Careful Now! The Black Pregnant Body is NOT Defective

May 16, 2018 by

DeEra - Anji Schoch PhotographerRecent press has spotlighted the tragedy of more Black women and babies dying than Whites in the United States. It has amplified the voices of Black women and allowed more people to hear their stories. As we listen to the medical horrors of women not being listened to about their own bodies and symptoms, and the medical miracles of ill babies kept alive, it’s very tempting to buy into the accompanying idea that there must be something very wrong with the Black pregnant body.

This theme is represented strongly in the responses published in the New York Times a week after their article on Black maternal mortality. Three of the five testimonies are from African American women who had medical emergencies occur because nurses and physicians dismissed them. One was an emergency room physician in her own hospital. The primary story is that medical professionals are not listening to their patients simply because their skin is not pale. But buried in these stories is also the idea that the Black body is more fragile and precarious and needs more intense medical attention. Centuries of slavery and racism have made it defective. That’s a seductive belief and its also wrong. As birth professionals we have to be really careful about the ideas we absorb and how they influence our thinking.

A defect is not what I see at all.

Obstetrics already has a core belief that the female body is defective because of its variability. Healthy female bodies do not follow rigid norms, making them unpredictable and open to a variety of influences. There are many ways that female bodies can be healthy. Unlike the midwifery model, obstetrics doesn’t see this; it sees variations from the norm in pregnancy as problematic and requiring more technology and more interference to protect it. Something bad could arise quickly and without warning. This makes the Black woman’s body a scary place for obstetricians; she and her baby could die without warning at any moment. If any complication is missed, the physician and their insurance company could be sued. (That’s a mechanism we use in the U.S. to help parents financially when their child has a disability.) This is unfortunate because it leads to the use of interventions that look good on paper to a judge or jury, but do little to actually help patients. It also leads to the idea that whatever we do to keep mothers and babies alive is justifiable – even if there are negative side effects on their mental health or relationships that can never be rectified. Further, the current system implies it is up to the physician to decide the cost/benefit ratio of any intervention, not the person living in the body who bears the consequences of any decision.

The bodies of Black people record the full impact of life in today’s environment and also the positive and negative events felt by their ancestors. Hearts are heavy and cardiovascular disease predominates. Pancreases hunger for the sweetness of life and cannot process the sugars and carbohydrates in food. Placentas yearn to support and grow new life but don’t function well in a steady shower of stress hormones from anger and fear. The physical body is a metaphor for the spiritual journey that Black people face in our White majority world.

Racism and White supremacy are embodied experiences. They don’t just happen in your head – in how or what you think; they happen to every part of the body. Heads ache from tension, stomachs grip in fear for safety. That’s what makes microaggressions so insidious. Whites and other people making the “micro” aggressive behavior think it should be brushed off because it was so small. But a person doesn’t get to decide whether they feel a lack of safety – that would happen in the thinking part of the brain, the cerebral cortex. Instead, the assessment of safety is made by the amygdala in the limbic system. It assesses in three seconds whether a situation is safe or unsafe and releases stress hormones accordingly. Three seconds!

The human nervous system also develops a bias towards safety or a lack of safety. People with PTSD have systems that have reconfigured to attenuate to danger. Instead of assuming safety unless proven otherwise, trauma experienced brains assume danger unless safety is proven. This means the continuous stimulation of epinephrine and norephinephrine which is metabolically expensive. It results in what we think of as stress-related diseases.

So, if racism and White supremacy are the problem, and the Black body is showing the results of centuries of systemic racism in housing, health care, education, food access, and everything else you ought to know by now, doesn’t that make it…defective? No, that makes the body affected. It also means it is permeable and open to healing. That’s where the doula enters the picture.

What I see is a deficit of support, not a defective body.

Not just support in that moment, but all along – even in the years prior to the pregnancy. For example, reproductive health procedures (i.e. biopsies, vaginal ultrasounds, D&C) are violating to the body and the brain. It goes against all our human programming to lie there if you don’t feel 100% safe. Anyone who has had a medical, genital or sexual trauma may have to do mental gymnastics to maintain or get back to a normal state. Yet we have no mechanism for a trained support person to be there throughout to soothe someone.

Black people entering pregnancy with health conditions need more support, not more technology. Hearts are hurting – both physically and emotionally. The hurting heart needs empathy, needs to be listened to, needs a companion to be quiet and hear their story, it needs someone to amplify their voice, to soothe and comfort and be present with. It needs to be with their own people. It needs someone speaking on their behalf when needed. It needs shouting and protests and people to right the wrongs of the last generations. It needs willingness to hear Black anger and rage and fury and not melt in the face of it all. It needs those of us willing to be companions to know their history and what is required of us White people without being told. Pregnant Black people need practical solutions, understanding, commiseration, and acknowledgement of how strong they already are and how much they have already faced.

They need to rest.

They need to feel safe.

They need to be loved just as they are for exactly who they are.

The pregnant person does not need to be seen as inherently defective because they are Black, but as a culmination of years of abuse that can be remedied. It is strength and joy in the lives they are living that we need to see; not weakness or brokenness. The eggs of one’s grandchildren are already developing inside a person’s body. If those eggs are bathed in love, safety, beauty and reassurance, they are already starting out better than the eggs that made this pregnant person. We make a difference for tomorrow, today, but only when we see wholeness and healing as possible, and affirm the healthy core in Black people that already exists.

 

Photo used with permission. Credit: https://www.facebook.com/photographybyanjilen/

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How the U.S. Women’s Movements Influence The Lack of Doula Research, Part IV of IV

Jan 23, 2018 by

Protest2

The last major influence on why there isn’t pressure for more birth doula support research is that it doesn’t fit neatly into a feminist or women centered agenda in the United States.   During the Second Wave of Feminism in the 1970’s, women’s health issues moved to the forefront. Exploration of women’s bodies, books on reproductive health, and access to abortion became public topics. At the same time there was considerable tension within the movement itself about how to honor motherhood and childbirth while simultaneously working for economic freedom from the home. What most feminists did was decide to tackle abortion access first and once that was accomplished, move on to childbirth rights. No one anticipated decades of divisive and continuing arguments about abortion. Almost everyone knew a woman who had died or lost her fertility due to an illegal abortion, so it seemed like common sense to many people. There was little religious opposition like we associate with the issue today.

During the 1970’s and early 1980’s, when birth activists tried to make rights in childbirth a national agenda item, no one was really sure how to go about it. Anything to do with motherhood or reproduction seemed to feed the opposition’s arguments against women’s economic independence from the home. Because of the pushback on abortion rights and ambiguity in how to pursue birth issues, women’s rights and experiences in having babies disappeared from the feminist agenda of U.S. mainstream organizations.

The doula movement in the U.S. today also reflects this larger chasm. As Mahoney and Mitchell point out in their book, The Doulas; Radical Care for Pregnant People, we tend to see abortion and motherhood as two extreme acts happening to different people. Instead the fundamental truth is that they are different choices made at different times during the same person’s reproductive lifespan.

In the 1980’s when the Cesarean Prevention Movement (now International Cesarean Awareness Network) was founded, birth activists expected that the cause would be taken up by cesarean and VBAC mothers as well as other women who cared about perinatal issues. The books of that time reflect this thinking: Silent Knife (Wainer Cohen), Open Season (Wainer Cohen), and VBAC: Very Beautiful and Courageous (Baptisti Richards). I think leaders honestly forgot that these women were raising children and likely wanted to avoid the reminders of their unpleasant birth experiences. There was also the idea that we didn’t know who to appeal to – there was no government agency or right to be proclaimed. What we have been asking is for the whole profession of obstetrics to change how they view female bodies and the people who live in those bodies. Instead of political forces, women tried to use the market force of economics and choose careproviders that honored them. But because of the insurance system in the U.S., patients did not get to choose between medical careproviders with different styles of practice. How people are treated in childbirth today is a direct consequence of the inability to push a human rights focus into obstetric care and shift how the female body is viewed. In general, our current system does not value the individual person’s experience and bodily integrity unless a doula is present to remind people. That is why doula research is so integral to any kind of change in obstetric care.

Not until the last five years have any national women’s organizations taken the U.S government to task about women’s rights in childbirth. We had cesarean birth rates of over 30% for ten years before anyone outside of the birth community even whimpered about it on a national scale. From a consumer perspective, birth doulas are part of the answer. It is one of the few measures a pregnant person can take on their own behalf.

National women’s organizations have not (yet) pushed to make funding of doula studies an important national health agenda item. We need their support and demanding voices for health equity and reproductive justice to make sure that how people are cared for in labor enhances their life and parenting, rather than creating more injuries to heal from.

Will Things Change?

If activism and organizing can make a difference, things are certainly more hopeful than they were even six years ago. Along with Human Rights in Childbirth and Improving Birth (formerly Coalition to Improve Maternity Services), we have the March for Moms and their partners, Every Mother Counts, and an expose on Motherhood in America by The Guardian news service.

These organizations are focusing on best practices for birthing people and they include doula support on ALL of their agendas. However, health care policy relies on current data. It’s not good practice to rely on randomized trials from twenty years ago. We need better research on doula support now, based on the way doulas practice today, to show that we still get fabulous outcomes. Those same studies also need to reveal how much agency the birth doula actually has in influencing obstetrical practices. If all laboring participants have to have continuous electronic fetal monitoring, are confined to bed, are not allowed to eat, have IV’s, and time limits are placed on the length of labor, the outcomes are not going to be as good as if the laboring person has freedom of choice in those areas.

Together we have to demand high quality and recent doula research and make caring for pregnant and laboring people in the best way possible a national agenda item. We must not compromise with items that look pretty (birthing rooms and fashionable labor gowns) but that don’t fundamentally change how our bodies or psyches are treated. As members of these and other general interest organizations, we have to put the need for this research on their agendas, and let them know why it is so important to have.

Moving Forward

We need to work together to create a research agenda for birth doula support in the United States and elsewhere. Birth doula studies need multidisciplinary teams of physicians, nurses, researchers and birth doulas to gain review board approvals, hospital staff approvals, funding, and be published in peer reviewed and database listed journals. Most of all we need to push through the political barriers that keep our hospital systems from serving the most vulnerable with the best care: our mothers and children. Only together can we put enough pressure on systems to change and gain the research we need to keep up that pressure.

I’ve been doing what I can from outside that system – collecting data on doula practices, developing theories on why doula support influences physiologic birth so positively, and publishing in journals and peer reviewed books that accept my work. I now have a university fellowship to move forward in my research and publishing. But I, Amy Gilliland cannot do it alone – and neither can Rebecca Dekker or Katy Kozhimannil or Christine Morton. So if you are reading this and you have influence – as a nursing graduate student or the partner of an obstetrician-gynecologist at a research hospital – or maybe you are that doctor, STEP UP! If you are a journal editor, consider announcing a special issue on doula support for 2021. Let researchers know their quality work can be published. If you are a university professor, consider a doula research project that would include two or three graduate students so everyone can publish. If you are a person, consider joining or volunteering with one of the organizations mentioned here. The future of our medical system needs you, and it needs all of us to put the pressure on and get the research we need that will continue to create change.

 

 

Photo from 1/21/17, Madison, Wisconsin March for Women, used with permission

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It’s Your Turn to Make Doula History

Apr 3, 2017 by

AmyConf1993

Amy Gilliland, Madison Area Birth Assistants booth, Oct 1993, Madison Women’s Expo

Lately I’ve thought a lot about what’s left after someone is gone – and who tells their story. It has made me really think about who is going to write the story of our movement. Traditionally history is written by people after events have happened, after the world has already changed. It’s written by people who have the power to write and disseminate information – which is why so many of our perceptions of history are distorted.

What about us? What about our history? Who will write the story of birth and postpartum doulas across North America and the rest of the world? Who will point out the indigenous women who never abandoned each other under the pressures of western medicine? Who will write about the women in the seventies and eighties who said, “I will go with you and I won’t leave you”? Who will write about how we took care of each other when our own families would not support us in breastfeeding or avoiding another cesarean?

The battleground of the doula revolution was not on a national stage. It was quiet, in every labor room across the planet, where one woman held another’s hand and said, “You can do this, I believe in you.” We made a stand for another person’s mental and emotional wellbeing in a system that had little room for it. We protected the space. We stood by her side when she said, “No.” We agitated the system with a smile on our faces. We kept doing it, over and over again, for years, until eventually those in power could no longer ignore us or their own research.

That’s the big story. But what about the little stories? What about the doulas in Pueblo, and Springfield, and West Bend? How did birth change there because of the presence of those early doulas? All of our communities have little stories. Each weaves a thread into the tapestry of our great big story of doulas changing birth in the world. Where are those stories?

Who came before you, person reading my blog? And what was birth like in your town? The time has come for you to seek out retired doulas and nurses and midwives and find out.

You see, if we don’t write our own stories, someone else will tell a tale that serves their own purposes. Or they will be forgotten, seen as not being important. Much of women’s daily lives has been unimportant to historians. But doula history is significant. If any one movement will be singled out as creating change in our system of birth, it is going to be birth doulas. Mostly we’ve been like dripping water, slowly eroding rock, getting the system to change. Lots of drips lead to pitting a foundation, causing it to change in response or else collapse. So while we may not be at most births, we don’t have to be. Our impact continues to grow. We aren’t done yet.

What is your community’s story of change?

Starting in the 1990’s I was the Archivist for Doulas of North America (DONA). Doulas sent me articles from their hometown newspapers. Back then it was a rare occurrence. While we might have wanted to change birth, what we really wanted to do was make sure women didn’t lose their power while having their babies. We couldn’t do that for everyone, so we just focused on the family in front of us. We hoped that over time the value of what we did would show.

Our strategy (if you can call it that) worked. Nowadays there are tens of thousands of trained doulas, and many cities have well established doula communities. ACOG recognizes the value of birth doulas. That means to me that it’s an excellent time to look backwards.

That sounds good to me, you say. But what are you suggesting I DO?

  1. Have fun! Talking about this history of birth in your town can be really fun. Most people like to reminisce and are excited that their memories are important.
  2. Investigate! If you don’t know who came before you, start asking. More experienced doulas may be able to remember a name or two. But don’t stop there. Ask the nursing unit director, the lactation consultant in her sixties, and your local midwives. Childbirth educators often last for decades and may be very knowledgeable about past trends. If everyone is young, ask who they’ve heard about being important in years past. Sometimes the only people who are remembered are the ones people didn’t like, but they don’t want to admit it! That’s fine. One name will lead to another. Look for old newspaper articles in the online archive. Most articles will reference older ones, sometimes going back ten years or more.
  3. If you can’t find a specific person, ask retired perinatal professionals about birth trends. Hospitals were remodeled, attitudes towards induction, breech birth, VBAC, episiotomy, cesarean birth, and having family members present have all changed dramatically in the course of my career.
  4. Interview alone or have a party! Sometimes a celebration is in order. In fact I think we need more parties in our lives that celebrate our accomplishments, especially when it comes to birth. Instead of interviewing one person, you could lead a group of people to reminisce. That might be more enjoyable for everyone.
  5. Ask questions that encourage explanations and depth about events. Here are some OralHistoryTips (pdf doc) I compiled to help you.
  6. Create a timeline of the order of events and include anything that might be relevant. This will likely lead to more interesting questions and observations. If you like mystery novels, this is your project! It’s a discovery of how your community moved from where things were in 1980 to where they are today.
  7. Record your interview and make sure your participant has a microphone near their face to avoid recording background noise. Many smartphones can do this well.  There are apps that can transcribe your interview into written form as long as there is no background noise. You may end up with a really interesting podcast, or a local historical society or oral history project may want your recordings for their files.

Then what?  If you complete your local project, I will publish it on a web site devoted to doula history that is available for everyone to read, including students of history to use in their papers.

This project is about more than you. It’s about those who came before but also for those who will come after. You may not know what they will look like or how they will interpret doulaing for their generation, but our history is important for them to know. And if you don’t record it, probably no one will.

 

Resources:

Christine Morton covers much of the big history of doulas in her book, Birth Ambassadors: Doulas and The Re-Emergence of Women Supported Birth in America. It’s our most extensive resource. Since I lived that history, what struck me the most was what wasn’t in there – including all of our small struggles in our own communities. It’s our responsibility to build on Dr. Morton’s achievement and share our stories to build a more comprehensive history.

Along with Mothering magazine, in the 1980’s and 1990’s many of us eagerly read The Compleat Mother, a quarterly newsprint periodical that espoused a radical wholistic philosophy of empowering women through childbirth.  It was more raw and less polished than Mothering. It did not shy away from exposing the patriarchal philosophy entrenched in the medical system and the feminist power available to us when we took charge of our bodies.  Famous Midwife Gloria LeMay wrote “Remembering Catherine Young”, founder of The Compleat MotherRemembering Catherine Young, 21 July 1952 – 11 September 2001

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