Think Global, Birth Local

(editorial from the new issue of The Birth Project Issue VI Spring 2008)

This spring ACOG (American College of Obstetrics and Gynocology) released their updated statement on home birth (reprinted on pg. 12), generally reiterating that they oppose homebirth as well as individuals and organizations who offer or support such options for women and families. We have a few great articles responding to this ACOG statement. This statement is not supported by much of the research; in contrast, research shows that homebirth and freestanding birth centers are statistically safe and actually produce better outcomes overall.

Also this spring many meetings were held by home birth midwives and those who support them discussing The Big Push for Midwives (see pg. 26 for web link), debating the future of midwifery in the United States. Check out their website for more information about the issues around the legislating midwives. Some are in favor of this movement towards “legalization” and some are against it. There are members of the “medical” community opposed to anything that would support homebirth options but also within the homebirth community some see legislation not as progress but as restriction on their practice and how they are able to serve women and families.

What most people don’t realize is that in some states the right to make the decision to birth at home and birth centers have been taken away from women and families. As seen on Good Morning America on January 2008 unassisted homebirth is something that women are turning to when they cannot find a midwife to attend to them at home. Some also make the decision to have an unassisted homebirth in areas where midwives are available for personal or sometimes financial reasons since homebirth care is usually paid out of pocket. Like other women’s reproductive rights issues, we need to ask: should it be a case of choice, availability and safety? One would think...

On the internet many bloggers are also discussing/debating these hot birth topics and more. There is a buzz of something going on. We are talking about it too, here in The Birth Project.

Most think or assume that birth and birth culture is fine and dandy (more or less outside of the fear of pain that the majority of women have). Many times I end up having conversations about birth with expecting parents, in either doula consultations or in my childbirth education class, friends and family, or even sometimes strangers (although I don’t go out of my way to get on this topic with strangers, it just sometimes comes up). I can see it in their faces that they are realizing that birth, birth culture, birthing decisions, and birth politics are not fine and dandy. They are complicated, multi-layered, politically charged shades of gray, with the eye of the storm - mothers, babies and their families, usually unaware of the huge conflict spinning around them. There are issues- health care issues, human rights issues, women’s rights issues, safety issues, ethical issues, legal issues, psychological issues, emotional issues, physical issues, even environmental issues.
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One of the many books on my reading list this spring is actually not about birth. It is Animal, Vegetable, Miracle by Barbara Kingsolver. It makes a ”passionate case for putting the kitchen back at the center of family life and diversified farms at the center of the American diet”. This book speaks to the idea of eating local and seasonal to, among other things, reduce one’s carbon footprint. So what do agricultural sustainability, and carbon footprints have to do with birth politics you ask?

It is all about how we live and think. Like sustainable agriculture, birth is about business. If we eat more local and seasonal it causes economical issues for the businesses (corporate farms, trucking, packaging, etc.) and employees of those businesses that grow and transport food all over the world. On the flip side local farmers, markets, dairies etc. would be more supported. If more women birth at home or in birth centers a large portion of hospital revenue will take a economical hit along with the companies that make and distribute much of the equipment used at hospital births as well as the income of the doctors that do deliveries in the hospitals. Again on the flip side community midwives would be supported and if the demand were higher for these birth settings momentum could be made for insurance coverage and more accessibility for all who seek alternative birth options, potentially reducing insurance premiums. The waste byproduct from the equipment and apparati at hospital births is many times that of home and birth centers. So again, it is also an environmental issue - reducing the human carbon footprint.

On this beautiful spring-y day (finally!) I ask you to open your mind to the big picture. Think big and also with empathy for the whole picture on both sides. The only way we can hope to move forward is to work together (see the well written open letter to ACOG on page 13). I also ask you to incorporate this kind of thinking to other aspects of your life - how you eat, if you recycle, speak of politics, how you parent, and so on.

Act with thought and empathy for all.

We are dedicating this issue to midwives since May 5th is National Midwife Day. If you have had a midwife in your life and feel so inclined, send her a letter of appreciation this May. It is hard, amazing work that these women take on ~ send them some love to help get through that next sleepless night. The month of May is also International Doula month so send them warm fuzzies too.

Life and Death

One of my life obsessions and fears is death. It may be why I work in birth and have a desire to do hospice work at some point in my life.

The collection of photographs is by German photographer Walter Schels, 72 Faces of Life and Death is a beautiful window into a part of our existence that most choose not to think about. There is a link at the end of this article where you can view some portraits from the collection. What a fascinating project.

Dare I say "childfree"???

It was recently brought to my attention a blog thread debating about "childfree". Read it here

Since the comments were closed I thought I would share my thoughts here.

First regarding the taxes for schooling issue: I homeschool my kids and I happily pay my taxes for the schools that we are not using because the kids that use those schools will some day be adults. Adults that will be most likely join the work force and be paying taxes into social security that I will (hopefully) someday get. These children will grow up to be adults that may become the nurses that wipe my ass if I become old and need assistance or maybe they will just come and sit with me and chat in the home (I hope I do not end up in a home but it could happen- you never know). The fact of the matter is that even the "childfree" adults reaped the benefit of taxes for schooling as children going through the school system.

Second regarding the infertility treatments: This one seems really out of left field. From the information I have most infertility treatment is NOT covered by insurance, it is an out of pocket cost for the desire to have children. When infertility treatments may be covered by insurance and you are concerned about it bringing up your insurance cost- it can be equated to my insurance costs being higher to support that cost of people who need extensive medical care because they choose to eat like shit their whole lives and not take care of themselves. I try to eat healthy, take care of myself and rarely use the medical system or pharmaceuticals. It is a crap shoot when dealing with private insurance. Fat unhealthy people ore more of a problem than folks who choose infertility treatment - other than the fact that once conditions usually takes a person out of the population and the other can add a person to the population.

Third regarding the cost of Childbirth: Ha ha ha... where do I start? I totally agree that the cost of childbirth in this country is disgusting. I am a birth activist and a birth worker and could really expand on this but I will keep it short. Childbirth is major revenue for most hospitals. As with most things it is a business and a business that makes $$$. I agree that it should not be about $$$ and about proper health care but like the second point I take a chance when I get insurance coverage that I am paying for a lot of shit for a lot of other folks that I have no control over. I had my second child at home and paid for it out of my own pocket a whole whopping $2000 (that is for prenatal, birth through 3-4 postpartum visits) for amazing care. More thorough, attentive and personal care than I got "in the system" with my first birth which the birth alone was $6000 (i cannot imagine how much the total was with prenatals, testing, ultrasounds, and that one postpartum visit). This is a ten year old article but not too much has changed in ten years and what has changes is not for the better - birth centers closing, the c-section rate going up to 30% and womens choices being taken away. Choices that would lower overall childbirth costs.

Fourth the pity factor: I do not pity you at all. The "childfree" have a freedom I do not have. They do not have the weight of raising another human being not to be an asshole. They do not have the stress of fighting with little irrational people. That is your choice and right as a "childfree" person and I would not change a damn thing about my life and the choices I made to have my children. I was pitied by my "childfree" friends when I had my unexpected child at 25 but from a distance. It was hard and it sucked and no one was there to help me. I am very aware of the "childfree" culture. I have changed diapers in the front seat of cars with the door open for room in hail storms because the bathroom did not have a changing table, I have breast fed my child on a toilet in a restaurant, I have gotten looks of contempt for taking my quiet well behaved children places, among other things. So you get no pity here and I do feel that most of you that feel pitied are being a little too sensitive - be a duck and let it roll off your back if they pity you then it is their ignorance. Let it go.

Fifth in regards to the "you had ‘em, they are your problem, expect nothing from me, and by-the-way, could you make them shut up?": This made me think of when I went out to brunch with some friends of mine (with out quiet well behaved children - we were armed with mini princesses to distract them) and a few tables over there was a family with an adult that was mentally impaired that had tendencies of turrets. This person was loud at times, very loud. I thought it was great that these folks could go out as a family including that special needs family member. Should I have interrupted this family and asked them to "shut up" their special needs adult member for the sake of my perfect civilized brunch experience? Do I mind that I pay into their health care needs? Do I not hold the door open for them as it takes them three times as long to get out the door because they are also disabled? We must remember that our culture generally looks on our elderly as we look at our children. Should I say to the "childfree" "expect nothing from me or mine as you get older and may need assistance, and by-the-way wipe your own ass"?And as for myself, I expect nothing but the same patience and understanding for myself and my child that you would offer any other human being.

This debate reminds me of my thoughts on vegans (sorry if i offend any vegans out there). We are privileged to live in a society that we have the opportunity to be so picky and opinionated about what we and others eat. Many places you eat what you have or die be it rice or rat. We are also privileged to live in a society that we can have such idealistic and lofty separatist ideas of family and society. Many places you would live in a 900 square foot house with your parents, aunts, grandparents and other extended family breeders and "childfree" alike working towards sustaining.

I did find many of the comments on the original blog post ill-founded generalizations and misinformed. I do not care if you are "childfree" that is your choice so live your "childfree" life but do not do things like go to the Corner Brewery (a family friendly brew pub) and bitch about kids being there. You have every other bar in town that is not family friendly. The "childfree" have the majority of public places built to their needs not mine as a breeder. We do not live in a family friendly culture.

I need to go garden now while my crotch droppings and the neighbors crotch droppings play delightfully together. Have a lovely Sunday.