Part 2: Conversations with Fargo Area Pro-Choice Doulas

Doula and Writer, Janelle Brandon, with her daughter.

By Vanessa Norton, BADP Volunteer

To me, the keystone of being a full-spectrum doula is giving non-judgmental support across the spectrum of reproductive choice. It's not about a polemic; it's about care and it innately recognizes the complexity of these choices. Although the term “full-spectrum doula” did not seem to be used in Fargo, it resonated with many of (birth and) reproductive workers we spoke with.*

In response to the term “full-spectrum doula,” Janelle Brandon, a writer and doula living in Moorhead, MN, told us, “when I heard the word “full-spectrum,” it was like 'flash of light.' This is the perfect term, something I've been talking about with trusted friends...it's an open term that makes you really consider...but it doesn't exist here.”

Although Janelle clearly felt in sync with supporting women's choices across the spectrum, and is “out” as pro-choice on Facebook, there are enough Christian Conservatives within the birth community that Janelle feels she is in the minority. “I want to be careful about ruffling feathers. It's something I'm a little sad about, often times I feel bullied, but while I would love to serve women no matter what, I don't want to engage in the argument [with anti-abortion people].”

In response to what she would do to support choice if RRWC were to close, she hoped RRWC would move across the river to MN, then stated, “but I don't want to live in that world.”

Crystal Wolf, another doula living in Moorhead, who runs Motherwise, an evidence-based parenting Facebook page, felt that the Fargo-Moorhead doula community was strong and developed compared with much larger population centers in the Midwest. “Maybe it has to do with the fact that it is so Christian and family-based here, and also the lack of rules around homebirth.” [Homebirth is a-legal in North Dakota.] In terms of supporting RRWC, Crystal stated, “if they're having a rally, I go to that, but I don't have the time to do much beyond that.” Crystal is mother to a 3-year-old daughter and was 37 weeks pregnant at the time of the interview. Still, she spoke of helping two friends miscarry unwanted pregnancies by suggesting herbs and acupressure points.

Heather Jackson, a doula and abortion rights activist living in Grand Forks, ND (90 miles north of Fargo) organized a rally attended by 150 people (“huge for Grand Forks”) when the Governor signed the anti-abortion bills last March. She is “out” on her online doula profile as pro-choice and queer friendly. Even as a time-strapped single mom and full-time graduate student, Heather not only organized the rally, but started making maps to clinics in Minnesota and was preparing to help women access those clinics.

Lysa Ringquist, a former patient educator and “hand-holder” at RRWC has a room named after her at the clinic. She spoke of breathing techniques, looking into patients' eyes, and helping to “keep the patient in her own calm, in her own strength." "I felt I was doing doula work,” she said. When asked about what she'd do if RRWC were to be shut down, she responded, "I know how to do the procedure. We talked about performing abortions ourselves."

It seemed that even if these doulas had not heard of the term “full-spectrum doula care,” they were each, in some capacity, thinking and operating within it. Not only was there a sense of identification with the idea, but it was clear that the actions of full-spectrum doula care were happening in Fargo too, despite the lack of a cohesive full-spectrum doula organization.  

*We also spoke with some doulas who identified as pro-life. More on this in another post.    

(more to come next week!)

Exploring the Concept of Full-Spectrum Doula Support Around North Dakota's Only Abortion Clinic

By Vanessa Norton, BADP Volunteer

Part 1:

In March of 2013, North Dakota Governor Jack Dalrymple signed three of the country's most restrictive anti-abortion bills into law, including the fetal heart law, which ostensibly would outlaw abortion in the state. At the time, I was safely tucked away in my Bay Area bubble, working to complete my birth requirements for doula certification, but noting the passage of anti-abortion bills in several states. The North Dakota legislation stuck with me, perhaps because my great-grandmother was born in Fargo, and I'd spent time writing in the Dakotas and knew something of the isolation of the landscape and the cold winter, which makes everything more intense. I wanted to be in Fargo, to see what it was like for the Red River Women's Clinic, the only abortion clinic in the state, and for the pro-choice community in general. I friended the Red Women's River Clinic on Facebook, and started paying attention.

In July, I had the opportunity to spend a week in Fargo with my friend and fellow full-spectrum doula, Lucy Yanow. Lucy works as an abortion counselor at SFGH's Women's Options Center. As full-spectrum doulas, we share how we see reproductive rights—as a spectrum of choices to be supported. Each of these choices is right, and each has the potential for empowering the woman making it.

We arrived in Fargo expecting a kind of anti-abortion frenzy around the clinic and the city, but found nothing of the kind. I realized in retrospect that this assumption revealed my own cultural isolation. The Red River Women's Clinic (RRWC) is located in a historic downtown building, next to a bar with outdoor seating. Although there are two prominent Crisis Pregnancy Center billboards within a block of the clinic, they didn't seem to effect the calm, confident atmosphere around the clinic.

Inside, this confidence extends to a highly-developed clinic culture. The place is clean, professional, and uplifting. There is a shelf holding plants in handmade ceramic pots with handwritten notes, well-wishes for clinic patients. Plants for Patients, the non-profit that creates these gifts, procures the pots from local ceramic artists and holds periodic note-writing and potting get-togethers in Fargo cafes. Not at all what I'd expected. Plants for Patients doesn't affiliate with either “side” of the abortion debate, but rather exists to support the women. It also acts to connect the Fargo community and the RRWC and de-stigmatize it.

When I patronized the local bars and restaurants, telling people why we had come to town, I heard some version of “good for you.” I never heard anything derogatory. RRWC Director, Tammi Kronemaker, pointed out numerous instances of support, or at least fairness, shown by local authorities. For example, Fargo added a subsection to its building codes to allow glass blocks instead of windows, so RRWC could maintain confidentiality for its patients; furthermore, the former chief of police approached the clinic to see how they could work together. Tammi showed me a hand-written letter from the family who'd owned the clinic building for decades, stating its support for women's rights and for the clinic.

So then why the most restrictive anti-abortion laws in the country? Tammi explained that these laws are the result of a strategy made outside of North Dakota by the pro-life movement (notably, Americans United for Life). “Outside of the few right wing extremists, most North Dakotans have libertarean values and are quietly pro-choice.” In fact, it's a misconception that there is one clinic in the state because the others were run out. Actually, one clinic serves North Dakota's population of 700,000 quite well. RRWC perfroms about 1200 abortions per year; if there were two clinics, the number would simply be halved. 

Clearly, the story was not about the anti-abortion frenzy surrounding the RRWC. We moved on to exploring Fargo's doula-midwife scene. We wanted to know where, within (or without) the spectrum of reproductive choice, did Fargo's birth workers situate themselves? Is there a notion in Fargo of full-spectrum doulas? What do they think, and what are they doing, if anything, in response to the new anti-abortion laws?  

 (More to come next week!)

Notes From the Salon: Midwifery Paths and Practices

By Becky Michelson, BADP volunteer

On October 23^rd, the living room of Langton Labs overflowed with people eager to learn more about midwifery paths, lifestyles, and perspectives. To understand the distinctions, nurse-midwifery student Holly Carpenter moderated a conversation with Kim Dau, a certified nurse-midwife (CNM) and Maria Iorillo, a certified professional midwife (CPM). Kim is the Assistant Director of the nurse-midwifery education program at the University of California, San Francisco (UCSF) while Maria has attended over 1100 births, primarily in homes.

Some general points of departure between CNMs and CPMs are their education, places of practice, and privileges. CNMs are initially trained as nurses, may practice in hospitals and clinics, and can provide first trimester non-surgical abortions in some states (and recently in California, thanks to the passing of AB154). CPMs can choose from a combination of midwifery certificate programs and apprenticeships and practice in homes and birth centers. There are many nuances regarding the legality of both roles on a state basis. Many research studies cite the benefits of having a midwife as your primary health provider, such as lower rates of preterm births and interventions.1 The American College of Nurse-Midwives has more information on essential facts about midwives.

The Salon Series was intended to shed light on the different ways of practicing midwifery and their respective certifications, work dynamics, and parameters. Instead of having this instructional focus, the gathering felt more like a community bonding through story sharing. Despite their differing paths, both midwives shared stories that reaffirmed their life’s purpose of being in service at births where they felt in awe of the immense courage and vulnerability displayed by mothers.

Kim’s path began working in a laboratory after finishing her undergraduate studies in Biology. She missed connecting with people in her work and her desire to pursue midwifery was sparked from reading Immaculate Deception by Suzanne Arms and Spiritual Midwifery by Ina May Gaskin. She embarked on a journey west to gain experience by working at birth centers in Oregon, New Mexico, and Texas. After attending the UCSF nurse-midwifery program she worked in North Carolina at Duke University for several years, before returning to San Francisco in clinical capacities at both Kaiser Permanente and San Francisco General Hospital. In the past few years, she has maintained a clinical role at SFGH while fulfilling her dream of working in CNM education as the Asst. Director fo the nurse midwifery program at the University of California, San Francisco. Meanwhile, Maria Iorillo attended midwifery school at age 23 and received her licensure in New Mexico. When she moved to California, midwifery was illegal. She has maintained attending 4-8 births a month and has been practicing her incredible craft for over 28 years.

Upon painting a picture of their paths, the conversation shifted toward what midwifery is about and the elements of inspiration. Maria explained that to her, midwifery is about creating a safe space for women who are being vulnerable and courageous enough to seek their own authentic power. Women often seek her care with a deep belief that they are capable of birthing, and she facilitates their connection with that inner power. Maria told two stories about unexpected c-sections and home deliveries where despite the unexpected changing circumstances of the women’s intended births, they emerged supported and empowered. Kim also shared poignant birth stories that included a family confronting melanoma and a laboring woman who was recently grieving her partner. Kim stayed present in these intense experiences, holding space for the brave families. She also spoke of how offering support during trying situations has led to her own potent self-growth.

The Salon Series also included a handout called, “A Baker’s Dozen Ways for Doctors and Midwives to Preserve Simple Birth.” Kim and Maria’s stories included elements of the handout’s holistic advice that supports birth as not just a clinical but also a social process. A few of these recommendations include:

• Ask permission to touch the laboring person in your own language

• Dissolve fear by providing options

• Keep the baby and mother together

Both midwives also highly recommended Witches, Midwives, and Nurses: A History of Women Healers by Barbara Ehrenreich.

In thinking of a vision for cultural change, both midwives promote women being treated with respect, kindness and as if they are smart enough, which they are, to make their own decisions without the manipulation of hospital staff. Beyond the birthing process itself, Kim is excited that more midwives are sitting at tables they previously have not before, meaning that the midwifery perspective is being taken into account more frequently on issues such as neonatal and infant care on state and management levels. Midwives are still a minority health care provider, but at least in the Bay Area, interest and support for them is rapidly growing.

After an evening of stories filled with with births, unexpected events, midwifery muses, and raw inspiration, Holly exclaimed that the UCSF midwifery program should be expecting many more applicants this year. With the full house of doulas, advocates, allies, and aspiring midwives bubbling with questions, anecdotes, and curiosity- she must be right. Thank you Holly, midwives, Salon Series team, and engaged audience!

1. http://www.huffingtonpost.com/2013/08/20/midwifery-benefits_n_3787058.html 

Meet the Doulas: Vanessa Norton

Who are the doulas who volunteer with the Bay Area Doula Project?  They're amazing, diverse people, doing so much great work in the world, it's hard to believe any of them has time to volunteer with us. We've been using this space to introduce you to many of the BADP doulas.  This week, meet Vanessa Norton.

Vanessa is a full-spectrum doula and freelance writer originally from Buffalo, NY. She is thrilled to work with BADP/ACCESS and sees this work as powerful and personally transformative.

She was introduced to reproductive justice as a high school senior in 1992. As an ACT UP activist, she took part in organizing the local community to successfully defend its clinics against Operation Rescue. For the following 3 years, she worked in clinic defense in Detroit and elsewhere around the country. She has since completed a BA in Anthropology/Gender Studies from Bard College, an MFA in Creative Writing from the University of Oregon, published several short stories, and spent years teaching English and Applied Arts abroad. In 2012, she became a certified birth and postpartum doula through Cornerstone Doula Trainings and fell in love all over again with the world of reproductive justice.

She often travels outside the Bay Area to research the places she writes about. This past summer, she spent a week in Fargo, North Dakota, where she interviewed local people working the full-spectrum of reproductive options: the director and workers at the Red River Women's [abortion] Clinic, birth doulas, midwives, and community members who publicly support the patients at the clinic through creative projects.

Vanessa lives in Oakland, where she loves tending her indoor garden and has recently taken up taxidermy. She plans to pursue a professional midwifery path this winter.

Blog Series: Notes from a Full Spectrum Nurse-Midwifery Student

by Holly Carpenter, RN, UCSF School of Nursing-CNM/WHNP Candidate 2014

Part I: Finding Full Spectrum Nurse-Midwifery

Part II: What are we being taught? What do we "want" to learn?

In the previous post in this series, I introduced the big picture of nursing education in sexual and reproductive health care. This section discusses the extent of training that currently exists within nursing education programs in U.S., including a student-led elective that was piloted at UCSF this past year.

Both APC and pre-licensure nursing students still face a fairly bleak picture in terms of standard SRH training and education. In a preliminary review of existing curriculum and educational programs, the results demonstrate a significant need for further study and development of curriculum. Most importantly, we have zero baseline data regarding the content in RN (or “pre-licensure”) programs in terms of sexual and reproductive health. Without this information, we can only operate on assumptions to make the case for improvement or plans for curricular change.

The sole national survey of APC programs (conducted in 2001 and not updated since) demonstrated that only 53% of schools in the U.S. offer didactic instruction in medication or aspiration abortion, and a mere 21% offer clinical training in these procedures (Foster et al. 2006). This is all despite the fact that “professional associations and accreditation bodies have repeatedly identified the need to include reproductive health in the standard curricula” including The American Association of Colleges of Nursing (AACN), the National Organization of Nurse Practitioner Faculties (NONPF), the AAPA, and the American College of Nurse Midwives (ACNM), all of whom have “...developed guidelines that recognize the need for their graduates to possess competence in providing care related to sexual and reproductive health” (Taylor et al., 2009). Even at UCSF, with the passage of AB154 a firm reality, CNMs only receive two hours of comprehensive options counseling training, and two didactic hours of instruction on medication and aspiration abortion*. Contraception is a very basic, pharmacology-focused online course.

In conversations with other nursing and medical students at UCSF, I have found a shared sentiment of disappointment in this educational gap. Nursing students at all levels are eager for more training and education in sexual and reproductive health - specifically focused on abortion. To meet these demands, a first year medical student and I designed a noontime interprofessional elective entitled “Family Planning and Reproductive Choice”, to which we invited guest speakers who covered options counseling, adoption, values clarification, clinical and public health aspects of abortion, and IUD insertion, among other SRH-related topics. As UCSF students, we were incredibly lucky to have access to the top SRH/abortion researchers and providers in the world, which made the task of selecting speakers very enjoyable. Dr. Tracy Weitz gave an electrifying introductory session on the state of abortion in the U.S., and Dr. Eleanor Drey followed with a comprehensive overview of clinical abortion provision. Residents and Family Planning Fellows taught our IUD and MVA papaya workshop, and Exhale (After Abortion Talkline) hosted a personal experience panel.

Student reception was overwhelmingly positive, and we had packed classrooms throughout the quarter. After presenting on this experience at the National Abortion Federation conference in 2013 and meeting with nursing students from around the country at the conference, it was clear to me that nursing students’ desire to be taught SRH curriculum is a national phenomenon. Anecdotally, their reasons included a desire to achieve competency in patient care provision, desire to increase abortion access in underserved and underinsured populations, and competitiveness in the job market, among others. In collaboration with an incredible, interdisciplinary group of nursing educators and innovators, I’m currently in the process of creating and disseminated the elective as a nationally applicable curriculum. We are planning to implement the first pilots at Oregon Health and Sciences University, Yale University, the University of New Mexico, and the University of Pennsylvania, among others. The elective materials and curricular resources will be added to the Nursing Students for Choice website as well. Through the efforts of dedicated grassroots nursing student activists at these campuses, we hope to demonstrate to faculty and administrators that we strongly believe this content needs to be included in our standard curriculum, not just to satisfy our own interests, but to prepare us to be competitive entrants to the nursing workforce, provide access to high quality sexual and reproductive health care to our patients, and normalize abortion care within the full spectrum of nursing scope of practice.

The final post in this series will review resources and opportunities that exist to build and improve SRH curriculum in U.S. nursing programs at both the pre-licensure and advanced practice levels.

*Due to the admirable efforts of several dedicated faculty, instruction in first trimester MUA is set to be implemented in 2014.

Please direct your feedback and comments to holly.carpenter@ucsf.edu.

References

Foster, A., Polis, C., Allee, M., Simmonds, K., Zurek, M., Brown, A. (2006). Abortion education in nurse practitioner, physician assistant and certified nurse–midwifery programs: a national survey. Contraception 73 (2006) 408–414.

Taylor, D., Safriet, B., Dempsey, G., Kruse, B., & Jackson, C. (2009) Providing Abortion Care: a professional toolkit for Nurse-Midwives, Nurse Practitioners, and Physicians Assistants. University of California, San Francisco. Accessible at: http://www.apctoolkit.org/index.html