Nothing like bad news to drive a message home

(Trigger warning for poor obstetrical outcome)

Less than one week after I blogged about the maternal mortality crisis among black women in our country, I lost a friend. She was of Haitian descent, a fellow medical student, an aspiring ob/gyn, and a kind and wonderful person. She was eight months pregnant with her first baby, and newly married. We talked for a while last week about her taking time off, breastfeeding, and pumping when she got back to rotations. She was incredibly happy about becoming a mother.

She went into premature labor this weekend. She had a hemorrhagic stroke. She died. The baby is doing fine.

This was not an underprivileged woman by most definitions, at least not currently. She may have been raised in an impoverished home. The Haitian population in South Florida in general is devastatingly poor. She was well educated. She was not “advanced maternal age”. She was not a teen mother. She was not obese. She had good prenatal care and insurance. She had family support and was happy about her pregnancy. As far as I know, she had no health conditions, didn’t smoke, and didn’t do any drugs.

But, she was a black woman in America, which puts her at much higher risk of premature labor and death. In recent years, the maternal mortality rate for black women in Miami has been up to 10 times that of white women. We don’t completely understand why. Different delivery of care, early life malnutrition or lack of health care, the stress of racism, biological or genetic differences…these all may play a role.

But, right now what we do know is that a baby is born without a mother, and a husband is welcoming a new baby in his life with a dead wife, and no mother to help raise it. That is a horrible shame.

Proud to be an American

Happy birthday, USA!

When I say I am proud to be an American, (a USian, really, but I am quoting a song title), I am proud of what we have done that is progressive, such as women’s suffrage, and the civil rights movement. I am also optimistic of the potential we have to improve ourselves. I do not think that means we have to ignore problems that we have, or not admit mistakes, as many people mistakenly consider patriotism to be. I think having low standards and ignoring our issues is the opposite of patriotism.

Anyway, despite the partially successful civil rights movement of the 60′s, there is still glaring racism and racial inequalities in our country. Please check out this blog carnival at the Uneccesarean. It’s a round up of posts discussing the shockingly and depressingly high rates of infant and maternal mortality suffered by black women and infants in our country.

And, before someone goes there (which has happened before on this blog and on others so often it’s on racism bingo cards), it’s not a class issue. These inequalities still exist even when the mother is college educated, compared to white mothers who don’t even have a high school degree. This is more pervasive and deeper than class. Not that poverty isn’t important, but there is no quota for issues we should address to make this country even greater.

Michel Martin rocks the mic

I have been a Michel Martin fan ever since I got satellite radio, and I was able to listen to her NPR show Tell Me More. She is a great interviewer, and I love the Barbershop segment.

But, it’s her “Can I Just Tell You?” commentaries that really impress me. She is thoughtful, analytical, intelligent, and not afraid to draw conclusions and make judgment calls. So much of journalism is pure regurgitation of talking points, it is refreshing to hear someone, especially a woman of color, not just break news, but put it back together, to paraphrase an NPR advert.

Well, her most recent “Can I Just Tell You” segment, No, We’re Not Going to Sit Down and Shut Up made it on my Newsfeed on Facebook, since I am a fan of NPR. Good for them for trying to increase exposure to this commentary.

She not only crosses ideological lines to defend Sarah Palin from some pretty atrocious sexism, but takes the unfortunately predictable blame-throwing response and uses it to paint a really insightful big picture. I recommend you read or listen to the whole segment at the link above, but here is a particularly great part:

“I cannot help but think that what the fury is really about is the loss of entitlement. It used to be that men with a shred of power could say whatever they wanted about women and women had to put up with it, or get a man to duel for them or something. Well now women get to rock the mike too.

It used to be, and often still is, that one set of values or perspectives dominates the way we look at issues and talk about them. You can see where the people who share that particular perspective begin to feel they are entitled to shape the conversation for all time. But things change — new voices rise, different people win elections, or dare we say it, get on the radio. Maybe some people have a problem with that. Tough. Because we’re not going anywhere.”

Reply turned post, health care reform style

A Facebook friend posted a link to a news story about how insurance companies still say they will fight to deny coverage of preexisting conditions. I replied that I am sickened (no pun intended) by the people throwing bricks through congressional office windows, spitting on politicians, firing bullets into a congressional office, cutting a gas line at a politician’s family member’s house and calling in death threats, all in the name of defending this horrid status quo.

She asked me in reply “What do you think of all this health care stuff?”

I don’t know how much I have written about it recently, even though I have been following the debate avidly. I got turned off one step at a time with each compromise that was made, when each compromise didn’t earn one single Republican vote. What could have been a progressive reform pretty much got turned into a pretty close copy of the Republican’s answer to the Clinton era Democratic reform proposal. In fact, it uses a lot of ideas from the Republican platform in the 2008 election. We scuttled the public option, contraception coverage, put in extra barriers to abortion, cut the minimum of premiums taken in that had to go to actual medical care, removed end of life counseling, put in mandates, etc. etc. Although I think we have a gutted shell of a reform plan, it is still better than the status quo.

Here is my reply:

I am a big fan of the book “The Healing of America” by T.R. Reid. He looks at health care delivery and payment in several “civilized” countries, including countries like Switzerland that made their transition when we failed during the Clinton era.

It is grossly apparent to anyone who looks, apolitically, at health outcomes, disparities and access that the United States has one of if not the worst health care systems in the industrialized world.

I think we could easily switch over to a single payment system by simply expanding Medicare to pay for all, and then use the best elements from all of the health care systems that already work much better than ours. It’s not like there isn’t ample good examples around. Japan’s cost control and ample access to excellent practitioners and treatments (more visits to physicians per year than the US and best in all outcomes, with a fraction of our cost, and universal coverage), Canada’s self referral system, France’s electronic records card and billing (which would save billions in overhead in offices and hospitals) – for the doctors and business owners, not just the government and patients!), England’s subsidized medical education (in fact, most countries have this), and even Germany’s use of existing private insurance companies to organize the care.

What I don’t like is the knee jerk, angry reaction we have to this kind of reform in our country. In Canada, in Japan, in the UK, this isn’t a left/ right issue. It’s a matter of human rights, and it’s hard to find a politician of any stripe who wants to switch to the US system. In fact, it’s a common insult in the UK in parliament to say that another politician would rather have the US health care chaos, and it’s used by both sides.

As a future practitioner, I would hate to have to turn down a pregnant patient like I was turned down as having a “pre-existing condition” when I was pregnant. Fundamentally, I can’t see why anyone in the health care industry would support the status quo.

Amnesty International takes on maternal mortality in the U.S.

Amnesty International just released a report on maternal mortality (and near misses) in the United States, treating it like a human rights issue. It’s often asserted, including in this report, that infant and maternity mortality are key indicators in the health and social justice of a country.

I need to finish reading the 154 page report (ulp!) so I can get my thoughts together to be a coordinator for local lobbying. I like their proposal to ask Representatives and Senators to call on President Obama and Health and Human Services Secretary Kathleen Sebelius to create an Office of Maternal Health at DHHS, and to improve collection of data on perinatal mortality and morbidity on a state by state level.

Then, I’ll report back, and hopefully get to my cousin Susan’s birth story and the NIH VBAC conference.

Exciting things a-brewin’

I am going to be in a production of Eve Ensler’s The Vagina Monologues tomorrow night. This is my third year being involved with our medical school V Day production. I was the narrator for the past two years. This year I am performing the poem at the end, a poem about birth called “I Was There in the Room”. It ends with:

The heart is capable of sacrifice
So is the vagina
The heart can forgive and repair
It can change its shape to let us in
It can expand to let us out
So can the vagina
It can ache for us and stretch for us, die for us
And bleed and bleed us into this difficult, wondrous world
I was there in the room
I remember

I also was selected to be a delegation coordinator for Amnesty International’s lobbying effort to bring attention to maternal mortality, including lack of prenatal care and racial disparities.

So, I know I am supposed to write up my cousin Susan’s birth story (which will probably be my first non guest post at Mothers in Medicine), and talk about the whole NIH VBAC conference thing, and recruit more doctors for my survey, but I’m a little busy right now. I’ll get to them soon, I swear.

Reply turned post, no line to cross

I have a reply, currently in moderation, at Media Matters for America. On a post about Sarah Palin’s wavering condemnation and acceptance of the term ableist term “retard” as an insult. Rahm Emmanuel: he should resign over it. Rush Limbaugh: It’s satire! Glenn Beck: Silence. Family Guy: Heartless! A kick in the gut.

One commenter thinks that

The creator of Family Guy has used the program to poke fun at political figures, folks with disabilities, and people of fame and pop culture… funny enough this make Sarah Palin the equivalent of a Family Guy trifecta. There is no line to cross if you were on the otherside of the line to begin with.

I replied:

It is how we treat people we don’t agree with that is MOST important, not least important. There is a line to cross – with prisoners, with conservatives, with hypocrites, with the KKK. That’s what separates the good folks from the bad folks. We recognize the lines and respect them.

The billboard in Atlanta

The first time I had heard of turning abortion into a racial genocide issue was during the run up to the 2008 election. I was at an Obama event in Miami that was centered around Women’s Issues, and a small group of African Americans staged a disturbance / protest during the event, unfurling signs they had apparently hidden among their clothes and belongings, with slogans like “abortion is black genocide” and comparing Obama to the KKK due to his (lukewarm) support of a woman’s right to choose.

Renee at Womanist Musings wrote about billboards in Atlanta that is essentially blaming black women for aborting too many of their children. I find this troublesome on so many levels, not the least of all that I feel like the black community is being manipulated, and black women are being shamed and blamed.

I do understand that some White women may be reticent to enter this debate because it is framed as saving a Black child, who we know to be universally undereducated and invisible. Even when Black women place their children for adoption, they are less likely to be adopted and so it would appear that Black women are really reduced to two choices, abort or raise the child themselves. Even if we validate that point, there is still the issue of placing a priority on women’s agency when it comes to reproductive rights. We do not have the right to question these women on their decisions. No one chooses to abort without putting great thought into the matter and if we truly respect the right to choose, it must apply to ALL women.

Finally, as scared as White women may be to interact because of the racial undertones of this argument, I must ask don’t Black women matter?

Please read the entire post. And, please read Rachel’s post about it, which is where I saw it first.

Reproductive Coercion

An outreach person from Women in Distress came to our medical school this week. Women in Distress is the local recipient of the proceeds from our performance of The Vagina Monologues. I am going to be in my third production of it this year. This year I will be performing “I Was There in the Room”, which is the closing piece about a forceps birth.

The representative from Women in Distress did a great presentation. I did add one thing at the end for the group, considering we are all intending to be health care practitioners. I made sure that they knew how common contraceptive sabotage or reproductive coercion was a facet of domestic violence. I thought it was important to know that a patient may complain of frequently losing her birth control pills, or who gets pregnant unintentionally often, or seems very uncomfortable talking about contraception and refuses without discussing it, or outright tells you that her partner will flush it down the toilet or won’t let her use birth control, and any of these should be a red flag that there may be an abuse problem.

Well, today I decided to do something about my burgeoning blog reader. (Be prepared for lots of hat tips and a blogaround or two.) Cara at The Curvature linked to this press release from the Family Violence Prevention Fund about reproductive coercion.

From August 2008 to March 2009, researchers worked at five reproductive health clinics in Northern California, querying some 1,300 English- and Spanish-speaking 16- to 29-year-old women who agreed to respond to a survey about their experiences. They were asked about birth-control sabotage, pregnancy coercion and intimate partner violence. Approximately one in five young women said they experienced pregnancy coercion and 15 percent said they experienced birth control sabotage. Fifty-three percent of respondents said they had experienced physical or sexual violence from an intimate partner. Thirty-five percent of the women who reported partner violence also reported either pregnancy coercion or birth control sabotage.

This is not only a “little recognized form of abuse”, but it is also an important facet of the discussion of unintended pregnancy and abortion. Some people think the male partner should have a say in abortion. I think this highlights why that is not something that can nor should be enforced by the courts, and is really should not be a priority.

Collaboration can be cool

I am almost done with this part of reviewing the chapters for Our Bodies, Ourselves. I was really happy that I was able to recruit some help from trans activists, a disability activist, and a female sexual dysfunction activist with whom to discuss some of the material, to help make it more inclusive. I am also passing on some resources to the editors of websites I find useful that deal with size acceptance, including size acceptance in pregnancy, women of color and lactation, and the like.

Although these topics can tend to be difficult, I am happy I have had a mostly wonderful experience reaching out. Spending time in progressive communities, and finding blogs and websites on these issues in the past helped me work with existing relationships that I was very grateful for, and I built a new bridge, too.

Being an ally can be a good thing, and can be really gratifying and worth it. I know it can be potentially irritating for members of these groups to point out obvious things to people like me (e.g. If you don’t have to mention gender, don’t mention it! When in doubt, leave it out. It’s easier than it seems. Pregnant woman Pregnant patient. See how simple? Edited to add: I in no means want to imply that a physiologically normal birth should be medicalized with unnecessary interventions. My chapter dealt with medical procedures and medical conditions, but the changes I made did not use the term “patient”. It was a quick example with an unintended backlash below.)

But, as an activist / advocate / rabble rouser myself, I don’t want to just complain, and I am sure I am not alone. I want to discuss issues with people who want to improve our culture together. No, I don’t feel like educating everyone all the time, and everyone doesn’t feel like being educated all the time. But there’s a great middle ground where we can communicate with each other. It’s a great place.