Mamas on Bedrest: An Interview with Paula Rojas, Community Organizer, Social Justice Activist and Co-Founder of Mamas of Color RisingAugust 31st, 2012
Today I had the great joy and privilege to interview my friend, Paula Rojas. Paula is one fierce woman for women! As a community organizer, she has 20 years of experience in helping communities come together to address causes of vital importance and to fight for solutions that will be for the good of the community. After moving to Austin over 5 years ago, Paula helped poor and low income Black and Latina women organize Mamas of Color Rising, a grassroots social justice and social activist organization. The group is currently completing initiatives in its Birthing Justice Campaign and Paula shares with us some of the other social issues the group is contemplating addressing as agents of social change.
Yesterday, August 28, 2012, I attended a public hearing to witness testimony regarding a proposed ruling concerning certified nurse midwives and licensed professional midwives: whether or not they will be able to attend the births of women on Texas Medicaid and be reimbursed for their services.
For those of you who don’t know, this is HUGE!!! Texas has very high rates of maternal and infant mortality and those rates are disproportionately highest amongst women of color and low income women of color in particular. In an effort to try and reverse these statistics, Mamas of Color Rising, a grassroots coalition of women of color, has come formed to address issues of health, welfare and economics in women of color. For more than a year, Mamas of Color Rising-in partnership with Texans for Midwifery-has worked on what they call a Birth Justice Campaign to petition the Texas Department of Health and Human Services to change the rules regarding the practice of midwives in Texas. In their letter to the department of HHSC, Mamas of Color Rising makes the following statements regarding birth equality and birth justice,
Through this campaign we aim to make options like midwifery care, homebirth, and birth companion (doula) support, options which currently are most available to those who have the resources to pay for them, equally accessible to poor women of color in our community. We believe that equity in birthing options is both a matter of social justice and empowerment for birthing women, such access also leads to improved pre-natal, post-natal, and maternal outcomes for mothers and babies that can have long-lasting positives effects.
The coalition collected signatures for a petition that culminated in a letter to Texas HHSC asking that Certified Nurse Midwives and Licensed Professional Midwives not only be able to attend births of low income women, but to also be reimbursed by Medicaid. The terms and provisions for practice and reimbursement are summarized here. In summary, here is what the proposed ruling entails:
Certified Nurse Midwives (CNM)
- Must be a licensed CNM and certified by the American College of Nurse Midwives
- Must be enrolled and able to participate in the State Medicaid Program
- Must have a physician or group participating in the State Medicaid Program to whom she can refer and/or consult in the event of medical complication
- If the supporting physician or group is not a State Medicaid Participant, the Midwife must apprise her client that she will be responsible for any additional charges incurred.
- If the Midwife changes physician association, she must notify HHSC in writing of her new physician association within 10 business days.
Licensed Midwives (LM)
- The LM must be licensed and approved by the Texas Midwifery Board
- The LM must be enrolled and approved for participation by the Texas Medicaid Program
- She practices within the rules and protocols set forth by the Texas Midwifery Board
- She provides services within a freestanding birthing facility approved by and able to participate in Texas Medicaid.
There were two areas of contention.
- The proposed rule is proposing to reimburse Midwives at 70% of what physicians are reimbursed
- Licensed midwives would have to retain a physician to serve as backup for all Medicaid patients
The hearing was a culmination of all that work, and an opportunity for Texas Medicaid officials to hear testimony from those supporting the new rules. I was heartily impressed by the testimony. While some hearings are screaming matches between opposing parties, this hearing was well organized, well conducted and from what I saw, all parties conducted themselves with poise, grace and consideration of opposing viewpoints. In watching the proceedings, I do believe that the representatives for the department of HHSC were also impressed by the testimonies and the overall conduct of the participants. While the proposed rules change looks to be on track for passage, proponents and activists are concerned about the 2 aforementioned provisions; the decreased reimbursement on an already substandard payment will deter Midwives from attending Medicaid patients and the requirement to have physician back up-nearly impossible in today’s obstetrical climate-will render the ruling ineffective despite passage.
The officials at the Texas HHSC are expected to receive additional written testimony and begin the decision making process by the end of the week. While a decision could be made as early as next week, most at the hearing think that the officials will not make a final decision on the rules changes for about 30 days.
I “shared” the image at the right on our Facebook Page last week because I thought that it was an interesting statement and one that we all need to consider. Needless to say, it created quite a bit of controversy. At first, I was dismayed by the negative comments. Not because they pertained directly to the image, but because the insinuation is that we here at Mamas on Bedrest & Beyond don’t care about women and babies and how best to help mamas have healthy babies. I thought for awhile about the comments and then replied directly on the post. But the more I thought about it, the more I had to say.
When it comes to reproduction, the issues are much more than pro-life or pro-choice. At the heart is the fact that a woman has become pregnant and she may or may not want to be, and she may or may not have the resources to adequately care for herself and her unborn child. I think that rather than having a philosophical debate about whether or not she should be made to keep the child, I think that our first obligation is to mama herself because after all, if mama is well cared for, her baby will be well cared for.
Many people think that women who have abortions do so because they don’t care about their babies or that they are somehow loose and just want their freedom. In my experience, nothing is further from the truth. Women that I have spoken with who are either contemplating an abortion, having an abortion or have had abortions, at the time felt that they had no other recourse. Often at the ends of the age spectrum, many were young, under educated women without money or resources to care for themselves-let alone a child. Others were older women for whom another pregnancy would place undue hardship on them financially, emotionally and physically. And of course there were all the ages in between. But the one thing that I can say across the board is that not one woman that I ever spoke to ever had an abortion without great thought and consideration. Most women agonized over the decision.
I think that the image brought up such emotion because it asked, “Will you still be Pro-Life after she’s born?” It’s a really great question. We have to ask ourselves, if we save a baby girl’s life (or any baby’s life), are we as committed to her once she is here? Are we committed to making sure that her mama has a safe and secure place to live free from harm and/or danger (the questions of homelessness/poverty/violence)? Are we committed to making sure that her mama has adequate food to feed her at all stages of her life (starvation/malnutrition and poverty)? Are we committed to making sure that she has access to quality health care so that she will be properly immunized and have proper health, dental and vision care throughout her life (the questions of poverty and access to health care)? Are we committed to her education, and making sure that she will be a functioning and contributing member of society (poverty/economics)? Will we commit to keeping her safe (out of the ravages of war, rape and pillage)? Are we committed to making sure that she doesn’t end up in growing up and living in some of our country’s most impoverished and contaminated areas (Planetary Degradation) that are waste infested (and not just sewage. We’re also talking about chemical and industrial wastes as well as electrical and nuclear wastes emitted from industrial complexes residing beside some of the nation’s poorest communities)? And are we committed to teaching her right from wrong so that she doesn’t end up in prison and, the worst case, on death row (capital punishment)?
When considering these questions, I realized that I am not pro-life or pro-choice. I am pro-action. Quite frankly, I don’t believe that either of the political parties in the United States are aware of the scope of the problems affecting women nor are they equipped to deal with them. I think that it is going to take a concerted effort on all of our parts to make sure that mamas and babies are provided with all the resources that they need not only to survive but to thrive. What good does it do if we save a baby from abortion yet can’t ensure its survival beyond its first year?
So to those who were offended by the post, I say this. Bring your offense. But also bring your ideas. If you believe that all babies, all people, have the right to life (as I do) then come to the table and offer suggestions on how we are going to ensure that these babies have all that they need to survive. Better than that, come to the table and share what you are prepared to do-right here, right now-to save babies and mamas. (I say babies and mamas because bottom line is that an unborn baby is only as “viable” as its mama. If mama is malnourished, ill or ill equipped, that poor little baby really doesn’t stand a chance at a healthy life!). Are you willing to take a teen mama under your wing and nurture her not only through her pregnancy but also through motherhood? Are you willing to help mamas and their babies get the prenatal, intrapartum, post partum and childhood healthcare that they need? Are you willing to be a doula or birth coach to a mama without resources? Are you willing to house a pregnant, homeless mama? What are you willing to do?
Your moral indignation is not enough. We need action! Quite frankly it doesn’t matter if you are pro-choice or pro-life. What matters is what you do with your convictions. If you are pro-life, get out there a help provide the resources necessary for women to have a healthy pregnancy, and to raise a healthy and contributing member of our society. Provide baby clothes or diapers, offer to volunteer at a shelter. If you feel strongly that women should not have abortions, work hard to help them have access to birth control. Help them, if they are pregnant, to access prenatal care. Take them to office visits. Help them get vitamins. Get in there and do!
Likewise, if you are pro-choice, then be willing to sit with a woman as she mulls over her choices. Be able to share with her the pros and the cons (all of them, not just the moral ones!) of each of her options and be an unbiased support for her. Be willing to go with her to a clinic, cross the lines and sit by her side. Be willing to listen to her after if she is sad or depressed. Step in and help if she is struggling. Be willing to DO, not just speak!
I’m pretty sure that I may lose a few readers with this post. No matter. I don’t have time to get bogged down worrying about what some people may think of me. My focus has always been and will continue to be trying to help mamas on bed rest get the medical care, home care and personal care that they need to have healthy pregnancies and healthy babies. And if that offends people, so be it.