3 Things I Expect from My Visits to the Ob/Gyn

Photo by Clarke Sanders on Unsplash

So I had my annual visit to the lovely lady doctor recently and when I left, I couldn’t help but reflect on how horrible all of my experiences have ever been.

I literally had high blood pressure during my visit. The nurse asked me, “You feeling anxious, honey?” “Honestly, yes,” I answered her, too eager to get the whole thing over with to mince words. “I’m probably overdue for this visit, but I haven’t had many good experiences.” She offhandedly said they’d take care of me and launched into a series of monotonous questions.

As I walked out of the appointment, I called my mother and processed through my first TERRIBLE gynecology visit with her, for the first time. “Why didn’t you tell me,” she asked me. And I admitted that I’d felt really embarrassed and ashamed by the whole thing. My first gynecologist offered me no helpful education and made me feel really insecure about my body.

Why, I thought, WHY is this so difficult? Have I just had bad luck? Is my experience typical? If my experience is typical, is a good experience too much to ask for?

When I got home, I googled how to find a good gynecologist. And what came up but an article called, Why Is It So Hard to Find a Good Gynecologist? Here's a little excerpt:

"After sitting in a waiting room... I'd get a brusque and formulaic appointment that consisted of a pelvic exam, Pap smear, and a quick question about birth control, and then I was sent on my way. There was nothing horribly wrong with the care that I got, but having [had] an excellent general practitioner who was extremely thorough and spent a lot of time with me during my appointments addressing my questions and concerns [before], I suspected that it was possible to be more satisfied..."

It rung so true to me! Though it seemed to suggest that this is a single woman / non-pregnant woman phenomenon, while I’d go further and say it’s an overarching issue for most people. As for me, personally, this is what I'm still looking for, when it comes to finding an Ob/Gyn:

A Welcoming Atmosphere

In a perfect world, I would enter my gynecologist’s office to a lovely person offering me a glass of water with some cucumber or some fruit on the bottom of the glass; then I would be led to a massage chair, and I’d snack on dark chocolate until my name was called to see my doctor.

In the real world, I’m satisfied to sit in a reasonably comfortable chair and flip through magazines (magazines that show people who like myself and my family and my friends... just putting that out there 'cause I'm often a little salty about the lack thereof...).

Overall, this aspect of my gynecologist visits, though, tends to be just fine.


A Qualified, Caring Doctor Who Talks With Me

I’ve found that at most of my gynecologist visits, I’ve had doctors who’ve talked AT me, rather than with me. At this appointment more than any other I’ve had, I felt like I was on a clock. It was like a stopwatch had been started the moment I went into the room and it was just tick, tick, ticking away with every word I said. There was a tangible sense of impatience in the air when I mentioned that I had a list of questions that I had wanted to make sure I asked. At some points I felt talked down to. And overall, I just felt like the whole experience was an impersonal blur.

P.S. doctors, The American College of Physicians says there's "monetary value to [patient] comfort." (source) Good for me and for your bottom line! Let's do it.


A Genuine Attempt to Make Uncomfortable Exams as Comfortable as Possible

Well, of course some parts of going to the gynecologist are just uncomfortable. That’s health, that’s life. But I’d really appreciate an authentic attempt to curb that discomfort.

For me, I like to know what’s about to happen when my body is on a medical table. Asking for a patient’s preference on exam approach would be an easy enough thing for a doctor to add to their bedside manner. But realistically, it seems it’s probably something I’ll have to declare. Just a solid, “Hey, I’d really appreciate it if you just gave me a head’s up before you started something so it doesn’t catch me off guard.”

Also... redesigned speculum, anybody? The speculum dates back to the 1840s, an invention of James Marion Sims, "Father of Gynecologist," who experimented on slave women without anesthesia. The design is pretty much the same today as it was back then. Seriously.

Over 150 years later, we put a man on the moon, have phones that recognize faces, and speaker systems that talk to us, but the same damn cold metal device that people literally avoid gynecologist visits to stay away from.

Honestly, that’s all I want. It's pretty straightforward and simple. I want a comfortable wait, I want a doctor who’s not rushing me out the door, and exams done in a way that makes unavoidable discomfort a little more bearable.

It is NOT too much to expect a positive Ob/Gyn visit. Our reproductive health is too important for us to feel like we can’t talk to the health professionals who are supposed to care for us! Or have to mill in and out of their offices according to some arbitrary clockwork. Plus... shouldn't visiting doctors not just be about managing potential / current problems, but reaching higher levels of health / bodily satisfaction?

Have thoughts? Share in the comments below!


5 Ways To Pursue Birth Free of Oppression in the United States Today

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Last weekend I attended the 2017 Decolonize Birth Conference in Brooklyn, NY, by Ancient Song Doula Services and it was BEAUTIFUL — two full days of talking about the challenges and possibilities surrounding birth in the United States, especially as people of color, with what felt like at least 100 other reproductive health advocates and birth justice advocates.

It made me think about ways I can improve my own practice as a birth doula, as well as what innovative practices my community might utilize to improve the support and experiences parents have. Here's a breakdown of just five of the many things that touched me at this conference:

FIGHTING HISTORIES & SYSTEMS OF OPPRESSION IN THE BIRTH WORLD BY CREATING PATHWAYS TO SELF-DETERMINATION

“You must understand white supremacy. Reproductive justice without understanding white supremacy is only half the story.” Loretta Ross, Decolonize Birth 2017

On what grounds do we say that white supremacy has impacted or is today impacting the reproductive health landscape and realities of people in the US?

• The foundation of gynecology in the experimentation upon black bodies (learn more)

• The destruction of the legitimacy of black midwives to benefit the power structure of the white American male doctor (learn more)

• The statistical reality that Black women are 4 times more likely to die in or after childbirth than their white counterparts, regardless of class or educational status (learn more)

• Wide-reaching accounts of disrespectful treatment women and babies have received in birth settings, ranging in severity from offensive comments or behaviors (example, example) to harm due to ignorance/misbelief (learn more), to death (learn more, learn more)

So how do we combat this? How do we prepare ourselves and our communities to pursue the best outcomes? To pursue safety, let alone empowerment and births that fit who we are as unique individuals and families?

Well that's what social services are for, right? Filling the gaps for those who cannot afford the costs of this care? Having a case worker, having a program, having the ability to qualify to receive A, B, or C. Yet where has that led?

“Social services create dependency. Social justice creates pathways to self-determination.” Chanel L. Porchia-Albert, Decolonize Birth 2017

It’s a complicated web. Because while social services programs have offered access to many necessary materials and services, they have also been used to control who we think of as "deserving" access, and how we look at anyone who uses them.

Take the image of the Welfare Queen, for example — the myth of the Black woman who has children again and again and again to receive more money from the government.

Then look at how, because of this myth, caps were placed on the amount of social services assistance that families could have once they’d grown to a certain size (learn more, learn more) So that now we have families in economic need from the start being economically punished for growing another child larger.

Self-determination. The ability to choose which way one is going. So what does it look like to choose your care provider, to choose your birth location, to choose your vaginal birth or c-section birth, to choose your labor interventions or lack thereof (within medical reason), your comfort measures, your breastfeeding or pumping or formula, your disposable diapers or cloth diapers?

This is an area where doula work comes to life. A parent can only choose what they want if they know what they can choose from. And with care providers like OBGYNs and midwives carrying so many clients at a time, doulas have the time and space to sit one-on-one with parents and sort through their options and desires. This particular solution is happening in cities across the U.S. and we're seeing it work (learn more).


DECIPHERING BIRTH OPTIONS FOR PARENTS ON MEDICAID

Medicaid funded one third of all births in the state of Virginia in 2015 (source) and funds about half of all the births in the US, generally (source). So why does looking for the answer to a question like, “Can I have a home birth on Medicaid? And if so, what do I need to do?” feel like trying to solve a Rubik's cube? When I typed it into Google, all I could find was a few of mentions on message boards. No concrete examples, no practical advice or direction.

“How can you have a choice if social policies are targeting/impacting your choices?” Dorothy Roberts, Decolonize Birth 2017

Parents should have easy access to information about their options in pregnancy and birth, and how that intersects with their insurance coverage. The choice of care provider, or birth location should not be made because “we thought this was just the way it had to be.” Too often I’ve heard that it was.

There is a solution here. It’s simply (I hope simply, at least) a matter of finding out what’s going on in the community and sharing the information. I’ll be exploring this more as it pertains to Richmond, VA. And I hope it’s explored more in other cities and shared widely in those places as well.


HOLDING OUR LOCAL BIRTH PROVIDERS ACCOUNTABLE WITHOUT LAWSUITS

“When parents were asked whether they’d received respectful care, they often said yes. Yet when they were asked if they'd experienced specific disrespectful or abusive behaviors from providers, they often said yes.” Ynanna Djehuty, Decolonize Birth Conference 2017

I want to start this section with two acknowledgements: one is that no one goes into the medical profession thinking, "I want to hurt people." OBGYNs, labor and delivery nurses, anesthesiologists, etc. — all of these people save lives and we need them!

At the same time, we have this issue. The approach and quality of interaction and communication between birth providers and parents in the hospital setting has left many parents feeling unheard, disrespected, disregarded and sometimes even emotionally or physically traumatized, with a birth experience that was forced upon them without medical necessity.

Well, why not turn to lawsuits, then? While this reaction has its place, the fear of lawsuits also drives some of the disconnected, authoritarian ways that some care providers interact with birthing parents. Lawsuits aren't the only option, and they're not enough.

Rather than place the accountability into the legislative system's hands, what does it look like to put that power into the community?

Are there ways we can incentivize what we want to see? Like The Baby Friendly Hospital Initiative, developed by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) to encourage hospitals to support breastfeeding and bonding. Hospitals across the country now market themselves with this qualification.

Are there ways we can organize our concerns about care in a way that's helpful to providers? Like what was done with the Respectful Maternity Care Charter, created by the White Ribbon Alliance for Safe Motherhood, NGOs around the world, government groups and grassroots stakeholders. As a part of this campaign to assert and protect human rights around care in birth, groups created local accountability measures like hotlines and community dialogues reporting and discussing mistreatment in medical settings, which was then shared with health providers in trainings, and did result in changes (source).

What could that look like locally, for birth world stakeholders and community members to create a birth care standard and not only offer the ability to meet that to our local care providers, but also create a way for parents to report their experiences, and to create safe spaces to share these experiences with providers, so that they can use them as constructive professional development opportunities, rather than destructive career threats?


LEARNING HOW TO “BE” WITH WHEN WE DON’T “AGREE” WITH

"We have to learn how to 'be' with those who we don't 'agree' with." Loretta Ross, Decolonize Birth 2017

What does it mean to “be” even if we don’t “agree” as those who care for parents? What do these situations even look like?

• the collaboration between home birth midwives, hospital providers, public health professionals, researchers, and more (example)

• the communication between care providers trained through the technocratic model of care, which sees the body as a machine the doctor needs control to care for, and patients seeking the holistic model, which sees the patient as the decision maker in their health care experience?

• the collaboration between hospital staff that do not acknowledge the role of doulas and the doulas parents bring in those hospitals?

What “be” ultimately means is mutual respect. There has to be mutual respect between OBGYNs and home birth midwives, between care providers and patients, and between hospital staff and doulas to allow them to “be” in the situations above.

How do we get to mutual respect? Knowing each other’s roles and purposes, knowing each other's strengths and how we complement each other, meeting each other, and having spaces to safely dialogue about concerns and to be on the same page and establish trust.

In a field where there is literally potential work to be done every hour of every day, I think one of the major challenges in this area is simply finding the time and the space for so many birth workers to come together and learn.


PROMOTING REPRODUCTIVE JUSTICE AS MORE THAN A RESISTANCE MOVEMENT

“What’s going to happen when we win? This can’t just be a resistance movement.” Loretta Ross, Decolonize Birth 2017

My final lesson from Decolonize Birth 2017 is that this work isn’t just about resistance. It's not about one type of birth worker or model being better or worse. It's not about a system that's hopelessly broken. It’s about human rights.

Reproductive justice is about moving toward a brighter reality of birth in the United States. One in which the maternal mortality rate falls instead of rises, one in which birthing people – of all ages, races, ethnicities, gender expressions, family types, etc. – can be active participants in their health decisions, and can receive safe and respectful care with the same simple result time after time: happy, healthy babies and parents.

Did anything above strike you as something you want to learn more about or have something to say about? As always, feel free to comment below!


This Month in Music: September Vibes

Photo by Matt Glm on Unsplash

Photo by Matt Glm on Unsplash

I listen to music constantly. Work, eat, workout, play — these are some songs that have been traveling with me through September. What songs have been getting you through your month?

4 Simple Reasons the Educated Birth Is Here to Stay

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Welcome to the beautiful, blossoming little corner of my life where doula and design work get together and — ah! It's amazing. ☀️ There's something really sweet and funny about the fact that it's been nine months since I began this journey. January 16th, I opened up a little Etsy, with just one product, with very little expectation, and now, September 15th, after nine months of growing and working and editing and illustrating and thinking and receiving feedback — with over 30 items in shop — I feel really ready to just say, "Hey! Look! Look at my beautiful little bundle... of birth educational materials!"

So, yes! Intro! The Educated Birth is a collection of childbirth education materials created to equip parents for well-informed and empowering birth by equipping birth educators and doulas with them. And these past nine months are just the start, for a few very simple, and very meaningful reasons:

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1. Education Needs to Be Within Reach to Really Educate Anyone

It's really important that people — and their partners — understand their bodies and their rights when engaging with healthcare during pregnancy and birth. And while there are classes and books all over the place these days, it's not realistic that everyone will be able to access those items. Why? Many reasons, including:

lack of/ limited transportation, heavy work schedule, lack of/ limited time, lack of/ limited money, limited literacy/ language barriers, not knowing where to start/ feeling overwhelmed, discomfort with educational settings/ feeling like one doesn't belong in a space

One of the things that I love about doula work is that doulas can go to the parents on their terms, on their schedule, in space they feel is safe, and even at no cost if the doulas choose to volunteer or are a part of an outside-funded group.

That's why The Educated Birth is created with doulas and other birth workers in mind, rather than with parents as the target audience. Parents are welcome to all of these materials on their own! But it's most accessible if it's provided through a free, and relevant outlet.

And this is why The Educated Birth is created to keep text at about a high-school reading level max, with easy to skim blurbs to introduce parents to concepts that they can dive into more deeply with a doula, care provider or through other kinds of research, like the sources that are always quoted at the bottom. And this is why The Educated Birth will be expanding into other languages, as soon as I can make that happen!

I hope that these pieces can serve as a doorway into the education that parents need to pursue the birth and postpartum that fits them, and to defend them when necessary.

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2. We Need More Things That Say, "This Was Made With You in Mind Because You Matter."

I've said it before and I'll say it again. Reproductive health affects everyone:

women, men, non-binary & trans individuals, POC, LGBTQI, immigrants, communities in poverty, faith communities, incarcerated people, youth, disabled individuals, etc.

Yet, in the few materials that I was able to find when I was starting out as a doula, there was very, very limited diversity shown. And this was something that I've heard echoed again and again by others in the birth world.

When I started out, my main concern was showing women of color in my pieces. Throughout the first 14 infographics that conviction definitely shows. But my perspective has been widened since then, thanks to many amazing people who helped me see beyond my initial concern — one that I personally identified with — to other concerns that had never personally occurred to me.

This is why The Educated Birth is committed to using gender neutral language that doesn't assume the reader's self-identification. And this is why as I illustrate for TEB, I will continue to be intentional about showing a variety of ages, cultures, gender expressions, family structures and other lived experiences.

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This is truly a journey, and one I'm so grateful to be on. I'm sure there will be many moments in which I go back and make changes and updates because I realize I could have created something better. I welcome that. I need accountability, and I need support. I'm not perfect, and I'm not going to hit the mark every time. I'm very thankful to those who have reached out to me about aspects of diversity that are important to them and I cherish that, so please, feel free anytime.

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3. Artwork is Attention-Grabbing, Tone-Changing and Revolutionary

Color draws peoples' attentions, and impacts tone and mood. And if I see a nice illustration that reminds me of myself or my sister or my friend — I'm probably going to take a closer, second look. And I might even share! And I might even read the little two-line description by the image, haha.

So much of the healthcare world comes across as stark and sterile: white walls, tiled floors, waiting rooms, and dreary brochures on a table. Although, even that's beginning to change, as some hospitals realize the power of color and plant-life and making these medical spaces more vibrant and welcoming.

I approach my design style by asking myself, "What kind of images on this topic would empower me? What might help me fight my anxiety as I learn about this experience I'm nervous about? What will make me smile? What feels realistic? Not sugar-coated?"

I pull a lot of my illustration work from styles I see out in the world everyday! And let me just tell you, I LOVE illustrating hair! Ah!

Moreover, there is so much politics to what kind of styles are appropriate, relevant, and beautiful today. Just the very act of showing someone can be a revolutionary statement, a declaration of existence, and an insistence that that existence is both beautiful, relevant and here to stay.


4. This is How I Doula and How I Want to Invest in More Doulas in My City

Let's be completely real. Just like there are many reasons it can be difficult to get education and support throughout pregnancy and birth as a pregnant and birthing person, there are many reasons it can be difficult to choose birth worker or doula as your job!

I feel so fortunate to be self-employed and have the flexibility to say, "Yes, I can be your doula at no cost," to many families I work with. And honestly, The Educated Birth has been a huge reason why I have been able to do that.

But I don't want The Educated Birth to just be about my own personal doula journey. Already, I've been working with a collective in my city called The Richmond Doula Project. Being able to offer my infographics to other new doulas, and get feedback from others here — you can't put a price on that experience.

BUT. REAL TALK. We've got to make money to open doors for all of our doulas to take time off of other jobs or to pay for childcare.

So this is the part where I am ready to say, I want to keep this ball rolling! I've been so amazing and excited by the amount of sharing that has happened so far just via word-of-mouth, FB groups, and Instagram.

If you can share with your circles, please share! If you have a blog, let's chat about connecting! If you're a part of an organization that could benefit from having some The Educated Birth stuff around, yesssss, let's get on the phone! If you have any other thoughts or ideas, let's connect on those too!