Sunday Morning ~ Common Ground 2023
Padutsa khasu sipanama. ~ Where the hoe has passed one can not lie.
~ Chewa proverb
September 24, 2023
Because of the pandemic and travel, it’s been a few years since I’ve been back at the Common Ground Fair, a wonderful fall event. The Maine Organic Farmers Association produces an immense agricultural fair focused on organic and rural living. The innovation, the commitment to the environment and living close to the earth, the political action, it’s all so encouraging and hopeful. I’m thinking of a hoe and how it leaves its mark, how it cradles a seed, how it fosters change. This fair always inspires me to advocate and think creatively.
For the past twenty-five years the nurse-midwives in Maine have had a table here in the Health and Healing tent, sharing space with naturopaths, yoga instructors, reiki masters, reflexologists, nature spas, chiropractors, and other midwives. There have probably been a few others over the years I’ve missed but it is an interesting and loving environment. Struggling to educate people about what we do, we decided years ago this would be a great venue. Over twenty thousand people a day come to this fair, many interested in alternatives to corporate health care. We are able to talk one on one with people, direct them to care in their part of the state, answer questions, listen to their stories, help find advocacy, educate them about their rights, and encourage them to promote those rights.
The fair is remarkable in many ways. There are talks given all day long over the three days, in a wide range of topics. Farming, gardening, forestry, livestock, cooking, herbs, environment, and whole living. Health falls under that last category and each year I put in a proposal to talk about some pertinent issue in women’s health. This year I spoke about what is happening in rural Maine with maternity care as yet ANOTHER hospital has closed its maternity ward. My time slot wasn’t ideal, but ten people came and they were energized. As I spoke, the fury about what is happening to women welled up and there was no one there shooting me down. The audience was all over it. Then I thought I’d summarize my presentation in my blog and see how far it spreads.
I acknowledge the privilege I’ve been afforded. I was able to pursue my career in nursing and midwifery at an early age, without discrimination. My passion for working toward justice for women has grown steadily, though now morphs from clinical practice into teaching and advocacy. I have worked with marginalized communities and have a fair amount of international experience that guides me toward a global perspective when discussing health care for women.
When we talk about problems within our health care system we don’t frame it in terms of human rights, but I think we should. The frustration about how long it takes to get an appointment, short and impersonal office visits, long commutes for care, limited choices of practitioners, all sounds more like inconvenience than what it really is: a glaring abuse of human rights. The media and public relations teams at hospitals minimize the effect of vanishing services for pregnant women, but I believe we need to reframe these problems and describe them using a human rights perspective.
The World Health Organization defines universal rights for childbearing people including:
*Freedom from harm and ill treatment.
*Information, informed consent, and respect for choices including refusal of care.
*Confidentiality and privacy.
*Dignity and respect.
*Equality, and freedom from discrimination.
*Timely healthcare and the highest attainable level of health care.
*Liberty, self determination, and freedom from coercion.
In order to advocate for these rights we first must know they exist. Then we need a voice to speak out in support of them, and then we need the energy to persevere in maintaining them. It’s a lot to ask of women who live in poverty and are struggling to survive day to day.
When I moved to Bar Harbor in 1992 there was a movement, initiated by local women, to create a health center that specifically addressed the needs of women. At that time, maternity care was controlled by a doctor who did not provide the respectful care women sought. Alternatives were home birth or traveling to a nurse-midwife an hour away. The board at the Mount Desert Island hospital was sensitive to the problem of families leaving their community for their birth. It was, and still is, an economic factor for communities. Where people have their births influences where they obtain health care for the entire family, so not only is it morally and ethically responsible to provide this service, it behooves a community economically.
Founders of the Women’s Health Center envisioned a setting where women could feel safe, heard, and have their needs specifically addressed. The endeavor was not without controversy. There was pushback from the existing establishment but it is a story of what is possible. The practicing OB/Gyn there at the time was not supportive. He ultimately quit in protest, leaving the hospital without this specialty. There was a lot of discussion about how we would continue providing maternity services without him, the major factor being the ability to perform cesarean sections if needed. Our general surgeons stepped up and committed to being on-call and willing to do this and for the past thirty years that community has provided a place where people could have a respectful, safe, birthing experience. We worked with home birth midwives to create a safe transfer system for those choosing home birth. Midwives and doulas could remain with their patients if they had to have a hospital birth. Outcomes have been excellent. But instead of becoming the norm, the MDI hospital has become the outlier.
Access to maternity care in rural settings is becoming more and more difficult. In Maine, hospitals in eleven communities: Calais, Millinocket, Lincoln, Greenville, Pittsfield, Blue Hill, Bridgeton, Sanford, Rumford, Fort Kent, and now York have eliminated maternity services.
Maternity services in rural areas close because they are not financially lucrative. Think about what this means. An essential service, one that will be needed as long as the human race exists, is eliminated. They argue that specialists are too expensive. Well, I argue specialists are not needed in those settings. As we’ve demonstrated in our community, midwives and general surgeons can provide the service safely and with excellent outcomes. Why isn’t this held up as a model? When these services disappear women must travel hours to get both prenatal and birthing care. On bad roads and in unreliable cars, they miss work, leave families, and often abandon getting care altogether. Is it any wonder that our maternal mortality rates are rising?
Volumes of data demonstrate better outcomes when women are cared for in their own community. For all it’s touting of evidence based practice, our system feels free to ignore this evidence. Obstetricians are not needed in rural hospitals that can’t afford them. Midwives are. A general surgeon can perform a c-section if needed, a surgery well within their capability, but most refuse to do it. So why do doctors have the right to refuse necessary care? The argument we hear is “they don’t do enough of them to keep their skills up” but I reject that argument as invalid, and discriminatory. I’d be embarrassed to say that if I were a surgeon. Small hospitals have requirements for skills training for other procedures they do few of, but again, for this one affecting only women, they are allowed to refuse.
All of this is birthing injustice. All of this adds to the rising maternal mortality rate in our country, the highest of any industrialized country in the world. Most maternal deaths are preventable with access to qualified respectful caregivers WITHIN THEIR COMMUNITIES.
Addressing maternal mortality also means preventing unwanted and unintended pregnancies: this means access for all people of childbearing age to contraceptive services, safe abortion services, and safe post abortion care.
So, what can we do?
1. We can understand our rights and identify barriers to them.
2. We can speak up locally when our communities are faced with decisions about services. Letters to the Editor can be powerful. Storytelling is powerful. Tell your story!
3. We can educate our legislators and vote for those who will uphold our rights to health care.
4. We must educate more midwives and support diversity of those seeking midwifery education. Many labor and delivery nurses could become midwives if more educational programs were available.
5. We can honor and acknowledge those working within their communities supporting women in childbirth.
6. We can facilitate licensing for midwives trained in other countries to care for their immigrant communities.
7. We can support legislation addressing the unacceptable maternal mortality rates in the U.S.
There is a bill before congress called the Midwives for Maximizing Optimal Maternity Services Act (MOMS bill). This bipartisan legislation will increase access to high quality, evidence-based midwifery providers with federal grant funding for midwifery education programs. The goal is diversifying our nation’s midwifery workforce. There is A LOT of support for this legislation, but unsurprisingly, Congress hasn’t acted on it yet.
I urge everyone to contact their House and Senate members and urge support for this bill. I can provide talking points on this so contact me if you want them!
I want to reiterate that the crisis in rural America with lack of maternity services is blatant discrimination and a human rights abuse sanctioned by hospital boards and administrators. We need to start calling it such.
When compromised care becomes the norm, expectations are lowered. Vulnerable populations suffer disproportionally. It doesn’t have to be this way. There is a problem and we can problem solve. Don’t believe anyone who says it’s not possible. If we sued hospitals and doctors for discrimination things might change. For some reason this is what motivates them. Just a thought.
Love to all,