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Honoring Women’s Childbirth Choices

freedom

I’d like to honor women who make childbirth choices that make them vulnerable to judgment in their social circles, like planning a repeat cesarean or a home birth.  While no one is obligated to defend any of their family’s personal healthcare decisions, I’d like to open the conversation about the complexity and diversity of individual situations that create the context for such an important decision as how to give birth to one’s child.

1.)           Support: While it may be easy for an outsider to say, “Screw your family member or provider,” most people rely on support within their relationships long after the birth of their children.  For some women, it may be worth it to avoid conflict around their birth decisions knowing that they will not have to heal wounds in the future.  Relationships are complicated and based on a history that predates this event.

2.)           Timing: Babies arrive on their own schedule, paving the way for the unpredictability of parenthood.  Unfortunately, modern life is not always so flexible and accommodating.  Wanting to schedule the birth of a child around the availability of the one person you cannot imagine not having by your side at the moment of birth or in the weeks to follow is rational.

3.)           Tradition: Some choices are normalized in a family.  Other times, we seek to not fall into the footsteps of our foremothers.  Carrying on or rebelling against a historical family pattern are both common and natural reactions.

4.)           Economics: What a family can afford is often the driving factor behind their reproductive decisions.  When the top choice is not feasible, compromises are inevitable.

5.)           Experiences: Our individual experiences with birth are unique.  Negative past memories, whether personally or vicariously lived, sometimes impact us more than facts.

6.)           Values: What each parent holds dear will influence their decisions around birth.  Filtering our options through our values helps us move from knee-jerk to more conscious decision-making.

From the outside, someone’s choices may seem completely irrational or even self destructive, but under the surface lays the foundation for their actions.  For example, many people will judge someone who chooses to stay in an abusive relationship without trusting them to best know how to stay safe in the face of adversity. Imposing strong opinions or even facts that dispute another’s choices does not honor our diversity. Instead, we can strive for confidence in our own decisions while respecting the choices of others.

Have you every felt frustrated by the choices or judgement of others?  What helped you reach a greater understanding?

Top 5 Predictions for Childbirth in 2016

These are my predictions for childbirth in 2016.  What do you think? Please include your thoughts and your own predictions in the comments!

5.)           WHO changes their position on episiotomies

“Perhaps it is time to move beyond the question ‘What are the appropriate indications for episiotomy?’ to the more fundamental question ‘Is there an appropriate indication for episiotomy?’

— From D. Lyon, Global Library of Women’s Medicine

In 1996, the World Health Organization published “Care in Normal Birth: A Practical Guide,” recommending an episiotomy rate of 10%.  Since that time, episiotomy rates in most countries have declined.  The practice of selective episiotomies has continued despite the fact that there has never been a randomized controlled trial showing that they have any benefit whatsoever.

This has become a point of contention between some birthing women and their providers.  In fact, in 2015, an obstetrician in the United States surrendered his license after being caught on video performing a forced episiotomy on a patient.

In 2014, a study was undertaken in Brazil called, Comparison of Never Performing an Episiotomy to Performing it in a Selective Manner, or EPISIO.  Although the study is complete, the results are not yet published.  The researchers collected data on newborn, as well as maternal outcomes.  If this research shows that, even in cases of macrosomia and fetal distress, episiotomy holds no benefit, the World Health Organization may take a stand that even 10% is too high, with global implications.

4.)           ARRIVE study results increase elective inductions

In June of 2015, the Over the Moon Doula Group in Grand Rapids, Michigan, hosted Rebecca Dekker of Evidence Based Birth as a part of their Seminar Series.  The topic was due dates.

Dekker’s lecture introduced me to the A Randomized Trial of Induction Versus Expectant Management (ARRIVE) study, in which women would be randomly assigned to either induction at 39 weeks or expectant management.  Although some of the sites are still recruiting subjects, the data should be in by the summer of 2016 and results may become public by the year’s end.

Other than furthering the schism between the medical and natural childbirth camps, news that elective induction at 39 weeks prevents adverse outcomes could place a strain on hospitals.  As Dekker pointed out, if hospital maternity wards are full with women being induced, will there be enough room left for women who arrive already in labor?

3.)           US cesarean rates continue to decline

The cesarean rate for birth in the United States hit an all-time high in 2009, but has declined for most racial and ethnic groups since. This has not been an accident, but due to a concerted effort by consumers, researchers, hospitals and providers.

For example in 2014, the American Congress of Obstetricians and Gynecologists (ACOG) changed the definition of active labor from 4 to 6 cm, cause more women who present in early, or latent labor, to be sent home.

The coming year may also see changes in hospital policies on Vaginal Birth After Cesarean (VBAC), which holds the potential to further decrease the cesarean rate.  Many women choose to have their VBAC at home, not because that is their first choice, but because no other options are available. A study published in the Dec. 2015 issue of Birth showed that, although Home Births After Cesarean (HBAC) have high success rates, when a uterine rupture does occur, perinatal death is more likely.  As local work on perinatal regionalization, a system of designating where infants are born or are transferred based on the amount of care that they need at birth, continues, more community hospitals may reverse their VBAC bans.  This will make VBACs more accessible and safer for women who prefer a hospital birth closer to home.

2.)           Out-of-hospital birth rates continue to rise

While out-of-hospital births represent a small percentage of all birth in the United States, they have been on the rise since 2004. When it comes to home births in one West Michigan county, Kent, home births have increased 116% in the last 8 years!

According to the American Association of Birth Centers, the number of freestanding birth centers in the United States also continues to rise, from 170 in 2004 to 248 in 2013. There are currently two freestanding birth centers in West Michigan, Cedar Tree Birthing Suite in Grand Rapids and Midwifery Matters in Greenville.  As more birth centers continue to open, the number of women choosing this option will also grow.

1.)           More states will pass laws providing insurance reimbursement for doulas

All the research points to the potential healthcare savings if doulas become more widely available, due to the lower rates of cesareans, pitocin induction, medical pain relief and more.  At the present, only two states, Minnesota and Oregon, require Medicaid to cover the cost of a birth doula.

All that could change now if three national organizations, Choices in Childbirth, the National Partnership for Women and Families and Childbirth Connection, have anything to do with it!  Key Recommendation in an executive summary released in early 2016, include having congress mandate Medicaid coverage for doulas and state legislatures mandating private insurance coverage for doulas.  If policy makers take their advice, 2016 may turn out to be “The Year of the Doula”!

ACES Muskegon: A Childhood Trauma Survey

Flyer for the ACES Muskegon Study, sponsored by Health West.

Flyer for the ACES Muskegon Study, sponsored by Health West.

I pride myself in being a trauma-informed birth worker.  So, when I was chosen as a “ACE Champion” as a part of the release of a new Health West survey, I registered for and attended the one-hour training on November 17th in Muskegon Heights.

The Adverse Childhood Experiences Study, or ACES, began in 1995 and found that the more traumas a person experienced in their youth, the worse their lifelong health.  Since Muskegon County ranks worse than every other county in the state of Michigan for health behaviors, such as smoking and obesity, there is a high likelihood that childhood traumas are driving these outcomes.

Health West, through a grant called Wellville, is conducting the ACES Muskegon survey just for county residents who are 18 years or older.  Their goal is to get 3,000 people to complete the survey, using the results to raise awareness of the need for trauma-informed treatment and prevention, as well as grant funding to address the problem.

I cannot express strongly enough how much I support the intentions of this initiative!  Still, I must acknowledge my deep hesitations in supporting ACES Muskegon.  Although completing the survey will be easy and for most people, for those with traumatic memories, asking them to spend even 10 minutes thinking about the worst moments of their lives is a lot to ask.  I don’t feel comfortable asking people to do it unless I know that there will be a serious effort to get to the root causes of violence and oppression in our neighborhoods.

As someone who is very well-versed in the theories of primary prevention, I know that for this data to be effective, it must not just lead to providing services with more compassion knowing anyone could be a survivor.  Action must be taken to influence change at the highest rungs on the Spectrum of Prevention, influencing policy, legislation and organizational practices.  Unfortunately, many of those involved in the dissemination and promotion of ACES Muskegon work for organizations who have misogynist, racist, homophobic, transphobic, classist, and other oppressive and exclusionary policies and practices!

The conundrum of social change is that what is palatable to those in power is the least effective and what stands to be the most effective is shut down in its earliest stages.  I speak from experience too vast to include in a blog and I am not alone.  I am close to many people who have lost their livelihoods due to their social justice work.

After contemplating my reasons for skepticism, I shifted my focus to thinking about my own personal healing journey.  I’m always saying that I need to devote more time and energy to self-care.  If I complete a survey, I will receive educational emails.  Maybe I can use this survey as an opportunity to consciously carve out more time to learning about healing my own traumas and those of others.

I have a lot of respect for the Health West staff for putting in the effort to launch such a bold campaign.  Kelly France and others were very supportive of me when I organized the Perinatal Care – A Trauma-Informed Approach conference in April of 2013.  I believe in the sincere intentions of behavioral health professionals to make an impact on the heartbreaking abuse they see in their work every day.  I’m going to take the survey and I encourage you to do the same.

Coming Out as an LGBT Welcoming Business

welcoming project rainbow

As a person who has dedicated much of her life to fighting for equality and social justice, I knew that the journey is not without its obstacles.  Over the years, I’ve messed up more than once.  My mistakes have taught me that my biases can fool me and that I must never stop examining and reexamining my own privilege.  Putting yourself out there as an ally is a vulnerable position because you invite accusations of hypocrisy.  I’ve been called out on many occasions and had to defend myself or apologize.  Even though it is work, I welcome the opportunity for personal growth, a precursor to societal transformation, toward an end to oppression.

When I first started my work as a doula, my goal was to serve all families without discrimination or judgment.  Despite my best intentions, I had to be honest with myself that I lacked the experience and training to feel confident in serving LGBT (lesbian, gay, bisexual and transgender) families.  Since then, I have taken these steps:

1.)           Inclusivity.  I re-wrote my intake forms so that instead of asking information on the baby’s “mom” and “dad,” I now have space for information on up to four parents.  This allows families to define their own roles, separate from gender, as well as include information on biological and adoptive parents.

2.)           Continuing education.  I found a wonderful resource in The National LGBT Health Education Center.    Their on-demand webinars taught me so much about health disparities, pathways to parenting and ways to be more welcoming in my practice.

3.)           Visibility.  I have a listing on the resource directory, Trans Birth, “created to connect Trans* and gender non-conforming people and their families to midwives, OB/GYNs, and doulas who provide welcoming care to our communities.”

This is just a start.  In the coming year, I plan to create a local resource list of welcoming providers in my community.  Do you provide welcoming healthcare services in West Michigan or have a favorite resource you’d like to share?  Please contact me!

Hospital VBAC Bans Hurt Women in Not-So-Obvious Ways

Trial of Labor (10-15)

At the last West Michigan Better Birth Network meeting, the other co-leaders and myself discussed lack of access to vaginal birth after cesarean (VBAC) at lakeshore hospitals.  Mercy Health Hackley, North Ottawa Community and Gerber Memorial hospitals all have official policies banning VBACs.  Despite the ban, doctors at Gerber have a national reputation for supporting the birthing decisions of moms who desire VBACs there, but not without resistance from administration.  We decided to take up their cause through a letter-writing campaign.

Although I do not have a personal story about VBAC, I do have the insight of a preventionist.  This is the letter I will send:

Richard C. Breon, President and CEO
Spectrum Health
100 Michigan St. NE
Grand Rapids, MI 49503

October 6th, 2015

Dear Mr. Breon:

I am writing concerning the official policy of Spectrum Health that does not allow women to have a trial of labor after a cesarean at Gerber Memorial Hospital, despite the fact that many women do safely have vaginal births after cesarean (VBAC) there.  I am a birth and postpartum doula, childbirth educator and Certified Prevention Specialist through the State of Michigan.  Prior to becoming self-employed, I coordinated the Muskegon County Fetal Infant Mortality Review for seven years.  During that time, I abstracted over 150 cases of fetal and infant death, compiling the data that informed Muskegon’s infant mortality prevention efforts, which I also spearheaded.

The Spectrum of Prevention, developed by Larry Cohen based on the work of Dr. Marshall Swift, places policy and legislation on the highest rung of influence, with the most potential to impact the strategies below it.[1]  For this reason, policies that prohibit women’s access to VBAC at community hospitals, despite ACOG’s recommendation that this decision should be made by the patient and her provider[2], have widespread implications far beyond the health risks of repeat surgery.  VBAC bans undermine women’s autonomy by taking the decision for where and how they will give birth away from them and their providers and placing it in the hands of administrators.  The underlying message is that women cannot be trusted to decide what is best for themselves and their families.

Groundbreaking research has recently been conducted that examines how structural and institutional policies impact individual behavior.  Several such studies have been published in the September 2015 issue of The American Journal of Preventative Medicine.  In “A First Look at Gender Inequality as a Societal Risk Factor for Dating Violence,” researchers show that there is a relationship between the Gender Inequality Index (GII) and adolescent dating violence[3].  While VBAC access is not an indicator on the GII, policies that respect the decisions of women and their providers in childbirth, so long as they are demonstrated to be safe, may reduce gender-based violence.  Domestic violence is not only one of the leading cause of pregnancy-associated injury deaths[4], it is also a risk factor for tobacco[5], alcohol[6] and other drug use[7] in pregnancy.

The official ban on VBACs at Spectrum Health Gerber Memorial should be lifted, not only for the health and safety of birthing women in West Michigan, but to improve gender equality, reduce gender-based violence, and prevent perinatal substance use and the resulting maternal and infant mortality.

Thank you for your time and consideration.  Feel free to contact me if you have any questions.

Sincerely,

 

Faith Groesbeck, BA, CCCE, CPS

 

cc: Dr. Tami Michele, DO
Dr. Stephen Rechner, MD
Randall J. Stasik

 

[1] The Prevention Institute. “The Spectrum of Prevention: Developing a Comprehensive Approach to Injury Prevention.”  Accessed online at: http://preventioninstitute.org/component/jlibrary/article/id-105/127.html on 10-6-15.

[2] American College of Obstetricians and Gynecologists.  “Vaginal birth after previous cesarean delivery. Practice Bulletin No. 115.”  Obstet Gynecol 2010;116:450–63.

[3] Gressard, Lindsay A. et al.  “A First Look at Gender Inequality as a Societal Risk Factor for Dating Violence.” American Journal of Preventive Medicine, Volume 49 , Issue 3 , 448 – 457.

[4] Chang J, Berg CJ, Saltzman LE, Herndon J. Homicide: A Leading Cause of Injury Deaths Among Pregnant and Postpartum Women in the United States, 1991–1999. American Journal of Public Health. 2005;95(3):471-477. doi:10.2105/AJPH.2003.029868.

[5] Bacchus, L., Mezey, G., & Bewley.  “Domestic violence: prevalence in pregnant women and association with physical and psychological health.”  European Journal of Obstetrics & Gynecology and Reproductive Biology.  113: 1 (2004): 6 – 11.

[6] Project CHOICES Research Group.  “Alcohol-exosed pregnancy: Characteristics associated with risk.  American Journal of Preventative Medicine.  23 (2002): 166 – 173.

[7] Martin, S.L., Acara, J., & Pollock, M.D. (2012, December). Domestic Violence During Pregnancy and the Postpartum Period. Harrisburg, PA: VAWnet, a project of the National Resource Center on Domestic Violence.  Accessed online at: http://www.vawnet.org on 10-6-15.

“Any amount of liquid gold is better than none :)”: Results of my Breastfeeding Survey

As a doula, I hear many stories of the difficulties some women experience with breastfeeding. Although I have lots of training in the basics, my role is to help facilitate early initiation of breastfeeding through skin-to-skin contact immediately after birth. In the postpartum period, I can provide referrals to lactation specialists, but my main form of support is informational and emotional.

What if I could provide education prenatally that would help women prevent the most common challenges? If not properly identified and corrected, many breastfeeding issues can get out of hand in a short amount of time, before some women are even able to identify who to seek help from!

This gave me the idea of a survey.   What better way to improve my understanding of the experiences of local women than to ask them? The response was overwhelming: in 48 hours, I had over 80 responses!

Before I share the results, I have to clarify that this is not the same as research. Most of the respondents found the survey through My Breast Friends, a Muskegon-area Facebook group started by Mercy Health to provide a social media extension of their twice weekly support groups.  For this reason, they are not representative of the general population, but it’s a great group to ask if you want to know what works!

For example, the WIC (Women, Infants and Children) program collects data on breastfeeding for program enrollees. While not all breastfeeding women are enrolled in WIC, the program provides some data to compare our group to. As of Spring 2015, 81% of infants in the program were breastfeeding at 1 week, dropping to 12.8% at 6 months and 1.29% at 11+ months. In contrast, among the women who responded to my survey who had stopped breastfeeding, 20% had done so at more than a year! Even so, 23.5% of the women did not reach their breastfeeding goal, indicating that improvement is still possible.

What was most interesting to me was what and who women found helpful. With few exceptions, when women do seek support, they find it! At the top of the list were:

  • Hospital Breastfeeding Support Group: In Muskegon we are so lucky to have a support group that meets twice weekly at the Mercy Health Hackley Campus on the second floor, 2210A. Mondays 5 – 7 PM and Thursdays 11 AM – 1 PM.
  • Husband/Partner/Father of the Baby: 80.25% of respondents found their partner to be very or somewhat helpful. Let’s hear it for dads! (Want to learn how to best help your breastfeeding partner? Click here!)
  • The Internet/Social Media: Since the survey solicited responses from a Facebook breastfeeding support community, this should come as no surprise.

Great bonding, a healthy baby and confidence as a mother topped the list of benefits. One respondent reminded me of the cost savings of breastfeeding, while others let me know that the confidence and sense of accomplishment they enjoyed extended beyond that of parenthood. Said one mom, “It was the best thing I ever did”!

Now for the bad news. Sadly, childbirth educators were found to be the least helpful. Not to say they were harmful, but 36% found them to be neither helpful nor unhelpful. Next came prenatal care providers, whom 12% of women found somewhat unhelpful or not at all helpful. The third least helpful group was workplace/coworkers. One in 10 women found their workplace to be not at all helpful! This may contribute to the fact that over 1/3 of respondents indicated difficulties with breastfeeding and work.

Nearly 60% of women experienced pain when breastfeeding, followed by cracked nipples (56%). Low milk supply and difficulties latching tied at 48%.

The advice moms gave formed a couple of distinct themes:

  • Find a support group: Overwhelmingly, moms who have breastfed want other moms to know that they should connect with others, ask for help when needed and not be afraid to seek professional support. As one mom said, “Find your momma tribe”!
  • Don’t give up: Many moms stated that if you can get through the first few weeks, it gets easier. All agreed that it was worth it in the long run.
  • Be flexible: 38% of respondents supplemented breastfeeding with formula. Said one mom who’s been there, “Don’t be too discouraged if you have to supplement with formula.”

Thanks to everyone who completed the survey! For more information on breastfeeding resources in the Muskegon area, check out the “resources” section of my website.

Childbirth Classes?  Yes, you should!

The question of if and how families benefit from childbirth classes is complex.  Despite some research in this area, there is wide variation among curriculum, instructors, duration and settings.  Instead of drastically impacting the physiological outcomes of birth, I found that classes help families prepare mentally to “complete an important developmental milestone” (Koehn 2008) and “expand the social network of new parents” (Fabian et. al. 2005).

How do Cooperative Childbirth Education classes vary from other classes?

  • Cooperative childbirth education is based on the experiences of women, not named after a male doctor who made a “discovery” through observation. While I can’t ignore the work of my male predecessors, such as Lamaze, Bradley and Grantly Dick-Read, my education was based on the writings of women in the field, such as Ina May GaskinSheila Kitzinger and others.
  • I write my own entire curriculum and do not follow anything copywrited. This means that I can update the information I present at will or tailor it to fit the needs of my students, without having to receive permission or approval from a certifying agency.
  • Unlike hospital classes, in which the instructor, usually a Registered Nurse, is an employee of the hospital, I am independent and self-employed. Hospital classes are sometimes criticized for creating more compliant patients instead of empowered consumers.
  • I have no agenda. Most classes center around “natural” or “unmedicated” childbirth as their goal.  While most people seek out classes to achieve an unmedicated birth, I want families to have enough information to make the right decisions for them.
  • As the Cooperative Childbirth Education website states, we are trained to be “passionate consumer advocates.” I’m not just doing a job, I’m a part of a movement.  Many movements in fact, all working toward the shared goal of increasing access to childbearing options for all families.

I hope you will join me at an upcoming class, where you can prepare for your birth quest and connect with other parents!

Fabian, Helena M., Ingela J. Rådestad, and Ulla Waldenström. “Childbirth and parenthood education classes in Sweden. Women’s opinion and possible outcomes.” Acta obstetricia et gynecologica Scandinavica 84.5 (2005): 436-443.

Koehn, Mary. “Contemporary women’s perceptions of childbirth education.” The Journal of perinatal education 17.1 (2008): 11.

Galacta-what!? Increasing Your Breastmilk the Yummy Way

galactacookies1

I must start off by saying that most women make plenty of milk for their babies without having to pay any attention to their diet or using herbs or other supplements. However, the truth is, many moms are looking for ways to boost their milk production due to having stressful, busy lives that require them to eat for convenience or be separated from their babies. As a mom, I’ve personally faced these obstacles and looked for natural ways to make more milk.

Galactagogue, from the Greek words for “milk” and “leading,” is the term for something that increases breastmilk production. The Wise Woman Herbal, by Susun S. Weed, suggests many foods and herbs that can be used as galactagogues. Many of these herbs are found in the Traditional Medicinal’s blend called “Mother’s Milk.” Unfortunately, many women do not like the taste of black licorice, which comes from the addition of fennel and anise. One alternative is to create single herb infusions of Red Raspberry Leaf, Nettles, Alfalfa or Red Clover. According to Weed, you can “Rotate, using each one for a week, to derive the unique benefits that each offers” (85).

Ultimately, though, there is no substitute for good nutrition. Healthy fats, whole grains and lots of leafy greens help women with postpartum healing and lactation. Adding fennel seeds to your granola and making your greens with Indian curry, which contains Fenugreek, a well-known galactagogue, are easy ways to “eat your medicine” naturally.

Which brings me to my favorite – galactacookies (named by my friend, Amber, who thought “lactation cookies” would contain breastmilk). Everyone has their own favorite recipe, but nearly all of them contain a few main ingredients: brewer’s or nutritional yeast, wheat germ, flax seed meal and whole (not instant) oats. My recipe is based on my mom’s 10-Cup-Cookie recipe, which is like a meal in a cookie. Feel free to decrease the sugar based on your own taste-buds.

Galactacookies

1 c. butter
1 c. white sugar
1 c. brown sugar
1 egg
1 c. flour (I use a mix of unbleached and whole wheat flour, adding flax seed meal, wheat germ and nutritional yeast to make a cup)
1 tsp. salt
1 tsp. baking soda
1 tsp. baking powder
1 c. oatmeal
1 c. coconut
1 c. raisins
1 c. chocolate (I buy the super dark bars and cut them in pieces)
1 c. nuts (I use walnuts)

With an electric or hand mixer, cream the butter and sugars. Add egg and mix well. Beat in peanut butter. In a separate bowl, mix flour mixture, salt, baking soda and baking powder. Reduce mixer speed to low and gradually add dry ingredients to wet. By hand, stir in remaining ingredients. Drop by spoonfuls onto ungreased cookie sheet. Bake for about 12 minutes at 350° F. Let them cool a bit on the pan before transferring to a cooling rack. Store in an airtight container.

I encourage you to make your own cookies or get someone to make them for you, but I am also happy to bake some special order. I sell them for $3 for 2 or a baker’s dozen for $15. The cottage food law requires me to sell them in person, so no mail or internet orders allowed. They also make a great gift to bring to a postpartum friend! I also supply organic herbs to my birth and postpartum doula clients as a part of my fee and am happy to provide them to women in my area at a reasonable cost.

Muskegon: Not the Worst Place on the Planet to Have a Baby

HCC PMD support group perinatal mood disorders provider list

When I found out the Postpartum Support International (PSI) Conference was being held in MI this year, come heck or high water, I was going to find a way to get there.  And I did.  With my 10-mo.-old daughter in tow, I headed to Plymouth at 5 AM on Friday, June 26 for two days of learning, friendship and amazing food.  Everyone kept commenting on how well-behaved my baby was, but imagine being surrounded by hundreds of baby-loving therapists and other providers who have dedicated their careers to serving new parents.  Yes, it was baby and momma heaven!

Living in a small city like Muskegon, it’s easy feel a sense of hopelessness around our birthing options.  We have a hospital monopoly with religious restrictions that limit some women’s reproductive health choices.  Both Hackley and North Ottawa Community Hospital (NOCH) have bans on VBAC, or Vaginal Birth After Cesareans.  Lack of resources and insurance reimbursement limit the options of many families.

The theme of this year’s conference was “Planting seeds of hope” and I have to say that I feel renewed gratitude for all West Michigan has to offer childbearing women.  I first had this feeling in a workshop on skin-to-skin after cesarean.  As workshop participants shared strategies to implement this at their local hospitals, I thought, “Really?  This is standard practice at my area hospitals.”  I’m sure there is room for improvement, but this is one battle I haven’t had to fight.

One of the keynotes and a break-out session I attended were presented by the Mother Baby partial hospitalization program at Pine Rest.  Thanks to pioneers like Nancy Roberts, who received a standing ovation when accepting the Ilyene Barsky Memorial Award for outstanding PSI coordinator, West Michigan stands out as leaders in collaboration for developing resources for postpartum depression and anxiety disorders! Our local Lakeshore Perinatal Mood Disorders Coalition (LPMDC) has helped to create support groups at Hackley Community Care, NOCH and in Zeeland, as well as a list of trained providers.

Thank you PSI and the hardworking LPMDC members for providing hope and healing to so many!

Opioid Addiction in Pregnancy: Ending the Stigma

On Friday, May 8th 2015, I attended Pine Rest’s Annual Perinatal Mood Disorders Conference in Grand Rapids. The topic was “Perinatal Substance Use and the Journey to Wellness.” I learned so much and want to share some reflections on a subject so near and dear to my heart.

The first time I taught childbirth education classes was to the pregnant inmates at the Rose M. Singer Center, A.K.A. Rosie’s, on Riker’s Island, the largest penal colony in the world. There were so many pregnant and postpartum inmates at Rosie’s that they had their own unit. There were two reasons for their high numbers. First of all, New York State, unlike Michigan, has laws that require correctional facilities to accommodate newborns. So long as the mom doesn’t have a conviction that involves harming a child, she can apply to keep her infant with her for one year (or 18 mo., if she will be released within that time) or bring her breastfeeding infant with her during her incarceration. Studies done at Bedford Hills Correctional Facility, which houses one of the oldest prison nurseries in the country, show that there are no harmful effects on the children. Many of the women at Rosie’s are either already participating in or planning to be a part of their on-site nursery.

The second reason has to do with opiate addiction. Riker’s, a jail, housed a methadone treatment program. Withdrawing from opiates during pregnancy can be deadly for both the mother and the fetus, so opiate-dependent women who would otherwise be transferred to a prison to serve a longer sentence remained at Riker’s during their pregnancy to receive methadone maintenance. (At the time I taught there, methadone was the drug of choice for the treatment of opioid addiction during pregnancy. Since other treatments are now available, this may no longer be the case).

There is so much stigma surrounding moms who use during pregnancy, making it even less likely that these women will seek help. Many people believe that a mom who is addicted to an opiate should stop using during pregnancy. Discontinuing opiates during pregnancy is not the standard of care. One of the speakers at the conference, Dr. James Nocon who is both an obstetrician and an attorney, had this to say about providers who encourage women to withdraw during pregnancy, “In my retirement, I want to sue doctors whose patients suffer negative outcomes because they receive improper treatment during pregnancy.” He can be contacted at jnocon@me.com.

My heart breaks every time I hear someone say an infant is “born addicted.” Addiction, by definition, is continuing to use a substance (or repeat a process) despite negative consequences. An infant can be born dependent, but cannot be an addict. I know that many people have personal experiences caring for the children of parents who could not themselves care for them due to substance abuse disorders, resulting in strong emotions. However, vilifying parents with addictions will not help these children. As a Certified Substance Abuse Prevention Specialist, I know that if we want to help infants and children, we need to look at the underlying causes of why women use. The vast majority of women who use during pregnancy are self-medicating due to the effects of trauma and abuse. This is true whether the substance is cigarettes, alcohol, crack or heroin.

If we are truly dedicated to helping children prenatally exposed to substances, we should focus not just on treatment, but prevention. Gender-based violence is the result of oppression, which stems from inequality. When we fight for gender equality (e.g. pay equity, paid parental leave, paid sick time, LGBTQ rights, etc.), we are working to elevate the status of women and end the trauma of abuse.

Developed by Larry Cohen, based on the work of Dr. Marshall Swift. Available at: http://home.preventioninstitute.org/tool_spectrum.html

Developed by Larry Cohen, based on the work of Dr. Marshall Swift. Available at: http://home.preventioninstitute.org/tool_spectrum.html

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