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MLK Day: Thoughts on Racism, Feminism, Faith, and Birth

Over the summer of 2016, I spent 160 hours looking at the theology and ethics of Dr. Rev. Martin Luther King, Jr. as part of my seminary studies. It was hard to spend that kind of time immersed in stories of injustice, contemplating racism, mourning over the little progress we’ve made, and trying to think of ways to be an agent of hope and change. But, however hard it was for me, it was only ten weeks. Many people live with these issues day-in and day-out and cannot simply walk away. That ability to walk away–to shelve the empathy and anger and uncomfortable smallness against such a giant evil–is a mark of privilege, of ignorance, or apathy. While I know many inclusively-minded people who embrace others no matter the color of their skin, racism is more than that. Color-of-the-skin racism is but one definition. The issue that is mind-blowingly complicated to me, the one that I cannot simply absolve myself of with kindness to all, is systematic racism.

In terms of systematic racism, the US has made little-to-no progress from King’s days on so many fronts: the urban poor, the war on drugs, mortality rates of Black mothers and infants in certain areas, stories of police brutality that are echoes of the Jim Crow South. If you are not sure what systematic racism is all about, I’m about to give you an example. I’m going to share my term paper research with you. I put a tremendous amount of time, prayer, heart, and tears into it. I’m nervous about sharing it. The mind-tapes say to me: it’s only Master’s-level work, I’m not an expert on birth or race, I’ve only been applying theology this way for so long , anything birth-related hits nerves fast, anything race-related hits nerves fast. But I pray that God will use it for good in some way. 

I want to offer a closing prayer up here, a word of hope, so it doesn’t get missed amidst the considerable footnotes (there are great quotes and stories in with the citations) and bibliography. So, read the paper right below the picture, and then scroll up back here when  you are done.

Dear God,

We could walk away from the heaviness we feel when we encounter stories of injustice.
But, may we not.  
May we instead find ways to
listen and support,
vote in the polls and with our wallets,
teach our children well,
and speak up as allies.

We echo Dr. King’s prayer:
“Eternal God, out of whose mind this great cosmic universe, we bless you.
Help us to seek that which is high, noble and good.
Help us in the moment of difficult decision.
Help us to work with renewed vigor for a warless world,
a better distribution of wealth,
and a brother/sisterhood that transcends race or color.’”

As we celebrate Dr. King’s birthday,
as our country moves into a new administration on Friday
which brings up so many feelings,
we offer a resounding
AMEN.

MLK Birth Racism Theology

 

Certified Professional Midwifery as a Kingian Solution to Systematic Racism and Oppression in Birth Care in the Unites States

Thesis

In this paper, I will argue that when it comes to pregnancy and birth care in the United States (US), the mainstream Western medical birth care model of hospital births is one that facilitates systematic racism and oppression of women in ways that Martin Luther King, Jr. would take issue with if he were alive today. I will argue that the care model of Certified Professional Midwifery is a worthwhile alternative that demonstrates Kingian theology and ethics. Finally, I will offer suggestions for expanding access to Certified Professional Midwives (CPMs).

Introduction to Midwifery

In the US, there are three major categories of midwives: Direct Entry Midwives, Nurse Midwives, and CPMs, each with different educational backgrounds, ways of practicing, and legality by-state.Direct Entry Midwives (DEMs) may be self-taught or may be licensed. They may or may not have an overseeing body or required education. State regulations vary widely.Because of extreme diversity in DEMs, I cannot base my arguments in this paper around them. However, some licensed DEMs may align with the features of CPMs. Nurse Midwives (NMs) have a Bachelor in Science and a Master’s or Doctorate in Midwifery but some states still require them to work under an overseeing physician. US NMs mostly deliver hospitals and practice within the mainstream Western medical hospital model. Because of this complicity with that system, most NMs fall outside of the scope of this paper. However, there are NMs who practice autonomously outside of hospitals.

CPMs, in particular, are the focus of this paper because of rigorous standards for educational and hands-on training required for accreditation. They prepare specifically for homebirths and related low-intervention, non-hospital births (hereafter simplified as homebirth).[1] Low-intervention, non-hospital births may include birth in the home, a hotel (as in the cases of women who must cross state-lines to get legal midwifery care), or a freestanding natural birth center that operates as a bedroom-away-from-home rather than as a medical facility.

 CPMs are also the focus of this paper because of their holistic, personal approach to care. In up to hour-long appointments, the midwife learns the mother’s unique cultural and family context and what that means for pregnancy, delivery, and infant care, and offers ideas for wellness in each of those stages with sensitivity to the mother as an individual. It is reflective of the African spirituality that influenced King, “It refuses to divide a person into separate parts, such as mind, body, and soul.”[2] The CPM system is set up to utilize philia (Biblical Greek word for friendship-love) between midwife and mother and agape (Biblical Greek word for goodwill-love) toward her unique needs, wants, cultural context, etc.[3] It is a warm, empowering model that demonstrates Kingian love and seeks to even the power structure between midwife and mother.

The outcomes are notable. A comprehensive homebirth study showed that the hospital transfer rate was 10.9% (typically for non-emergent reasons) and the Cesarean section (C-section) rate was 5%.[4] A compelling 93% of homebirths resulted in a physiologic birth.[5]

Introduction to Hospital Birth in the US

Now we must look at what the CPM model stands in contrast to: the mainstream Western hospital model. This is where 98.5% of US births happen.[6] US hospitals offer a host of policies and interventions that are not evidence-based; may not accommodate for personal, cultural, or psychological individualities;[7] and lead to a cascade of interventions. The US reports a C-section rate of over 32%,[8] which are more expensive and higher-risk than vaginal birth. This number is in stark contrast to the World Health Organization’s finding that a rate above 10%, at population level, is not correlated with a better maternal or infant mortality rates.[9] The US has the worst maternal death rate of any developed country and this is the most severe when it comes to urban families.[10]

Black women in the US have the highest level of C-sections of any race.[11] They experience a higher mortality rate during birth than any other race: this is a staggering 2.2 times the rate of non-Hispanic white women, a disparity that has over doubled in the past ten years.[12] However, in New York City (NYC), the Black maternal mortality rate is nearly eight times higher than for White women, and the infant mortality rate is triple.[13] One study concluded that, “Racial disparity in outcome is confirmed and is unexplained by traditional risk factors.”[14] In other words, women are dying during birth simply because they are Black.[15]

 What Would King Say?

NYC provides an apt case study for looking at systematic racism in birth care because of these staggering statistics about mothers and infants, but also because in Where Do We Go From Here, King bemoaned NYC’s 1961 vitality rates. At that point, Black infants had double the mortality rate, less than it is now.[16] King saw statistics like these are as marker of general wellbeing, and we see now an even grimmer picture.

During the Civil Rights Movement, King took a particular interest in the Black urban poor in the North where racism was deeply systematic despite legal desegregation. Modern-day NYC still exemplifies this with stark contrasts between poor neighborhoods of Color like the Bronx and Brooklyn and affluent White neighborhoods. There is incredible disparity in education, poverty, HIV, teen pregnancy, single mother-households, and birth and infant mortality rates.[17]

In a 1966 press conference, King said, “Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death.”[18] In King’s day, simple access to hospital healthcare was challenging for Black patients.[19] Nonetheless, Coretta King had access to hospitals for her births.[20] I was curious what these birth stories might tell us about his views on birth rights. His involvement in Coretta’s labors (1955-1962) seems minimal,[21] which was symptomatic of his culture.[22]  It was an era of high intervention in hospitals that rendered fathers helpless and mothers victims. Hospitals administered not just analgesic pain relief to women but amnesiacs which subdued women into controllability by the delivery team as the laboring mother either blacked out or was held down with straps.[23] This “Twilight Sleep” concoction led to high use of instruments (e.g vacuum or forceps) and surgical or medical induction[24] as women’s bodies were rendered helpless.



In the name of pain relief, of medical progress, families gave their power away. King said, “There is nothing wrong with power if power is used correctly,”[25]  but this form of subjugation became so culturally normal that the actual horror of it was unrealized.  The Drum Major Instinct of obstetric “progress” has taken us too far into a high-intervention, high-cost system that disempowers birthing women. It was a reality in King’s day that has continued on. In 2012, hospital birth was a $15.9 billion-a-year industry with C-sections bringing in the most money, followed by vaginal birth with complications.[26] A staggering 91.3% of vaginal delivery stays were cited as having a complicating factor that year.[27] This brings to mind King’s teaching that, “We are confronted by powerful forces telling us to rely on the good will and understanding of those who profit by exploiting us,”[28] and we need to rally against those forces.  

Theology, King, and Birthing          

When only 5.8% of all hospital births are deemed “uncomplicated”, the cultural perception becomes that women birthing bodies are inherently broken and need to be rescued by a high-cost patriarchal system. [29] What a contrast to Psalm 139:13-14a that sings, “For it was you who formed my inward parts; you knit me together in my mother’s womb. I praise you, for I am fearfully and wonderfully made.” God made the human body to be wonderful. In Genesis, we read that God made women’s bodies in God’s own image to be fruitful and multiply, to be very good.[30] While we certainly live in a fallen world with genuine health issues that Western medicine does benefit, a system that treats healthy women’s bodies as dysfunctional by default does not respect the imago dei in us, a key tenant of King’s theology.[31] In contrast, the CPM model empowers women to lean into the wonderful form and function of physiologic birth.[32]

Karen Montagno likens midwifery and pastoral caregiving through the example of Exodus 1:16-20 when the Hebrew midwives secretly delivered the male babies to save them from genocide by Pharaoh. “The midwife seeks to preserve health and ensure safety—by attending, listening, witnessing to the process and what is emerging. The midwife honors what is being birthed by encouraging and urging the one giving birth to use collective resources necessary for birth.”[33] In this way, birth can be an act of worship to the Creator God for mother and midwife. Furthermore, just as the midwives of Exodus sent a message with their surreptitious deliveries, modern day CPMs and homebirthing families are participants in direct nonviolent action against a broken system. By participating in this alternative model they engage in an act of boycott to the hospital system.

King’s Triple Evils

In today’s medicalized birthing climate, we see the Kingian idea of the Triple Evils of capitalism, racism, and (indirectly) militarism: we must suspect capitalism in prioritizing money for high-intervention birth over what is best for moms, and systematic racism visible is the c-section and mortality rates. “King upheld a universalist view of human dignity; created in the image of God, every person has an inherent worth, and therefore should always be treated as an end, not a means.”[34] It seems as though hospital birth very well may not be doing that.[35].

As for militarism, King was concerned about military spending at the expense of social justice in his day.[36] In 2015, US national defense costs $609.3 billion dollars; this is significantly less than the $1.05 trillion spent on Medicare and health costs, which shows progress.[37] Yet, our maternal and birth mortality statistics are so poor that clearly we are not spending that money well. With more strategic spending with the current healthcare budget as well as reduced spending in wars, change for women and their babies should be possible.

Furthermore, King’s objection to militarism was also about choosing violence over life-enriching solutions. When we scale this idea to birth, we see that today violence against birthing women is not facilitated by Twilight Sleep, but instead is precipitated by now-standard, but not evidence-based interventions that are not best for women but rather the medical system.[38] I believe that if King was alive today in our more egalitarian culture, he would be incensed by the injustice toward pregnant women.[39]

Conclusions and Suggestions for Change

CPM care has the potential to get us closer to King’s ideal Beloved Community and with public policy and ecumenical support, this can become more of a reality. Midwifery is as old as birth itself, but its place in the US has been largely forgotten, and women have suffered injustice because of it. It is time for a rebirth to happen on a grand scale, for CPM care to prevalently treat women with the dignity inherent from the Creator. Here are key suggestions to get us there:

Access to CPMs is severely restricted because of insurance coverage. In order for private and public insurance to cover a CPM, the midwife must have liability insurance.[40] There are few companies that offer this and costs can be prohibitively high.[41] In those cases when CPMs do become in-network under health insurance, the reimbursement rate, particularly for Medicaid, is so low that CPMs cannot viably accept that rate, so they decline to accept insurance.[42] This means that CPM care becomes gentrified, which must stop.

State and federal governments can support CPMs by allowing them as in-network providers and by subsidizing the cost of liability insurance and giving a higher reimbursement rate. This is socially and financially worthwhile because of better health outcomes and substantial healthcare savings. [43] With a CPM, the cost for prenatal care, delivery, and six weeks of post-natal care comes to a modest cost of $4,500-$5,500. Hospital labor and delivery alone (excluding prenatal and postnatal care) costs double that for a low-intervention vaginal birth and five times as much for a C-section.[44]

Government and businesses can provide grants to organizations that support homebirth care and education, like Mamtoto Village in Washington, D.C., Uzazi Village in Kansas City, and Commonsense Childbirth Florida. Each focuses on empowering birth workers of Color and offer affordable or free prenatal care to under-served mothers.

Churches can partner with such organizations through tithing out of their budget and offering space for fundraisers. Additionally, churches can offer space for childbirth and parenting classes as well as appointments. CPMs are used to working out of whatever space the mother has, so no special equipment is needed.

Grassroots efforts can include the nonviolent direct action approach of “voting with the wallet by” utilizing CPMs as well as lobbying for increased midwifery access, participating in marches like the annual Labor Day Rally to Improve Birth, and volunteering as mentors to disadvantaged mothers so that physiologic birth can become normalized through a mother-to-mother relationships. King might today tell birthing families today, “First, we must massively assert our dignity and worth. We must stand up amidst a system that still oppresses us and develop an unassailable and majestic sense of values.”[45]


Footnotes

[1] “They monitor the physical, psychological and social well-being of the mother throughout the childbearing cycle, provide the mother with individualized education and counseling that emphasizes health promotion and the prevention of pregnancy problems, provide hands-on assistance during labor and delivery, and postpartum support, identify and refers the few women who need obstetrical attention.” (“Certified Professional Midwives Fact Sheet,” ed. The Midwives and Mothers in Action (MAMA) Campaign (Putney, VT).)

[2] Not all midwives are theists, but the homebirth midwifery mindset is one of spirituality, as the mother of modern midwifery, Ina May Gaskin, shows in her quintessential book Spiritual Midwifery.  Quote is from Hak Joon Lee, The Great World House : Martin Luther King, Jr., and Global Ethics (Cleveland, Ohio: Pilgrim Press, 2011), 25.

[3] Martin Luther King and James Melvin Washington, A Testament of Hope : The Essential Writings and Speeches of Martin Luther King, Jr, 1st HarperCollins pbk. ed. (San Francisco: HarperSanFrancisco, 1991), 8.

[4] Melissa Cheyney et al., “Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009,” Journal of Midwifery & Women’s Health 59, no. 1 (2014).

[5] Physiologic birth is a midwifery term for unmedicated vaginal birth optimally guided by the mother’s intuition and natural inclinations

[6]Brady E. Hamilton et al., Births: Final Data for 2015 2015. Vol. National Vital Statistics Reports. pt. Volume 64, Number 12, 7.

[7] E.g., A woman is often required to have an internal progress to be admitted. This policy disrespects the need of some abuse survivors to avoid unneeded invasive touches and maintain bodily autonomy.  This check benefits the staff, but has no medical benefit to the mother.  (Rebecca Dekker, “State of Maternity Care in the United States: “Routine” Vs. Evidence Based Care,”  (Evidence Based Birth, 2012).)

[8] Hamilton et al., Table 18.

[9] World Health Organization Department of Reproductive Health and Research, W H O Statement on Caesarean Section Rates (Geneva, Switzerland: World Health Organization, 2015), 1.

[10]Andis Robeznieks, “U.S. Has Highest Maternal Death Rate among Developed Countries”, Modern Healthcare http://www.modernhealthcare.com/article/20150506/NEWS/150509941 (accessed August 30 2015).

[11] Hamilton et al., Table 18. 32.2% overall,  35.8% for Blacks

[12] T.J. Mathews, Marian F. MacDorman, and Marie E. Thoma, Infant Mortality Statistics from the 2013 Period Linked Birth/Infant Death Data Set2015. Vol. 64 Number 9. pt. National Vital Statistics Reports, 3.

[13] C. Nicole Mason, Economic Security and Well-Being Index for Women in New York City (The New York Women’s Foundation, 2013), 5.

[14] D. Goffman et al., “Predictors of Maternal Mortality and near-Miss Maternal Morbidity,” Journal of Perinatology 27, no. 10 (2007): 597.

[15] “In multivariable logistic regression, race remained significant while controlling for other significant factors and markers of socioeconomic status.” Another factor was previous C-section. This puts Black women at a disadvantage, as well, given their higher incidence of surgical birth.  Ibid.

[16] King and Washington, 559.

[17] Mason, throughout.

[18] Oshkosh Daily Northwestern, “King Berates Medical Care Given Negroes”, The Associated Press http://www.pnhp.org/news/2014/october/dr-martin-luther-king-on-health-care-injustice (accessed August 30 2016).

[19] King and Washington, 156.

[20] I would like to know more about how the Kings chose this option as, “The granny midwives of the south were seen as uneducated/illiterate women, and midwifery was seen as the choice of the poor.” King was an activist for the rights of the poor, going so far as to live among them, but his middleclass upbringing may have tempered the choice for hospital birth. (quote from Kim Pekin, “Midwifery Research Help,” ed. Pamm Fontana, Email (2016).) Kim Pekin is on the Board of Directors, NARM; chair of the Virginia Board of Medicine’s Advisory Board on Midwifery; and was the attending midwife at two of my births

[21] E.g., Martin III was born as his father was speaking to members of the Southern Christian Leadership Conference. (Manheimer, Ann S. (2004). Martin Luther King Jr: Dreaming of Equality. Carolrhoda Books, 46.) With Bernice, he flew home to take Coretta to the hospital and then left after a family photograph. (http://www.atlantamagazine.com/civilrights/bernice-king-carrying-mlk-legacy/)

[22]“Despite his respect for the human rights of women (their equality with men and equal pay for

equal work), he did not pay any systematic attention to the structural nature of sexism. Rather he still carried some of the traditional, male-oriented assumptions toward women.Lee, 61.

[23] Grantly Dick-Read, Childbirth without Fear; the Principles and Practice of Natural Childbirth (Great Britain: Pinter & Martin Ltd, 1959), Ch 13.

[24] Ibid., 15.

[25] King and Washington, 247.

[26] E. Stranges, L.M. Wier, and A. Elixhauser, Complicating Conditions of Vaginal Deliveries and Cesarean Sections, 2009. (Rockville, MD: HCUP Statistical Brief #131. Agency for Healthcare Research and Quality, 2012), 2.

[27] Ibid.

[28] King and Washington, 202.

[29]Stranges et al., Table 1. (Total numbers of discharges + footnote † divided by the number of vaginal deliveries without complicating conditions)

[30] Genesis 1:27-31

[31] “King upheld a universalist view of human dignity; created in the image of God, every person has an inherent worth, and therefore should always be treated as an end, not a means.” Lee, 54.

[32]e.g., Lowered state of consciousness in the second stage, the baby’s head cutting off circulation to the perineum as a natural analgesic, breastfeeding helps the uterus to contract down reducing blood-loss. Dick-Read, Ch 12 & 17.

[33] Karen Brown Montagno, “Midwives and Holy Subversives: Resisting Oppression in Attending the Birth of Wholeness,” in Injustice and the Care of Souls: Taking Oppression Seriously in Pastoral Care(Minneapolis: Fortress Pr, 2009), 8.

[34] Ibid., 54.

[35] “But many common institutional childbirth practices have been researched by the birth movement and recognized as abusive. These include denial of food and water during labor, women not being free to choose a birth position, the routine use of epidurals, a high rate of unnecessary C-sections, and others.” n.b.,These practices are not evidence-based but are holdouts from the era of Twilight Sleep. Shafia M. Monroe, “Reclaiming Childbirth: How a Resurgent Movement Is Taking Birth Back from the Medical Establishment,” Sojourners Magazine 39, no. 11 (2010): 1.

[36] “A nation that continues year after year to spend more money on military defense than on programs of social uplift is approaching spiritual death.” King and Washington, 241

[37] National Priorities Project, “Federal Spending: Where Does the Money Go”, National Priorities Project https://www.nationalpriorities.org/budget-basics/federal-budget-101/spending/ (accessed August 28 2016). Figure: Total Federal Spending

[38] One example: In August 2016, $16 million was awarded to Caroline Malatesta for medical assault during her birth and because of a “bait and switch” marketing campaign by her delivering hospital that promised gentle options to birthing women and then denied them to her during a smooth delivery.  https://www.yahoo.com/news/woman-sues-hospital-for-traumatic-birth-that-201605478.html

[39]“ If he were alive today, his attitude would differ because genuine sexual equality is more consistent with his ethics; he would agree that sexism, like racism, is interlinked with other social evils.” Lee, 61.

[40] Requirements vary by state

[41] Ana Vollmar and Autumn Vergo, “Creating Access in Changing Times: Transitioning New Hampshire Midwives to the Commercial Insurance Market,” Midwifery Matters2016

[42] Pekin.

[43] “More babies are carried to full-term, there are fewer C-sections and NICU admissions, the maternal mortality rate is lower, etc., and the overall cost is lower due to less intervention and low rates of hospital admissions for homebirth families. Breastfeeding rates are higher, which further reduces costs and improves outcomes for mothers and babies, as well as provides for natural child spacing (in an ideal world).”Ibid.

[44] Authors medical records from three births and “Average Facility Labor and Birth Charge by Site and Method of Birth, United States, 2009-2011,”  (New York, NY: Childbirth Connection, 2013). Note: Ironically, few insurance policies cover CPM services, so families who elect this care must pay out-of-pocket potentially costing them more money than a hospital birth would. This also means that only families with the financial ability to pay such a fee are able to benefit from this lower-cost, higher-service care.

 [45] King and Washington, 245.

 

Bibliography

“Certified Professional Midwives Fact Sheet.” edited by The Midwives and Mothers in Action (MAMA) Campaign. Putney, VT.

 “Average Facility Labor and Birth Charge by Site and Method of Birth, United States, 2009-2011.” New York, NY: Childbirth Connection, 2013.

Cheyney, Melissa, Marit Bovbjerg, Courtney Everson, Wendy Gordon, Darcy Hannibal and Saraswathi Vedam. “Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009.” Journal of Midwifery & Women’s Health 59, no. 1 (2014).

Dekker, Rebecca. “State of Maternity Care in the United States: “Routine” Vs. Evidence Based Care.” Evidence Based Birth, 2012.

Dick-Read, Grantly. Childbirth without Fear; the Principles and Practice of Natural Childbirth. Great Britain: Pinter & Martin Ltd, 1959.

Goffman, D., R. C. Madden, E. A. Harrison, I. R. Merkatz and C. Chazotte. “Predictors of Maternal Mortality and near-Miss Maternal Morbidity.” Journal of Perinatology 27, no. 10 (2007): 597-601.

Hamilton, Brady E., Joyce A. Martin, Michelle J.K. Osterman, Sally C. Curtin and T.J. Mathews. Births: Final Data for 2015, 2015. Vol. National Vital Statistics Reports. pt. Volume 64, Number 12.

King, Martin Luther and James Melvin Washington. A Testament of Hope : The Essential Writings and Speeches of Martin Luther King, Jr. 1st HarperCollins pbk. ed. San Francisco: HarperSanFrancisco, 1991.

Lee, Hak Joon. The Great World House : Martin Luther King, Jr., and Global Ethics. Cleveland, Ohio: Pilgrim Press, 2011.

Mason, C. Nicole. Economic Security and Well-Being Index for Women in New York City. The New York Women’s Foundation, 2013.

Mathews, T.J., Marian F. MacDorman and Marie E. Thoma. Infant Mortality Statistics from the 2013 Period Linked Birth/Infant Death Data Set, 2015. Vol. 64 Number 9. pt. National Vital Statistics Reports.

Monroe, Shafia M. “Reclaiming Childbirth: How a Resurgent Movement Is Taking Birth Back from the Medical Establishment.” Sojourners Magazine 39, no. 11 (2010): 20.

Montagno, Karen Brown. “Midwives and Holy Subversives: Resisting Oppression in Attending the Birth of Wholeness.” In Injustice and the Care of Souls: Taking Oppression Seriously in Pastoral Care, 3. Minneapolis: Fortress Pr, 2009.

Oshkosh Daily Northwestern, “King Berates Medical Care Given Negroes”, The Associated Press http://www.pnhp.org/news/2014/october/dr-martin-luther-king-on-health-care-injustice (accessed August 30 2016).

Pekin, Kim. “Midwifery Research Help.” edited by Pamm Fontana, 2016.

Robeznieks, Andis, “U.S. Has Highest Maternal Death Rate among Developed Countries”, Modern Healthcare http://www.modernhealthcare.com/article/20150506/NEWS/150509941 (accessed August 30 2015).

Stranges, E., L.M. Wier and A. Elixhauser. Complicating Conditions of Vaginal Deliveries and Cesarean Sections, 2009. Rockville, MD: HCUP Statistical Brief #131. Agency for Healthcare Research and Quality, 2012.

Vollmar, Ana and Autumn Vergo. “Creating Access in Changing Times: Transitioning New Hampshire Midwives to the Commercial Insurance Market.” Midwifery Matters2016

World Health Organization Department of Reproductive Health and Research. W H O Statement on Caesarean Section Rates. Geneva, Switzerland: World Health Organization, 2015.

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About More Green for Less Green

Hi, I’m Pamm. Welcome to my little slice of the web! As a progressive Evangelical female pastor and crunchy homeschooling mom, I’m never quite what anyone expects of me. But, hey, that’s what makes blogging interesting, right? Join me as I try to wholeheartedly parent my three little boys, slowly fix up the trashed foreclosure we bought in 2009, and live simply.

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