Now that I’ve made it past the halfway point on my second pregnancy, things are starting to become a little more real. I’m realizing that actual plans to give birth should be made, and that I will soon need to make realistic decisions about how I plan to raise and care for this child once he is born.
I assumed with everything that I learned and experienced having Violet, things would be easier the second time around. For some situations, like the actual event of giving birth, I am hoping that I will have a second chance to succeed in the delivery room, and have the experience I was denied the first time. Now I’m hoping maybe I can have a second chance at breastfeeding, too.
With Violet, I had every advantage a breastfeeding mother could ever want: access to a hospital pump for her first ten days, a bevy of NICU nurses all who said they were certified lactation consultants, a strong baby who appeared to have a voracious appetite and no issues with latching, and an endless supply of mother’s milk tea, peanut butter toast, apple juice and advice.
But every advantage came with a roadblock: my NICU baby was full term and mostly healthy, just on an antibiotic IV. She was also the only child in the ward for most of her stay. The same nurses who encouraged and advised me non-stop on my breastfeeding adventures would also give her bottles when she woke up hungry, just to “let me get some rest” after a grueling labor, an emergency c-section, an infection, and massive blood loss. After my stay in the hospital ended and Violet had another week still to go, they told me that I should concentrate on getting myself healthy by going home at night to sleep, while my daughter woke up to more staff cuddles and even more formula.
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I did all of the things I was told I needed to do. I drank the teas. I woke up every three hours, pumping at home with my Mendela electric, spending 30 minutes on each side, crying when a full night’s work combined to make three small ounces that were gone within the first feeding back at the hospital.
Then, back to the formula.
I’d go to the family room to get more juice or heat more tea, weary, in pain, staring at the giant poster that listed all of the horrible things that companies put in formula that you would never have to expose your baby to if you just gave him the breast. I was trying to give her the breast. But it was never enough.
The nurses came up with a myriad of reasons why I just didn’t seem to be producing enough milk. C-section surgery can stall your milk coming in, they told me. You had a severe loss of blood your body is trying to make up first, said another. You need to keep pumping more, I heard from a third. I would feed my baby, hand her over to my husband or a nurse, and then go back to a dayroom in the hospital and pump some more.
Except for the first moment they wheeled me into her room, I don’t think I ever just sat and held my baby during the entire first ten days of her life. Instead, I only held her to feed.
Once her antibiotics were done and she was discharged, things became much easier. I nursed her when she cried. We began to have that feeling of closeness that people had told me about, but I always seemed to be missing at the hospital. On the nurses’ advice I’d feed her for 20 minutes on each side, then if she still seemed hungry I would make her a small bottle to top her off.
When we went into the doctor for her follow-up a week later, she had lost 6 ounces. The doctor forbade me from breast feeding, because he wanted to monitor how much food she was receiving.
Violet was officially being classified as “failure to thrive.”
Suddenly, I was in a completely different breastmilk world. My husband’s paternity leave and vacation had ended, and I was alone for the first time with my daughter. I was pumping now for 40 minutes every two hours, trying desperately to build up supply. I still had hardly enough for one feeding, and now I had to combine pumping time and feeding time, forming this endless loop with either a bottle or a pump in my hands at all time. It was never enough. I found myself resenting the baby, who would be in a glider, crying for me while I pumped. Couldn’t she see I still had five more minutes left on my right side and I was doing this for her!
That was when I realized that it wasn’t just my daughter that was “failing to thrive,” but our relationship, too.
I began to taper down my pumping. It had been four weeks, and she had begun to put on weight. I pumped three times a day, getting just enough milk to make me feel like I was providing a little bit of antibodies if nothing else, mixing it with the water in her formula. Soon I switched to twice a day, then once, finishing up the day she turned six weeks old.
I held her more. We had time to cuddle on the couch, where she would nuzzle up and sleep on my chest. She was already pushing herself up on her arms, rolling over, things I had time to enjoy because I wasn’t stuck in the constant cycle of pumping and feeding and yes, even crying. She started to sleep through the night. I started to sleep through the night. And I started to think maybe I wasn’t the most horrible mother in the world after all.
My milk never came in. I never was able to really give her my breast. But I was able to give her me.
Now, I will have a chance to try this all again. This time I am more prepared. I know that many of the roadblocks that might have hindered me previously will probably not be an issue this time. With no induction, my likelihood for an emergency c-section is greatly reduced, since we should end up with either a vaginal birth or a planned c-section. With IV antibiotics during labor, the baby should come out perfectly healthy, and I should be able to keep him in my room, away from well-intention but somewhat contradictory nurses. We should be able to be together, from the moment of birth, through our discharge, and at home, providing the best foundation for potential breastfeeding. And, having watched my incessantly moving, constantly underweight newborn blossom into a healthy, mentally-advanced and physically exhausting toddler has taught me that what may at first look like failure to thrive might instead be a child settling into its own skin.
But I’ve also learned a valuable lesson from my experience with Violet. Despite all of your plans and best intentions, sometimes breastfeeding just might not work out. I can only do what I am capable of, and this time, I will recognize that the milk from my breast is not as important as the time I get to spend with my baby, nurturing him, helping him grow and develop.
Mothers struggle constantly with their desire to breastfeed being hit head-on by extenuating circumstances, as fellow Rewire reporter Amie Newman discussed elequantly last year. But while I will go into this second attempt optimistic, I will also be easier on myself, not falling prey to the potential feelings of shame and inadequacy that can sometimes accompany bottle-feeding should things not work this time, either.
Being a good parent has less to do with what goes into your infant’s stomach, and everything to do with what goes on when you hold that baby in your arms.
Donald Trump's running mate has said that "life is winning in Indiana"—and the biggest winner is probably a chain of crisis pregnancy centers that landed a $3.5 million contract in funds originally intended for poor Hoosiers.
Much has been made of Republican Gov. Mike Pence’s record on LGBTQ issues. In 2000, when he was running for U.S. representative, Pence wrote that “Congress should oppose any effort to recognize homosexual’s [sic] as a ‘discreet and insular minority’ [sic] entitled to the protection of anti-discrimination laws similar to those extended to women and ethnic minorities.” He also said that funds meant to help people living with HIV or AIDS should no longer be given to organizations that provide HIV prevention services because they “celebrate and encourage” homosexual activity. Instead, he proposed redirecting those funds to anti-LGBTQ “conversion therapy” programs, which have been widely discredited by the medical community as being ineffective and dangerous.
Under Pence, ideology has replaced evidence in many areas of public life. In fact, Republican presidential nominee Donald Trump has just hired a running mate who, in the past year, has reallocated millions of dollars in public funds intended to provide food and health care for needy families to anti-choice crisis pregnancy centers.
Gov. Pence, who declined multiple requests for an interview with Rewire, has been outspoken about his anti-choice agenda. Currently, Indiana law requires people seeking abortions to receive in-person “counseling” and written information from a physician or other health-care provider 18 hours before the abortion begins. And thanks, in part, to other restrictive laws making it more difficult for clinics to operate, there are currently six abortion providers in Indiana, and none in the northern part of the state. Only four of Indiana’s 92 counties have an abortion provider. All this means that many people in need of abortion care are forced to take significant time off work, arrange child care, and possibly pay for a place to stay overnight in order to obtain it.
This environment is why a contract quietly signed by Pence last fall with the crisis pregnancy center umbrella organization Real Alternatives is so potentially dangerous for Indiana residents seeking abortion: State-subsidized crisis pregnancy centers not only don’t provide abortion but seek to persuade people out of seeking abortion, thus limiting their options.
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“Indiana is committed to the health, safety, and wellbeing [sic] of Hoosier families, women, and children,” reads the first line of the contract between the Indiana State Department of Health and Real Alternatives. The contract, which began on October 1, 2015, allocates $3.5 million over the course of a year for Real Alternatives to use to fund crisis pregnancy centers throughout the state.
Where Funding Comes From
The money for the Real Alternatives contract comes from Indiana’s Temporary Assistance for Needy Families (TANF) block grant, a federally funded, state-run program meant to support the most vulnerable households with children. The program was created by the 1996 Personal Responsibility and Work Opportunity Reconciliation Act signed by former President Bill Clinton. It changed welfare from a federal program that gave money directly to needy families to one that gave money, and a lot of flexibility with how to use it, to the states.
This TANF block grant is supposed to provide low-income families a monthly cash stipend that can be used for rent, child care, and food. But states have wide discretion over these funds: In general, they must use the money to serve families with children, but they can also fund programs meant, for example, to promote marriage. They can also make changes to the requirements for fund eligibility.
As of 2012, to be eligible for cash assistance in Indiana, a household’s maximum monthly earnings could not exceed $377, the fourth-lowest level of qualification of all 50 states, according to a report by the Congressional Research Service. Indiana’s program also has some of the lowest maximum payouts to recipients in the country.
Part of this is due to a 2011 work requirement that stripped eligibility from many families. Under the new work requirement, a parent or caretaker receiving assistance needs to be “engaged in work once the State determines the parent or caretaker is ready to engage in work,” or after 24 months of receiving benefits. The maximum time allowed federally for a family to receive assistance is 60 months.
“There was a TANF policy change effective November 2011 that required an up-front job search to be completed at the point of application before we would proceed in authorizing TANF benefits,” Jim Gavin, a spokesman for the state’s Family and Social Services Administration (FSSA), told Rewire. “Most [applicants] did not complete the required job search and thus applications were denied.”
Unspent money from the block grant can be carried over to following years. Indiana receives an annual block grant of $206,799,109, but the state hasn’t been using all of it thanks to those low payouts and strict eligibility requirements. The budget for the Real Alternatives contract comes from these carry-over funds.
According to the U.S. Department of Health and Human Services, TANF is explicitly meant to clothe and feed children, or to create programs that help prevent “non-marital childbearing,” and Indiana’s contract with Real Alternatives does neither. The contract stipulates that Real Alternatives and its subcontractors must “actively promote childbirth instead of abortion.” The funds, the contract says, cannot be used for organizations that will refer clients to abortion providers or promote contraceptives as a way to avoid unplanned pregnancies and sexually transmitted infections.
Parties involved in the contract defended it to Rewire by saying they provide material goods to expecting and new parents, but Rewire obtained documents that showed a much different reality.
Real Alternatives is an anti-choice organization run by Kevin Bagatta, a Pennsylvania lawyer who has no known professional experience with medical or mental health services. It helps open, finance, and refer clients to crisis pregnancy centers. The program started in Pennsylvania, where it received a $30 million, five-year grant to support a network of 40 subcontracting crisis pregnancy centers. Auditor General Eugene DePasquale called for an audit of the organization between June 2012 and June 2015 after hearing reports of mismanaged funds, and found $485,000 in inappropriate billing. According to the audit, Real Alternatives would not permit DHS to review how the organization used those funds. However, the Pittsburgh Post-Gazettereported in April that at least some of the money appears to have been designated for programs outside the state.
Real Alternatives also received an $800,000 contract in Michigan, which inspired Gov. Pence to fund a $1 million yearlong pilot program in northern Indiana in the fall of 2014.
“The widespread success [of the pilot program] and large demand for these services led to the statewide expansion of the program,” reads the current $3.5 million contract. It is unclear what measures the state used to define “success.”
“Every Other Baby … Starts With Women’s Care Center”
Real Alternatives has 18 subcontracting centers in Indiana; 15 of them are owned by Women’s Care Center, a chain of crisis pregnancy centers. According to its website, Women’s Care Center serves 25,000 women annually in 23 centers throughout Florida, Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin.
Women’s Care Centers in Indiana received 18 percent of their operating budget from state’s Real Alternatives program during the pilot year, October 1, 2014 through September 30, 2015, which were mostly reimbursements for counseling and classes throughout pregnancy, rather than goods and services for new parents.
In fact, instead of the dispensation of diapers and food, “the primary purpose of the [Real Alternatives] program is to provide core services consisting of information, sharing education, and counseling that promotes childbirth and assists pregnant women in their decision regarding adoption or parenting,” the most recent contract reads.
The program’s reimbursement system prioritizes these anti-choice classes and counseling sessions: The more they bill for, the more likely they are to get more funding and thus open more clinics.
“This performance driven [sic] reimbursement system rewards vendor service providers who take their program reimbursement and reinvest in their services by opening more centers and hiring more counselors to serve more women in need,” reads the contract.
Classes, which are billed as chastity classes, parenting classes, pregnancy classes, and childbirth classes, are reimbursed at $21.80 per client. Meanwhile, as per the most recent contract, counseling sessions, which are separate from the classes, are reimbursed by the state at minimum rates of $1.09 per minute.
Jenny Hunsberger, vice president of Women’s Care Center, told Rewire that half of all pregnant women in Elkhart, LaPorte, Marshall, and St. Joseph Counties, and one in four pregnant women in Allen County, are clients of their centers. To receive any material goods, such as diapers, food, and clothing, she said, all clients must receive this counseling, at no cost to them. Such counseling is billed by the minute for reimbursement.
“When every other baby born [in those counties] starts with Women’s Care Center, that’s a lot of minutes,” Hunsberger told Rewire.
Rewire was unable to verify exactly what is said in those counseling sessions, except that they are meant to encourage clients to carry their pregnancies to term and to help them decide between adoption or child rearing, according to Hunsberger. As mandated by the contract, both counseling and classes must “provide abstinence education as the best and only method of avoiding unplanned pregnancies and sexually transmitted infections.”
In the first quarter of the new contract alone, Women’s Care Center billed Real Alternatives and, in turn, the state, $239,290.97; about $150,000 of that was for counseling, according to documents obtained by Rewire. In contrast, goods like food, diapers, and other essentials for new parents made up only about 18.5 percent of Women’s Care Center’s first-quarter reimbursements.
Despite the fact that the state is paying for counseling at Women’s Care Center, Rewire was unable to find any licensing for counselors affiliated with the centers. Hunsberger told Rewire that counseling assistants and counselors complete a minimum training of 200 hours overseen by a master’s level counselor, but the counselors and assistants do not all have social work or psychology degrees. Hunsberger wrote in an email to Rewire that “a typical Women’s Care Center is staffed with one or more highly skilled counselors, MSW or equivalent.”
Rewire followed up for more information regarding what “typical” or “equivalent” meant, but Hunsberger declined to answer. A search for licenses for the known counselors at Women’s Care Center’s Indiana locations turned up nothing. The Indiana State Department of Health told Rewire that it does not monitor or regulate the staff at Real Alternatives’ subcontractors, and both Women’s Care Center and Real Alternatives were uncooperative when asked for more information regarding their counseling staff and training.
Bethany Christian Services and Heartline Pregnancy Center, Real Alternatives’ other Indiana subcontractors, billed the program $380.41 and $404.39 respectively in the first quarter. They billed only for counseling sessions, and not goods or classes.
“We don’t provide medical services. We provide human services,” Bagatta told the City Paper.
There are pregnancy centers in Indiana that provide a full range of referrals for reproductive health care, including for STI testing and abortion. However, they are not eligible for reimbursement under the Real Alternatives contract because they do not maintain an anti-choice mission.
Parker Dockray is the executive director of Backline, an all-options pregnancy resource center. She told Rewire that Backline serves hundreds of Indiana residents each month, and is overwhelmed by demand for diapers and other goods, but it is ineligible for the funding because it will refer women to abortion providers if they choose not to carry a pregnancy to term.
“At a time when so many Hoosier families are struggling to make ends meet, it is irresponsible for the state to divert funds intended to support low-income women and children and give it to organizations that provide biased pregnancy counseling,” Dockray told Rewire. “We wish that Indiana would use this funding to truly support families by providing job training, child care, and other safety net services, rather than using it to promote an anti-abortion agenda.”
“Life Is Winning in Indiana”
Time and again, Bagatta and Hunsberger stressed to Rewire that their organizations do not employ deceitful tactics to get women in the door and to convince them not to have abortions. However, multiple studies have proven that crisis pregnancy centers often lie to women from the moment they search online for an abortion provider through the end of their appointments inside the center.
These studies have also shown that publicly funded crisis pregnancy centers dispense medically inaccurate information to clients. In addition to spreading lies like abortion causing infertility or breast cancer, they are known to give false hopes of miscarriages to people who are pregnant and don’t want to be. A 2015 report by NARAL Pro-Choice America found this practice to be ubiquitous in centers throughout the United States, and Rewire found that Women’s Care Center is no exception. The organization’s website says that as many as 40 percent of pregnancies end in natural miscarriage. While early pregnancy loss is common, it occurs in about 10 percent of known pregnancies, according to the American Congress of Obstetricians and Gynecologists.
Crisis pregnancy centers also tend to crop up next to abortion clinics with flashy, deceitful signs that lead many to mistakenly walk into the wrong building. Once inside, clients are encouraged not to have an abortion.
A Google search for “abortion” and “Indianapolis” turns up an ad for the Women’s Care Center as the first result. It reads: “Abortion – Indianapolis – Free Ultrasound before Abortion. Located on 86th and Georgetown. We’re Here to Help – Call Us Today: Abortion, Ultrasound, Locations, Pregnancy.”
Hunsberger denies any deceit on the part of Women’s Care Center.
“Clients who walk in the wrong door are informed that we are not the abortion clinic and that we do not provide abortions,” Hunsberger told Rewire. “Often a woman will choose to stay or return because we provide services that she feels will help her make the best decision for her, including free medical-grade pregnancy tests and ultrasounds which help determine viability and gestational age.”
Planned Parenthood of Indiana and Kentucky told Rewire that since Women’s Care Center opened on 86th and Georgetown in Indianapolis, many patients looking for its Georgetown Health Center have walked through the “wrong door.”
“We have had patients miss appointments because they went into their building and were kept there so long they missed their scheduled time,” Judi Morrison, vice president of marketing and education, told Rewire.
Sarah Bardol, director of Women’s Care Center’s Indianapolis clinic, told the Criterion Online Edition, a publication of the Archdiocese of Indianapolis, that the first day the center was open, a woman and her boyfriend did walk into the “wrong door” hoping to have an abortion.
“The staff of the new Women’s Care Center in Indianapolis, located just yards from the largest abortion provider in the state, hopes for many such ‘wrong-door’ incidents as they seek to help women choose life for their unborn babies,” reported the Criterion Online Edition.
If they submit to counseling, Hoosiers who walk into the “wrong door” and “choose life” can receive up to about $40 in goods over the course their pregnancy and the first year of that child’s life. Perhaps several years ago they may have been eligible for Temporary Assistance for Needy Families, but now with the work requirement, they may not qualify.
In a February 2016 interview with National Right to Life, one of the nation’s most prominent anti-choice groups, Gov. Pence said, “Life is winning in Indiana.” Though Pence was referring to the Real Alternatives contract, and the wave of anti-choice legislation sweeping through the state, it’s not clear what “life is winning” actually means. The state’s opioid epidemic claimed 1,172 lives in 2014, a statistically significant increase from the previous year, according to the Centers for Disease Control and Prevention. HIV infections have spread dramatically throughout the state, in part because of Pence’s unwillingness to support medically sound prevention practices. Indiana’s infant mortality rate is above the national average, and infant mortality among Black babies is even higher. And Pence has reduced access to prevention services such as those offered by Planned Parenthood through budget cuts and unnecessary regulations—while increasing spending on anti-choice crisis pregnancy centers.
Gov. Pence’s track record shows that these policies are no mistake. The medical and financial needs of his most vulnerable constituents have taken a backseat to religious ideology throughout his time in office. He has literally reallocated money for poor Hoosiers to fund anti-choice organizations. In his tenure as both a congressman and a governor, he’s proven that whether on a national or state level, he’s willing to put “pro-life” over quality-of-life for his constituents.
For all 29 years of my life, the right to abortion has been under attack. In early March, I slept at the Supreme Court overnight, waiting for oral arguments, and had time to reflect on the experiences that have made me an advocate.
I am a Texas native, a Latina, a lawyer, and a reproductive justice advocate, so this case, Whole Woman’s Health v. Hellerstedt, naturally hits close to home.
In the years since HB 2 has passed, I have heard from friends who have waited weeks and been forced to drive hours just to get an appointment at a clinic. And, as my colleagues and I wrote in an amicus brief the National Latina Institute for Reproductive Health filed with the Supreme Court, women of color in Texas, particularly the 2.5 million Latinas of reproductive age, have been disproportionately affected by the clinic closings resulting from the expensive, onerous, and medically unnecessary standards HB 2 imposed. For example, if the law had been allowed to go into full effect, residents of my birthplace, El Paso, Texas, where 81 percent of the population is Latinx, would have to drive over 500 miles to San Antonio in order to get an abortion in the state.
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In early March, I slept at the Court overnight, waiting for oral arguments. In the 24 hours I spent outside the Court, I had time to reflect on the experiences that have made me an advocate.
I am 12, with my mother and her dear friend at the dinner table. As the three of us sit together, I regale them with stories of a teacher I deeply admire. She’s been telling us about how she prays the rosary and speaks to women entering abortion clinics, urging them to “choose life.” I believe this is a good act, something I want to be part of, and I’m proud of my righteousness. My mother’s friend says to me simply, “There are a lot of reasons women have abortions.” Almost 20 years later I will learn that this friend had an abortion, which makes sense statistically speaking, since one in three women do.
I am 14 and sitting in high school religion class. The male instructor tells us that pre-marital sex and contraception are forbidden by our Catholic faith. He says the risk especially isn’t worth it for women: It is, according to him, physically impossible for women to orgasm. At the time, and still, I despair for this man’s wife, and for him. Shortly after this lesson the class watches a 45-minute “documentary” about “partial-birth abortion.” This concludes my sexual health education.
I am 18 and counting 180 seconds, waiting to see whether one or two lines appear on a white stick. In a few weeks I am moving to New York to begin college. In those 180 seconds I decide with little fanfare that, regardless of the number of lines, I will not be pregnant when I go. One line appears and I move, able to begin the education I’ve dreamed of and worked for.
I am 19 and talking with a friend. We get to a question that often comes up among women: What would you do if you got pregnant? She tells me calmly and candidly that she would have an abortion. She is the first person I’ve heard say this aloud. Her certitude resonates with me. I know that I would too, and that though I always felt I should be sorry, I would not be. I feel the weight of the shame I’ve been carrying and I stop apologizing for what I know.
I am 20 and teaching sexual education classes to high school students. More than one young woman tells me that she believes she can prevent pregnancy by spraying Coca-Cola into her vagina after intercourse. We talk about safe and effective methods of contraception. Years later, I still think about the damage and danger inflicted upon young women out of fear of our sexuality and power.
I am 21 and lying naked in bed next to a man I’ve been seeing. We’re discussing monogamy. I’m on the pill and he’d like to stop using condoms. He wants me to know, though, that if I become pregnant he won’t let me have an abortion. Because I am desperate to be loved and because I don’t yet understand that love doesn’t mean conceding your autonomy, it will take another year before I leave him.
I am 22 and my friend—the first I know of—tells me she is having an abortion. After the procedure I do not know the right thing to do or say or how to comfort and support her. We will lose touch. Like 95 percent of women who have abortions, she will not regret her choice. When we reconnect years later, we will talk about her happiness and success and about how far we’ve both come.
I am 24 and reading about Congress making a budget deal contingent on “defunding” Planned Parenthood. I understand that though I now refuse to date men who believe they have a say in my reproductive choices, I’m stuck with hundreds of representatives and senators who think they do and who will use my body and health as a bargaining chip.
Today I am 29 and five justices of the Supreme Court have declared the burden imposed by two provisions of HB 2 undue. Limiting abortion and lying about the effects of these laws hurts women’s health, and now the highest court in this nation has declared these actions and these laws unacceptable and unconstitutional. I am in Washington, D.C., 1,362 miles from the home where I grew up, the day the decision is announced, but it is not just about me and it’s not just about Texas. It is about the recognition and vindication of our worth and rights as human beings. All 162 million of us.