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Tuesday Tidbits: Human Rights and Birth

“It takes force, mighty force, to restrain an instinctual animal in the moment of performing a bodily function, especially birth. Have we successfully used intellectual fear to overpower the instinctual fear of a birthing human, so she will now submit to actions that otherwise would make her bite and kick and run for the hills?”

–Sister Morningstar (in Midwifery Today)

486253_470181139659475_1370955888_nWhen I end my introduction to human services class and then again when I begin my social policy class, I ask my students to consider the above: What would happen if everyone cared? What would happen if our first reaction was compassion? What would happen if we focused on what matters? What would happen if we assumed everyone had inherent worth and value and deserves humane care and compassion?

I have said for a long time that women’s rights in birth represent a human rights issue, so I was very interested to receive word of a Human 10360685_10152979214427627_4161278366266845515_nRights in Childbirth campaign:

Women do not lose their basic human rights once they become pregnant. And yet, across the globe, women’s human rights are compromised and violated around childbirth. Examinations, interventions and procedures that pose risks to both mothers and their babies are routinely performed without informed consent, or through coerced compliance via threats or fear. When women come out of childbirth with post-partum PTSD from disrespect, abuse, or obstetric violence, the goal of a “healthy mother and healthy baby” has not been met.

via Home | Human Rights in Childbirth.

Childbirth IS a women’s rights issue and a reproductive issue:

Childbirth is a women’s rights issue and a reproductive justice issue. The United States maternity system is one of the costliest in the developed world, yet our birth outcomes compare poorly to those of other industrialized nations. Among industrialized countries, we consistently rank last or second to last in perinatal and maternal mortality rates. Moreover, birth is depicted in mainstream media with fear, medical intervention, and crisis…

via Business of Being Born: Classroom Edition | Talk Birth.

But, childbirth is also, quite simply, a human issue:

This is the whole point—women’s rights aren’t about “taking” rights from anyone else OR about demanding “special treatment,” they are important for a HUMANE WORLD for all people. I think it is hilariously awful that “women’s rights” are considered a political issue and that there is a section about “women’s rights” in the “opposing viewpoints” database for my social policy class. As long as women’s rights are considered a political issue or as something about which an opposing viewpoint can be held, rather than as self-evident, we are in continued, desperate need of revolution.

via Women’s Power & Self-Authority | Talk Birth.

Human rights in childbirth include access to the provider of one’s own free choice, so on a related note check out this set of consumer-oriented materials about the midwives model of care offered by collaborative effort of several midwifery organizations and endorsed by several others:

“Normal Healthy Childbirth for Women & Families: What You Need to Know” clearly explains and advocates the benefits of normal, physiologic birth for the average health care consumer. This helpful tool was created from a 2012 consensus statement developed by ACNM, the Midwives Alliance of North America, and the National Association of Certified Professional Midwives.

via OMOT Normal Birth Document Feature Page.

The below quote may seem obvious to birth advocates, but it is revolutionary in terms of health care. When Citizens for Midwifery shared this quote, they noted that, “One the KEY findings of the Lancet Special Series on Midwifery affirms the importance of women and their families participating in planning of health care.” For more from this special series on midwifery, go here: TheLancet.com.

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And, in case we get so caught up in theorizing about appropriate care that we forget the lived experiences of the women who need it, read this tough, sobering article about why “going in pushing” does not a VBAC birth plan make:

Karen’s story is not uncommon and nor is the advice she was given about “going in pushing” but when we tell women they can not be cut unless they consent are we telling the truth? Whilst it’s true that legally the hospital can not physically force you into an operating theatre without your consent, they are not afraid to gain consent using underhand methods…

via Go In Pushing – It’s not a VBAC Birth Plan – Whole Woman.

And, of course, some relevant quotes to remember:

“If women lose the right to say where and how they birth their children, then they will have lost something that is as dear to life as breathing.” –Ami McKay

“Mothers need to know that their care and their choices won’t be compromised by birth politics.” – Jennifer Rosenberg

via As dear as breathing… | Talk Birth.

Is there anything that can be done, or are we facing an insurmountable struggle? I think we can remember that our “small stone” birth activism does matter:

While reading the book The Mother Trip by Ariel Gore, I came across this quote from civil rights activist Alice Walker: “It has become a common feeling, I believe, as we have watched our heroes failing over the years, that our own small stone of activism, which might not seem to measure up to the rugged boulders of heroism we have so admired, is a paltry offering toward the building of an edifice of hope. Many who believe this choose to withhold their offerings out of shame. This is the tragedy of our world.” Ariel adds her own thoughts to this: “Remember: as women, as mothers, we cannot not work. Put aside your ideas that your work should be something different or grander than it is. In each area of your life—in work, art, child-rearing, gardening, friendships, politics, love, and spirituality—do what you can do. That’s enough. Your small stone is enough.”

These quotes caused me to reflect on the myriad methods of “small stone” birth activism that can be engaged in as a passionate birth activist mother embroiled in a season of her life in which the needs of her own young family take precedence over “changing the world”…

via Small Stone Birth Activism | Talk Birth.

And, on a fun note, you might enjoy this lovely homebirth treasury on etsy: Home Birth by Kayleigh on Etsy. 🙂

“Thousands of women today have had their babies born under modern humanitarian conditions–they are the first to disclaim any knowledge of the beauties of childbirth…” –Grantly Dick Read, Childbirth without Fear

“I am not free while any woman is unfree, even when her shackles are very different from my own.” –Audre Lorde

“Humanizing birth means understanding that the woman giving birth is a human being, not a machine and not just a container for making babies. Showing women—half of all people—that they are inferior and inadequate by taking away their power to give birth is a tragedy for all society.” –Marsden Wagner

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SHE…(Hysterectomy Sculpture)

July 2014 094Recently I received a special request to create a sculpture in honor of a woman’s hysterectomy experience. I haven’t really been taking custom orders for a while now, since it hard to keep up with everything I feel like making let alone what someone else wants me to make, but I was intrigued by the request and decided to give it a try. I sat with my clay for a long time. I never want to inadvertently dishonor someone’s experience with my sculpture work—I had several ideas, but I wasn’t sure if they were going to speak to the experience since I have not been there myself. It feels like a sacred responsibility to try to interpret another’s experience artistically. I found a sun charm to use as her center to symbolize how she holds the energetic imprint of her reproductive experiences, but I couldn’t figure out what word to put in her scar. Then, as I sat there, a word floated into my awareness…SHE

I created the basic design of the sculpture and went to bed without coloring or firing her. When I awoke the next morning, a poem was in my head and it was for her:

She who is open to possibilities. July 2014 097

She who has taken her own journey
carved her own path
learned her own lessons
and carries her own wisdom.
She who carries the story of a woman’s life written on her body.
She who has spun cells into life
She who has traveled
laughed
shared stories
danced
hugged
cried.
She who is….
complete
magnificent
ever-changing
surprising
unmistakably
SHE…

July 2014 102

Guest Post: Pelvic Exams Need Rethinking

June 2014 045I almost never reprint any of the random articles, press releases, and news tidbits that find their way to my email address. However, this one was too interested to skim past. Conclusion: The pelvic exam has been a standard part of a woman’s annual checkup for decades — yet it serves no clear purpose and may do more harm than good.

Considering that I’ve written about Pelvic Exams I Have Known (watch for my eventual stand-up routine, 😉 ), I found this very interesting…

UC SAN FRANCISCO
Jennifer O’Brien, Assistant Vice Chancellor/Public Affairs
Source: Elizabeth Fernandez (415) 502-6397 (NEWS)
Web: www.ucsf.edu
Twitter: @EFernandezUCSF

TO COINCIDE WITH PUBLICATION IN ANNALS OF INTERNAL MEDICINE

UCSF Commentary: Pelvic Exams Need Rethinking

The pelvic exam has been a standard part of a woman’s annual checkup for decades — yet it serves no clear purpose and may do more harm than good.

That’s the conclusion of a new guideline by the American College of Physicians (ACP) based on a review of scientific literature spanning more than 60 years. In an article to be published July 1, 2014 in the ACP’s flagship journal, Annals of Internal Medicine, the national organization of internists strongly recommends against pelvic examinations for adult women who are not pregnant and show no signs of disease.

In issuing the new guideline, the nation’s largest medical-specialty organization contends that pelvic exams rarely detect “important disease” or reduce mortality. Under the new guideline, the ACP advises that pelvic exams are appropriate for women with symptoms such as vaginal discharge, abnormal bleeding, pain, urinary problems, or sexual dysfunction.

The recommendation is expected to be controversial, according to an accompanying editorial by George F. Sawaya, MD, a UC San Francisco professor of obstetrics, gynecology and reproductive sciences, and epidemiology and biostatistics; and Vanessa Jacoby, MD, a UCSF assistant professor of obstetrics, gynecology and reproductive sciences.

“The recommendation is based on a systematic review that found no data in support of the examination but did find evidence of harms ranging from distress to unnecessary surgery,” they wrote in the commentary.

Sawaya and Jacoby point out that tens of millions of pelvic exams are performed annually at well-woman checkups in the United States but whether the exams actually benefit asymptomatic women has largely been unstudied. To help fill the void, surveys recently have sought to establish the goal of clinicians in performing the exams: some physicians contend the exams help detect benign uterine and ovarian lesions while others mistakenly say they effectively screen for ovarian cancer, noted Sawaya and Jacoby.

The editorial called into question the nature of the medical literature review by the ACP because some of the research analyzed focused on older women and failed to evaluate “the most important goal of the pelvic examination cited by obstetrician-gynecologists – detecting noncancerous masses.”

“Thus, it is reasonable to disagree with using these findings to recommend a major change in clinical practice for women of all ages attending well-woman visits,” Sawaya and Jacoby wrote in their editorial. “Many will ask ‘Have all of the pertinent clinical questions been addressed?’”

“Deciding when evidence is sufficient to conclude that an intervention should be promoted, discontinued, or submitted to further study is challenging,” they continued. “The determination relies largely on judgment about evidence quality and the likelihood that more evidence will tip the balance in making either a favorable or an unfavorable recommendation.”

Numerous routine screenings, including mammograms and prostate tests, are being reevaluated for their medical and financial value.

In their commentary, the UCSF authors stress that whether or not the new guideline actually changes current practice, it could lead to a better evaluation of the benefits and harms of pelvic exams.

“The pelvic examination has held a prominent place in women’s health for many decades and has become more of a ritual than an evidence-based practice,” said the authors.  “With the current state of evidence, clinicians who continue to offer the examination should at least be cognizant of the uncertainty of benefit and the potential to cause harm through a positive test result and the cascade of events that follow.”

UCSF is the nation’s leading university exclusively focused on health. Now celebrating the 150th anniversary of its founding as a medical college, UCSF is dedicated to transforming health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy; a graduate division with world-renowned programs in the biological sciences, a preeminent biomedical research enterprise and two top-tier hospitals, UCSF Medical Center and UCSF Benioff Children’s Hospital San Francisco. Please visit www.ucsf.edu.

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