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Response to the Consensus Statement on the Management of Intersex Disorders

intersex families

[vc_row][vc_column][vc_column_text css=”.vc_custom_1731959260366{margin-bottom: 0px !important;}”]This year, in the course of my prenatal and birth support work, I had the occasion to read The Consensus Statement on the Management of Intersex Disorders published in 2006. Now eighteen years old, the Consensus statement is still used by medical teams to guide ethical decision-making regarding the medical care of intersex newborns, infants, and young children. 

Given this, doulas should be familiar with this Statement and ready to provide informational support to parents that is free from stigma and based on current evidence, including the stories of intersex adults. There are numerous concerns with this statement from a health equity and intersectional social determinants of health perspective. Many issues arise from how dated the document is. There are four problem areas with this statement: 1) Guidance on Terminology, 2) Guidance on gender assignment, and 3) Lived experience of intersex people not valued as evidence 4) The Kenneth Zucker controversy. 

Guidance on Terminology

The term “Intersex” is used in the article title, however, in the article body it lists “intersex” as potentially pejorative alongside several outdated and offensive terms. It then goes on to advise providers that “Disorders of Sexual Development” is the preferred term. This differs from the position of advocacy groups by and for intersex people, who counsel their audience that “intersex” is the term they prefer. 

Intersex conditions are numerous and diverse. Framing all of them as disorders discounts the reality that many intersex people are able to have sexual relationships and children without ever needing medical intervention. The universal use of the term “disorder” insinuates that all intersex people have something “wrong” with them that needs to be corrected. This is simply untrue. Some intersex conditions can cause issues with the ability to eliminate urine, in which case this must be treated as soon after birth as possible. Other conditions may impact fertility, and sexual functioning, or increase the likelihood of having cancer later in life. None of these issues need to be treated during the newborn phase and parents should be encouraged to focus on bonding with their baby. The blanket use of the term “disorder” and the fear it is apt to inspire in parents does not support the measured and stigma-free approach to decision-making that is best here. 

Guidance on Gender Assignment

Unsurprisingly given the statement’s age, concepts like non-binary identity and gender-open parenting are not entertained. The Statement positions it as a given that parents will be deeply disturbed if they are not able to assign a gender to their baby at birth. It promotes making a gender assignment as quickly as possible after birth as the way to alleviate parental anxiety. Much of the pressure to diagnose and treat early that it advocates is rooted in the belief that parents need guidance on how to assign gender. The statement then offers guidance on what gender should be assigned to people with certain conditions.

The idea that each individual is the most qualified person to identify their gender is never considered. According to the statement assigning gender is strictly the purview of the parents, in this case, guided by medical experts. 

Earlier this year, I wrote about the concept of “gender-open parenting” and how and why it is enacted. This approach to parenting is guided by the belief that each individual has the right to assert and express their gender as free from external pressure as possible. Gender-open parenting is a wonderful option for parents of an intersex child to consider. Gender formation and expression happen in early childhood. Anecdotally, most children who have been raised gender open have self-identified their gender by the time grade one is over. At this age, most medical complications will not have arisen, and most medical interventions are still on the table. From the standpoint of promoting bodily autonomy and informed consent, parents should be encouraged to defer decisions about gender assignment and non-urgent medical intervention until the child can be a part of those conversations.

The Lived Experiences of Intersex People

More recent research on intersex people has found that many intersex adults have extensive medical trauma from repeated examinations and in some cases multiple surgeries during childhood. Moreover, many intersex adults attest that the surgeries they endured were cosmetically motivated, medically unnecessary, and in some cases harmful to their sexual functioning and/or fertility. Still, other intersex people whose parents forewent medical interventions state that they are happy, functional adults. 

This qualitative evidence from intersex adults needs to be viewed as legitimate evidence regarding how intersex people should be cared for in childhood. I’m not sure how much qualitative evidence from intersex adults existed in 2006, but if there was any, it wasn’t included in the statement. 

The statement does use statistical evidence drawn from intersex adults, using the gender identity held by the majority of individuals with specific conditions to justify assigning that gender to all infants with that condition. The Statement notes that gender may need to be reassigned if the initial assignment proves wrong. Again, the experts are to make this reassignment. The concept of the individual deciding their gender for themselves is not mentioned. 

Throughout the document, the intersex child is discussed as a passive bystander to their health care decision-making. This is not aligned with contemporary approaches and attitudes regarding the importance of client-centred and directed care, informed consent, and bodily autonomy that should be enacted in every part of the healthcare system.

Kenneth Zucker Controversy

The Statement is a consensus among international experts on the diagnosis and management of intersex conditions. The Canadian expert who contributed to the statement is Dr. Kenneth Zucker. His name will ring a bell for many members of the Toronto 2SLGBTQ community, especially trans people, parents of trans kids, and their allies. For many years, Dr. Zucker was the director of the Gender Identity Clinic at the Centre for Addiction and Mental Health (CAMH). Many trans youth and their parents have accused Dr. Zucker of harming them by gaslighting them about their gender identity and trying to convince kids who were certain that they were trans that they were wrong and that in his expert opinion, they were cisgender and should focus on being comfortable with the gender they were assigned. Following significant and sustained outcry from the 2SLGBTQ community alleging conversion therapy, Dr. Zucker was relieved of his duties at CAMH, and the Clinic was closed. He defended his practices, appealed this decision, and was eventually offered an apology and a settlement by CAMH.

The consensus statement manifests many of the concerns that were raised about Dr. Zucker’s ideology. They included:

  • The individual is not considered a valid authority on their own lived experiences and identity. 
  • Conforming to the gender you are assigned is the ideal outcome. 
  • Non-binary, genderqueer, agender, and genderfluid identities are not legitimized or even considered. 
  • Everyone must eventually conform to the box of “male” or “female”. 
  • Gender is something that is assigned to you, not something that you define for yourself. 
  • Having a child that can’t be easily slotted into one of those boxes is “disturbing” for parents.

On this platform, I have talked about how these beliefs are harmful to trans people. They’re harmful to intersex people too, especially in infancy. The pressure to rush to gender assignment, potentially reinforcing the assignment with surgical procedures, is driven by these beliefs. Intersex people are being physically and psychologically harmed as a result. 

~

For many parents, their child being diagnosed with an intersex condition will be the first time they have given any thought to the existence of intersex people. This is through no fault of their own. The gender binary is the dominant perception of reality. The lives of intersex people are shrouded in stigma and silence. As such, parents are highly vulnerable to accepting what they are told by medical experts at face value. The Consensus Statement is an excellent example of how medical guidance is not always objective. Our interpretation of “facts” is always mediated by our preexisting beliefs. 

Doulas have a vital role to play in helping parents understand where medical recommendations are coming from and unpacking the beliefs on which seemingly evidence-based recommendations rest. The B.R.A.I.N (Benefits, Risks, Alternatives, Information/Intuition, (do something) Now/Never/Not Now) model of decision-making is an excellent approach to apply. We can also reduce stigma by sharing stories of positive outcomes for intersex individuals. Role models and other resources can be found at Intersex Canada or InterAct: Advocates for Intersex Youth.

My social media post from October 28, 2022, offers guidance on specific questions parents should ask if their child is diagnosed with an intersex condition. A huge part of the magic of this work is the power to improve lives by being at the ready with unbiased, affirming, open-minded information and compassionate support. If we lead with compassion and inclusiveness, we can alleviate the medical harms currently happening to intersex babies and children. 

 

Keira GrantKeira Grant (she/her) Inclusion and Engagement Lead – Racialized Communities

Keira brings a wealth of experience to the Online Community Moderator role. She is a Queer, Black woman with a twenty-year track record in Equity, Diversity, and Inclusion (EDI) education, projects, and community building initiatives.[/vc_column_text][/vc_column][/vc_row]

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Anti-Oppression Anti-racism work collaboration community decolonization national indigenous peoples day Trauma

National Day for Truth & Reconciliation: Action is Our Collective Responsibility

[vc_row][vc_column][vc_column_text title=”National Day for Truth & Reconciliation: Action is Our Collective Responsibility” css=”.vc_custom_1727115223782{margin-bottom: 0px !important;}”]In 2015, the Truth and Reconciliation Commission of Canada announced that its investigation into the inter-generational trauma caused by the “Indian Residential School” system that the Federal Government of Canada operated in partnership with Christian Institutions between about 1880 and 1996 was complete. The commission published a final report that made 94 Calls to Action. Many Indigenous experts believe that completing these Calls to Action is an imperative aspect of rectifying the harm that settler colonialism has done to Indigenous people.

It’s been nine years since the commission published its report. The concept of Truth and Reconciliation is that repairing the damage can only be achieved with honesty. The truth is that the federal government has not done much to change outcomes for Indigenous peoples since the report’s publication.

On the 8th anniversary of the final report’s publication, the federal government issued a statement claiming that 85% of the calls to action were either complete or well underway. Indigenous Watchdog paints an entirely different picture. According to their analysis, only 66% of the Calls are completed or in progress. Twenty percent of the calls are stalled, and 20% have not yet started.

At the time of this writing, Indigenous communities across Canada are mourning and speaking out about injustice. Over 2 weeks this month, 6 Indigenous people were killed by police, with the RCMP responsible for 4 of the deaths. This overt violence at the hands of the police is a stark barometer for the level of violence Indigenous people are subject to in other institutions, including health care.

When it comes to the federal government’s action on the 7 health care calls, it is slim to non-existent. None of these urgently needed calls have been completed. This lack of action shows in the numbers. A 2023 study found that 18.6% more non-Indigenous women had a regular healthcare provider during pregnancy than Indigenous women. This was connected to statistically lower access to primary and specialized care. This applied to rural and urban settings, and disparities remained when socioeconomic status was controlled for. Similarly, the infant mortality rate is twice as high for Indigenous babies as for non-Indigenous babies. The studies’ authors conclude that racism and the resulting deep mistrust of the system are to blame.

Given the ongoing violence that Indigenous people face at the hands of institutions, mistrust is entirely justified. If our government were serious about establishing trust, it would be honest about its accomplishments on the Calls to Action and get the work done.

The Call to Action that has the most direct impact on how we should practice as doulas is number 22, which calls upon us to recognize the value of Indigenous healing practices and incorporate them in healthcare delivery. When engaging with Indigenous clients seeking perinatal support empowering and facilitating their reclamation and implementation of Indigenous teachings if desired is essential. For non-Indigenous birth workers, this looks like making referrals to an appropriate Indigenous doula where possible and doing the work of managing our colonial unlearning proactively and independently when not. We should also listen deeply and with humility to the teachings the client would like to impart.

As a training Institution, we are committed to enacting the 24th call: ensuring that all students who will be working alongside the healthcare system take Indigenous culture and awareness training. The goal of our Truth & Reconciliation module is to ensure that all program graduates are prepared to fulfill the 22nd call in their practice. We recognize that the module is a work in progress and we are paying close attention to feedback from our Indigenous students on how the module can be made more relevant and impactful. As our program grows to include students from more and more countries, we are exploring ways to connect the oppression of Indigenous people on Turtle Island to experiences of colonization, displacement, and resistance around the world.

We know our work is far from complete and that our spheres of influence are small. However, each small organization’s actions to fulfill the Calls to Action is an example and a challenge to our Federal government and other powers to step up and honour their commitments. We trust our actions will ripple out, and we look forward to continuing this essential work in our community.

 

Keira Grant (she/her) Inclusion and Engagement Lead – Racialized CommunitiesKeira Grant

Keira brings a wealth of experience to the Online Community Moderator role. She is a Queer, Black woman with a twenty-year track record in Equity, Diversity, and Inclusion (EDI) education, projects, and community building initiatives.

 

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About Us Canada certification community Members Mentorship

Doula Training Canada Becomes Doula School Canada

September newsletter

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Q & A: Doula Canada’s Rebranding to Doula School

We’re thrilled to announce that Doula Canada is officially rebranding as Doula School! 🎉 This change reflects our evolving commitment to providing top-tier education and support to those passionate about birth work. As Doula School, we’ll continue to offer the same high-quality training you’ve come to expect, but with an expanded focus on community, innovation, and growth within the doula profession.

Why the change? We’re rebranding to “Doula School” to better reflect our unified mission of supporting you through learning, mentorship, and professional growth. This new name represents our commitment to a shared educational journey, whether you’re just starting out or expanding your practice.

Q1: Will the courses be staying the same?

You can expect the same high-quality content and resources from Doula Training Canada. Our commitment to providing valuable, comprehensive education remains steadfast. We’ve been working tirelessly behind the scenes for the past year doing a full educational audit of all courses, making lots of updates to our core offerings. We know that this will mark some of your lessons as incomplete that were previously complete and will add some new quizzes and assignments to the courses.

Please note that if you are very close to being done your course you DO NOT need to complete the new assignments, but we feel there is much benefit in you having access to them! If you’ve just begun your journey then we’d encourage you to go back and complete them when you can. Reach out to the mentorship with questions or if you need support with these changes. Anything you’ve previously submitted we continue to have access to, even if you don’t see it in your course outline anymore!

Q2: Will my certification still be valid?

Absolutely! Your certification remains fully valid, and all courses will continue to operate as usual. The rebranding to Doula School will not affect the terms of your certification or the recognition of your credentials. Everything will remain exactly as it was when you earned your certification through Doula Canada. You can rest assured that your qualifications are still recognized and respected within the industry, with the same commitment to excellence that you’ve always experienced.

Q3: Will the requirements change for those currently enrolled in courses?

New Changes to Education Units: Previously students were required to obtain additional Education Units (EUs) to complement their learning (in addition to the doula specific content you learn in the courses). We have now added requirements for CPR/First Aid, Infection Prevention and Control (IPAC), and a Food Handling Certificate (for postpartum doulas). To align with the latest standards and ensure comprehensive training, these have been added to the certification requirements. Please review these changes to understand how they may impact your certification process and reach out to us with questions/concerns. These new additions now REPLACE the EUs needed to certify. But please note that if you were almost ready to submit your certification documents based on the former requirements we will be happy to accept that instead.

Q4: What else is changing?

Enhanced Learning Materials: We have made updates and improvements to our training materials to reflect the latest knowledge and best practices. These changes are designed to enhance your learning and provide you with the most relevant and up-to-date information. Over the coming weeks you will see many new handouts that you can use in your practice and with your clients.

Q: How can I stay updated on the latest news from Doula School?

You don’t need to do anything differently! Just keep following us on social media, stay subscribed to our newsletter, and check our website as usual. Everything will remain the same except for our new branding, and we’ll continue to keep you updated with all the latest news and developments.

Still have questions? Send us an email.

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Anti-Oppression Anti-racism work Canada collaboration community decolonization Equity indigenous doula intersectionality national indigenous peoples day

Land Back, Bodies Back

Indigenous standing on the dock of a lake and greenary

[vc_row][vc_column][vc_column_text title=”Land Back, Bodies Back” css=”.vc_custom_1717529147132{margin-bottom: 0px !important;}”]Many settlers (i.e. all non-Indigenous residents on Indigenous land) are resistant to the Land Back Movement. Misinterpreting “Land Back” as a call for all settlers to “go back where they came from”, they often get scared, then angry.

I am a Black settler on Turtle Island and I support the Land Back Movement. I certainly have no intention of “going back where I came from”. Aside from the fact that this would split up my interracial family, my ancestors hail from a Caribbean island wherein there are more of us in the diaspora than there are living on the island. If all of us who are now settlers elsewhere suddenly “returned” this would lead to social chaos and economic collapse.

Land Back isn’t symbolic either. It is about restoring the stewardship of this land and its resources back to Indigenous people, ensuring they have self-determination. It’s about changing the narrative such that Indigenous ways of knowing and doing become the status quo.

I am ride or die for a Turtle Island stewarded by Indigenous leaders. Climate change is heating up quite literally, with “wildfire season” starting earlier with bigger outbreaks each year. There is growing talk of returning to Indigenous “controlled burning” practices to mitigate the devastation. Indigenous communities were forced to abandon the practice because their colonizers thought controlled burns were “barbaric”. It’s one of countless examples of traditional resource stewardship practices that were abolished to the detriment of all.

The Canadian state has a long history of interpreting its treaties with Indigenous nations in bad faith. Settler-colonists spuriously interpreted the land as meaning nothing more than the ground we are standing on. Where treaties have designated the land to specific nations, the state and its agents have still felt entitled to help themselves to the resources on that land, including plants, water, minerals, and animals.

Indigenous nations have a more holistic understanding of the land. Everything the land produces is part of the land and the Indigenous elders representing their people signed the treaties with that pragmatic worldview. Seen in this way, our bodies and families are also part of the land. As such, reproductive and perinatal health and services are significant arenas for the Land Back movement.

Indigenous midwives and doulas are at the forefront of actions to decolonize and reclaim birth. Here are a few examples of their initiatives that are bringing Indigenous birth back to the land:

 

  • Konwati’shatstenhsherawi’s means “Women are Giving Each Other Power” in the Mohawk language (Kanien’kéha). This collective trains Indigenous birth helpers to support birthing people using ancestral worldviews and practices. Since the grassroots program’s inception in 2017 demand has been high and the 4-person training team is busy teaching new cohorts all the time.

 

  • Call Auntie is an Indigenous-led sexual and reproductive healthcare clinic operating weekly at Toronto Birth Centre, and as a pop-up at other locations around the city. They offer a holistic suite of services rooted in traditional Indigenous knowledge, including mental health, primary care, and social support programs. Their service model emphasizes problem-solving, removing barriers, and community-led care.

 

  • Pauktuutit Inuit Women of Canada is making important strides forward in expanding access to traditional midwifery in remote northern communities. Their position is that this access is a health and cultural right for Inuit people. They recently published a report finding that governments do not provide adequate financial support to culturally safe sexual and reproductive health care. They advocate for an end to forced birth evacuation and a return to traditional birthing practices on the land.

 

  • Mālama Nā Pua o Haumea is a collective of Hawaiian traditional midwives who are working to reduce maternal mortality rates which are higher in Hawaii than in the continental US. Recently, legislation governing midwifery care has changed and they are now required to become certified nurse midwives (CNM) or certified professional midwives (CPM). Pale keiki (traditional Indigenous Hawaiian birth attendants) experience multiple institutional barriers to completing this certification, including cost and relocating to an urban centre. In contrast to these 4-year certification programs, pale keiki train with a mentor versed in intergenerational knowledge for over a decade. Some pale keiki are continuing to provide culturally safe care in Pidgin, despite these legislative changes. (US)

 

  • Kehewin Cree Nation has launched a program to train traditional midwives and has received federal funding to open a birth center on its territory. The nation aims to see more Cree babies born on their land and to honour sacred traditions such as placental ceremonies. Trainees in the program learn the knowledge of their midwife ancestors alongside Western medical knowledge. Four women are in the inaugural cohort and the program will take up to 4 years to complete. Kehewin Cree Nation anticipates these 4 trainees will be the first of many.

 

 

Keira Grant (she/her) Inclusion and Engagement Lead – Racialized Communities

Keira brings a wealth of experience to the Online Community Moderator role. She is a Queer, Black woman with a twenty-year track record in Equity, Diversity, and Inclusion (EDI) education, projects, and community building initiatives.[/vc_column_text][/vc_column][/vc_row]

Categories
Anti-Oppression birth Canada community Equity fear intersectionality LGBTQ2S+ pride reducing stigma sexual health shame

The Importance of Being Seen: Trans Day of Visibility & Pink Shirt Day

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When I was a kid, we were taught that not seeing differences, or being “colour-blind” was the right way to be “tolerant” and “accepting” of diversity. We hear echoes of this sentiment when we hear “They can do whatever they want behind closed doors, but why do they have to flaunt it in our faces?”

March 31 was Trans Day of Visibility and April 10 was International Day of Pink. Both observances attest to the importance of being seen as an integral dimension of human rights and inclusion. People who can only be their authentic selves behind closed doors can’t hold their same-sex partner’s hand during the anatomy ultrasound, or tell their care team that they want to be called “Papa” after they give birth. People who are forced to hide their identity behind closed doors are at risk of getting beaten up in bathrooms and dying by suicide behind closed doors. Trans people need to be seen so that kids like Nex Bennedict can go to school safely. Behind closed doors is exactly where abuse and violence hide.

Having safety to be seen means being able to fully participate in society. It boils down to countless everyday things that people take for granted when their identities are not contested. Being able to use public washrooms without risking confrontation or violence. Accessing information on reproductive health that normalizes your body and healthcare experiences. Not being asked to explain where your partner is at prenatal appointments when they are in the exam room with you. Being able to find pregnancy attire that aligns with your usual style.

Trans and queer people need to call for visibility and wear pink to get noticed so that we can lead normal lives.

As birth workers, here are some things we can do to help queer and trans folks feel seen in the reproductive and perinatal wellness sphere:

  • State explicitly in your promotional materials that you welcome and affirm queer and trans people
  • Use gender-neutral language in your promotional materials and handouts
  • Have open conversations with clients about their preferred pronouns and terms for their parenting roles and body parts.
  • Become familiar with resources in your community that support queer and trans families so you can make great referrals.
  • Educate yourself on health inequities faced by queer and trans birthers
  • Challenge queer and transphobia in yourself and others

You can find out more about Trans VisibilityVisibilty Day here

You can find out more about International Day of Pink here

 

Keira Grant (she/her) Inclusion and Engagement Lead – Racialized Communities

Keira brings a wealth of experience to the Online Community Moderator role. She is a Queer, Black woman with a twenty-year track record in Equity, Diversity, and Inclusion (EDI) education, projects, and community building initiatives.[/vc_column_text][/vc_column][/vc_row]

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balance community connection

Embracing Mothering, Releasing Motherhood: Women’s History Month

[vc_row][vc_column][vc_column_text css=”.vc_custom_1711640523303{margin-bottom: 0px !important;}”]I loved one-sided “conversations” with my son when he was an infant and it’s one of my favorite things about postpartum visits now. I refer to all my clients by their first names, however, when I’m providing postpartum support to clients I know identify with terms like “woman”, “mother”, and “mom”, I often find myself talking to Baby about how wonderful their mama is and what a great job she’s doing, especially when they get to the stage where their eyes follow her around the room lovingly. 

This often sparks a conversation with the client, especially if no one else is there. That’s part of my goal. In a patriarchal world, “mother” is a loaded construct. Adjusting to the idea that you are now someone’s “mama” is one of the most emotionally and psychologically intense aspects of the postpartum experience for first and only-timers because of everything that is expected of motherhood. 

Canadian feminist scholar Dr. Andrea O’Reilly has devoted her academic career to understanding what it means to be a mother. A mother of three herself, she understands “motherhood” as something separate from “mothering”. Motherhood is a patriarchal institution that sets rigid, specific, and unattainable expectations on the care work of raising children as a means of exerting control over women’s bodies and lives. To meet patriarchal expectations of motherhood women must be selfless, long-suffering, patient and kind, and compliant with expectations of good, wholesome women. Patriarchy’s archetypal mother does not sexualize herself, but she also doesn’t “let herself go”. She keeps an immaculate home and serves balanced, from scratch meals. She has well-groomed, well-behaved children. She always knows exactly what to say and do to comfort her family and keep peace and order in the home. By the 1980s, contributing to the household income was added to the list of expectations. As an avid fan of The Cosby Show, it did not strike me as unusual that high-powered lawyer and mom of 5 Clare Huxtable would make fresh squeezed OJ and pancakes from scratch for her brood on Saturday mornings, served in the comfort of their stunning, self-cleaning Park Avenue home.

As a working mom of one in 2024, it strikes me as absurdly implausible, and that’s intentional. The point is not for anyone to be as perfect as an 80s sitcom mom. The point is for all of us to feel like we’re failing by comparison.

Conversely, O’Reilly defines “mothering” as autonomous, empowered, and priceless social labour that we construct and define according to our deep knowledge of family, community, and personal needs. As a verb rather than a noun, “mothering” is action-oriented and the role is created by those who enact it. Mothering does not require the relinquishment of self but affirms each mother’s right to undertake the role in a manner that is faithful to her authentic self. 

When supporting new mothers I hold space for their joy and discomfort with being called “mama”. I normalize using alternative monikers if that’s preferable. My wife was not comfortable with “mother” as a label, so we went with a variation of her nickname instead. I encourage them to insist on making space for the things that made them “them” before they had their beloved baby. We unpack unrealistic and sexist expectations of moms as they arise. I affirm the need to putting yourself first sometimes, for the overall good of the family. We lay the groundwork for them to define the role according to what works for them and their family. Liberating new mothers from the constraints of motherhood and facilitating their intuitive enactment of mothering is one of my favourite aspects of being a doula. 

 

We hope our woman-identified audience is having an affirming Women’s History Month this March. For those of you who mother, we affirm your right to do this living giving, nurturing work on your terms. [/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_single_image image=”534490″][vc_column_text css=”.vc_custom_1711640593876{margin-bottom: 0px !important;}”]Keira Grant (she/her) Inclusion and Engagement Lead – Racialized Communities

Keira brings a wealth of experience to the Online Community Moderator role. She is a Queer, Black woman with a twenty-year track record in Equity, Diversity, and Inclusion (EDI) education, projects, and community building initiatives.[/vc_column_text][/vc_column][/vc_row]

Categories
Anti-Oppression Anti-racism work community

The Mothers of Gynecology

[vc_row][vc_column][vc_column_text css=”.vc_custom_1707747263915{margin-bottom: 0px !important;}”]Anarcha, Betsy, and Lucy’s gynecological advancements have undoubtedly saved and improved countless lives. Yet they are not celebrated in most textbooks on gynecology or its history. Lucy, Betsy, and Anarcha were not medical researchers. Their ingenuity was a matter of survival. They were among the enslaved Black women that physician Marion Simms tortured and butchered by experimenting on them without anesthesia in the name of medical research.

Marion Simms is regarded as the “Father of Gynecology”. Not only is he remembered in the textbooks, but there is also a statue in his honour in his hometown of Alabama, in front of the clinic where he tortured Black women. He invented the speculum and the position of lying on one’s back with feet in the stirrups, that most birthers are expected to adopt in medicalized deliveries is named after him.

Simms believed that as a result of being less human than white women, Black women did not feel pain. He had no ethical qualms about conducting his “experiments” without anesthesia, despite the need to restrain the screaming women. When his medical assistants did and quit, he trained Lucy, Betsy, and Anarcha to perform this role. The three women perfected many of the procedures he was developing to save each other’s lives. Simms took the credit of course.

In 2022, a sculpture by Afrian-American artist and activist Michelle Browder finally began giving these women the recognition they are due while raising awareness of the suffering that was inflicted on them without their consent or free will. “Mothers of Gynecology” tells the stories of these heroes visually. 

All three women had suffered painful pelvic floor injuries during childbirth that affected their bowel and bladder control, making them unfit for hard labour on plantations. Now useless to their owners, they were leased to Dr. Simms in the hopes of him finding a cure that would restore them to productivity. His first experimental surgeries were failures. Undaunted, he continued his experiments, training the women to function as his assistants after his white assistants quit. They each became skilled medical providers in their own right. Simms experimented on a total of 12 enslaved women, but only Anarcha, Betsey, and Lucy’s names are preserved in his reports. To make his research more palatable, his reports state that the experiments were conducted on white women with assistance from white nurses. 

Browder’s arresting sculpture manages to convey the details of this horrific story in a way that transcends words and restores power and dignity to these exploited women. The sculptures are intricately fashioned from found metal. The three women are towering in this commanding piece, with Anarcha standing at 15 feet, Betsy standing at 12 feet, and Lucy at 9 feet. While the viewer’s emotional reaction to the piece is immediate and visceral, the symbolism possesses such a wealth of detail that you’d need to stand in front of it for at least an hour to pick up on everything. This Smithsonian article describes the symbolism like this:

“The statues incorporate meaningful—and painful—symbolism. Anarcha’s abdomen is empty, except for a single red rose where her uterus would be. Her womb sits nearby, full of cut glass, needles, medical instruments, scissors, and sharp objects intended to help viewers feel the women’s pain and suffering.

Medical scissors are attached to one woman. Another wears a tiara created out of a speculum—a device Sims invented for vaginal exams. The names of Black women [civil rights heroes] are welded to the statues.”

The figures have no arms or lower legs to represent the women’s lack of bodily autonomy.

Michelle Browder uses art as one aspect of her reproductive justice work. In 2022, she bought the land on which Simms conducted his experiments and is working on opening a clinic and museum for Black women’s health on the site. 

Simms’ racist belief that Black women had a higher pain tolerance than white women is still prevalent among healthcare providers. In perinatal health, this means Black birthers’ pain goes under or unmanaged, and pain that should sound the alarm regarding complications goes ignored. Black birthers know this and the main reason we seek birth doula support is to ensure we have an observer and advocate making sure our pain is being taken seriously and treated appropriately. 

Learning more about the mothers of gynecology is one activity that you can do to observe Black Future Month. You can find out more here:

 

Artist Works to Correct Narrative of Gynecology’s Beginnings

https://www.anarchalucybetsey.org/ 

 

 

[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_single_image image=”534490″][/vc_column][/vc_row][vc_row][vc_column][vc_column_text css=”.vc_custom_1707747309073{margin-bottom: 0px !important;}”]Keira Grant (she/her) Inclusion and Engagement Lead – Racialized Communities

Keira brings a wealth of experience to the Online Community Moderator role. She is a Queer, Black woman with a twenty-year track record in Equity, Diversity, and Inclusion (EDI) education, projects, and community building initiatives.[/vc_column_text][/vc_column][/vc_row]

Categories
Canada community Health Care

Learning from US Healthcare on Doula Access

[vc_row][vc_column][vc_column_text css=”.vc_custom_1706711380769{margin-bottom: 0px !important;}”]I vividly remember “The Greatest Canadian”, a 13-part  competitive series produced by CBC in 2004. Each week, a biographical documentary on individuals who have made a great contribution to Canada aired, including Terry Fox, David Suzuki, and Tommy Douglas. Viewers got to vote on who the greatest Canadian of all time was. Tommy Douglas, recognized as the father of publicly funded health care in Canada, emerged victorious. 

Douglas’ win says a lot about the value we attach to our healthcare system and the national pride we take in making sure that every Canadian has access to the care they need. We often look to our American neighbours with pity when we hear about $700+ a month insurance plans ($2000+ for a family plan) or families going into debt or going bankrupt to pay for life-saving treatment. But if the Canadian healthcare system is so superior to that of the US, why is publicly-funded doula access expanding by leaps and bounds in the US, while progress on the same front has been stagnant in Canada?

Over the last few years, an increasing number of jurisdictions in the US have made doula care payable via Medicaid. Medicaid is public health insurance for people who are unable to access private coverage. 11 States that have introduced Medicaid-funded doula care programs include New York, California, and Michigan. California cites familiar research as the rationale for its decision: “doula care was associated with positive delivery outcomes including a reduction in cesarean sections, epidural use, length of labor, low-birthweight and premature deliveries. Additionally, the emotional support provided by doulas lowered stress and anxiety during the labor period”. 

One reason why advocates for publicly funded doula care have gained more traction in the US is that the US collects race-based healthcare data, along with information on many other social determinants of health. This data has demonstrated significant disparities in perinatal outcomes based on race, income, and other factors. The Black maternal and neonatal mortality crisis has emerged as a system disaster that requires urgent solutions. Combined with a growing body of health research demonstrating that doulas are an effective intervention that improves outcomes for Black birthers and babies, this has made a strong case for access to doula care for Black and other at-risk communities.

In Canada, we have the same research to show that doulas solve a problem, but we don’t have the same amount of data to show that there’s a problem to solve. That being said, while our race-based data collection needs to improve, we do collect data on other topics. In 2023 OBGYN researchers at McMaster University published findings on operative deliveries and 3rd and 4th-degree tears in Canada. They found that “among high-income countries, Canada has the highest rate of maternal trauma after births in which tools like forceps and vacuums are used”. Sadly, their research only compares operative deliveries (forceps/vacuum) to surgical deliveries (cesarean sections). They do not take into account the ample evidence that California and other US jurisdictions considered showing that support from a birth doula reduces the likelihood of any of these interventions. 

Not only do we need to collect data that demonstrates the impact of the social determinants of health, we need to put the research we do have into action. This action needs to encompass the role that all care providers play in improving conditions and outcomes for birthing people. This includes ensuring that all birthers can access the reduction in medical interventions and related increases in good birth outcomes and satisfaction that skilled doula support can achieve. [/vc_column_text][vc_single_image image=”534490″][vc_column_text css=”.vc_custom_1706711516822{margin-bottom: 0px !important;}”]Keira Grant (she/her) Inclusion and Engagement Lead – Racialized Communities

Keira brings a wealth of experience to the Online Community Moderator role. She is a Queer, Black woman with a twenty-year track record in Equity, Diversity, and Inclusion (EDI) education, projects, and community building initiatives.[/vc_column_text][/vc_column][/vc_row]

Categories
Anti-Oppression Anti-racism work birth community

Respecting All Life: Reflections on International Holocaust Remembrance Day and National Day of Remembrance and Action Against Islamophobia

[vc_row][vc_column][vc_column_text css=”.vc_custom_1706563078413{margin-bottom: 0px !important;}”]That horrible day in 2017 when for no reason other than hate a 6 Muslim Canadians were killed at a Mosque in Quebec is still haunting. In a society that claims to love peace, equality, and freedom, the level of hate that spawned this horrific attack should never have been able to arise. What’s almost as haunting is that in the intervening 7 years, we’ve learned very little about the thinly veiled hate that is clearly pervasive in this country because we haven’t learned how to have an ongoing, brave discussion about it.

This year, Holocaust Remembrance Day (Jan. 25) and National Day of Action Against Islamophobia fall as a very deadly conflict in Israel-Palestine has raged on for over 100 days. While Jewish and Muslim Canadians are no more complicit in the conflict than any other Canadians, they have been forced to endure an unprecedented increase in hate-motivated attacks against them. I wish I was more surprised.

We’re too polite to talk about hate until people are getting killed, and by then it’s too late. We hold the guilty party accountable when the van attack and similar crimes happen, but we don’t hear the call to examine the society that created the van attack.

As birthworkers, we see and snuggle many brand-new babies. Every single one is special and they all deserve to grow up and live the lives they create for themselves based on the values that were cultivated in childhood. The presence of hate in the world makes this right impossible to realize for all children, so hate must be eradicated.

To our Israeli, Jewish, Muslim, and Palestinian alumni and audience, we know this has been an unbearably distressing last few months within your communities here in Canada and internationally. As birthworkers in your communities, you have had to process your own feelings while supporting birthers in your community who are under incredible strain. We know that extreme stress can contribute to complicated pregnancies and challenging outcomes. We see the vital work you are doing in your communities at this time and we are continuing to extend our compassion and support.

As doulas, we will continue to shine a light on hate in the healthcare system, institutions, communities, and ourselves. Only when hate is diligently brought out into the open and swept away can we have communities where all life is truly respected and it is safe for all children to grow. 

If you are looking for guidance on how you can support your community and access support for yourself at this difficult time, please visit our blog post “Our Hearts Are With You” from November 10, 2023. [/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_single_image image=”534490″][vc_column_text css=”.vc_custom_1706554746991{margin-bottom: 0px !important;}”]Keira Grant (she/her) Inclusion and Engagement Lead – Racialized Communities

Keira brings a wealth of experience to the Online Community Moderator role. She is a Queer, Black woman with a twenty-year track record in Equity, Diversity, and Inclusion (EDI) education, projects, and community building initiatives.[/vc_column_text][/vc_column][/vc_row]

Categories
Anti-Oppression birth community

Facilitating Accountability

[vc_row][vc_column][vc_column_text css=”.vc_custom_1706107261056{margin-bottom: 0px !important;}”]As birth workers, we often see things or hear things from our clients that should not have happened. It could be an ultrasound tech sharing an interpretation that is later contradicted by their primary care provider, causing the patient confusion and anxiety. It could be membrane sweeps, AROMs, or episiotomies performed without the client’s consent. Or nurses disclosing information to family members while the client is unconscious, leaving the patient to receive a broken telephone story from their family later. 

 

These incidents range from irritations to serious breaches of practice standards, and things are more likely to “just go wrong” for systemically marginalized people. Clients are usually at a loss as to how to seek accountability or believe they can do nothing to address the harm they’ve experienced. 

 

Some may be aware of complaints processes that exist, but concerns about outcomes on either end of the spectrum – nothing will happen, or the worker will get fired – are often a deterrent. And of course, our clients who have just had babies or experienced a loss may simply not have the time and energy to engage with a complaints process.

 

In truth, there are far more opportunities to address what happened than most people think. Speaking up can lead to many positive outcomes, including a faster return to well-being for the client, and learning and improved practice on the part of the care provider. The processes focus on restorative justice, learning, and growth, rather than punishing the provider.  There is an understanding that the vast majority of workers in the healthcare system care about people and want to help. The options outlined below are suitable depending on the context and seriousness of what happened.

 

Speaking with the Care provider directly

For my clients who decide to speak up about their experience, this is usually the option they go with. This is especially true of midwifery clients who have an ongoing relationship with their care provider. 

 

We can support clients in this process by clarifying the concerns and rehearsing the conversation to make sure key points are captured and that the client feels empowered to self-advocate. 

 

I’ve seen improved treatment relationships and greater client well-being arise from these conversations. Especially in the case of complex births, creating a safe environment to debrief the experience with the provider is essential. Debriefing a traumatic birth with the care provider is a protective factor against birth trauma.

 

Engaging the Care Team

If multiple people are involved in a client’s care, sometimes a care provider with whom the client has a positive relationship can be a liaison between them and a provider with whom the client is having challenges. For example, in the case of the oversharing ultrasound tech mentioned above, it might be appropriate for the midwife or OB’s clinic to reach out to the ultrasound clinic to let them know about the impact this had on a client. This leverages the clinics’ mutually supportive relationship that should incorporate giving and receiving constructive feedback. 

 

Patient Relations and other “in-house” processes

Talking with the provider directly isn’t always the right option. This is especially likely to be true in a dynamic where the client felt intimidated or belittled by the provider, such as a discriminatory incident. Our debriefs with clients can explore their level of comfort with the various options.

 

Depending on the setting in which the care took place, there is usually an internal process for raising concerns. For example, most hospitals have a patient relations department that can work with you to resolve issues. There is often a mechanism for the hospital to anonymize information raised with the provider. Staff within patient relations will investigate the complaint and decide on the best way to address it. This could include seeking an apology from the care provider, supporting them to learn from what happened, or more serious action depending on the nature of the complaint.

 

Regulatory Body

Suppose a client has a serious concern about someone involved in their care who is a member of a regulated health profession. In that case, they have the option of filing a complaint with the care provider’s regulatory body. In Ontario, these regulatory bodies are called “Colleges”. They may be called “Boards” or “Associations” in other places.  If you’re unsure of the system where you live, I recommend searching for “regulated health profession [your province/state]” and finding out more about health professional regulation where you live, especially for the professions providing perinatal healthcare, such as nursing, midwifery, medicine, pharmacy, and diagnostic imaging.  

 

Professional regulatory bodies fulfill a range of functions including setting educational requirements, registering members, setting professional standards, and investigating complaints and reports. 

 

Anyone can go to the College with a complaint about one of their members. When health professionals work in settings where they have oversight, such as a hospital or clinic, management is legally required to report certain types of information to the regulator. It’s one of the reasons why it’s always best to take the complaint somewhere internal first. 

 

A range of things can happen, such as a letter with recommendations, reflection exercises and activities to support professional development, and a meeting with an expert in an area where more learning is needed. In some instances, the regulator may take no action. In some situations, the College can pursue an internal prosecution of the member. Again, a range of outcomes is possible, including having their license to practice their profession removed. This outcome is very infrequent.

 

Complaints Commissioner, Ombudsman, etc.

Provinces in Canada have arms-length government bodies that ensure the quality of public services such as healthcare. In Ontario, complaints regarding healthcare can be taken to the patient ombudsman. In Quebec, complaints can be made with the Complaints Commissioner. This 2022 case study explored the advocacy potential of many individuals accessing this complaints process. In 2019, “Obstetric violence” became a focus of media attention in Quebec due to a series of articles published in La Presse about experiences during childbirth, including inappropriate comments, procedures performed without consent, and being separated from babies. In the weeks following these publications, the Complaints Commissioner received an influx of complaints that spoke to a systemic pattern. The Commissioner is well placed to liaise with government policymakers and she produced a report with recommendations aimed at improving perinatal care. This led to several outcomes, including workshops for service providers on communication, information sharing, and consent.

 

“It’s me, hi! I’m the problem. It’s me”

Transparency with our clients about accountability includes making sure they know what their options are if they have concerns about us! Keeping the lines of communication open so they feel comfortable coming to us with concerns is ideal. If a client has a concern about a certified doula or perinatal educator that can’t be worked out, the client can go to their certification organization. In Ontario, If clients have concerns about how their personal information was used or shared, they can file a complaint with the privacy commissioner.

 

Seeking accountability has the potential to be healing and empowering for clients, while providing a learning opportunity for the client. When working with diverse humans at a sensitive time, hearing critical feedback compassionately and receptively is integral to our ability to grow in our practice. It may not always feel great in the moment, but if we reflect honestly on constructive feedback, it can be a wonderful catalyst for deepening our practice.[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_single_image image=”534490″][vc_column_text css=”.vc_custom_1706107304539{margin-bottom: 0px !important;}”]Keira Grant (she/her) Inclusion and Engagement Lead – Racialized Communities

Keira brings a wealth of experience to the Online Community Moderator role. She is a Queer, Black woman with a twenty-year track record in Equity, Diversity, and Inclusion (EDI) education, projects, and community building initiatives.[/vc_column_text][/vc_column][/vc_row]