Welcome address by Dr. Jonathan Slater of the Institute for Ethics in Public Life and introduction of Alexander Enyedi, President of the State University of New York at Plattsburgh.
Opening remarks by President Alexander Enyedi, President of the State University of New York at Plattsburfh
Overview of the conference by Dr. Jonathan Slater.
Introduction and showing of the Birth Time documentary trailer by Gloria Bobbie, Department of Anthropology, State University of New York at Plattsburgh. Documentary is rated as not suitable for people under age 17.

BECOMING MOTHERWISE – Avoiding the Cascade of Intervention The USA has the worst maternal morbidity and mortality rates in the Western World … double even Canada right next door, which altogether is deplorable! Semi-retired senior Kiwi midwife Kathy Fray specialized in natural labor and normal birth, resulting in impressive statistical outcomes: With a caseload demographic of 50% immigrants (English second language), 45% primips, 40% advance maternal age, and 40% pre-existing medical conditions; the outcome was consistently 85% of her clients’ labors having Vaginal Births, 90% fully exclusive breastfeeding at one-month, and virtually no Postnatal Depression. And Kathy says “It’s not rocket science – it’s just in-depth advanced prenatal Childbirth education, and naturopathic partus preparatus” … preparing the mind emotionally, and preparing the body holistically … it’s about focusing on the natural to support the normal. During this session Kathy will teach the steps on how her primips would set themselves up to experience an average 3-4 hour Active Labor (and multips an average 1-2 hour Active Labor). Kathy will discuss the practical ways women can help themselves to avoid the unnecessary medicalization of their labor and birth, in order to avoid the unwarranted cascade of intervention resulting in such crazy high rates of traumatic instrumental deliveries and dramatic C-Section deliveries, and their corresponding maternal and neonatal morbidity and mortality rates. Kathy will include introducing her “Organic Birth” guides to natural labor and normal birth, and her mind-blowingly comprehensive MotherWise MasterClass prenatal curriculum for expectant mothers. Knowledge is Power is Kathy’s go-to motto, along with the Kiwi midwifery slogan “Pizzas are delivered – strong women give birth”.

One Size Does Not Fit All

Bringing culturally-matched midwifery care to India’s 3rd largest city (by population) Indians usually trust medical care providers, sometimes to the extent of it becoming blind faith. Pregnant persons and providers o ten think that one needs a lot of procedures, tests and scans to be done to ensure the growth and development of their babies, irrespective of their health status. Care o fered in Indian hospitals during labor and birth is one of the most interventive in the world. Pregnancy and birth are viewed primarily as pathological. Midwifery does exist in pockets of India- either the grandmother/ traditional midwives, OR nurse midwives (Ancillary Nurse Midwives-ANM and General Nurse Midwives-GNM). Traditional midwives practice in their communities with no formal education and are usually not supported by mainstream medical care providers. Nurse midwives practice alongside doctors, in urban areas which could have ample or scarce resources. Other nurse midwives practice independently, predominantly in remote or low resource rural areas. Their education is mainstream and their practice is intervention-heavy. At The Birth Home in Bangalore, a group of 4 mid-career professionals have come together to bring modern, evidence-based, compassionate midwifery care. As the first and only midwifery-run center in the city, we advocate for and support interested parents in their childbirth journeys, o fering respectful care and informed decision-making. The care o fered at our center combines the practice of the modern midwifery model of care, blended with cultural traditions and practices. Setting up our center has been a roller coaster ride - building back up systems, getting training, planning logistics and building clinical teams. In my presentation, I will share our journey so far, our practice statistics and our future plans, to make midwifery care accessible to every family in our city and our country

The Birthing The New Humanity panel is presented by a group of experts, professionals and parents. They are raising awareness on the life-long impact of the period of development from conception through infancy. This critical period is when the foundations of health, wellbeing, intelligence and creativity are laid. We offer a new paradigm that gives every human being optimal conditions to develop holistically, from conception, so that they can reach their full potential and thrive. Participants will discover some of the disastrous consequences of current practises which often lead to trauma, preterm births, higher interventions and feeling unwanted, stressed, lonely, unsafe, abandoned, angry, powerless and violent behaviour. They will receive new perspectives on early development, empowered pregnancy and natural normal birth that respect natural instincts and meet the real needs of the mother, father and baby. Long-term effects on the family of this loving, nurturing and supportive, midwifery approach, include feeling wanted, safe, loved and empowered. Healing trauma with brief, yet transformative methods, can be taught so that future parents can heal trauma and change subconscious programming and limiting core beliefs. Empowering them to prepare consciously for conception, pregnancy, birth and beyond. This will prevent the transmission of trauma giving their children optimal conditions for them to not only survive but thrive. An opportunity to collaborate to make this vision for a new global paradigm a reality through a global community and the BTNH App will be proposed.

TITLE- Channeling Doxa is Recuperation: Stories that a medical anthropologist in making should hear. 'I am a woman and I have to', is the story of fifteen Kashmiri Muslim women of Doda, J&K, who were asked to narrate, as what, Postnatal Recuperation meant to them. The vantage point of mitigation of joy, trauma, essence, recovery, and a will to start a new life as a mother, ran interaffectively among these women who shrugged off their agency to transform, create and combine their emotions and feelings into anything new, but to the same old gender expectation that prevails unquestioned. The study was aimed at exploring recuperation as the liminal stage between childbirth and an acceptance from a woman of her new life in a social role of a mother. For over sixty-five days, during a lockdown in place amidst an ongoing pandemic and a network shutdown in J&K, these women were telephonically interviewed in quest of uncovering what recuperation holds to them, besides all the rituals that unfold for the newborn's protection in their community. Their stories have traveled across the boundaries of delivery rooms, that tend to look at them as, 'women doing their jobs'. It essentially runs as a story that went on to find out what was their story of recuperation, only to find out that their community and the women themselves questioned recuperating for or after something as 'natural' as childbirth.

Statement of problem: Globally in 2019, it was reported that 295,000 women die during pregnancy and childbirth every year. In Ethiopia, skilled birthing care service uptake was low. Marginalized women are vulnerable to poor birthing care uptake, and addressing women’s social marginalization could play an important role in increasing the uptake of skilled birthing care. Thus, the study aimed to assess the uptake of birthing care uptake, and associated factors among women from socially marginalized minorities in Kambeta-Temabaro Zone, Southern Ethiopia. Methodology: multistage sampling procedure was employed to enroll 521 study participants at community level point in time. An interviewer administered questionnaire was used to collect the data. Bivariate and multivariate analysis was done and the degree of association was assessed using odds ratios with 95% confidence interval and variables with p values <0.05 were declared statistically significant. The model fitness was checked using Pearson’s Chi-square with a value of 3.45 and significance of 0.026 Result: The skilled birthing care service uptake among socially marginalized minorities was 19% in the study area. Maternal education, occupation, and awareness of birthing care, pregnancy plan, and number of births, mothers’ lifestyle, and social discrimination were significantly associated with birthing care service uptake among women from socially marginalized minorities. Conclusion: The prevalence of skilled birthing service utilization among women from socially marginalized minorities was low [19%]. Thus, awareness creation on skilled birthing, improving access to education for women, increasing employability of women, and conducting community forums to avoid social discrimination of minorities are highly recommended.

Seventeenth century witnessed “medicalization” of pregnancy care and delivery in most of the western industrialized nations. By the twentieth century, most of the developed countries and many developing countries adopted to have births of babies n controlled hospital settings and "social birth" was replaced by "medical birth" Evidence-based maternal care respecting every individual pregnant woman’s right to choose must be dignified and humane. When medical intervention is undertaken appropriately, it can save lives both mother and the unborn. Using of medical facilities, maternal mortality was reduced 38% between 2000 to 2017 . But when this intervention is unchecked and undertaken for non-recognized reasons then it is a cause for concern. Iran as a case example for over medicalization Iran is a middle income country with near 80 million population. Iran one of the countries that experienced considerable decreasing in maternal mortality ratio (MMR). MMR from 48 /100,000 live birth in 2000 was decreased to 16/100,000 live birth in 2017. However this country has been faced with another challenges. CS rate (as an indicator for over medicalization) shown steady increasing during past 20 years in Iran. CS rate in Iran from 35% in 2000 has been received more than 50% in 2018 . Yazdizadeh et al in their qualitative study identifies barriers of CS reduction I Iran. Lower tariff for vaginal delivery, legal issues, lack of cooperation between midwives and obstetricians, inefficient obstetric residency and midwifery teaching system are among marries . There are another evidences about over medicalization during pregnancy and child birth in Iran. Labor pain induction and augmentation without medical indication, episiotomy, over use of ultrasonography scan, continues fetal heart monitoring for low risk pregnancy, especially in university affiliated hospital and high rate of prescription of vitamins supplements during pregnancy. Maternity care can be achieved effectively, efficiently and economically by considering the three basic factors: • The informed input of the pregnant woman. Easily understandable information bearing in mind the language needs to be available to her so that she can decide for herself what her preferred pathway of pregnancy care she envisages for herself. • Evidence collected over many years in different countries will influence care based upon cultural sensitivities, economic wellbeing and role of health insurances companies towards maternity care allowances. • Uniformity in government’s maternity care policy with their politically opponent parties to ensure such maternity care is not to be compromised by jargon of politics.

Elaine will outline her journey to motherhood, giving an insight into her life and personality. She will describe her pregnancy and hospital stays when she was pregnant then share the details of the birth of her son. This will lead into the impact of the challenging birth and subsequent mental and physical difficulties that had wide reaching consequences. Although Elaine believes that surgery was necessary immediately following the delivery of her son and that her physical needs were met well, very little was acknowledged of the mental impact upon all the family. She will demonstrate the decline and ultimate hospitalization required as she spiraled into postpartum psychosis. Elaine will share her reflections upon the factors that she believes helped and hindered her perinatal care with a desire to make the journey of motherhood happier and healthier for others. Her aim is to inspire healthcare professionals to treat the ‘whole’ woman whilst working in cooperation with all involved in the care of the family. Her message is ultimately one of hope as she did go on to make a full recovery and subsequently has published two books on perinatal mental health. Her story illustrates that there are small changes that can be made in practice at every level, from the family to healthcare professionals and policy makers. These small changes can have significant benefits to all concerned including personal and financial. They could even be life changing and definitely will improve the outcomes for happy and healthy perinatal journeys and beyond.

Background: Obstetric violence (OV) threatens providing women with dignified, rights-based, high-quality, respectful maternal care. The dearth of evidence on OV in the Eastern Mediterranean Region poses a knowledge gap requiring research to improve policy and practice. While efforts to improve quality of maternal health have long-existed, women’s experiences of childbirth and perceptions of dignity and respect are not adequately or systematically recorded, especially in the Region. Aim: This study centers the experiences of women’s mistreatment in childbirth to provide an overview of OV and offer recommendations to improve policy and practice. Methods: A literature review included and analyzed 38 articles using Bowser and Hill’s framework of the seven typologies of Disrespect and Abuse (D&A) in childbirth. Findings/Discussion: Birthing women in the EMR experienced every type of D&A, regardless country-income, with 6 out of 7 types of D&A found in almost two-thirds of included countries. In the EMR, physical abuse (especially overused routine interventions) and non-dignified care (embedded in socio-cultural norms) were most common. The intersections of these abuses enable the objectification of women’s bodies and overuse of unconsented routine interventions in hierarchical and patriarchal systems that regards the power and autonomy of doctors above birthing women. If unchecked, the perpetuation and underreporting of OV and passivity towards human-rights violations in birth continue. Conclusion: To eliminate OV, a paradigm shift is required involving infrastructure and policy changes, education, empowerment, advocacy, and women-centered and gender-sensitive approaches to health system strengthening. Multi-level recommendations are proposed to ensure childbirth is dignified, respectful, and empowered. Keywords Obstetric Violence; Disrespect and Abuse in Childbirth; Respectful Maternity Care; Sexual and Reproductive Health and Rights; parturition/childbirth; Eastern Mediterranean Region

Like climate justice, reproductive justice is concerned not only with individuals, but is also critical to our future, to human resilience, planetary and health service sustainability, and to our reproductive future. Childbirth is a critical and sensitive period in life. It should be a time of promise and potential. It is a time that holds the possibility of the growth of love, and optimal health and wellbeing, not only in the short term but over a lifetime, and into the next generation. There is hope for the best, or at least a better chance, in life. There is the possibility of joy, delight, ecstasy, even when the world is turned upside down in this profound life transition with physical and psychological change, changing family roles, and the exhaustion, chaos, employment, survival, money, and housing worries that often mark parenthood. Yet, as this conference will report, despite progress made in maternity care, the detrimental effects of the medicalisation, institutionalisation, dehumanisation of pregnancy and birth, limit health and wellbeing, and happiness around birth, traumatise individuals and families, not only for this generation, but for future generations too. Medicalisation limits our hope for the future. The problems described as medicalisation of childbirth will not be resolved one by one. They will require a different mindset, a different perspective, a different paradigm. Humanising childbirth brings the changes required to enable the transformative and humanising effects of birth to individuals, the family, community, and wider society. Humanised birth enhances the life affirming possibilities of human pregnancy, labour and birth, and the early weeks of life. It creates awareness of the significance of childbirth, through providing culturally, socially, and psychologically sensitive health and medical care, that responds to the unique personal and health care needs of every woman, her baby and family. One of the most profound and pressing questions facing humankind is ‘‘how might we realise the promise of childbirth, the potential of new life, and make safe, humanised childbirth a sustainable reality, for every childbearing woman and her baby, every parent, every family, no matter what their circumstances and where they live’. Thus, enabling better lives and a better future for humanity (and our planet). From this question intersecting pathways leading to humanising childbirth will be mapped. These include raising awareness and acceptance of current advances and problems, importance of regulated midwifery, changing the conversation around birth, exploring essential domains of knowledge and skills, learning from others, imagining the best start for all concerned, imagining humanising maternity services and communities, building communities for political and media activity.

Although caesarean section (CS) can be a life-saving intervention for mothers and children, it can also lead to short-term and long-term health consequences. Greater understanding of how the mode of birth can affect longer term health outcomes for women is crucial to inform decision making by clinicians, women, and policy makers, considering the very different circumstances and varied risks between low-resource and high-resource settings. Due to the continuous increase in caesarean sections in the Limbe Regional Hospital and the Buea District Hospital where I practiced, most of which I felt were unindicated, an investigation was carry out on all CS performed both past and present in the two main hospitals, to understand whether they were indicated as well as understand the impact on the procedure on the mental health of the women. Using a cross sectional study design, 50 CS cases from 2017,2018 and 2019 were randomly selected and hospital registers looked upon for indications of CS. Attending midwives and gynecologist that attended to the cases were further interviewed. Interview with the women was done using a structured questionnaire. 50 CS cases from the following years (2020 and 2021) were monitored for its indication and interviews done with the women and their families to access its impact on their mental health. Results revealed 47% of CS conducted were not indicated, with 37% conducted out of convenience and 10% conducted due to financial gain.67% of women experienced atleast 1 episode of PTSD and PND. 6% of the cases required medical intervention(psychotherapy).58% of the women believed they would given birth vaginally and were not involved in the decision making regarding CS.It is therefore apparent that unindicated CS increases the prevalence of PSTD and PND in post-partum women causing severe damage to their mental health.

My presentation will involve research on the findings in recent years and how being fathers inclusive in the perinatal period and beyond will have far better outcomes for the whole family and the development of the child. The presentation will explore how fathers are affected from areas including birth trauma, supporting their partners with a perinatal illness, and suffering themselves. THE ANTENATAL PERIOD Whilst discussing their experiences, some fathers said that their behaviour totally changed during the antenatal period. They attributed this to stress and not being able to cope with the changes in their moods. This caused substantial anxiety for their partner during her pregnancy ENGAGEMENT WITH HEALTH CARE PROFESSIONALS Fathers are often under the misapprehension that the Health Professionals is only there for their partner. SCREENING AND ASSESSMENT Fathers who admitted to suffering from undiagnosed disorders – which included Bi-polar Disorder, Antisocial Disorder and Attention Deficit Hyperactive Disorder – had not been asked about their mental health history nor was any information made available to them during the antenatal period. PRESSURES FROM WIDER SOCIETY Interestingly, research into new dads experiencing postnatal depression acknowledged that a lack of understanding of the modern fathering experience is one of the biggest barriers in supporting new dads. IMPACT ON CHILD DEVELOPMENT Both parents play an important role in their children’s lives and being able to do the very best for our children is challenging. In the past, researchers have concentrated on mothers’ mental health and not really paid attention to that of the father, and yet fathers play an enormous role in their child’s life. Added to this the fact that the “prevalence of suicide risk in fathers in postpartum was of 4.8%”; fathers with perinatal mental health problems are 47 times more likely to be rated as a suicide risk than at any other time in their lives. I will be speaking from a livid experience, working with parents and professions over the last twelve years and will explain signs and symptoms, how to engage with fathers while updating about policy changes in the United Kingdom.

Track for which you are submitting a proposal (see above): Medicalization of Pregnancy and Birth Title: Barriers to patient-centered obstetric care in hospital birth And Improving Pregnancy, Birth, and Postpartum in St. Lawrence County Abstract: I propose to present about my research on how obstetrician-gynecologists make decisions in labor and delivery as well as to describe my current applied research project in the North Country. The research presentation is based on my dissertation for which I interviewed 50 obgyns who work in Louisiana, Vermont, and Massachusetts about their decision-making in labor and delivery. I will be discussing how clinical decisions in birth are based on a case-by-case negotiation of clinical experience, standards of care, and patient preferences in addition to organizational contextual factors. I will show how obgyns take a conditional approach to following patient preferences depending on their interpretation of the patient and the situation at hand. This judgement of patient worth is a moment when racism, sexism, classism, and other forms of discrimination may cause birth trauma. Despite health care’s emphasis on patient-centered care, the majority of the doctors in my study believe they own authority over the labor and delivery and share it selectively with patients, only a few rogue obyns are fully committed to patient autonomy. I will discuss how cultural and organizational changes must occur in maternity care to produce quality care that respects childbearing people’s rights and dignity. As part of my presentation, I would also like to introduce my current research project on childbearing people’s experiences of pregnancy, birth and postpartum in St. Lawrence County. This study will measure person-centered experiential aspects of care and outcomes, people’s knowledge of and use of education and support resources in the community, and the degree to which the care they received was trauma informed. My aim is to use the research findings towards advocacy efforts to improve perinatal care in SLC, work with service providers to improve areas of need, educate the local community of their rights to quality care, and the development of a community doula program in St. Lawrence County. TBA

When it comes to surrogacy, Israel expresses both very liberal and very conservative values at the same time. On the one hand, Israel enacted the Law of Agreements to Carry Embryos in 1996, the first legislation of its kind in the world to regulated domestic surrogacy. On the other hand, the law was applied in a discriminatory way, excluding single women and men. In 2018 eligibility was extended to single women, leaving single men and same-sex couples ineligible. After appealing, on February 27, 2020, an Israel Supreme Court ruling regarding the men’s eligibility for domestic surrogacy services was handed down, establishing the eligibility of same-sex couples and single men for domestic surrogacy services. To decide how to change the current policy so it incorporates the ruling, the Court has returned legislation authority to the legislature, which faced a delicate task: On the one hand it had to provide non-discriminatory access to domestic surrogacy services. On the other it had to address the exposure of more women to risk and the implication of increasing demand on the market. While a non-discriminatory access to a legal arrangement is desirable, the Court ruling under-addresses the implications on surrogate women. To incorporate the ruling while empowering surrogates and protecting them, the Article suggests either to restrict the practice in a non-discriminatory way, or, if surrogacy is indeed an unrestricted market as the ruling implies, remove impediments that allow women to gain from the rising demand. Key words: Surrogacy; Gay Rights; Reproductive Practices; Israel; Women’s Health