Summit Day 1 (cont.)

How Might You Be Prosecuted: Let Me Count the Ways: Punishing Pregnant Women Based on Claims of Fetal Rights and the War on Drugs

• Whitner v. South Carolina (NAPW fact sheet here) expanded the state's child abuse and neglect laws to include pregnant women. Initially aimed at presecuting women who use drugs while pregnant, it has also been used to force a woman to have a c-section
• once a fetus is elevated to personhood a woman's identity is inevitably devalued and her rights are subordinated to a third party (the state)
• (sorry I don't have a good reference for this one) a woman pregnant with triplets wanted to have a vaginal birth, and expressed this desire to her doctor who then, unbeknownst to her, passed the information on to the police, who filed child endangerment charges, the court granted custody of the fetuses to the hospital. No one ever told the woman any of this until she was in active labor and being prepped for a c-section, which she had, against her will.

An overriding theme of this conference has been that we are all, to some extent, the same. That the media tries to portray women who have children as different from women who have abortions as different from women who choose not to have children, when the reality often is, these are all the same woman at different stages of her life. Likewise, some of us may find it difficult to sympathize with women who consume drugs or alcohol during pregnancy, and yet the same laws that are used to prosecute them may one day be used against us (or someone we care about) concerning an unwanted c-section or an at-home birth or the use of a midwife. We have to find our common ground and work together because laws and court decisions and medical decisions that are detrimental to the health of one woman affect all of us.

Tayshea Aiwohi, the first woman in Hawaii to be charged and initially convicted of manslaughter due to the death of her child, was brave enough to share her story with us. There were many tears and at the end, a much-deserved standing ovation. Tayshea has gotten (and stayed) sober, regained custody of her other children, and opened a recovery house, in her son's memory, for other substance-abusing pregnant women.

Mary Barr stepped forward to say that she was here in spite of the system, not because of it. She says she has recovered from many things more damaging than addiction - poverty, low self-esteem, and lack of social services. She reminded us that lack of education and lack of options keeps people addicted longer and that the majority of politicians these days are legislating from a place of emotion rather than common sense. Barr was sent to prison while she was pregnant, and told that prison may save her life because at least she wasn't on the street doing drugs. Meanwhile, in prison she was raped by a guard and she and her fellow inmates were infested with lice so badly that you could see the eggs on their eyelashes. Not once was she offered any prenatal care.

Pregnancy, Birth, and Distortion of Risk
This panel featured four women (Margaret Olivia Little, Elizabeth M. Armstrong, Lisa Harris, and Anne Drapkin Lyerly) who are all part of the same research team, trying to get a handle on how to improve healthcare for pregnant women and new moms. Their main theme was that prior to birth, interventions (of any kind) are frequently avoided due to concern for the fetus, and then during birth interventions are often used, again due to concern for the fetus. Often in both cases to the detriment of the woman. Armstrong told a story about a pregnant woman whose appendix burst, because doctors were too concerned about possible radiation poisoning to conduct a CT scan to confirm appendicitis. "We notice the risks of intervening to the exclusion of the risks of not intervening." As another example, women 35 and over are recommended to have amniocentesis to screen for the possibility of down syndrome. This age was chosen because it is the age at which risk of downs equals risk of loss of pregnancy from the procedure. But most women do not equate those two risks. Women should be empowered to make an informed decision about whether or not to have amnio. But women under 35 who want amnio, say, because of a strong family history of down syndrome, must have some sort of other diagnosis, like pregnancy-related anxiety, to get her insurance to cover the test. Lastly, many hospitals refuse to perform VBACS (vaginal birth after c-section) and yet the risk of the baby dying during vaginal birth for first time moms is equivalent to the risk of the baby dying during VBAC (different causes, same risk; fortunately in both cases, extremely small). The group is working on making the move from a single standard of care to a 'range of reasonable options,' but worry about how this will work from a legal/insurance standpoint. And lastly, a reminder from Harris, "Pregnancy means what a pregnant woman tells you it means."

After this session I had the pleasure of being invited to have a drink with Little and the rest of her research group and a few other friends (after kissing up a bit by telling Little that over the past few days I'd read everything by her I could get my hands on and loved every bit of it). Unfortunately, my drugs were starting to wear off, so I had to make it an early night. But not before hearing a wonderful woman named Kitty tell stories about choosing to become a midwife, witnessing her first home birth, babies in saddle bags, and singing midwife songs!