brick road when he introduced me to his pregnant girlfriend, a four-hundred-pound black prostitute named Rosebud.

She’d gotten pregnant by Vinnie two months before he began hormones in preparation for a sex change operation. New breast implants already bulged on his bony chest. Vinnie wore tight-fitting gold lamé pants, purple high heels, a snug, purple-knit tank top, and that six-foot fuchsia boa that he just couldn’t leave alone. False eyelashes, impeccable makeup, and a short, androgynous hairstyle topped his flashy outfit.

… Only the telltale bulge in his snug pants revealed his original sex.

Rosebud, an enormous women [sic] whose skin and face you couldn’t help but admire, sat quietly smiling at his antics. Where Vinnie’s skin glowed so black he looked almost blue in certain light, Rosebud’s face and arms reminded me of coffee with lots of rich cream.

When Rosebud entered the hospital in labor five months later … an eight-pound baby slid from between her thighs with the ease of chocolate melting on a Chevy’s dashboard in August. Vinnie pranced and danced in the background, garbed in a cowgirl outfit that would have made Annie Oakley blush. With the short skirt flaring around his slim thighs, I couldn’t tell if he’d completed the sex change surgery. Although I’m sure he wouldn’t have minded my asking, it didn’t seem appropriate, given the circumstances.

Let me pause right here to scream a little inside. Vincent’s insistence on using a male pronoun to refer to Vinnie is deeply insulting and dehumanizing. Especially when, as Vincent describes, Vinnie left little doubt as to her public gender identity and chosen pronoun.

And what is with her obsession with Vinnie’s genitalia? She continues to mention her genitals and surgical transition several more times in this book. Not that Vincent is alone in her fascination, cisgender folks the world over are strangely obsessed with the genitalia of trans folk. The physical presence of male or female genitalia does not make someone male or female, it runs much deeper than that. Regardless of whether Vinnie physically transitioned (and Vincent’s account assumes that she has), it shouldn’t matter. It was almost as if Vincent needed proof of Vinnie’s surgery before she would use her preferred pronoun.

So I ask Vincent the question I always ask when it comes to things like this – would you have felt at liberty to describe in such detail the genitalia of any of your other clients? No? Well then don’t do it here. The same goes for Vincent’s bad habit of describing someone’s skin color only when they aren’t visibly white. We’re talking anti-racism 101 here

And yet, she delivers a touching, poignant, sensitive story about two interracial, married Muslim teenagers who choose to give birth at home with the father catching his daughter as she emerges from the womb. It is hands down my favorite story from the book and one of the most beautiful. Not once does she make disparaging or offensive comments about the parents’ age, race, or religion. At times like these she is at her best.

The bottom line: midwives need to be extra aware or race, sex, gender, and sexuality issues. If they want to operate outside of the typical top-down heirarchical system that is western medicine (and particularly modern obstetrics), they need to be able to work effectively and sensitively with groups that are marginalized by these same systems – people of color, queers, transfolk, immigrants, refugees, etc. Vincent’s book is not exceptional in her misunderstanding of these important issues, which is why it is so important that we educate ourselves and consciously work to create space within our practices that is welcoming and affirming to all of our clients.

Pregnancy and Power

I recently read independent historian Rickie Solinger’s book Pregnancy and Power: A Short History of Reproductive Politics in America. Solinger’s central argument is that women are not accorded full personhood and cannot be fully participatory members in a society where they are not allowed to manage their own reproductive lives, a premise with which I fully agree.

Solinger’s narrative about abortion was especially eye-opening for me. She argues that abortion today is far more heavily regulated and oppressive than it was pre Roe v. Wade when abortion was outright illegal.  It floored me to read Solinger’s account of the ease with which both women (read: middle class, White women) and doctors circumvented the law to procure the medical procedures they needed. General practitioners who performed abortions were hailed for performing a necessary service. There was no harassment of individual women terminating pregnancies and little organized public outcry, even from the religious right.

Working at Planned Parenthood straight out of college, I was constantly made aware of the perilous state that abortion rights are in today. My first day at work, I was shown around the building, shown which glass was bulletproof, where the panic button was, and what to do in the case of a clinic shooting or bombing. Several times a week, we had protesters lining the streets with ugly signs and shouting uglier slogans at anyone entering the clinic. Despite the FACE act, they repeatedly tried to follow women into our parking lot or physically block their access, at which point we called the police. They took photos of everyone who worked at the clinic and I would not  be surprised if my face was on an anti-abortion site somewhere. Working in an abortion clinic today can feel like a warzone.

Pregnancy, abortion, and motherhood have heavily shaped our ideas of race, class and gender in the US. One of the most engaging aspects about this book is the Solinger breaks down the reproductive realities of women throughout time by race and class. She portrays state-legitimized motherhood, and therefore the right not to reproduce, as a class and race-based privilege. Her narratives of the reproductive lives of White middle class, White poor, African American (both pre and post slavery), Native American, and Chinese women fill a glaring gap in many of our reproductive histories.

Regarding abortions pre-Roe, it was much easier for middle class White women and women of color to obtain care than it was for poor White women. Middle class White women could afford to purchase privacy and competent medical care. In a racist, pro-eugenics era, policy makers all but encouraged women of color to have abortions so as not to produce more “inferior” children. Plus, the lives of women of color were valued less than those of middle-class White women so if these women received substandard care, the government did not spend time searching out incompetent care providers. This was of course completely unconscionable, but the effect was still that women of color had an easier time procuring abortions than poor White women.

 

For poor White women, their ability to access abortion was tied up in their race and gender. There was no question that middle class and upper class White women were White. If they transgressed the strict boundaries of their gender by not carrying a pregnancy to term, it did not call their whiteness into question. However, poor White women existed in a boundary zone, especially if they were immigrants from countries not always seen as White – Ireland, Italy, eastern Europe, etc. Solinger describes how socioeconomic class was/is inherently tied up in our ideas of race. By virtue of being low class, poor White women were seen as in danger of becoming Black. The way to rectify this unthinkable circumstance was to strictly police and enforce gender norms, one of which was bearing and raising White children who would become productive White citizens. It was poor White women who were arrested and tried in the courts if they were discovered to have received an abortion. It was poor White women who were jailed and fined for such acts. Of course middle and upper class White women were having abortions as well, but they were not transgressing race boundaries and so were allowed to do so by and large without interference.

 

As time marches on, class and race still have great effects on our ideas of who is and can be a mother, what makes a “good” mother, which mothers deserve to mother their children, and what children are worthy of being raised in “good” homes. Just look at our racialized and gendered stereotypes of the welfare system, which parents can choose to stay home and mother their children, which children get adopted, and which children wind up in the foster care system. As responsible citizens, we need to actively question and combat racialized and gendered ideas of pregnancy and power where we find it in order to create a world where all women are equal and full citizens with autonomy and agency.