Category Archives: Health

Telling Birth Stories: New online workshop starts Nov. 1!

Telling Birth Stories: An Online Writing Workshop

with Award-winning author & journalist, Elayne Clift

This baby is shown just after a water birth. - Photo (c) E. Vest

How do you write a good birth story? What makes any story compelling? How can we tell our own birth stories, as remembrance and as a gift to other women?

In Birth Ambassadors: Doulas and the Re-emergence of Woman-supported Birth in America (Praeclarus Press, 2014), Christine Morton and Elayne Clift include stories by women for whom a doula was present at their birth. These beautifully crafted first-persons narratives give voice to the extraordinary experience of giving birth. Join the growing chorus of women whose voices, and birth stories, are being heard!

This 4-week online workshop guides participants – moms, dads, midwives, nurses, doulas, docs – through the elements of good storytelling as they relate their personal experience while giving or assisting birth. Weekly prompts will serve as a guide to setting the scene, involving characters, using dialogue, making wise word choices, and more. Work will be shared each week among participants who will respond to each other. Elayne will offer in-depth feedback and suggestions for each piece and facilitate dialogue among participants.

If you’re interested in painting a word portrait that carries your audience with you as you tell your birth tale, please register by Oct. 15. Register by Oct. 5 for one of two chances to receive a signed first edition of Birth Ambassadors! Space is limited to 8 participants!
WHEN: The online workshop will begin November 1 and conclude Nov. 22.

COST: $80/pp (sorry, no pro-rations)

QUESTIONS: eclift@vermontel.net 802-869-2686

* * * *

Elayne Clift (M.A.), a specialist in gender issues and women’s health, has been an international educator and advocate on maternal and child health issues for more than 25 years. She is Sr. correspondent for the India-based syndicate Women’s Feature Service, a columnist for the Keene (NH) Sentinel and the Brattleboro Commons, and a reviewer for the New York Journal of Books. Her articles, prose and poetry appear in numerous anthologies and publications internationally and her novel, Hester’s Daughters, a contemporary, feminist re-telling of The Scarlet Letter, was published in 2012. She lives in Saxtons River, Vt. (www.elayneclift.com)

MacArthur Grant Sheds Light on Reproductive Technologies

A couple has had miscarriages, considered in vitro fertilization (IVF), discussed adoption and finally opted for a surrogate to bear their baby in India. They visit her before signing on and feel that the agency’s “gestational mothers” are well cared for and decently compensated. But how much do they really know about the practice of cross-border surrogacy?

Thanks to a recent MacArthur Foundation grant to the Center for Genetics and Society (CGS) and Our Bodies Ourselves (OBOS), the information gap surrounding surrogacy and other assisted reproductive technologies (ART) will be addressed, with an emphasis on human rights and social justice. Light will also be cast on the rapidly growing industry ARTs have spawned.

“Cross-border surrogacy raises thorny questions,” says Marcy Darnovsky, Executive Director of CGS. “Some people look at women selling their eggs or reproductive capacity as an individual right within the context of wage labor. Others see these practices as deepening gender and class inequalities in a not-so-free market.”

“Most information available in the mainstream fails to paint a complete picture,” adds OBOS’s Ayesha Chatterjee. “With faceless images of pregnant bellies, the narratives of gestational mothers remain untold. Convenience, concierge-like services and various packages geared to attract intended parents in a competitive market are what get emphasized.”

Both CSG and OBOS support ART as a reproductive choice but they are deeply concerned by gaps in evidence-based knowledge to aid in comprehensive and well-informed decision-making within a rapidly growing, mostly unregulated market that positions surrogacy as women helping women, a win-win for all.

But what is the reality for gestational mothers?

“Often gestational mothers live in communities where cultural beliefs and systemic institutional oppression/marginalization makes it hard for them to achieve financial independence and security,” say Chatterjee, co-author with Sally Whelan of an OBOS paper on cross-border surrogacy. “In India, for example, many gestational mothers are poor with little social mobility. These factors create a power imbalance that makes it impossible for them to negotiate fair ‘work’ conditions within surrogacy arrangements. It allows those in positions of power like recruiting agents and fertility clinics to get away with a range of exploitive practices.”

These practices include the lack of “informed” consent since many women can’t read documents they are made to sign, minimal compensation and unfair payment schedules, isolation from family and restricted movement outside of surrogacy “residences,” constant monitoring, high risk medical procedures, and unnecessary C-sections to accommodate traveling parents. Post-partum medical care may be poor or lacking altogether and should problems occur there is no life or disability insurance.

Add to this the risks taken by egg providers when an intended parent’s egg is not used. “Egg providers must undergo an intensive and risky process using hormones that have multiple short and long term effects,” OBOS points out. “Similar to gestational mothers, many egg providers receive minimal and sub-standard information about the health risks and they are often provided with little to no follow up care.”

There are also issues for the babies “commissioned” by intended parents. These children have a genetic link to egg providers, are birthed by gestational mothers, and handed over to intended parents. As policy struggles to catch up with technology myriad legal issues remain unresolved regarding the child’s legal parent, immigration status, and best interests should custody disputes occur.
Another problem occurs when intended parents are scammed. Recent reports exposed a California-based medical tourism company. One couple reported sending Planet Hospital thousands of dollars but the company failed to deliver on its promises, or to return more than $20,000 the couple had spent in the process. This year Planet Hospital removed surrogacy from their list of medical tourism procedures and then claimed bankruptcy, continuing to deny any wrongdoing.

SAMA: Resource Group for Women and Health New Delhi, cites “an explosion of fertility services,” noting that the Indian fertility industry, worth more than 400 million U.S. dollars annually, is proliferating despite the absence of regulatory or monitoring mechanisms. “Commercial surrogacy is often portrayed as a win-win situation,” SAMA reports. “It is positioned as giving ‘desperate, infertile’ parents a child while providing poor surrogate women with income. But given growing globalization of capital and shrinking local jobs, women from marginalized communities find themselves more impoverished, powerless and vulnerable.”

Feminists offer diverse voices on surrogacy and egg retrieval. Some raise questions about women’s health while others focus on the implications for gender analysis and the effects of surrogacy on women’s lives and marriages. Others claim that “patriarchal ideology” focuses excessively on biology. But despite differences of opinion there is consensus that more needs to be known about ARTs and their impact on the personal, social, political and economic lives of those that use reproductive services.

Thankfully CGS and OBOS will bring much needed information about surrogacy and egg retrieval into the mainstream, helping to pave the way for “a real win-win for everyone.”

# # #

This column is based on a blog posted to Our Bodies Ourselves Blog in August 2014.

 

Telling Birth Stories Workshop

Telling Birth Stories

An Online Writing Workshop with Award-winning author & journalist

Elayne Clift

How do you write a good birth story? What makes any story compelling? How can we tell our own birth stories, as remembrance and as a gift to other women?

In Birth Ambassadors: Doulas and the Re-emergence of Woman-supported Birth in America (Praeclarus Press, 2014), Christine Morton and Elayne Clift include stories by women for whom a doula was present at their birth. These beautifully crafted first-persons narratives give voice to the extraordinary experience of giving birth. Join the growing chorus of women whose voices, and birth stories, are being heard!

This 4-week online workshop guides participants – moms, dads, midwives, nurses, doulas, docs – through the elements of good storytelling as they relate their personal experience while giving or assisting birth. Weekly prompts will serve as a guide to setting the scene, involving characters, using dialogue, making wise word choices, and more. Work will be shared each week among participants who will respond to each other. Elayne will offer in-depth feedback and suggestions for each piece and facilitate dialogue among participants.

If you’re interested in painting a word portrait that carries your audience with you as you tell your birth tale, please register by July 15. Register by July 4 for one of two chances to receive a signed first edition of Birth Ambassadors! Space is limited to 8 participants!
WHEN: The first online workshop will begin August 1 and conclude Aug. 25.

COST: $95/pp

QUESTIONS: eclift@vermontel.net       802-869-2686

Announcing “Birth Ambassadors” – the “definitive” book on Doulas!

Drum Roll, Please!  I am thrilled to announce that my book with lead author Christine Morton, Birth Ambassadors: Doulas and the Re-emergence of Woman-supported Birth in America, has just been published by Praeclarus Press!  Here’s an endorsement written by the noted midwife Dr. Robbie Davis-Floyd:

This book is THE definitive work on doulas in the United States. It is clearly and compellingly written, immediately drawing readers in to the story of the development of doulas in the U.S. and of the social movement that arose to support their incorporation into American hospital birth. Want to know what a doula actually does for laboring mothers? Read this book! Want to know what a doula can do for you personally, if you are expecting? READ THIS BOOK! Want to know if you yourself should become a doula? READ THIS BOOK! If you are an obstetrician, professional midwife, or obstetric nurse, read this book to find out how doulas can augment your care in ways that support you as well as the mother, the baby, and the family. You will find all your answers within its beautifully written pages.

 

The many individual stories written by mothers and by doulas themselves bring life and light to their experiences, and the many photos illuminate the stories even further. The authors do not avoid what is widely known as “the doula dilemma”—do doulas really make a difference in the birthing experience, or do they just make women feel better about traumatic births? Their strong affirmation of the multiple benefits of doula care should be read by all expectant parents, by all birth professionals who attend them, and by those thinking of becoming doulas as well as those who already are. This comprehensive, evidenced-based, and fascinating book will compel its readers to work hard to make birth better—more humanistic, more compassionate, more physiological, and more successful in terms of healthy babies and empowered mothers and families. 

 

–Robbie Davis-Floyd PhD, Senior Research Fellow, Dept. of Anthropology, University of Texas Austin, author of Birth as an American Rite of Passage, and co-editor of Mainstreaming Midwives.

Available from Praeclarus Press, Amazon.com, or order at your local bookstore.

Please share with anyone in the birth and parenting community, as well as with relevant practitioners. Thanks!ba mini pc 10-11

When It Comes to Mental Health, Do No Harm

Recent gun violence has shone new light on mental health issues. There is renewed focus on meeting the needs of people with mental health challenges and that is a good thing. But an exhibit at a public library in Ithaca, New York serves as a reminder that extreme caution must be exercised as the mental health establishment addresses the complex topics of how to insure accurate assessment and improve services.

http://tcpl-exhibits.blogspot.com/2013/09/the-exhibit-lives-they-left-behind.html

The Lives They Left Behind: Suitcases from a State Hospital Attic, mounted by the Tompkins County Public Library and the National Alliance on Mental Illness/Finger Lakes, is an emotional exhibit and a chilling reminder of what can go wrong when individual practitioners and health systems fail to understand their patients and assume too much power over the lives of others.

When Willard Psychiatric Center closed in 1995, hundreds of suitcases were found in the attic of an abandoned building. The suitcase contents bear witness to the lives of their owners before they were incarcerated at Willard. They were individuals with jobs, families and friends who led normal lives. But because many of them suffered loss and grief, poverty, unemployment and other life stresses they were diagnosed, labeled, and sent off to an asylum that they never left.

Over 50,000 people were admitted to Willard during its 125-year history. Many of them died there, alone and quite possibly driven insane by the experience.

Among them was a Scottish woman named Margaret who lived at Willard for thirty-two years until her death. A nurse in London, her fiancé was killed in World War I, after which she emigrated to the States. While doing graduate work, Margaret suffered a serious head injury; then she contracted tuberculosis. Still, she traveled, worked and enjoyed her friends. While hospital records report that she became paranoid, a friend described her as “a woman to be admired, easy to entertain, pleased with so little.” Margaret was committed to Willard at the age of forty-eight. When she told her intake interviewer that she felt “like a fly in a spider web,” he had neither the imagination nor, it seems, the intelligence to understand her metaphor and so she was locked up and subjected to experimental, high-dose psychiatric medication until she died.

Ethel was another inmate. She married young and had two children. Her husband proved to be a violent alcoholic and womanizer. Later she lost three more children, after which she left her husband, sewing to support herself. Alone and desperately sad, she took to her bed. Her landlady had her committed. She spent forty-three years at Willard, probably in part because she resisted regulations. Her two surviving children visited her only three times. In her suitcase were family photos, silverware and linens, a bible, and a set of handmade baby clothes.

In their important book Women of the Asylum: Voices from Behind the Walls, 1840 – 1945, Jeffrey Geller and Maxine Harris share the stories of twenty-six women like Margaret and Ethel whose first-person accounts of incarceration in mental institutions are horrifying and moving. (Some of them were put there by husbands who found their unpopular views or behavior inappropriate for proper ladies.) One of them wrote, “How little did I know where I was and what I was put into that house for. Such a crime I never read of, and it is covered up under the garb of derangement, and I am the poor sufferer.”

http://www.amazon.com/Women-Asylum-Voices-Behind-1840-1945/dp/0385474237/ref=sr_1_1?s=books&ie=UTF8&qid=1382408491&sr=1-1&keywords=women+of+the+asylum+voices+from+behind+the+walls+1840-1945

In my 2002 anthology, Women’s Encounters with the Mental Health Establishment: Escaping the Yellow Wallpaper, contemporary women tell their stories in poetry and prose. What’s startling is that they are saying the same things that the women of the asylums did, often using the same words to describe their experiences.

http://ecx.images-amazon.com/images/I/51zH-kew-JL._BO2,204,203,200_PIsitb-sticker-arrow-click,TopRight,35,-76_AA300_SH20_OU01_.jpg

And that is why knowing about the suitcase exhibit, especially as the fifth edition of the “psychiatrist’s bible” or DSM-V (Diagnostic and Statistical Manual), has recently been published, is important. For while asylums like Willard no longer exist (and while not only women were put there), and in spite of the fact that some people really do suffer terribly from mental illnesses, a very real danger still lurks within the broad range of psychiatric assessment and care.

http://ecx.images-amazon.com/images/I/41gV0NZ22vL.jpg

It continues to be all too easy to mislabel, to assume, to wield power over, to not understand, to misdiagnose when people face emotional challenges and traumatic life events. Whether females, veterans, children, or others who find life daunting extra care must be taken, and deep compassion called upon, among the helping professions as they encounter mental and emotional suffering.

It is too easy, even for “experts,” to miss the real stuff of people’s lives, to jump to conclusions, to confuse pain with pathology. Therefore the pledge to “do no harm” must be urgently recalled. Not doing so could be catastrophic, as Margaret, Ethel, and multitudes of others could attest to, if they’d ever been allowed to speak the truth of their lives.

What the Shutdown Means for Women

She’s a young mother, pregnant with her second child, who relies on the Special Supplemental Nutrition Program for Women, Infants and Children – WIC – for food and medicine when her son gets sick. When the federal government shut down she became one of almost nine million mothers, and their children under five, who lost their vouchers for food, baby formula, and breastfeeding support.

She’s a victim of domestic violence who has nowhere to go for help because funds usually available under the Violence Against Women Act have been reduced or eliminated.

She’s Michele Langbehn, a beautiful young mother who told her story on CNN and then started a Change.org petition to try to save her life. Having endured multiple surgeries, nine months of chemo, and two cycles of radiation to stop the spread of her rare form of cancer, she was under consideration for a clinical trial of a new medication that just might save her life when the shutdown hit the National Institutes of Health.

Michele Langbehn and her daughter

“I’m furious that Congress has chosen to shut down the government and leave so many of us behind,” Langbehn’s petition said. “This is not just about the debt ceiling or national parks. For me, the shutdown means that Congress is denying me potentially life-saving treatment. I speak for everyone battling cancer when I saw we don’t have time to wait.”

Why, I wonder, haven’t the critical needs of women like these – caretakers, breadwinners, mothers, daughters, elders in need – been given the priority of parks, monuments, food safety, and deserving veterans when it comes to policy and publicity?

All over this country, women who struggle to make ends meet in the best of times now face disastrous challenges, setbacks, and fears for the future of their families. Most of these women remain invisible, certainly in the eyes of privileged, uninformed, insensitive, politically driven policymakers under that big white dome in Washington. What do they know of moms who have to miss work and lose pay because Head Start programs or adult day care facilities for their aging parents have been closed? How many of them have looked at the face of a sick child and had to choose between food and medicine? Who among them has a child who won’t be able to attend college because financial aid has been cut?

As one blogger noted on slate.com, “Republicans are all about how babies are so great that women shouldn’t be able to say no to having one. … However, they clearly don’t love babies enough to make sure the alive ones are fed.”

That observation reminds me of what feminists pointed out back in the 1990s: Mean-spirited conservatives in Congress are all for supporting children from conception to birth. After that, it’s up to you, Mom.

And it’s not just about mothers. It’s about young women in college – and there are more of them than men – whose financial aid is being cut. Will they skimp on contraception, or meals, or meds, to make ends meet?

It’s about elderly women who can’t afford to heat their homes in winter if they depend on help from the Low Income Home Energy Program.

It’s about single women whose economic stability is seriously challenged when they are furloughed, and it’s about their health and wellbeing when they have to forego health care or preventive services like birth control, HPV testing, and pap smears for lack of funds or because of the moral objections of Neanderthals who get to hold them hostage.

The Affordable Care Act – can we please stop calling it Obamacare – has already meant that millions of women across the country have been able to access preventive health care without a co-pay, and more will benefit when the law takes full effect. It has already been measurably cost-saving: The Guttamacher Institute, for example, has shown that for every dollar invested in birth control services, nearly six dollars is saved in the long term.

As Dr. Atul Gawande, who writes for The New Yorker, and others have made clear, to date the Affordable Care Act has allowed more than three million people under age twenty-six to stay on their parents’ insurance policy. Seventeen million children with pre-existing medical conditions cannot be excluded from insurance eligibility or forced to pay inflated rates. And more than twenty million uninsured people will gain protection they didn’t have. A “new norm is coming,” Gawande says. It’s a norm that underscores that Americans are “entitled to basic protection.”

Who but the meanest and most politically driven could be against that? Virginia's Tea Party-er Eric Cantor

The answer is a group of nasty, small-minded, heartless Tea Party members who are about to go down in flames. It gives me no pause to watch that happen. But taking women like Michele Langbehn and so many others down with them positively turns my stomach.

Pesticides and Chemicals Make It Dangerous Out There

When lawmakers failed to pass the far-reaching farm bill recently, which already threatened cuts in food stamps by $2 billion a year, it also put an end to proposed regulations requiring farmers and food companies to exercise greater caution to prevent food contamination. The rules would have ensured that food workers wash their hands, irrigation water is clean, and animals are kept out of fields, among other things.

Such regulations seem warranted in view of the latest contamination of salad greens. And in June a frozen berry mix caused a hepatitis-A outbreak in eight western states. Bacteria was the culprit when a food-borne illness sickened people at a food festival in New York while E-coli made people ill at a Mexican burrito restaurant in Illinois. A Kansas beef processing plant was also found to have E-coli. Let’s not even count the salmonella outbreaks.

Then there was the GMO wheat found on an Oregon farm, thanks to Monsanto’s testing of a genetically-engineered wheat variety it had developed.

But food isn’t the only source of worry when it comes to what we consume, or subject our bodies to. Pesticides and chemicals pose other risks. As the Toxic Action Center points out, “pesticides are the only toxic substances released intentionally into our environment to kill living things.” This includes substances that kill weeds, insects, fungus, rodents and other pests. “Pesticides are used in agricultural fields and in homes, parks, schools, public buildings, roads, and forests. They are found in the air we breathe, the food we eat, and the water we drink.”

Not a very comforting thought when you consider that Rachel Carson began warning about the harmful effects of pesticides in 1962 when her groundbreaking book Silent Spring appeared. Since then the use of pesticides has only increased while evidence of their harm mounts. One 2012 study, for example, conducted by Canadian and American scientists, found that exposure to pesticide residues on vegetables and fruits can double a child’s risk of attention deficit disorder.

Rachel Carson

Pesticides can cause health problems ranging from headaches and nausea to cancer and reproductive disorders. Sometimes the problems take years to surface. Some of us are old enough to remember running after trucks spewing DDT in the summer when we were kids; many of those kids grew up to get breast cancer. In fact, children are particularly susceptible to the hazards of pesticide use. The short version of all the evidence about pesticides harmful effects is this: Pesticides are toxic to living organisms.

So are many chemicals. More than 380 of them listed by the Environmental Protection Agency (EPA) as inert ingredients were once or are still registered as pesticide active ingredients. That means we aren’t playing with a full deck when it comes to knowing the contents of pesticide products that may be hazardous. Yet we assume that chemicals in shampoos, detergents and other everyday products have been proven safe despite the fact that industrial chemicals are not required to be tested before hitting the market.

According to a recent article in The New York Times, in its entire history the EPA has mandated safety testing for only a small percentage of 85,000 industrial chemicals in use. Once they’re being used, it’s extremely difficult for the agency to restrict a particular chemical because of stringent requirements needed for banning them. After the 2010 BP oil spill, two million gallons of chemical dispersents were used to break up the slick but federal officials could not say they were safe because only minimal testing had been done.

Thankfully, the Safe Chemicals Act of 2013 has been introduced in the Senate by Sen. Kirsten Gillibrand (D-NY) and the late Frank Lautenberg (D-NJ). It requires the chemical industry to prove that a chemical is safe before it is sold and puts limits on trade secret practices. It also requires the industry to reduce the use of chemicals designated by the EPA to be of “greatest concern” because of their toxicity. It’s no surprise that the proposed legislation is already garnering strong opposition from the Republican side of the aisle.

Kirsten Gillibrand

Clearly, we need to make our food, air, water, and soil free from toxic pesticides and chemicals. That will require better testing, reduced dependency on pesticides and chemicals, legislation aimed at protecting land, waterways, buildings, cleaning and hygiene products, and foods.

Rachel Carson knew this fifty years ago. “If we are going to live so intimately with these chemicals, eating and drinking them, taking them into the very marrow of our bones – we had better know something about their nature and their power,” she said. “The road we have long been traveling is deceptively easy, a smooth superhighway on which we progress with great speed, but at its end lies disaster.”

Can Women’s Health Trump the Abortion Debate?

When Margaret Sanger was a young nurse working in New York tenement houses early in the 20th century she was called to assist a 28-year old woman who had attempted to terminate her fourth pregnancy. Recovering from the infection that nearly killed her, the woman asked Sanger how to stop having children. “What did the doctor say?” Sanger asked. “He said ‘Tell Jake to sleep on the roof,’” the beleaguered mother replied. Promising to learn more about birth control and return with answers, Sanger’s research began. Several months later she was called to the same house where the woman she’d promised to help had tried to end another pregnancy. This time the young mother died, leaving behind three small children. Sanger redoubled her efforts to educate women about “family planning.” Her lifelong work began culminating in the organization now known as Planned Parenthood.

The bad rap that Planned Parenthood and other women’s full service health clinics get because of the abortion debate in the country is unfortunate and dangerous. Women’s health clinics provide a wide range of services including cancer screenings, pre- and post-natal coverage, care for some chronic illnesses, and well-woman visits. They are not “abortion clinics,” although many do provide that constitutionally protected service. Most of them serve women ranging in age from early teens to end-stages of life. An estimated three million women and men use Planned Parenthood affiliate health centers annually; more than 70 percent of them receive help to prevent unintended pregnancies. Over half a million women get Pap smears and breast-cancer screenings. Only three percent of all Planned Parenthood health services are abortions. In short, the organization is about quality comprehensive health care within the context of privacy and personal rights.

Republican legislators in states like North Dakota, Arkansas, Virginia, and Texas still don’t get it. Their ignorance and political agenda put innumerable women at risk because the regulations they want to impose on clinics providing abortions among a cafeteria of services will require many of them to close. Where will women, especially those in rural areas or lacking health insurance, go when they are hemorrhaging or suspect a breast lump or need birth control pills? In Texas alone in 2011 fifty-six health centers were closed, thanks to Gov. Rick Perry and his ilk. More than 130,000 women lost their access to health care.

This year Perry and his pals proposed a law that would ban abortions after the twentieth week of pregnancy and close thirty-six of forty-two Texas clinics that provide abortions among other services. Nevermind that the 20-week abortion ban gaining traction relies on a false measure of pregnancy only politicians use. Medical professionals know that the accepted term “20 weeks pregnant” indicates time since last menstrual period, not 20 weeks “post-fertilization.” (A pregnancy does not start at fertilization, but at uterine implantation.) As Cecile Richards, head of Planned Parenthood says, “When it comes to a woman’s health, no politician should be able to decide what’s best for you.”

President Obama agrees, noting that “Planned Parenthood is a vital partner” to his administration in “protecting women’s health.” Unlike him, those arguing as Texas legislators do, that demanding abortion providers have hospital privileges and abortion facilities meet ambulatory surgical-center standards “in the interest of protecting women’s health” are doing nothing more than demonstrating “the last refuge of scoundrels,” as one noted scientist and women’s health advocate remarked.

In my novel Hester’s Daughters, a contemporary, feminist re-visioning of Nathaniel Hawthorne’s The Scarlet Letter, there is a scene in which an illegal abortion takes place. There is also one involving a woman having to run the gamut at a Planned Parenthood clinic. Both of these are imagined narratives: Thankfully, I’ve never had to seek an illegal abortion, nor have I been confronted with vengeful protesters at a women’s health clinic. But I have known women who lived both experiences. In the days before Roe v. Wade I “covered” for a 19-year old friend who flew to Puerto Rico for an abortion. (Luckily the man with whom she conceived had funds to cover costs.) I have counseled married friends on where to obtain a safe abortion, and I’ve used women’s clinics for my own health needs. I know firsthand from working in women’s health for thirty years how vital these clinics are for providing women access to safe, accessible, affordable health care, whether preventive, diagnostic or service-oriented. There is so much more to Planned Parenthood and women’s health clinics than people realize.

In my novel, for instance, one woman is forced to abort a pregnancy she wishes to complete. The other seeks help at a Planned Parenthood clinic, not for an abortion but for infertility treatment. These two narratives are not unrelated; they both offer a glimpse of women’s health needs, physical and psychological.

Margaret Sanger understood their connection. In this important juncture in women’s lives, when politicians have no business in our bedrooms or doctors’ offices, so must we all.

Mastectomies, Movie Stars, Media and Medicine

How ironic that Angelina Jolie chose National Women’s Health Week – and the week after Barbara Brenner, executive director of Breast Cancer Action and a feisty advocate for women with the disease died (from Lou Gehrig’s Disease) – to share with the world that she had elected to have a double mastectomy in an effort to avoid breast cancer.

The press lit up with the news. Breast cancer “experts” and media moguls leapt at the chance to say Jolie had been “brave,” and “courageous,” and indeed she had: Choosing to have your healthy breasts amputated at the age of 37 takes guts and must have been a heart wrenching decision to make. In her case, it is understandable. Having an estimated 87 percent chance of contracting a potentially fatal disease is enough to make any woman think twice about whether prophylactic mastectomy is warranted. (I still wonder how that precise percentage was derived.)

Still, a chill ran down my spine when I heard the news and I wondered what Barbara Brenner, an outspoken breast cancer educator who had had breast cancer herself, would have said. Here’s why.

Only about one percent of American women carry the BRCA1 or BRCA2 mutation that Jolie’s doctors identified. Therefore, as H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice pointed out in a CNN commentary, her story “is not relevant to more than 99 percent of women [here].” Although it’s a terrible thing to carry the gene, it affects relatively few women. Yet, now that Jolie has gone public, even more women will be seeking mastectomies, adding to an alarming increase in demands for the surgery ever since Sherly Crow, Marlee Matlin, and Miss America contestant Allyn Rose made the same choice or heartily endorsed it.

Mastectomy and all that it entails is not something to be taken lightly. As with other major surgeries, it can result in serious complications, along with persistent pain and limited mobility. Repeat surgeries may be necessary, especially if a woman chooses to have breast implants. If tissue is transplanted from other parts of the body to reconstruct the breasts, more incisions will be needed, and if muscle is removed for this purpose, long-term weakness can result. As one advocate put it, “it is not a breeze” and not a cure-all.

It is also an expensive proposition, as is the testing for BRCA 1 and 2. It costs about $3,000 dollars to be tested and many thousands of dollars to have elective surgery. Some insurance companies cover some of the costs, but many don’t. That’s okay if you’re a movie star, but ordinary women, including many women of color, will never be able to afford treatment close to what Angelina Jolie has just experienced. And even she still has a chance, reduced though it may be, to getting breast cancer.

In The New York Times op ed. revealing her surgery, Jolie said “cancer is still a word that strikes fear into people’s hearts.” How many women’s decisions around prophylactic mastectomy are based on fear-mongering rather than evidence-based decision-making? Was it responsible for Jolie to remind readers that “breast cancer alone kills some 458,000 people each year,” without also providing the stats on the gene she carries?

Many women are choosing mastectomy – even for healthy breasts – when advances in early detection and subsequent treatment, including lumpectomy, offer viable alternatives. Joan Walsh of Salon.com made this case, based on her own personal experience. “I chose a course of rigorous medical follow-up,” she posted, “[including] an annual screening mammography and twice-yearly breast exams by a surgeon.” Walsh elected not to be tested for the BRCA gene, instead giving emergency attention to the slightest anomaly. “I’m so glad I didn’t listen to the doctor who wanted to treat my breasts like ‘ticking time bombs,’” she says. As respected breast surgeon Dr. Susan Love noted in The New York Times, “When you have to cut off normal body parts to prevent a disease, that’s really pretty barbaric when you think about it.”

The risks and benefits of any breast surgery, and especially mastectomy, vary from woman to woman. As Dr. Isabelle Bedrosian, a surgical oncologist at M.D. Anderson Cancer Center in Houston put it in a New York Times report, “There is an upside to [Jolie’s] story and that is that women will hopefully be more curious about their family history. [But] we need to be careful that one message doesn’t apply to all. Angelina’s situation is very unique. People should not be quick to say ‘I should do like she did,’ because you may not be like her.”

Fortunately, few of us are. That should be the starting point if we are ever faced with a decision about breast cancer treatment options, even if that decision proves to be as difficult as the one Angelina Jolie made

The Heart of Birthing: Doulas and the Support They Offer

With the second annual World Doula Week having just ended, I’ve been reflecting once more on why I became a volunteer doula and what the work means to me.

I’m a baby freak, plain and simple. As a young candy-striper I routinely snuck into the pediatrics ward so I could rock sick kids. While my high school friends dated, I babysat. If I hadn’t been a product of the fifties, I might have considered becoming a obstetrician or a midwife. Instead I followed the path that most girls my age did: I went to college for a liberal arts degree and then became a secretary — a medical secretary.

My real career began when I became program director in 1979 for the National Women’s Health Network, a Washington, D.C.-based education and advocacy organization dedicated to humane, holistic, evidence-based, feminist approaches to women’s health care. In 1985 I went to Nairobi for the final international conference of the United Nations Decade for Women (1975-1985). Inspired by that amazing event and armed with a master’s degree in health communication, I began working internationally on behalf of women and children, always trying to bring a gender lens to the table.

In the midst of all this, I gave birth twice. My children were born in the seventies as the women’s health movement, and individual women, were beginning to advocate for natural childbirth and to resist the traumas of overly-medicalized birth experiences. We took Lamaze classes, learned about nursing, expected dads to be active in our deliveries. I was lucky: not only were my labors quick and unremarkable, but the small community hospital where I delivered was sympathetic to the changes taking place in birthing. There were no monitors, no drugs “to take the edge off” if you didn’t want them, no enemas, no shaving, and no macho-docs (although I couldn’t talk my doctor out of the episiotomy). I labored with my nurse and my husband and when the time came to push, I watched my babies come into this world in total awe of what had just happened and what I had done.

Several years ago, I learned that my local hospital had a volunteer doula program. Signing up was a no-brainer and I’ve now had the honor of supporting dozens of women and their partners as they’ve done the hard work of delivering a baby. Not one of them has failed to say afterwards, “I couldn’t have done it without you!” (They could, but I’m glad to have eased their experience.)

One of the early births I attended stands out in my mind. It was a first pregnancy and the mom labored stoically for thirty-six hours, pushing for five, before her son was born. As the hours passed, I held her hand, wet her lips, wiped strands of matted hair from her eyes, rubbed her back. “You can do this,” I whispered in her ear when she grew doubtful. “You’re doing a magnificent job! Soon your baby will be born.” As the baby finally crowned, wet, dark hair pressing urgently against her, I held the mother’s leg in my arm, her hand clenching my free wrist as she cried out with that guttural groan of a woman pushing her child to life outside the womb. And suddenly, there he was, head emerging, wet and pinking up even as his perfect little body swam into being. Later, swaddled and suckling at his mother’s breast, his father, eyes wet, whispered across the bed to me, “Women’s bodies are so miraculous!”

“Yes,” I said, my own eyes filling, “Miraculous.” Always miraculous, no matter how many times you give witness, or weep yourself to see a woman giving birth.

Doula supported childbirth has been proven to reduce the incidence of c-sections, shorten the length of labor, reduce the number of medicated births, increase breastfeeding and provide higher satisfaction for mothers regarding their birth experience. As one pediatrician put it, we are “the descendants of those millions of women who gathered at bedsides around the world” to help women through labor and delivery. “Some day we may again reach a point where women rely on the traditional circle of birth-experienced [women] to ease them through childbirth. … Until then, skilled, compassionate doulas will ably stand in for them.”

That is why I feel privileged to do this voluntary work. It is simply an honor to give witness to birth, and to offer as many women as possible the opportunity to have a birth that is supported, memorable, and full of joy.