pregnancy

With this coming Tuesday marking the 40th anniversary of Roe v. Wade, I’m inspired to post this month’s column early.

I encourage readers to check out the work of ANSIRH (Advancing New Standards in Reproductive Health), a UCSF research program “dedicated to ensuring that reproductive health care and policy are grounded in evidence.” So, rather than cover the breadth of political and social dynamics related to abortion policies, I’m focusing on one specific new study which has important implications for protecting women’s health:

A newly published landmark study by ANSIRH demonstrates that trained nurse practitioners, certified nurse midwives, and physician assistants match physicians in the safety of aspiration abortions they provide. We hope that these results will give policymakers the evidence they need to move beyond physician-only restrictions in order to enable more women to have their reproductive health care needs met in their local communities by health care providers they know and trust.

The results of this study are significant because PAs, NPs and CNMs have been shown to be important and accessible health care providers for rural and low-income women. ANSIRH’s new findings support policies which would reduce health care disparities and increase continuity of care because a larger group of health care providers would be able to offer early abortion care. For more on this topic, read the latest post by Tracy Weitz, Director of ANSIRH.  This research should inform health policy across the U.S.

For more on the realities of abortion in the U.S., watch Abortion in the United States, a short video from the Guttmacher Institute.

Crossposted at The Pink and Blue Diaries.

I honestly think parents judge each other too much. So far be it for me to judge the expectant parents in yesterday’s New York Times article, “A Boy or a Girl? Cut the Cake”. But let’s just say, as a researcher, if I were going to judge the concept of a gender-reveal party, here are 5 things I might say:

1. The stat in the article regarding the percentage of people who find out the sex of their fetus through amnio or ultrasound is at odds with other stats I’ve read. The percentage is more like up to 80, not 50.

2. Gender – and therefore gender stereotyping – begins in utero. How do we know? Because in 1986, around the time that amniocentesis first allowed pregnant women to find out fetal sex, sociologist Barbara Katz Rothman asked 120 pregnant women to describe the movements of their fetuses. “Women who’d learned they were having a girl gave answers such as ‘very gentle, slow, more rolling it seemed than kicking,’ ‘moderate, reassuring but not violent,’ ‘quiet in the mornings and afternoons,’ ‘lively but not excessively energetic.’ Mothers who knew they were carrying a boy described ‘many somersaults and very vigorous movements,’ ‘rolling from side to side and little kicks and punches up and down,’ ‘a constant jabbing under my ribcage,’ and ‘a saga of earthquakes.’ Tellingly, the responses of women who did not find out the sex of their fetus showed no such stereotypical patterns.” (Lots more about this in Annie Murphy Paul’s meaty chapter on sex and sex selection in Origins)

3. This story about gender-reveal parties is the antithesis of last year’s stories about Pop and Storm – kids whose parents didn’t divulge their child’s sex, for months after they were born. I wonder what that says about us as a culture, or a zeitgeist, in terms of how we feel about young children and gender.  Thesis, antithesis, anyone?

4. I realize that finding out the sex is a threshold moment. It’s the thing that makes a pregnancy feel real. Sex transforms a fetus from an abstract “it” into a specific “he” or “she.” But don’t most enlightened parents these days act with shock and glee regardless of which sex is announced? So why all the fuss?

5. Shouldn’t we be a tad more concerned with “Who will it be?” than “What will it be?” in the end?  I’m mean, if I’m going to get all lofty about it and all.  And why, for that matter, are these called “gender-reveal” parties and not “sex-reveal” parties, which is what they actually are?

Lastly, a personal story:

When I was mentally preparing for the great reveal, lying on the table waiting for my ultrasound at week 20, I thought back to my grandmother who was pregnant with my mom and her twin sister back in 1941. Grandma Pearl, an orthodox Jew, assumed she was carrying boys—or, rather a boy. She didn’t even know she was carrying twins until the doctor suspected a second heartbeat in the seventh month and ordered an X-ray. My grandparents didn’t bother picking out girl names. Their sons would be David and Jonathan. When David and Jonathan turned out to be baby girls, my grandparents ended up naming them after two Catholic nuns who took care of my grandmother on the maternity floor: Sister Rita and Sister Renee.

I’m not sure what all this means, but I find it damn funny somehow. I mean come on, it was an act of irony destined to make even a stern Old Testament God crack a smile.

PS. Did anyone else find the photo below incredibly creepy?

This week, a drug company called Sequenom has made their prenatal blood test, MaterniT21, available in select markets.  This is the test I made reference to in a post or two over the summer:  it’s the test that can examine fetal DNA from a maternal blood sample.  What this means is that it can provide the information that, until now, could only be gotten from amniocentesis or CVS, and these are tests that carry a risk of miscarriage.

Well, I say it can provide the information that an amnio or CVS provides.  These are tests that examine fetal genetics for a wide range of things.  MaterniT21 looks for one thing, and one thing only:  Down syndrome.

Amber Cantrell and I have interviewed quite a few women as part of an extended research project. Those who’ve chosen not to have an amnio or a cvs have said this was because of the risk of miscarriage.  A maternal blood test carries no risk of miscarriage, and it can be done quite a bit earlier in the pregnancy than an amniocentesis.  Earlier in the pregnancy matters because 90% of people who discover through testing that their fetus has Down syndrome decide to terminate the pregnancy.  If you can learn that your fetus has Down syndrome earlier in the pregnancy, abortion is safer and easier.

As you all know, I am a big advocate of reproductive rights, so this isn’t a post saying that folks shouldn’t have abortions.  It’s a post saying that I’m interested in seeing how this new technology affects our conversations about parenthood and disability.  We’re a culture that often lets technology–rather than thoughtful ethical conversations, for instance–take the lead.  So where will this technology lead us?  What will it mean for the decision-making processes of women who are pregnant?  What will it mean for people, like my daughter, who have Down syndrome?

Cross-posted at Baxter Sez.

Is the legality of abortion in the U.S. a moot point if too few ob-gyns are willing to perform the medical procedures?  A recent post on FREAKONOMICS inspired me to find out more about a new article in the journal Obstetrics & Gynecology titled “Abortion Provision Among Practicing Obstetrician-Gynecologists.”

This group of researchers mailed surveys to practicing ob-gyns and reported on the data from 1,800 who responded. The article’s main findings are as follows: “Among practicing ob-gyns, 97% encountered patients seeking abortions, whereas 14% performed them.” Their analysis of the data revealed that male physicians were less likely to provide abortions than female physicians. Age was also a factor, with younger physicians being more likely to provide abortions.

The new article’s abstract states, “…physicians with high religious motivation were less likely to provide abortions.” I wonder if the large numbers of ob-gyns who do not provide abortions speaks to moral judgments that this medical procedure is a sin. So, the legality of abortion may be rendered pointless by physicians who may be making decisions based on religious doctrine? Access to abortion remains limited by the willingness of physicians to provide abortion services, particularly in rural communities and in the South and Midwest.” Does a woman’s geographic location doom her to restrictions on her ability to obtain a medical procedure that is protected by law?

During my study of women and men living with genital herpes and HPV/genital warts infections, I coined the term moral surveillance practitioner to describe the doctor-patient interaction style of health care providers who conveyed a sense of disapproval, judgment, condemnation, and even disgust to their patients who had sought their sexual health services.  In the case of STDs, these practitioners tended to blame their patients for having contracted a medically incurable infection because of their own “bad” and sinful sexual behaviors.

It would be interesting to see if a companion study to the newly published one, perhaps a qualitative interview study, would reveal a more nuanced understanding of the attitudes and values that ob-gyns hold about their female patients who seek abortion services.  With women’s physical and/or mental health often hanging in the balance of the ability to receive a legal abortion, we deserve to know more about the large number of ob-gyns whose moral opinion may be taking precedence over their ethical obligation to, in the words of the Hippocratic Oath, “First, do no harm”…in this case, to do no harm to their female patients who may be harmed by not having a medically safe, legal abortion.

__________

Note: If you’re curious about physicians’ insights and experiences in providing (or not providing) abortion care, then check out two recent books: Carole Joffe’s Dispatches from the Abortion Wars: The Costs of Fanaticism to Doctors, Patients, and the Rest of Us and Lori Freedman’s Willing and Unable: Doctors Constraints in Abortion Care. And, for more of the latest research on reproductive health care and policy, explore the work of UC San Francisco’s reproductive health think tank ANSIRH.

It’s been a long while since a book kept me up at night — both because I compulsively had to finish reading it, and also because it invaded my dreams. Home/Birth, recently published by 1913 Press did both.

Co-written by two poets I much admire, Rachel Zucker and Arielle Greenberg, the book’s subtitle, A Poemic offers a first cue to the passion and conviction the authors infuse into this original, collage-like work. Interweaving their personal narratives about their home (and initial hospital) birth experiences, they also include the voices of home birth providers (midwives, doulas, supporters), as well as layer in statistics about the safety of home birth and the dangers of the hospital experience — both physical and emotional.  Quoting largely from Jennifer Block’s book Pushed, there is no attempt to portray a spectrum of opinions about birthing.  Their position is focused, their zeal is clear — staying at home is the best option for a woman to have an experience that is empowering to her, causes her to trust in her body, and to holistically bring her child into the world.

For Zucker, a trained doula, and Greenberg, (soon to leave her tenure-track job for a move to Maine and a possible transition to birth education work) clearly, this is a topic around which they feel a deep sense of mission, both in terms of changing the received notions about the safety of home birth, as well as doing political advocacy to overturn restrictions which have limited the scope of midwifery and “normalized” medical intervention.  Greenberg is explicit about how her first home birth (in Illinois) was actually illegal and the limitations this placed upon her care, as well as the demands caused by her sudden second home birth — fleeing the state to temporarily move to Maine so she could be attended legally by a midwife practice.

The medicalization of what is a natural process, (once left entirely in the hands of women, both literally and spiritually) has long been a topic of hot debate, as Block outlines here. Recent movements have (controversially) named “birth rape” as a phenomenon some women experience after acts of obstetric violence have been inflicted upon their bodies during childbirth.  Suffering PTSD after birth has also more recently been acknowledged as an aftereffect of a traumatic birth experience. Then there’s the recent news about how Disney has been barging into the delivery room, another way in which birth has been co-opted for corporate gain.

It’s impossible to not be moved by the testimonies offered in the book — women robbed of a sense of their body’s power, nevermind a profound moment with a new child.  Yet, I am certain many will approach this book with deeply entrenched resistance and even feel enraged by the staunchness of the authors’ position.  A refrain the two insert throughout the text is “What if something goes wrong?” no doubt a line each has been asked continuously.  I found myself wanting to hear this more directly answered, rather than just offered as a rhetorical question.  The stories relayed about home birth don’t all end happily, and the book concludes on a deeply poignant note that offers through example an answer to this question — yes, things can go wrong, but “holding the space” for a woman to meet her child within a sense of connected power is still worthwhile.

It is most difficult to critique Home/Birth as a poem. Collaborative writing doesn’t have a strong tradition within the U.S. and there were moments I wished for more clarity and shape around the narrative(s).  Attention to the line is found most strongly in the interstices between chapters — where the two take phrases previously included and collage them into more precise lines, as in this excerpt:

Never thought this would —

dreamed of —

be my story.

Every child. Changes. You

feel sane, like a witch with her silky moonlight or goddess.

Feel grateful like a feminist, like an activist, like a friend and

the truth is when you saw what you could do —

women watching over —

it changed everything and was safer and feminist

all the drawers and doors and windows

at once and the low noise we make

opening, opening.

I almost longed for Zucker and Greenberg to write a nonfiction book about their experiences rather than knitting the threads of so many others voices together.  Their use of the word “witch” is intriguing, but unclear — is this a straightforward reclamation or modern reconstitution of the word?  Likewise, this is clearly a political topic for both, one that affects a range of women’s health issues, yet I wished their desire to tie this to the feminist movement had been more explicit.  They intersperse T-shirt and bumper sticker slogans about home birth throughout to show both the popular embrace of this movement and counter attitudes to its resistance.  While the phrases are clever and sound lighthearted, (“Childbirth is a natural procedure, not a medical event” “Yes, I gave birth at home.  Now ask your silly questions” and “Peace on earth begins with birth”) they reveal the flame this movement ignites (the countervailing, “Home deliveries are for pizza”).  They serve as poetic tropes of sorts, but I would have liked more rendering of these messages in the poets’ own voices.

Greenberg and Zucker offer a unique pastiche, a chorus of female voices, sometimes speaking simultaneously, sometimes in fugue, as they layer facts, scraps, nuances, and feelings about this topic.  The result is profoundly affecting, and their invention of word “poemic” is the right refraction of polemic, serving as an invented form that allows them to bring their poetic talents to bear about this deeply felt topic.  The book’s opening epigraph by Muriel Rukeyser, “Pay attention to what they tell you to forget,” can also serve as its parting invocation as both authors advocate for remembering what has always been known.

Guest poster Amber Cantrell is a student at the College of Charleston, majoring in Women’s and Gender Studies.  The research project she discusses is partially funded by a Student Undergraduate Research Fellowship from the College.

Although this might be somewhat disappointing, rather than Alison Piepmeier authoring this blog post, it is in fact her undergraduate research assistant. However, I am writing a lot about her, so perhaps that will be a small consolation prize. My name is Amber Cantrell, and I’m a junior at the College of Charleston eagerly benefiting from working with a feminist scholar like Alison.

This summer Alison and I are working on a project about prenatal testing. Initially, we’d thought prenatal testing was going to be one chapter in Alison’s book project about the intersection of feminist disability studies and parenthood. As we’ve begun to explore all the different topics that Alison and I find interesting about prenatal testing, the information gathering stage seems to have exploded rather than becoming focused and topic specific. As the person who is primarily doing the research that Alison requests, I have delicately pointed out that this chapter on prenatal testing may really a book project on prenatal testing.

Our plan for the summer was to talk with parents of children with disabilities, particularly Down syndrome, because we wanted to hear their stories. How did prenatal testing function as part of their pregnancy, if at all? How did these prospective parents make their decisions about prenatal screening, diagnostic testing, and potentially terminating their pregnancy?  In particular, what sorts of narratives—stories from their doctors and families, stories from pop culture—shaped their decision making processes?  These questions are intensely personal and potentially upsetting to those who might have chosen to terminate a fetus that they had anticipated with excitement until they found out about a particular disability. Alison and I hoped we could secure 12 interviews, but we thought this might be ambitious; we thought that perhaps only a few people would consent to talk about their stories.

When Alison contacted some of her own friends and acquaintances as well as posted our interview request on her blog, we received 9 responses in the first 24 hours. Within the next 12 hours, we had our total of 12 people who had contacted us with their desire to participate in this project.  And people keep responding.  People who Alison has never even met have agreed to be interviewed—people from around the country, some who are living happily with large families, some who are dealing with the death of a child with disabilities, some who are pregnant again and considering testing from a new perspective.

Their generous willingness to talk about their experiences is something that Alison and I are finding overwhelming (in a good way).  Why do so many people want to be a part of this project?  We think this is evidence that we haven’t developed a cultural space for women and their partners to talk about prenatal testing, which many have come to consider an inherent part of pregnancy. As a society, we need a space to grapple with the implications of choice and what it means, especially when statistics show that upwards of 85% of pregnancies with Down syndrome are terminated.  Alison and I are both pro-choice feminist scholars, but we recognize that although the word “choice” implies something easy—a quick decision—in the case of prenatal testing and disabilities, the process is anything but easy or quick.

We’re eager to hear these stories, to start collecting and examining the complexities and paradoxes that these parents are sharing.

I’m collaborating on a study of traumatic childbearing experiences, so I’ve been thinking a lot about the types of injuries that can occur as a result of pregnancies, labors, and different types of deliveries.  My research partner forwarded me a recent blog post on a board-certified urogynecologist’s website titled “Cesarean on Demand Does Not Eliminate Risk of Prolapse.”  This post highlights the findings of a 2009 research article published in the International Urogynecology Journal. In this research, three groups of women were studied: “vaginal delivery with sphincter tear (n = 106), vaginal delivery without sphincter tear (n = 108), and cesarean without labor (n = 39).” [The numbers reflect how many women were in each of the three groups.]

Now, I’m no urogynecologist, but I found it hard to believe that c-sections “on demand” (a.k.a. without labor) would not at least reduce the risk of pelvic floor damage, including pelvic organ prolapse (pelvic organs “slipping out of place” when the supportive muscles and ligaments are weakened or torn).  Prolapse can greatly impact the health and quality of life: for example, women with prolapse may suffer one or both types of incontinence and/or painful sexual intercourse.

I recognize that many medical practitioners, authors and laypeople have come to believe we have too high a rate of c-sections here in the U.S.  Research studies, such as the one celebrated in the recent blog post, call into question whether there are any health benefits of c-sections without labor.  As a medical sociologist who teaches research methods, I consider it to be of utmost importance to discuss research findings with the highest degree of accuracy.  No study is perfect: no study is without bias and no study is without limitations.  So, I read the complete research article to find out if it truly supported the blog author’s contention that these researchers “found NO DIFFERENCE in moderate prolapse between the three groups.” 

I was struck by significant methodological flaws and limitations which, while acknowledged by the authors of the original article, were glossed over or flat out ignored by the author of the blog post.  I found myself asking several questions:

Question #1: how healthy were the women before this childbearing experience?  No one knows: the researchers admit, “our findings cannot be attributed with certainty to delivery method, since some women may have developed prolapse before delivery or pregnancy and prolapse was not assessed prior to delivery in this population.” 

Question #2: who were the women who participated in this study?  The women for this study were recruited from prior studies performed through the Pelvic Floor Disorders Network, specifically from the follow-up study to their CAPS Study (which focused on “fecal and urinary incontinence after childbirth”).  How can we rule out a self-selection bias of those women who said “yes” when they were recruited to this initial study?  Could it be certain women who had C-sections, perhaps those feeling some pelvic/vaginal discomfort immediately following delivery were more likely to say “yes” because they saw value in being interviewed about incontinence?

Question #3: did the researchers recruit enough women for each of the three groups to be able to answer their main question?  No.  The authors wrap up their article by noting that “further research would be required to determine whether cesarean delivery before labor reduces the incidence of pelvic organ prolapse.”  So, this research doesn’t actually determine anything about what they claim as their primary research question.  Why not?  The short answer is that they never got enough women to participate.  The authors claim that they would have needed 132 women per group in order to test the statistical significance of the difference in rates of stage II prolapse between those women who had C-sections without labor and those women who had vaginal deliveries.  While they got reasonably close to their sample size goal of 132 for the two vaginal delivery groups (106 and 108), they only got 39 women to participate in the C-section group.  Is this acceptable?  Statistical significance is key to evaluating any study because it means that the results are “probably true (not due to chance).”  The researchers finally own up to the likely irrelevance of their study towards the end of the published journal article: “Furthermore, our sample size was not sufficiently large to exclude a significant difference between groups.”  In plain language: they didn’t study enough women to know whether or not there are not real differences between the health outcomes for women who have c-sections without labor and those experience other types of labor and delivery.

Question #4: can the researchers say anything definitive that might help improve women’s health?  Hmmm.  The only factor they definitively connect with less pelvic floor damage is lower birth weight: I’m betting that it won’t surprise many to find out that smaller babies causes less damage.  But, what are we supposed to do with this finding? 

The author of that recent blog post dares to call it a “beautifully executed study,” and that’s why I had to wrote this post: to help those of us who are not medical researchers better understand what we should value and what we should question when it comes to research studies that can impact women’s health.

On my other blog, I recently posted a review of the book Origins:  How the Nine Months Before Birth Shape the Rest of Our Lives (Annie Murphy Paul, 2010). I wasn’t particularly fond of the book.  It offers an overview of research being done in the last few decades to determine fetal origins, or the ways in which people are affected—perhaps for generations—by what happens during the time that they are gestating.  Despite the author’s good intentions, I found it to be a troubling book.  As I recounted in my review, even as a woman who isn’t pregnant, I felt uncomfortable reading, like I was being indicted for not being careful enough while I was pregnant, back in the day.  While Paul acknowledges the danger of this research being used to bolster already culturally prevalent “mother blame,” she frames her work in the hope that it can provoke broader cultural change and positive evaluation of mothering, from the point of conception onward.  I said I didn’t think it worked, and that I did, in fact, feel blamed.

What I wanted to talk about here is not my review but the comments it received.  I’ve had a number of responses, and the thing that’s interesting is that many have been lengthy.  Folks haven’t just been weighing in—”I disagree!”—but offering counterarguments or lengthy explanations of how fetal origins research is or isn’t valid.  Some have been arguments based in personal experience, others have been based in professional expertise (medical anthropology, for instance, or anesthesiology).

So my question is, why did this matter enough to readers that, in responding, they essentially wrote blog posts of their own?

I think the answer is that parenthood is a high stakes endeavor, particularly for the middle-class (overwrought?) parents cohort I belong to.  More specifically, motherhood is a high stakes endeavor—and I say this with all respect to my partner, who is an outstanding father to our daughter, but who doesn’t face the pressure that mothers routinely face.

All of us who are in the realm of motherhood—either as parents or as scholars of motherhood—know this.  The internet is full of jokes about “mompetitors” that friends regularly send me.  This piece from Salon maps out the topics you simply can’t discuss, and it’s not wrong:  breastfeeding, attachment parenting, the family bed, and crying babies are topics I’ve found to be so highly-charged that I’m incredibly careful about talking about them, even with very close friends.

The reason I read Origins is that I’m currently doing research into prenatal testing, and that’s another subject that’s so high stakes that many of us simply don’t talk about it at all.  When some of my friends have been pregnant, they haven’t shared the news until after they’ve had the amniocentesis that determined that this is a pregnancy they’re actually going to continue.  I’d hoped that Paul would discuss this aspect of our cultural assessment of the fetus, but she didn’t.  She did, however, share that many of the studies base their assessment of prenatal health on postnatal IQ scores, a fact that I found very troubling.

We’re raising kids in a culture that’s perfectionistic and that seems to believe, by and large, that we—as mothers—are always wrong.  If something “bad” happens involving our child (such as short attention spans, low IQ scores, or asthma), it’s our fault.  Since we’re already pummeled with this viewpoint, scientific research that says, “And it’s true while the baby’s in utero, too!” isn’t necessarily helping matters.  This isn’t to say that the scientific research is or isn’t valid.  I’m not a scientist, and my skepticism about some of the studies Paul reports on isn’t definitive.  What I’m saying is that this science is emerging from and feeding into a culture that has some very troubling, individualizing, and sexist views.  I think my readers are attuned to that culture, as well, and it makes all of us a bit defensive.

This month’s guest column* by Christine H. Morton, PhD, a research sociologist at the California Maternal Quality Care Collaborative, draws on her research and publications on women’s reproductive experiences and maternity care advocacy roles, including the doula and childbirth educator. She is the founder of ReproNetwork.org, an online listserv for social scientists studying reproduction.

The ever-evolving history of the childbirth reform movement has new developments, which need to be incorporated into the older story which documents the shift from home to hospital birth; and the paradigm clash of midwifery and medical models of birth reflecting holistic and technocratic values, respectively. We need to incorporate the story of the doula, which I argue, is one of many efforts to bridge the divide – to provide, as Robbie Davis-Floyd has called it, humanistic care in birth, which is what most women desire.

History is happening now. In addition to the emergence of the doula in the past thirty years, more recently, we see efforts underway in maternal health policy (Childbirth Connections’ Transforming Maternity Care), among physician and nursing professionals (most especially around maternal quality measures, and maternity quality improvement) and resurgence among, for lack of a better word, ‘consumers’ or childbearing women, who seek greater access to vaginal birth after cesarean (VBAC). What are the goals of each stakeholder; how do they intersect and overlap, and come into conflict with one another? This is a big story, and we need to tell it!

I take a small slice of this larger historical backdrop to consider the interconnected history of childbirth educators and doulas, which will be the subject of my research presentation at the Lamaze-ICEA Mega Conference in Milwaukee.

To back up a bit, when I embarked on my sociological investigation of the doula role, I was interested in many aspects of this innovative approach to childbirth advocacy and support. What strategies and mechanisms enabled women with no medical training to insert themselves at the site where medical care is delivered to a patient in a hospital, and enact their self-defined role? Why did women become doulas and what did the work mean for those who were able to sustain a regular practice over time? How were doulas utilizing and leveraging the corpus of evidence based research which suggested their impact was as great, if not greater, than that of the physician, the culture of the obstetric unit, or the labor and delivery nurse? Where did doulas come from? What, in the history of childbirth reform, or childbirth education, or labor/delivery nursing, could help me understand how doulas emerged at this point in time in U.S. history?

Later, after learning that there were limited histories of childbirth education (by non-childbirth educators), and little research on the history of obstetric nursing, I had to take a step back and consider these factors as well. Why was the work and perspectives of women who support other women during childbirth an overlooked piece of historical research? Why did histories of women’s health reform efforts largely exclude childbirth reform? Why had there been no history of the women who were involved in childbirth education; in labor and delivery nursing; in the mainstream arena of birth care in the US? So as not to be accused of ignoring the scholarship that does exist in this area, I acknowledge my debt to Margot Edwards and Mary Waldorf; to Judith Walzer Leavitt, to Barbara Katz Rothman, Robbie Davis-Floyd, Margarete Sandelowski, Deborah Sullivan and Rose Weitz, Judith Rooks and Richard and Dorothy Wertz (I can make my full bibliography available to those interested). I have been inspired by these histories, but they focused less on the women (childbirth educators) who were making history and more on the larger cultural shifts in beliefs about medicine, technology, women’s bodies and reproduction.

When childbirth education per se was a topic of inquiry, the research focus tended to be on the primary sources of the male physician champions – Grantly Dick-Read, whose work informed the natural birth movement, and Ferdinand Lamaze (and his US counterparts – Thank you Dr. Lamaze author Marjorie Karmel and Elisabeth Bing) who formulated a method for accomplishing unmedicated, awake and aware childbirth. However, most of this scholarship makes unsubstantiated generalizations about what particular childbirth educators (of various philosophies /organizations) believed, and how they taught. There is surprisingly little in the way of empirical research – few scholars interviewed childbirth educators or conducted systematic observation of their classes over time.

So after completing my dissertation on the emergence of the doula role, I had the great opportunity to continue with my research interest through a research grant from Lamaze International to conduct an ethnographic investigation of childbirth education, with my colleague, medical anthropologist Clarissa Hsu. We talked to educators, observed their classes and analyzed our data.

We found that educators who were actively practicing doulas drew heavily on their direct labor support experiences as authoritative resources for stories and examples that supplemented the material they taught. Actively practicing doulas also included more curricular content on early labor than educators without such experience. Having real births to draw upon provided doula-educators a different type of credibility and authority than educators without such current labor support experience. These educators relied on other mechanisms to establish their authority, such as knowledge of the latest research on birth and use of more authoritarian teaching styles.

We found that the intersection of doula practice and childbirth education has significantly affected how childbirth preparation classes are taught, and this new infusion of practice and ideology is worth exploring. I encourage you to explore this with us, and welcome your thoughts.

*Note: this column was originally posted on the Science & Sensibility blog.

I dedicate this month’s column to parents who are in the midst of crises which are well-articulated on the website A Heartbreaking Choice:

Pregnancy does not end happily for everyone. Sadly, some parents receive grim prenatal news that something is seriously or fatally wrong with their loved and wanted unborn baby. They have to make a decision about continuing or ending pregnancy. We realize that all parents make a loving choice, one they feel is better for their baby. Regardless of the fetal anomaly found, the decision to end a pregnancy is always a difficult one.

Although it is estimated that between 80 and 95 percent of parents receiving a severe prenatal diagnosis choose to end the pregnancy, those who face this nightmare often feel alone. There is very little in the way of support programs for them. With this site and the dedication of courageous parents willing to reach out, we hope to create a safe haven of encouragement, validation, hope and healing.

How many of us have thought about all that is involved with therapeutic abortions?  Parents in these situations have to navigate a medical system which is under the influence of a legal system which (in my humble opinion) has succumbed to a failure of the separation between church and state. It saddens and infuriates me that these mothers — especially those in their third trimesters — may be denied access to medical options which could best protect their physical and mental health. In this day and age of U.S. abortion policies, should we be grateful that any states allow any options at all?  Gratefulness is hard to come by in the face of so much suffering.  My prayers and love go out to all parents who face these heartbreaking choices.