HW #41 - Independent Research

Government support for pregnant women and mothers in poverty - if you're poor and becoming a mother in NYC what programs could help you and how would you apply?

A:
Wintour, Patrick. "Pregnant Women To Be Given Assistance In Extension of Anti-poverty Strategy." guardian.co.uk. Guardian News and Media Limited, 09 Feb 2001. Web. 28 Mar 2011. http://www.guardian.co.uk/society/2001/feb/09/socialcare1.
This government program's aim is to increase the potential for overall health and academic success in children, by educating pregnant women on the importance of health and diet during the duration of pregnancy. (Reasoning = Poor pregnant women have lower iron intake, and decisions taken in pregnancy can permanently set the life chances of their child). (evidence = low weight babies have long term health and education problems). Because this source is from 2001, it might not be very helpful or relevant to present issues. I also don't know if this program is taking place in the UK or in the US. This helps my research because it potentially contrasts with organizations in NYC, or provides and example of one of the NYC organizations, or tells poverty-strickent NYC women to move to the UK. Regardless, poor pregnant women (somewhere) can take part in this program.

Hope For New York, . "Midtown Pregnancy Support Center." hfny.org. Hope For New York, 2011. Web. 28 Mar 2011. http://hfny.org/midtown-pregnancy-support-center/.
This Christian organization's goal is to help working women in NYC that are otherwise unsupported by social service programs. It seeks particularly to provide women with an alternative to abortion, with healing after abortion, and with practical assistance in areas pertaining to pregnancy. This organization is thriving and successful, so it is very reliable as an example for helpful organization in nyc. Although this source may gear more towards middle-class women than women in poverty, it is relevant to the great chasm of need regarding birth/pregnancy help in nyc.

"Expert Design of Online Database Systems." www.medkind.com. Medkind Cororation, 2011. Web. 28 Mar 2011. http://www.medkind.com/.
The Free Clinic Foundation of America lists the national free clinics via this website. Pregnant women can go to free clinics and recieve care, free of cost, if they do not qualify for medicare/medicaid, and cannot get private insurance.
"Medicaid In New York State." www.health.state.ny.us. New York State Department OF Health, Feb 2011. Web. 28 Mar 2011. http://www.health.state.ny.us/health_care/medicaid/.
If you are a pregnant woman who cannot afford medical care, you can apply for free medical care provided by Medicaid at most clinics and hospitals. Womens' rights granted by Medicaid: family planning services, treatment for children under age 21, care through home health agencies, clinic services, transportation to hospitals (ambulance or public transportation), and prenatal care. This website is reputable because it is Medicaid's home page.  This is an example of an opportunity for poor pregnant women in nyc.

"Pregnancy." www.nlm.nih.gov. Medline Plus , 04 Mar 2011. Web. 28 Mar 2011. http://www.nlm.nih.gov/medlineplus/pregnancy.html.
also
HRSA, . "Women's Health." www.hrsa.gov. U.S. Department of Health and Services: Health Resources and Services Administration, 2011. Web. 29 Mar 2011. http://www.hrsa.gov/womenshealth/.
also
HRSA, . "Maternal and Child Health Bureau." www.hrsa.gov. U.S. Department of Health and Human Services: Health Resources and Services Administration, 2011. Web. 29 Mar 2011. http://mchb.hrsa.gov/.
Free general pregnancy related information and guidelines are available from sources like this. These are reputable because they are US government, computer-based national medical libraries and resource centers.

NYC Department of Health and Mental Hygiene, . "Info and Services for Pregnancy and Baby Care." www.nyc.gov. The City Of New York, 2011. Web. 28 Mar 2011. http://www.nyc.gov/html/doh/pregnancy/html/home/index.shtml.

If you are pregnant or thinking about having a baby, New York City has free and confidential sexual health services and health insurance programs as well as clinics to help with many pregnancy-related conditions.

Bloomberg, Michael R. . "Health Bulletin: How To Find A Doctor." www.nyc.gov. New York City Department Of Health and Mental Hygiene, 2011. Web. 28 Mar 2011. http://www.nyc.gov/html/doh/downloads/pdf/public/dohmhnews3-10.pdf.

Doctors are necessary and contribute to the health of individuals, families, and societies. Almost all low-income pregnant women and children are eligible for Medicare, Medicaid, Child Health Plus B, and Family Health Plus. This includes details of eligibility for different government provided insurances.

Department Of Health, . "WIC Programs - Women, Infants, Children." Health.state.ny.us. Department OF Health, 2011. Web. 28 Mar 2011. http://www.health.state.ny.us/prevention/nutrition/wic/.

Offers nutrition education, breastfeeding support, referrals and a variety of nutritious foods to low-income pregnant, breastfeeding or postpartum women, infants and children up to age five. Participants have longer, healthier pregnancies and fewer premature births.

"Head Start Locations." Head Start Locator. Web. 29 Mar 2011. http://eclkc.ohs.acf.hhs.gov/hslc/HeadStartOffices#map-home.
This source reveals a list of all the nyc locations for Head Start, a program that financially helps mothers and mothers-to-be of all races, and young children so that children can reach their full potential and live with less risk.

B.
If possible, I would like to volunteer at one of the organizations above and observe first-hand what it is like to be a poor pregnant woman in NYC, and what it takes (on an individual, communal, and governmental level) to help them. I am waiting for a response regarding volunteer opportunities from HFNY. I know a woman who works there, so I hope to be able to tag along with her for a day as she counsels and works. This would enable me to learn how organizations help these women, and what challenges they face in the process.

HW #40 - Insights From Book - Part 3

I find myself at a cocktail party with Jennifer Block, the author of the book I just finished reading. I want to demonstrate that I really read it.
I: "Hey - thanks for writing Pushed. Your main idea that pregnant women seeking medical care have both the right to recieve and refuse treatment, that they have the right to know the risks and benefits of each treatment option (including the option of no treatment at all), and that informed consent is fundamental ethical obligation of health professionals, made me percieve pregnancy in a new way."

But the Block is surprised to be talking to someone who instead of sharing their own birth story actually rephrased the main idea of the text she spent months giving birth to.
Jennifer Block: "Really, which parts were most effective or important for you?"
I: "Well, in the last third of the book you focused on pregnant women's rights (or lack thereof) in hospitals and society, which built upon your assertions in the first two thirds of the book, because it discussed how women are pressured to forgo their rights in favor of "norms" (which are often dangerous, unnecessary, industrialized and atrocious). But let me elaborate! You mentioned on page 226 that "The birth of a child is literally the making of community, the creation of the next generation, the transformation of a couple into a micro community....what we've done is criminalized women's options, and more than that, we've criminalized the making of community." It is clear that the removal of rights in the OBGYN can lead to communal and generational problems that last. You said on page 248 that "I think there will come a time when we will remember or will rediscover - perhaps it will be so distant that we'll feel we have discovered - the intrinsic value of birth where we realize all of this is folly. That we can't control health in the ways we think we can. And that in fact the most important and valuable thing we can give ourselves is a woman under her own steam, bringing her babies forth." The industrialized, harried nature of hospitals has led to so much drug use and physiologically un-savy procedures that we are quickly losing understanding of what it means to have a birth that is not industrialized. If we give women their rights, then perhaps we will gain the meaning of natural, physiological birth back into society. Lastly, page 254 of Pushed discusses one of the ultimate cases of unnecessary, harmful situations for pregnant women who have lost rights: Angela Carder, who had cancer and who suffered the death of her baby soon before her own death (with both deaths resulting from lawyers forming lawsuits and at the same time ignoring "basic concepts of bodily integrity and informed consent.")

At this point, Blcok is realizing that she's having a unique conversation with a serious reader of her book.  Jennifer Block: "But what could I have done to make this a better book - that would more effectively fulfill its mission?"
I: "Well, let's be clear - Pushed sought to provide narratives, historical analysis, and statistical analysis from the perspective of midwives, mothers, doctors, lawyers, and doulas for the book-reading-public to better understand pregnancy & birth in our culture. Given that aim, and your book, the best advice I would give for a 2nd edition of the text would be to extend your analysis of what happens when a procedure such as a VBAC or home birth is banned in a given area. You said that women would go to a place that allows for the kind of birth they desire, but the economic and medical implications of that occurence were not discussed. It occurs to me that there will be a sudden demand for obstetritic care in that area. How do you think that will affect the OBGYN or practicing midwives in the stricter states? Will there be more babies and pregnant women living in these "baby- and birthing-friendly states? Will this affect the quality and quantity of post and prenatal care in the rest of the country? But I don't want you to feel like I'm criticizing. I appreciate the immense amount of labor you dedicated to this important issue and particularly for making me think about weighing the pros and cons of all birth-related procedures I might encounter and empathizing with doctors and their lifestyle and cause without necessarily agreeing with their judgement as I percieve it. In fact, because I read your book, I'm likely to do attempt to forgo all drugs and hospitalization if I become impregnated, and encourage the pregnant women with whom I am close or become close to educate themselves before agreeing to do anything to their body.
Jennifer Block: "Thanks! Talking to you gives me hope about our future as a society!"

HW #39 - Insights From Book - Part 2

1.

Citation:

Block, Jennifer. Pushed: The Painful Truth About Childbirth And Modern Maternity Care. 1st. Philadelphia, PA: De Capo Press, 2007. Print.

Pushed and the “Business of Being Born” have similar arguments, which are that hospitalized birth is horrible, industrialized, traumatic, and in some ways more dangerous than a different kind of birth. They both argue that maternity care is in crisis, and that birthing decisions are made for monetary and legal reasons and not for women. The two also contrast regarding their arguments about birth. Both argue that midwives are a healthy, safe, and happier alternative to OBGYNs. However, Pushed describes the struggle of finding and being a competent midwife without overstepping a given state’s birthing laws. If everyone suddenly turned to midwives for their births, which is what the “Business of Being Born” seems to encourage, the demand for midwives would be far too high. Additionally, the Business of Being Born portrays births that were difficult, but ultimately were driven by inherent physiological desires of the woman: push, end the pain, surrender to the pain, and bring the baby into the world. Pushed explores the fact that women do not always feel these inherent desires: “Labor felt more endless and unrelenting to Jessica than she had expected. The act was also less intuitive than she had expected. ‘I never felt the urge to push,’ she says. ‘It was hard for me to figure out how to push’” (Block, 209). Jessica’s lack of inherent feelings during labor somewhat refuted the point of the Business of Being Born; sometimes women need professional or medical direction and don’t know how to facilitate their births.

2.

I think the second 100 pages of Pushed communicate that many women feel pressure from doctors, family, and society in general to comply with the “norms” of childbirth, and thereby often go to hospitals, undergo subsequent administration of drugs and surgeries, suffer Post-Traumatic Stress Disorder, experience a long recovery and maternal morbidity, bear an unhealthy baby, and lack the ability to have future children in manners dominantly viewed as safe. It is mentioned on page 134 that “Normal is customary and usual but that may not be necessarily what evidence shows to be best.” Pushed recommends that low-risk women should not go to the hospital unless they want a (possibly violently and highly) medicated birth.

 The assertion of Pushed that the hospital is an inappropriate place for a baby to be born makes sense to me, simply because the hospital is a business for the ill to be healed; Doctors have been trained by their schooling and experience to heal, but also to think in terms of what is best for the hospital as a business and they, the doctors. In the doctor’s mind, I visualize a scale. On one side of the scale is the mother’s and baby’s well-being, and the value of physiologically natural births. On the other side is the pressure to make the mother’s bed available as soon as possible and to remove any risks that would result in a lawsuit, and to treat the birthing woman like other people in the hospital: someone who requires fixing. I wish that midwives had more legal opportunities in more states, as well as more recognition as a substitute for OB-GYNs.

3.

It struck me that even with the option of utilizing a midwife, it is extremely difficult and even impossible to have a baby how one wants. “I was really upset, I thought why is this so damn hard–to have a baby the way I want to have a baby?” This, I think, is the fundamental horror of birth. This natural and necessary part of life is hindered by society. Clearly the act of reproducing (which entails sex) is not being hindered by society to an extent that threatens life, since the population of the world is growing. Ridding oneself of waste has become a relatively easy process due to the obsessively sanitary norms of society.

I found it interesting that “Today…the proportion of women suffering morbidity (“an adverse impact on a woman’s physical health during childbirth, beyond what is expected in a normal delivery”) is probably well over half” (Block, 115). According to this quote, the majority of women are suffering unnecessary and invasive procedures that they probably do not want and of which they do not understand the risks. Why have we let this become the norm? Perhaps this could be reversed by training more midwives, transferring nurses in hospitals to the profession of midwifery, and decreasing the legal shenanigans that keeps midwives from practicing legally or advertising themselves, so that more women have the opportunity of escaping morbidities.

An irony of Pushed that deserves attention is in the discussion of animalistic vs. humanistic nature in birthing women of society. "Historically, women have sought support. It's part of what separates us from animals: our babies are helpless, neonatal" (Block, 104). By going to other humans (such as midwives or doctors) for emotional and physical support, women are embracing their human nature. However, they have done so to such an extent that their flight from animalistic living has, perhaps, reversed. "...Let us tether them to machines so that they cannot move. Let us make them stay silent and make no noise in their pains. Let us expose their most private parts and threaten them with cold steel. Let us make them push their babies upwards, against the pull of the earth...This is not the natural cry of a woman in labour bringing a child to birth, although if you have ever witnessed childbirth in a medicalized setting you might be forgiven for thinking so. This is the screaming plea of a tethered animal in pain" (Block, 174-175). Women are buying into the idea of optimal support in hospitals, and have inadvertently fled from any animalistic nature. In doing so, they have (also inadvertently) allowed themselves to be treated like animals.

Pushed described in a particularly simple and strong way how women should fundamentally be helped to give birth. "For caregivers, the best thing to realize is to sit on your hands if you don't need to intervene - to be vigilant, not hyper vigilant. That's the art of obstetrics: learning to do nothing" (Block, 105). I think that if more doctors understood to do nothing unless necessary for the well-being of the mother and child, then there would be less effecting trauma and harmful procedures.

Another concept of Pushed that struck with me was that, by enforcing various procedures, surgeries, and drug use in the birth, doctors are forgoing natural, physiological needs of both mother and baby. “The value of spontaneous vaginal birth–the conditioning of the fetal lungs, the priming of the breastfeeding relationship, the infusion of the ‘love hormone’, the physical proximity of mother and baby–is a radical notion among some obstetric leaders” (Block, 142). When a doctor offers the option of a C-section, Pitocin, epidural, etc., they should not knowingly disclose information from the mother at the doctor’s convenience. The mother may be in pain, exhausted, angry, overly stubborn, and hungry, but she has a right to deciding what happens to her body, of which her baby is a part.    

4.

            Jennifer Block claims that women don’t remember horrible, oppressive birth experiences accurately because of “birth amnesia and part psychological coping–Maria blocked out the treatment so it wouldn’t manifest as depression or worse” (Block, 153). Some women later report their birth experiences as positive and say that they’d go to the same hospital and doctor that actually caused their maternal morbidity. “The gap between reality and perception leaves a ringing dissonance” (Block, 154). Her claim is indeed valid; birth amnesia has an easily explained physiological cause. Oxytocin, a hormone that functions in the mother’s body throughout the birth, hinders memory. “Oxytocin significantly impaired recall performance… and selectively influences memory performance” (http://www.ncbi.nlm.nih.gov/pubmed/15501488). Forgetting an event to protect the mind from depression or worse is common among mothers. “Postnatal cognitive processing included retrospective appraisal of birth, such as taking a fatalistic view and focusing on the present, for example, concentrating on the baby. Memories of birth included not remembering parts of the birth and forgetting how bad it was. Women with posttraumatic stress symptoms reported more panic, anger, thoughts of death, mental defeat, and dissociation during birth; after birth, they reported fewer strategies that focused on the present, more painful memories, intrusive memories, and rumination, than women without symptoms” (http://www.ncbi.nlm.nih.gov/pubmed/17718876). Women who had traumatic memories associated with their births also focused on the present and forgot how “bad” the birth was. Block’s claim that women cope with traumatic births with amnesia and selective memory is reputable, according to the sources above.

HW 38 - Insights From Book - Part 1

 1) The book is organized into 9 major topics: Introduction, Arranged Birth, The Short Cut, Denied Birth, Consequences, Mothers' Helpers, Underground, Criminalized, and Rights. These topics are led by acknowledgements and followed by two appendices and an index.  

                        

2) Jennifer Block goes about writing “Pushed” with one general question in mind: How do the processes surrounding birth in the US entail risks (often unbeknownst) to mothers and strip mothers of their rights? It had not occurred to me before reading this book that pregnant women (and therefore babies) might not be granted the rights they should have or did have in certain historical times, but this appears to be the case. Perhaps the title “Pushed” has several connotations; I think it is referencing the instinctual muscular movement that pushes the infant out of the birth canal, and the push in our society for women to follow certain norms, or simply to follow the doctors’ orders, even though they should be able to make independent decisions. If a grown, sane, and healthy adult in the US can use the bathroom when they wish and partake in sexual intercourse without a crowd of people forcing them to defer their instincts, why can’t people birth their children in a manner that they see fit?  

3) Block begins to answer this question in the first 100 pages of the book. According to her data, interviews and inferences, there are many risky procedures (such as Cesarean-sections, inductions, administration of Pitocin, Cervidil, Cytotec, Oxytocin, and narcotics, overall immobilization, episiotomies, repeat C-sections, and manual water breakage) to which women are subjected “…without their consent, and sometimes despite their express refusal“ (page xxiv). These procedures are controversial; there are pros and cons to both vaginal births and C-sections, natural birth and a birth with drugs, home births and hospitalized birth, mobile and immobile births. Doctors justify the decisions they make by stating the pros of their decision and the cons and risks of the alternative. Block remarks that “These justifications are common, but all are controversial” (page 9). Block, through data and interviews, explores the possibility of a safe birth minus the industrialized, mindless attention of “professionals”.

  
4) I am struck by the fact that, during childbirth, doctors see women as incapable of making decisions for themselves. Perhaps doctors and nurses are so used to being in a position of authority over the patients in hospitals (especially those lying in bed with various drugs in their system), that to consider the opinion of such a patient during a crucial time is foolish to them. The idea of an episiotomy makes me shudder, but it angers me to think that a woman would be unwillingly subjected to one just because she is in a bed, in pain, feminine, in a potentially fatal situation, etc. I would like to learn more about the careers and lives of midwives. Block said naturally birthing children in part a very underground, illegal process. It is saddening to think that a woman cannot easily partake in a completely physiologically natural process without a) embracing the unnatural or b) putting herself and others in danger of suffering the consequences of disobedience to governmental authority c) putting she and her baby in some danger by being at home with no trained birthing assistants.

5) Jennifer Block incorporates evidence into her book thoroughly and convincingly. Unless citing an interview or anecdote (which is quoted), the evidence is cited via footnotes. she uses statistical evidence (for example, when supporting the point that other countries rank higher in medical maternal care than the US, she mentions percentages of home births and caesareans that occur in the Netherlands, Sweden, and Denmark.) She cites doctors, mothers, midwives, nurses, psychologically traumatized mothers (a result of ineffective or incorrect treatment during the birth), and the Discovery Channel. The evidence was relevant to the overall idea of the chapter or paragraph, but sometimes there was so much information packed into one module of writing that it was distracting form the main idea. Block does not have a structurally typical thesis, so the volume and diversity of evidence appears rather haphazard in the form that it’s in.

I personally did not do background research on most of the cited pieces of evidence, but there was one cited fact I found especially unlikely to be true: “Today most fetal monitoring is done externally, but the original models were applied internally. The monitor was a wand-like device with a sharp steel screw at the tip, which was inserted through the cervix and driven into the fetus’s scalp. Corometrics experts claimed EFM would reduce the chance of infant death and mental retardation, but by 1976, questions about its efficacy and safety were surfacing” (page 33). I found evidence that scalp electrodes were used during the early 1970’s (http://journals.lww.com/greenjournal/Abstract/1976/05000/The_Effect_of_Unselected_Intrapartum_Fetal.2.aspx), but not “wand like devices with a sharp steel screw”. This causes me to question the validity of Block’s other citations, and therefore the inferences she makes based on her evidence.

 

HW #37 Comments on Birth & Pregnancy Stories

From Daniel (Mentor):
Casey-
Well done. I'm especially impressed that you found a family of 7 children here in NY :) I found it really interesting that subject A's peers would blame her for being "selfish" for staying home with her child. It is as if those people expected her to bare the burden of pregnancy AND the burden of providing financially for the family. I wonder if they simply relinquished the father of all responsibility or just assumed he'd fail. Either way, they seemed to assume a lot. I wonder what Subject B made of those comments (I'd like to have seen that elaborated on). Did he feel added pressure? Or was providing for his family the aspect in which he could be better than helpless?
In terms of Subject C, I find it interesting that the wife had reservations for having that many children. Did adoption ever come up as a viable path? The situation seemed perfect for it.

From Braxton (protege):
Casey,
Woah, I'm shocked at the experience of Subject A in the most sympathetic of ways. Her employers and co-workers accusing her of "being selfish to her husband and baby by cutting her family’s income in half and staying with the child instead of working," seems largely out of line! You'd think that a group of civilized adults would respect the opinion of a parent in relation to their own child...
I chuckled at Subject C's proposal experience. "C, will you marry me?" "Oh my god, i don't know what to say!...Of... of course I will!" "Great! I hope you like children as much as I do because I'm gunning for twelve of 'em!" "Oh... um... about that..." (Jokes, jokes; though it is a rather entertaining scene to imagine.)

From Natalie:
"Additionally, actions speak far louder than words. Saying “Good luck” or “I hope you have a healthy baby” or “you’ll do fine” obviously does not stick in one’s mind or help as much as throwing baby showers, building baby furniture, preparing meals, or just being there for emotional support."
I think this is a really interesting point that you bring up. When we meet someone who is pregnant we tend to say congratulations or wish them the best, but we do not perform any actions to create a more positive experience. While it is of course positive reinforcement, like you said, will they really remember? But maybe what we really need to be asking is: why do we feel obliged to say these things? We do not actually know that the person will do fine, and if it's not something they're going to remember, then perhaps we shouldn't say anything at all. I believe if we truly care, then an action is necessary. Just as you proved in your writing when a meal was prepared or furniture was built. Or possibly if we said these things less, when we actually said good luck to a pregnant woman, they would know we meant it.

From SarahL:
Casey: I really liked your post, and was struck by this line, “making families was just what people did. Family wasn’t really a question…the only question was timing”. This got me thinking about how our society maps out the normal way to live. It seems as though marriage and babies come hand in hand. It poses as sort of strange that if two people were to make a baby and didn't have the golden rings on their left hand then society as a whole would frown upon their decision... Why do the two have to go hand in hand? Why can't two people create something or move forward without a certificate?

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
To Sarah:
Sarah,
Your post hit upon many interesting ideas I think could have benefitted from further elaboration. For example: "After hearing a very similar story to my first interviewee it made me wonder if subconsciously we set up the type of image we want to be seen as a pregnant person. If through our choices we connect the dots to make one sort of person. It then made me think about the stereotypical types of pregnant people floating around our society. The teenage mom, the Zen mom, the older mom, when and how we give birth seems to make more of a statement than the birth itself." Perhaps you could have touched upon this topic later, in connection to how your interviewees fit into these stereotypes.I liked your quote in the beginning, although (forgive my slowness) I didn't quite see its relevance to your interviews.

To Natalie:
Natalie,
I loved the structure of your post; it was very easy to follow and coherently organized. I was struck by the line, "As sacred as she tries to make birth for the woman, she said that after becoming a midwife, she 'realized how normal birth is.' Birth is a completely natural thing that society makes too much of a fuss over. 'If we leave women alone- and simply support the woman and her family, provide education and safety – things will turn out ok.'" 
I wonder how this midwife explains (in light of this statement) the complications or lack of resources in the home that have led to injury or death of the baby/mother? All of your interviewees seemed like amazing people; perhaps the idea of a pregnant woman is favorable because what is going on in them is amazing.