Say Goodbye to Home Birth? A New Bill Pushes Too Far

Amie Newman

A bill in the Washington state Senate seeks to shut down the only association providing liability insurance to professional midwives, putting midwives in this state out of business and denying women one more option for safe childbirth.

It’s hard not to appeal directly to fiscal conservatives these days – the old school conservatives – the ones who appreciate how to save money long term without the neocon knee-jerk reaction to slash everything and anything in this time of economic difficulty. If this country wants to save money, it’s not enough to simply cut government funding for programs, brush off our hands, take a deep breath and say, "well, that’s that" and walk away.

So it is with a bill in the Washington state Senate (SB 5588) that seeks to shut down various State Boards and Commissions throughout the state in an effort to cut costs. Inexplicably, the bill has targeted the JUA (Joint Underwriting Association) for closure – despite the fact that the group does not even receive state funds. The bigger issue, however, is that this is the association that ensures liability coverage for certified professional midwives throughout the state. Without the JUA, midwives will not be able to obtain malpractice insurance and will effectively be put out of business in Washington state. 

But here’s the part to try out on your fiscally conservative pals (old-school, remember):

A recent Department of Health report revealed that in Washington state, professional midwifery services saves the state $250,000 a year – a number which increases to $1.3 million a year when you factor in private insurance.

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JUA is the only place where professional midwives in Washington state can obtain liability insurance so it’s critical to make sure JUA is not closed by this bill. 

Though it is likely you will read impassioned attacks on professional, certified midwifery in the comments section of this post (or any other on this site), the facts tell the real story. Certified, professional midwifery is safe for the mother, for the newborn baby, saves money for both the consumer and insurance companies, and results in better heath outcomes with significantly reduced rates of c-sections.  In addition, midwifery services for pregnant and birthing women offer another safe and (in some states) legal option for prenatal, childbirth and postnatal care. 

If you live in Washington state, here’s a copy of the letter you can send to your legislator whom you can find here:

Dear_______________________,
Senate Bill 5588 includes a list of State Boards and Commissions that will be shut down as part of cost-cutting efforts, and they’ve included the JUA in that list despite the fact that the JUA receives no state funding of any kind.

Without the JUA, licensed midwives and birth centers will not be able to get liability coverage. Without liability coverage, they will lose their credentialing with insurance companies. The effect will be to put most licensed midwives and birth centers out of business.

Please exempt the Joint Underwriting Association from SB 5588. Closing down the JUA would cost far more money than it saves, whilst also eliminating a much needed resource for women and their families. A recent Department of Health study found that licensed midwives save the state $250,000 per year, and (if you include private insurance too) that number climbs to $1.3 million per year. Clearly it makes no sense to eliminate licensed midwifery in the pursuit of saving money.

Thank you for your time and for your support of Washington State midwives and families.

Sincerely,____________________________

News Contraception

New Hawaii Law Requires Insurers to Cover a Year’s Supply of Birth Control

Nicole Knight Shine

Insurance companies typically cover only a 30-to-90-day supply of birth control, posing a logistical hurdle for individuals who may live miles away from the nearest pharmacy, and potentially causing some using oral contraceptives to skip pills.

Private and public health insurance must cover up to a year’s supply of birth control under a new Hawaii law that advocates called the nation’s “strongest.”

The measuresigned by state Gov. David Ige (D) on Tuesday, applies to all FDA-approved contraceptive medications and devices.

Hawaii joins Washington, D.C., which also requires public and private insurers to cover up to 12 months of birth control at a time.

Oregon passed a similar measure in 2015, but that law requires patients to obtain an initial three-month supply of contraception before individuals can receive the full 12-month supply—which the Hawaii policy does not.

“At a time when politicians nationwide are chipping away at reproductive health care access, Hawaii is bucking the trend and setting a confident example of what states can do to actually improve access,” Laurie Field, Hawaii legislative director for Planned Parenthood Votes Northwest and Hawaii, said in a statement.

Insurance companies typically cover only a 30-to-90-day supply of birth control, posing a logistical hurdle for individuals who may live miles away from the nearest pharmacy, and potentially causing some using oral contraceptives to skip pills. Both the American Congress of Obstetricians and Gynecologists (ACOG) and the U.S. Centers for Disease Control and Prevention recommend supplying up to one year of oral contraceptives at a time, as the Hawaii Senate Committee on Commerce, Consumer Protection, and Health noted in a 2016 conference report.

Fifty-sex percent of pregnancies in Hawaii are unintended, compared to the national average of 45 percent, according to figures from the Guttmacher Institute.

Women who received a year’s supply of birth control were about a third less likely to experience an unplanned pregnancy and were 46 percent less likely to have an abortion, compared to those receiving a one- or three-month supply, according to a 2011 study of 84,401 California women published in Obstetrics and Gynecology.

Reproductive rights advocates had championed the legislation, which was also backed by ACOG–Hawaii Section, the Hawaii Medical Association, and the Hawaii Public Health Association, among other medical groups.

“Everyone deserves affordable and accessible birth control that works for us, regardless of income or type of insurance,” Planned Parenthood’s Field said in her statement.

Culture & Conversation Maternity and Birthing

Exploring Birth Justice: A Conversation With Julia Chinyere Oparah and Alicia Bonaparte

Kanya D’Almeida

Rewire delves into the emerging birth justice movement and some of the historic and contemporary examples of how Black women and women of color, as well as trans and gender nonconforming people, have fought to preserve pregnancy and childbirth as a safe and sacred experience.

The numbers surrounding maternal and child health are bleak: Black women are three times as likely to die giving birth as their white counterparts; infant mortality rates for Black children are three times higher than those of white kids; and despite a widely held belief that vaginal deliveries are the safest route for both mother and child, women of color represent the highest cesarean rates of any other demographic in the United States.

Behind these statistics, however, are powerful stories of grassroots childbirth activists and traditional birth workers of color, including midwives and doulas, coalescing for “birth justice.” Building on a long history in which Black women and women of color have resisted birth oppression through the centuries, the term birth justice was coined in an effort to foreground activism and justice for birthing parents in movements around reproductive justice and Black lives.

A newly released anthology titled Birthing Justice: Black Women, Pregnancy and Childbirth explores some of the key issues within the nascent movement, including efforts to end the criminalization of pregnant women of color and trans or gender-nonconforming people, advocacy that aims to expand access to traditional and indigenous birth workers, and struggles to resist medical violence. The anthology is a project of Black Women Birthing Justice, a collective dedicated to transforming birthing experiences for Black women.

Foregrounding the stories in this collection are historical analyses of medical violence and “medical apartheid,” which shaped the fields of obstetrics and gynecology in the United States, as well as a close look at the ways in which “a patriarchal medical establishment seeks to control women’s bodies.”

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In an interview with the book’s co-editors, Julia Chinyere Oparah, co-chair of ethnic studies and director of the Research Justice at the Intersections Scholars Program at Mills College, and Alicia Bonaparte, associate professor of sociology at Pitzer College, Rewire delved into some of the intersections between the emerging birth justice movement and the broader reproductive justice movement, and explored some of the historic and contemporary examples of how birthing parents have fought to preserve pregnancy and childbirth as a safe and sacred experience.

Rewire: Walk us through the current landscape of the birth justice movement.

Alicia Bonaparte: I consider this a movement that is designed to respect the rights of all individuals who aspire to become birthing parents and have a child in a supportive environment: one in which the birthing parent has autonomy over their body and the ability to choose the ways in which their birthing process flows, from the prenatal to the postpartum process.

Julia Chinyere Oparah: This is a movement led by Black women and women of color, so the focus is on dismantling inequalities around race, class, citizenship, sexual orientation, and all of the intersecting oppressions that lead to negative birth outcomes, particularly for women of color, trans folks, low-income communities, and immigrant women. We are working toward reclaiming a midwifery tradition that originates within communities of Black women and women of color, and making sure these communities have access to these alternative birthing practices, including doula services. We are trying to raise awareness and build grassroots power, so we focus on ways in which communities can come together, talk about the violence, coercion, and neglect that’s happening in medical contexts, and work together to improve birth inequalities. We look at disproportionate maternal and infant mortality as the very visible tip of the iceberg, but we also go further to examine issues that might not necessarily cause mortality but that lead to pain and lasting trauma.

Rewire: What are some of the synergies between the reproductive justice (RJ) movement and the birth justice (BJ) movement? Are there distinctions between the two?

JCO: The BJ movement is part of the broader movement to dismantle reproductive oppression. Both the RJ and BJ movements aim to decolonize our bodies, and both advocate for the right of every person to choose whether or not to carry a pregnancy to term. Many of us in the BJ movement are birth activists who come from the RJ movement, so there isn’t a huge difference in terms of our frameworks, which are really intersectional. The only real difference is that we try to center issues that sometimes get sidelined in the larger RJ movement, such as fighting the stereotyping of women who choose home births as selfish and irresponsible, or highlighting the disproportionate impact of VBAC (vaginal birth after c-section) bans on women of color. We foreground the right to choose when, where, how, and with whom to birth, and try to lift up experiences that have been somewhat invisible in reproductive justice organizing, such as the right to access traditional and indigenous birth workers.

AB: Another synergy is that both the RJ and the BJ movements aim to lift the voices of women of color and resist a narrative that is dominated by white middle- and upper-class women. Both movements also aim to push beyond the narrow boundaries of “choice” and instead use a lens of economic and racial justice. But the movements diverge slightly when it comes to policy. Birth activists are trying to raise legal and policy issues that would, for instance, force insurance companies to pay for midwife-assisted births. Nationally, midwifery services covering everything from prenatal to postpartum care run between $6,000 and $8,000. In comparison, hospital births can cost upwards of $15,000, depending on what interventions are deemed “necessary” for the birthing parent. So midwifery-assisted birth is actually cheaper than a hospital birth assisted by an OB-GYN, and yet policy fails to address this—so this is something the birth justice movement is fighting for.

Rewire: The book talks a lot about medical violence and medical apartheid. Can you explain these terms, in both historical and contemporary contexts?

JCO: Both terms refer to the ways in which the bodies of Black people, both alive and dead, have been made into sites of medical examination, to achieve medical advances that improve the health of white communities. It’s important to foreground Black women’s stories here: such as the story of Anarcha, an enslaved Black woman who was forced to endure a series of horrendously painful medical experiments at the hands of J. Marion Sims, a white physician who is often held up as the so-called father of modern gynecology for “pioneering” a technique to repair vaginal fistulas (a condition caused by traumatic or obstructed labor resulting in an opening between the birth canal and the bladder or rectum) by experimenting on Black women with fistulas. Scholars like Harriet Washington have documented the legacy of American obstetrics, in which the bodies of enslaved Black women have been used to further birth options for white women. She documents the work of Louisiana surgeon Francois Marie Prevost, who “introduced” the cesarean section in the 1820s. At the time, opening up a woman’s abdomen was considered a death sentence, yet this was exactly what was done to Black women in the name of advancing medical techniques.

AB: An example of contemporary medical apartheid might include the ways in which, for example, Black and Hispanic women receive disproportionately fewer screenings for potential birth complications like preeclampsia. The medical establishment is grounded in racism, classism, and inherent sexism, and so unfortunately these axes of oppression come to the fore in doctor-patient relationships. Involuntary c-sections are another example of medical violence in the way we see women of color experience far higher rates of c-sections than white women. In particular, women of color are coerced by OB-GYNs and nurses [who convince them] that they are acting in the best interest of the child, despite the fact that many of these c-sections are unnecessary and unwarranted. We see hospital workers like nurses resort to fear-mongering to create the narrative that you are not a good mother if you don’t subject yourself to the unnecessary interventions and processes that the medical establishment has chosen for you, and this also hits Black women and women of color hardest.

Rewire: Who are “birth revolutionaries,” and how are they reclaiming natural birthing traditions?

JCO: Two sections in the book, “Changing Lives, One Birth at a Time” and “Taking Back Our Power: Organizing for Birth Justice” really lift up the stories of birth workers and birth activists working to change the systems, policies, and spaces surrounding pregnancy and childbirth. The word “revolutionary” suggests that the movement is not only about reform and tinkering around the edges, so to speak. We are not looking to simply reduce disproportionate mortality rates; we are seeking a fundamental transformation of the conditions under which we become pregnant and give birth so these inequalities no longer exist. One example I can point to is Tina Reynolds and the Women on the Rise Telling HerStory initiative, an advocacy organization comprised of current and formerly incarcerated women resisting the brutality of the prison system, such as the shackling of women during labor.

AB: I co-authored a chapter in the book with a Black birth revolutionary named Jennie Joseph who works to change deleterious birth outcomes for women. She has worked specifically in the three counties in Florida that have the worst maternal and infant health outcomes for women of color and has created a program called the JJ Way, which unites volunteer community health workers with birthing parents in underrepresented and underserved neighborhoods to improve overall health outcomes. Such efforts amplify birth advocacy and activism for the benefit of the entire community, and I would argue that this is revolutionary.

Rewire: The book discusses the “commercialization” and “co-optation” of traditional birthing practices. Can you tell us what this means?

AB: If you have a global perspective on childbirth, you will notice that midwife-assisted births are the most common form of delivery worldwide. Here in the United States, however, midwifery has long been denigrated by the white medical establishment, and associated with superstition and other “non-scientific” practices. Birth workers have fought against this quality versus quantity approach, which frames hospital births and all their attendant interventions as being the better option. This is largely the result of living in a highly consumer-driven society.

JCO: The other side of the coin is that natural birth and midwifery activists have achieved greater acceptance of these practices, but this has not opened the door to women of color because the system is premised on the ability to pay. A typical response within a highly commercialized and consumerized society is that the establishment will recognize certain demands, but only for those who are able or willing to pay. Coming at this from an economic justice lens, we see this as exclusionary, since many Black women and women of color do not have the means to “purchase” their preferred birthing process. This is where we return to what civil rights activist Ella Baker called “legalism”—the idea that laws alone will not build participatory democracy. She believed that change would not come only from individuals speaking to power in the language that power understands, and advocated for the mass mobilization of collective power. In the same way we see arguments for the legalization of midwifery, which stops short of calling for it to be accessible.

Rewire: What would you say are some of the most important messages in the book?

JCO: One of the messages I’d like to lift up is that this is an urgent movement about saving our lives. I consider birth justice part of the broader Black Lives Matter movement, especially the SayHerName campaign, which has really worked to center women’s voices and stories. In the same way, this book highlights how Black women are reclaiming birth as a powerful and beautiful experience, despite all the forces of birth oppression. Many stories in the anthology uphold moments of what I would call “autonomy,” where Black women and women of color have created completely separate spaces and moments of full empowerment. This is a message of hope in the now—we are not only struggling for a future birth experience but celebrating the birth revolutionaries who are decolonizing the birth experience in the present moment too.

AB: One thing I think the book highlights that is missing in conversations about reproductive justice is the shame associated with miscarriage. I think there has been a lot of internalization of the idea that women are machines who exist solely for the purpose of producing children—and when we are unable to do so it means we are defective in some way. It’s extremely important to interrupt this narrative with one that centers the autonomy of women and birthing parents, and fights the notion of miscarriage as something shameful. We have a chapter in the book by Viviane Saleh-Hanna, a professor at University of Massachusetts Dartmouth, “On Natural Birth and Miscarriage,” which really speaks to this important message.

And finally, one of the things that I find incredibly powerful about the anthology is that we historicize the cultural traditions of Granny Midwives, older Black women who have functioned within Black communities not only as birth caretakers but also health workers for the entire community. So we start there, and end the book by looking at ways in which activists are reclaiming these traditions, and reclaiming the birth space as something sacred, which I see as a really hopeful message.

This interview has been lightly edited for clarity.