Sunday Morning ~ Birthing Justice

Tangosauka opanira mphika ali cete. ~  We just suffer, but those who handle the relish-pot are quiet.

~ Chewa proverb

March 5, 2023

Hi Everyone,

As yet another small hospital in Maine closes it’s maternity services, I’m thinking about birthing justice. It’s been awhile since I’ve attended a birth. I know there are many injustices surrounding this event, some of which we are studying in the class I’m teaching. The racial injustice in our health care system affects women, of course. Cultural discrimination is widespread for those giving birth and most just take what they can get. What else can you do when vulnerable and in need of care? 

I’d like to think I’ve worked toward justice for all women but looking more closely at what that means, the hurdles for marginalized populations were always much higher. Working in my small town on an island in Maine, the diversity I dealt with was mostly socio-economic. A rich donor to the hospital? Immediately accompanied by upper management to cut the line. Poor women who have to travel hours in an unreliable car to get to an appointment? They could wait. 

I listened to a researcher speak about how awe affects our happiness and well being. He spoke of finding awe in our daily lives and how it can affect our mood and alleviate depression and loneliness. I thought about the word awesome. It’s used so commonly now as a routine response to ordinary events. But when I think of the true meaning, true awe-inspiring events, the ones that stop us in our tracks, the word seems insufficient. What inspires awe in me, I wondered? Birth is awe-inspiring. Anyone who has experienced it, either as birth giver or birth witness understands this. No matter how I was feeling, whatever my mood or situation, there was no feeling of awe compared with being present at birth. The depth of human emotion, the physical feat, the community support, it is an infusion of joy like no other. Why then do we make this event so hard for women? Our culture has it locked away, expensive and secretive, scrutinized and controlled, mystifying. Depending on reimbursement and the willingness of medical staff to be available, women can have a good or bad experience. I want it to be good. I want safe undiluted awe for all women.  

I’ve emphasized to my class the macro and micro systems in health care. It’s been a dilemma functioning in a macro system in which I did not wholly believe, while thinking my micro service was providing benefit. But I often felt it was enabling, allowing a system to grow more dangerously into a killer of women. The only industrialized nation with a rising maternal mortality, it is astonishing how our medical system can eliminate a critical service for women when they deem it unprofitable. Black women, Indigenous women, Women of Color, die in greater numbers than whites. Rural women have no access to care.

Maternity services close in rural areas because they can’t find an affordable specialist. I argue, specialists (Ob/Gyns) are not needed in small rural hospitals. Though midwives and general surgeons could provide the service safely and with excellent outcomes, hospitals dispose of this viable solution altogether. I’ve argued for years that midwives could provide the needed services, but rural hospitals still focus on the lack of obstetricians willing to practice in these areas, and without a physician willing to be on-call, they close. Subsequently, women must travel. Poor women in rural areas must travel miles, hours, to get both prenatal and birthing care. They must travel to services over bad roads and in unreliable cars, missing work and leaving families, instead of accessing services close to home. There is a plethora of supporting data demonstrating better outcomes when women are cared for in their own community, so why is our health care system allowed to act on only the studies they choose? Obstetricians are not needed in rural hospitals. Midwives are. A general surgeon is needed if an emergency cesarean section is needed, a surgery well within their capability. But if they refuse to do it, the service closes. Our community has been fortunate that the general surgeon agreed to this and I’m forever grateful to him. Why isn’t this a model for other hospitals? Why do doctors have the right to refuse care? Doctors have to follow other rules they don’t like. They couldn’t refuse to care for a person because of their race, so why are they allowed to refuse to do this one procedure? Why are they allowed to abandon a segment of their population? The argument we hear is “they don’t do enough of them to keep their skills up” as if that is a legitimate argument. Where is the critical thinking? There are many ways to keep skills up! That’s why hospital staff does simulation for CPR; because they don’t do it very often. These arguments are empty, invalid, and discriminatory.

This blatant discrimination sanctioned by hospital boards and administrators isn’t portrayed as such, but that’s what it is. Rural and marginalized communities have a muted voice. Compromised care, sometimes fatal, becomes the norm. Tired of their voices being unheard, they stop speaking. After awhile, when education standards are diminished, when expectations are lowered, when poverty and hunger give way to escape via drugs or alcohol, there’s little fight left. Economies of rural towns suffer when maternity services close. Families take their business to the cities an hour or more away. 

I am thinking this over at this stage of my career and life. The calling I’ve had to be there for women in their most awesome moment, needs to morph into something useful on a macro scale. I just can’t pinpoint what that is.

Love to all,

Linda