Talking Midwives in Midtown: an Aha! Moment

Yesterday, I met an old friend for breakfast. We met at Norma's in Le Parker Meridien hotel. As we noshed on a delicious breakfast, pondered who has actually ordered the $1,000 caviar breakfast item, we had a ground shaking conversation about the role of midwives in changing the landscape for maternal health.

My fellow diner was my good friend Shirley McAlpine, a beautifully statuesque British woman. She became my friend when I lived in London and is now doing some amazing work in the U.K and U.S. about prenatal education and natural childbirth through her popular Birthwise DVD http://birthwisedvd.com/us/ and consulting work. The tagline for Birthwise is "Your Creation. Your Choice." I love that.

Shirley had just returned from the Midwives Alliance of North American conference in the Nashville, Tenn., area and she was buzzing. Her energy was infectious. And while we are both involved with maternal health issues across the board, as two black women we are also particularly concerned about the issues in our community. So the questions began to roll. Could midwives be key to helping reduce the high pre-term birth and low birth-weight baby rate that continue to plague black women of all socioeconomic levels? Could midwives help reverse the high exceptionally C-section rates among black women and reduce the shamefully rising maternal mortality rates among black women?

Shirley and I are convinced, yes. And birth center models like The Birth Place, http://thebirthplace.org an unique midwifery and women's health center in Winter Garden, Florida run by Jenni Joseph, show impressive results in reducing pre –term births.

But, why? The answer, as it unfolded before us, was in the education that midwives provide. Expecting moms who work with midwives are more informed about the birth process than women who work with doctors only. We all know that most doctors prefer that you know less, and trust them more, so that they can do what works best for them and not deal with any pesky little questions about your own life that you may have.

After all knowledge is power.

So when a woman who has had a midwife is told she needs to be induced. She knows she can ask why, if the baby's heart rate is fine and other measures she's been educated on are still ok.

When a woman whose water has broken is told that she must be induced, a woman with a midwife may have been taught that actually unless other indicators show otherwise a baby can be fine for up to 24 hours after the water breaks. It is Hollywood that has told us otherwise, and turned the water breaking into the mad dash to the hospital event that makes for great cinema but woefully misinformed moms to be.

And when a woman has a true (not Hollywood or doctor-friendly) understanding of how long the labor process can be, she won't stand for being told that a C section is necessary because it's been five hours and she hasn't dilated. She will also have been educated on the real signs of labor, so she won't go the hospital too soon where labor can be stunted by laying in a bed and you are more likely to be given unnecessary medical interventions.

These are key pieces to the puzzle. As we know, the answer is not in the prenatal care. Women are getting that. But that hasn't improved matters. The key is in the education--an education that often does not happen in its full measure at a traditional doctor's office. And that midwives can provide.

And that nuanced understanding of how black women end up on the operating table more and remain six times more likely to die from pregnancy-related complication is worth more the $1,000 caviar.

Breastfeeding On My Time

By Tangela Walker-Craft
WeNews guest blogger

I decided to breastfeed my daughter until she was 2 years old. I was the first person in my family to practice what is called extended breastfeeding since the introduction of baby formula.

I thought this was a personal decision, between me and my husband and my child, but boy was I wrong.

I taught her a few baby signs by the time she was about 9 months old, so she knew how to tell me when she wanted to be nursed. During the first year she was exclusively breastfed. By the second year she had a diet consisting of breast milk and toddler appropriate foods. During her second year, she breastfed less than the year before.

Unfortunately, unwanted and unwelcomed advice on when I should wean her came from everywhere. People that have never breastfed a day in their lives will offer their advice about when's the best time to wean YOUR baby. Even people that have never had a child will somehow know when you've breastfed long enough. Unbelievable!

If you resist their unsolicited advice, people may even switch from asking when you plan to wean to trying to scare you into weaning.

You'll likely hear, "If you don't wean her soon, you won't be able to do it." You may even get the, "She's going to start biting you when she gets teeth," threat. It's funny how most people accept that a baby will start to walk when he or she is ready, and talk when he or she is ready, but they think that there is a magic age when all babies should stop being breastfed.

Once threats don't manage to scare you into submission, the attempts to shame you into weaning may begin. You'll get the loaded, "You STILL breastfeeding that child? How old is she?"

Family members and people that feel that they can will make snide remarks about how your
child might be driving, married, or doing something else that's totally ridiculous before you wean him or her.

Things were particularly challenging because breastfeeding, especially extended breastfeeding, is not necessarily encouraged in Black families.

Like many breastfed babies, my daughter lacked the "baby bloat" that frequently occurs in formula fed babies. My well-meaning grandmother asked me dozens of times if I was sure my baby was getting enough to eat. She'd ask me, "Are you sure you're making enough milk?"

She and other members of my family refused to believe that my baby could survive on just breast milk. I was constantly guarding against my family's threats to give my daughter "real food". formula.

After breastfeeding six children of her own out of necessity, my 85-year-old grandmother seemed to view my decision to voluntarily breast feed as something out-dated or odd.

I think that moms that do not practice extended breastfeeding sometimes secretly resent moms that do. There is a competitive spirit that makes women want other women to make the same child care decisions that they've made. Women that do not, or did not practice extended breastfeeding, may feel that moms that do are judging them for their choice.

Contrary to the warnings, weaning for me was easy. Taking natural cues from my daughter during that second year, I breast fed less and less during the day time. Breastfeeding became more of a bonding and comfort activity for us at night. When I sensed that she was ready, I began telling her that mommy wouldn't have any more milk soon. My breast naturally responded by producing less milk because of the less frequent feedings.

My daughter's nursing slowed down to a few minutes only at bed time.

Over a three day period I cut the feedings down to quick bouts, which culminated in the end of what was one of the best experiences of my life. I am glad I never succumbed to the pressure to wean before we were ready, but it bothers me that such pressure exists.

Why are we so uncomfortable with extended breastfeeding?

Tanglela Walker-Craft is the creator of Go Pillow! a patented, multipurpose childcare item that allows moms hands-free breastfeeding with comfort and president of Simply Necessary Inc. After nursing her own daughter for two years, Walker-Craft, realized that there was not a product on the market that allowed mothers to have nursing privacy and cradling comfort when others were present. Existing nursing pillows were too bulky and cumbersome for travel and cover-ups on the market required too much manipulation. The GoPillow! satisfies the needs of both breast feeding and bottle feeding mothers and caregivers.


Learn more at:
http://www.simplynecessary.com/

New Study Links Race and Delayed Breast Cancer Diagnosis

It's breast cancer awareness month. And for all the much-needed talk and fundraising done to help raise awareness about this important women's issues, a new study shows a troubling link between race and breast cancer diagnosis.

African American women are more likely than white women to be diagnosed at later stages of the disease and are more likely to die from it. Researchers have long wondered why and considered lack of health insurance as a likely factor. Yet, a troubling new study says that race and/or ethnicity -- rather than insurance status – is the leading cause in these delays in breast cancer diagnosis in minority women.

Researchers at George Washington University in Washington say they were surprised to find among women with health insurance, African-American and Hispanic women experienced greater delays in diagnosing breast cancer than Caucasian women.

The number of days from abnormal screening to definitive diagnosis for those with private insurance was 15.9 days for white women, 27.1 days for black women and 51.4 days for Hispanic women.

The most staggering and disturbing disparity was among women with government insurance. In that group, delay times were 11.9 days for white, 39.4 days for black and 70.8 days for Hispanics. Among women without insurance, times were 44.5 days for white, 59.7 days for black women and 66.5 days for Hispanic women.

"We thought having health insurance would even the field among all women," researcher Heather Hoffman said in a statement. "Insured women should have had the same rapid evaluation regardless of race and ethnicity."

The study shows even further, the effects of race and ethnicity on a woman's health outcomes. And while researchers probe medical causes, there must be a deeper dive into the systemic bias and racism that exists among medical professionals and healthcare providers.

Far from a level playing field, women of color are battling against forces they can't see or control to have equitable healthcare.

So, now what?

For Our Sons Police Stops Are Part of Growing Up

Guest Blog by Dionne Grayman

My son was small for his age, having a birthday late in the year and always looked younger than he was. We all do. It's the family "curse".

When he began high school at the age of 13, I insisted upon driving him. He insisted upon taking public transportation. Living in New York City, part of the rites of passage for most of our children includes independent travel through the hundreds of miles of subway tunnels, elevated train tracks and bus routes. Daunting to tourists and suburbanites in for a show but not to the savvy city kid raised on pre-paid MetroCards and sightings of rabbit-sized rats. I won the battle the first day; he, the second. Sort of. I made him ride the bus, which was about a 90 minute ride; the train would have saved him half an hour. I gave him money to call me when he got there and he was supposed to call me when he was leaving. This was before cell phones became the mandatory kid-accessory. That would come on his third day of school, September 11, 2001.

I wanted him to ride the bus because I figured he would be safer on the bus, more protected. He had made the football team and became friends with other kids on the team who lived in our neighborhood and rode the train. Friends with names like Big Lou and Tall Mike. For a month he begged to be allowed to take the train, assured me that he would be fine, introduced me to his "bodyguards" and I relented.

And it happened, shortly after.

But we had had the conversations. I gave him pop quizzes when he came out of the shower, at dinner, in between his second and third helpings, because you never approach a hungry male asking anything-and after I had hosed him awake. And he went to private school, had his whole life. Wore a uniform which was known to every transit employee between here and there. He was articulate, bilingual, could speak "adult" as well as he spoke "teenager". He was clean cut, no earrings, no tattoos, no saggy pants, no gaudy chains. In the fall and spring, he wore the hoodie of the moment, in the winter a black Northface and black Timberlands with his oxford and khakis, just like every other young man at the all-boy school he attended-Pinero, Caluccio, Feist, Harden, Schwartz. It would be hard to tell them apart if they were all on the school steps with their faces turned away from the street parents used for pickup.

And it happened anyway.

One day, he was stopped by the police on his way home. Asked to present identification, asked where he was headed. That was the first time. The second time, he was asked for identification and frisked. Then the third time, the fourth, and the fifth. And he was patted down, had his backpack gone through, returned to him, sometimes gently, most times not.

My brother-in-law is a New York City police officer, a detective within a homicide division. New York's Finest, they're called. He gave him a courtesy card issued to officers to give to their relatives in the event they have an interaction with a fellow cop. I have used the card and received a warning instead of an expensive fine. My son has had the card thrown into his face and onto the ground. His "dealings" with the police did not end with his graduation from high school-with honors. Did not end despite his admission into nine of the ten colleges he applied to. It has not ended with his being a college senior with 3.5 GPA in a dual major. My son is no angel; he can be surly, argumentative and obstinate. He has experimented with alcohol and marijuana. He listens to rap music, I have heard him curse and I'm pretty sure he's no longer a virgin. Your typical all-American boy. Except it's only typical for African American young men and other men of color to be subjected to this kind of police treatment.

In addition to the coming-of-age conversations parents have with their children, black parents have to add the "What to Do WHEN You Are Stopped By the Police" talk to the list of ones they have with their sons. We have to, for their safety and our sanity. Because in our collective memory, there's the horrifically mutilated body of Emmet Till. There's Amadou Diallo and Sean Bell. My son's name is Sean. And every single time he's stopped, I feel I have failed him and I have failed in the God given responsibility of protecting my child.

The saddest part of all of this is he'd begun to become "immune" to being stopped. He, like too many other men of color in this city, had become desensitized to being treated criminally. They take it as par for the course; they shrug it off and most will laughingly share their war stories. But listen closely and you can hear anger comingled with humiliation and a weary, reluctant acceptance.

Not exactly the stuff that dreams are made of.

Dionne Grayman is the founder of Mothers Empowered, a coalition of mothers who are in search of their best selves and committed to the business of making this world a better place for our children. At Mothers Empowered the mission is ME! A former high school English teacher, Dionne has taught the full spectrum of New York City's children ranging from incarcerated juveniles on Riker's Island to gifted students at one of the city's most prestigious high schools. She has also served on the executive board of the Community Education Council in District 13 in Brooklyn and is the co-vice president of the PS/MS 282 PTA Executive Board. Grayman holds a bachelor's degree in English and journalism, a graduate degree in special education, and has completed CCC's Community Leadership Course. Learn more about Mothers Empowered at www.mothersempowered.org

SisterSpace: I Will Not Write a Blog for Infant Mortality Awareness Month

This is not a blog for infant mortality awareness month. Something so weighty deserves more than to be relegated to web log. I will not make any witty observations. I will not use any metaphors, similes, idioms, or analogies. There will be no alliteration or onomatopoeia used to help you get it.

There will be no opinions, only facts. The jarring sort that aren't typically welcome in a blog. This will not be entertaining. You will probably not "Like" this.

This is my virtual moment of silence for the babies who needlessly die every year. This is my silent cry in the blogosphere for greater awareness in the African American community where our babies are 2.3 more likely to die before their first birthday than in the white community. This risk exists for all black women regardless of income or education.

This is my anti-blog for the unborn who deserve to live to see their first birthday and my homage to those who didn't.

• Currently, the national infant mortality rate for Black babies is 13.7 per 1,000, compared to a rate of 5.6 per 1000 for White babies, 3.5 per 1000 for Asian babies, and 5.3 to 6 per 1000 for Latino babies.




• Black babies are four times as likely to die as infants due to complications related to low birth weight as compared to non-Hispanic white infants.




• African Americans have 2.3 times the infant mortality rate as non-Hispanic whites.




• African Americans had 1.8 times the sudden infant death syndrome mortality rate as non-Hispanic whites.




• College- and graduate-school educated black mothers have a higher infant mortality rate than white moms who didn't finish high school.




• The infant mortality rate for African American mothers with over 13 years of education was almost three times that of non-Hispanic white mothers.




• Black women who get prenatal care in the first trimester have double the infant mortality rate of white mothers with first-trimester care.




• Only 17 percent of all U.S. births were to African-American families, but 33 percent of all low-birth weight babies were African-American, according to one report.




• Black women with similar levels of prenatal care as Hispanic women (generally less educated and with lower incomes than blacks) have higher rates of low birth weight, preterm deliveries, and infant mortality.




• According to Dr. Michael Lu, assistant professor of obstetrics and gynecology and public health at UCLA, researchers have found that even when they control for such varied factors as poverty, housing, employment, medical risk, abuse, social support and so on, 90 percent of the differences in birth weight between black and white moms remains unaccounted for.

"Most studies have looked at black-white differences during pregnancy, for example, differences in prenatal care utilization or maternal behavior," he says. "What we're finding is that these differences really explain very little of the disparities in birth outcomes."

Sister Space: A Mother's Tale of Survival: Part 1

A Sister's Story: Erica Simone Turnipseed was having a great pregnancy when she developed HELLP syndrome at 24 weeks. HELLP stands for Hemolysis or rupture of the red blood cells, Elevated Liver enzyme levels in the blood, and Low blood levels of Platelets. HELLP is similar to preeclampsia, toxemia and pregnancy-induced hypertension. Erica's blood pressure climbed to over 240/110, her kidneys failed, and a priest came in to absolve her of her sins. The last thing she remembered thinking as she lay on the operating table was, if I die will I go to heaven? Erica survived. Her baby, named Grace Ayodele Webb, lived a miraculous four days before she died. This is Erica's story:

"The day started normally but I didn't feel very good. But I thought it was something that I ate. I began to feel worse and I thought, something is not right. I went outside to catch a cab to the hospital but because of the rain and the heavy traffic the trip took nearly an hour. During the time in that cab, I went from discomfort to pain to continuous pain to the point where I was crying. I felt like something was really going wrong. When I finally got to the hospital there was a lot of protein in my urine and my blood pressure was rising.

The doctor said I had the symptoms of HELLP syndrome and I was given two steroid injections to help mature the baby's lungs so we can make it to twenty-seven weeks. To them twenty-seven weeks was the magic number for my baby's chance of survival.

I was in some sort of Twilight Zone. I had heard things about preeclampsia and HELLP syndrome but it was in the back of the pregnancy books and I hadn't gotten that far yet.

Things got progressively worse and during the night, the doctor came and said that they were going to have to take the baby immediately. My kidneys had shut down and my blood platelets were low.

A perinatologist came in and explained to me the prognosis for a 24-week-old fetus. There were what seemed like hundreds of people in this frenetic energy all around and you know it's all for you. A priest came in and gave me the Sacrament of the Sick, which is something they do if they think you might not make it. I realized that I was really, really ill. I sensed that at 24 weeks, they didn't expect the baby to live, but what was now clear was they weren't sure if I was going to live.

I heard them yell, "200/110."

I'm not a doctor but I know that is too high to be anybody's blood pressure. By this point I'm crying and thinking, this might be it. You get to a point where you can choose to fear death, but if it's going to come, it's going to come. A priest came and prayed over me and for me. He absolved me of my sins. And I told them that I wanted to donate my organs. When it was time for anesthesia, he told me to count to ten. I remember counting to three and that was it.

When I woke up, the first thing I heard was, "She's alive, Erica." It was my partner, Kevin. The baby had been baptized and he saw it. He said he heard her cry. She was under one pound. They wouldn't let me go see her. They said I was too ill. My pressure had gone up to 240 before they were able to stabilize me. That was very tough. How can you say that to a mother? Part of my recovery was to see her…

Read the rest of Erica's story next week in SisterSpace.

Erica Turnipseed-Webb, a graduate of Yale, is now a married mother of two other children and author of A Love Noire and Hunger, two critically acclaimed novels. She lives with her husband, Kevin Webb, in Brooklyn, New York. Her life-changing story appeared in The Mocha Manual to a Fabulous Pregnancy by Kimberly Seals Allers.

Do you have a pregnancy story you'd like to share on SisterSpace? Email me at kimberly@mochamanual.com

New Orleans' Lower Ninth Draws Tourists, Not Aid

Recently I attended a conference on health disparities in communities of color. The National Health Policy Training Alliance for Communities of Color hosted over 40 journalists of all hues and ethnic origins to convene in New Orleans to discuss how we can better cover healthcare related issues and the health disparities that still plague our communities. For three days, we sat in a top floor of well-appointed hotel in the lovely French Quarter, having a lively discussion on how we can get better and more thorough coverage of the issues.

Turns out the real story about health disparities and racial inequities was but 20 minutes away, across the bridge and down Claiborne Blvd in the Lower Ninth Ward of New Orleans. The Lower Ninth ward was destroyed during Hurricane Katrina five years ago. The area was the hardest hit when the levees broke and the low-income community residents were the last to get help. The images of bodies floating through the water still haunt me.

One would have no idea of what is still going on in the Lower Ninth Ward by walking through the downtown area of New Orleans. I too, enjoyed walking up and down Bourbon Street, looking at all the new apartments, shops and restaurants that were alive and bustling in the downtown area. There, you would think Katrina never happened. The city looks like back to business as usual.

Tale of Two Cities, Still

I've never been one to take things on face value. It is my experience that in most urban environments there is almost always a tale of two cities, and the tale of the brown city that exists across the railroad tracks or the bridge or whatever socioeconomic divide exists in that particular locale, is almost always starkly different.

So when a few of the local community leaders came to address us, what they had to say about the Lower Ninth Ward was appalling but not surprising. They said that of the $90 million that FEMA allocated to rebuilding, that the Lower Ninth Ward has not received any money. Nobody has been told a definitive answer as to why.

They said the Lower Ninth Ward only has one working school for kindergarten through 12 grade with 750 students and a 450 student long waiting list. There are no hospitals in the area and God help you if you need emergency care and have to travel across the bridge and across town to get it.

They expressed their outrage that tour companies bring bus loads of people through the Lower Ninth Ward everyday to gawk at their despair, yet never sharing any of their profits or stopping to support local businesses. They said that many displaced residents would love to return, but can't because there are no schools and no real health care options for the elderly.

Concrete Steps Lead to Empty Lots

On my last day in New Orleans, instead of buying souvenirs and taking in the tourist traps, I asked a friend to drive me to the Lower Ninth Ward. It looked mostly like a wasteland with a few nice new homes put up. I saw plenty of concrete steps that once led to a house, but now only lead to a field of 5- foot-tall grass. I saw where do-gooders like Brad Pitt and other organizations have helped rebuild new and colorful housing, that quite frankly, ust looks weird sitting next to devastation.

But what I mostly saw was the biggest disparity of them all--the wealth disparity. Money given to help those who have and no money to those who don't. In fact, it is clear that the powers that be have no intention of rebuilding that community. To them, Katrina has become a tragic opportunity to rid the city of some of its poorest residents--I mean, really, who wants them around anyway. So why rebuild so they can return?

Now a new plan for the Lower Ninth Ward is in the works and its message is clear: Poor blacks need not apply. New developments and higher rents are on the horizon, but there are no jobs to support them. Even though blacks built that city, created its music and its food culture, the winds of economic racism have no regard for history. So the displaced stay displaced. And the disparities linger. In health and in life.

Note: Please watch Spike Lee's latest documentary, If God is Willing and Da Creek Don't Rise on HBO http://www.hbo.com/documentaries/if-god-is-willing-and-da-creek-dont-rise/synopsis.html for a real look at the Lower Ninth Ward and the impact of the BP oil spill.