The Silent Mother

Esoteric & Historical Gravidity & Parturition

Elizabeth Warren’s Plan to Penalize Hospitals Will Not Help Black Mothers

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Truly, I do like Elizabeth Warren as a Democratic candidate for president in 2020. She’s said a number of things that jive with the direction I’d like to see this country move. However, upon reading this article from CNN this morning, I find that she’s made a statement that sounds really great on paper about reducing maternal mortality among black women. However, when you look at the high level, talking points plan, it falls very short of the mark and smacks of a lack of in depth understanding of the issue of why black mothers die at a rate of four times higher than the rate of their white counterparts.

Photo by Thiago Borges from Pexels

Her approach, according the article is to reward hospitals financially for reducing rates of black maternal mortality while reducing funding and financially penalizing hospitals that don’t reduce rates of black maternal mortality.

This sounds an awful lot like “No Child Left Behind” where failing schools are penalized financially and the best schools are rewarded. This cycle perpetuates the poor schools by not granting them the resources needed to do better. It’s no different with her hospital plan.

Penalizing hospitals will mean they may close their maternity units, thus reducing access to care. Most maternity units cost hospitals money, they aren’t money makers. Many rural hospitals have closed or consolidated their maternity units to urban centers, leaving women with drive times of an hour or more for prenatal care, let alone for birth. Better access to care is imperative.

This country is also short about 100,000 obstetricians. We would do well to have thousands more midwives in this country too, to provide care. Midwives are lower cost and have a different model of care for their patients with better outcomes. More providers isn’t enough of a solution. We need to work with the providers we have currently too.

Warren is correct in that we need better education for all medical providers on the issues of race and medical care. However, this is much deeper than cultural competency. Competency is what Warren showed us – she understands there is an issue and it needs to be fixed. Cultural humility is what is truly needed to cover the complexity of human identity and experience. It includes life long learning, mitigating the power imbalances between patient and provider and the institution needs to change. (credit to Melanie Tervalon and Jann Murray-Garcia) For more information please do watch their video on the topic.

This issue of systemic racism starts well before black women are pregnant and in need of prenatal care and care during childbirth. Our medical system has erroneous beliefs about black women’s bodies that go back generations. Please do read “Medical Bondage: Race, Gender, and the Origins of American Gynecology” by Deirdre Cooper Owens if you’d like an in depth, academic history of why and how these beliefs came about and the impact they have currently on black women’s healthcare.

Warren’s response is a gross oversimplification of a problem of endemic racism and weathering in the black community. This penalizing of hospitals won’t solve it. Quite frankly its a panacea. It sounds great, but won’t make the change she’s seeking.

Warren needs to look to the places like the CMQCC and other similar state programs to see what’s working and what’s not. The March for Moms and their team of experts, who have a much deeper understanding of the issues than I do, should be consulted as well. She needs a panel of people who are experts in their fields to consult with and who will initiate evidence based plans to combat maternal mortality specifically among black women.

This issue isn’t as simple as “we’ll charge them money for not making improvements.” See how well that works for the EPA and big polluters. It’s cheaper to pay the fine than to make the change. Making real change, with a multi-factor, nuanced issue like this isn’t easy or straightforward. It will take time, expertise, education and a whole lot of people to admit they have racial biases and are willing to make the change needed.

Warren’s acknowledgement of the issue of black maternal mortality is a good start. However, humility is knowing what you don’t know and where and from whom to seek help. Warren needs help to make real change. I hope she asks for it from the right people.

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Where do we go from here? Implications for modern childbirth education. Part 12

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The interconnectedness of faith and medicine, as illustrated with the case of Dr. Grantly Dick-Read, offers us a new perspective when tackling ethical issues where faith and medicine seems to collide. When physicians can have the understanding that patients can, consciously or otherwise, regard them in a parallel status to that of a priest, with their words and suggestions as gospel truth on their health and well being, it may help physicians to communicate with patients in a new way that is more conducive to collaborative care.

By Edwardx – Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=38918671

This knowledge can also help medical providers better reach patients with dogmatic beliefs against standard of care treatments, such as childhood vaccinations or other arenas where patients values and beliefs may lead them to cause harm to self or to others.

Yet, I caution about this because there are other areas in medicine where doctor knows best, does not apply. The case of a physician refusing to offer birth control or abortion rises to the top of my list of where physician beliefs and faith in their own rightness can interfere negatively with patient care.

More broadly, this pushes out into politics and legislation. When issues like this are seen as an “either / or”, rather than an “and”, then one side is “right”, rather than having a deeper understanding of the nuance and complexity of the issues. When an issue is seen as two boxers in a ring, one will always need to come out as a clear winner. Rather, when, as suggested by Levin, Vanderpool, Mann and Messikomer, we see the integration of faith and medicine, faith can become a powerful tool to motives patients to act.

If the broader avenues of scholarship, religious studies, anthropology, sociology, law, public health, medicine, etc. can widen their perspectives and work in an interdisciplinary manner, then, I propose, we may see a new paradigm for research in the field.

After doing this research, I am left with more questions that I am as of yet, unable to answer. As a childbirth educator and doula, I see my own teachings reflected back in Read’s words and method, and yet, I am dismayed and left wondering, knowing the history of eugenics, the desire to control women’s bodies and their childbearing ability and the foundations of modern childbirth education in this concept of the noble savage and the overcivilized woman, how can we childbirth educators teach in good conscience?

Are the positive outcomes regarding happy parents and satisfied consumers of our classes, enough to keep teaching as we do?

To use a colloquial term, now that we are “woke” because the evidence shows the roots of Read’s method to be buried in the idea of white racial superiority and the continuation of the race, how do we move forward?

Knowing that Read was, in effect, an anti-science doctor, how do we still teach his techniques and theory?

Are the results worth the little lie we tell ourselves and our students? Is it a little lie after all or is faith alone what women need to preserver through a potentially long and painful experience?

Is is that faith in themselves, in the work they did to prepare for birth and faith in their medical providers enough?

Is childbirth education effective not because of what we teach, but because of how we teach it?

Fundamentally, Read’s encouragement and direct support of women, whether at the bedside or through his book, gave women the faith they needed to shirk unnecessary medical interventions and have births that were predominantly physiologically normal, with limited medical interventions. The seeds he planted and germinated grew to be an international movement promoting natural childbirth which still thrives today, though with the same controversies as when it originated.

Fin.

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Rethinking Faith vs. Medicine to become, Faith and Medicine, Part 10

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At first glance, faith and medicine seem to be two separate spheres. However, when, as suggested by Levin, Vanderpool, Mann and Messikomer, when there is the integration of faith and medicine, faith can become a powerful tool that motivates patients to act and for physicians to practice better medicine. Natural Childbirth, as created by Read and cultivated by pregnant mothers since, is a movement rooted in both faith and medicine, as inseparable as sperm and egg once joined to create a new human. The line between one and the other blurs to create a new being, which is to be defined on its own terms, not by that of an outsider who only uses the one familiar perspective.

Read’s critics, using their singular perspective as medical doctors, claimed that because of his lack of scientific evidence and his reliance on “his own eyes” that his method lacked credibility and validity. Yet, the testimony of the mothers who used his method tells us otherwise. Read’s preacher-like storytelling engaged his readers and listeners such that he created a fervent set of believers. Childbirth without Fear, still in publication seventy-six years later, illustrates the strength of Read’s teachings and the faith people have in him and his method.

It is the combination of both Read the self-proclaimed prophet and Read the method that created his success. When we look to the models of clergyman and physician, we not only see the corresponding personal callings, but we also see distinct expressions of faith in both fields. It is these parallels and similarities, rather than the superficial differences in outlook on specific topics within medicine that scholarship could be applied.

Read viewed pregnancy and birth as a fulfillment of a woman’s highest calling and that far from being pathological and something to be feared, birth can be pain free through proper preparation with adherence to Read’s method. Read believes that birth is normal and that it is a woman’s God given duty to produce children and raise them. By doing so, she is introducing and creating “motherlove”, which in turn will save the world.

Read, as the preacher of his gospel, views himself as a savior of women and of all mankind. Women have found faith in Read and his method for generations. It is through this faith that they can have births that create feelings of empowerment and strength as opposed to fear and weakness. Although Read’s prophecy of saving the world through “motherlove” did not come to fruition, his prophetic insights in to childbirth education, relaxation techniques and labor support from fathers have endured.

Next Up: Where do we go from here? Implications for modern childbirth education.

Bibliography, Deena Blumenfeld, The Silent Mother, Dr. Grantly Dick-ReadDownload
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