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Women toppling the business monopoly on childbirth

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    As Kentucky families desperately seek safer, more cost effective maternity care options, the Kentucky Hospital Association and Kentucky Medical Association cling to their monopoly on the market.

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    For pregnant people and those who work with them, these ethical concepts around their care are critical.

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    So what does a doula do when her client is being violated right in front of her?

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    ACOG discourages physicians “in the strongest possible terms” from the use of coercion and court-ordered threats or interventions against pregnant women.

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    There is no excerpt because this is a protected post.

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    The performance of medical procedures without consent on a competent adult is unethical, unprofessional, and possibly illegal.  More specifically, when a medical or midwifery professional administers a procedure without the consent of the pregnant or laboring person–including a vaginal exam, stripping of the membranes, breaking of the water, or episiotomy–it is obstetric violence.  Procedures involving the genitals may […]

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    "It is not at all obvious that we should always be so focused on perinatal mortality."

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    This short Birth Monopoly video looks at the reality families face in a state where, in many ways, hospitals have more control over birth than women do.

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    How are women "allowed" and "not allowed" to give birth on their own terms? In our first three episodes, we discuss the Kentucky birth monopoly, home birth, obstetric violence, bans on vaginal birth after Cesarean (VBAC), and being a doula in an abusive system.

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    Cristen talks with Susan Jenkins, perhaps the most experienced midwifery law lawyer in the U.S., about the decades-long struggle of midwives and consumers vs. "Organized Medicine."

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    **TRIGGER WARNING** for description of assault of a laboring woman

    In our fifth episode, Cristen speaks with an anonymous doula in Alabama who describes the cultural shift that is happening there slowly, but where women are still largely disempowered from making choices among a full set of options.  While things have improved over the last decade, there are still the doctors who tell women they will die if they attempt to have a natural (unmedicated) birth in the hospital.

    The doula says, “I think that’s the message that gets thrown out a lot: ‘You’re broken.’  Most of the time when that happens, generally moms switch from a more self-directed path to a more managed path. . . . They become more stressed, more fearful. .  . . If you’re looking at it from the perspective of, ‘I want this woman to do what I want her to do,’ it’s a really effective message, saying, ‘You’re broken.  I can fix you.'”

    More information on the Malatesta v. Brookwood case, mentioned in the show:
    Caroline’s story in her words
    Yahoo! article on the lawsuit
    WELD Birmingham article on other women’s stories in the community
    WELD Birmingham analysis on the verdict

    More Birth Allowed Radio episodes here

    Episode 5 - A Doula Watches Culture Shift in Alabama, Assault in Labor & Delivery

    LISTEN

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    Sen. Vivian Davis Figures drops a truth bomb in the Alabama legislature: "Who do you think birthed your ancestors. Uneducated slaves, ok? They were midwives."

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    Episode 6 - A Feminist OB Puts Her Patients in Charge & Outcomes Improve

    In this episode, Cristen speaks with Jesanna Cooper, an obstetrician at an urban Alabama hospital serving a high-risk population.  Dr. Cooper describes the unintentional outcomes of a change in practice at her clinic: Once they implemented a feminist care model, putting women in charge of their own medical decisions, Cesarean rates began to drop and other outcomes, like breastfeeding and NICU admissions, improved.  Dr. Cooper also discusses her own job-related trauma and medicine’s blame culture. (May 2017)

    LISTEN

    Episode 7 - Georgia Mothers Fight a Hospital Monopoly / **TW for description of non-consented episiotomy**

    In Episode 7, Cristen speaks with Zawn Villines, lead organizer of the community effort to push back on Dekalb Medical’s policies involving childbirth options and rights and their decision to push out a midwifery practice and doctor known for respecting patient decisions.  Katie Kissel, a local mother, shares her surprise at discovering that the head of obstetrics at Dekalb as these events transpired is the same doctor who laughed at her birth plan and gave her an episiotomy without consent during the birth of her first child. (May 2017)

    Families protest birthing polices at DeKalb Medical, suspension of doctor

    LISTEN

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    Episode 7 - Georgia Mothers Fight a Hospital Monopoly / **TW for description of non-consented episiotomy**

    Katie Kissel was stunned when, she says, Dr. Dawn Mandeville didn’t wait for her consent and cut an episiotomy on her during her first baby’s birth at Dekalb Medical in Atlanta, Georgia. The doctor simply stated she was going to do it, and before Katie could respond, it was already done.

    This was after, Katie said, the doctor and some staff had shared a chuckle at her birth plan in her presence.

    For her next birth, Katie transferred her care to SeeBaby Midwifery, a popular practice overseen by “top doc” Dr. Brad Bootstaylor. That birth was “like night and day” compared with her first. The events of that birth and the healthcare she received matched her expectations in a way that made her feel respected and empowered. It was such a great experience, she “couldn’t wait to do it again.”

    So, Katie was upset to find out that SeeBaby and Dr. Bootstaylor were under fire at Dekalb not once, but twice this year, with hospital policies changing to restrict patient choice in a way that seemed targeted at SeeBaby patients. Finally, in May, the practice’s privileges at the hospital were suspended with just two hours notice–leaving pregnant women scrambling. It happened so fast that some of them even showed up to give birth at the hospital without realizing that their care providers could not attend them.

    Even more stunning for Katie was finding out that Dr. Mandeville was the head of OB as all this went down.

    Hear all about Katie’s story, as well as from local mother Zawn Villines, who has led the very effective community protests and organizing against the changes at Dekalb on Episode 7 of Birth Allowed Radio.

    UPDATE: Here is local coverage on the May 19 protest of Dekalb Medical.  SeeBaby Midwifery has since moved its practice to a new facility in Atlanta and is serving families there currently.

    LISTEN

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    ARTICLE COMING SOON (JUNE)!

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    PREVIEW:

    This question comes up because of the many women who have contacted me to report that when they complained to a hospital about receiving a non-consented or forced procedure in birth, they were told by the hospital that their explicit consent was not necessary because they had a) agreed to be admitted to the hospital or b) signed blanket consent forms giving the medical staff permission to treat them.  When it comes to maternity care, hospitals sometimes cite the idea of “implied consent” to describe this idea, that admission to the hospital or signatures on consent forms mean automatic consent to any and all treatment decided upon by medical staff.

    This belief and these statements by hospitals are wrong, legally and ethically.  Here’s why…

    Listen to Birth Allowed Radio’s latest podcast on this topic!
    Episode 8 – Woman Records Confrontation with Hospital re: Consent, Experts Refute Hospital Defense


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    Here the actual recording of a hospital misinforming a violated woman about her clinical care and legal rights, plus commentary from experts on why the hospital is so wrong.

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    In this episode, Cristen speaks with an experienced Labor & Delivery nurse about the obstetric violence she has witnessed and even participated in.  She says, “I’ve seen doctors pry women’s legs apart with their elbows… I’ve seen doctors check people [vaginally] while the women were saying, ‘no,’ …”

    She also talks about advocating to change a patriarchal system: “I truly believe that the women in any given community have way more power than they realize. [They] can take over if they really put their minds to it.”

    Episode 9 - An OB Nurse Talks Obstetric Violence, How to Make Change

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    [45 minutes] “Brookwood is my Brock Turner”: In this episode, Cristen speaks with Caroline Malatesta, the Alabama mother who won a lawsuit against her hospital after she was permanently injured in a “wrestling match” with her nurses during childbirth–in a place that promised support for unmedicated birth. One piece of Caroline’s journey that she has not spoken about publicly before is how, in the aftermath of the assault, her doula and the local doula community responded to her. It’s an important perspective from a birthing mother and doula client.

    “It became crystal clear to me that doulas weren’t interested in talking about my abuse, much less associating with me. After all, the relationship with my abuser was too important. This is where the trauma begins and the counseling begins, is that…. I was expecting the exact opposite. Because I naively thought doulas were advocates for women, for birthing women, not advocates for hospitals. And it stung really badly. I felt incredibly isolated and alone because of that response. And I’ve never really got over it. And frankly it almost silenced me and stopped me in my tracks right there.” – Caroline

    Listen on SoundCloud or iTunes

    Episode 10 - An Injured Mother/$16M Lawsuit Winner Offers Her Perspective on Doulas & Abuse

    LISTEN

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    [56 minutes] In this episode, Cristen speaks with Traci Weafer, a Southern doula who believes that speaking up for laboring women and having great relationships with hospital staff are not mutually exclusive. As an example, she shares about the time she stopped a doctor from cutting her client when he started to do an episiotomy without consent–a doctor who later asked her to share more information about why her clients were declining episiotomies.  Traci has a wealth of knowledge and experience about bringing together everyone in the birth room to support the birthing person in an area where that can be extra challenging to do.

    Listen on SoundCloud or iTunes


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    The concept of "implied consent" is sometimes mischaracterized by hospitals to justify violations of women's dignity and rights in childbirth.

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