Surprise! Pitocin Is Linked to Postpartum Depression | Mother Rising

 BY 

Pitocin®, a synthetic form of oxytocin, is routinely given to women before, during and immediately following birth to induce and augment labor and to also prevent and treat postpartum hemorrhage.  Much to the surprise of the medical community, a recent study showed that Pitocin® is linked to postpartum depression and anxiety.

The mothers aren’t surprised.

For women with a history of depression or anxiety prior to pregnancy, receiving Pitocin® increased the risk of postpartum depression or anxiety by 36%.

For women with no prior history of depression or anxiety, receiving Pitocin® increased their risk of postpartum depression or anxiety by 32%.

Let that sink in for a moment.

I Bet the Numbers Are Even Higher

While I pondered these incredibly high numbers, it occurred to me that the numbers may actually be higher.

The information used in the research study came from women that received a diagnosis and/or a psychotropic medication.  What about those that didn’t seek help?

In my experience, for whatever reason, many women do not seek professional help when experiencing postpartum anxiety and/or depression.

How many anxious or depressed mothers never confide to their care providers about what they’re feeling?  Or even worse, were dismissed and told “everything will be fine”.

It’s Not Just in Our Heads

Even if the numbers may be higher, the research as is, is incredibly validating.  Ladies, what you are feeling is not “just in your head”.  It’s real, and it’s a big problem (that society has no idea how to handle).

*For a list of symptoms of postpartum mood disorders please visit Postpartum Progress.  (Postpartum Progress is a non-profit that aims to raise awareness, fight stigma and provide peer support and programming to women with maternal mental illness.)

Pitocin Is Not the Same as Oxytocin

The strangest thing about the research study was that the hypothesis was the opposite of what made sense to me as a mother and childbirth educator.  The hypothesis suggested that synthetic oxytocin, Pitocin, would in fact lower postpartum depression and anxiety.

The underlying assumption I am gathering is that, despite the evidence, medical professionals believe that Pitocin® is the same as oxytocin.

A few years ago I was attending a Pitocin® induction at my local hospital.  My doula client was struggling BIG TIME with the sudden wave after wave of strong, painful contractions.  Her nurse, not knowing what else to do, told her, “this is just labor, honey”.  As if what she was experiencing were normal labor sensations.  How sad.

Believe me, Pitocin® does not feel warm and fuzzy, and isn’t “just like labor”.  My pitocin augmentation birth was much harder than my first two births.  For me, Pitocin® made my active labor phase feel like the transition phase, and lasted far longer than the transition phases I had experienced in my non-Pitocin® births.

Oxytocin is Needed to Mother Well

Oxytocin, on the other hand, is helpful for coping with stress, supporting emotional and mental well-being and also helps with bonding – which are absolutely necessary for a successful transition to motherhood. (source)

Another study showed that women given Pitocin in labor had low oxytocin levels during breastfeeding.  This revealed that the exposure to Pitocin® has consequences that last on into mothering. (source)

What About the Baby?

If oxytocin is an important hormone for becoming a mother and synthetic oxytocin is linked to postpartum depression, anxiety and low oxytocin during breastfeeding.  I can’t help but wonder – what about the baby?

If oxytocin effects how women transform into mothers, how is this synthetic hormone affecting the baby?

How is the baby affected by synthetic oxytocin before, during and after labor?

Frighteningly, we have no idea.

Re-Examine Routine Procedures

If Pitocin® is linked to postpartum depression and causes a lack of oxytocin during the postpartum period, maybe it’s time to re-evlatulate the use of Pitocin® as it pertains to each woman.  (Never mind the baby…)

According to the CDC, induction has more than doubled from 1990 (10%) to 2010 (23%). (source)  However, just because a procedure is routine does not mean that it’s a good enough reason to do it.

 

We Need More Research

I’m not suggesting to eliminate Pitocin®, as it is an important life saving tool in modern obstetrics.  (Shoot, I’ve even experienced it first hand!)  However, because the consequences of routine childbirth interventions such as Pitocin® on human maternal behavior have been understudied, it would be wise to limit the use of Pitocin® until further research is completed.

And if Pitocin® is deemed necessary, it would be wise and compassionate to provide quality postpartum care, especially to those with high risk factors for postpartum depression.

What if care providers were required to pay for 40 hours of postpartum doula services to women that received Pitocin®?  I bet we’d quickly see the true motivations behind the choices made in the care of new mothers.

Oxytocin is essential for our species to thrive as mothers.  Our current methods meddle with the mental health of these new mothers – the backbone of society.

Is the crumbling mental health of new mothers important enough for us to take action?

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Chrissy Teigen Believes Eating Her Placenta Helped Her Avoid Postpartum Depression After Second Baby BY ANDREA PARK

About a year after giving birth to daughter Luna, in April 2016, Chrissy Teigen penned a powerful essay for Glamour in which she described her experience with postpartum depression. In the essay, she says PPD left her unable to leave the couch for months at a time. Her experience in the months after welcoming son Miles in May, however, has thankfully been completely different. In a new preview of her upcoming interview with Rita Braver forCBS Sunday Morning‘s 40th anniversary primetime special (airing September 14), Teigen theorized why she was spared the pain of PPD this time around.

“It sounds ridiculous, but people have this belief that if you eat your placenta, it gets all those nutrients that you lost when you were pregnant, rather than just losing them immediately and losing that rush of endorphins,” she said. “By taking these dry placenta pills, you can kind of keep this energy up and be weaned off that feeling more. And I didn’t do that with Luna so…I remember looking back and being like, ‘I shoulda ate my placenta!'” When Braver said she didn’t think the cookbook author could include placenta as an ingredient in her cooking demonstration on the special, Teigen joked, “Really?! That’s not a normal thing? I’m in L.A., it’s very normal — they grill it here.”

 

Though it’s fantastic that Teigen hasn’t experienced PPD after her second pregnancy, there’s not actually any definitive research linking eating placenta to preventing depression or, in fact, to any other health benefits. According to Self, the Centers for Disease Control and Prevention actually recommends that new moms avoid eating their placenta in capsule form since it could contain dangerous bacteria that can then be passed on to newborns via breastmilk or skin-to-skin contact. Additionally, women’s health expert Jennifer Wider, M.D., told Self that mothers who eat their placenta could also see an increased risk of blood clots as a result of ingesting extra estrogen. If you’re worried about PPD or any other potential post-birth conditions, your best bet is to talk it over with your doctor, who can recommend a (scientifically sound) course of action.

The 32-year-old also described another major life change she’s experienced since welcoming two kids and putting out two cookbooks. “I really prefer being happy and getting to eat things that I love, still wanting to be healthy,” the former Sports Illustrated swimsuit model told Braver. “But I just don’t care about looking good in a swimsuit anymore. I guess that’s the only way to put it.”

Just a few weeks ago, Teigen took to social media to talk about learning to love her body. “I think it’s awesome people have killer bodies and are proud to show them off (I really do!!), but I know how hard it can be to forget what (for lack of a better word) regular ol’ bodies look like when everyone looks bonkers amazing,” she wrote on Twitter after sharing a video of herself after giving birth to her two children, complete with stretch marks. She added, “Also I don’t really call this ‘body confidence’ because I’m not quite there yet. I’m still super insecure. I’m just happy that I can make anyone else out there feel better about themselves!”

 

New York City Launches Initiative to Eliminate Racial Disparities in Maternal Death

A Central Brooklyn hospital featured in ProPublica and NPR’s “Lost Mothers” series for its high hemorrhage rate will serve as a pilot for quality reforms.

In response to alarming racial disparities, New York City announced a new initiative last week to reduce maternal deaths and complications among women of color. Under the new plan, the city will improve the data collection on maternal deaths and complications, fund implicit bias training for medical staff at private and public hospitals, and launch a public awareness campaign.

Over the next three years, the city will spend $12.8 million on the initiative, with the goal of eliminating the black-white racial disparity in deaths related to pregnancy and childbirth and cutting the number of complications in half within five years.

“We recognize these are ambitious goals, but they are not unrealistic,” said Dr. Herminia Palacio, New York City’s deputy mayor for health and human services. “It’s an explicit recognition of the urgency of this issue and puts the goal posts in front of us.”

The city’s health department is targeting nearly two dozen public and private hospitals over four years, focusing on neighborhoods with the highest complication rates, including the South Bronx, North and Central Brooklyn, and East and Central Harlem. Hospital officials will study data from cases that led to bad outcomes, and staff will participate in drills aimed at helping them recognize and treat those complications.

Health department officials approached SUNY Downstate Medical Center in May to serve as a pilot site for many of the new measures.

 

The Central Brooklyn hospital was featured in the “Lost Mothers” series published by ProPublica and NPR last year as one of the starkest examples of racial disparities among hospitals in three states, according to our analysis of over 1 million births in Florida, Illinois and New York. In the second half of last year, two women, both black, died shortly after delivering at SUNY Downstate from causes that experts have said are preventable. The public, state-run hospital has one of the highest complication rates for hemorrhage in the city.

“We look forward to working with all of our partners to provide quality maternal health care for expectant mothers,” said hospital spokesperson Dawn Skeete-Walker.

“SUNY Downstate serves a unique and diverse population in Brooklyn where many of our expectant mothers are from a variety of different backgrounds, beliefs, and cultures.”

The city will also specifically target its own public hospitals, which are run by NYC Health + Hospitals, training staff on how to better identify and treat hemorrhage and blood clots, two leading causes of maternal death.

The initiative is “aimed at using an approach that encourages folks to have a sense of accountability without finger pointing or blame, and that encourages hospitals to be active participants to identify practices that would benefit from improvement,” said Palacio.

In addition to training, the city’s public hospitals will hire maternal care coordinators who will assist high-risk pregnant women with their appointments, prescriptions and public health benefits. Public hospitals will also work to strengthen prenatal and postpartum care, including conducting hemorrhage assessments, establishing care plans, and providing contraceptive counselling, breastfeeding support and screening for maternal depression.

Starting in 2019, the health department plans to launch a maternal safety public awareness campaign in partnership with grassroots organizations.

“This is a positive first step in really being able to address the concerns of women of color and pregnant women,” said Chanel Porchia-Albert, founder and executive director of Ancient Song Doula Services, which is based in New York City. “There need to be accountability measures that are put in place that stress the community as an active participant and stakeholder.”

The city’s initiative is the latest in a wave of maternal health reforms following the “Lost Mothers” series. Over the past few months, the U.S. Senate has proposed $50 million in funding to reduce maternal deaths, and several states have launched review committees to examine birth outcomes.

As ProPublica and NPR reported, between 700 and 900 women die from causes related to pregnancy and childbirth in the United States every year, and tens of thousands more experience severe complications. The rate of maternal death is substantially higher in the United States than in other affluent nations, and has climbed over the past decade, mostly driven by the outcomes of women of color.

While poverty and inadequate access to health care explain part of the racial disparity in maternal deaths, research has shown that the quality of care at hospitals where black women deliver plays a significant role as well. ProPublica added to research that has found that women who deliver at disproportionately “black-serving” hospitals are more likely to experience serious complications — from emergency hysterectomies to birth-related blood clots — than mothers who deliver at institutions that serve fewer black women.

 

In New York City, the racial disparity in maternal outcomes is among the largest in the nation, and it’s growing. According to a recent report from New York City’s Department of Health and Mental Hygiene, even as the overall maternal mortality rate across the city has decreased, the gap between black and white mothers has widened.

Regardless of their education, obesity or poverty level, black mothers in New York City are at a higher risk of harm than their white counterparts. Black mothers with a college education fare worse than women of all other races who dropped out of high school. Black women of normal weight have higher rates of harm than obese women of all other races. And black women who reside in the wealthiest neighborhoods have worse outcomes than white, Asian and Hispanic mothers in the poorest ones.

“If you are a poor black woman, you don’t have access to quality OBGYN care, and if you are a wealthy black women, like Serena Williams, you get providers who don’t listen to you when you say you can’t breathe,” said Patricia Loftman, a member of the American College of Nurse Midwives Board of Directors who worked for 30 years as a certified nurse-midwife in Harlem. “The components of this initiative are very aggressive and laudable to the extent that they are forcing hospital departments to talk about implicit bias.”

MOST MOMS AREN’T AWARE OF FREE BREASTFEEDING INSURANCE BENEFITS, SURVEY SHOWS

Progress has been slow, but we’re starting to see the US become a more supportive place for breastfeeding moms. Laws entitle women to nurse in public, pump at work and have access to free products and services designed to give breastfeeding a boost in this country. But surprisingly, 82 percent of moms aren’t aware of all their legal rights and benefits, a new survey shows.

By law, women have the right to a private space to pump (and no, the bathroom doesn’t count), and their employers are required to let them take pumping breaks at work—something 61 percent of women weren’t aware of, according to a recent survey sponsored by Byram Healthcare, a medical supply company that provides no-cost breast pumps through insurance. The fact is, there are a whole host of free health benefits breastfeeding moms are legally entitled to, thanks to the Obama-era Affordable Care Act—but these big money-savers apparently aren’t well known.

Of the 1,000 expectant mothers surveyed, 64 percent didn’t know that sessions with a lactation consultant are covered at no cost to them under most of today’s insurance policies. That’s right—it’s mandatory for most insurance plans to cover lactation support and counseling, as well as equipment for the duration of your breastfeeding period, including before and after you’ve given birth.

That means you’re entitled to a breast pump through your health insurance (and whatever else your doctor deems medically appropriate for you). But 42 percent of women didn’t know you can order a breast pump, usually at no cost (though some policies might require a co-pay). And we’re not just talking a basic manual pump—insurance also covers premium double-electric pumps. Worried you won’t be able to get your pump of choice? You’re not alone, the survey shows, but rest assured plenty of popular name-brand breast pumps, like Medela, Spectra, Lansinoh and others, are available.

 

So how can you go about getting your free pump? First check with your insurance policy to see what’s fully covered and what retailers would be considered in-network. You can place an order as soon as get that positive pregnancy test, if you’d like. The only caveat for many insurance companies is that the pump won’t actually be shipped until 30 days before your due date.

The American Academy of Pediatrics recommends breastfeeding exclusively for the first six months and continuing as long as mom and baby desire—so taking advantage of these benefits could save you big bucks. Breastfeeding isn’t always easy, but at least there are policies in place to help you succeed. If you’re in need of more help, check out these 12 tips for making breastfeeding a little easier.

PAMPERS DIAPERS ARE ABOUT TO GET MORE EXPENSIVE

EXPECT TO SEE SLIGHT PRICE HIKES STARTING THIS FALL.

PUBLISHED ON 08/02/2018

Parents know just how quickly you can blow through a stash of diapers—and for every wet nappy you toss, your mental cash register tallies up the cents you just spent. It’s estimated that families spend $2,000 to $3,000 on diapers alone in those first two years. Unfortunately, that price tag may be getting even higher, now that Pampers is jacking up their prices.

Procter & Gamble, Pampers’ parent company, announced this week they’re raising prices for Pampers diapers by an average of 4 percent, although the exact increase will depend on the size and type of diaper as well as the retailer.

Before you get too upset, a 4 percent price hike likely won’t break the bank. According to MarketWatch, Target sells a 100-count pack of Pampers Swaddlers diapers for $25. With the increase, the cost will be about $26. It’s not great, but it’s likely not going to be a total deal-breaker.

So why the jump in price? Procter & Gamble pointed to the rising cost of pulp, a raw material used to make disposable diapers, and higher transportation and freight costs. This isn’t the first time they’ve had to raise their prices, and it likely won’t be the last. In 2011, P&G and Kimberly-Clark Corp., the company that makes Huggies diapers, upped their price points for similar reasons.

For now, the new higher prices are expected to roll out between October and December, making now is a good time to stock up on Pampers if you’re looking to save a few dollars.

 

If you’re going to buy in bulk from Amazon, a word of warning: Be on the lookout for counterfeit diapers. There have been multiple reports of people buying what they believe are Pampers brand diapers, only to discover they’ve actually purchased lesser quality fake versions when the package finally arrives. If the price looks too good to be true, it probably is.

PHOTO: Courtesy Manufacturer

Science Daily: For women with history of pregnancy loss, walking may aid chance of becoming pregnant

Date: May 8, 2018

Source: University of Massachusetts at Amherst

Summary: Results of a recent study to better understand modifiable factors such as physical activity that may affect a woman’s ability to conceive a child suggest that walking may help women to improve their chances of becoming pregnant.

Results of a recent study to better understand modifiable factors such as physical activity that may affect a woman’s ability to conceive a child suggest that walking may help women to improve their chances of becoming pregnant.

The study was conducted by recent graduate Lindsey Russo and her advisor Brian Whitcomb, associate professor of biostatistics and epidemiology in the School of Public Health and Health Sciences at the University of Massachusetts Amherst.

Russo and Whitcomb’s findings among healthy women ages 18 to 40 years old with a history of one or two pregnancy losses are based on their secondary analysis of the multi-site Effects of Aspirin in Gestation and Reproduction (EAGeR) study. It is led by Enrique Schisterman of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Results are in the current online issue of Human Reproduction.

Russo says, “One of our main findings is that there was no overall relationship between most types of physical activity and the likelihood of becoming pregnant for women who had already had one or two pregnancy losses, except for walking, which was associated with higher likelihood of becoming pregnant among women who were overweight or obese.”

Whitcomb, whose research on the determinants of fertility and pregnancy outcomes usually involves studying biomarkers at the molecular level, adds, “Lifestyle is definitely relevant to these outcomes because it can have an effect at the molecular level. What we eat and what we do are potential factors we can change to shape our health. So this sort of research is important because it helps provide information on the things people can actually do something about.”

Further, he says, “We were happy to be able to add scientific evidence to general recommendations about physical activity. This is especially true for the results about walking for even limited blocks of time. Walking has great potential as a lifestyle change because of its low cost and availability.”

For the 1,214 women in the study, the association of walking with the ability to become pregnant, known as fecundability, varied significantly by body mass index, the authors report. Among overweight/obese women, walking at least 10 minutes at a time was associated with improvement in fecundability. Further, in statistically adjusted models, women reporting more than four hours a week of vigorous activity had significantly higher pregnancy chances compared to no vigorous activity.

Moderate activity, sitting and other activity categories were not associated with fecundability overall or in BMI-stratified analyses, they add. Russo and Whitcomb say one finding that is still not clear is the different associations related to vigorous compared to moderate and low-intensity activities. Whitcomb says, “We don’t know what to make of the finding that high intensity physical activity may have different biological effects than walking, but our study doesn’t offer enough detail to get at why vigorous activity would work differently than other levels.”

Among a number of cautions the researchers point to in this work is that physical activity is related to other behaviors and lifestyle factors, and women who are more physically active may be different from women who are less active in many ways. Russo says, “We did our best to try to account for the differences and to address them statistically.”

The researchers also note that the overall generalizability of this work is limited because the study population may not be representative of the general population with regard to fecundability, and exercise habits may differ in women with prior miscarriage compared to those without.

Whitcomb says another way in which this study is distinct from other work in this area has to do with who was included in the study. The EAGeR trial focused on women with a history of one or two prior pregnancy losses. However, he adds, “We were happy to be able to conduct research considering women having the most difficulty getting and staying pregnant, and to provide messages about common lifestyle factors they may be able to address.”

The researchers conclude that “these findings provide positive evidence for the benefits of physical activity in women attempting pregnancy, especially for walking among those with higher BMI. Further study is necessary to clarify possible mechanisms through which walking and vigorous activity might affect time-to-pregnancy.”

 

Story Source:

Materials provided by University of Massachusetts at AmherstNote: Content may be edited for style and length.

Rewire.News: Maryland Legalizes Home Births With Midwives (2015)

 Martha Kempner

Maryland Governor Larry Hogan (R) is expected to sign a bill Tuesday that will license direct-entry midwives and make it legal for them to attend to home births.

Maryland Gov. Larry Hogan (R) is expected to sign a bill Tuesday that will license direct-entry midwives and make it legal for them to attend to home births.

Maryland was one of six states that forbid midwives from helping mothers give birth at home unless the midwife is a nurse. Advocates have pushed for legislation to change this law for many years, but opposition from medical groups and concerns about safety had prevented it from gaining traction in the state’s Democratic-majority legislature.

Around the country, the number of births that take place outside of a hospital setting spiked by 60 percent between 2004 and 2012, according to the Centers for Disease Control and Prevention (CDC). Currently, somewhere between 1 and 1.5 percent of all Maryland births occur out of the hospital.

Proponents of changing the state’s law argued that these women and the midwives that help them have few legal protections. They believe that changing the law to allow for licensed certified midwives—as 28 other states have done—could enhance safety through education and regulation and give everyone involved legal protection.

Groups representing doctors, nurse-midwives, and nurses had previously opposed similar laws, as had the state’s health department, but the bill introduced this year included compromises on many issues that had been at the center of legislative disagreement. The bill set specific education requirements for certified midwives, noted which health conditions precluded home birth, and explained when and how midwives would transfer care to another medical professional if they encountered problems during delivery.

The sticking point this year was related to what is known as vaginal birth after cesarean section, or VBAC deliveries. It used to be settled science that once a woman had a c-section section, all future births would be by c-section to reduce the risk of uterine tearing.

New surgical procedures, however, have made this risk much lower and allowed some women to have a vaginal delivery with their next pregnancy or pregnancies. Fear remains that VBACs are more dangerous and many in the medical profession are against VBACs attempted outside of a hospital.

Pam Kasemeyer, a lobbyist for the Maryland State Medical Society and other physicians groups, told the Baltimore Sunin April that VBAC was “the one remaining very contentious issue.”

“We understand that women are going to make that choice and deliver at home, and that’s their right,” she said, adding that medical groups weren’t going to agree to the bill unless VBACs were excluded.

To get the bill to move forward, both sides agreed that VBACs would be prohibited for now. But the bill requires a committee to report on the safety of such deliveries and leaves open the possibility that the law could change.

Delegate Ariana Kelly (D-Montgomery County), who sponsored the bill in the house, was not surprised by the contention. She told the Baltimore Sun: “Medical licensing bills are brutal. They’re turf wars.” Once the last compromise was reached, however, the bill, HB-9, was passed unanimously by both the house and the senate.

Rewire.News: “The Midwives’ Resistance: How Native Women Are Reclaiming Birth on Their Terms”

 Mary Annette Pember

Birth has become dangerously medicalized for them.

Aboriginal or indigenous midwifery is seeing a resurgence as conventional health-care policies in hospital and clinics perpetuate an environment in which most contemporary pregnant Native women are considered pathologically unhealthy.

“The mainstream medical narratives surrounding Native women depict moms who don’t breastfeed and don’t have partners. According to this portrayal, Native women don’t exercise, eat poorly, and have diabetes. We are seen as hopeless,” said Marinah Farrell, an indigenous Chicana certified professional midwife based in Phoenix.

“When I worked in the hospital, I saw so many Native mothers who would hemorrhage and have terrible outcomes during their births. It seemed so abusive; they were treated like they were sick already when they entered the hospital doors,” said Rebekah Dunlap, a member of the Fond du Lac Band of Ojibwe who works as a doula and is a registered nurse, bachelor of science nurse, and public health nurse in Minnesota.

What began quietly as the efforts of a few dedicated women has in recent years grown in size, scope, and agility. Today, Native women across the United States and Canada are putting their skills to work in challenging the status quo of mainstream medicine.

Birth has become dangerously medicalized for them. Cut off from traditional diets, support networks, and community midwives due to colonization and assimilation, many Native women have chronic health conditions that mean giving birth is a high-risk activity—and one that requires travel to well-equipped hospitals.

Many indigenous women in the United States and Canada give birth in governmental health facilities overseen by Indian Health Service (IHS) in the United States, and First Nations and Inuit Health Branch in Canada.

Health-care policies at IHS and First Nations and Inuit Health are comparable to those at conventional health-care facilities in both countries.

Aboriginal or indigenous women, especially those in the United States, are overwhelmingly classified as high-risk. In Canada, according to Statistics Canada, birth outcomes among indigenous peoples are consistently less favorable than among the non-indigenous population. Native American and Alaska Native women have higher rates of maternal morbidity or injury compared to the general population, according to the Centers for Disease Control and Prevention (CDC). The risk of maternal death for Native women is twice that of white women in the United States.

The infant mortality rate for Native American and Alaska Native babies is .83 percent, second only to rates for non-Hispanic Black American babies of 1.13 percent.

The practice of forcing Native women to travel to hospitals because their traditional ways of caring for pregnant people were outlawed contributes to an endless cycle of poor outcomes. Despite the public health industry’s best attempts at addressing Native women’s high-risk status, this cycle can’t be addressed by the same Western-style institutions that are complicit in perpetuating the problems in the first place, according to indigenous midwives including Katsi Cook of the Mohawk Nation.

For instance, governmental policies such as forced attendance at Indian residential schools in Canada and Indian boarding school in the United States were explicitly intended to eradicate and denigrate indigenous cultures, languages, and ways of healing and birthing. Many children in these schools were subjected to sexual and physical abuse and denied access to their families, thus creating generations of untreated post-traumatic stress disorder or historical trauma. After being cut off from families and traditional lifestyles and foods, which some suggest offer nutritional benefits, indigenous peoples began developing high rates of diabetes and poor health outcomes, such as high rates of lung, chest, and intestinal disorders.

Forcing Native women to birth in hospitals is another in a long line of colonial acts of violence, explained Kanahus Manuel, a member of the Neskonlith Indian Band of Secwepemc Nation in British Columbia, Canada. “Birth is the ultimate act of decolonization and resistance,” she said.

Reclaiming Tradition

The efforts of indigenous midwives in Canada and the United States run a wide spectrum of styles and practices. However, according to Nicolle Gonzales, Navajo nurse-midwife, “Indigenous peoples share a worldview of connection to the land. We view birth and motherhood as ceremony,” she said.

“Traditional midwives took time to sit and talk with the mothers about their lives, families and challenges,” Dunlap noted.

“Our women were given time and support to have their babies; there was no agenda dictating the various stages of labor,” she said, drawing a clear distinction between birthing experiences at hospitals versus in Ojibwe communities. According to the American Pregnancy Association, there are three stages of childbirth including early labor when the cervix moves toward complete dilation of 10 centimeters, active labor when the baby is delivered through the fully dilated cervix, and third stage which includes delivery of the placenta. The first stage of labor is usually the longest period and can last from a few minutes to many hours.

Among indigenous peoples, as birthing women moved through the stages of labor, they were fed certain foods to provide physical, emotional, and spiritual strength.

When the baby was born, its feet touched the earth even before it was given to the mother.

“All of these ways had important meanings that are not yet completely lost,” she said.

“Woman is the first environment,” Cook said, echoing Dunlap’s sentiments. “With our bodies we nourish, sustain, and create connected relationships and interdependence. In this way the Earth is our mother, our ancestors said. In this way, we as women are earth.”

Cook has influenced and inspired generations of midwives to embrace their traditional Native ways. “I have a long tail in championing indigenous midwifery extending back to when I was first pregnant in 1973,” Cook said.

Cook has worked as an indigenous women’s health and midwifery advocate for many years. In 1983, she helped create a “Birthing Crew” of local elders and midwives on her home reservation of Akwesasne in New York and Canada. The crew provided midwifery services and health education to tribal members. In 1985, after the nearby St. Lawrence River was polluted by polychlorinated biphenyls (PCBs) from General Motors, Cook established the Mother’s Milk Project. A study found PCB contamination of breast milk of Mohawk women who ate fish from the St. Lawrence River.

Today, Cook’s many devotees and students continue taking up the challenge to revitalize indigenous midwifery.

Aboriginal midwife Kanahus Manuel is a self-proclaimed warrior, freedom fighter, and well-known indigenous land and water protector.

Manuel was pregnant with her first child while opposing the Canadian government’s plan to build facilities for the 2010 Winter Olympics on Secwepemc lands. When she learned that authorities had issued a warrant for her arrest for these activities, she fled to the Marble Mountain range deep in Secwepemc territory when her time came. “I knew I wanted an unassisted birth as my ancestors have done for centuries; I didn’t want to have my baby in a prison cell,” she said.

She educated herself in both mainstream and traditional birth practices and has since birthed all four of her children in the Secwepemc way, at home attended by family and/or midwives.

For Manuel, revitalizing indigenous midwifery is a declaration of sovereignty over women’s bodies and autonomy from colonial governmental systems.

Other advocates are finding ways to work within the systems to revive Native birth ways.

Gonzales is working within U.S. medical laws and regulations to create what will be what she describes as the first Native culturally focused birth center on tribal lands. Founder and executive director of the New Mexico-based Changing Woman Initiative, Gonzales received her bachelor’s of science in nursing and master’s degree in nurse-midwifery from the University of New Mexico and is a member of the American College of Nurse-Midwives and certified with the American Midwifery Certification Board. Although eligible to practice in a conventional hospital, Gonzales envisions creating a birthing environment that is friendly and welcoming and where Native women can have ceremony, eat traditional foods surrounded by family, and reclaim their traditional ways of birthing and healing.

According to the CDC, in 2015, 98.5 percent of births in the United States occur in hospitals. Out-of-hospital deliveries represented 1.5 percent of births in 2015. Of the more than 61,000 out-of-hospital births, 63 percent occurred at a home and 31 percent at free standing birthing centers. However, most insurance companies don’t cover home births and may only offer limited coverage at birthing centers.

Gonzales hopes she can establish Medicaid certification for the birthing center they are building and establish other ongoing funding in order to offer services for women who may lack other health insurance.

She and her supporters and co-workers at Changing Woman Initiative equate Native women’s rights to birth in their own ways as inherent and inalienable rights affirmed by the United Nations Declaration on the Rights of Indigenous Peoples.

They hope to complete the birthing center, on the Pojoaque Pueblo, north of Albuquerque, this year.

Providing Truly Culturally Sensitive Care

Gonzales and her colleagues argue that although the Indian Health Service is tasked with providing health care to Native Americans, it is unable to effectively meet its mission. IHS is the federal agency within the federal Department of Health and Human Services that is charged with meeting treaty agreements between federally recognized tribes and the U.S. government, which promises to provide tribal members with health care. These promises have their base in Article I, Section 8 of the U.S. Constitution governing duties and powers of the Congress.

Criticism of the type of health care offered by IHS, however, could be lodged against other conventional health-care facilities in the United States that are also subject to the same limitations and laws regarding types of services that can be offered.

A statement provided by the Phoenix Indian Medical Center indicated that it employs ten certified nurse-midwives who provide culturally sensitive and relationship-based services. According to the statement, the health center provides pregnant people with therapeutic massage, hydrotherapy, and lactation support. Gonzales, however, argues that although IHS insists it offers culturally sensitive birthing practices, most of the midwives are non-Native and the facilities are still governed by the same strict hospital-style protocols as its mainstream counterparts. So no matter where a Native pregnant person might reside, their access to culturally sensitive care will be limited, if nonexistent. Birthing mothers are restricted regarding food consumption and the use of open fires, and ceremonial food preparation is restricted.

Aboriginal midwifery in Canada, however, has long been recognized by mainstream organizations such as the College of Midwives of Ontario. The college, responsible for registering midwives in the province, declared in a 2001 vision statement that midwifery care in Ontario, including aboriginal midwives, was defined by ongoing support for community-based midwives working in partnership with childbearing women. Aboriginal midwifery is seen as a valuable way not only to improve patient and infant health outcomes, but also as a means to help reverse overall health disparities among Native peoples.

In 1994, many Canadian provinces added a special exemption to the Canadian Midwifery Act. It allows aboriginal midwives who provide traditional midwifery services to tribal communities to practice without registering with the Regulated Health Professions Act. The act varies by province but requires midwives to complete a set of mandatory courses and abide by the rules of the act. Aboriginal midwives can practice legally without accreditation under the often-rigorous demands imposed by the act.

“Indigenous midwifery and healing practices are keystones in addressing reproductive health and longstanding problems in communities such as addiction, disease, shame and trauma,” said Cook, who helped create the 1994 exemption.

Preliminary data and evaluations indicate that birth outcomes have improved since the exemption was added. For instance, Inuulitsivik Health Centre’s Midwifery Service in Nunavut territory has provided care by traditional Inuit midwives to clients since 1986. According to research funded by Health Canada and published in Birth Issues in Perinatal Carefindings indicated low rates of intervention for births despite the high-risk designation of many Inuit mothers. Ninety-seven percent of births were documented as spontaneous vaginal deliveries; Inuit midwives attended 85 percent.

Midwifery in the United States, however, is not as accepted as in Canada. Laws governing its practice vary greatly from state-to-state. Only certified nurse midwives (CNMs), not other midwives, can practice legally in all 50 states. They are afforded hospital privileges in 30 states. After earning a bachelor’s degree in certified nursing, most CNM candidates also complete graduate studies in programs certified by the American College of Nurse-Midwives.

Some midwives may practice under other designations, including direct-entry midwives, certified midwives, or certified professional midwives, who may work in birthing centers and/or help with home births. Training for and attainment of these titles varies from state to state. In some states, many midwives run the risk of arrest for practicing medicine or nursing without a license.

For most women in the United States, the path to childbirth begins with a trip to a traditional hospital. Native mothers frequently must travel great distances from rural home communities and frequently can’t afford to bring along family or other support people. More insidious, however, according to indigenous midwives, is the impact of ongoing trauma from sexual assault as well as unresolved historical trauma created by U.S. federal policies designed to separate Native peoples from their lands, cultures, and languages. According to the Department of Justice, Native Americans are 2.5 times more likely to experience sexual assault compared to other ethnicities. One in three Native women reports having been raped in her lifetime.

The hospital environment with its rigorous, sterile protocols forbidding food; regulations regarding the number of visitors; agendas dictating when to induce birth or perform cesarean sections seem like another in long line of traumatic events.

According to Cook, Native peoples won’t be healthy and whole until Indigenous midwifery, which helps to combat trauma affecting poly-victimized people, is restored to their communities.

In that vein, Dunlap and a handful of other Native women in her area are creating a local effort to spend time with traditional midwives and healers and encourage expectant people to learn more about their Ojibwe birthing ways.

“Our Ojibwe stories describe how the fathers would keep a fire burning while the woman birthed so the baby’s spirit could find its way.” Having a prescribed role for the father provides him with a sense of connection and purpose with the birth.

“For Ojibwe, birth is a ceremony; baby is on a spiritual journey before they actually arrive,” Dunlap said.

“We have ancestral knowledge that Ojibwe women can share with each other,” she added.

The reclamation of indigenous women’s medicine is a true grassroots endeavor, Cook pointed out.

“In indigenous communities, health begins at home, at the kitchen table, using the everyday language of everyday people,” she said.

CORRECTION: This piece has been updated to clarify Kanahus Manuel is a member of the Neskonlith Indian Band. A previous version of the piece also listed Rebekah Dunlap as her online pseudonym R.A. Mackelberry.

Evidence-based journalism is the foundation of democracy. Rewire.News, is devoted to evidence-based reporting on reproductive and sexual health, rights and justice and the intersections of race, environmental, immigration, and economic justice.

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Cities turn to doulas to give black babies a better chance at survival by, Michael Ollove Washington Post*

This city has opened a new front in its effort to give black newborns the same chances of surviving infancy as white ones: training doulas to assist expectant mothers during pregnancy, delivery and afterward.

The initiative is the latest salvo in the Baltimore City Health Department’s seven-year-old effort to combat high mortality rates among black newborns.

“The impetus for this program is the huge disparity in infant mortality between blacks and whites born in this city,” said Stacey Tuck, maternal and child health director at the department.

Baltimore is not alone. New York, Chicago and Tampa have also used doula training programs to improve newborn health.

Other cities may follow, according to Dale Kaplan of the MaternityWise Institute, which conducts doula training in Baltimore. Other cities, including Denver, San Antonio and San Francisco, have contacted his organization to inquire about starting programs.

The U.S. infant mortality rate among African Americans is more than twice as high as it is for white babies.

“Doula” comes from a Greek term meaning “a woman who helps.” Although doulas are trained to assist expectant mothers through labor, delivery and beyond, they are not medical providers, as midwives are. Dona International, which calls itself the largest doula-certifying organization in the world, said doulas help mothers achieve “the healthiest, most satisfying experience possible.”

A 2013 study found that doula-assisted mothers were less likely to deliver babies with low birth weights or with birth complications than were mothers who opted not to receive such support, and they were more likely to breast-feed their infants. Another study found that mothers attended by female caregivers during labor were less likely than others to have Caesarean births, require painkillers or deliver babies in poor health.

“Continuous one-to-one emotional support provided by support personnel, such as a doula, is associated with improved outcomes for women in labor,” according to the American Congress of Obstetricians and Gynecologists, which cites other benefits, such as shortened labor, less need for pain medication and fewer operative deliveries.

African American women have a long history with doulas, particularly during the Jim Crow era when hospitals denied access to black women, forcing many to deliver their children at home, said Andrea Williams-Salaam, a doula trainer in the Baltimore program. But as race-based legal barriers vanished and the medical profession strongly promoted hospital deliveries as the safest option, fewer women practiced as doulas.

While a few continued to work in Baltimore, she said, the city decided to start training doulas, following the example of New York, which started its doula program in 2010. So far, New York has trained 68 doulas who have attended 580 births.

Gabriela Ammann, director of the By My Side Birth Support Doula Program, which seeks to reduce infant mortality in Brooklyn, helped start the New York program. She had been a part-time doula while teaching infant education classes in the Brooklyn Healthy Start Program.

“I noticed when we talked about labor and birth support, participants often said they weren’t sure they’d have someone with them,” she said. “Sometimes they didn’t have someone to support them, or that person had to stay home to take care of the other kids.”

As a result, many of the women had to go through labor and delivery with only the help of strangers, adding to the stress of childbirth, she said.

Ammann started connecting some of those expectant mothers with doulas she knew. She persuaded the city to formalize the program and to train new doulas.

Like New York, Baltimore wants its doulas to work as independent contractors rather than as city employees. In addition to advising women about their pregnancies and baby care, Baltimore’s doulas will be trained to connect needy women to housing, transportation, nutrition and employment services.

“The doulas are there to assist, support and empower a woman in whatever way she needs assistance,” Williams-Salaam said. “That could be accompanying the woman to medical visits to help with the terminology used by the caregiver or helping her obtain proper nutrition, housing or employment.”

It was the idea of empowering other women that induced Keyona Hough to become one of the five doula trainees in Baltimore.

Too often, poor African American women are treated disrespectfully by the institutions they interact with, she said. She wants not only to advocate for her clients but also to “teach them how to advocate for themselves.”

“Like me, a lot of these moms have been subjected to violence and trauma,” she said. “That’s why I want to help them understand what their rights are, so they can move through that system without being re-traumatized.”

Training the initial group of Baltimore doulas cost about $5,000, Tuck said. She hopes to find thefunding to train many more.

The cost of hiring a doula varies widely, from as little as $100 to as much as $5,000, according to Ammann. There is generally no insurance reimbursement for doula services. Unlike New York, Baltimore will not pay the doulas for their work, so any money they make will come from clients.

The architects of the Baltimore program said they warned trainees from the start that they would not be able to make a living from their doula work. Many of their patients cannot afford to pay.

“This is primarily about service and giving back to the community,” Tuck said. “The five women who have enrolled as trainees, their motivation is not compensation, that’s for sure.”

 

https://www.washingtonpost.com/national/health-science/cities-turn-to-doulas-to-give-black-babies-a-better-chance-at-survival/2017/09/22/07420956-8363-11e7-ab27-1a21a8e006ab_story.html?tid=ss_fb-bottom&utm_term=.6b0d19a7c1a2

Birth Statistics ~ The need for more Midwives

Demetra Seriki is a NARM registered Midwife and owner of A Mother’s Choice – Birth Options and Beyond

She is also a Midwife who serves the community of Colorado Springs, Colorado and is currently seeking Student midwives of Color who are interested in training to complete their education as midwives. With so many hospitals closing in many states across the country, the necessity for properly trained Midwives are seemingly increasing.

She recently shared some disturbing but much needed statistics about birth:

 

It is with a very HEAVY heart that I will report the 2016 birth statistics in El Paso County (Colorado Springs) for families of color. They do not separate the stats by birth location so these numbers represent total births and all birth locations.

Total births (all races) 9,499
1. Hispanic – 1,517
2. Black – 814
3. Asian – 468
4. Native – 92

Low Birth Weight (<2,500):
1. Hispanic – 8.8
2. Black – 14.1
3. Asian – 9.0
4. Native – 13.0

Very Low Birth Weight (<1,500)
1. Hispanic – 1.5
2. Black – 2.5
3. Asian -0.9
4. Native – 6.5

Preterm
1. Hispanic – 10.4
2. Black – 13.5
3. Asian – 9.8
4. Native – 19.6

52 infant deaths
34 neonatal deaths

Unfortunately the data that I can see does not identify these babies (angles babies) by race. (I can’t imagine why)

 

If you are a student midwife or a women seeking health services in the Colorado Springs, Colorado area please feel free to contact her.

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