VBAC Bans and Court Ordered Cesareans

CTBirthAdvocate

Unfortunately we are seeing this trend across the country. Women being denied VBAC for the same reasons stated above, or because Doctors simply do not do them.

Arizona Mother Joy Szabo

All around the country we are starting to hear stories just like the
one of Joy Szabo, threatened by a court order for a cesarean section if
she was to show up at her local hospital Page Hospital of Lake Powell,
AZ. in labor attempting to have a VBAC.
Now, lets get into the history of Joy’s pregnancies. She had a healthy
vaginal birth with her first child, and then with her second child she
had an emergency cesarean section for a placental eruption, which was
followed by a healthy and safe VBAC with her third child. For those not
familiar with the term VBAC it means Vaginal Birth after a Cesarean
Section.
So what is the problem with Page Hospital?
Recently in June, the hospital decided they would no longer allow VBAC,
because of staffing problems they are having. Stating that they would
not be able to urgently deliver a baby if there is a problem with a
VBAC. But then comes the question about other moms who may need an
emergency cesarean section who have not had a previous cesarean
section. How are they able to deliver those babies under an emergent
situation, but not a mother who is having a VBAC?
Sorry but if you can’t handle one emergency, you can’t handle any and shouldn’t be delivering babies at all.
It is a cheap cop out.

Unfortunately we are seeing this trend across the country. Women
being denied VBAC for the same reasons stated above, or because Doctors
simply do not do them.

For more information on VBAC bans across the country visit http://ican-online.org/vbac-ban-info

To speak out against this human rights violation, contact Page
Hospital President and CEO Peter Fine at peter.fine@bannerhealth.com
Or visit their Facebook page and inform them of your outrage.
http://www.facebook.com/home.php#/BannerHealth?ref=ts

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Commentary Maternity and Birthing

What My First Pregnancy Taught Me About Birth Justice

Ruth Jeannoel

The medical community needs to do more to support women of color, particularly Black women, who must confront a number of hurdles in order to have a vaginal birth after cesarean.

This piece is published in collaboration with Echoing Ida, a Forward Together project.

After discovering I was pregnant for a second time, I had concerns that my previous cesarean section would keep me from having a vaginal birth. But what I learned after speaking with medical professionals and reading up on vaginal birth after cesarean (VBAC) is that it is possible, with the appropriate resources. I also came to realize that the medical community needs to do more to support women of color, particularly Black women, who must confront a number of hurdles in order to have a VBAC.

All across the country there has been an injection of #BlackLivesMatter in our decades-long Black liberation movement, and reproductive justice, including birth justice, is a critical part of those efforts. Birth justice includes making sure Black moms have full control of their own health and birth process through proper childbirth education and community resources.

It was around 9:30 p.m. on October 22, 2008, when I began to have contractions and I went to the hospital. I was about 32 weeks into my first pregnancy, which was well before my “safe period” of 37 weeks, which in 2008 was described as the stage when the fetus has fully developed. (The “safe period” has since changed to 39 weeks.) Within six hours of labor I developed preeclampsia, which is a pregnancy condition affecting as many as 8 percent of all pregnancies and can be deadly for Black women.

At about 10:30 p.m., the doctors explained I would need an emergency cesarean or else I could lose the little one I had been carrying.

I was scared: At the age of 21, I had to have major surgery.

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The nurses quickly changed my gown, gave me an epidural, and moved me from my hospital room to surgery. I kept thinking about how I didn’t want any of this, because I wanted to give birth naturally and without any pain relief medication, but it sounded so urgent. It sounded like I needed to really have a cesarean for both my safety and the health of my baby. And so on October 22 at 11:59 p.m. I had a c-section.

C-section rates are declining in the United States, but Black women continue to have them more frequently than their white counterparts. According to 2014 data from the Centers for Disease Control and Prevention, the cesarean delivery rate “declined for non-Hispanic white women for the fifth consecutive year, down 2% from 32.0% in 2013 to 31.4% in 2014 and 4% from the 2009 peak. Rates declined 1% for both non-Hispanic black (from 35.8% to 35.6%) and Hispanic women (32.3% to 31.9%). For the second year in a row, non-Hispanic white women had the lowest cesarean delivery rate; non-Hispanic black women continued to have the highest rate.”

Throughout my pregnancy I saw a midwife at a birth center, who ultimately was not with me when I developed preeclampsia and had to go under the knife. I felt disempowered because everything happened so fast and it seemed as if all of the decisions were made for me.

After the surgery, my family and close friends were glad that the baby and I were both safe. But beneath their concern for our safety I could see there was an underlying stigma around having a cesarean birth. Even though the c-section was not planned, I would get looked down on as if I wasn’t “woman enough” because I didn’t have a vaginal birth. I felt ashamed and didn’t know how to share my birth story because in a way I had lost decision-making control over it. I was unprepared to deal with the stigma that was attached with having a c-section.

A couple years after having my first child, I began to have a different understanding of what reproductive justice is and began to reflect more on what it would look like in my own life. SisterSong Women of Color Reproductive Justice Collective describes reproductive justice as, “the human right to have children, not have children, and parent the children we have in safe and healthy environments.”

During that period between my two pregnancies, after having more conversations with other mothers and hearing different birth stories, I began to understand that what I was attempting to deal with wasn’t about vaginal birth vs. cesarean birth; it was about women having the bodily autonomy to make their own decisions. I told myself that if I ever got pregnant again, I would make sure that I had all the necessary information to ultimately decide how my birth went: I would do everything in my power to have a vaginal birth. For example, had I known in advance that I may be susceptible to preeclampsia, I would have looked into methods to lower the risks of complications.

While telling everyone who asked (or didn’t) that I would have a vaginal birth, I ran into several myths. The main one was that you can’t have a vaginal birth after c-section. It just didn’t make sense to me because I knew that birthing was a natural process, meaning that I needed to trust my body and know that every pregnancy was different and that my body could handle a vaginal birth.

At that point I had a lot more questions than answers.

I began reading and asking my OB-GYN about vaginal births and she described the risks and benefits of having a VBAC and emphasized that it was very possible. And she, of course, was right.

As research from the National Institutes of Health explains, “VBAC is a reasonable and safe choice for the majority of women with prior cesarean.” The American College of Obstetricians & Gynecologists (ACOG) agrees, adding that “most” women with one prior cesarean and “some” women with two prior cesareans are candidates for VBAC.

The main problem a woman seeking to have a VBAC might encounter, I found during my research, was a potential uterine rupture. However, a report published in the Obstetrics & Gynecology medical journal found:

Despite increased rates of VBAC attempt and VBAC failure among black women as compared with other racial groups, black women are significantly less likely to experience a uterine rupture. It is unclear whether this discrepancy in magnitudes of risks and benefits across race associated with VBAC trials is attributable to selection bias or inherent racial differences.

My research helped me to better understand that the risks associated with a VBAC weren’t as high as I thought.

When I found out that I was pregnant five years later, I moved forward with my plan to have a VBAC. By that time I had moved to another state, and VBACs were not as common or accessible in Florida as they were in Massachusetts.

I quickly learned that not every OB-GYN I encountered performs VBACs. In South Florida, I had only three doctors to choose from. With help from my doula, I was able to find the right one and a hospital where VBAC was an option.

Unfortunately, in Black communities, not everyone may have access to doctors who do VBAC. Because of the higher risk of uterine rupture, many hospitals, especially in low-income communities of color, are not able to make this accommodation. Also, I found that doctors often do not promote VBACs; therefore, many women who may want to have one may not know that such an option exists.

In 2014, at 37 weeks, I was able to have a successful VBAC and give birth to my second born. I was proud of myself that I was able to have a vaginal birth under my own terms in a hospital room with an amazing team of doctors.

It’s important to dispel the myth that you can’t have a vaginal birth after a previous c-section. Doctors and the medical community have a responsibility to make sure that all women have the appropriate information to make an informed decision over their body. It will always be a woman’s right to choose how she wants to have her child, and where she wants to have her child if her local hospital doesn’t offer the services she requires.

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.