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IH/IBP teams up with Healthy Start.

When I attended one of Informed Homebirth's (there was no IBP yet) very first childbirth educator trainings in Sacrameoto in 1980, I had no idea how greatly it would influence the rest of my life. At that time, I thought that becoming a birth educator was merely a step on the path to midwifery. What I didn't realize at the time was that birth education wasn't just a step but a foundation and that IH wasn't just an organization but a role model.

Over the years, I've observed IH/IBP to be a good model of a proactive organization. By 1981, IH added "Informed Birth and Parenting" to its name in the realization that all women need to be informed, regardless of where they give birth. By 1982, the childbirth educator manual had evolved from the half-inch thick version I'd received to a much larger version. Many of the added pages addressed psychological aspects of pregnancy as well as sexuality during pregnancy. No one else was doing this. I too had evolved from a young woman on her home birth soapbox, to a slightly older young woman who was teaching three classes a week in an obstetric practice (they even put my name on the office door!) for predominantly hospital-bound students. Everything in my teaching outline was avidly consumed by these classes, especially the psychology and sexuality material.

In 1983, IH/IBP and Karen Parker introduced the Basic Midwifery Skills workshop, later to become the Childbirth Assistant Training. The switch from Basic Midwifery Skills to Childbirth Assistant Training was a response to what IH/IBP perceived was the need of all women giving birth, not just those fortunate enough to have a midwife. We, as an organization, are now in yet another evolutionary phase as reflected in the latest versions of the childbirth assistant training and certification program. This once again demonstrates IH/IBP's responsiveness, sensitivity, and innovativeness.

Sometimes the chance to be responsive comes to us. In late May, the director of training for the Healthy Start Program in Pittsburgh contacted IH/IBP. Healthy Start is a federal program to help lessen infant mortality in the United States. Their first goal is to decrease infant mortality in 15 selected communities that have alarmingly high rates of infant mortality. Special grants help these communities expand health and social services, outreach, childbirth education, and infant care education in their "clients" neighborhoods.

Eartha Sewell, Healthy Start's dynamic director of training, had been trying uosuccessfully to get her crew of social workers, outreach workers, and nurses trained as childbirth educators. Appallingly, Eartha was running into racism in her efforts. Fortunately, Eartha mentioned her dilemma to a frieod, who knew someone (Cordelia Hanna, Southern California Regional Coordinator) who might be able to help. Cordelia spoke with Eartha and told her to talk to IH/IBP. I was the person that Eartha called. I couldn't believe what a great opportunity this would be for both of our organizations!

Things rapidly fell into place, and IH/IBP scheduled a training for the Healthy Start group in Pittsburgh in late June. I spent some time speaking with Eartha about their specific needs and concerns so that I would be able to customize a training that would meet these needs while still incorporating IH/IBP's unique approach.

As I started to work on this program, I had the startling realization that childbirth education, like so many other important rites of passage in the United States, was really only a white, middle- and upper-class phenomenon. How could the preparation for birth, a universal women's rite of passage, bypass whole populations of women? How did this tie in to the horrendous infant and maternal mortality statistics for these very women and their babies? Of course it occurred to me that there would be culturespecific preparation going on, but what about the essential preparation needed to protect oneself and one's baby from the system? Were women of color going blindly into the medical complex and having to place their trust in "the man" yet again?

As it is, I'm on the radical fringe of birth education, working for an organization whose mission is to provide women with information about alternatives in birth, parenting, and early childhood. The goal is to empower all women in the childbearing years to become informed of their options and to take back their decision-making power concerning their bodies, their health, and their children. Seemingly, this mission applies to all women--but can it really apply to all women in our society?

My initial excitemeot about being offered the opportunity to bring this sort of information to an inner city minority population was tempered by my concerns about the appropriateness of me, a white woman, being the one to share this knowledge--especially after my realization above. It was repugnant to me to think that I might be perceived as patronizing or insensitive. The material that I try to share with all women, regardless of ethnicity, socioeconomic status, religion, or any other difference is too vital to all women to not be heard because of white clumsiness.

I was also concerned because I realized that my own inner-city upbringing (Oakland, California) and my fairly progressive beliefs did not remove the societal privilege that is inherent in being white. I knew I was not exempt from bias in my attitudes and beliefs concerning women of color; as conscious as I thought I might be--and as great as my IH/IBP training was--my training certainly didn't include much in the way of ethnic or cultural concerns. In short, I did not want to uomindfully drag all of my white, middle-class baggage to Pittsburgh, so I started to do some homework.

I saw two issues to work on: (1) how I could be the most effective, given my expertise and backgrouod, and (2) how to learn more about the "world," the experience of life of the group Healthy Start was focusing on. I started at the library. First, I tried to find relevant ethnic and cultural information with emphasis on women's health. I searched uoder "Health, African American"--nothing! I looked uoder "Health, Minority"--some government statistics. Uoder "Health, Black Women's," there were two listings, and both were disgustingly inadequate. The material presented had more information on hair care than on women's health. What was going on here? I was appalled by the lack of real, usable information regarding women of color and health.

I kept searching uoder various headings, and in the end, I was able to find four books that seemed like they'd be helpful. Out of these four, only two turned out to be of value. One of the four, pertaining to Black women's health, had a total of 1-1/2 pages devoted to concerns of pregnancy, birth, and infancy--when maternal and infant mortality are considered to be one of the top health concerns of African Americans!

Of course I could find mountains of numbers (statistical information), courtesy of the U.S. Department of Health and Human Services. For example, African American children are twice as likely as white children to

* die in the first year,

* be born prematurely,

* be born with low birth weight, or

* have mothers who had very little or no prenatal care.

African American children are three times more likely to have their mothers die during birth and five times more likely to have an unmarried teen mother.

With statistics like these, I would have thought that there would be many, many resource materials to help women of color get the information that they need for healthy pregnancies. This made me angry--angry at the lack of meaningful and usable health information for women of color, angry about women and their children receiving substandard care, angry that politics and society still have the ability to affect access to good perinatal care.

Health care in the United States, as we know, is currently a commodity rather than a right. It requires money. But perhaps more important, it requires a lot of courage for a woman of color to enter the health care complex. In this complex, women of color have to deal not only with the sexism that all women face but often also with blatant racism and elitism. But there is more: there is the potential violence within the experience.

As a birth activist, I have often compared the routine hospital birth experience with violence against women. Sheila Kitzinger, a birth anthropologist, calls it "institutionally sanctioned violence against women." She is referring to the routine depersonalization (removal of her own clothes), forced restraint (IVs and fetal monitors), multiple vaginal penetrations by people unfamiliar to her (to "check the progress of labor"), and often, geoital mutilation--also called episiotomy. When I read in more than one article by women of color that "the system" is genocidal toward their people, it struck a familiar chord. No wooder the statistics show little or no prenatal care and poor maternal and infant outcome. A woman with any sense at all would stay away as long as possible.

One way I could use this anger was to do something about this situation. I taught the workshop in Pittsburgh (it was great!), but that isn't enough. Since then I've spent a lot of time thinking about a curriculum and materials that would work for all women. It is fascinating, challenging, and discouraging. It has been, and continues to be, an ongoing and uphill battle. This work directly challenges the technocratic version of health care that we have in the United States. Not only is the current medical system not woman centered, but it is often not even accessible if one doesn't have money or education or is the "wrong" color. When I feel that discouragement, I like to look at this quote from Audre Lord (from A Burst of Light, Firebrand Books, 1988):

When I needed to know, there

was no one arouod to tell me that

there were alternatives to turning

myself over to doctors who are

terrified of not knowing every-

thing.... Sometimes we are

blessed with being able to choose

the time aod the arena and the

manner of our revolution, but

more usually we must do battle

wherever we are standing. It

does not matter much if it is in

the radiation lab or a doctor's

office or the telephone company,

the streets, the welfare depart-

ment or the classroom. The real

blessing is to be able to use

whoever I am, wherever I am, in

concert with as many others as

possible or alone if needs be.

After reading this, I can usually let go of the frustration and rejoin the battle: the very important work that IH/IBP continues to do for all women.
COPYRIGHT 1993 Association of Labor Assistants & Childbirth Educators
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1993, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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Title Annotation:Informed Homebirth, Informed Birth and Parenting
Author:Stone, Catherine
Publication:Special Delivery
Date:Sep 22, 1993
Words:1787
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