This is the time of year when we reflect. We remember what the past year has brought, and focus on what we’re looking forward to in the new one. I for one have been astounded by how much maternity and postpartum issues have been in the news recently. Y’all…people — like medical people — are actually paying attention to the effects of pregnancy on the mother, as well as the deficits in healthcare. They are recognizing that our bodies function, and often they function differently from men’s (shocker) because of — HUH — hormones! Shhhhh! More shock. Science has also become more vocal about the environmental factors — many of them social, like race and class — that affect our health as well. We don’t grow in a vacuum, ladies. Nope…no we don’t.
And all this news about women’s health this year — maternal health and health disparities in particular, hit pretty close to home. Sometimes a little too close. But here we are. And I am also reflecting, because I — as a woman, as a person of color, as a mother — have experienced much of it and/or could be highly likely to (says FACTS). So we’re going to take a little journey, through my story AND the top eight issues Science (via the Media) shared with us in 2018. Instead of putting this in “top-picks order” or chronological order, I’ve put it in storytelling order. Journey with me.
2018 Shines a Light on Maternal Health & Health Disparities
All mothers have a pregnancy and birth story. A natural birth gone wrong, an emergency C-section, a shockingly fast delivery.
Issue 1: Facts About Maternity Should Be Mainstream
There is actually good hard science behind why we do what we do when we’re pregnant, and during labor, delivery and postpartum, but we as a culture, don’t know much of it in the mainstream — meaning we don’t talk about it, it’s not common lore, it’s not passed down….we have to SEEK IT OUT — which means time + money. If there’s any book on my list of must-reads, it’s this one: Like a Mother: A Feminist Journey Through the Science and Culture of Pregnancy. It was written by a woman who is both a mother and a journalist — imagine that. I mean, the interview with Terry Gross is super-informative (natch), but there’s so much information about pregnancy hiding in really good books, that I highly recommend reading them (maybe even before your next pregnancy?).
I definitely credit Ina May’s Guide to Childbirth and Midwife Wisdom, Mother Love for most of the agency I had during my labor and delivery. Garbes’ book goes into the science behind “why” — it’s about facts and information related to maternity and postpartum, and because she’s a journalist and a mother, her research (and experience) are super-thorough.
Let’s just get this out there: I had kind of a shitty pregnancy. It wasn’t completely shitty…I was in a good place when it came to self-love, and we were moving from the Middle East to Southeast Asia, and those two things made a hell of a difference. (A bit of background: Then-Husband and I were working at an American school in the United Arab Emirates, and got hired in January to go to an international school in Ho Chi Minh City — a few weeks later I learned I was pregnant). I was able to emotionally care for myself despite the misgivings of Then-Husband, and I was leaving a place where I’d slowly but steadily built many friendships, and moving to a place where we found community (and friends) almost immediately. Luckily, two members of that community (Heather and Victoria — I’m looking at you) were pregnant and due around the same time I was (meaning we were able to lobby for longer maternity leave), and quite a few of my new coworkers had recently given birth in Saigon, our new home. I’d be remiss not to mention Karen, the amazing midwife and lactation counselor at our local (“expat-quality” ?) health clinic.
BUT…physically, good GAWD! I had morning sickness my first trimester (not the end of the world). And then I just kept getting really sick. I had respiratory infections (so I thought), and then I came down with vertigo due to either vestibular neuritis or labyrinthitis — for almost the entire second trimester. It hit me at the Mall of Dubai, which happened to be the biggest mall in the world at the time, while we were creating our baby registry. Wheel chair. Hellish drive. Emergency room trip…No diagnosis. I spent most of my time in bed because I couldn’t walk and know where the floor was (or read or work on a computer, much less teach). Weeks later, I was in the emergency room AGAIN with what we thought was appendicitis. An attempt at an MRI (since doing an appendectomy on a woman between 22 and 24 weeks pregnant was tricky at best), likely helped facilitate a relapse of my whatever-ear-infection-induced vertigo and/or at least cause its delay….MORE FUN! There was no appendicitis. After seeing an ENT, I had to re-train my brain to accept motion by spending the days out of bed, but not working…just me and my HGTV…
Issue 2: Acknowledge Postpartum Depression + Focus on Prevention
So, one of our top issues this year is that doctors want to focus on preventing peri-natal and postpartum depression — novel idea there, Folks….prevention. Panel: Doctors Should Focus On Preventing Depression In Pregnant Women, New Moms is worth the read because we know how stigmatized and under-discussed this topic is. But it shouldn’t be:
The risk of developing depression is high — about 1 in 7 pregnant women and new mothers suffers from depression during pregnancy or in the year after childbirth. And for some groups of women, the rate is even higher.
Postpartum depression was also covered here by the Associated Press: Know what to say when postpartum depression hits a loved one — because when it happens to rich and powerful people, the public starts to notice. #thanksserena
Around this time seven years ago, I was making weekly visits to the little neighborhood gym in our quaint Thao Dien neighborhood in Viet Nam. I would put little Goose in her little car seat, and place it on the cool floor of a minimalist-chic massage room, where the amazing Briar with her lovely Australian accent would talk me down. I would share with her the horrific images (and very real fears) in my mind — throwing my baby off the balcony, tossing her into the Sai Gon River, dropping her on the shiny marble floor, where she would undoubtedly break — and worse. And Briar, first with Science, would explain that if I was really going to do these awful things, I would have had a psychotic break and done them, and then with exposure therapy (true, more Science) that I could be OK holding my baby and not burning her with the tea kettle or harming her in any other way. (She also made me do things like stop watching Grey’s Anatomy — sad but true (and necessary). — Turns out I am a highly visual person. Ahhhh, those were the days…NOT! They were very lonely, very tormented days.
If you don’t know anything about postpartum OCD, it’s a fun mind f*^k (form of anxiety and postpartum depression) WHERE YOU ARE CONVINCED you will harm your baby (and visualize it in SO MANY CREATIVE (arghhh) ways).
Postpartum Depression is ROUGH (understatement?). It can be life-changing — it can affect the way a woman bonds with her baby (or not), and it can test a marriage. Mine broke. It was already pretty fragile, so I just credit PPD with indirectly hastening the process.
BUT, most importantly, PPD is an outcome, so there are plenty of factors that likely contribute to it. And in case I forget to mention it — these factors are likely NO ONE PERSON’S FAULT — so there’s no point in blaming yourself, blaming your partner, blaming your in-laws or blaming your OB-GYN. PHEW. (I’ll mention it again in another post, but if you had PPD or feel like you’re pre-dispositioned to it, just leave the blame at the door and Eat the Day.) Which leads us to our next newsy acknowledgement from 2018:
Issue 3: You’re Pregnancy Is NOT A Victorian Novel
The title of The Atlantic‘s article says it best: Bedrest is Bunk. I mean the subhead is “There’s little to no evidence to show that restricting pregnant women’s activity has any benefits—so why do doctors still prescribe it?” Lisa Lerer, the author, elucidates us to not only the lack of evidence for bed rest, but also the risks. It’s in The Atlantic, so grab a cup of ☕️, or something stronger should you need it?, and read on.
The treatment has not proved effective in treating preeclampsia, preterm birth, low infant birth weight, high blood pressure or a shortened cervix. …The risks, however, have been well documented: Women prescribed bed rest may suffer from bone loss, muscle atrophy, and a wide range of postpartum psychological disorders at higher rates compared to pregnant women who do not go on bed rest.
This one hits really close to home for me. I finally recovered from the vertigo about two months later (if you want to know what vestibular neuritis or labyrinthitis is really like, listen to this Radiolab episode on “Gravitational Anarchy”.) But within a few weeks or a month after moving to Viet Nam, I was sent home on bed rest (sigh…more bed rest). It was 2011, the height of the Arab Spring, so the recommended doctor, who’d recently left VN to go to Libya, was back in VN and his speciality was high-risk situations (which clearly would have included the location). Talk about someone who poo-poos your birth plan (everyone delivers in stirrups, with the lights on, he uses the forceps, he catches the baby…). He basically said you can’t have a premmie here, it’s too risky to deliver before 37 weeks — bed rest. Little did I know he put everyone on bed rest around this time. Anyway, there’s a lot more to that story, but I followed doctor’s orders.
So much for being at that new job for longer than two weeks. Needless to say in my isolation, I began reading a lot about giving birth. I had the blessing of learning some labor hacks from the likes of Ina May Gaskin and Sarah James, while at the same time doubting the entire birth experience I was about to have. Awesome. It was far from ideal. I mean, I had vertigo when we were planning the move, so I couldn’t do any research, and it was Then-Husband who chose the hospital and whatever. Once I started reading, I knew I wanted a different birth experience, but it would have required us going to Thailand or Singapore (for the midwives and the walls painted colors that induce positive hormones (WHAT!!!???) and it was too late to plan for that. I tried to counter the mounting sadness — this on top of waiting for Then-Husband to come home from work every evening, only to have him leave almost immediately to go explore our new city — with whatever agency I could — meditation, making birthing soundtracks, creating images for the hospital, prenatal massage, getting outside when I could — but…
Subsequently, following labor — and the aforementioned Then-Husband who didn’t believe I was in labor when it was TIME TO GO TO THE HOSPITAL NOW!!! [insert the annoyance/life-scare of delivering with Strep B because my water had been broken for more than 24 hours AND no one told me until five days after I delivered AND NO ONE GAVE ME ANTIBIOTICS WHILE I DELIVERED OR TESTED THE BABY!!!]….I soon also had to contend with postpartum OCD. Shit girls….this stuff is not unrelated. BUT apparently, now that it’s 2018, seven years after ALL THAT, we have more insight into this interplay.
Issue 4: Keep Moms From Dying Before They Experience Motherhood
Sounds like a good idea, right? If you remember S’ weekend post from before her summer trip, in which she mentioned the changes California (of course) is making to decrease the maternal death rate, you’ll remember that the U.S. maternal death rate is ridiculously high for a high-income country (like our incarceration rate and our gun death rate), BUT we’re finally making strides to change that. Double woot from my point of view. So that’s our number one this year:
The Last Person You’d Expect to Die in Childbirth is the first major project that brought this topic most recently into the forefront. I keep thinking of that poor youngest sister from Downton Abbey — the feminist — who died of preeclampsia. So that’s what the U.S. is like when it comes to childbirth these days: early 20th-century England. Sigh. This special project is a collaboration between Nina Martin, of ProPublica, and Renee Montagne, of NPR. It is heartbreaking. You can listen to the 2017interview with Martin and Montagne here (if you can handle hearing creepy Leonard Lopate’s voice (#metoo)).
Allison Young wrote 2018’s groundbreaking update (Hospitals know how to protect mothers. They just aren’t doing it.) for USA Today, which S referenced above and you can read here. You can also listen to her August 2018 interview on Midday here.
Issue 5: All Women Are Not Treated Equally
If you really want to understand how deep the health disparities in our country run, read: Black Mothers Keep Dying After Giving Birth. Shalon Irving’s Story Explains Why. Who is Shalon Irving? I can’t do a better job of summing up the story than Nina Martin and Renee Motagne (noted above), so we’ll use their words and the facts.
“At 36, Shalon had been part of their elite ranks — an epidemiologist at the Centers for Disease Control and Prevention, the pre-eminent public health institution in the U.S. There she had focused on trying to understand how structural inequality, trauma and violence made people sick.
Then the unthinkable happened. Three weeks after giving birth, Shalon collapsed and died from complications of high blood pressure.
The researcher working to eradicate disparities in health access and outcomes had become a symbol of one of the most troublesome health disparities facing black women in the U.S. today: disproportionately high rates of maternal mortality. The main federal agency seeking to understand why so many American women — especially black women — die, or nearly die from complications of pregnancy and childbirth had lost one of its own.
Even Shalon’s many advantages — her B.A. in sociology, her two master’s degrees and dual-subject Ph.D., her gold-plated insurance and rock-solid support system — had not been enough to ensure her survival. If a village this powerful hadn’t been able to protect her, was any black woman safe?
According to the CDC, black mothers in the U.S. die at three to four times the rate of white mothers, one of the widest of all racial disparities in women’s health. Put another way, a black woman is 22 percent more likely to die from heart disease than a white woman, 71 percent more likely to perish from cervical cancer, but 243 percent more likely to die from pregnancy- or childbirth-related causes. In a national study of five medical complications that are common causes of maternal death and injury, black women were two to three times more likely to die than white women who had the same condition.
So, another thing we need to get out there: I was actually pretty lucky I was pregnant and gave birth overseas. I’m not sure how things would have turned out if I’d been in the U.S. I’m a person of color — I’m also a woman. On one hand, I didn’t have to bear the burden of being “black” while living overseas. There was no race box to check on any form I filled out for six years (unless I was visiting the U.S. and say, renewing my driver’s license or something). Race (a “tool” and manmade social construct beneficial for imperial colonialism and its vestiges) isn’t utilized categorically in the Middle East and Southeast Asia the way it is here. That’s not to say that the Middle East didn’t participate in the slave trade or that Viet Nam wasn’t colonized — I mean, skin-tone IS a thing in both countries, and in the Middle East religion IS a thing, I’ll give you that, but not “race”. On the other hand, maybe I could have had that midwife, pretty-painted-wall, access-to-a-birthing-pool birth.
Therefore, I was simply an American or a lady from of one those rich Western/white countries, and I had some agency while in the care of doctors and hospitals. I also had enough time to release all the stress and baggage that comes with living under the very heavy cloak of systemic racism and the a lack of social structures that accompany a capitalist society (like affordable, high-quality health care). Also, ironically, while we had U.S. health insurance while working overseas, we also had way better plans than I ever had here. I’m not saying my labor would have necessarily been less than ideal here, but statistics say possibly — just take a look at our next items:
Issue 6: Unequal Treatment Leads to Unequal Health Outcomes
From Breastfeeding to Breast Cancer
You’ll find a similar story to that about maternal death rates among women of color in the United States when it comes to other healthcare issues. In Why Are Black Women Less Likely To Stick With A Breast Cancer Follow-Up Treatment?, the expert, Niasha Fray who counseled women with breast cancer about sticking to their treatment, becomes the patient. Because black women are less likely to have health insurance and get mammograms, and furthermore less likely to afford endocrine therapy after diagnosis (among a whole host of other reasons worth reading about), they’re more likely to have later diagnoses and less likely to maintain treatment. Sigh.
And…because poor health outcomes for mom can also lead to poor outcomes for baby, the medical community is actually acknowledging this trend: “Black infants in the city are twice as likely to die as white infants. They are more likely to have a lower birth rate, and they are more likely die of a sleep disorder that can be prevented. This trend is not unique to Philadelphia — infant mortality rates among African-Americans are notably higher nationwide.” To promote breastfeeding among women of color, Philly campaign features black mom illustrates that while breastfeeding cannot solve ALL the problems of the “impact that racism can have on the stress and experience of black mothers,” it can help mitigate them:
While it’s not a silver bullet, breastfeeding has demonstrated health benefits for mothers and infants. For babies, it reduces risk of sudden infant death syndrome, obesity, asthma, and complications of preterm birth. For mothers, it reduces the risk of Type 2 diabetes, high blood pressure, ovarian and breast cancers. Economically, breastfeeding has been shown to reduce health care costs for families. And yet, according to the Centers for Disease Control and Prevention, black infants are 21 percent less likely to be breastfed than white infants.
This is actually another area where I feel incredibly lucky to have birthed my baby in the community I did. I had access to SO MUCH BREASTFEEDING SUPPORT. It had nothing to do with race, because, again, I was not in a racialized/colorized community, but it did have a lot to do with nationality — not mine, but the international people around me. We had the amazing midwife and lactation consultant Karen, who would let us call her, and come to visit us, and do counseling sessions to help us get through those agonizing early days (errr….weeks) where you wonder HOW IN THE HECK people ever made this look easy or natural?! Then, once I went back to work, the lovely school nurse gave me a bed in the clinic where I could pump during my planning periods. I could also leave my milk in the fridge for the rest of the day (and wash my pump). And then Nicola, who let me feed wee Goose in her office during my lunch break (not to mention a helper who would bring Goose to school each day — #costoflivingfactor). AND leadership at our school — my department head, our principals who were all OK and supportive of this.
I do have to highlight here, though: the U.S. itself isn’t very supportive when it comes to breastfeeding overall, regardless of race. In the same post referenced above, by Shana from over the summer, it was the U.S. who opposed a UN World Health Assembly breastfeeding resolution just this year. It turns out our country is not especially “baby-friendly” (a World Health Organization and United Nations Children’s Fund designation based on ten steps hospitals can take to support new mothers in breastfeeding), and neither, when it comes to local Vietnamese, was the country of Goose’s birth. More about that Ina May’s Guide to Breastfeeding, if you’re interested.
Issue 7: Pay Attention, We’re Doing It Wrong
Of these next four trends to watch in women’s healthcare, the crazy rate of C-Sections worldwide is definitely one of them. It’s not that C-Sections are bad, some women actually need them. It’s the rate of elective C-Sections that is a greater concern. Why?
It’s likely three factors working together: financial, legal and technical,says Holly Kennedy, a professor of midwifery at the Yale School of Nursing and contributed to one of the studies. As an obstetrician told me … ‘You’re going to pay me more [to do a C-section], you’re not going to sue me and I’ll be done in a[n] hour,’ ” Kennedy says.
This next one is kind of mind-boggling: Report: Women Everywhere Don’t Know Enough About Ovarian Cancer. Not because a professional community historically dominated by men doesn’t know that much about diagnosing the goings-on in women’s innermost parts, but because it highlights exactly that. And it’s 2019. And it underscores just how much all of this is news right now. Which is kind of scary.
The World Ovarian Cancer Coalition found that not only is ignorance about ovarian cancer common among 44 countries surveyed, but also, women intimate that their doctors take a long time to diagnose them and/or refer them to the proper specialists (more on that below in Doing Harm…). The report states that worldwide, an average diagnosis takes about 31 weeks — from the first signs of illness. And, they point out — not one country does this well. This is truly a Health Gap we’ll continue looking at — “The World Ovarian Cancer Coalition estimates that one in six [women] will die within three months of diagnosis and fewer than half will be alive in five years.” SOB. That seems like a shitty reason to put the health of mama and baby at risk, no? This article looks at the numbers from the World Health Organization.
Issue 8: We’ve Come A Long Way Baby, But Not Far Enough
We now have an author, and a book, and FACTS that confirm WOMEN ARE NOT CRAZY. Or hysterical. Or weak. Maya Dusenbery’s new book captures how ‘bad medicine and lazy science’ harm women. This point could easily have been my number 1, considering that it affects more than half of the world’s population, but most of us, as women, already know that it takes a hell of a lot of persistence (and tears and anger and restating and rewording) to get our health concerns HEARD.
Dusenbery, author of Doing Harm: The Truth About How Bad Medicine and Lay Science Leave Women Dismissed, Misdiagnosed and Sick, highlights that “it takes an average of four years and four doctors to fight through the label of “chronic complainer” for most patients with a rare illness—often longer for low-income patients and women of color.” We frequently talk about implicit bias when it comes to racism and other structural “isms”, and it applies just as much in healthcare, especially with women. Thanks to Dusenbery for pointing out this significant gorge in the Health Gap.
Soooo, back to that little “it wasn’t appendicitis” episode. Sigh….due to some complicated gender hierarchies at the hospital when I’d gone to the emergency room, the female OB-GYN (not the male surgeon eager to cut me open) had me transferred to a different hospital, where I was able to recover enough to show THAT DUDE IN CHARGE that I didn’t need surgery. (Side note, both times I was whisked away to the ER during my pregnancy, were on Friday. In the Middle East, that’s the equivalent of going to the ER on a Sunday, but worse. So the battle over What To Do With The Lady Two Weeks Shy of Having Her Baby Saved If Something Goes Wrong During Surgery, was literally only between that one ER surgeon (male) and that genius female OB-GYN who transferred me to a hospital with a PICU — even though whether that mattered was debatable.) Because of some other complications with the MRI that we won’t get it, we learned that I had an intestinal blockage at the exact same place as and pushing up against an Ovarian cyst…ugh.
BUT, it turns out it wasn’t that simple…In 2015, four years later, I was diagnosed with food allergies and Ulcerative Colitis. Symptoms and precursors of which I’d presented with FOR MORE THAN A DECADE before I got diagnoses. I likely would have gotten one of my diagnosis in Dubai, but my terrible second trimester meant I couldn’t have the diagnostic tests my physician was hoping to administer. That being said — all of the symptoms I went to the doctor (or ER) with for years in the Aughts — all related to food and digestion, but never once was I tested for food allergies, and when I even mentioned intolerances, I was talked down to. The body aches I experienced, are part of the number 1 co-morbid syndrome that accompanies Ulcerative Colitis.
Yet, when I read my medical charts — which I have, because I needed them to go overseas — all the notes are psychiatric…they thought it was “all in my head”. This is significant, because when women who have Cronh’s and Ulcerative Colitis want to get pregnant or are of child-bearing age, there are a lot of warnings and A LOT of caution. You’re not supposed to get pregnant with active disease, and I likely did. I’ll never know to what extent my disease affected my pregnancy, but I know that it did. And knowing now, what I — what we — didn’t know then…makes me super-grateful…because when you look at the facts….?
And because it’s the end of the year, and we all want to have a good time and a giggle, I’ll add another 2018 book to your reading list: Why Women Have Better Sex Under Socialism: And Other Arguments for Economic Independence.
The Vox interview is here, but why not start the year with a fun and intellectual read — that might lead us to better social systems (not necessarily, Soviet-Style communism #thanksbutnothanks) AND better sex.
Happy New Year!