Commentary Maternity and Birthing

Stoking Fire: ‘Laboring,’ A Midwife’s Tale

Eleanor J. Bader

Laboring: Stories of a New York City Hospital Midwife provides an anecdotal look back at Ellen Cohen's nearly three-decade-long tenure as a midwife. By turns, the book is heartbreaking and exhilarating.

When midwife-turned-memoirist Ellen Cohen had her first child in 1963, she says that women were routinely tied down during labor, had their genital area shaved, and were given sedatives whether they wanted them or not. Partners were excluded from the labor and delivery rooms, and babies were whisked away within minutes of their arrival.

“Several years after I had my kids—my son was born a year after my daughter, in 1964—I read an article about modern midwives, women who challenged this model. As soon as I’d finished it, I said, ‘That’s what I want to do,’” Cohen told Rewire. “At that time there was no professional recognition of non-nurse midwives. As far as I knew, if you wanted to help women through pregnancy, and then deliver their babies, you had to go to nursing school, so that’s what I did.”

“I’m a city girl,” Cohen laughs, which is why she has always worked in public and private hospitals and community-based health centers in urban areas. She estimates that she has assisted in 1,400 births, aiding the affluent and the poor, the healthy and the sick, the native born and the immigrant.

These experiences form the crux of Laboring: Stories of a New York City Hospital Midwife, an anecdotal look back at Cohen’s nearly three-decade-long tenure as a midwife. By turns, the book is heartbreaking and exhilarating.

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Cohen reports that the approximately 12,000 certified nurse midwives working in the United States are responsible for nearly 8 percent of all domestic births. “Ninety-five percent of midwife deliveries take place in hospitals,” she writes. “The public associates midwives with home births because of the media attention to that part of our practice. … My patients did not always have homes. They were randomly assigned to me in busy clinics and no-frills hospital labor rooms where it was often a struggle to give each woman the time and attention she deserved.”

Still, Cohen makes it clear that for her and her colleagues, midwifery was more than a job. She calls their approach “high-touch, low-tech” and emphasizes that it questions a medical model that favors intervention over natural processes.

“Most newborn and maternal deaths take place in hospitals because 99 percent of births take place in hospitals,” Cohen said. “But there are some processes, some interventions that may not be necessary. I’m referring to inductions and c-sections. Caesarians are now performed for one of every three births, even when there are no identifiable risk factors, when the mothers-to-be are young and of normal weight. I think the pattern of practice has changed so that there is now greater acceptance of c-sections by obstetricians and, to a lesser extent, by women, as a normal procedure for birth.”

On a more positive note, Cohen says that many medical facilities have stopped doing inductions before 39 weeks, a practice that has led to fewer newborns being placed in neonatal intensive care units.

“Over the last few years, the March of Dimes has been trying to inculcate the idea that no inductions or elective c-sections should be performed before 39 weeks because each week of fetal development, up to term, is important for the development of the lungs, brain, and nervous system. The prematurity rate has finally leveled off, and it may be because the idea of not delivering before 39 weeks has finally taken hold,” she said.

Still, premature births continue to occur, as do unanticipated complications, and Laboring is filled with stories ranging from the tragic to the triumphant. Although Cohen retired in 2005, the dramatic details she recounts make the book simultaneously jolting and memorable.

There’s Mia (not her real name), a young woman suffering from schizophrenia who had been brought into the hospital by emergency medical personnel after she was found, in labor, in a Manhattan subway station. Although she screamed that she was not pregnant, she admitted using both Thorazine and crack cocaine. By the time Cohen met Mia, the patient had already had an altercation with a medical resident. The doctor, frustrated by Mia’s refusal to consent to a vaginal examination, had urged her to sign out of the hospital. “In effect,” Cohen writes, he was “sending the patient out into the street to give birth.”

Mia did not follow the doctor’s orders. Instead, she became increasingly agitated as the contraction became stronger and more frequent. Eventually, Cohen writes, Mia leaped out of her bed and ran into a large, open area near the nurse’s station. “I ran right behind her,” Cohen recalls. “Mia leaned against the wall with the next contraction as the baby’s head emerged. ‘Squat down, Mia,’ I told her. She flopped on the floor on her back, refusing to open her legs and batting away my hands as I knelt beside her, attempting to help ease out the baby’s shoulder.” The baby delivered himself, Cohen continues, and was subsequently placed with a family member.

Laboring also includes stories about assisting prisoners who were forced to give birth while shackled—a practice that was officially ended in New York state in 2009. Other accounts introduce women who had previously lost children to gun violence or illness; women with gestational diabetes, preeclampsia, and other illnesses; babies born with health concerns; and pregnant teenagers, some of them abused and most of them scared. It’s a potent mix that celebrates the valiant work of a little-known, and often misrepresented, profession.

Especially insightful is a section about HIV and AIDS. “I worked in a research study that was incredibly gratifying,” Cohen told me over tea on a frigid afternoon in late January. “It led to the first breakthrough in prevention and to this day, it is one of the only breakthroughs we’ve had in limiting mother-to-child transmission of the virus.” That said, she admits that working with HIV-positive women in the late 1980s and early 1990s took its toll. The work, she says, was weighted down by secrecy since most of the women felt that it was essential that their HIV status remain hidden.

But beyond HIV and AIDS, Laboring includes revealing data about the impact of occasional stillbirths, birth defects, and delivery complications on staff. “Whenever there is a bad outcome,” she writes, “we’re told that because of liability concerns we should not talk to anyone about it. This leaves midwives and other health-care providers to suffer in isolation from feelings of distress, anger, and sadness. I always pushed my coworkers to do a major review of the cases that ended with a death or complications so that we could see if there was something to rectify.”

Despite this attention to detail, Laboring gives scant mention to male physicians who are sexist toward midwives and female nurses, bureaucratic missteps, or the weaknesses of the U.S. health-care system. Instead, it celebrates midwifery and the humane care its practitioners provide. As Cohen explained, “Physicians deal with disease and injury. Their education in the “normal” is largely to prepare them for the abnormal: When pathogens or tumors invade the body and the immune system is overwhelmed, when organs do not function properly, blood is lost, or tissues tear.”

“Midwives probably spend more time studying normal pregnancy and birth, with their many variations, than medical students. We do not view the “normal” as preparation for interesting complications,” she said. “The ordinary miracle of life is interesting enough.”

News Sexual Health

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

Nicole Knight Shine

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Roundups Politics

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

Ally Boguhn

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

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

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

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

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

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

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

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

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

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

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

“Mothers of the Movement” Take the National Spotlight

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

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

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

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

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

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

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

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

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

What Else We’re Reading

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

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

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

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

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

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

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

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