Family Planning Forum, 2016

Advocates for women’s health hold a vigil in Nov. of 2015 in Muskegon

“It’s so great to be around friends. The work we do is so hard.”

                                — Participant, 2016 Society of Family Planning’s North American Forum

In November of 2016, I had the honor of attending to the Society of Family Planning’s North American Forum, a life-changing experience, not so much because of what I learned, but because of what it made me feel. I knew this conference was going to be different from any other I had attended when I went to register and realized that I needed two personal references to even complete the online form.

This was heavy. It’s heavy because healthcare providers are risking their lives every day to provide comprehensive reproductive healthcare services to women. It’s heavy because by being in the presence of so many abortion doctors at one time, I was myself at risk for being murdered. Every conference attendee received a name badge, with a photograph that had to be scanned every time we entered the conference area. We were to turn off the location-finders on our electronic devices. We were to take off our name badges if we left the conference area. We were not to take photographs with other attendees and share them.

I’ve been to a lot of conferences before, but nothing with this level of security. One might think that I would be afraid for my own safety, but the measures taken were reassuring. A lot of people don’t understand the sacrifice people make to perform abortions. Often, it is the only work a doctor can do, due to stigma. This can result in social isolation. Going into the work is not taken lightly and is often the consequence of life-changing experiences, some of which were shared with tears and great conviction at the microphone. Sharing space with such brave people opened my heart to a small taste of what they experience daily. I can read about statistics and danger, but this experience brought me closer to a more personal understanding.

Doctors weren’t the only ones in attendance, though. There were also attorneys, researchers, academics, students, and advocates, but I think I was the only doula and childbirth educator present. I’ve shared a lot of the resources I gathered, but I haven’t written about some of the things that I learned that may be useful in my work. Here are some highlights:

  • Catholic Healthcare:
    • Although there are over 600 Catholic hospitals in the US, over 1/3 of women surveyed did not correctly identify the hospital where they sought care in terms of religious affiliation.
    • Most women believe that hospitals should never be able to restrict care.
    • Residents who graduate from programs at Catholic institutions report dissatisfaction with their training. Although they may not be able to provide abortions, they can still be taught how to do them, through online modules and off-site collaborations.
  • Zika Virus:
    • Many of the countries affected by Zika also have some of the most restrictive abortion laws in the world.
    • Zika is not transmitted through breastmilk
    • Men should wait 6 months after potential exposure before trying to conceive. Women should wait 8 weeks.
    • We don’t yet know what the outcomes will be for infants who were exposed, but are “normal” at birth.
    • Vertical (mother-to-fetus) transmission is less likely in the first trimester, due to the impermeability of the placenta, but if contracted, outcomes are worse. Later in the pregnancy, the fetus has a more mature immune system and the mother has transmitting immunity, so the outcomes are better.
    • Affected countries are advising that women avoid pregnancy, without giving them access to contraception and abortion, which is an unfair and unreasonable expectation.
  • Immediate Postpartum Long-Acting Reversible Contraception (LARC)
    • LARCs can be inserted immediately postpartum.
    • 50% of women ovulate and 60% resume sex before their 6-week postpartum visit
    • Up to 35% of women never attend their postpartum visit
    • Subdermal implants inserted 1 to 3 days postpartum have shown no negative impact on infant health or breastfeeding.
  • Male Contraception
    • There are 3 options for male contraception:
      • Injectables
      • Pills
      • Gel
    • Acceptability determines if men will use available options.
      • Surveys show 44 – 83% of men would use, if available.
      • Lowest acceptability is in Indonesia; highest is in Spain.
    • Women play a role in acceptability – men are more likely to participate in studies when encouraged by their spouses.
    • A barrier is that men don’t have a designated healthcare provider for birth control, but family planning clinics may be the most logical place for them to go.
    • Methods exist, but are not yet labeled for use as male birth control.
    • LARC methods exist for men, but are hindered by lack of precision and research.
    • There is likely to be less of an environmental impact with male hormonal contraception methods than female methods because those are excreted into the waste-water and impact fish reproduction.
    • There are potentially non-contraceptive benefits to male hormonal contraception, such as an increase in lean mass, decrease in fat mass and decrease in bone loss.

Overall, I left the conference feeling that the training of most doulas in family planning is inadequate. Doulas and childbirth educators play a role in reducing infant mortality, poor birth outcomes and perinatal mood disorders when we have knowledge of family planning to decrease unplanned pregnancies and increase interpregnancy intervals. We can also help educate clients about the wide range of birth control options and their potential impact on breastfeeding and future fertility. As a full-spectrum doula, it’s important to provide information and support that is respectful of the values of the families I serve, across the wide-range of reproductive health decisions they face.

Waterbirth – What’s the Big Deal?

While attending the American College of Nurse Midwives (ACNM) Michigan Affiliate conference in January of this year, I had the pleasure of hearing Joanne Bailey, PhD, CNM, speak on “Hydrotherapy and Waterbirth: Evidence, Outcomes and Challenges.”

According to Dr. Bailey, the first documented waterbirth occurred in France in 1803. It wasn’t until the 1970’s and 1980’s that waterbirth started to become more popular in Europe and Russia. In 1983, Michel Odent described 100 stories of waterbirth, mostly positive. In 1989, Barbara Harper, who had studied waterbirth in Russia, held the first waterbirth conference in the U.S. She later went on to found Waterbirth International.

Despite such a long, successful history, there are only three options for someone who wishes to have a waterbirth in West Michigan today. The first is to deliver at home. Those choosing a homebirth may rent or purchase a pool that can be set-up in their home and in which they may labor and/or give birth in. The second option is to choose to give birth in a free-standing birth center. The Simply Born Birth House, in Grand Rapids, has deep tubs to labor and birth comfortably in. The third option is for rebels. If a provider is knowledgeable about how to safely manage a waterbirth, the birthing person may refuse to get out of a hospital tub and deliver underwater.

Why is waterbirth so difficult to access within a hospital? Rebecca Dekker of Evidence Based Birth asked herself that same question while delving into the research and case studies that led to the 2014 joint ACOG (American Congress of Obstetricians and Gynecologists) and AAP (American Academy of Pediatrics) statement against waterbirth. Her conclusion was that they based their decision on limited, isolated cases and not on the larger body of evidence suggesting that waterbirth is safe.

While all West Michigan hospitals have policies against waterbirth, this is not the case everywhere. In fact, Dr. Bailey tells the story of how the first waterbirths occurred at University of Michigan Health System in 1996 as the result of a consumer-driven effort. Currently, 16.4% of the births there occur underwater.

How about you? Did you have a waterbirth and if so, how did you achieve it? Please share your story!