I Am A Midwife

Nicole SistaMidwife Deggins

I did not start out to become a midwife. But my journey through nursing school led me first to be a labor and delivery nurse, and then a midwife.  I will always be a midwife.

This post is one in a series of pieces Rewire is publishing to highlight National Midwifery Week 2010 (Oct 3- 9).

My first experience with a laboring woman (my aunt) left me running for my room and making a pact with God. If boys and sex were what caused that pain, I promised I would never have either.  I asked God to protect me from both. I was nine years old.

My next experience with birth came ten years later. I was a junior nursing student at Georgetown University at the beginning of my OB clinical rotation. My classmates and I were being assigned patients and our clinical instructor said:

“There is a patient who is in very early labor; only one centimeter dilated. It is her first baby and the charge nurse does not think she will deliver while we are here. But – she is alone, and nervous, and she really needs someone who can be with her and talk to her.” 

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Being the loquacious person I am, everyone immediately looked at me and it was unanimously decided that she would be my patient. Lo and behold, four hours later I was the only student to witness the miracle of birth that day and it was an awe-inspiring experience to say the least. The new mother was grateful for my presence and I was delighted. The registered nurse I worked with was fabulous. The entire experience was unforgettable. I knew right then –  I wanted to be a labor and delivery nurse.

In 1995, I began working as a labor and delivery nurse at a public, teaching hospital. We served the highest-risk patients of the city. We were often understaffed and overwhelmed with the number of deliveries. While working there, reality set in.  Maternity care was not always the quiet, comfortable, pleasant experience I witnessed as a Georgetown nursing student.  It could also be tough, rough, gritty, and scary.  It tested my stamina, my sense of humor, my skill set, and my knowledge base. It made me take a close look at my personal prejudices and ideas around birth, race, drug addiction, women, men, sex, and relationships. It forced me to examine the truth of who I was and opened my eyes to a world of joy, heartache, life, death and more.

Because this hospital was a teaching facility, many of the women unfortunately became teaching fodder. Their prenatal care was impersonal. They were simply numbers in a box. Patients were offered no prenatal education, were ill-informed and often arrived not able to tell us if they were a “T” or an “L” patient, each letter representing a different residency program. I was always amazed by this. I would think to myself, “I know these women are not stupid. Why are they unable to remember one letter?” I attempted to raise this concern to coworkers and was given the “Oh you know these young, uneducated, minority, drug addict, etc …” type of comments.  I had my doubts. It didn’t make sense to me. These girls, and women, were not stupid and I knew that. Still, I was confused.

I knew there had to be another way. I knew that laboring women with absolutely no familiarity with their provider was wrong.  I knew all the screaming and yelling, the bright lights, the long pushing, and loud counting was not right. I knew it was not right that doctors had not a clue as to the name of their female patients. I didn’t know how to make things right but I was sure – in my soul, in my spirit, in my gut – that there had to be another way. Something different, something better. Birth was not meant to be this way. Babies were not meant to be brought into the world amidst such chaos. 

And then it happened. 

In this often chaotic environment, among the many crash cesarean sections, crack-addicted babies and “baby mama dramas,” among the tears and laughter, the joy and the pain I caught my first baby (and my second, and third, and fourth….). It was in this same environment that I witnessed my first midwifery-attended birth.  And again, like the life-changing experience I had when I was a student at Georgetown, I knew immediately that midwifery was my calling. This midwifery delivery was so different from the loud, rushed, impersonal resident deliveries to which I had become accustomed. I had always known there had to be another way and finally I was there to witness it. I was overjoyed.

That was just the beginning.  Fast forward to 1997 and there I sat: the youngest in a class of twelve midwifery students at Emory University in Atlanta. 

While studying midwifery, I learned that I had a great-great aunt who had been a community midwife. Midwifery was in my blood. I learned that when treated with respect, as a person and not as a number, women and girls of any race, of all socioeconomic classes and of any age could vocalize their wishes,  and create an empowering birthing experience.  I learned that when women feel respected and genuinely cared for they will keep prenatal appointments and ask questions, and learn about birth –  all of which improves birth outcomes.  I learned that I was not in control. I learned that birth is an intricate interplay between mother, fetus, and the universe which should not be feared but respected. I learned that there was another way. It was called Midwifery.

Because of a number of necessary professional choices, today I sit once again working as a labor and delivery RN while longing to get back to practicing as a midwife. The current climate in my state for practicing midwifery is not the best and opportunities for working as a midwife are few and far between.  I was recently assured of this by a physician who said with venom,

“Nicole you are a midwife?! Well, you know, midwives have a very bad reputation in this city.”

This was in response to me asking her if she needed any help in her office.  For a nurse practitioner, “Yes,” she said. But for a midwife? Absolutely not! I felt like it was 1940 and she was calling me the “N” word. But no. It was the “M” word and her tone was just as negative.

Regardless of the “reputation” of midwives in this city and around the country in many places, I am proud to call myself a midwife. I believe that it is truly a calling and I feel blessed to have received it.  Often, as I work as a labor and delivery RN, I am asked “I heard you used to be a midwife?” I tell them, there is no “used to.” While I continue to temporarily work in the role of an RN, the spirit, the energy, the way of birth that I believe in has never left me.  I continue to be “with women.” I am a midwife and I am proud.

News Politics

Missouri ‘Witch Hunt Hearings’ Modeled on Anti-Choice Congressional Crusade

Christine Grimaldi

Missouri state Rep. Stacey Newman (D) said the Missouri General Assembly's "witch hunt hearings" were "closely modeled" on those in the U.S. Congress. Specifically, she drew parallels between Republicans' special investigative bodies—the U.S. House of Representatives’ Select Investigative Panel on Infant Lives and the Missouri Senate’s Committee on the Sanctity of Life.

Congressional Republicans are responsible for perpetuating widely discredited and often inflammatory allegations about fetal tissue and abortion care practices for a year and counting. Their actions may have charted the course for at least one Republican-controlled state legislature to advance an anti-choice agenda based on a fabricated market in aborted “baby body parts.”

“They say that a lot in Missouri,” state Rep. Stacey Newman (D) told Rewire in an interview at the Democratic National Convention last month.

Newman is a longtime abortion rights advocate who proposed legislation that would subject firearms purchases to the same types of restrictions, including mandatory waiting periods, as abortion care.

Newman said the Missouri General Assembly’s “witch hunt hearings” were “closely modeled” on those in the U.S. Congress. Specifically, she drew parallels between Republicans’ special investigative bodies—the U.S. House of Representatives’ Select Investigative Panel on Infant Lives and the Missouri Senate’s Committee on the Sanctity of Life. Both formed last year in response to videos from the anti-choice front group the Center for Medical Progress (CMP) accusing Planned Parenthood of profiting from fetal tissue donations. Both released reports last month condemning the reproductive health-care provider even though Missouri’s attorney general, among officials in 13 states to date, and three congressional investigations all previously found no evidence of wrongdoing.

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Missouri state Sen. Kurt Schaefer (R), the chair of the committee, and his colleagues alleged that the report potentially contradicted the attorney general’s findings. Schaefer’s district includes the University of Missouri, which ended a 26-year relationship with Planned Parenthood as anti-choice state lawmakers ramped up their inquiries in the legislature. Schaefer’s refusal to confront evidence to the contrary aligned with how Newman described his leadership of the committee.

“It was based on what was going on in Congress, but then Kurt Schaefer took it a step further,” Newman said.

As Schaefer waged an ultimately unsuccessful campaign in the Missouri Republican attorney general primary, the once moderate Republican “felt he needed to jump on the extreme [anti-choice] bandwagon,” she said.

Schaefer in April sought to punish the head of Planned Parenthood’s St. Louis affiliate with fines and jail time for protecting patient documents he had subpoenaed. The state senate suspended contempt proceedings against Mary Kogut, the CEO of Planned Parenthood of St. Louis Region and Southwest Missouri, reaching an agreement before the end of the month, according to news reports.

Newman speculated that Schaefer’s threats thwarted an omnibus abortion bill (HB 1953, SB 644) from proceeding before the end of the 2016 legislative session in May, despite Republican majorities in the Missouri house and senate.

“I think it was part of the compromise that they came up with Planned Parenthood, when they realized their backs [were] against the wall, because she was not, obviously, going to illegally turn over medical records.” Newman said of her Republican colleagues.

Republicans on the select panel in Washington have frequently made similar complaints, and threats, in their pursuit of subpoenas.

Rep. Marsha Blackburn (R-TN), the chair of the select panel, in May pledged “to pursue all means necessary” to obtain documents from the tissue procurement company targeted in the CMP videos. In June, she told a conservative crowd at the faith-based Road to Majority conference that she planned to start contempt of Congress proceedings after little cooperation from “middle men” and their suppliers—“big abortion.” By July, Blackburn seemingly walked back that pledge in front of reporters at a press conference where she unveiled the select panel’s interim report.

The investigations share another common denominator: a lack of transparency about how much money they have cost taxpayers.

“The excuse that’s come back from leadership, both [in the] House and the Senate, is that not everybody has turned in their expense reports,” Newman said. Republicans have used “every stalling tactic” to rebuff inquiries from her and reporters in the state, she said.

Congressional Republicans with varying degrees of oversight over the select panel—Blackburn, House Speaker Paul Ryan (WI), and House Energy and Commerce Committee Chair Fred Upton (MI)—all declined to answer Rewire’s funding questions. Rewire confirmed with a high-ranking GOP aide that Republicans budgeted $1.2 million for the investigation through the end of the year.

Blackburn is expected to resume the panel’s activities after Congress returns from recess in early September. Schaeffer and his fellow Republicans on the committee indicated in their report that an investigation could continue in the 2017 legislative session, which begins in January.

Commentary Contraception

Hillary Clinton Played a Critical Role in Making Emergency Contraception More Accessible

Susan Wood

Today, women are able to access emergency contraception, a safe, second-chance option for preventing unintended pregnancy in a timely manner without a prescription. Clinton helped make this happen, and I can tell the story from having watched it unfold.

In the midst of election-year talk and debates about political controversies, we often forget examples of candidates’ past leadership. But we must not overlook the ways in which Hillary Clinton demonstrated her commitment to women’s health before she became the Democratic presidential nominee. In early 2008, I wrote the following article for Rewirewhich has been lightly edited—from my perspective as a former official at the U.S. Food and Drug Administration (FDA) about the critical role that Clinton, then a senator, had played in making the emergency contraception method Plan B available over the counter. She demanded that reproductive health benefits and the best available science drive decisions at the FDA, not politics. She challenged the Bush administration and pushed the Democratic-controlled Senate to protect the FDA’s decision making from political interference in order to help women get access to EC.

Since that time, Plan B and other emergency contraception pills have become fully over the counter with no age or ID requirements. Despite all the controversy, women at risk of unintended pregnancy finally can get timely access to another method of contraception if they need it—such as in cases of condom failure or sexual assault. By 2010, according to National Center for Health Statistics data, 11 percent of all sexually experienced women ages 15 to 44 had ever used EC, compared with only 4 percent in 2002. Indeed, nearly one-quarter of all women ages 20 to 24 had used emergency contraception by 2010.

As I stated in 2008, “All those who benefited from this decision should know it may not have happened were it not for Hillary Clinton.”

Now, there are new emergency contraceptive pills (Ella) available by prescription, women have access to insurance coverage of contraception without cost-sharing, and there is progress in making some regular contraceptive pills available over the counter, without prescription. Yet extreme calls for defunding Planned Parenthood, the costs and lack of coverage of over-the-counter EC, and refusals by some pharmacies to stock emergency contraception clearly demonstrate that politicization of science and limits to our access to contraception remain a serious problem.

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Today, women are able to access emergency contraception, a safe, second chance option for preventing unintended pregnancy in a timely manner without a prescription. Sen. Hillary Clinton (D-NY) helped make this happen, and I can tell the story from having watched it unfold.

Although stories about reproductive health and politicization of science have made headlines recently, stories of how these problems are solved are less often told. On August 31, 2005 I resigned my position as assistant commissioner for women’s health at the Food and Drug Administration (FDA) because the agency was not allowed to make its decisions based on the science or in the best interests of the public’s health. While my resignation was widely covered by the media, it would have been a hollow gesture were there not leaders in Congress who stepped in and demanded more accountability from the FDA.

I have been working to improve health care for women and families in the United States for nearly 20 years. In 2000, I became the director of women’s health for the FDA. I was rather quietly doing my job when the debate began in 2003 over whether or not emergency contraception should be provided over the counter (OTC). As a scientist, I knew the facts showed that this medication, which can be used after a rape or other emergency situations, prevents an unwanted pregnancy. It does not cause an abortion, but can help prevent the need for one. But it only works if used within 72 hours, and sooner is even better. Since it is completely safe, and many women find it impossible to get a doctor’s appointment within two to three days, making emergency contraception available to women without a prescription was simply the right thing to do. As an FDA employee, I knew it should have been a routine approval within the agency.

Plan B emergency contraception is just like birth control pills—it is not the “abortion pill,” RU-486, and most people in the United States don’t think access to safe and effective contraception is controversial. Sadly, in Congress and in the White House, there are many people who do oppose birth control. And although this may surprise you, this false “controversy” not only has affected emergency contraception, but also caused the recent dramatic increase in the cost of birth control pills on college campuses, and limited family planning services across the country.  The reality is that having more options for contraception helps each of us make our own decisions in planning our families and preventing unwanted pregnancies. This is something we can all agree on.

Meanwhile, inside the walls of the FDA in 2003 and 2004, the Bush administration continued to throw roadblocks at efforts to approve emergency contraception over the counter. When this struggle became public, I was struck by the leadership that Hillary Clinton displayed. She used the tools of a U.S. senator and fought ardently to preserve the FDA’s independent scientific decision-making authority. Many other senators and congressmen agreed, but she was the one who took the lead, saying she simply wanted the FDA to be able to make decisions based on its public health mission and on the medical evidence.

When it became clear that FDA scientists would continue to be overruled for non-scientific reasons, I resigned in protest in late 2005. I was interviewed by news media for months and traveled around the country hoping that many would stand up and demand that FDA do its job properly. But, although it can help, all the media in the world can’t make Congress or a president do the right thing.

Sen. Clinton made the difference. The FDA suddenly announced it would approve emergency contraception for use without a prescription for women ages 18 and older—one day before FDA officials were to face a determined Sen. Clinton and her colleague Sen. Murray (D-WA) at a Senate hearing in 2006. No one was more surprised than I was. All those who benefited from this decision should know it may not have happened were it not for Hillary Clinton.

Sometimes these success stories get lost in the “horse-race stories” about political campaigns and the exposes of taxpayer-funded bridges to nowhere, and who said what to whom. This story of emergency contraception at the FDA is just one story of many. Sen. Clinton saw a problem that affected people’s lives. She then stood up to the challenge and worked to solve it.

The challenges we face in health care, our economy, global climate change, and issues of war and peace, need to be tackled with experience, skills and the commitment to using the best available science and evidence to make the best possible policy.  This will benefit us all.

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