smart tips and empowered births

October 11, 2009 § 8 Comments

i wrote this over a week ago…and am now just getting to posting it…better late than never, right?


cara at curvature has a couple of posts up that i wanted to comment on.  but i felt like what i was going to say was a bit off topic.  so i decided to say it here instead.

the first one is on these smart tips and the class assumptions by the author of these tips.

The press release, though, was actually promoting a book about pregnancy. And it provided “tips” — tips which use the acronym SMART — for how pregnant American women can “improve their chances of having a healthy baby”:

S = Seek prenatal care early. Tests for potential chromosome problems, including mental retardation and spina bifida (a condition that causes paralysis) can be conducted only in the first and second trimesters. A first trimester ultrasound is also the most accurate in terms of determining a due date.

M = Mention all risk factors such as a family history of diabetes, high blood pressure, Rh negative blood, premature labor, bleeding problems or genetic conditions to your healthcare professional as soon as possible. Do not omit information such as smoking or using “recreational” drugs because such activities can affect your baby.

A = Ask to have your cervix measured during your ultrasound if you have a history of premature contractions or delivery. A cervical length of 2.5 centimeters or less is a risk factor for preterm labor. If you are at risk for delivering before 37 weeks, ask your healthcare provider about receiving steroids to help your baby’s lungs develop.

R = Research your hospital and prospective physician or midwife carefully. Is the physician or midwife skilled in managing high-risk conditions? Will your care continue if you lose your insurance? Has the newborn nursery had any recent outbreaks of antibiotic-resistant infections? Is the hospital a level-three facility?

T = Test for potential problems such as gestational diabetes, sickle cell trait and cystic fibrosis, and check for appropriate fetal growth with an ultrasound.

I imagine that this might pretty solid advice (though I don’t actually know one way or the other) — if you’re actually able to follow it.

But considering the email’s opening, and the highly relevant fact that tens of millions of Americans do not have health care access, I was basically blown away by the “advice” and the necessary level of privilege that it involves — even if this kind of thing is an incredibly and increasingly common sight. And its frequency is a big part of the reason why it’s worth discussing.

now i am super glad that she is engendering a convo about birth pregnancy and class.  especially when you look at the infant mortality rate for the states.

i am super serious when i say that the reproductive justice movement shoots itself in its own foot by the way it marginalizes birth trauma and rape.

so  her socio-economic analysis is sound.

these tips.  these tips help though to uphold a culture in which birth rape is common and expected and praised.

1. seeking prenatal care early.  most mothers dont need those tests.  and those tests carry some risk to the development of the fetus.  and the doctors wont tell you that part.  if you arent planning to abort the fetus because of the results of the tests.  if you are then yeah, take the tests.  instead of running to your doctor or obgyn the second you realize you are preggers.  it would probably be helpful to enjoy yourself.  de-stress your life as much as possible.  celebrate.  spend a lot of time just being in touch with your body.  (i will write soon about how we can learn to be confident enough to trust our bodies…) and go to a doctor when you feel it is right.  not when the calendar tells you to.  and if you never go.  its fine. oh yeah and only 5 percent of women give birth on their due date.  most first time pregnancies go past the due date.  what you really get is a due month.  or a due couple of months.  and hell, you can probably figure that out for yourself.

2. if you go to a doctor or midwife.  do not tell them anymore than you are comfortable with.  and i woudl seriously think for a moment before i admitted to ‘recreational drug use’.  especially when in some states in the us a woman can be imprisoned for drinking a beer while pregnant or breast feeding.  the more risk factors you mention the more likely they are going to decide that you are probably going to need interventions whether or not you want them.  yr personal medical history, the history of your body and the histories of your family’s bodies are no one business but yours.

let me explain my midwife decided that i was high risk because my grandmother has diabetes.  i dont have it.  my mom doesnt have it.  i eat really really healthy.  i didnt have it during my pregnancy.  she still decided that i probably had gestational diabetes.  even when the test proved her wrong.  i mean im black, right?  you know how we are with sugar…

3. cervix measure during the ultrasound.  why do you need an ultrasound?  and even if you do choose to get an ultrasound (and i think that is a personal decision)–it is just not true that you need to have your cervix measured during it.  and this  –A cervical length of 2.5 centimeters or less is a risk factor for preterm labor.–is not true.  patently false.  fuck it.  dont let any body insist on sticking their fingers or anything else up your genitalia for unnecessary reasons. i dont think that vaginal checks are necessary except in the most extreme of cases.  or if the mother asks.

a lot of women are guilted into letting doctors touch them in ways that they are not comfortable for ‘the good of the baby’.

4. research.  yeah.  i agree with the fact that research and knowledge are good things to be armed with.  (yes, its a war.  sweetie.  and you got to choose a side.  choose you. cause if you dont.  no one else will.) but just about every obgyn is educated to deal with ‘high risk’ situations.  actually that is what most of their training is about.  what they dont know is the difference between ‘high risk’ and inconvenient to the medical establishment.  a 72 hour labor is not high risk.  an obese pregnant woman is not high risk.  a rape survivor is not high risk.  a woman who smoked mary jane during her pregnancy is not high risk.  being of color or poor or an immigrant is not high risk.  a vbac is not high risk.  post 42 weeks is not high risk.  being a teenager is not high risk.

yes research carefully.  first thing.  does the midwife or doctor respect you, your voice, your agency more than they respect the medical est’s approval, their insurance rates and coverage, everything that they learned from books and lectures, statistics, etc.  when in conflict who will your birth worker side with?  you?  or all that other shit like dead paper words and medical industrial system?

5. ok tests. test. test. you are going to have to figure out what tests you should take.  and dont let folks doctors experts pressure you into tests you arent comfortable taking.


i am not saying that women who follow these tips and are traumatized during their birth are somehow responsible for being traumatized because they trusted the medical industrial system.  nope the abuse is the fault of the abuser.  plain and simple.  what i am saying is that encouraging women to trust experts more than themselves does not decrease the likelihood of being traumatized in birth nor is there any proof that it leads to a healthier pregnancy or baby.  these tips make as much sense as ‘rape prevention tips’.

the problem with all these smart tips is that they are a prescription for not having individual choice in one’s pregnancy or birth.  pregnany is no longer just a pregnancy.  but an illness.  a disease that has to be managed.  by experts.  by you encouraging doctors and midwives to have more control over your body and yr choices.  that they know more about your body than you do.  that you give a bunch of personal information and they decide what choices you have considering that info.

ok check this.  leading causes of infant mortality according to the cdc.

“1. birth defects.*

2. birth weight

3. sids.”

these smart tips not really address these issues.  (testing for birth defects doesnt prevent them.)

leading causes of maternal mortality?

1. embolism

2. hemorrhage

and why are black mothers dying at twice the rate as white mothers…?  ill tell you my hypothesis.  its because black women live in black communities.  and in black communities the very air, the water, the grass, the houses.  are poisoned.  i think its environmental.  mixed with not having access to fresh foods.  and of course there is the stress of racism which is statistically deadly.


*i hate the term birth defects.  i cant believe when i first wrote this i let that term slip by me.  there are no defective babies in the world.  the problem for me isnt just the term.  it is that it lumps a bunch of human conditions and states of experiences that are widely different.

Birth defects are defined as abnormalities of structure, function, or body metabolism that are present at birth. These abnormalities lead to mental or physical disabilities or are fatal. There are more than 4,000 different known birth defects, ranging from minor to serious, and although many can be treated or cured, they’re the leading cause of death in the first year of life.

see why i dont like the term?  by that definition being born black or poor could be considered a birth defect…



§ 8 Responses to smart tips and empowered births

  • Cara says:

    Hi Mai’a, thanks for bringing all of this up! As I said in the post, I really don’t know one way or the other (never having been pregnant, never intending to be pregnant, and not having any kind of formal training whatsoever in the area at all), and a couple people brought up in the comments that unsurprisingly, the “conventional wisdom” that is expressed up above isn’t really all that sound, and doesn’t have the best interest of women in mind. Thanks for offering an alternate perspective from a place of experience and knowledge — I certainly learned several things from this post.

  • Aaminah says:

    tbh, my first reaction was just offense/annoyance that they would use SMART at all, as it implies automatically to anyone who questions it/can’t do it/whatever that it’s because they AREN’T smart! absolutely i agree with cara’s class-based criticism of it; like you said, it assumes that the woman has insurance, assumes that it is good insurance, assumes that she can pay the copays/portions not covered even by good insurance, assumes that she has access and CAN be choosy about who her doctor is (let’s not even get into the issue of how many insurance plans/state health plans will not cover a midwife at all), it assumes that the woman has any agency at all – which is actually a privileged position. let’s talk about reality. let’s talk about poor women. women of color. women who are criminalized for not wanting to have dangerous ultrasounds or other testing done. women who are told that they “must” have these things done. or about the ableism inherent in telling all women that they need to test for Downs and other disabilities. because why do those tests, which are dangerous to the fetus and the mother, when they don’t change anything? like you said, it isn’t going to prevent anything. and the implication i read isn’t “you want to know in advance so that you can plan for your baby’s needs” but “you need to know in advance to prepare yourself for the fact that you’re going to have a ‘problemmatic’ baby”. how about the fact that these recommendations are things that poor and of color women are practically “not allowed” to really do? i remember being pregnant and being a new mom, having researched a lot at the library, having talked to other women, having a very difficult pregnancy and knowing that he was going to be the only baby i would ever have… i remember being told to ask less questions. i remember being told that i didn’t know what to expect, that i didn’t know anything really, that my instincts were counter to science and that i should just do what i was told. i remember the pediatrician being in such a rush that he refused to answer my questions. do i think that might have been directly related to the facts that i was a “single” woman of color on medicaid with my first child? heck yes, i KNOW that is why i was treated that way. and omg, yes yes yes to your answer to point #2! hell no, you don’t tell anyone that you’ve used anything, ever, if you want to keep your baby! and that is your right. why tell, on the off chance that your baby is “at risk”. wait until there’s an actual problem… and even then, there are plenty of other valid causes for most “problems” so that what you’ve done in the past is not necessarily the cause, nor is there any real benefit in the child being taken from you.

    • mama says:

      its funny i woke up this morning thinking about the time that pcs nearly took aza from us. and i was thinking about how after the c section. i was telling a doula about the birth. and she said. oh. if you didnt want to be at the hospital. why didnt you just leave? ok. well not only was i 4 cm dilated and really *in labor*. (how the fuck was i going to drive a car 30 min. home when contractions are coming every 5 mins?) but how the fuck am i a working class black woman going to just walk out of the hospital in the middle of birth? what was the likelihood of them calling pcs and having my new born taken away because i had endangered my childs life by walking out on my doctor and midwife?
      and this white doula just shakes her head like im *so* paranoid. they would never do that…blah…blah…blah…
      yeah right.
      but i learned a lot during my pregnancy and birth. like never hire a midwife who gets annoyed when you ask *too many questions*.
      and yeah. the way that my midwife treated me during my pregnancy and birth was so disrespectful i realize now. and it was directly related to working class black mama with no health insurance or proper furniture in her house. but i let her treat me disrespectfully because i was in a time in my life when i didnt feel like i had the right to stand up for myself. my in laws and my family refused to take seriously what i said when it contradicted with what they had decided i deserved in life. (my mom decided that me getting sexually harrassed by uncle was okay. and my in laws, dear god, my in laws just had a litany of changes that i needed to make now that i was going to be the mother of their first grand child. like, how i spoke, how i dressed, my career, my lifestyle, my future plans, my politics etc. etc. etc.) and i was told that i was over reacting, and then i was dismissed.
      i mean how dare poor woc think that they have a right to agency or choice in their birth or motherhood? hasnt history taught us foolish woc anything?

    • mama says:

      oh and i hate the term ‘birth defects’. i am going to have to re edit that part. like there are defective babies out there…

  • Aischa says:

    Ooooh! That is some list. I hate to say dumb, because,I have had two healthy pregnancies and births, alhamdulillah, and not sure how it would be to approach pregnancy knowing something problematic may occur during pregnancy because of X,Y, or Z.
    The only things I would ever recommend would be to eat as well as you can, and take a prenatal vitamin if you can afford them. Keep good company who can support you (emotionally, and around the house). I think that was the main recommendations of my midwives. The most valuable thing they offered me was support in being there, witnessing, and holding my hand as I freaked out over labor pains. Not to be-little their efforts at all, but it seems women can have perfectly healthy pregnancies and deliveries with out much poking and prodding and expense. Not sure why we have hospital births at all (except for true emergencies), there is no point, nor excuse for the cost. It’s a racket.

  • Aischa says:

    I forgot–started my 1st pregnancy with Kaiser—it felt like a baby factory, sterile, no emotional support, swift appointments with strangers. Plus the 1st group appointment for new mothers is enough to freak anyone out—no cold cuts, soft cheeses, no hot showers, etc. Makes you want to live in a bubble. None of it was the same advice given by my midwives.

  • […] i wrote this a couple of months ago: smart tips and empowered births and why are black mothers dying at twice the rate as white mothers…?  ill tell you my […]

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