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March 30, 2020

NAPW: Seeing Connections During a Time of Isolation

Dear Friends and Allies,

Even as we socially distance, and many of us are entering the third week of isolation, NAPW continues to make vital connections. For example, the coronavirus pandemic is revealing barriers to safe, effective, and respectful care for pregnant people, whether they are seeking to end a pregnancy or to continue a pregnancy and give birth. A New York Times editorial calls on the government to "Make Abortion More Available During the Pandemic - Not Less" and NAPW issued this statement addressing What We Can Learn From Hospital Restrictions on Birth Support During the Coronavirus Pandemic."

The pandemic is also exposing the harm done by overregulation of certain medications people need as a matter of basic health and well-being. These medications include mifepristone and misoprostol (medications that can be used safely and effectively to end a pregnancy at home, with or without formal medical support). Lack of access has prompted an online petition calling on the FDA to lift restrictions on medication abortion.

The harm done by overregulation of methadone and buprenorphine (medications used to treat opioid dependency) is also being exposed. Current regulations, for example, often require methadone patients to travel every day to a clinic to obtain their daily dose of medication. Thankfully, SAMHSA has made it possible for states to take action that would allow so-called "stable" patients to receive more take-home doses (up to 28 days worth). This change, however, is not enough. Methadone, buprenorphine, mifepristone, and misoprostol should be accessible to everyone who needs it; these medications should have been accessible before the pandemic. And if these medications become (as they should) more available during this pandemic, increased accessibility must be sustained after this emergency has passed.

Finally, calls to reduce incarcerated populations in light of the pandemic also speak to the need to stop adding to that population by arresting women in relationship to their pregnancies and pregnancy outcomes. Elected prosecutors and groups such as Color of Change have called attention to the fact that outbreaks of the coronavirus in jails and prisons can spread quickly and impact not only those behind bars but entire communities. This concern provides yet another reason to end efforts to criminalize the people who get pregnant as well as the people who provide care to pregnant patients, including abortion providers and midwives. That is why NAPW is calling for quick action to reduce the incarcerated and detained population, including Chelsea Becker, a California woman incarcerated for experiencing a pregnancy loss. Now would also be a great time for prosecutors in upstate New York to drop felony criminal charges against home-birth midwives.

Of course, these are only a few of the connections between policies and issues that are exposed during this extraordinary time. Others include income inequality, the lack of a coordinated health care system, and the corporatization of public goods and services. NAPW looks forward to continuing to work with you (remotely) on all of these issues close to our hearts and that are core to our mission.

With best wishes for health, safety, and fortitude.


Sincerely yours,

Lynn M. Paltrow
Founder and Executive Director
National Advocates for Pregnant Women

March 26, 2020

What We Can Learn From Hospital Restrictions on Birth Support During the Coronavirus Pandemic

National Advocates for Pregnant Women

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The coronavirus pandemic, and our country’s lack of preparedness for it, give us an opportunity to make important observations and learn (or relearn) key lessons. Foundational issues including severe income inequality, lack of a national health care system, and corporatization of public goods and services are being exposed during this pandemic. Also exposed are the Trump Administration’s totally inadequate, often misleading and counterproductive responses to the coronavirus that have put all of us at risk.

For example, as Dr. Anne-Marie Slaughter explained in a New York Times op-ed, South Korea mobilized health care companies to make coronavirus tests in late January, when the country had only four cases. Soon, 10,000 Koreans a day were being tested, and now new infections are dropping. The first cases in the United States were identified in January, too, and yet we still don’t have enough tests.

People providing health care, including doctors and nurses are also facing the coronavirus without enough protective gear. In many places, a shortage of personal protective equipment, something that could have been anticipated by the federal government, means that medical staff have to reuse masks and do without key protective measures. Governors, mayors and public health officials have been begging President Trump to address shortages in medical equipment. On March 18, Trump signed an executive order invoking the Defense Production Act, a law that authorizes the President to compel U.S companies to produce equipment necessary to protect national security. But the President has refused to require production so that private companies can profit, forcing states, counties, and localities to fend for themselves and to compete among each other for scarce protective gear and medical equipment.

This is the context in which some hospitals are limiting or prohibiting visitors for all patients, including those in Intensive Care Units, those who are dying, and those who are giving birth. Some hospitals have announced that only one person will be allowed to be with a pregnant patient in labor. Women giving birth at two leading New York City hospital networks (with over a dozen hospitals) have been told that they must labor without anyone - spouses, partners or doulas. This has prompted an online petition and particular concern about the impact of such prohibitions on Black maternal health.

Certainly, among the legitimate reasons for the prohibition on visitors is protecting the health of medical staff – a group at particularly high risk for contracting the virus.That risk undoubtedly could have been significantly reduced if testing had started earlier, if there were enough tests for everyone, and if there was enough protective gear for medical staff, patients, and visitors. Lack of planning and Trump’s refusal to use his power to ensure production and coordinated distribution of medical supplies leaves hospital staff, pregnant patients and their support people at grave risk.

We could also have been prepared by policies supporting births outside of hospitals and training in homebirth skills.

In 2006, in the aftermath of Hurricane Katrina, the White Ribbon Alliance for Safe Motherhood recognized the critical importance of “homebirth skills” in times of disaster, when hospitals may be unavailable, inaccessible, or overwhelmed with casualties.

In a 2010 editorial in the Journal of Perinatal EducationI, Elizabeth Mitchell Armstrong, PhD, MPH, similarly recognized the value of homebirth and the need for homebirth skills in light of experiences with infectious diseases. As she explained:

"[S]entinel events of the last decade underscore the downsides of routinely bringing new life into the world in settings otherwise dedicated to the care of the sick, where the risks of infection necessarily run high. During the SARS epidemic in Toronto in 2003, several hospitals closed their maternity wards to contain the infection (at least one hospital quarantined five newborns and their mothers for 10 days), and area midwives reported an uptick in interest in home birth among pregnant women as they came to appreciate the risks of giving birth in hospital settings. Fears about the H1N1 virus [in 2010] have served the same purpose; indeed, many hospitals have banned all visitors under 18 years old and severely restricted adult visitors out of concerns about H1N1. For many families, hospital restrictions on visitation have delayed the joyous first meeting of newborn and older siblings and other extended family members. The SARS and H1N1 events remind us that hospitals ought properly to be the preserves of the sick and the individuals who care for them."

The current coronavirus pandemic calls on us, as Dr. Armstrong suggested in 2010, “to rethink how and where birth takes place—in particular whether it really makes sense for all babies to be born in high-technology, intervention-intensive hospital settings.”

The lack of integration of midwives into our healthcare system; lack of continuity among the providers caring for pregnant people prenatally, during birth and during the postpartum period; inadequate use of low-tech methods during delivery; and lack of capacity to meet the needs of healthy people during childbirth outside of hospitals, are all problems that could have been addressed before the pandemic.

For many people anticipating birth during this crisis, this is their first direct experience with the limitations of hospital-based births and our maternity care system. Yet, many of the issues raised in the Change.org petition about why support for pregnant women is needed in hospital births point to long standing systemic problems with giving birth in settings designed for people who are sick, and where birthing care is provided by people who are trained primarily in surgery rather than in the midwifery model of care.

In this moment, some people will be able to transfer from planned hospital births to birth at home or at freestanding birth centers that are capable of accommodating social distancing. Many if not most people, however, will not want to or know how to. In addition, they might find that their insurance won’t cover out of hospital births, or that they are unable to transfer care because there are simply not enough birth centers or homebirth providers.

Indeed, the human rights of people during pregnancy and birth are regularly violated in the United States and all over the world. The United Nations finally recognized this problem in a report to the General Assembly last year, and a survey of pregnant people in the United States found that one in six experience mistreatment during childbirth. The report to the U.N. identified as key problems the lack of governmental response and legal remedies for human right violations relating to pregnancy and childbirth.

People facing the exclusion of partners and support people at their births during this pandemic may wonder what legal recourse they have. Unfortunately, the law does not yet provide useful mechanisms for addressing or resolving this issue or any related to rights violations during labor and birth. For example, litigation during the 1970s tried to establish the right of fathers to be at births. Hospital policies at that time regularly excluded fathers from the delivery room. These cases, however, were not successful and a right to be with a partner and attend the birth was never recognized by the legal system. Importantly, those policies have changed not because of laws but because of consumer advocacy, public pressure, and changing norms. The Affordable Care Act has a provision that requires equality in visitation policies, but it does not require hospitals to allow any visitors. As we are seeing in the midst of this pandemic, hospital policies limiting visitors are being applied across the board, not just to doulas or pregnant people.

Nevertheless, there are many dedicated birth professionals in every community doing everything they can to make sure pregnant people have the information they need to take care of and support themselves during this time.

Conclusion

We recommend individuals look for local childbirth educators, doulas, lactation support providers, midwives and doctors offering digital support, information and resources during this challenging time.

We recommend States take steps to lift restrictions inhibiting home births and birth centers births as part of emergency executive orders:

● Remove barriers for midwives to practice autonomously and attend out-of-hospital births.
● Recognize and treat midwives as health care providers, with access to the resources, exemptions, provisional licensure, and special orders for pandemic response.
● Change scope of practice laws so that midwives can practice in all states and territories without fear of arrest.
● Provide all practicing midwives with information, equipment, and resources regarding pandemic risks and response to promote the safety of the workforce and the public.
● Reimburse for midwifery care at 100% of the rate of physicians for the same service, whether from insurance or Medicaid.
● Remove barriers to opening freestanding birth centers to increase capacity.
● Fast-track student midwives with provisional licenses when they are close to completing their credentials.
● Preserve hospital personnel and beds for pandemic response by encouraging hospitals and hospital-based providers to refer low-risk births to out-of-hospital midwifery care.
● Require hospitals to meet best practice transfer protocols to ensure a safe and efficient interface with out-of-hospital birth providers when a laboring patient is in need of a higher level of care.

We hope this pandemic and the federal government’s failure to protect us will motivate people to fight for national policies that prepare for and protect the health of all. Fortunately, we work alongside many wonderful advocates and groups working on these issues.

Here Are Some of Those Groups:

Academy of Perinatal Harm Reduction
All Options
A Mother’s Choice
Ancient Song Doula Services
Birthmark Doula Collective
Birth Monopoly
Birth Rights Bar Association
Black Mamas Matter Alliance
Center for Optimal Living
Citizens for Midwifery
Elephant Circle
Every Mother Counts
Forward Together
Groundswell Birth Justice Fund
Harm Reduction Coalition
Harm Reduction Therapy
Health Care for America Now
If/When/How
Improving Birth
International Cesarean Awareness Network
Michigan Prison Doula Initiative
National Association for the Advancement of Black Birth
National Birth Equity Collaborative
National Black Doulas Association
National Partnership for Women and Families
National Perinatal Association
National Perinatal Task Force
Public Citizen
Radical Doula
Rise Up Midwife
SisterSong
Vocal NY
We Rise! Leadership Collective Minnesota
White Ribbon Alliance

Find More Information:

To find a doula try searching “Your State + doula + association”
https://radicaldoula.com/becoming-a-doula/doula-trainings/,
https://transform.childbirthconnection.org/action/consumeradvocate/cbe-doula/,
https://doulamatch.net/national-and-local-doula-certifying-organizations.aspx
https://blackdoulas.org/

For a List of Organizations Doing Birth Justice Work Consider Looking at the List of Past and Present Grantees of Groundswell’s Birth Justice Fund:

https://groundswellfund.org/birth-justice-fund/

For more information please contact:
Shawn Steiner | 917.497.3037 | SCS@AdvocatesforPregnantWomen.org

We Call for Quick Action to Reduce the Detained Population During the Coronavirus Pandemic, Including Chelsea Becker, California Woman Incarcerated for Experiencing a Pregnancy Loss

A Statement From National Advocates for Pregnant Women

Recognizing that an outbreak of the coronavirus in jails and prisons will spread quickly and impact not only those behind bars, but entire communities, elected prosecutors from across the country, including from California, are calling on officials to reduce the incarcerated population. In light of this situation, it is particularly disappointing that Chelsea Becker remains in Kings County Jail, in Hanford, California.

On November 6, 2019, Ms. Becker was arrested and charged with murder under California Penal Code §187. Ms. Becker had experienced a stillbirth that the prosecutor claims (without scientific basis) was caused by her methamphetamine use during pregnancy. Ms. Becker was charged with this crime despite the fact that §187 does not authorize, nor has it ever been interpreted to authorize prosecution of a woman in relationship to her own pregnancy or any outcome of a woman's pregnancy. In fact, the statute clearly states that it cannot be used to prosecute the "mother of the fetus." §187(b)(3). Nonetheless, Ms. Becker was taken into custody and bail was originally set at $5,000,000.

On January 29, 2020, Ms. Becker's counsel Jacqueline Goodman, with the support of National Advocates for Pregnant Women, filed a motion to reduce her bail. The motion was reinforced by a letter from two nationally renowned physicians with board certifications in obstetrics and gynecology and addiction medicine. In their letter, Drs. Mishka Terplan and Tricia Wright expressed grave concern that Ms. Becker's incarceration was based on "the unsupported assumption that substance use disorders should be treated as dangerous criminal activities and/or the unfounded supposition that methamphetamine use causes stillbirths."

If released, Ms. Becker poses no danger to anyone in the community. Neither pregnancy nor drug use nor the dual status of being pregnant and addicted are crimes in California, nor are they indicative of a danger posed to others. Courts may not incarcerate people to prevent them from becoming pregnant and neither becoming pregnant nor losing a pregnancy makes a person dangerous. In fact, according to the Centers for Disease Control and Prevention, in California 2,465 pregnancies end in stillbirths each year and none of the people who experienced these losses should be incarcerated.

Argument on bail was held before the Superior Court of Kings County on February 20, 2020. The Court reduced Ms. Becker's bail to $2,000,000. Neither she nor her family have the financial means to pay this bail. Setting bail at this level means that Ms. Becker remains incarcerated for a non-existent crime and, worse, at a time when jails are fertile ground for the spread of the potentially fatal coronavirus within the jail, to the staff who work there, and anyone in the community connected to those people.

For more information, or to schedule a phone interview with NAPW, medical experts or legal counsel, please contact: Shawn Steiner | 917.497.3037 | SCS@AdvocatesforPregnantWomen.org

March 19, 2020

We Can Engage in Social Distancing and Still Fight for Social Justice

Dear Friends and Allies,

NAPW knows that we can adhere to the recommendations for social distancing while still fighting for social justice. As we monitor the rapidly changing developments regarding the COVID-19 pandemic, we are taking every measure to protect the well-being of our staff while not wavering in our commitment to advocating for reproductive health, rights, and justice.

NAPW staff remains a team while working remotely. We are answering the phones. We are working on cases. And we are organizing and educating.

One thing we are not doing is being surprised by the lack of preparedness for COVID-19 from the Trump administration. The administration's response to COVID-19 revealed a dangerous disregard for science. We are familiar with this disregard - it reflects the same disdain for science that the administration has shown when it comes to reproductive health generally and abortion care specifically. In fact, in 2017, the Trump administration told top public health officials not to use certain words, including "fetus" and "diversity." There is no surprise in light of the slow and inadequate response to the current pandemic that "evidence-based" and "science-based" were also on that list.

But, as we all work together to follow health recommendations (we won't be offended if you break from reading this to wash your hands), many of us no doubt are dealing with disappointment for the many family, social, and work events that have been canceled or postponed. As we shift all communications to digital spaces for the time being, NAPW is disappointed that we will not see our peers in person at critical information-sharing and ally-building conferences and educational forums.

Of the many, one particularly heartbreaking cancellation is the Wisconsin Film Festival. We were thrilled to learn that "PERSONHOOD: Policing Pregnant Women in America" was selected for this festival. While the film has been accepted for a number of notable festivals that have already occurred, including DOC NYC and the Athena Film Festival, this excellent and moving documentary focuses on a Wisconsin case that NAPW helped bring to the federal courts. We were looking forward to working with the filmmakers and our allies at Reproactionto use the festival as an opportunity to build state-based knowledge and power that could be used to shut down Wisconsin's Unborn Child Protection Act. We know that the filmmakers will be thinking about how to distribute the film in these chaotic, no-social-gathering times. We look forward to supporting the film's distribution so as many people as possible can watch this must-see story exposing the impact of fetal personhood laws on the rights and health of all people.

NAPW will also be providing digital communications through webinars. This Friday, March 20, we have a planned webinar with the Birth Rights Bar Association "Policing the Womb: Invisible Women and the Criminalization of Motherhood" featuring Michele Goodwin, J.D. (please see graphic and registration information below). Follow our social media for updates on future webinars and actions we may ask you to take from home.

Despite the anxiety, disruption, and illness caused by COVID-19, we hope there will be positive lessons learned from this experience. Indeed, this story about the work of motherhood (that specifically mentions NAPW) is extremely relevant at a time when schools are shut down, and the unpaid essential work of childcare is literally driven home.

In the meantime, we urge you to follow the calls for social distancing and send our wishes for health and safety.

Sincerely yours,


Lynn M. Paltrow
Founder and Executive Director
National Advocates for Pregnant Women



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