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Entries in full spectrum doula (13)

Tuesday
Jan142014

Full-Spectrum Reproductive Health Care in the Making: An Interview with Sally Heron of Buffalo Womenservices/The Birthing Center of Buffalo

By: Vanessa Norton, BADP Volunteer

What incredible news to hear that Buffalo, NY, the city where I was born and raised, would be home to the country's first combination birth center/abortion clinic. Buffalo Womenservices, the abortion clinic, has been operating for several years, performing abortions through 22 weeks of pregnancy. The Birthing Center of Buffalo is set to open in February 2013, as an extension of the practice of OB/GYN Dr. Kathleen Morrison (owner of Buffalo Womenservices) and CNM Eileen Stewart.   

While home for the holidays, I visited Buffalo Womenservices/Birthing Center of Buffalo and spoke with Sally Heron, Services Coordinator of the birth center, Intake Coordinator and former Counselor at the abortion clinic.

Vanessa: How did the idea of combining non-medicalized birth and abortion care in the same facility materialize?

Sally: For myself and Dr. Morrison, the combination really comes from a commitment to reproductive justice. People have been working to open this center for 30 years...NY State has very restrictive laws when it comes to birth centers and we wouldn't have been able to open if we didn't already have the abortion clinic.

Vanessa: Why's that? 

Sally: We had to establish that there was a specific need to expand the business of Womenservices. that's the only way we could get the birth center opened.

Vanessa: So, in a sense, the state bureaucracy helped create this unique place?

Sally: It happened because Dr. Katherine Morrison fought for it and put everything into it.

Vanessa: How was the news of opening the Birthing Center of Buffalo as part of the same practice as Buffalo Womenservices received in Buffalo?

Sally: Buffalo is a conservative, Catholic town, so it's been mixed...People have said things like, 'what if a woman walks into the wrong room and accidentally gets an abortion.' [laughs.] Having said that, The Buffalo News wrote an article that described what we do. We offer real birth options that pregnant people can not get in a hospital.

Vanessa: Tell me about these options.

Sally: We give group classes using the Centering model of prenatal care. We offer a jacuzzi and large shower for labor and birth. Our patients are able to eat and drink and birth in whatever position suits them. We don't use epidurals, pain medication or continuous fetal monitoring, and all our patients are required to use a doula and be committed to breastfeeding. We also have a VBAC support group.

Vanessa: Wonderful. All patients are required to use a doula?

Sally: Doulas are critical for support and confidence. I think a lot of the people who don't initially want a doula think the doctor will be a doula.

Vanessa: How have your options affected the local discourse on birth?

Sally: The birth rate in Erie county has dropped in recent years, so there has been a battle over the pregnant population. Hospitals have tried to attract patients by offering Sabres blankets and flatscreen tvs in the rooms. Since we've announced the opening of the birth center, Women and Children's Hospital is now claiming to be a great place for waterbirth. Our presence is changing the conversation of what real birth options are. 

Vanessa: There is no parallel organization in Buffalo like ACCESS/BADP. Would such an organization be useful here?

Sally: Definitely, I think that in Buffalo we could do a lot to raise the visibility of abortion. I have friends who I know would put someone up for the night or offer a ride, but no organization exists to facilitate this. Although I think our counseling services cover the need for abortion doulas, I don't know what goes on at the other clinics. We don't offer counseling services for medication abortions, so there's a need there.

Vanessa: How do you feel about the term “full-spectrum doula?

Sally: It makes so much sense. I first heard that with the NYC doula collective and in the radical doula blog. We have a lot of queer patients, a lot of trans patients and I see their care as related as well. There are options people don't have and they should.

Vanessa: Do you think this practice would use the term “full-spectrum?”

Sally: I think that makes a lot of sense for us.

Vanessa: Do you foresee an organization that supports full-spectrum doulas in Buffalo?

Sally: I hope so. I would like to see “Birthworks,” the local doula collective, be that.

Vanessa: Why in Buffalo and why now?

Sally: Our opening now has more to do with the national movement for more birth options. 

Vanessa: How do you feel coming to work?

Sally: It's the best job I've ever had.

Wednesday
Oct092013

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

 

by Holly Carpenter, RN, UCSF School of Nursing-CNM/WHNP Candidate 2014 (originally posted on the Nursing Students for Choice Blog

Part I: Finding Full Spectrum Nurse-Midwifery

When I was choosing between various CNM (Certified Nurse Midwife) graduate programs in 2010, the faculty biographies at UCSF were the deciding factor. Every CNM on faculty was described as “Full Spectrum”, meaning they cared for patients through every reproductive health outcome, including abortion. My initial interpretation of this term was, “Wonderful! These midwives are providing abortions, and that means that I’ll be taught how to provide abortions.” As it turns out, while some UCSF CNM faculty provide medication abortions and place laminaria, CNMs in California do not typically perform first trimester “therapeutic abortions” or manual uterine aspiration procedures (MUAs).

This situation is not unique to California; CNMs and other advanced practice clinicians (APCs) are permitted to provide MUAs in only four states: Vermont, New Hampshire, Montana, and Oregon (Weitz et al., 2013). While the skills involved in first trimester MUAs are identical to those used in “miscarriage management” – a procedure that is legally within the APC scope of practice – many states have explicitly banned APCs from providing MUAs. Obviously, anti-choice politics play a major role in these bans, as evidenced by the recent rash of APCs-as-provider bans that have gone forward during the past two years of abortion limitation legislation. The impact of these bans is substantial, and connecting the dots is not difficult:

  • Under the Affordable Care Act, the proportion of the US population receiving primary care from APCs is expected to increase substantially (Taylor, et al., 2009).

  • NPs, CNMs, and PAs are …more likely than physicians to practice in medically underserved settings (Taylor, et al., 2009)

  • Abortion is one of the most commonly performed procedure for women (Boonstra, et al., 2006)

  • Limiting access to abortion is harmful to women (Foster, 2013)

  • The logical conclusion: banning the most accessible providers from performing a commonly demanded procedure is going to have a negative impact on medically underserved women.

However, progress is being made. In California, the Health Worker Pilot Program has been training APCs as first trimester MUA providers under a legal waiver from the CA State Legislature since 2005. The results of this project have been studied and published, and they offer proof that APCs are equal to MDs in safety, efficacy, and patient satisfaction (Weitz et al., 2013). The positive outcomes reported in this study have formed the basis for AB154, a CA bill which formally designates first trimester MUA procedures as within APC scope of practice. With the chances of passage of this bill looking promising, (it is currently on Governor Jerry Brown’s desk awaiting his signature), APCs in California are poised to address the important gap in abortion access that MD-only provider laws have created. There are millions of American women between the ages of 15-45, ⅓ of whom will seek an abortion at some point in their reproductive years (Weitz et al., 2013).

The first step in addressing this gap in access and care, however, starts with provider education at both the pre-licensure (RN) and APC levels. RNs play an important healthcare role by providing pregnancy options and contraceptive counseling in many clinical settings, and therefore need to meet competency standards in SRH care provision as well. In the next post in this blog series, the state of sexual and reproductive health in nursing education will be discussed, as well an innovative UCSF project: a student-led elective focused on abortion and family planning. Thanks for reading!

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

References:

Foster, D., (2013). The Turnaway Study. ANSIRH. Accessible at: http://www.ansirh.org/research/turnaway.php.

Weitz, T., Taylor, D., Desai, S., Upadhyay,  U., Waldman, J., Battistelli, M., & Drey, E. (2013). Safety of Aspiration Abortion Performed by Nurse Practitioners, Certified Nurse Midwives, and Physician Assistants Under a California Legal Waiver. Accessible at: http://www.ansirh.org/_documents/library/weitz_AJPH2012.pdf

Boonstra, H., Benson Gold, R., Richards, C., & Finer, L. (2006). Abortion in Women’s Lives. Guttmacher Institute. Accessible at: http://www.guttmacher.org/pubs/2006/05/04/AiWL.pdf.

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.

- See more at: http://www.nursingstudentsforchoice.org/blog-series-notes-from-the-full-spectrum-nurse-midwifery-student/

Tuesday
Apr302013

Abortion doulas and abortion stigma: finding the link

By Poonam Dreyfus-Pai, BADP Co-Director

Attending the Civil Liberties and Public Policy (CLPP) conference in Amherst, MA is something of a rite of passage for young abortion activists. For years, when I lived in New York, it was described to me as a mecca for those interested in talking about abortion care, provision, and support – a pilgrimage that many of my colleagues made every year.

Earlier this month, I attended for the first time. It was also my first time presenting. The annual conference, “From Abortion Rights to Social Justice: Building the Movement for Reproductive Freedom,” is hosted by Hampshire College, a liberal arts school with a decidedly progressive bent (for example, the bathrooms were labeled “self-identified men” and “self-identified women”). For 27 years, the conference has brought together researchers, advocates, clinicians, non-profit staff, community organizers,students, and community members to discuss and create strategies for achieving reproductive justice. For my part, I was there to discuss my experiences working as a full-spectrum doula with the Bay Area Doula Project and researching abortion stigma with ANSIRHInterestingly, these two ideas – abortion doulas and abortion stigma –were continuously linked in numerous presentations.

Why such a salient link? I’ve been an abortion doula for four years, and I would argue that the abortion doula movement arose directly as a response to abortion stigma. I wanted to research abortion stigma because I saw it in front of me constantly: stigma that not only prevented people from reaching out to their families and partners for support, but also reinforced the perception that they were somehow bad, and deserving of pain and unhappiness. I was interested in how to conceptualize stigma, and how to create an evidence base that would allow for services to reduce it.

Abortion stigma perpetuates the idea that people who have abortions have something to be ashamed of, which makes people less likely to seek out social support. Studies have shown that abortion stigma – not the abortion itself – negatively impacts a person’s emotional wellbeing and their relationships. It also serves to divorce a person’s experience of an abortion from the full continuum of their reproductive experiences. For example, we know that one in three women will have an abortion during the course of her reproductive life. We also know that most women who have abortions are also mothersBut because people worry about what their health care providers may think or say, people may not divulge that they’ve had past abortions or unintended pregnancies, which can pose various health risks.

Abortion doulas are individuals who provide compassionate, continuous presence before, during, and after an abortion experience, and employ many of the same pain management and comfort techniques used by traditional birth doulas. Those that began the “full-spectrum doula” movement believed that people who have abortions deserved the same kind of compassionate support that traditional doulas offer to people in labor. This work explicitly acknowledges that abortion stigma – the inferior status of and prejudicial attitudes faced by people associated with abortion – has made it difficult for people to believe they deserve compassion, let alone focused, free support throughout their entire abortion experience. By listening to people, providing empathy, massage, and breathing techniques, abortion doulas can normalize their experiencesbroaden social support for these individuals, and hopefully reduce some of that sense of inferiorityIn so doing, we are fostering a culture of support, and expanding the quality of care that people should come to expect when pregnant, regardless of the outcome.

The CLPP audience was, excitingly, already sold on the value of full-spectrum doulas in combatting abortion stigma, as evidenced by the sheer number of individuals who identified as abortion doulas, full-spectrum doulas, radical doulas. At a time when new anti-abortion legislation is introduced every day, it can be challenging to think about new ways to combat rampant abortion stigma. But what we know is this: the lived experiences of people matter, and the more that we can bear witness to their abortion experiences and support them, the more we are breaking down the structures that keep abortion stigma in place.

Wednesday
Apr172013

Revolutionizing Doula Care Across the Country

The Bay Area Doula Project is proud to be part of the full-spectrum doula movement. That's why we love this map from Calyx Doulas in Portland, that shows how the movement is growing.

 

Want to join the movement? We're currently accepting registrations for abortion doula training.

Monday
Feb112013

Announcing In-Home Support for Medication Abortions

We are thrilled to announce that starting today, the Bay Area Doula Project volunteer doulas will be offering in-home support to those experiencing medication abortions.

While providing the obvious benefits of privacy, confidentiality, and comfort, medication abortions pose some challenges to patients who may require extra support during their experience. Our doulas are prepared to offer free in-home physical, emotional, educational, and spiritual support during the medication abortion experience. BADP has created a comprehensive model for providing in-home support after months of careful planning and training. To do this, we have consulted with medical experts, home-birth professional doula groups, and abortion access communities to ensure that it has responded to various practical concerns: for example, client contracts will be used to address issues of doula and client safety and legality of practice. The BADP has also created internal procedures to provide on-going guidance to volunteer doulas as they provide in-home support to clients.

 

For clinics:

If you are a clinic providing women’s health care in the Bay Area, and would like to offer referrals for our in-home support services, please contact info@bayareadoulaproject.org. While it will be up to the clients to initiate a request for doula support, the BADP would be more than happy to make a presentation to your staff about the services offered that could then be described to patients. 

For finding support:

Click here to find out how you can get support.

For doulas and friends:

Our potential to serve women in their home through medication abortion depends on our network of contacts. If you know of a site that could refer patients to us for MAB support, please contact info@bayareadoulaproject.org for outreach materials. Thank you so much for supporting our work!