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.
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!
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
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. 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, 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. 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, it is also a risk factor for tobacco, alcohol and other drug use 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.
Faith Groesbeck, BA, CCCE, CPS
cc: Dr. Tami Michele, DO
Dr. Stephen Rechner, MD
Randall J. Stasik
 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.
 American College of Obstetricians and Gynecologists. “Vaginal birth after previous cesarean delivery. Practice Bulletin No. 115.” Obstet Gynecol 2010;116:450–63.
 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.
 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.
 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.
 Project CHOICES Research Group. “Alcohol-exosed pregnancy: Characteristics associated with risk. American Journal of Preventative Medicine. 23 (2002): 166 – 173.
 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.
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.
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 Gaskin, Sheila 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.