Mother-Friendly Childbirth Is A Consumer Issue

Susan Hodges

Maternal mortality in the United States is under-reported and increasing, and we have a higher infant mortality rate than many other industrialized countries. In many of the countries with better outcomes, midwives are the primary care providers for pregnant women.

Maternity care clearly is part of "reproductive healthcare" and a key component of "maternal health", but is rarely addressed in that context. There is an unspoken assumption that U.S. maternity care is great just the way it is, with 99 percent of births in the hospital and skyrocketing rates of interventions (PDF) from induction of labor to cesarean section. However, U.S. maternity care does not compare favorably with the rest of the industrialized world. Maternal mortality is under-reported and increasing, and we have a higher infant mortality rate than many other countries. In many of the countries with better outcomes, midwives are the primary care providers for pregnant women, according to Marsden Wagner.

A recent San Francisco Chronicle article stated that the percentage of births attended by midwives in the United States has decreased in recent years (to just below 8 percent), and implied this was due to fewer women wanting the natural childbirth associated with midwives. However, less access to certified nurse midwives in hospitals and birth centers may be the reason. Many birth centers and hospital-based midwifery services across the country have been closed in recent years, not because they were not popular, but because, as one hospital administrator pointed out, "midwives are not good money-makers," or because of enormous increases in malpractice insurance rates (even though midwives are hardly ever sued). Additionally, midwives are unevenly distributed, with none in many areas. Restrictions in health insurance policies also impose barriers for women desiring midwifery care in or out of the hospital.

In the United States, certified nurse-midwives (CNMs) practice almost entirely in hospitals, a few in free-standing birth centers, while non-nurse midwives such as Certified Professional Midwives (CPMs) specialize in out-of-hospital births, mostly in homes. For a woman having a normal pregnancy (most women), and attended by a well-trained midwife, the evidence shows that a planned home birth (PDF) or birth center birth is as safe for the woman and her baby as a planned hospital birth, but with much lower rates of all interventions as well as injuries and complications. Non-nurse midwives such as CPMs are licensed in many states, where midwives and their supporters worked hard to pass legislation.

Women who have educated themselves about the evidence regarding the many practices and interventions included in standard hospital-based maternity care often want to avoid the "cascade of interventions." They seek alternatives including in-hospital midwifery care, free-standing birth centers staffed by midwives, and midwives who specialize in attending births at home.

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Today a pregnant woman can not assume that the care offered by obstetrician and in hospitals will be in her and her baby's best interests. Maternity care is "business," and women need to be well-informed and careful consumers. For one example, cesarean sections are more efficient and convenient for obstetricians and hospitals, resulting in more income. A recent Philadelphia Inquirer article points out that cesarean section rates have increased dramatically to nearly one third of all births, but there have been no changes in maternal risk factors to justify the increase, nor are any significant number of women demanding cesarean sections for no medical reason, contrary to the widely circulated myth. Other practices, such as early induction of labor, lead to more cesarean sections (PDF), and ACOG's recommendations about vaginal birth after cesarean (VBAC) have lead many hospitals to ban VBACS (PDF). Epidurals have been popularized, but based on my experience, women rarely are informed about the economic incentives for selling epidurals, the risks for themselves and their babies, or alternative and non-invasive pain-management techniques that are often sufficiently effective with virtually no risks.

For a variety of reasons, however, most women will continue to give birth in hospitals. Those who want a safe birth, even a somewhat natural vaginal birth, will need to thoroughly educate themselves about the risks and benefits of interventions, learn how to exercise their rights to informed consent and informed refusal , know their rights, and "just say no" to unwanted, unnecessary interventions. Women planning a hospital birth can help to optimize their labor and delivery as much as possible by arranging for a labor support person, such as a doula, to work with them throughout labor, and by having a nurse-midwife as their primary care provider if at all possible.

When women have the choice, many prefer the respectful, empowering, evidence-based, woman-centered care described as the Midwives Model of Care and as Mother-Friendly Childbirth. This kind of care could be the standard for all maternity care providers in all settings, but at present is most frequently found in midwife-attended out-of-hospital births.

For consumer-oriented information about maternity care and resources for bringing about change, check out the following:

News Sexual Health

State with Nation’s Highest Chlamydia Rate Enacts New Restrictions on Sex Ed

Nicole Knight Shine

By requiring sexual education instructors to be certified teachers, the Alaska legislature is targeting Planned Parenthood, which is the largest nonprofit provider of such educational services in the state.

Alaska is imposing a new hurdle on comprehensive sexual health education with a law restricting schools to only hiring certificated school teachers to teach or supervise sex ed classes.

The broad and controversial education bill, HB 156, became law Thursday night without the signature of Gov. Bill Walker, a former Republican who switched his party affiliation to Independent in 2014. HB 156 requires school boards to vet and approve sex ed materials and instructors, making sex ed the “most scrutinized subject in the state,” according to reproductive health advocates.

Republicans hold large majorities in both chambers of Alaska’s legislature.

Championing the restrictions was state Sen. Mike Dunleavy (R-Wasilla), who called sexuality a “new concept” during a Senate Education Committee meeting in April. Dunleavy added the restrictions to HB 156 after the failure of an earlier measure that barred abortion providers—meaning Planned Parenthood—from teaching sex ed.

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Dunleavy has long targeted Planned Parenthood, the state’s largest nonprofit provider of sexual health education, calling its instruction “indoctrination.”

Meanwhile, advocates argue that evidence-based health education is sorely needed in a state that reported 787.5 cases of chlamydia per 100,000 people in 2014—the nation’s highest rate, according to the Centers for Disease Control and Prevention’s Surveillance Survey for that year.

Alaska’s teen pregnancy rate is higher than the national average.

The governor in a statement described his decision as a “very close call.”

“Given that this bill will have a broad and wide-ranging effect on education statewide, I have decided to allow HB 156 to become law without my signature,” Walker said.

Teachers, parents, and advocates had urged Walker to veto HB 156. Alaska’s 2016 Teacher of the Year, Amy Jo Meiners, took to Twitter following Walker’s announcement, writing, as reported by Juneau Empire, “This will cause such a burden on teachers [and] our partners in health education, including parents [and] health [professionals].”

An Anchorage parent and grandparent described her opposition to the bill in an op-ed, writing, “There is no doubt that HB 156 is designed to make it harder to access real sexual health education …. Although our state faces its largest budget crisis in history, certain members of the Legislature spent a lot of time worrying that teenagers are receiving information about their own bodies.”

Jessica Cler, Alaska public affairs manager with Planned Parenthood Votes Northwest and Hawaii, called Walker’s decision a “crushing blow for comprehensive and medically accurate sexual health education” in a statement.

She added that Walker’s “lack of action today has put the education of thousands of teens in Alaska at risk. This is designed to do one thing: Block students from accessing the sex education they need on safe sex and healthy relationships.”

The law follows the 2016 Legislative Round-up released this week by advocacy group Sexuality Information and Education Council of the United States. The report found that 63 percent of bills this year sought to improve sex ed, but more than a quarter undermined student rights or the quality of instruction by various means, including “promoting misinformation and an anti-abortion agenda.”

Roundups Politics

Campaign Week in Review: ‘If You Don’t Vote … You Are Trifling’

Ally Boguhn

The chair of the Democratic National Convention (DNC) this week blasted those who sit out on Election Day, and mothers who lost children to gun violence were given a platform at the party's convention.

The chair of the Democratic National Convention (DNC) this week blasted those who sit out on Election Day, and mothers who lost children to gun violence were given a platform at the party’s convention.

DNC Chair Marcia Fudge: “If You Don’t Vote, You Are Ungrateful, You Are Lazy, and You Are Trifling”

The chair of the 2016 Democratic National Convention, Rep. Marcia Fudge (D-OH), criticized those who choose to sit out the election while speaking on the final day of the convention.

“If you want a decent education for your children, you had better vote,” Fudge told the party’s women’s caucus, which had convened to discuss what is at stake for women and reproductive health and rights this election season.

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“If you want to make sure that hungry children are fed, you had better vote,” said Fudge. “If you want to be sure that all the women who survive solely on Social Security will not go into poverty immediately, you had better vote.”

“And if you don’t vote, let me tell you something, there is no excuse for you. If you don’t vote, you don’t count,” she said.

“So as I leave, I’m just going to say this to you. You tell them I said it, and I’m not hesitant about it. If you don’t vote, you are ungrateful, you are lazy, and you are trifling.”

The congresswoman’s website notes that she represents a state where some legislators have “attempted to suppress voting by certain populations” by pushing voting restrictions that “hit vulnerable communities the hardest.”

Ohio has recently made headlines for enacting changes that would make it harder to vote, including rolling back the state’s early voting period and purging its voter rolls of those who have not voted for six years.

Fudge, however, has worked to expand access to voting by co-sponsoring the federal Voting Rights Amendment Act, which would restore the protections of the Voting Rights Act that were stripped by the Supreme Court in Shelby County v. Holder.

“Mothers of the Movement” Take the National Spotlight

In July 2015, the Waller County Sheriff’s Office released a statement that 28-year-old Sandra Bland had been found dead in her jail cell that morning due to “what appears to be self-asphyxiation.” Though police attempted to paint the death a suicide, Bland’s family has denied that she would have ended her own life given that she had just secured a new job and had not displayed any suicidal tendencies.

Bland’s death sparked national outcry from activists who demanded an investigation, and inspired the hashtag #SayHerName to draw attention to the deaths of Black women who died at the hands of police.

Tuesday night at the DNC, Bland’s mother, Geneva Reed-Veal, and a group of other Black women who have lost children to gun violence, in police custody, or at the hands of police—the “Mothers of the Movement”—told the country why the deaths of their children should matter to voters. They offered their support to Democratic nominee Hillary Clinton during a speech at the convention.

“One year ago yesterday, I lived the worst nightmare anyone could imagine. I watched as my daughter was lowered into the ground in a coffin,” said Geneva Reed-Veal.

“Six other women have died in custody that same month: Kindra Chapman, Alexis McGovern, Sarah Lee Circle Bear, Raynette Turner, Ralkina Jones, and Joyce Curnell. So many of our children are gone, but they are not forgotten,” she continued. 

“You don’t stop being a mom when your child dies,” said Lucia McBath, the mother of Jordan Davis. “His life ended the day that he was shot and killed for playing loud music. But my job as his mother didn’t.” 

McBath said that though she had lost her son, she continued to work to protect his legacy. “We’re going to keep telling our children’s stories and we’re urging you to say their names,” she said. “And we’re also going to keep using our voices and our votes to support leaders, like Hillary Clinton, who will help us protect one another so that this club of heartbroken mothers stops growing.” 

Sybrina Fulton, the mother of Trayvon Martin, called herself “an unwilling participant in this movement,” noting that she “would not have signed up for this, [nor would] any other mother that’s standing here with me today.” 

“But I am here today for my son, Trayvon Martin, who is in heaven, and … his brother, Jahvaris Fulton, who is still here on Earth,” Fulton said. “I did not want this spotlight. But I will do everything I can to focus some of this light on the pain of a path out of the darkness.”

What Else We’re Reading

Renee Bracey Sherman explained in Glamour why Democratic vice presidential nominee Tim Kaine’s position on abortion scares her.

NARAL’s Ilyse Hogue told Cosmopolitan why she shared her abortion story on stage at the DNC.

Lilly Workneh, the Huffington Post’s Black Voices senior editor, explained how the DNC was “powered by a bevy of remarkable black women.”

Rebecca Traister wrote about how Clinton’s historic nomination puts the Democratic nominee “one step closer to making the impossible possible.”

Rewire attended a Democrats for Life of America event while in Philadelphia for the convention and fact-checked the group’s executive director.

A woman may have finally clinched the nomination for a major political party, but Judith Warner in Politico Magazine took on whether the “glass ceiling” has really been cracked for women in politics.

With Clinton’s nomination, “Dozens of other women across the country, in interviews at their offices or alongside their children, also said they felt on the cusp of a major, collective step forward,” reported Jodi Kantor for the New York Times.

According to Philly.com, Philadelphia’s Maternity Care Coalition staffed “eight curtained breast-feeding stalls on site [at the DNC], complete with comfy chairs, side tables, and electrical outlets.” Republicans reportedly offered similar accommodations at their convention the week before.