Archive for April, 2009

April 27, 2009

Birth Survey Offers Reviews of Local Maternity Care Providers and Facilities

The Coalition for Improving Maternity Services (CIMS) has released results from their birth provider and facility consumer feedback survey at You may have noticed our link to The Birth Survey over the past several months – this resource is the result of those survey submissions, and includes more than 17,500 ratings for providers and 6,500 ratings for facilities.

The website provides:

…feedback on obstetricians, midwives, hospitals, birth centers, and home birth services. The consumer reviews include overall ratings and recommendations for birth facilities and care providers, and also a seven-item set of questions on providers’ interpersonal and communication skills, facility intervention rates [for nine states at present-ed.], and information on finding good care. A national average of ratings is also displayed to provide comparison with individual ratings.

Elan McAllister, founder of Choices in Childbirth in New York City and co-chair of the The Birth Survey committee says of the project and resulting web resource:

“A woman who looks at a list of names from her insurance company is often choosing a provider on nothing but blind luck. Where and with whom to give birth are important health care decisions. Research shows that both provider and location have a significant impact on birth outcomes. CIMS wants expectant parents to ask questions of their providers and facilities, and have access to more information about their local options.”

In addition to the currently available provider and facility rankings, there is more to come – according to the press release, “in the summer of 2009, free-text responses will be displayed on the website, and in 2010, detailed information on patients’ experiences with prenatal, labor, birth and postpartum care will be added to the website as searchable custom reports.”

We’re excited about the new resource – a first of its kind – for the very reason described by Robin Elise Weiss, author of “The Complete Illustrated Guide to Pregnancy” and member of The Birth Survey Committee:

“While consumers have long been sharing information online about products and services, more data was available for the purchase of a digital camera than had ever been available to women as consumers of maternity care. The Birth Survey directly addresses that information deficit.”

Our congratulations and thanks go to CIMS, for all their work in creating the survey and making the results available to all.

April 27, 2009

Impacting Lives in South Florida: Carol Cohan

Entrant: Penny Kfare Jacobs
Nominee: Carol Cohan, Executive Director, Women’s Emergency Network

carol-cohanCarol is the pro bono executive director of Women’s Emergency Network (WEN), an abortion fund in Miami, Florida.  She manages all facets of the organization including client care, coordination with clinics, volunteer force, and all administrative and fundraising activities.

Under her leadership, WEN’s operating budget increased from $60,000 per year to $250,000 per year and WEN’s client capacity increased from 170 to over 900. She has built a coalition of reproductive rights advocates and organizations to prevent passage of 2004 parental notification law, and when that law was passed, organized the first attorney assistance for minor girls seeking judicial waivers, a project which developed into the Florida Path Project providing pro-bono assistance for girls seeking judicial bypass throughout the State of Florida.

She also spearheaded a coalition to improve access to emergency contraception for low-income women, developing a multi-media awareness campaign, including a dedicated website, which was adopted by 17 communities nationwide.  She has been an inspiration to board members of abortion funds throughout Florida and the United States.

In conjunction with her leadership of WEN, Carol sits on the board of the National Network of Abortion Funds, where she co-chaired the Emergency Contraception Task Force. She is also a member of the Ethics Committee of the Health Council of South Florida, the Florida Healthy Teens Coalition, and the Florida Prevention First Coalition.

In addition, she served on Congresswoman Debbie Wasserman Schultz’s Health Care Working Group, the Steering Committee of the Low Income Access Program of the National Institute for Reproductive Health, the Florida State Coalition for Women’s Health, and the planning committee of the Florida Abortion Conversation Project.  She is a 2007 recipient of the National Council of Jewish Women’s Woman of Valor award.

Carol is a true Women’s Health Hero!

April 27, 2009

Vulvalutionary: Dorrie Lane

Entrant: Self
Nominee: Dorrie Lane, Vulvalutionary

bastSeventeen years ago, in the foggy, summer light of San Francisco, the very first Wondrous Vulva Puppet was handmade, by me. I was a 40-year-old woman. At that time, there was NO representation of our  vulvas in an honorable, beautiful and embraceable way that satisfied me. I began with drawings and playing with different materials; finally,  I chose velvet and satin.

The simple message I attached to the puppet, “Share A Story”®, inspired the Vulva-lution! Most notably, Eve Ensler’s Vagina Monologues. By making the Vulva Puppet available, I want to change the way women feel about their own bodies. I want them to know the vulva is the source of life. I want them to know how exquisitely beautiful  and unique our vulvas are; I want to remind the world the vulva is the source of life.  Most of all, I want the puppet to challenge the stigma of  shame, disrespect and invisibility.

I have handmade over 4,000 puppets. They are all over the world, stories are being shared, women are healing, waking up, becoming friends and supporters of our common threads and our unique lives. We are letting go of the negative messages we have of our bodies.

The puppets are named after ancient goddesses to inspire us and because it’s a puppet, she speaks all languages, in YOUR words.

The Puppets are still handmade, now in a women-owned Fair Trade co-op in Peru.

Read the rest of this entry »

April 27, 2009

The Ears to Listen and Understand: Heather Corinna

Entrant: Stephanie Kline
Nominee: Heather Corinna, Founder & Editor of Scarleteen

When I think of the word hero, what comes to the front of my mind is someone who is present through all of the tough times. They are the people wanting to make a change, and willing to take the steps others are unwilling or unable to, because of what society, friends, family, and even strangers may believe or say. A hero is the one who remains when there seems to be no other place to turn, the one who offers the helping hand and guidance that was being searched for all along.

With this understanding of a hero, if I were asked to show the world who a true Women’s Health Hero is, I would without hesitation say the Scarleteen organization and its founder Heather Corinna.

Scarleteen is a comprehensive, feminist sexual education resource. Everyday Heather and her volunteers give their time, offer a listening ear, and most importantly offer accurate information to teens and young adults, a group that often receives information that is inaccurate or incomplete.

At Scarleteen, young women are given the knowledge that their sexuality and sexual desires are complete on their own, rather than an answer to, or product of, male sexuality and sexual desire. Here women are encouraged to not only learn about themselves on a holistic level, but also to recognize and respect that the body and genitals of all people are active, engaged parts of a whole, rather than passive or objects.

Read the rest of this entry »

April 27, 2009

Nutrition and Fitness Advocate: Sheila Fawbush

Entrant: Kathy McCardwell
Nominee: Sheila Fawbush, County Extension Agent for Family and Consumer Sciences (Shelby County, Kentucky)

sheilas-camara-147I nominate Sheila Fawbush as my “women’s health hero” because of her work for the improved health of women in rural Shelby County, Kentucky.

As an agent for the University of Kentucky’s Extension Services, Sheila works in daily direct contact with women—and men and children—offering classes and workshops on a variety of topics focusing primarily on nutrition and fitness.

Her services are particularly valuable because they are available at no or low cost and are thus accessible to low-income individuals. She has also made a conscious effort to reach out to Shelby County’s large and growing (im)migrant population, offering mini-sessions to ESL groups on, for instance, making healthy and cheap choices when grocery shopping.

She also makes available, when possible, a range of trial products and services, ranging from milled flaxseed to cooking utensils to one-day passes to the local fitness facility. Because she promotes the health of women and families of Shelby County, and because she does so particularly with regard to often-underserved communities, including lower-income individuals and racial, ethnic, and language minority groups, Sheila Fawbush is a “home-grown” woman’s health hero.

April 27, 2009

Double Dose: How Effective is Your Treatment?; History of Women, in Four Volumes; High Cost of Insurance Scares Off Buyers; Tips for Writing About Violence Against Women …

Being “Maddy”: Jennifer Finney Boylan wrote a beautiful piece about her relationship with her sons as she transitioned from male to female. Published as a New York Times “Modern Love” column, the essay was adapted from “The Book of Dads,” to be published in May by Ecco.

Determining Which Medical Therapies Work: “Good luck trying to learn what medical treatment works best to relieve low back pain, alleviate depression or prevent the spread of prostate cancer. The information isn’t available — to you or your doctor — because studies comparing potential treatments and how effective they are haven’t been done,” writes Judith Graham at the Chicago Tribune.

The story looks at the government’s plan to invest $1.1 billion in “comparative effectiveness” research and evaluate potential therapies head-to-head. Four medical experts weigh in on conditions they consider most deserving of research on comparative effectiveness. Rachel previously wrote about public input sought on research priorities.

marilyn_french_history_of_wThe War Against Women: Writing at The New York Review of Books, Hilary Mantel discusses the four volumes of “From Eve to Dawn: A History of Women in the World,” by Marilyn French. The collection is published by Feminist Press.

Words Matter: Feminist Peace Network has posted useful tips for reporting about domestic violence and sexual assault. It’s a good resource for bloggers, journalists and anyone writing about these issues.

Sticker Shock: “A new national poll, conducted by NPR, the Kaiser Family Foundation and the Harvard School of Public Health, shows that what most uninsured people are willing to pay is a long way from what insurance really costs,” reports NPR’s “Morning Edition.”  “Two out of three uninsured Americans say they’d be willing to pay no more than $100 a month for coverage. But, according to the Kaiser Family Foundation, the average individual health plan costs about $400 a month, and a family policy costs more than $1,000.”

When Accidents Happen: According to the Guttmacher Institute, more than half the pregnancies in the United States each year are unintended; poor women are four times as likely to have an unplanned pregnancy compared with higher-income women. NPR’s “Morning Edition” looks at the use of and access to contraceptives. Reporter Brenda Wilson notes that “the health system often throws up barriers to contraception, especially for young women who are the most vulnerable.” The story, however, focuses more on one woman’s situation.

Call for More Family Planning Aid: Dominique Soguel writes at Women’s eNews about a report released Tuesday calling for aggressive investment in family planning to curb population growth, poverty and maternal mortality. Five former directors of the population and reproductive health program of the U.S. Agency for International Development recommend the United States increase its spending to $1.2 billion in the next year’s funding round from $475 million in 2008.

Also from Women’s eNews: Five women will be recognized this week for their scientific discoveries.

“There is still a very big glass ceiling for women in science,” said Milbry Polk, director of Wings WorldQuest, which runs the awards. “You don’t find them in the history books. Women are left out. Their projects aren’t.”

Search Me: One of my favorite reads last week was Dahlia Lithwick explaining how Supreme Court justices can act like total dingbats:

When constitutional historians sit down someday to compile the definitive Supreme Court Concordance of Not Getting It, the entry directly next to Lilly Ledbetter (“Court fails utterly to understand realities of gender pay discrimination”) will be Savana Redding (“Court compares strip searches of 13-year-old girls to American Pie-style locker-room hijinks”). After today’s argument, it’s plain the court will overturn a 9th Circuit Court of Appeals opinion finding a school’s decision to strip-search a 13-year-old girl unconstitutional. That the school in question was looking for a prescription pill with the mind-altering force of a pair of Advil — and couldn’t be bothered to call the child’s mother first — hardly matters.

Read the rest.

April 26, 2009

Bea Arthur: Thank You for Being a Friend

Bea Arthur, known best for her roles as Maude Findlay in the television situation comedy “Maude” and Dorothy Zbornak in “The Golden Girls,” and for her earlier stage work, died Saturday at the age of 86. The cause was cancer, a family spokesperson said.

“Maude,” an off-shoot of “All in the Family,” aired from  1972 to 1978. Calling it groundbreaking is not hyperbole, as this excerpt from the Museum of Broadcast Communications demonstrates:

Like many of [Norman] Lear’s productions, “Maude” was a character-centered sitcom. Maude Findlay was opinionated like Archie Bunker, but her politics and class position were completely different. Strong-willed, intelligent and articulate, the liberal progressive Maude spoke out on issues raised less openly on Lear’s highly successful “All in the Family.” While questions of race, class and gender politics reverberated throughout both, certain specific issues, like menopause, birth control and abortion were more openly confronted on “Maude.”

In a two-part episode that ran early in the series, the 47-year-old Maude finds out that she’s pregnant and decides, with her husband Walter, that she would have an abortion which, had just been made legal in New York state. Part two of the double episode also dealt with men and birth control as Walter considers getting a vasectomy. Thousands of viewers wrote letters in protest of the episode because of the abortion issue.

“It was a little slice of realism rarely seen today, when the option of abortion is so often pushed again into the virtual back room and rarely mentioned in pop culture; the movie ‘Knocked Up’, for example, uses the euphemism ‘rhymes with smashmortion’ rather than mention this — the most common women’s surgical procedure — by name,” writes Gloria Feldt.

Feldt adds that with her next television hit, “The Golden Girls,” “Arthur had a chance to open up for public discussion yet one more previously off-limits topic: aging, especially the issues women face aging in a youth-oriented culture.”

Jill Miller Zimon has a round-up of links and “Maude” lyrics. This scene from “Maude” gives you an idea of how television once dealt directly with abortion:

The viewers’ response surprised Arthur.

“The reaction really knocked me for a loop,” she told The New York Times in 1978. “I really hadn’t thought about the abortion issue one way or the other. The only thing we concerned ourselves with was: Was the show good? We thought we did it brilliantly; we were so very proud of not copping out with it.”

“I think we made television a little more adult,” Arthur also said. “I really do.”

April 24, 2009

Political Diagnosis: Over-the-Counter Birth Control for 17-Year-Olds; Upcoming Vote on Sebelius for HHS; Budget Debate Picks Up Speed; Groups Call for Insurance Expansion …

Plan B OK’d for 17-Year-Olds: The FDA announced this week it will permit over-the-counter sales of the morning-after pill Plan B to women as young as 17. In a statement released on its website, the FDA said it would not appeal last month’s federal court ruling directing the government agency to permit the sale without a prescription. Read more at the Washington Post.

A New York Times editorial called the decision a “further break from the Bush administration’s ideologically driven policies on birth control.” While this is certainly good news, the FDA has not yet addressed the additional order that it consider removing any age restrictions.

Vote on HHS Nominee Sebelius Expected Early Next Week: The Senate Finance Committee on Tuesday voted 15-8 to approve Kansas Gov. Kathleen Sebelius as HHS secretary. The vote was mostly along party lines, except for Sens. Pat Roberts (R-Kan.) and Olympia Snowe (R-Maine), who joined Democrats voting in favor.

We thought we might see a full vote this week, but Senate Minority Leader Mitch McConnell (R-Ky.) delayed the vote, saying lawmakers need more time to consider the nomination (read: need more time to make abortion a wedge issue). Now it’s set for Tuesday, April 28, with debate starting at 10 a.m.

Plus: The American Prospect looks at how President Obama’s cabinet picks may affect politics and public policy in six states. From the introduction:

In his effort to choose politicians who have a history of working in concert with Republicans, many of his nominees are from conservative-leaning states where they played a large role in negotiating more progressive policies on everything from taxes to reproductive health to education. In their absence, not just more conservative politicians but more conservative legislation is likely to result. Here, we look at just a few of the states Obama’s Cabinet members have left behind — and consider just how complicated the fallout could be.

Budget Resolution Speeds Up: Can Congress pass President Obama’s fiscal year 2010 budget resolution by April 29 — Obama’s 100th day in office? Democrats are hoping so. A tentative deal apparently was reached today to use a fast-track budget process to advance health care reform.

“The first formal House-Senate negotiations aren’t expected until Monday,” reports Politico. “But the administration appears in love with the symbolism of completing action in the first 100 days and the hope is a package can be filed Monday, setting the stage for the House to vote Tuesday and the Senate on Wednesday.”

Calling the budget debate thus far “surprisingly lackluster,” the story notes that the budget resolution is basically just an internal congressional planning process that doesn’t even go to the president for his signature. But completing the action by Wednesday would “open the door to health care reform” and “it would be a symbolic victory the White House clearly covets.”

Plus: Read more on what the budget means for women and families at the National Women’s Law Center.

Reforming Healthcare Delivery: The Senate Finance Committee on Tuesday held a roundtable discussion on reforming America’s healthcare delivery system. All the witness statements are available on the committee’s website, including comments by Debra Ness, president of the National Partnership for Women & Families.

“Delivery system reform must put patients first,” said Ness. “Achieving a patient-centered delivery system will require significant change in what we provide and how we provide it. Toward that end, we must pursue two key strategies: a payment system that rewards and encourages better coordinated, integrated and accountable care, and a health care infrastructure that supports the delivery of this care.”

Note to Obama — We’re on It: Senate Finance Committee Chairman Sen. Max Baucus (D-Mont.) and Senate Health, Education, Labor, and Pensions Committee Chairman Edward M. Kennedy (D-Mass.) sent a letter on Monday to President Obama, reiterating their commitment to moving health reform legislation in the Senate this year. They also laid out their schedule for committee action, noting that both committees will mark-up legislation in early June.

Groups Call for Insurance Expansion: The National Council of La Raza, the Asian American Justice Center, the National Association for the Advancement for Colored People, the National Congress of American Indians and the Children’s Defense Fund have formed a partnership to lobby for health insurance coverage of all children and pregnant women. Kaiser Health Disparities Report, drawing on information from the subscription-only CQ HealthBeat, has more.

Take Action
Via National Women’s Law Center
: The Paycheck Fairness Act, passed in the House and now pending in the Senate, aims to strengthen current laws against wage discrimination and require the federal government to be more proactive in preventing and battling wage discrimination. Among other things, the Paycheck Fairness Act would also close a significant loophole in the Equal Pay Act to allow for full compensation for sex-based wage discrimination. Are your senators on board? The NWLC is calling on all senators who have not yet signed on to co-sponsor the bill to do so by Equal Pay Day — April 28. Send a message to your senators.

And don’t forget to tell your senators to confirm Gov. Kathleen Sebelius for secretary of Health and Human Services.

Via True Majority: The chemical industry is angry at First Lady Michelle Obama for not spraying toxic chemicals on her family’s garden. CREDO has been working hard to show support for the First Lady and tell the chemical companies to back off. Show your support by signing their petition.

April 24, 2009

Just Another Day in Washington: Clinton Breaks “Political Sound Barrier” on Global Health Aid

Secretary of State Hillary Clinton on Wednesday, during her first congressional testimony since her confirmation hearing, broke “the political sound barrier,” writes Jodi Jacobson at RH Reality Check.

The moment came during questioning by Rep. Chris Smith (R-NJ). When Smith asked whether the Obama administration would seek to “overturn pro-life laws” in Africa and Latin America, Clinton replied:

We have a very fundamental disagreement and it is my strongly held view that you are entitled to advocate and everyone who agrees with you should be free to do so anywhere in the world, and so are we.

We [the Obama Administration] happen[s] to think that family planning is an important part of women’s health and reproductive health includes access to abortion, that I believe should be safe, legal and rare.

Here’s Clinton on the U.S. government’s role in supporting global access to safe abortion, contraception, maternal health care and education:

April 24, 2009

Ensuring Women’s Rights: Elisabeth Sowecke

Entrant: Beth Robins
Nominee: Elisabeth Sowecke, Board Member and Co-Director of Case Management, DC Abortion Fund


Elisabeth Sowecke changes the trajectory of women’s lives every day. Imagine finding yourself pregnant, sure that abortion is your best option, and unable to pay for the procedure. Each year, thousands of women in this desperate situation reach out to the DC Abortion Fund (DCAF) for emotional and financial support. When these women call the DCAF hotline, Elisabeth is frequently the advocate they find on the other end of the line.

Through her tireless work with the DCAF hotline, Elisabeth fields about 100 calls a month from women throughout the metropolitan DC area who can’t pay for the abortion they urgently need. These women call from the most desperate and tenuous of situations, and Elisabeth invests hours in each case.

Women who reach Elisabeth through DCAF find a compassionate supporter, a tenacious champion,and a knowledgeable guide. With any given call, Elisabeth might advise a woman on circumventing restrictions limiting access to family planning services, reach out to area clinics to negotiate on behalf of a patient, prepare a woman for what the abortion experience will be, coach someone to find funds in the unlikeliest of places, and offer DCAF funds to make up the critical difference.

When not answering the hotline, Elisabeth serves on the board of DCAF, co-directs the case management program, leads a dozen hotline volunteers, and raises money to replenish the fund. Perhaps most incredibly, Elisabeth does this on a volunteer basis in between working two paid jobs. In addition to her essentially full time volunteer work at DCAF, Elisabeth is a key member of the communications team at the Association of Reproductive Health Professionals and is a patient counselor at a family planning clinic.

Friends and colleagues marvel that the many hours Elisabeth invests in her reproductive justice work never seem to diminish her spirit. She is consistently a shining example of kindness, humor, and an abiding spirituality. She generously shares her gentle spirit and poetic talent with the world at large through the inspired musings that make up her blog. By tirelessly giving of herself to ensure every woman’s right to healthcare, Elisabeth is truly a women’s health hero.

April 24, 2009

Sex and Disability Educator: Dr. Tuppy Owens

Entrant: Zelda Plum
Nominee: Dr. Tuppy Owens, Founder of The Outsiders

tuppyDr. Tuppy Owens founded Outsiders 30 years ago, for disabled men and women to find partners. She has continued to run this group ever since, and within it runs the V-Group for disabled women with sexual problems. She also runs the Sex and Disability Helpline and campaigns for visually and speech impaired people to receive more understanding so they can find partners.

She recently launched the TLC, which is a website for disabled men and women to find responsible sex workers. She is now working to improve the sex education that disabled teenagers receive, so that it is relevant to their disabilities. All this work is funded by her own fundraising events – the Erotic Awards that honour the stars in the erotic universe, and the Night of the Senses which is an all-night ball to offer guests a glimpse of what a mature sexually free society could be like, and welcomes disabled and shy people.

April 23, 2009

Their Birth, Their Way: Nikki Macfarlane

Entrant: Lynne F.
Nominee: Nikki Macfarlane, Founder of Childbirth International

Nikki Macfarlane advocates for informed choice. She believes we have the right to make personal choices about our health and we make better decisions when we understand the implications – pros and cons – of the choices available to us.

Nikki’s professional work has focused for many years on pregnancy, childbirth, and parenting. She helps women and their partners discover all their options and make informed choices that lead to their own best possible physical, emotional, and spiritual health as they go through perhaps the most important transformation of their lives: giving birth and then becoming parents.

Nikki’s work began as she trained to be a childbirth educator, helping women truly have “their birth, their way.” Nikki listened to women demoralized by impersonal and routine approaches to maternity care and developed tools to help women gain the skills and acquire the knowledge they needed to make their births personal, healthy and free of unnecessary and unwanted interventions.

Nikki’s approach to helping parents prepare for birth and parenthood was unique – she emphasized communication skills, decision-making skills, reflection, and assertiveness skills. These were unconventional topics for a childbirth class at the time, but stemmed from the realization that traditional classes were not enough to help women reach their goals. Women needed more than just facts and figures. They needed to take charge of their own health care decisions and work with their caregivers rather than just learn “what to expect.”

And so Nikki created Childbirth International (CBI). It offers the most comprehensive training and certification programs for birth doulas, postpartum doulas, childbirth educators, and breastfeeding counselors anywhere in the world. With CBI, Nikki’s vision of preparation for birth as a time for parents to discover their own power and abilities can reach many more women through each doula and each educator trained.

CBI’s message is that birth is about physical health as well as emotional discovery, self-reliance as well as developing a community, and personal growth as well as family connection. CBI’s students come from over 60 countries across the globe, helping each student connect her local birth culture to the traditions of the wider world. Her initiatives have already affected thousands of women globally.

Read the rest of this entry »

April 23, 2009

Wind Beneath My Wings: Dr. Cheryl Holder

Entrant: Marie Perez
Nominee: Dr. Cheryl Holder, Internal Medicine

Sometimes in our lives, when we most need it, but least expect it, we find the person who we never thought we would find, “Our Hero.” And that is who I met in April 2006 when I suffered a pulmonary embolism, was hospitalized, and sent to a primary physician at the North Dade Health Center in Opa Locka, Florida.

At that present time, I had no money, was living (and still am) in a room in the house of a family member. I was suffering from a bad depression and it got to the point where life had no meaning for me. Until the first day Dr. Holder walked in the examination room and started to treat not just my sickness, but took me under her care. She was an angel sent from above, lifting me up from the bad depression I was going under.

This is a person, a doctor, we all need in our lives.

Her first sad experience was at the age of 12 when she lost her father. Some ambulance attendants decided he was not sick and didn’t bring him to a hospital. Yet, this didn’t make her change her devotion, care and love for medicine and outreach to helping others. On the contrary, she is always developing new programs to help and educate our community.

She developed Project Care (Community AIDS Reduction through Education). She raised more than $350,000 in funding for the Care program. At the North Dade Health Center that had around 16,000 patients, she was the head and successfully managed to pull the system together providing medical care to all of us that have no means.

Another of her many other great merits is F.I.U. School Of Medicine, which opened its doors in 2009. Many people have benefited from her contributions to this program. There are so many other awards and accomplishments that I could list, but it would be endless. Dr. Holder is a person who has no limitations when it comes to reaching out to others, educating, no matter what a person’s race or sex, or even if they have the means for medical assistance or not. She is always there.

Sadly, money comes first in medicine. But medicine is supposed to save lives, give hope, never give up, and fight till the end. That’s why she is a HERO, because she never leaves your side, and I can say that. Why? Because she never left mine. Life had meaning when she became the wind beneath my wings. For this, I have made her a web page and invite those of you who wish to meet my HERO to visit.

April 22, 2009

An Essay on the Factory Model of Childbirth

Obstetrician/gynecologist Lauren Plante has a remarkable essay in the International Journal of Feminist Approaches to Bioethics in which she condemns the rising cesarean rate and compares current U.S. childbirth practices to the industrial revolution.

Critical of the drive to standardize and medicalize obstetrics, a phenomenon that is reducing choices within hospital settings for childbearing women, she writes:

…despite the implied promise of safety if all the rules are followed — ID bracelets, intravenous lines, electronic fetal monitoring — labor may follow an unpredictable path. The definition of  ‘normal’ becomes ever narrower, and toleration of deviance ever lower. The final stage of this philosophy takes the process of birth away from the woman entirely and turns it into a surgical procedure performed by the doctor. Childbirth becomes a manufactured experience, shorn of any real risk or real power, one in which the woman is so far alienated from the capabilities of her body that she is only a package on an operating table for a professional to open.

Plante notes that while the “choice” may be available to have a “maternal request” cesarean (something that does not appear to happen in demonstrably high numbers), this does not equate to increased real choice or autonomy for women.

In the US, we have heard arguments that women are entitled to autonomy in making their birth choices, and that therefore it is ethical to perform cesarean for no reason other than maternal request. Curiously, this vaunted autonomy stops at the door of the labor room. Women are implicitly allowed, or encouraged, to make only those choices which increase the power of the physician and which decrease their own.

Plante explores some possible reasons for the narrowing of women’s choices.

The drive toward fewer delivery options appears at first glance to be supported by upper-middle-class women, who have the least number of social and economic obstacles to autonomy.  In fact, cynical staff at hospitals delivering large numbers of well-insured upper-middle- class women often refer to their institutions as baby factories: these are the places in which cesarean rates are highest. It is, after all, a paradox: women with higher incomes, higher levels of education, and commercial insurance have higher rates of cesarean delivery. If cesarean is a response to any perceived risk, why would women at statistically lower risk of a poor outcome have higher cesarean delivery rates? New Jersey has the highest cesarean rate among states, but no lower levels of maternal or perinatal mortality. What it does have, however, is the highest median household income.

Plante notes that a “new normal” has been created:

…seduced by the promise of pain-free, risk-free childbirth, women and their doctors are driving the cesarean rate ever higher. Rates approaching—or exceeding– fifty percent are now seen in some hospitals. This is the normalization of deviance. This is the new normal.

She describes what a full spectrum of childbirth choices entails:

Women can give birth at home unaided; at home with family or with trained assistance; in a birth center, either freestanding or hospital-based; in the hospital delivery room with trained assistance; or in the operating room where they are acted upon.

Then she remarks:

The American College of  Obstetricians and Gynecologists calumniates not only women who want a home birth but anyone who advocates leaving that option open. Once in the hospital, women who might like to exercise their right to self-determination by choosing vaginal birth after cesarean, or vaginal breech delivery, will have a hard time of it. Is it not the opposite of autonomy to support only those choices which increase the woman’s reliance upon the physician?

Plante includes a sober look at the challenges we face as we try to restore choices in childbirth:

The paradox is this: women wish to be treated as individuals, and assert for themselves a wish to exert control, yet in the commodification and industrialization of childbirth they are so much more likely to be treated as units of production. I know of one large community hospital revamping their labor floor and planning for a 50% cesarean delivery rate: and just as we learned in the 1989 movie, Field of Dreams, if you build it, they will come. The staffing and scheduling patterns for a 50% cesarean rate, as well as administration plans for hospital length of stay, can’t be turned on a dime. Hospital administrations like predictability, in patient patterns, patient care pathways, and everything else. If we normalize this industrialized approach to childbirth, we are likely to be stuck in it for a very long time indeed—and we can’t look to the medical profession to correct it.

Her conclusion is shared by those of us at Our Bodies Ourselves:

We must clearly understand that real autonomy does not mean cesarean on request, but instead a spectrum of birth options that honor women’s authentic choices. Real autonomy also means, to borrow a sentiment from Gandhi, that women should bring forth the change they wish to see in the world.

The full article is available online (for a fee).

Plante, an ob/gyn at the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology at Thomas Jefferson University, has written a number of other articles supportive of choice in childbirth.

For more information on how to preserve women’s choices in childbirth, see the OBOS statement Choices in Childbirth, now signed by more than 400 clinicians and educators in the maternal and child health field.

Citation: Plante, L. Mommy, What Did You Do in the Industrial Revolution? Meditations on the Rising Cesarean Rate. The International Journal of Feminist Approaches to Bioethics. 2009 Spring;2(1):140-147.

April 22, 2009

Keeping Readers in the Know:

Entrant: Amy

I would like to nominate the great blogging women of as my Women’s Health Heroes. I have been enthusiastically reading feministing for quite some time and I feel that it gives young women a space to voice their concerns, in addition to learning about other’s perspectives on important health issues. The women of feministing deserve recognition for always keeping readers up-to-date and for also sharing lighter and funnier news.