What has Improving Birth done for the woman in the “forced episiotomy” video besides exploit her?

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Over the last few days I’ve been writing about the cynical exploitation by Human Rights in Childbirth of a woman who endured a forced episiotomy. Human Rights in Childbirth is protecting the identity of the doctor in the video, and is now deleting and banning anyone who dares to question why they have not filed a complaint against the doctor with the California Board of Medicine. Apparently the right to free speech is not one of the human rights in childbirth.

But HRiC was not the first group to exploit the mother in the video to promote homebirth midwifery while simultaneously doing nothing to obtain redress for her. That distinction goes to Improving Birth.

Who is Improving Birth and how do they aim to improve birth for women?

I know you will be shocked, shocked to learn that they are homebirth professionals who earn the bulk of their income by promoting birth outside hospitals. The founder is Dawn Thompson, a doula. As far as I can determine by perusing the sponsors, there is no one involved who could actually improve birth for the 99% of women who give birth in hospitals. The organization, just like Human Rights in Childbirth (also a sponsor) is yet another astro-turf organization hiding behind “grass roots” support of improved birth, but actually shilling for greater market share and profits for homebirth midwives and doulas. And just like HRiC, their favored technique for fundraising and publicity is fomenting distrust of doctors by implying that the wrong doing of one doctor represents the standards of all obstetricians.

What has Improving Birth done to seek redress for “Kelly,” the mother in the video? Not a damn thing because they don’t really care about Kelly beyond using her for fundraising. They haven’t assisted her in filing an official complaint with the hospital, they haven’t helped her file a complaint with the California Board of Medicine, they haven’t helped her obtain legal counsel, and, most importantly, they have not outed the doctor and hospital where the incident took place.

What does Improving Birth recommend that viewers of the video should do:

Helps Improving Birth

What a surprise! Every suggestion — sign a petition, use social media to promote Improving Birth, attending an Improving Birth rally, tell a story of violation under the aegis of Improving Birth, and give money to Improving birth — benefits Improving Birth. And NONE of the suggestions benefit Kelly in any way!

It’s actually not a surprise when you look past the inspiring language of Improving Birth to the real purpose of the organization. I imagine that they aren’t opposed to improving birth in hospitals, but they aren’t particularly concerned about it, either. The purpose of the organization is to increase market share and profits for homebirth midwives and doulas. Individual women are merely the dupes employed for the purpose.

It is both easy and free for Kelly, or Improving Birth, or Human Rights in Childbirth to file a complaint with the California Board of Medicine. According to Improving Birth:

As far as we know, this doctor is still attending women and babies at this hospital.

And as far as I know, neither Improving Birth or HRiC has lifted a finger to prevent it.

That’s rather surprising when you consider that:

… In [Kelly’s] case, there is no question about the facts she relayed. We can confirm her story, because it was captured on video (see “The Birth” below). Kelly’s mother filmed her grandson’s birth (with the full knowledge of the doctor in attendance)…

In other words, it isn’t a “he said, she said” situation. There is video evidence and the video was taken with the doctor’s permission, so there is no legal barrier to submitting it to the Board of Medicine.

According to Improving Birth:

Kelly told us that when she hand-delivered her complaint six months ago, she spoke with the hospital’s Director of Women’s Services for 45 minutes about what had happened.

She says she never received a response, even after inquiring several times about what was being done or what the next steps were…

But I bet a follow up letter on the stationery of Improving Birth or HRiC would elicit a prompt response, yet neither organization has sent one.

Why haven’t either Improving Birth or HRiC made ANY efforts to help Kelly seek redress?

There are a number of possible answers and all of them undermine the stated purposes of the organizations:

1. The video excerpt does not reflect the full story of what happened.

2. The doctor has already been disciplined and IB and HRiC don’t want women to know that the system works.

3. IB and HRiC couldn’t care less what happens to Kelly. They got what they wanted from her, yet another opportunity to increase market share and income of homebirth midwives and doulas by fomenting distrust of doctors. Now that they the propaganda they wanted, poor “Kelly” is on her own.

Perhaps IB and HRiC really mean that crap that they spew. After all, Hermine Hayes-Klein of HRiC came to this blog hoping to call my bluff by soliciting my services as an expert witness. I called her bluff; I’d be more than happy to serve as an expert witness. Moreover, I’d be happy to help Kelly file a complaint with the California Board of Medicine or find legal counsel in California.

If HRiC (or IB) were really interested in improving birth and promoting human rights in childbirth, they would have jumped on my offers of assistance. Instead, HRiC erased my comments from their website and Facebook page and banned me from commenting.

Why? Because HRiC (and IB) don’t give a damn about Kelly and her forced episiotomy and it was far too embarrassing to have that pointed out.

  • sdsures

    When Kelly had her baby, did she sign a blanket consent?

  • sdsures

    Is this the best place to get updates on this story?

  • You’ve done far more to “improve birth” for far more women than you will likely ever know. What’s endlessly frustrating is how one sided these organizations are – when its a forced cesarean or forced episiotomy it’s outrage. When its a forced vaginal delivery – crickets. Most roads are two-way streets, but around HRiC and IB – it’s a one way only zone.

    • Young CC Prof

      I don’t hear them saying much about women who are denied pain relief due to cost-cutting or provider ideology, either. Pain relief is, according to the WHO, definitely a human right.

      • Yep those women are just SOL…and traumatized.

      • Women are human? Jeez, I never knew!

  • The Bofa, Being of the Sofa

    This is something I’ve often asked about old Andy Wakefield. I’ve asked the question, what has he actually done for parents of kids with autism?

    Even assuming that he had been right, notice that he never actually did anything of any substance for kids with autism or their parents, except someone to blame.

    Nothing at all useful.

    • Young CC Prof

      He takes photos with them.

      • SporkParade

        I don’t know about Wakefield, but I’ve heard it argued that Jenny McCarthy has done a huge service for kids with autism, even though her kid was never autistic, by bringing more awareness to the disease, which makes it easier for families of children with autism to bring them out in public. Which is nice, except for the thousands of parents in the US alone who will never be able to bring their children out in public because their children died of vaccine-preventable diseases, but whatever. {}

        • The Bofa, Being of the Sofa

          But how much damage has Jenny McCarthy also done in getting autistic kids treated like crap, with stupid treatments like massive doses of EDTA and crazy enemas?

          By misrepresenting autism, she also introduces autistic kids to a world of crap.

          • sdsures

            I shudder to think.

            Isn’t EDTA the stuff that is present in most foods in small amounts, and is also present in vials used to collect blood and other specimens, to aid preservation and prevent clotting of blood samples? What on earth could it have been parrotted as a treatment for autism – I mean, what was the reasoning?

          • Sullivan ThePoop

            EDTA is a chelating agent

          • sdsures

            Which means what?

          • Poogles

            Chelating agents are used to remove heavy metals from the body; there is a myth that vaccines cause autism by loading the body up with heavy metals and thus they need to be removed. Dangerous shit.

          • sdsures

            Ah, yes. Stuff that’s been used as quackery in some unnecessary medical conditions that ends up killing the patient.

        • Anj Fabian

          I’ll give IDEA and ADA more credit than Jenny McCarthy.

        • The Computer Ate My Nym

          I might agree if McCarthy didn’t seem to be advocating euthanasia at times. Her tone strikes me as creepy.

        • LibrarianSarah

          If Jenny McCarthy’s (or autism speaks for that matter) brand of “autism awareness” make things easier for parents, it is at the expense of autistic people. Ironically, “autism awareness” has done nothing but increase the amount of myths and ignorance that the public has about autism. Hell you demonstated your own ignorance about autism by calling it a “disease.”

          Most “autism awareness” campaigns a dehumanize autistic people in the name of “awareness.” Jenny McCarthy herself told the world that autism took her son’s soul. Now as an atheist and a skeptic, I am not a believer in the soul but I do know a lot of the world takes that shit very seriously and it is funny that Jenny used the same language to discribe her son’s “regression into autism” that my mom used to describe my grandmothers regression into brain death. And by “funny” I mean sad and scary.

    • DiomedesV

      Never underestimate the importance of someone — anyone else — to blame.

      Never.

      • Sue

        The reason Wakefield is a darling of the ant–vaxers is that he has given parents struggling with kids who have behavioural or developmental issues an external locus of blame.

        Clever marketing, clever transformation from a low-profile academic surgeon who had patented separate M-M-R vaccines to someone who now purports to be an expert in areas way outside his training and experience.

        People who are desperate for validation don’t want experts to tell them the facts, they want sympathetic people with ”authority” telling them what they want to hear. Sad.

        (meanwhile, organisations like the Austism Science FOundation stand apart – rational parents wanting real answers, not just celebrities).

        • Sullivan ThePoop

          Just today Brian Deer wrote an article about one of the main mothers from wakefield’s study. Apparently they have taken her son who is in his 20s because everything she said about his condition is a lie, exposed him to terrible biomedical treatments, and the judge believes she has Munchausen by proxy.

          • Box of Salt

            STP: Do you have a link?

          • Sara
          • Dr Kitty

            The Septrin hate on that site is interesting.
            Me, I love Co-Trimoxazole.
            It is one of the few antibiotics that won’t kill me (I’m very, very allergic to macrolides, beta lactams and quinolones) and I have zero side effects with it. It was a serendipitous discovery when my Dr decided to go old school to find an antibiotic I could take.

            It is now very, very rarely used in the UK by anyone other than the infectious disease consultants, or for anything other than PCP prophylaxis. I’ve personally never prescribed it.

            Trimethoprim alone though, that is used a LOT.

          • Mishimoo

            I’m loving Silver Sulfadiazine right now. I know the Cochrane review on it wasn’t favourable, but it’s working pretty well for me and it feels lovely when it’s reapplied.

            It’s a bit weird though – I’m allergic to Celebrex (puffy face/breathing difficulties/itchiness), but not to Silvadene and they’re from the same family.

          • Mike Stevens

            celebrex is a NSAID, so not the same group, no.

          • Silvadene worked beautifully on the blisters I had on my arm. It even smells nice.

          • Mishimoo

            Yes! It reminds me of dandelions.

          • It reminds my husband of cold cream.

          • Sullivan ThePoop
  • Guest

    I’m curious how you know that nothing is being done? Are you privy to some information that the rest of the general public is not?

    • attitude devant

      We know this because Dr. Amy has offered real-world help: helping her find a lawyer, being an expert witness, drafting a complaint to the Board of Medicine, and those offers were batted away, simply refused. As the discussions went on, it became abundantly clear that obtaining redress was the last thing on their minds. They just wanted to talk about how awful doctors are.

      But the thing about medicine? When a doctor screws up or is an ass, there are actual true-life consequences that accrue. People lose their license or face prosecution for doing procedures without consent. The same does not hold true in the midwifery world, where accountability is limited to the mother ‘owning her choices.’

    • staceyjw

      LOL, can you even imagine a time when they wouldn’t scream about getting a doc in trouble, from the roof tops? You don’t think that had they complained, it would be something they might have mentioned? Maybe explaining to others how to file c implants, if they found themselves similarly hurt?

      Plus, read what THEY actually wrote. Their VERY OWN statement said that they wouldn’t “witch hunt” the doc. They ask for help, but refuse it when its offered, even if its from someone that would be able to help a lot. They don’t even have the excuse that they have tone quiet for a lawsuit, as releasing that video all over the web negates that possibility.

      I think its pretty clear whats up.

      • Just a statement declaring that the matter had either been subject to a court-decreed settlement, or that the relevant authorities, i.e. the hospital and/or the local medical board, had investigated and appropriate disciplinary action had been taken — no details released — would be useful in clearing up what the heck has happened. Right now, it seems as if nothing has.

    • auntbea

      It’s possible that there was already a settlement and now there is some sort of gag order. But in that case they are lying when they say she hasn’t been able to find redress. And that doctors do what they want without consequence.

      • Young CC Prof

        Is it possible for the mere fact that a settlement happened to be confidential? I mean, aren’t court cases a matter of public record?

        • Houston Mom

          Usually the parties file a pleading asking that the case be dismissed and informing the court that settlement had been reached. Terms of settlement are usually kept private. Court cases are public record, but ease of access and cost vary widely depending on the jurisdiction.

    • Jen Jen

      Actually despite interviewing over 50 lawyers. NO ONE WOULD TAKE THE CASE. So no its not settled and they are currently still trying to file a complaint and case

      • Amy Tuteur, MD

        No one would take the case FOR FREE. Undoubtedly there are many lawyers who would take the case if they were paid.

  • Guest

    Of the possible explanations, I am leaning toward (2) they did file a complaint and the doctor was/will be disciplined. I have a hard time believing (1) because if IB lied about this case and it got out, that would be the undoing of their organization. I don’t like 3 because I have a hard time accepting they don’t care about this case on some emotional level, since Dawn showed up to protest at the Babies by the Sea grand opening. I do believe they are trying to squeeze every last bit of propaganda out of this and have no problem exploiting Kelly’s story to achieve their own goals, which is consistent with omitting successful handling of this case by the MBOC. They would also need to keep the doc’s identity and hospital secret or people would be able to look up this grievance online and find out that the whole campaign is moot. Are there enough details available publicly to try and find out if a complaint was filed?

  • MS

    It’s called Slacktivism.

    • Smoochagator

      Yup! Share this meme on FB and make a difference. Or… not.

  • Trixie

    Dawn showed up in our VBAC Facebook group a few weeks ago and posted a huge “TRIGGER WARNING” followed by the video. She never announced who she was until asked. Keep in mind that Gavin’s mom and other loss moms are in the group. We all denounced the actions in the video, asked how we could help, and whether Dawn would also be willing to work to improve birth for women harmed by OOH midwives. She got defensive, hemmed and hawed, and ultimately left the group because she no longer felt it was a safe space or some such BS. I think Dawn is aware of OOH abuse, but can’t say a thing about it because of her sponsors, who include ICAN, Birth Without Fear, and VBACFacts. http://www.improvingbirth.org/our-sponsors/

    • Amy M

      I have lost track here…who is Dawn?

      • Trixie

        Dawn Thompson is the founder of Improving Birth.

    • Guest

      Dawn also admitted in the VBAC group that she’d had an HBA3C.

      • Trixie

        She shared the birth story — have to find the link again. Large baby,IIRC.

    • no longer drinking the koolaid

      I went on her Improving Birth site when she was asking for stories. I explained that I was a home birth CNM and told her I had several stories about women harmed by home birth midwives. Mentioning that the women who were harmed would be more than happy to share their stories.
      Her reply was that she didn’t think it was appropriate for the stories she was looking for.
      She never did reply to why.

  • attitude devant

    I will say one thing for Dawn: she joined in at the protest of the opening of Babies By the Sea.

    • Karen in SC

      True. And she’s been contacted with information about how to report a bad midwife experience and reportedly will include that soon – she is waiting on a website upgrade.

      No one is holding their breath, but it would be great if IB covered both hospital and out of hospital births on their website.

    • Sally RNC-NIC

      Babies By the Sea? Good grief. I’m gonna have to look into this nonsense.

      • Amazed

        Don’t, unless you are in the mood to see the incredible stupidity and entitlement a Biter supported demonstrated. As usual, they keep it classy.

      • Bombshellrisa

        Yeah, Dr Biter even had a Pinterest board to show all the furniture he designed and how he decorated it.

        • Sally RNC-NIC

          Zoiks!

        • sdsures

          Please tell me you’re joking.

          • Bombshellrisa

            I wish I was joking-if you are on Pinterest just search for it.

          • Samantha06

            Have you seen his You-tube video promoting Babies by the Sea? It’s really eerie.. his manner is so smooth and persuasive.. his demeanor seems genuine and caring and if you didn’t know his background, I could see how people could easily get sucked in.. he’s an excellent con artist for sure…

  • Amy M

    Is “Kelly” aware of any of this? I would hope that if she really wants this addressed, she will contact Dr. Amy or one of the other people offering real help, so can file a complaint to the CA board of medicine, and/or out the doctor, and/or find a lawyer.

    • MaineJen

      That’s what I have been wondering this whole time. How is this woman doing now? And would she accept help if it was offered? I have a hard time believing any of these actually-useful offers of help are being passed on to her. But if the birth truly went down the way the video portrays it, that doctor is absolutely guilty of malpractice and I would think that many lawyers would be willing to take this on. Even if she is of limited means, don’t they do pro bono work?

    • Sue

      Is this ”Kelly”” (totally inappropriate pseudonym for a Latin woman) happy that they fuzzed out faces while leaving her PERINEUM in full view?!

      • Medwife

        Not all Hispanic women are named Maria.

        • Sue

          Point taken.

          Whatever her name, how happy is she with the broadcast of her perineum to the world?

          • Sue

            But just to explain – I wasn’t so much thinking all Hispanic women had stereotypical names as much as Kelly being SO stereotypically angloceltic/Irish in Aus – maybe it’s not in the US.

          • toni

            I attend a church with a lot of Mexican Americans/Puerto Ricans and most do have names like Maria, Sofia, Pedro etc but plenty have names like Teagan, Courtney and Jessica as well. Pretty sure Jennifer is not a Latin name either (as in Jennifer Lopez)

          • attitude devant

            I get it Sue. Given that we know that she’s a Latina, I thought the choice of “Kelly” reeked of HRiC trying to make her more Anglo for their very Anglo audience.

          • Trixie

            Here, it’s not necessarily automatically an Irish name anymore. There were so many Irish immigrants to the US that huge swaths of the population have at least some Irish ancestry, even people who present as non-white. Barack Obama, for example.

        • LovleAnjel

          “Juanita Doe” – except all the Juanitas I know are painfully white.

  • CNM

    These organizations only care about ‘improving birth’ for white women- otherwise they would focus on racial disparities in perinatal mortality, but none of them will touch that with a ten foot pole. To the point where at the last Improving Birth Rally they actually banned black midwives from carrying signs that said black women were more likely to die in childbirth, as it wasn’t on their ‘approved list’ of things a sign could say.

    • Amy M

      How do the black midwives, the ones who were aware of the greater perinatal mortality rate for their ethnicity at the rally, get involved with homebirth? Or were most of them CNMs, and genuinely believed Improving Birth was about improving birth? My impression is that most of the homebirth crowd doesn’t like to acknowledge any perinatal mortality except to confuse it with infant mortality in an attempt to say that US hospitals are dangerous places to a have a baby. Also, how would those midwives (the black ones) take that whole “some babies are meant to die” spiel? The makes the whole thing even more racist, if they are aware of the disparate perinatal mortality rates.

      • moto_librarian

        And isn’t preterm birth a major problem in the African American population that exists across socioeconomic lines? Preterm deliveries are NOT something that can be fixed by home birth.

        • attitude devant

          Ummmm, well, funny you should mention that. I have several times seen homebirth midwives boast about their statistics regarding premature births as if homebirth prevents preterm birth. Pretty hilarious, except from the headache I get from banging my skull on my desk….

          • Young CC Prof

            And they all cite that recent CDC report, which was apparently written by a homebirth sympathizer and may have been deliberately misworded to allow for that particular error. “Lower risk profile” my foot. Try, “Terrible outcomes.”

          • Therese

            They probably think it’s their indepth counseling about nutrition that prevents preterm birth.

        • Actually a major problem is inadequate and inappropriate care in hospital settings is a major problem in the African American Community. I love how white women love talking about black women issues as if they are aware of what happens in our communities. You have to dig deeper than the statistics moto librarian. Are there any black women on this board. Or is it just white women discussing us.

          • Trixie

            Dreah, what do you disagree with moto about, specifically?

          • moto_librarian

            So Dreah, do you think that home birth would improve prematurity among African American women? The midwives who delivered my children do have a clinic in an underserved area of our community with the attention of improving prenatal care and childbirth for that population. They are delivering these women in the hospital, but I think they would be grossly offended by your assertion that they don’t care about what is going on.

          • staceyjw

            I didn’t see her state anything about HB, anywhere.

          • Karen in SC

            That’s true, but she said Moto was absurd for mentioning that there seems to be a prematurity problem in the African American community. This comment was a reply to that. Many more comments have been nested in between.

          • No I said her tone was absurd I was watching her tone when she was commenting on Jocelyn’s blog about 10 reasons why she would never home birth. I didn’t say anything to her there but I noticed that she carries that same tone everywhere she comments.

          • moto_librarian

            What did I do that offended you so much? I am not a mind reader”

          • moto_librarian

            And why bring up a different blog over here? Why not engage with me over there?

          • moto_librarian

            My original question was about how home birth midwives could help African American women when a leading problem is prematurity. Dreah is the one who initiated from there, Stacey.

          • I don’t think the leading problem is truly prematurity. A lot of times when black women attend doctors for prenatal care the ob/gyn’s have the same protocol for all women as if black women bodies and white women bodies are the same. They diagnose our bodies the same and give us the same test as if we are the same which indeed we are not. I think prematurity comes from lack of understanding how the black woman’s body works in a system that is catered to white women.

          • There is a cause and effect to everything.

          • Trixie

            Could you be more specific?

          • Sara

            The existing HPV vaccines don’t seem to be as protective for black women as they are for whites. It’s great that the problem has been recognized, but it comes some 8 years after it was released, and after however many years of development.

            “‘Since African-American women don’t seem to be getting the same subtypes of HPV with the same frequency, the vaccines aren’t helping all women equally,’ said study coauthor Adriana Vidal, PhD, in a press statement. She is also from Duke University.”
            http://www.medscape.com/viewarticle/813365

            So it’s not *necessarily* at the point of care, but the whole process of research and development, and all the data that professionals are relying on isn’t specific to black women unless health concerns unique to black women are intentionally considered.

          • The Computer Ate My Nym

            Would someone please go hit pharma, especially Merck, over the head with a clue by four? How did they miss that?

          • DiomedesV

            Given the expense of conducting clinical trials, it’s not at all surprising that any company that wants to get a drug past that will choose the cheapest route, by having as homogeneous a population to test it on as possible. If that needs to change, then there needs to be a policy shift from the top down.

          • moto_librarian

            So all that I noted was that prematurity is a problem that disproportionately affects African Americans. I did not say that it was the only problem, nor was I trying to be trite about the major disparities in health care faced by WOC. My point is that home birth midwives by definition should not be dealing with premature babies because they are not low-risk. I was not extrapolating to anything beyond that. I want to make that patently clear.

          • Dr Kitty

            Dreah, that is very interesting.
            What treatments or tests should black women be offered instead?
            If they currently don’t exist, then all OBs, of any colour, can do right now is offer what they have, imperfect though it might be.

            I feel that your entire point is that working from the premise that black women require different treatments and tests, that black doctors, nurses and midwives should be working towards finding out what those treatments and tests are.
            Which is a great goal to work towards, I agree with you.
            I disagree with your feeling that there is absolutely no role for non black people to help with that research though, because allies with the necessary knowledge may be helpful, and excluding them because they aren’t black could impede the process.

            Is that what you’re saying?
            Black people need Black HCWs and scientists to research, develop and market tests, medicines and procedures specifically for black people.
            You’d need a lot of Percy Julians.

          • Yes that is what I am saying but it will never be that way

          • I am not dismissing the fact that most black communities have poverty and drug issues but overall we have to dig deeper into what the real problems are. I don’t ever forget that I am a black woman and my body is my body. If someone can take my blood now without even looking at me and be able to tell that I am a black you can not continue to treat all bodies the same of the health code policies that are existing here today in America.

          • moto_librarian

            So do you not want anyone to help? Is it your insinuation that I don’t care about making maternity care better for everyone? That because I’m white I don’t have the right to cite factual information?

          • The problem is the issues are deeper than your research. It’s history our history here. Black women have a history and everything you say is based on something that you looked up or researched but I am a black woman and so is my grandmother, sister, mother and friends, and so on are and I can’t help but to think how white women try to understand the problem just by pulling up numbers and statistics and articles. When we black women live the problem everyday. None of you been to the ghetto I have imagine or have lived in the ghettos. The problem is that the black woman has not been able to get over the harsh history here in American that has marinated in our families. Poverty, equal opportunities, and even education has been a problem for a long time. More black women doctors we need, more black midwives we need. More of us in the health care system is what we need.

          • araikwao

            Hi Dreah, I’m not from the US, so please tell me if I’m speaking out of turn. (I’m from Australia, where we do have plenty of issues arising from the horrific treatment of Australian and Torres Strait Islanders in the past, and all the ongoing implications of generations of abuse and even attempted genocide.)
            Is the answer to have a parallel healthcare system? Is having a MW/doctor/nurse of the same race the only way to receive adequate care? What could be better about the existing system in the meantime?
            (Our government here has some initiatives to help train more ATSI doctors, but of course it’s not as simple as just giving a scholarship to university, unfortunately, and retention rates are not as good as they should be.)

          • When the government is involved that’s when the problem occurs with health care because you are no longer in control of your health the government is. The problem is when the people that are experiencing the horrific treatment are unaware that hey are experiencing genocide right in front of their eyes because normally genocide is covered up by free health care and when people are feeling like they are getting something good but they really are not. So it takes for the people to realize what is going on. That is a problem that occurs in my community. The black women are on welfare and as black women we think that we are making our own decision but in all reality it is the government that is controlling our health and the number of children that survive and die.

          • araikwao

            Crap, I never thought about it from that perspective at all…I really don’t want that to be the case, and I hope it’s not. Are there people involved in health policy advocating for the needs of African-Americans? (surely..)

          • Bombshellrisa

            Not in wide spread ways-the problem isn’t just for the younger African-American women trying to get decent healthcare, it’s for their older women too. Being able to have a real conversation about fibroids and what can be done for them and understanding their treatment options for breast cancer.

          • Aussiedoc

            Hey- just to let you know I’m actually an Australian doctor with aboriginal heritage ;). (although I don’t claim for complicated reasons).

            Most maternity services have an aboriginal midwife who provides antenatal care. In our service, as it happens, I look after most of the aboriginal women (because it’s a small town and you can’t hide your heritage forever). I suspect most small towns have similar arrangement with sympathetic GP OB/OB.

            I hope that helps.

          • Aussiedoc

            Aboriginal should be capitalized. Stupid phone 🙁

          • araikwao

            Wow!! Is having Aboriginal heritage a helpful thing in your role in your community? I’d like to think it could help make antenatal care more accessible for Aboriginal mothers.

          • Aussiedoc

            I’m not sure if it does/doesn’t. To be honest I’m not hugely open about it – and like many Aboriginal people you can’t tell by looking :). I’m very, very white skinned! I suspect I would have ended up doing the bulk of the care anyway – I’m young and female – my town has t had an OB that fills either of those categories before so my heritage wasn’t even mentioned and I already had a full roster of Indigenous patients. Having said that – I do think it helps them trust me – which is the main issue with Aboriginal folk – when the government stole your babies within living memory – why would you go to the hospital?

            Having said that I think there’s a big divide between what I do on the East coast of Australia and the far more poverty stricken NT/WA etc. a lot of what we deal with isn’t Indigenous specific – its socioeconomic – in that I deal with the exact same stories from the non-indigenous patients I see. In those areas it’s a much different story and the only way to fix that is, I really feel, to train more on country docs/nurses. How to do that though? No idea!

          • Who?

            Sorry to lower the tone, but Andrew Bolt will be after you, tedious moron that he is.

            Interesting that NT and WA are poorer than the east coast, considering the mining and general resource activity over there. Perhaps trickle down isn’t working quite so well as our neo-con mates would have us believe?

          • KarenJJ

            It’s not for those on welfare – costs have increased and welfare payments have not kept up. Plus WA and NT are far more remote and have some very remote communities. Getting health care in Darwin, for example, can be very hit and miss. One of my friends living in Darwin had to fly with a detached retina to Sydney to get it fixed. Even mining communities don’t have the facilities for much more than the basics. Many women fly down to Perth to give birth and one of the kids on the hospital ward with a broken leg when my boy was in for a night, was down from Karratha via Flying Doctors (a major regional mining town 2000km north of Perth).

          • Who?

            It’s such a huge country. I was talking to a doctor from a small town in South West Qld, who was responding to a suggestion that they get a helicopter for transfers. They are so far from anything that only a truly amazing helicopter can do the distance from there to Brisbane. Mining companies have them for their own use and make them available for medical emergencies, but otherwise there would be none. Helicopters are better than planes because they can land in more inhospitable spots.

            I guess in mining communities injuries and illnesses are likely to be predictable and either manageable or fatal, so basic is enough. An accidental explosion, rock fall or catastrophic fire, or a bad heart attack, probably won’t produce too many survivors in need of patching up.

            A friend was in Africa (can’t recall which country) working when her son suffered a badly fractured arm. Cape Town or Paris, she was asked. The shortest time to hospital was Paris, and that’s where they went, on a commercial flight. Same issue, but with multiple countries and languages mixed in.

            The horrors of health issues in Aboriginal communities, many of which are extremely remote, continue to be told.

          • KarenJJ

            Mining injuries can be very nasty and messy and unpredictable, but mostly from what I’ve come across (rarely – not in the medical field but I have worked in mining) it is a case of stabilisation locally and then transport to one of the big hospitals in Perth. Helicopters aren’t used due to the distances involved and most mine sites are near aircraft landing sites. The Royal Flying Doctors is a much loved and unique service in Australia but there’s also a lot of commercial flights around WA, with most of the very remote mine sites operating a Fly-In-Fly-Out (FIFO) workforce.

          • Sue

            I was attached to a rural Aboriginal Medicine Service as a student. I am of Italian background, have curly hair, and had tanned skin at the time. I was mistaken for someone’s grand-daughter. I have also been asked if I am Fijian! Go figure.

          • Dr Kitty

            I did an elective in Aus as a medical student.
            Interestingly, the medical and nursing staff was about 30% white Australian, with the rest being Black Zimbabwean, Indian, Burmese, White Zimbabwean, Nepalese, Chinese, Serbian and Russsian.

            The Russian Dr was particularly popular with the Aboriginal patients.

          • Amazed

            Russian? Like, European Russian or Asian Russian?

          • Dr Kitty

            European Russian.
            He was a recovering alcoholic, recommended all his male patients ate pumpkin seeds for their prostate, had spent years working for MSF in various war zones and was somewhat eccentric.

            Some things about Aboriginal culture were unusual for me (no eye contact, no talking about dead people), but once you know about it, you adapt.

            In Ireland we have issues with Traveller healthcare, and it would be lovely to have Traveller nurses and Drs, but as yet we don’t have any (that I know of).
            People can be disadvantaged because of their ethnic group without skin colour being a factor (Travellers look like every other Irish person).

          • Amazed

            Travellers? That’s another word for gypsies, right? Roma people, or I don’t know what the politically correct word is. I certainly don’t mean any offense to anyone.

            Same here. Healthcare is a huge issue. Among others, distrust do play an important part. The two polio cases a few years ago were both unvaccinated Roma children. When the healthcare organs started a campaign for checking the vaccine status and of course, vaccinating, the Roma community in the vicinity agreed and many even brought their children themselves but those who were not too close – many of them refused because they thought we were out to get and hurt them. At the end, everyone got the vaccine (I think) but it was an ordeal all over.

            Mind you, I am only talking about the extreme cases here. There are many others.

          • DiomedesV

            It is by no means certain that Travellers are gypsies. Their origins are disputed.

          • Dr Kitty

            The Travelling people are not ethnically Roma, but they have a similar cultural background of travelling in caravans from place to place as the Roma, and that is why I used “gypsy”, because it is a generic term referring to the traditional lifestyle and culture that most people can understand, even though it isn’t one that Travellers embrace.

            The genetic evidence suggests that Travellers are indigenously Irish, but genetically separate from the settled population for many generations, and are definitely not Roma. To almost everyone Travellers look like just another white Irish person.

            The easiest way to think about it is that there are two types of people identifying as “gypsy”.
            Irish Travellers, who are Irish and Roma, who are probably originally from India, and migrated to Europe a long time ago.

          • Aussiedoc

            I’ve always thought Travellers could be quite analogous to a fairly significant proportion of the Aboriginal community. You wouldn’t know I was unless you asked – but I have specific health issues unique to my community.

          • Dr Kitty

            Irish Travellers are not Roma, but you would understand them to be gypsies. They prefer Traveller or Travelling People.
            They are an indigenous Irish ethnic minority with a traditionally nomadic lifestyle- which worked well when people needed itinerant tinkers and horse traders, and works less well now.

            They marry young, from within their own community and have high rates of illiteracy. They have higher rates of alcohol and drug problems, mental health problems and genetic illness than the average and tend to die earlier too.

            Many still live in caravans on halting sites, some have been settled in houses.

          • Amazed

            Thanks. This is very interesting, I had no idea.

          • The Computer Ate My Nym

            Some things about Aboriginal culture were unusual for me (no eye
            contact, no talking about dead people), but once you know about it, you
            adapt.

            Really? There’s a culture where you don’t have to make eye contact? Do they need oncologists? Are they willing to make allowances for weird foreigners doing crazy things at times? I could work around the “no talking about dead people” thing.

          • KarenJJ

            It was (and probably still is) a cultural conflict in Australia – where amongst those with an anglo-saxon background “looking someone directly in the eye” is meant to show that someone is honest as opposed to looking down or away or not meeting someone’s eye meant to be an admission of guilt.

          • auntbea

            How are they disadvantaged?

          • Dr Kitty

            Firstly, by some of their own cultural practices.
            Travelling makes it hard for kids to go to school. Many Travellers are functionally illiterate.Formal education is not seen as valuable and many Travellers stop going to school altogether from about 12.
            It is difficult to fully participate in society if you can only write your name or read numbers.

            Travellers marry young- typically 16-19. They are devout Catholics and divorce and contraception are frowned on. Traveller women rarely work outside the home after marriage. The work that Travellers do is usually in construction, driveway paving, window cleaning etc.
            It is difficult to fully participate in society if you lack financial stability or independence.

            Travellers are not genetically diverse. There are some Hatfield/McCoy style family feuds reducing the pool of potential spouses further and eligible matches are often cousins. It is a hard lifestyle, and drug and alcohol problems are more common than in the settled community.
            It is difficult to fully participate in society if you are affected by a chronic genetic disease, severe mental illness or alcoholism.

            Secondly, Travellers are disadvantaged by the settled community because of prejudice.

            Maybe you don’t want Travellers doing your driveway because you think they’d do a bad job and disappear before you can get your money back, maybe you think they’re casing your house and will come back to rob you.

            Maybe you won’t host Traveller weddings in your hotel because you think there will be family feud or the bill won’t get paid.

            Maybe you think Travellers are all fiddling their taxes and benefits and are a lot richer than they seem to be.

            Maybe you don’t want a Traveller halting site near your village because you think it’ll lower the tone and your property values.

            Maybe you don’t let your children play with the Traveller kids in their class, because you think they are dirty.

            Irish people, often ones who consider themselves to be open minded, liberal and anti-racist can be blind to their own bigoted views about Travellers.

          • Sue

            There are lots of black Zimbabwean doctors and nurses where I work too – as well as Arabic Moslem, IndoCHinese, Mainland Chinese and many other cultures. We can’t and dont’ want to do health care by color or race – everyone looks after whoever needs it, and essentially everyone accepts care when they need it, with very few exceptions (rare patient discriminating against staff member – not vice versa).

          • Dr Kitty

            Northern Ireland is very homogenous. If I’m out in a restaurant or club and see a group of people at a table of many different ethnicities, they’ll be doctors or nurses on a work night out. The NHS is a melting pot.

            I’ve had interesting (and wrong) assumptions made about my race by patients. There are a significant number of elderly people in West Belfast who think I am either Filipina, Chinese or Indian, based on how often people forgot my name and asked for me as “that wee Asian/Chinese/Indian doctor”.I assume they don’t get out much and have cataracts.

            I had one drunken patient in A&E refuse to be treated by “a chink”. He was escorted from the premises by security after being told that since I was the only doctor on duty he was free to go to another hospital, because nobody would be able to treat him there.

          • Sue

            As an Australian-born person of Italian origin, who once worked in western Canada for six months, I was constantly having to explain to people how I could have Australian nationality and accent with an Italian surname. Migration! Just like in Canada!

          • Bombshellrisa

            I think this was brought up a week or two ago with Jane the NZ midwife, and her comment about “Pacific Women”. There was a paper written by a midwife who was of Pacific heritage and she did suggest the problem was the vast cultural divide and the solution being more midwives of Pacific descent. I am interested myself because while patients are forever trying to figure out what race I am (only one person had ever guessed the right combination), I have to be able to understand the cultures and how best to speak to and treat each patient so I can care for them in a sensitive and professional way. I wish I knew the answer
            (Two friends have grand parents who were of the Stolen Generation. Their life stories need to be written down and remembered)

          • Mishimoo

            At my hospital, there is an A&TSI antenatal clinic run by Indigenous CNMs. I’m not sure about the Ob/Gyn staff, but it’s a pretty multicultural hospital. We also have healthcare centres run for and by A&TSI people popping up in different suburbs, which I think is pretty cool.

          • attitude devant

            Well, Dreah, I’m a white doctor and I care about you. A lot. I do wish you’d stay here and comment more often.
            We actually do have women of color posting here, but I wish we had more. I value what you have to say.

          • I comment when I feel it’s necessary but I find it funny that Black women and babies are being talked about here and there are no black women here to speak on the issue. So I stopped in.
            I have a lot to say and I kind of keep it limited to my blog because people sometimes take things out of context.

          • Amy Tuteur, MD

            There are Black women here as well as many other ethnicities, religions, nationalities and sexual orientations. Just because they don’t feel it necessary to identify their race doesn’t mean they’re not here.

          • We are talking about black women hear doctor not other races.

          • wookie130

            And you assume you’re the only black woman commenting here because…???

          • Guest

            I thought we were talking about the Hispanic woman in the video actually. This goes to my point of all discussions of race being distilled down to black and white as though the rest of us don’t exist.

          • Karen in SC

            It was a few comments as an aside, sharing thoughts about a recent protest. No one is trying to co-op or disavow your experiences.

            Do you propose that any comments about African Americans or Hispanics, or Muslims, or Irish or whatever be prohibited here?

          • Again, we are commenting on this post which is talking about African American women and babies which I AM

          • Karen in SC

            I think we are using a different definition of “post.” I consider all the comments , comments. The post, for me, is written by Dr. Amy.

          • the wingless one

            Isn’t the woman in the video of Latino descent? (Going back to my other comment of anything other than black/white being ignored completely).

          • attitude devant

            Dreah, I follow your blog. I don’t see any place to comment there, so I don’t, but I want you to know that I am following your story. BTW, so happy to see you are pregnant. Did you find a health-care provider you are happy with this time? I hope so.

          • attitude devant

            So, Dreah, why don’t you BE that person? The one who speaks here. Because, while there ARE black women here, no one would have quite your views. And most of us would like to hear your views on healthcare for Black women and babies.

          • My views are based on experience and experience alone. Facts. not statistics. No studies. I don’t have to do studies. A lot of people get their facts about home birth, hospital births, deaths, and so on from articles, studies, doctors, nurses. Just because a person has a degree does not make their ideas and research more creditable than a person like me. But I can assure you that propaganda is alive and we see if everyday. I think that a lot of studies are false. I feel like that numbers are being played with. I feel like doctors always continuously try to make black women seem as though we are not capable of good health for ourselves and our babies. Don’t get me wrong. Black women we have lots of babies. A lot of times babies are born out of wed loc. A lot of times babies are born by different fathers but I notice that the studies always tries to insinuate that we are at the bottom of the food chain when it comes to prenatal health for ourselves and our babies. Abortions clinics are set up all over the ghettos. They advertise on our radio stations all day about planned parenthood, and thrive and all other organizations to get us to kill our babies. This has been going on for a long time. Although many women will argue with me about something specific that I just wrote about these are the facts. We black women are at war with more than just the health system. There is a plan out there to make sure that we do not produce more babies than white women. Hospitals, doctors and etc….try hard to control our population. They try to sterilize us soon as we have birth. I can talk about this all day long because it is real life for me and my fellow sisters.

          • Gozi

            I’m black.

        • White doctors in the hospital don’t care about the care of black women and or our babies neither do white midwives.

          • PrimaryCareDoc

            That is an incredibly unfair generalization.

          • No this is true. As a black woman with many black friends that are also mothers we share stories all the time about our treatment with medical care during pregnancies. Care to argue about that with me?

          • moto_librarian

            So how do we bring attention to this? Why are you posting here if you don’t want to have dialogue?

          • I post where I want. My dialogue is minimal to avoid arguments.
            Your tone is absurd at times.

          • There seems to be a paradox here: you claim white people treat black women badly in maternity services, then you say that white people CAN’T treat black patients properly BECAUSE whites are, ipso facto, not black.

            If that really is the case (which Ido not believe, btw), why should whites even TRY to improve maternity care for blacks since any attempt is doomed to failure?

          • Whites shouldn’t try to improve maternity care for us blacks. We have to take maternity care into our own hands for the sake of our families and further generations.

          • Trixie

            I want to make sure I’m understanding you. My OBGYN is an African-American woman, but she sees patients of all races. Are you saying there should be black-only maternity care?

          • Paradox no. All doctors nurses work under one code. The problem is that everyones body isn’t under that same code. Actually the insurance companies are really the ones in charge. When in search for black doctors etc… I noticed that they don’t want to be seen as a BLACK doctor helping the greater community of blacks under the code which is in best intrest for blacks. Their overseers are the insurance companies and insurance companies don’t care about color. So the black doctors that went to school and were able to experience the privilege of helping others they help everyone instead of helping their communities. They are most of time upity, and don’t want to be singled about by their race as the same as our president now.

            So the problem is that black women are stuck in this continous cycle of western medicine. I’m sure white doctors nurses seem to care but how can you care for black leave the hospital and go back to your neighborhood to never even interact with blacks. I’m confused on what’s so hard to understand.

          • So the problem is that black women are stuck in this continous cycle of western medicine.

            Are you suggesting that only persons of a particular race/ethnicity should treat those of the same race/ethnicity? In what way is “black” medicine different from “western” medicine? Please be precise. Is it inappropriate for me, a Jew, to therefore treat a Native American because I have no personal experience of being a Native American?

            To me, the only reason for noting race or ethnicity in the patient has to do with [1] possible increased risk factors [blacks do have a higher incidence of sickle cell anemia, persons of Mediterranean origin do have a higher incidence of thallesemia than Europeans do] which must be taken into account, or [2] possibly accomodating religious, dietary, or ethnic practices pertinent to the patient.

            IMO, if a black physician has a problem with being identified as a black doctor, that seems to me to be his problem, not that of the patient, except for rare and extreme situations. [As it happens, I belong to a minority group myself, and I do have particular dietary and ritual concerns, but it hasn’t led me to demand that health care practitioners be of my same minority “because they understand me better”]

          • Is your treatment with that Native American going to be the treatment code for Native Americans or will it be the standard code in which you treat everyone. The health care system treats every human body the same. I just don’t get what people are not understanding. What I am saying if your going to treat the person why can it not be treatments for the anatomy of the Native American not a European. We are talking about melanin skin vs non-melanin skin.

            I have been in a lot of heated discussion over the weekend because I am in St. Louis and another teenager has been shot by the police and has died. I commented in a few forums as this one about the shooting and about racism in St. Louis and do you know how many white people told me to go back to Africa.

            So lets take that racial slur for an example. For someone to say go back to Africa they are insinuating that my people are not from this land. They mean pack your stuff up and go back to Africa we don’t want you here.

            So if blacks came from Africa as slaves to work in America when they brought us over here did they bring our food? Did they bring our herbs? Did they bring our climate which is full of Vitamin D for the melanin skin? Did they bring our medicine our methods of healing in that land? No we just got stuck with western medicine and our bodies have been forced to adapt to a culture that is not ours. So the effects to this is being put on the top of every list when it comes to disease as if there is no reason why.

          • Sue

            Ms Louis says

            “So the black doctors that went to school and were able to experience the privilege of helping others they help everyone instead of helping their communities. They are most of time upity, and don’t want to be singled about by their race as the same as our president now.”

            What obligation does any individual have to dedicate their lives to helping only those within their birth community? This isn’t ‘upity’ – it’s having an equal right with all one’s colleagues to choose a course in life.

          • See your using the word individual and I am talking about treatment under health care code. I have decided over years that black women don’t experience great treatment in health care and it could be the reason for high infant mortality rates. That is my opinion. An obligation is based on standards presented before a person based on that persons reality. Please read in between the lines.

          • moto_librarian

            My tone is “absurd?” I find it absurd that you are complaining about the posters on this blog, and then when we ask how to help, you tell us that we can’t.

          • I’m not complaining about any posters just stating my OPINION as a black woman.

          • staceyjw

            Thank you for your contribution. I also follow your blog.

          • 🙂

            Thank you for following my blog there is so much info on it

          • Karen in SC

            Is it one hospital in particular? Or the system in the greater St. Louis area (or St. Charles area)? I believe that it happened, and hope you can group together and get some changes made.

          • Karen in SC

            Here in South Carolina, there are high rates of high blood pressure, type 2 diabetes and obesity that probably play into poor outcomes in the African American community as well. Many organizations here are working to bring attention to those conditions. (and treatment)

          • The Computer Ate My Nym

            But why do diabetes and hypertension occur so frequently and so often in minorities? Higher stress hormone levels elevate both blood sugar and blood pressure. I would at least hypothesize that prejudice contributes to the rates of HTN and DM in the black population and that part of improving public health is reducing racism and inequality.

          • Gozi

            It is like you are reading my mind…

          • It first starts with the prenatal care that we receive from the OB’s. The care that we receive when you don’t have the best insurance and being black is horrible combined not to forget to mention the treatment we get when we enter a hospital for birth. Black women for years have been battling this because the health care system is ran by non black people and in order to completely care about a black woman and her baby I feel you have to be a black man or woman helping the cause. A lot of times white people say they care about black women and babies but how do you care if you can not relate to a black women and child and their community.

          • KeeperOfTheBooks

            I’m not a doctor, but I was an educator for some time. A majority of my students were African-American, which I am not. I cared about them because they were human beings, just as I am. Period. That we had different backgrounds and experiences was an important consideration in how we related to and communicated with one another, but it didn’t mean I didn’t care about them, just that I had a lot to learn. If I saw someone struggling to read, I didn’t care if they were white, black, Hispanic, or Vietnamese. I cared that this was another human being having difficulty with a life skill, and I wanted to offer that person what help I could to master that life skill.
            Sure, I didn’t know what it was like to have to pay a coyote to bring me and my children across the border. I didn’t know what it was like to grow up as an African-American woman in the ghetto and, being fifty years old and having raised my kids, decide to finally go back to school to achieve a dream of being a teacher. None of that stopped me from wanting to help other human beings succeed in their chosen fields.
            I imagine the same is true in the case of a good doctor, regardless of race, who has a patient who needs care.

          • TsuDhoNimh

            “in order to completely care about a black woman and her baby I feel you have to be a black man or woman helping the cause”

            Don’t you DARE impugn my humanity by telling me that my skin color or that of my ancestors makes it impossible for me to truly give a damn about others.

            When did compassion come with color-coding?

            If you really feel that way, get off your butt and go to med school, become a nurse, or go into hospital management … because as a certain black radical may have said, “If you’re not part of the solution, you’re part of the problem.”

          • staceyjw

            What a shitty attitude^ (TDN), nice way to show your true colors and ignore the vast amount of racism out there.

            Of course a WOC would like to be cared for by another WOC! Just as many women would like to be cared for by another women. Just because you do not care, does not mean others don’t, or that others cannot feel this way. And having our own space that excludes our oppressors (whites for WOC, and men for women) is VITAL to our mental health.

            Whites can be ALLIES, (just like men can be allies to feminists), we can help to inform other whites, but we can never take the place of a strong black community.

          • the wingless one

            Just chiming in to say that as an Asian-American (woman, in case it matters since we’re playing this identity politics game) it gets really old how all discussions of race turn into a black/white thing. I guess the rest of us “colors” matter even less.

          • staceyjw

            What a shitty attitude there TDN!

            Dreah is right.

            *I cannot speak for the experience of black women*
            But I can say that what she says IS TRUE. Anyone with eyes and ears can see that WOC are treated much worse than whites in the USA. Why would maternity care be any different?

            I have heard about the bad care by listening to WOC speak about it, and have seen it happen to women that I know personally. Just looking at the stats, and sociological studies, can inform whites (and others) about this widespread mistreatment (at the hands of mostly whites), even though we cannot grasp how it feels.

            White people, even myself, can never understand the struggles that WOC go through. We should shut up and listen! As a women, I feel this way about men- they cannot ever fully understand what we go through. They cannot see through our eyes or live our lives. They can be good allies to us, but they can never represent us. The same goes for whites.

          • moto_librarian

            I know that institutional and structural racism exist. I also realize that I cannot ever truly understand what it is like to live under it. But I do very much want to help reverse this and make it better. I get the impression that Dreah does not want anyone who is not a WOC to participate in any efforts to improve the status quo, and that bothers me. I don’t feel like she is even interested in white women being allies.

          • AlisonCummins

            I think Dreah doesn’t want white women speaking for her, telling her what her concerns are or using her for political purposes.

            Which I think is completely fair.

            At a guess, Dreah probably also doesn’t want to deal with white women who accuse her of having problems or of being unrealistic or unfair when she talks about racism.

            Speaking completely out of my ass, Dreah might not appreciate white women changing the subject to what bothers them when she brings up the subject of racism.

            I’m a white woman so I’ve probably got the emphasis wrong. If Dreah responds angrily to me I probably deserve it.

          • What funny that you say this because so many women link my blog to prove their cases when they speak about home birth politics and don’t include me on the conversation as if I’m not qualified enough to speak about it. Everyone runs from racism. People want to act as if it doesn’t exist but it is alive in the flesh.

          • moto_librarian

            I agree with that. I certainly did not intend to make it look like I am speaking for WOC. I was simply noting that I failed to see what the home birth movement could possibly help to end high rates of prematurity.

          • Sue

            Is there only black and white? (literally and metaphorically?). What happened to the other continents?

          • Guesteleh

            Get over yourself. Nobody is impugning your humanity and even if Dreah was, you have no idea what she’s been through and what all black women go through in this country every day. Show a little humility. Open your mind to a different point of view. Let your privilege slip for a moment.

          • Sara

            Is it the race of individual providers that you are concerned about specifically, or the racism of the system as a whole that influences the care regardless of who your provider is?

            I ask because my ob/gyn’s have been black women about half of the time. My current OB is a black woman. As a white woman myself, I have never felt any difference in the care that I get from different providers based on their race or gender, but maybe I’m just clueless because of what I *don’t* see.

            I know the stats about racial disparities in maternity care, but not sure how that plays out in places where providers actually are of the same race as their patients.

          • I had a black woman ob/gyn. I had all my visits with her. When I went into labor she wasn’t available and her partner delivered my son(she was a white woman) but the black woman ob show up at the hospital the next day with papers for me to sign to come to her office to have my tubes tied.

            Sometimes I noticed educated black doctors are the worst because they have something to prove to their powerful white overseers .

          • Sara

            I’m sorry that happened to you.

            Not long ago a politician in Louisiana proposed payments to women on welfare who would get sterilized. Thankfully there was a public outcry. It didn’t pass but it’s disgusting that a bill like that could even make it into the legal system given this country’s history with forced sterilization. Some of it, I think, is plain ignorance more than cruel intent, but as you point out many black women are harmed in the process either way. There’s the frequent use (by politicians) of terms like “medicaid moms” and “welfare recipients” that have obvious, racially charged meanings behind them. It’s nasty.

            Outsiders shrug it off as a problem of the Deep South. Yes, that’s part of it, but I know it’s not just here.

          • This is major reason behind why a lot of black women are late in prenatal care, which statistics say is linked to high infant mortality rates. Black women have a history in America with the health care system and people will say that is sad excuse but. I remember listing to my great grandmothers who were share croppers and they would say that black women would go into the hospital to have babies and never come out. The black men would go into the hospital with a cold and never come back out. The stigma is still solid in the genetic membrane of blacks and hospitals do leave a bit of a sour taste and black mouth so when people always try to come with the statistics. I say its deeper than that. Its deeper than the research. It’s the history.

          • Young CC Prof

            So you believe that the problem of delayed prenatal care for black women (and possibly other disenfranchised groups) may have much to do with fear of the medical system rather than just lack of access.

            Interesting. What do you think could be done to change this?

          • exactly

          • attitude devant

            When I was interning in Philadelphia our Black mothers wouldn’t have epidurals because of a widely held belief that epidurals would be purposefully done wrong to cripple them. Horrible, no? How awful to grow up in such an atmosphere of distrust.

          • Amazed

            At least we know that they wouldn’t die without epidurals. Most likely. But here, in addition to our very own anti-vaxxer loonies, we have a large body of gypsies and many of them are convinced that vaccines are a huge conspiracy on our part to make them infertile. Their proof? There are gypsy women who were vaccinated. Some of them are infertile. See? It all fits.

            They’re exposing their children to a very real risk without even knowing it.

          • Sara

            Well, it doesn’t help that conspiracy theorists use legitimate history to prop up unfounded conspiracies. Take the “CDC whistleblower” thing recently where Wakefield and his anti-vaccine friends tried to say that the CDC is covering up MMR-autism link with black boys, and that it’s just like the Tuskegee Syphyllis experiments. Well, anyone who knows that history and is even a bit leery of vaccines is a target for this kind of misinformation campaign.

            Same thing happened when CIA really did use a public health campaign in Pakistan to find Bin Laden. It gives credence to unrelated, fabricated claims that western health workers have ulterior motives, and then polio workers are murdered.

          • Amazed

            But they don’t know. Unfortunately, gypsies here are the most uneducated part of society. They are just vulnerable to another kind of rhetoric. I don’t know what it’s called. It isn’t racism because we belong to the same race. But it’s basically the same.

          • AlisonCummins

            Yes. Horrible. And after Ferguson (etc etc etc) it’s not as though anyone can think that distrust of the system is irrational.

          • At one point in time I thought home birth was the answer but I ended up with a midwife that treated me horrible.

          • RNMomma

            So what can anyone do about it? Please help me out… Honestly, I’m not trying to be sarcastic. What I’m hearing from you though is that white providers can’t help because they can’t truly understand so they can’t truly care for black patients. But black providers aren’t better because they have something to prove.

            I agree that I will never be able to understand the long suffering and awful treatment that black women (and men and children) have endured and still endure. That doesn’t mean that I am unable to provide compassionate care. With risk of someone chastising me for this statement, I believe that the history and stigma you talk about, while valid, doesn’t help the situation. I have seen this working in my field… black patients tend to be far more worried about not receiving proper care (again, there is good reason for them to feel this way), than non black patients (including Hispanic patients). Most, when treated compassionately and as an equal (i.e. not spoken to like they are uneducated) let down their defensiveness. A few, however, will continue to refuse to believe that they are getting the same care as every one else, even if they are, because of the history you wrote about.

            I’m not saying that every provider and hospital treat black patients as they should. I’m not even saying that most do. I just don’t understand what else I am supposed to do as a care provider, if I can’t actually care about my patients because I’m not black.

          • RNMomma

            Rereading my reply sounds a lot more harsh than I intended it. I’m not sure how to rephrase things though. It’s an incredibly complex situation that I have minimal insight into. It’s just counter productive to say that white providers can’t care because we can’t understand. But since white providers aren’t ever going to be able to understand, and if black patients interpret this as not being able to care, how can we (black and white) ever find our way out of this awful mess?

          • Wishful

            I am sorry, but it sounds like you were pretty biased against your care provider before you stepped into their office. White providers cannot care and black providers have white overseers. That statement is insulting to providers of all races.

            I understand the history, my grandparents were both sharecroppers. My mother was in school under Jim Crow. I just don’t happen to agree with your massive conspiracy theory as the cause of all racial disparities in health care.

          • Its fine that you don’t agree. I don’t write for people to agree with me. I write from experience and what I see around me. No conspiracy theory. That’s the problem people always want to shout conspiracy theory when someone says something different then what everyone says or sees. Your experience is yours. Your opoinion is yours and mine is mine. I can say whatever I feel is necessary to say. I can care less if you agree or not.

          • Wishful

            Yeah, but the thing is you are not saying that this is just your experience. You are (maybe not intentionally) seeming to assert that this is the experience of all WOC. You aren’t saying, “in my area/neighborhood WOC have been having this problem” you are claiming its in the genetic membrane of WOC. That seems to be overstepping boundaries don’t you think?

            Look I realize that this is most likely a generation divide, I would wager I am a good deal younger then you and I noticed that younger WOC at least where I am at as a general rule care less about racial issues, and more about economic ones. Having grown up in an area were gun fire in the night was just a thing that happened, I feel no safer around people my own color then I do around people some other color. I just want to not live in a ghetto, it was an unpleasant place to live and the color didn’t make it better or worse.

          • HiI’m 28 I would consider myself a young woc but to be honest with you what you stated is your reality. If you want to debate about my pov that’s fine people do that on here everyday. My view is based on experience of genocide here in America. Black babies are not just dying for no reason. People always want to point to the mother. Its bigger than that. When I say white overseerers its true white men and women run everything. So how can one be offended its true. Your boss is probaly white, the head doctor in charge is probaly white. Its true. I been close ties with NARM the president is white the midwives in charge of accountability are white and so on. People get so touchy when reality is pointed out and I always find that a woc always wants disagree more than white women on an issue as serious as racial disparity in America. Its sad but real

          • RNMomma

            What genocide? Genocide is “the deliberate killing of a large group of people, especially those of a particular ethnic group or nation.” Racism in the US has been unbelievably horrible and continues to cause a plethora of issues, but while I’m sure that the death of all black people is on the agenda for a select few, it is not the intention of the majority, not even care providers who may treat WOC poorly.

            You share your point of view but make sweeping generalizations such as white providers don’t care about the care of WOC. Perhaps being more specific in your opinions would make for more more constructive conversation? Now that I think more about it, did you mean they don’t care because they don’t treat all patients the same? Or did you mean they don’t care because if they did they would be holding up the banner constantly for WOC?

          • I know what genocide means. I said in the content in which it was meant. Planned parenthood I would consider a part of the health industry and right now they are set up in my community everywhere advertising on the radio. They have buses located on the grocery store parking lots in parks and so on to get young black mother to abort their babies. Not just std assessments are going on here black babies are being killed in alarming numbers and white people are paying for this to happen. In hospitals and so on sterilization is still happening without consent which is considered Genocide. I quiet genocide but still genocide. Please stop acting like your not understanding what I am saying. I am being very clear. You and others are picking at my words as if I am not educated enough to speak on the matter. Many women here are talking about the lady in video was Latino why are we even talking about black women and babies? When I read the article I saw other wise. Genocide is going on black babies are dying and bringing awareness to it brings a sour taste to white women’s mouth as if white babies are more valuable and more important. Talking about race is ugly. And people don’t want to talk about it but please don’t play with my intelligence of the subject matter at hand. You felt like you needed to display the definition of genocide like I was using a word that I had no idea what it meant.

          • Dr Kitty

            Dreah,
            Planned Parenthood are offering those ladies a service that they want.
            Poor women may be less able to raise a child and more likely to choose an abortion, and black women may be more likely to be poor, but I don’t think PP is actually engaging in genocide.
            To prevent black women having abortions, surely the solution is to enable them to feel able to raise their children, rather than preventing access to wanted abortions. If the system is not in place to enable these women to feel able to carry a pregnancy to term, then abortion is the solution until the system changes. Forced birth is not a solution.

            Your use of the word “genocide” to describe PP is hyperbolic, and does your argument no favours.

          • look….
            are they advertising planned parenthood on your radio station that you listen to?
            We all know about advertisement and the agenda with and why they advertise. Abortion is not the answer to a young mother who does not know what to. Come on now

          • Wishful

            Yes! They are advertising Planned Parenthood on the stations I listen to. They are making that an available choice for me to make or not make as I see fit. They are not however grabbing pregnant women off the street and aborting their babies against their will. I am not even for abortion and that sounds like crossing the line into demonizing things. I might agree that abortion is not the solution, but obviously some people feel differently and as long as the law of the land says they can then that is their choice to make. You cannot blame Planned Parenthood for their choice anymore then you get to blame Ford for you not walking more

          • The Computer Ate My Nym

            are they advertising planned parenthood on your radio station that you listen to?

            Yes. And at risk of losing all respect anyone here may have for me, I sometimes listen to country music.

            Abortion is not the answer to a young mother who does not know what to.

            Abortion is the answer for a young (or middle aged) woman who is pregnant and does not want to become a mother or become a mother again.

          • Dr Kitty

            No actually, I’m in Northern Ireland, and I wish they did.
            I wish my patients didn’t have to make expensive journeys to the UK, Belgium and Scandinavia to access abortion.
            Improving access improves access. It does not create a demand where one did not exist before, and this is a demand which SHOULD be met.

          • Bombshellrisa

            “are they advertising planned parenthood on your radio station that you listen to?”
            Yes, and I live in a mostly white (I am one of three persons of color in my neighborhood) area where most everyone is religious (the bishop of one of the churches lives next door to us), families with six kids are pretty common and there are a lot of SAHMs.

          • The Bofa, Being of the Sofa

            Considering that PP provides much, much more than just abortions, is it even the case that these busloads of women being rounded up and shipped to PP are doing it just for abortions?

            Is that really what they are advertising? Abortions? Or are they advertising PP services?

          • Dr. Kitty you see how your response was not something I would think any woman would say. Abortion should be for rape victims, molested women.

            “Poor women may be less able to raise a child and more likely to choose an abortion”

            Why not adoption? Why educate poor, minority women to kill her baby. That’s sad that doctors feel that is a valid option for a woman, poor minority women.

            Planned parenthood has been engaging in genocide with black woman for as long as Margaret Sanger, in the eugenics time. Please don’t act like planned parenthood umbrella is not fully sponsored by research and abortions.

            The system will not change.
            Birth is the law of nature anything different from that has been implemented by other motives.

          • Dr Kitty

            It is my opinion that while abortion remains physically safer for a woman than carrying a pregnancy to term and if the woman herself feels that it is a better option for her than adoption, that it should be up to her what to choose.

            I think it is sad that not everyone feels able to continue their pregnancies, but that does not give me a right to decide that I know what is best for them and substitute my judgement for theirs.

            Dreah, it puzzles me why you can’t see the contradiction here.
            You want black women to be empowered to make their own choices, except when you don’t approve of their choice.

          • Stacy48918

            I know that even my 12 week miscarriage/D&C was much less physically demanding/traumatic than carrying my other children to term and giving birth. Forcing a woman to carry a baby she doesn’t want just because you disapprove…how does that help anyone involved?

          • Dr. Kitty nice chatting with you

          • Dr Kitty

            You too Dreah, no snark intended.
            You are obviously an idealist who has admirable goals and is very frustrated by the process of trying to attain them without compromising your principles.

            Where you and I disagree, fundamentally, I think, is not about race or different opinions about abortion. I’m pretty sure the essential difference between us is about pragmatism vs idealism.

            I hope you understand that I really value your opinions, even if I can’t agree with you.

          • Siri

            Abortion is for any woman who wants one, regardless of age, status, reasons or circumstances. Always and everywhere.

          • Amy Tuteur, MD

            In other words, you are anti-choice. Why don’t you just say so instead of pretending it has anything to do with racism?

          • RNMomma

            Okay, I wasn’t trying to insult you with the definition thing. I’m sorry about that. We weren’t talking specifically about abortion, so I was confused. I have a HUGE issue with abortion providers being touted as this great thing for women’s health care when situations such as what you are referring to are happening. I don’t personally believe it is an issue of genocide though so much as an issue of classism (obviously minorities are a majority in lower socio economic classes). I may be very wrong, but I would be surprised if the same things didn’t happen to poor whit women and their babies.

          • auntbea

            And it isn’t *possible* that providers are trying to provide a desired service in a place that lacks it? Do you have evidence that women are having abortions they don’t actually want? Or are they pethaps relieved to have the option?

          • Medwife

            That is nuts. “Planned Parenthood is out to kill black babies” is tinfoil hat talk. Like it or not a woman, any woman, in this country can choose whether or not she wants to continue a pregnancy. Providing the service is not genocide. No one is forcing anyone in those doors at gunpoint.

          • Any woman can choose whether or not she wants to continue a pregnancy in this country your right but some get pushed a little more than others by the right organizations. I’ve done many research papers on Planned Parenthood Eugenic so you can not tell me otherwise. Also have lived in the inner city for some time now and I know what the job of these organizations are.
            Sorry

          • Medwife

            I could do a research paper about how the moon landing was faked. It wouldn’t make it true.

          • Whatever you say Im about tired of the conversation. Didn’t want to be rude so I responded.
            Thanks

          • Sullivan ThePoop

            Not to get poor black women to abort their babies. What is wrong with you? They do it to get women healthcare. You know like pap smears.

          • guest

            “In hospitals and so on sterilization is still happening without consent”
            Can you provide specifics regarding this? I’ve worked in many hospitals over many years and have never seen a forced sterilization. On the contrary, I’ve seen doctors refuse to perform sterilization if the patient was still in her early 20’s. Where exactly is this happening? Thanks.

          • White nurses and doctors say “we care” “we care about everyone” Im like……how do you care about people that you don’t even interact with on a daily basis. Where I live at I see black people only were not shopping together, were not having lunch together, your not coming to my house for dinner. Come on. But you care. You care because your job entitles you to care but when clock out at the end of the day you go to your neighborhood and you live. How do you really deeply care for a race of people that you can not physically, mentally, socially, economically relate to? It sounds good to say. But when that black mother comes into the hospital to deliver with her welfare insurance do you think that the hospital really cares are they going to give her the off brand pain medicine are does she get the name brand medicine that the white women gets in the room next to her with the A 1 insurance. We she be treating the same as the white women with dual private insurance.

            I think not!

          • The Computer Ate My Nym

            I agree with your overall point about discrimination, but the hospital only has one formulary and all patients get the same generic (“off brand”) drug, regardless of race. What may vary by race is how promptly they get any drug or other treatment when they complain about one problem or another.

          • RNMomma

            I can’t speak for any hospital but my own. I can guarantee at my hospital, everyone got what they needed regardless of insurance. We didn’t carry off brand drugs for Medicaid patients and brand meds for the privately insured. Doctors and nurses actually would have to go to a completely different part of the chart to know what insurance a patient had. The only person on our unit who knew that info off hand was the case manager, because she was busy working her butt off to get patients what they would need when they went home. Medicaid is the issue here (and therefore, politicians), not the doctors or hospital. But that’s a non profit hospital. I’m sure it is different in many hospitals and the same in others. People are out there providing good care though, not because our job entitles us to, but because it’s the right thing to do. As you stated, lots of providers out there don’t care and we all have the same job.
            And yes, I agree that many white providers can’t completely relate to those they don’t have much in common with. That’s the case with anyone though and any situation. I may not feel completely understood by someone if they didn’t lose a parent at a young age, but that doesn’t mean I dismiss a person as not caring. I would be angry if they told me they understood, but they can still care. And yes, it does put me at a disadvantage when caring for patients when I can’t relate to their life, but I can choose to believe people when they say it is unimaginably hard and treat them compassionately. What more would you like white providers to do? And why should I keep doing that when you tell me it isn’t enough? (Because it’s the right thing to do.) If you are waiting for everyone to have the same background as you in order to acknowledge that there are some pockets in healthcare where people are treated equally in the care they receive, then you are going to wait a very long time, because we are not ever going to have the same history. Nobody can change history, as much as I wish it were different.
            And I actually have never known or interacted with a single one of my patients prior to caring for them in the hospital. Knowing them does make a difference though, “frequent fliers” are cared for on a much more personal level, as much as ethically allowed. I would still never assume to “know” any of them well though because I don’t do life with them. If I did come across a patient I knew personally, I would be reassigned, because HIPAA.
            Finally, if I met you and you invited me over, I’d come. Would you invite me over though?

          • Sue

            ”How do you really deeply care for a race of people that you can not physically, mentally, socially, economically and spiritually relate relate to?”

            I work with people of all ages, many racial and national backgrounds, various religions, atheists, criminals….I see grandparents, drug addicts, veiled Moslem women, newborn babies, the acutely psychotic, the highly anxious, people addicted to cigarette smoking, Africans, Fijian Indians, Arabic people, Koreans, mainland Chinese, Vietnamese… I don’t have the lived experience of any of those people, but I can still care for them as individuals.

          • KarenJJ

            I’m happy to get good professional care from compassionate people. I don’t particularly need for them to care deeply about me. It would feel a bit odd.

          • AlisonCummins

            Presumably it matters to you that they value your worth as a human being. Presumably you regularly get confirmation that your worth as a human being is recognized, several times a day by people of all origins.

            When I was visiting a city with a large first nations population, I was asked for help by first nations people much more often than I would have expected by chance. I realized that they would be standing as crowds of white people walked by but I was the only one who would see them so they could catch my eye. Horrible.

          • Caring for them and giving them the best treatments for their body is to different things. Okay you care but would you risk loosing your job if you found out that the person you were working for was doing something wicked? Unethical? Something imaginable? Something that does not go with your morals and values as a person.

            What if ran across some documents at your workplace? The documents were patients that you knew. What if you read something in the documents that you weren’t suppose to. Something that your patients didn’t know. These are the notes of your director or whoever is over you. Anyways you notice that client is being compromised but they have no idea. Would you tell them?

          • Dr Kitty

            Dreah, you really think that Sue, or anyone else, would, upon discovering such wrongdoing only report it if the victims were the same race as us?

          • Most of the time white people talk about welfare moms and how black women need to stop having children get off their ass go get a job. Black women are wasting our tax dollars and now that we are on this forum people want to act like there is no stereotype that has been implemented about black women and their children

          • The Computer Ate My Nym

            Eh, I may or may not count as “white”, but as far as I’m concerned, have as many kids as you* want. Support them with welfare if that’s what you want and/or all you can get. It’s no skin off my nose and barely any money off my taxes. I’m concerned about the amount of tax money that goes to the Pentagon or to “too big to fail” companies, but I really couldn’t care less about whether women on welfare have one child, two children, or 20 children. Up to them.

            *Generic “you” not Dreah Louis in particular.

          • RNMomma

            Yes, that may be the case with many people, but not every person. And certainly not my experience where I worked. We were typically only critical of people on the rare occasion of doing something like selling their kids medical equipment for drug money (that was a white family, if you are wondering). I couldn’t care less how many kids most people want to have, as long as they care about their kids.

          • AlisonCummins

            RNMomma,

            I know you know that large african-american and latina families are regarded as socially pathological in a way that large white or asian families like the Duggars and Gosselins are not. You may even have heard the phrase, “those people breed like rabbits.”

            The major public health challenges in reproductive health care for african-american women and latinas are commonly understood to be education and access to contraception and abortion. Not support for goals of having large, healthy families.

            I’ve heard very neutral discussion on this blog of women who, for religious (christian fundamentalist) reasons have a goal of raising very large families. This is accepted to be their choice and they are accepted as fully deserving of having their choice supported.

            The discourse of many of the fundamentalist christan

          • AlisonCummins

            … the discourse of many of the fundamentalist christian groups promoting very large families is explicitly racist. The goal is to protect the white, christian nature of the US by countering “those people” breeding like rabbits with large, white, christian families. White, christian children may be referred to as arrows in a man’s quiver, weapons in the fight against godlessness and PoC.

            Obviously you don’t believe any of these things and they aren’t the dominant discourse. But the Duggars and the Gosselins *do* get their own TV shows, and helping young african-african americans and latinas/os delay parenthood *is* considered to be a good thing.

            We can quibble over whether genocide is the appropriate word, but if Dreah’s experience is that african-american children are not valued, if you look at the executions

          • AlisonCummins

            … the widely publicized unpunished executions of young african-american men (latterly in Ferguson), the abysmal state of many public schools… I think it’s more relevant to listen to an african-american woman describe her experience of being an african-american mother in the US today than to change the subject to word choice.

          • RNMomma

            I definitely agree it’s relevant to listen to black opinion. Theirs is highly valid and change will only happen if they are consistently listened to. I also agree that their are some pervasive stereotypes that are extremely unfair. However, I will not agree that the best response though is to nod my head in agreement when someone appears to believe that no body is doing the right thing, or more specifically that no one is providing good care because of racism. That is simply not accurate. Arguing against that doesn’t mean I think everything is fine the way it is.

          • LovleAnjel

            Let’s not forget that this country was founded on the genocide of both its original inhabitants and the slave labor imported from across the Atlantic. Ending slavery did not rid us of the attitudes or effects of that genocide (it took over 100 years just to come to a slow creep), anymore than the end of WWII stopped anti-semitism and violent anti-semitic actions.

          • Sullivan ThePoop

            Things are changing and there is no genocide. Our president, you know the person in charge of the entire nation is black oh and so is my boss the dean of sciences at my university.

          • toni

            Wait what… your son was only your second child, right?

          • Yes

          • Sara

            Which # child is it appropriate to ask a woman to sign her consent for an unrequested tubal ligation?

          • exactly

          • toni

            Well usually they ask you after the forth, maybe third. They asked my mum after her forth. She sure as shit didn’t request one as she’s a devout catholic. She’s not black or white btw. She was only mildly offended though as she knows they ask most women when they’ve had a few babies in quick succession

          • Sara

            I could see a “do you want to schedule a date for this procedure?” but just saying “I have the papers for you to sign for your surgery [that you didn’t ask for]” is crazy.

            Maybe not so much offensive as just appalling.

          • toni

            Idk, from what I’ve heard doctors can be pretty pushy about it with everyone. They definitely upped the pressure on my mother during her fifth pregnancy. And I know a lady who was asked *during* her caesarean if she wanted them to tie her tubes ‘while we’re in there’. That was her third baby. This was in the UK though. So I don’t think it’s that unusual for doctors to be insensitive about it. But for them to bring in the papers after just two babies is super creepy

          • Medwife

            Interesting. Where I live we have a large Hmong population. Grand multips in their late 20s and early 30s are common, as are women having babies (and miscarriages) into their 40s. If we started pushing sterilization at them, bye-bye, patients. They’d be having none of it.

          • Medwife

            It’s weird and inappropriate. The correct question is, Do you plan on having more kids? Want to talk about your options for contraception? And the time is NOT as the baby is exiting her body.

          • The Bofa, Being of the Sofa

            With my sister, it was when she was pregnant with her third.

          • Rachele Willoughby

            They asked me every time in case of a c-section but this doesn’t sound the same at all.

          • The Computer Ate My Nym

            Um…the one where you’ve asked her “have you thought about your birth control options” and, after a discussion of the options including but not unduly emphasizing tubal ligation, she decides on tubal ligation?

            The only situation where I can see recommending or even pushing tubal ligation is if the woman is at severe risk of dying in a future pregnancy. Forcing is NEVER right, but a statement like “You nearly died in this pregnancy and you’d likely die if you tried again. Your safest route is tubal ligation.” might sometimes be.

          • DiomedesV

            The only woman I know who was offered tubal ligation was an alcoholic who had a tendency to have children with FAS that she couldn’t support. I certainly wish she had agreed before her sixth kid.

          • The Computer Ate My Nym

            Black doctors, nurses, etc right now are the ones who could survive the process of becoming doctors, nurses, etc in the current sociopolitical climate. So I fear that you’re right. However, I hope that if there was proportional representation or minorities were slightly over represented (i.e. about 15% of doctors were black, 10-15% hispanic, 5% Asian, etc) then there might be a substantial change in the climate and basic assumptions of the medical field. If only every attempt to improve minority representation in medicine weren’t met with hysterical resistence and gaslighting of potential candidates we might get somewhere.

          • Sue

            Professionals who come from families in minority groups don’t have any automatic obligation to work only for their own communities. They shouldn’t have any additional obligation to be martyrs for any particular cause than the rest of us, and every right to be as variable in approach and personality as the rest of us, within the expectations of professional competence and behaviour.

          • Aussiedoc

            Exactly. Everyone keeps asking me why I’m not in a remote Aboriginal community. Because I don’t want to. Why aren’t you?

          • Mishimoo

            My little sister is hoping to teach in one when she graduates, but that’s where her heart has been since she was in highschool.

          • The Computer Ate My Nym

            I agree. It wouldn’t work anyway–if you’re only doing medicine to martyr yourself you won’t do it particularly well. I’m just trying to make sense of the data that suggest that minorities and women are no better at taking the complaints of minorities and women seriously than white men are. I think it’s partly the way that people are trained and that’s still white male culture. Also, in my experience at least, there is still a huge amount of prejudice against minorities and women within the medical system. It’s extremely tempting to be “one of the (white) boys” and treat, say, complaints of pain from Hispanic women as being due to another “hysterical Latina” and not “real” pain.

            As an added bonus, that attitude also means that women and minority practitioners know exactly how much their own complaints will be denigrated and have extra incentive to never complain about anything.

          • Trixie

            I 100% believe that you’ve experienced mistreatment. I think we all believe you. Let us know how to help.
            That doesn’t mean that moto is wrong that women if African descent have higher rates of preterm labor, not just in the US.

          • araikwao

            Yup, the same issue of exists for women of Afro-Caribbean descent in the UK. Read it in a paper on epidemiology and causes of preterm birth just last week.

          • PrimaryCareDoc

            I am completely sure that you have been mistreated because of your race. Just don’t generalize it to all white doctors.

          • TsuDhoNimh

            “As a black woman with many black friends that are also mothers we share
            stories all the time about our treatment with medical care during
            pregnancies”

            As do white women with their white friends … are you saying that their experiences don’t count because they are somewhat the same color as the medical staff?

          • staceyjw

            Dreah is right.

            **I cannot speak for any black moms experience**
            but I do know it is true that across the board, black women as a group, are treated much worse than whites, overall. C’mon, anyone with eyes and ears knows that black women get hurt the worst, oppressed the most, of just about anyone in America. You don’t need to look at the stats and sociological studies to know this.

            It is called structural RACISM, meaning racism is built right into our systems. It is real, unavoidable, and should not be dismissed by saying “what about the white people!”. Examples of whites treating WOC well, or being harmed themselves, should not be used to silence WOC, or to make their claims look illegitimate. Doing this erases their struggle, and is disrespectful.

            Those examples do not make it less true that black women, as a group, get terrible treatment, and its done at the hands of whites.

            It is a fair generalization to make.

          • staceyjw

            (sorry for the repeat, I cannot edit or delete, and when I saw my comment not coming up I wrote others)

          • KeeperOfTheBooks

            I agree with your first paragraph, but not with your second. Examples of white people behaving as they ought to are perfectly valid arguments against remarks like “White doctors in the hospital don’t care about the care of black women and or our babies neither do white midwives” because the quoted statement simply isn’t true. It isn’t correct or fair to claim that all white medical professionals don’t care about black patients.

          • Smoochagator

            No. In the same way that one NCBer saying, “I had a HBA3C and my baby was fine!” does not change the reality that there was a very real and very high risk of her child DYING. We all know that one legendary anecdote does not erase the truth of a generalization, whether that generalization is that WOC are treated poorly by the medical establishment or that homebirth kills babies that would not have died had they received adequate medical care.

          • KeeperOfTheBooks

            I think that’s apples and oranges, though. A HBA3C is an unwise decision for reasons that are clear to anyone who has spent much time here, but it isn’t correct to say “All women who attempt a HBA3C will have their babies die and be hospitalized subsequently for serious and preventable complications.” It would be correct to say “A woman who choses to attempt a HBA3C is much more likely to have her baby die than a mother having a scheduled caesarian under the same circumstances, and the HBA3C-ing mother is much more likely to be subsequently hospitalized for serious and preventable complications than one who choses a scheduled caesarian.” The first statement is an incorrect absolute, while the second admits the high incidence of problems under such a scenario while also indicating that it isn’t an all-or-nothing guarantee.

          • staceyjw

            TDM- You are trying to erase the struggles of her community by saying “what about the whites”. Just because some whites are not racist, or are hurt themselves, does not make the oppression any less real. Why not just listen to what she has to say?

            I am white. I recognize that I belong to a group that harms and oppresses WOC, and that I have a lot of white privilege built up on their oppression. I try not to be part of the problem, and work to be an ally.

          • TsuDhoNimh

            Hold it!

            You complained that white people were speaking for black people, telling them how the felt and what their problems were, and then you go and do the same thing?

          • staceyjw

            I admit the whole system fails for all WOC, but I have seen more consideration from the OBs I have known that any NCBer or HB MW.

        • TsuDhoNimh

          And isn’t preterm birth a major problem in the African American population that exists across socioeconomic lines?
          If you correct for education and income levels, which are a good proxy for access to medical care, much of the disparity goes away …. this is not a “black people” problem.

          It’s a lack of medical care problem.
          It’s a poverty problem.
          It’s a lack of transportation problem.

          • Trixie

            Much of it goes away, but not all of it. It’s true outside the US, too.

          • DiomedesV

            Much of it goes away, but not all. According to the WHO, it is a multifactorial problem that includes a genetic component:

            http://www.who.int/pmnch/media/news/2012/preterm_birth_report/en/index1.html

            Chapter 2 is the relevant chapter. They cite evidence that babies of African ancestry tend to be born earlier but also suffer fewer problems associated with preterm delivery than Caucasian babies. I think it would be difficult, however, to separate genetic from epigenetic factors.

            But there are still major problems of access and quality of care and treatment of black patients in the US and these undoubtedly contribute.

          • The Computer Ate My Nym

            Much of the disparity goes away, but not all. I have three thoughts about what might account for the rest of the disparity:
            1. The chronic stress of having to cope with prejudice all the time. Every black person that I’ve known who felt comfortable enough talking to me to discuss things like this has said that they feel watched when they go into stores, even if they’re providing all the markers that say “middle class” (right language, right clothes, etc). That sort of chronic stress has to take a toll on you.
            2. Prejudice on the providers’ part. Not necessarily conscious or intentional, but a bias is certainly there. There have been studies demonstrating that providers are less likely to recommend aggressive care for a woman or a minority person of any gender describing the symptoms of an MI than a white man doing the same. I don’t know of similar work in OB (perhaps describing symptoms of preterm labor, for example), but I would expect to see a similar result.
            3. Genetics. No, wait, I don’t mean it like you think. Most medications and treatments are tested predominantly on white men. Therefore, if a drug acts differently depending on a certain polymorphism then it’s probably going to be optimized for the polymorphism that whites carry and possibly for the phenotypic characteristics of men (i.e. hormonal milieu, body size, etc). So minorities and women are more likely to have issues with the drug (more side effects, less effective, etc).

            For example, a PhD colleague of mine works on platelet function. He has found significant differences in platelet function by race and has started describing the way the genetic polymorphisms interact to produce these differences. In the mean time, a new drug for platelet inhibition in cardiac disease has come out. It is frequently ineffective in blacks because of the polymorphisms described. Now, the company making this drug couldn’t have known about the specific pathway when it was developing the drug–it hadn’t been described yet–but how did they miss that it wasn’t, on a practical level, working in blacks? Did they just not include minorities in their clinical trial? In 20bleeping14? Or maybe not subgroup analyze because “they don’t see color”? I’m puzzled.

          • Young CC Prof

            Maybe they didn’t feel like paying for a trial large enough to do subgroup analysis, which is a common problem. (I suppose doing no subgroup analysis is better than doing one which is meaningless due to insufficient sample size.) I’ve also heard blacks are less likely to enroll in clinical trials overall.

          • The Computer Ate My Nym

            In this case, no. It was a 26K person trial. They just didn’t look.

      • Young CC Prof

        Last month, this black midwife walked across the state of Missouri to raise awareness about the elevated rate of infant and perinatal death in the black community, and her group Utazi Village.

        http://www.scienceandsensibility.org/?p=8682

        Which is great, but I’m not sure how doulas are going to prevent perinatal death. It’s kind of like the Underpants Gnomes, missing step 2.

        • Guesteleh

          If the doula provides support throughout the pregnancy and not just during labor, I can see how it might help women to access care, understand what is or isn’t normal in pregnancy, when to go to the ER if needed, etc. So more of a general health navigator role than the traditional doula role.

          • KeeperOfTheBooks

            Yep. I have a friend who’s considering becoming a doula to help women mostly ante- and post-partum. She’ll do birth support, too, but her primary focus would be helping with cleaning/organizing/”yes it’s normal for your feet to be sore, no it isn’t normal for them to become twice their usual size within 48 hours CALL YOUR OB NOW” pre-birth, and helping with feeding, cleaning, holding-baby-so-mom-can-shower-and-sleep post-birth. She’s also rare among would-be doulas in that her feeding mindset is “What works best for both mom and baby? Awesome, go for it” rather than rabidly pro-EBFing, so while she could help a mom who wants to breastfeed but needs help with latch issues or sore nipples, she would also have no problem gently suggesting formula, saying that it’s ok to supplement or exclusively FF, and run out for a container of formula and some bottles when mom and baby need them, plus screen for PPD and help mom get help for that.
            In short, she wants to be kind of like what I’ve heard described as the norm in the UK–a sort of health visitor for mom and baby. Me, I think it’s a brilliant idea, and would seriously consider hiring someone like that.

        • Medwife

          Post partum support of almost any kind would help improve infant mortality rates, if not perinatal. And I mean post partum support for like, 6 months.

          • Wishful

            That is awesome! I am from Missouri and I know that there a lot of areas in which we as a state are a bit behind. I will never forget the woman who lost a child because she didn’t know how to use a thermometer to take the babies temperature or what the numbers meant. Sometimes its the little things that people take for granted that matter.

          • Young CC Prof

            That’s a good point. There ARE a lot of things a community group could do to fight maternal, perinatal and infant death, from helping women get access to medical care to parent support and education. But, reading Utazi’s website, it’s not clear to me what exactly they’re doing, other than promoting NCB myths.

    • Trixie

      Wowwww.

    • Mel

      Anyone else enjoying the irony of an “approved list” of slogans at a rally?

      Freedom of speech for the rally but enforced silence for the participants…

      • Trixie

        Especially forced silence of minority participants with an actual legitimate grievance.

    • staceyjw

      WOAH, they banned WOC for stating FACTS? OMG. Awful.

    • RNMomma

      I definitely agree that Improving Birth doesn’t seem to be doing much of what their name implies, but it’s not like they specifically targeted WOC with the sign banning. They only allowed certain sayings. It had nothing to do with race. (Although I agree that is a huge issue that needs to be addressed in order to actually improve birth.)

      • Medwife

        They only allowed certain sayings. Ones that did not talk about African American women having higher rates of maternal death. But that has nothing to do with race. Totally!

        • RNMomma

          I’m not saying they shouldn’t have included something regarding the higher mortality rates among African Americans in childbirth. But I don’t believe that they specifically excluded it because they are racist. They also excluded signs regarding women getting hurt by midwives. THAT was far more intentional, in my opinion.

          • Guest

            Actually, they did have a few slogans that included stats on African American women.

          • RNMomma

            Do you know what they were? Dawn Thompson stated only a few select slogans were permitted. It’s be very exciting if this to

          • Guest

            I can’t remember where I saw them… maybe on one of the facebook pages. But I remember they were a late addition. And if you look at their strategic plan, one of their “goals” is for improving maternity care for women of color:
            “Goal #4: To proactively work to engage stronger participation from women of color, particularly from African-American and Hispanic/Latino communities, in IB’s activities and programs, while recognizing and addressing the enormous racial and class disparities in maternity care.”
            I get it that it seems like they aren’t doing anything regarding “kelly’s” case, but I’m not ready to jump on the “hate everything they’re doing” bandwagon. I think they really are trying to do good things.
            http://www.improvingbirth.org/executive-summary/

          • RNMomma

            So they didn’t have specific slogans, but they did have specific messages. I guess some location coordinators didn’t feel that high African American mortality concerns didn’t fit into the push for safer care. “Messages” are in the comment section. http://rallytoimprovebirth.com/signs/

          • Amy Tuteur, MD

            Evidence Based Birth
            Informed Consent and Refusal
            Safe, Respectful Care

            Secondary Messages:

            ImprovingBirth.org
            Know Your Options
            Vaginal Birth After Cesarean
            Fewer Preventable C-Sections
            Question Your Induction
            Birth Matters
            We Can Do Better!
            Family-Centered Care

            In other words, these are the things that Western, white, well off women obsess about. Who cares about anyone else?

          • Sue

            “Question your induction”

            But how do you know the correct answer to the question?

          • Sue

            “Evidence-based birth”

            So, are they campaigning against home-births for first-timers, twins and breech? Against anyone being a primary birth attendant without medical or nursing specialty training? In favor of antibiotics for GBS?

        • Amy Tuteur, MD

          I suspect that it didn’t have anything to do with race directly. The point of the rally was to promote homebirth midwifery and homebirth is not the answer to high mortality of African American infants. Improving Birth is only interested in fomenting distrust of doctors in order to increase market share for midwives. It has nothing to do with improving birth for anyone, least of all African American women.