Birth Justice Toolkit

ILLINOIS CAUCUS FOR ADOLESCENT HEALTH

irth Justi c e To o B lki t A

About ICA H THE ILLINOIS CAUCUS FOR ADOLESCENT HEALTH (ICAH) IS A NETWORK OF EMPOWERED YOUTH AND ALLIED ADULTS WHO TRANSFORM PUBLIC CONSCIOUSNESS AND INCREASE THE CAPACITY OF FAMILY, SCHOOL, AND HEALTHCARE SYSTEMS TO SUPPORT THE SEXUAL HEALTH, RIGHTS, AND IDENTITIES OF YOUTH. WE ENVISION A WORLD IN WHICH ALL YOUNG ADULTS IN ILLINOIS USE THEIR POWER TO ACHIEVE HEALTH AND WELL-BEING IN THEIR OWN LIVES AND FOR THEIR COMMUNITIES.

Our Theory of Change

Table Of Contents

About Birth Justice and this Toolkit Introduction

1-2 3

Chapter One: Navigating Healthcare

Parenting Options Getting Covered Health Insurance Coverage and Pregnancy How to Get Insurance if You’re Pregnant

Questions to Ask Your Insurance Provider Questions to Ask about Coverage for your Baby Chestfeeding Coverage

How do I Choose a Healthcare Provider During Pregnancy?

Questions to Ask a Healthcare Provider

Prenatal Tests and Prenatal Vaccines Chapter

Two: Pregnancy and Birth

Developing a Birth Plan Where and How Your Baby Will Be Delivered

Support system Labor and Delivery Inducing labor Pain during labor and delivery Common labor positions

Birth bag What to expect that others don’t tell you Bill of Birthing Rights Chapter

5 5-6 5 6 7-10 8 9 11-12 12 13

15-16 16 17-18 19-21 19 19 20 21 22 23

Three: After Delivery and Postpartum Care

After delivery Chestfeeding Chestfeeding Bill of Rights

Postpartum Care

25-26 27 28

Acknowledgements

29

A Glossary of Terms

30-32

Definition of Birth Justice

Birth Justice exists when people of all ages and genders and their partners (if applicable) are empowered during pregnancy, labor, and postpartum to make healthy decisions for themselves, their babies, and their families.

Birth Justice Looks like:

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about the birth justice toolkit This toolkit was created by current and past members of ICAH’s Change, Heal, Act Together (CHAT) Network; a group of 15 young people and 15 adult allies from across the Chicagoland area who organize and advocate to improve programs and policies to expand the sexual health, rights, and identities of young people.

Birth Justice feels like:

The goal of the toolkit is to provide easy access to information about pregnancy, labor and postpartum to young people, ages 16-24, who choose to bring their pregnancy to term. The toolkit is meant to be as accessible and youth-friendly as possible. However, since Birth Justice means something different to everyone, ICAH was not able to include all of the physical, emotional, social, and legal components of birth in this toolkit. This toolkit offers a solid starting point to your journey as a young parent.

Birth Justice TAstes/Smells/ Sounds like:

This toolkit is for general educational purposes only and should not be taken as medical or legal advice.

Always consult your healthcare provider about your individual health care needs and for up-to-date information.

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Introduction

Congratulations! You have decided to have a baby! Throughout this toolkit, we’ll talk about many of the factors that come into play when getting ready for a baby. We cover information and resources available to you throughout pregnancy, labor, and postpartum.

You’ll notice gender-inclusive language throughout the toolkit in an effort to capture all the identities of expectant parents, including gender-expansive and trans folks. ICAH believes that ALL people should have access to the birth options they desire and deserve, regardless of gender identity or expression.

(If you are looking for healthcare that is affirming of gender-expansive identities, check out www.radremedy.org). Now, let’s get started!

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7

Chapter one

Navigating healthcare

7

ance and Choosin r u g a Pr ov i d e r Ins

Parenting Options

BELOW ARE SOME OPTIONS AVAILABLE TO YOU IF YOU DECIDE TO CARRY YOUR PREGNANCY TO TERM: PARENTING

(Single or Co-Parenting)

The financial, emotional, and supportive care and upbringing of a child at any point during that child’s life.

ADOPTION

When a person chooses to have a child and allows someone else to raise it.

There are two types: Formal Adoption - requires the birth parents to give up all parental rights to the child, allowing someone else to raise the child permanently.

Guardianship - a parent gives someone legal guardianship for a short or long period of time.

SAFE HAVEN LAW

States that up to 30 days after the birth of child, a parent can leave their unharmed baby at any hospital, fire station, police station or any site with the logo seen here with no questions asked, under the Safe Haven Act in Illinois.

Once the baby is found, they will immediately be taken to the hospital and receive any necessary medical attention. If the parent does not return within 60 days, they give up any parental rights over that baby.

Getting Covered

HEALTH INSURANCE COVERAGE AND PREGNANCY

Under the Affordable Care Act, pregnancy coverage, often referred to as maternity coverage, is one of the 10 essential health benefits that must be covered by all health insurance plans offered to individuals, families, and small groups. If you have a plan that is passed down, or an insurance plan that existed before the health care law went into effect (2010), some differences in coverage may exist. Be sure to ask your insurance company about the pregnancy coverage included in your plan. Keep reading to learn more about useful questions to keep in mind!

PREGNANCY SERVICES TYPICALLY COVERED BY HEALTH PLANS INCLUDE: * Outpatient Services: such as prenatal (before birth) and postnatal (after birth) doctor visits,

gestational diabetes screenings (pregnant people who have never had diabetes before but who have elevated sugar levels during pregnancy), lab studies, medications, etc. * Inpatient Services: such as hospitalization, physician fees, etc.

* Newborn Baby Care

5 * Lactation Counseling and/or Chest Pump Rental

HOW TO GET INSURANCE COVERAGE IF YOU’RE PREGNANT

If you are pregnant and in need of healthcare, there are two programs you are eligible to apply for. You do not have to be a citizen or a documented immigrant and you do not need to have a Social Security number.

MEDICAID PRESUMPTIVE ELIGIBILITY (MPE)

A short-term health care plan that offers immediate, but temporary, medical insurance to low-income pregnant people in Illinois. If you qualify, you will not have to pay for any outpatient services while you have MPE coverage. MPE only offers temporary medical insurance and does not include labor and delivery. You can also apply for Moms & Babies, which is a program that offers a longer-term health care plan for pregnant people and their newborns.

MOMS & BABIES

A health insurance plan that pays for medical costs for low-income people and their babies; coverage lasts while they are pregnant and for 60 days after the baby is born. Coverage includes: inpatient and outpatient services, prenatal care, labor and delivery care, and other services for the pregnant person.

If the parent is covered by Moms & Babies when the baby is born, then coverage also pays for medical services for babies for the first year of the baby's life. There are no additional payments required for the Moms & Babies plan. Babies born to a person on the Moms & Babies program will automatically receive free “All Kids” health insurance for one year. If you qualify for Moms & Babies, all of these services are available to you free of charge.

These two programs give pregnant people the care they need to keep their babies healthy. You can apply for both programs at the same time. To apply, you can call the “All Kids” Hotline at 1-866-255-5437 or make an appointment at your local Department of Human Services office. You can also learn more about the program here: http://www.allkids.com/pregnant.htm We encourage you to apply for insurance to get coverage for prenatal care throughout your pregnancy. However, if you are undocumented and don’t have insurance beforehand, childbirth is considered a medical emergency and any hospital emergency room is required to help you.

Some advice I would give to

pregnant young people is to get

informed. Know your options, know what

your rights are before anyone tries to tell

you what you can and can't do or even what you "should" and "shouldn't" do. Do not let

anyone intimidate you or make you feel bad in

any way. You can make your own decisions. Get the right information, ask questions.

6

Questions to Ask Your Insurance Provider If you already have insurance coverage, it’s more important than ever that you understand your health insurance policy and benefits. You'll depend on your health insurance for everything from prenatal, pregnancy, labor and delivery, and postpartum care for you to pediatric visits and immunizations for your baby. To avoid surprise medical bills and to set your mind at ease about the anticipated expenses, it's important to learn the terms of your health insurance coverage.

Contact your insurance company (with policy number or group number in-hand) and ask these key questions, making sure to write down whom you talked to and the date. You can also ask for a reference number in case you need to call back.

Group Number

SOME QUESTIONS TO ASK Areprenatal prenatalcare, care,labor laborand anddelivery deliverycovered coveredbenefits benefitsunder undermy mypolicy? policy?What Whatcoverage coveragedoes doesthe the 11--Are plan provide? plan provide? thereaaco-pay co-pay(a (aflat flatfee feeyou youpay payfor forservices) services)for foroffice officevisits? visits?IfIfso, so,how howmuch? much?

22--IsIsthere DoI Ineed needaareferral referralfrom frommy myprimary primarycare caredoctor doctorto tosee seean anOB-GYN OB-GYN(a (adoctor doctorwho whodelivers delivers 33--Do babies)or orother otherspecialists? specialists?(Although (Althoughmost mostplans plansdon' don'ttrequire requirethis, this,they theymight mightrequire requireaareferral referralfor for babies) a specialist in the event of complications). a specialist in the event of complications).

WillI Ineed needpre-authorization pre-authorizationfor forany anyprenatal prenatalcare? care?

44--Will Whatprenatal prenataltests testsare arecovered covered(ultrasounds, (ultrasounds,amniocentesis, amniocentesis,genetic genetictesting, testing,etc.)? etc.)?

55--What Whatcommon commonprenatal, prenatal,labor laborand anddelivery deliveryneeds needsare arenot notcovered coveredby bymy mypolicy? policy?

66--What Incase caseof ofan anemergency, emergency,will willmy myinsurance insurancecover coverservices servicesat atthe thenearest nearesthospital? hospital?Will Willthere therebe be 77--In anyadditional additionalfees? fees? any Whichdoctors doctorsand andhospitals hospitalsin inmy myarea areaare arein inmy myinsurance insurancepolicy’s policy’snetwork network(a (alist listof ofdoctors doctors 88--Which and hospitals that a plan has contracted with to provide medical care)? and hospitals that a plan has contracted with to provide medical care)?

Whatdo doI Ineed needto todo doto toensure ensurethat thatmy mynewborn newbornisiscovered coveredfrom fromthe themoment momentof ofdelivery? delivery?

99--What 10--How Howlong longof ofaahospital hospitalstay stayisiscovered coveredafter afterdelivery? delivery?Will Willthe theplan plancover coveran anextended extendedstay stayifif 10 medicallynecessary? necessary? medically 11--Does Doesmy mypolicy policycover coveraaprivate privateroom roomor orsuite, suite,or orwill willI Ihave haveto toshare shareaaroom? room?

11 12--IfIfI’m I’minterested interestedin inaaparticular particulardelivery deliveryoption, option,like likeaahome homebirth birthwith withaamidwife, midwife,or oraabirthing birthing 12 center, what are the coverage details for those? center, what are the coverage details for those?

13--Do DoI Ihave haveto tocontact contactthe thehealth healthinsurance insurancecompany companywhen whenadmitted admittedto tothe thehospital hospitalfor forlabor laborand and 13 deliveryor orcan canI Inotify notifythem themafter? after? delivery 14--IsIsthis thiscall calland andthe theinformation informationyou youprovided providedconfidential? confidential?(this (thisisisespecially especiallyimportant importantififyou youare are 14 under your parent’s insurance and looking to keep information confidential) under your parent’s insurance and looking to keep information confidential)

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QUESTIONS ABOUT YOUR BABY’S COVERAGE 1 - What's the procedure for adding my new baby to my plan?

2 - Will my policy cover my newborn's hospital stay including any immunizations, healthcare tests, and other procedures before discharge?

3 - If needed, will my policy cover the costs of a neonatal intensive care unit (NICU) stay for my newborn?

4 - What are my policy’s rules regarding in-network (a list of doctors and hospitals that a plan has contracted with to provide medical care) and out-of-network (outside of the predetermined list of doctors and hospitals, usually not fully covered by your insurance) pediatricians? If the plan provides greater coverage for in-network pediatricians, ask for a directory of ones in your area.

5- Does my policy cover well-child care, such as my baby's first set of pediatrician appointments and vaccinations?

Keep your eyes on your prize. It doesn't have to change because you're pregnant.

Ignore the criticism. People will always have negative things to say‐ You must develop a thick skin. Be the parent you would admire.

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Chestfeeding Coverage

Choosing whether to chestfeed or formula feed your baby is one of the decisions new parents will make soon after giving birth. Chestfeeding, which you might have heard referred to as breastfeeding, formula feeding, or a combination of both are healthy options available to you. While both provide your baby with the nutrients they need to grow and thrive, only chestfeeding is covered in most health insurance plans.

Health insurance plans must provide chestfeeding support, counseling, and equipment for the duration of chestfeeding. Contact your insurance plan about chestfeeding beneďŹ ts.

SOME QUESTIONS TO ASK 1 - What type of pump can I get? What brand?

2 - Can I get the pump before my baby is born, or do I have to wait until after delivery?

3 - What if I want a different pump from what's covered?

4 - Who are my in-network lactation consultants? Will my plan cover the cost of a consultant if there aren’t any in my network?

5 - Is there any other equipment (such as milk storage bags) that I can get if I choose to chestfeed?

And if so, how much and how long am I eligible to access that equipment?

Something I wish I had

known about during pregnancy

and even after giving birth is my

T itle IX rights. I wish someone told me that T itle IX existed. T hings

would've gone so much better for

me if I had known about my rights as a pregnant & parenting young person.

9

My Plan for Getting Covered WHAT’S IMPORTANT TO ME ABOUT MY COVERAGE

QUESTIONS I WILL ASK

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Choosing a Healthcare Provider During Pregnancy

Choosing a healthcare provider is a personal choice and depends on the care you’d like to receive throughout your pregnancy, delivery, and postpartum.

BELOW ARE TWO OPTIONS AVAILABLE FOR YOU TO CONSIDER: MIDWIVES

Healthcare professionals trained to give the necessary support, care, and advice during pregnancy, labor, and the postpartum period; conduct births; and provide care for the newborn.

In Illinois, only Certified Nurse Midwives (CNMs) are allowed to deliver babies without an OB-GYN present (see Bill of Rights section for more info).

OBSTETRICIANS (OB-GYN)

Doctors who deliver babies and are in the medical practice of obstetrics — the art and science of managing pregnancy, labor, and delivery.

In addition to a healthcare provider, you may also have other folks providing emotional support during routine prenatal office visits, labor and delivery, and postpartum. Continue reading to explore more about what your support system could look like. Remember to ask your doctor or midwife if they are willing to work with you to keep your information confidential.

I didn't choose my healthcare provider. I was directed to someone through my pediatrician.

My pediatrician referred me to someone that works with the hospital he is affiliated with.

11

SOME QUESTIONS TO ASK BELOW ARE SOME QUESTIONS YOU MIGHT WANT TO ASK YOUR OB-GYN OR MIDWIFE TO LEARN MORE ABOUT THEIR APPROACH AND STYLE TO CHILDBIRTH. 1 - What is your general philosophy concerning pregnancy and birth?

2 - Do you use written birth plans? If so, how do you use them?

3 - At which hospitals or birth centers do you have privileges?

4 - What arrangements do you have if labor complications occur?

5 - What routine tests do you require? What tests do you provide?

6 - What happens if for some reason you are not available at the time I give birth?

7 - What would you do in the event of an emergency?

8 - (If you’re considering a midwife) What type of certification do you have? (see Bill of Rights section for more details on why this question is important)

The most important thing when choosing a healthcare provider is that you feel comfortable with them. Remember, if you don’t like how one healthcare provider is treating you, you have the right to find another healthcare provider. These questions are a good starting point, but there may be more questions to ask your provider.

DRAW A PICTURE OF YOUR IDEAL PROVIDER AND INCLUDE A QUOTE IN THE WORD BUBBLE THAT YOU'D LIKE TO HEAR THEM SAY.

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Prenatal Tests and Vaccinations Once you choose a healthcare provider, you’ll visit them regularly for routine exams to make sure you’re healthy. These check-ups are called prenatal visits and happen about once a month in your first and second trimester, and every two weeks in your third trimester. During the visits you’ll be offered various prenatal tests. Prenatal tests are medical tests you get during pregnancy. They provide information about the health of you and your baby. There are several different tests that may be available to you during pregnancy. Talk to your doctor about the tests available to you and whether or not you want any testing at all.

You might also be offered vaccines. Vaccines can help protect you and your baby from certain harmful infections. According to the Center for Disease Control and Prevention (CDC), the specific vaccinations you need are determined by factors such as your age, lifestyle, medical conditions you may have such as asthma or diabetes, type and locations of travel, and previous vaccinations.

However, not all vaccines are safe to get during pregnancy. Talk to your healthcare provider to make sure any vaccines you get are safe for you and your baby.

To see a comprehensive list of vaccinations available to you before, during, and after pregnancy visit : http://www.cdc.gov/vaccines/pubs/downloads/f_preg.pdf Always remember the doctors are your assistant, not the other way around. Ask all the questions you need. Don't let them belittle you. Even if you don't pay them directly your insurance does so you have a right to feel and be empowered.

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7

Chapter two

Pregnancy and birth

7

Birth Planning and De

l ivery

Developing a Birth Plan A birth plan is a simple, clear, one-page statement of your preferences for the birth of your child. Using this worksheet, you can begin to think through what kind of birth you might want. For each question, you can circle all that apply.

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It’s important not to let your birth plan shape your expectations. Birth plans are great for helping you think through your preferences, but they are mainly a tool for you to use to feel prepared and empowered to advocate for (should you need to) your birth desires. While the goal is to have all of your desires outlined in your birth plan met, sometimes compromises and adjustments may need to be made for the health and safety of you and your baby.

WHERE AND HOW YOUR BABY WILL BE DELIVERED

In general, you can choose to deliver at a hospital, birth center, or at home. Most deliveries are done in hospitals but birthing centers and home births are becoming more and more common. Where you deliver will depend largely on your health, the type of experience you want, and what your insurance will or will not cover. Where you deliver will effect the type of delivery available to you.

Check the Birthing Bill of Rights that follows for more information on your legal birthing options.

THERE ARE THREE MAIN TYPES OF DELIVERIES: NATURAL

A natural birth is one without any type of pain medication.

MEDICATED

A medicated delivery is one where pain medication is used to limit the pain you feel throughout delivery.

CESAREAN

A cesarean (c-section) is a surgical procedure used to deliver a baby through incisions in the pregnant person’s abdomen and uterus.

All three types of deliveries can take place in a hospital but cesarean and medicated births are most common in hospitals. Home births and birthing centers promote a natural birth with little to no medicated pain relief. Sometimes you have a choice about where and how your baby will enter the world, but in the case of a medical emergency, your doctor will do what is considered to be in the best interest of you and your baby.

I wish I'd known that I could create a birth plan and choose a doula.

You might also be interested in a water birth.

A water birth is a birth in which the pregnant person spends the final stages of labor in a birthing pool, with delivery taking place either in or out of the water. A water birth can take place in a hospital, birthing center, or in your home.

Do some research to determine the best environment for you and your baby. You will also need to contact your health insurance provider to find out what options are available to you. Don’t forget to find out if the doctor or midwife you are considering can deliver your baby in the place you want to give birth.

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Support System

Having a baby is an exciting time! Labor and birth can also be an intense emotional and physical experience. Having a good support system throughout your pregnancy and in labor and delivery can help you feel empowered and provide the emotional support you may need to have a positive birthing experience.

Consider having a doula. Doulas are people trained in childbirth who provide continuous physical, emotional, and informational support to the person who is pregnant before, during, and after birth.

A doula is a support system while a midwife and an OB-GYN are medical professionals that deliver the baby.

SOME QUESTIONS TO ASK BELOW ARE SOME QUESTIONS YOU MIGHT WANT TO ASK A POTENTIAL DOULA. 1 - What is your philosophy regarding childbirth?

2 - Can you describe the support you will provide to me during pregnancy, labor, and postpartum?

3 - What made you decide to become a doula?

4 - Do you support young parents any differently than adult parents?

5 - How many births have you attended as a doula?

6 - What are your fees?

7 - Are you available for my due date?

8 - What happens if for some reason you are not available at the time I give birth?

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My boyfriend was my support system.

Throughout my whole pregnancy he was there through it all. He was the only support I had and every little thing he did meant the world to me.

Other support systems may include your partner, friends, or family members that can advocate for you and your needs. Regardless of whom you choose, make sure to surround yourself with people who are genuinely happy for you and the upcoming baby. No one deserves shame or judgment throughout any stage of the birthing process.

Who is your Support System?

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Labor and Delivery INDUCING LABOR

Most pregnancies last about 40 weeks, but some births can happen a few weeks earlier or a few weeks later. Sometimes labor starts naturally on its own, but sometimes labor can be induced, meaning it's started using medicine or other treatments. Labor is generally induced if there is a medical need, or if the healthcare provider thinks it’s safe to do so. It is very important to talk with your healthcare provider about the pros and cons of induction, and find out what risks may be involved for you and your baby.

PAIN DURING LABOR & DELIVERY (OUCH!)

Each person’s experience with birth is unique and the pain tolerance for each person is different.

Whether you choose to have a natural birth or a medicated birth, you’re likely to experience some pain and discomfort throughout your labor. If you prefer to have a natural birth, relaxation techniques, such as self-hypnosis, meditation, massage, and breathing techniques can help you manage the pain during labor and birth.

If the pain gets to be too much, there are many types of medications that can ease pain during labor and delivery. An epidural is the most common type of pain relief used during labor and delivery. The medication is given through a tube placed into the lower back. After about 20 minutes, your lower body will feel numb and you will not be able to feel the pain of contractions. There are also other drugs (narcotics) you can take to lessen some of the pain you may experience. Ask your healthcare provider what IV medications (given through a needle or tube that goes into the vein) are available and safe for you and your baby to take.

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COMMON LABOR POSITIONS

The most common sign that you are in labor is when your contractions, often described as intense menstrual cramps, get longer, stronger, and closer together. Another sign is when the fluid-filled sac that surrounds your baby ruptures; this is known as your water breaking.

If you’re delivering in a hospital, you’ll likely be pushing and giving birth lying on your back. But there are other positions that can be better for pushing and therefore better for you and your baby. Once your labor starts, you can ease yourself into different positions and movements that help you cope with contractions. You also might feel uncomfortable switching positions or moving around by yourself. Listen to your body to figure out which position feels good. Your body will tell you what position is best at every point in your labor.

BELOW ARE A FEW BIRTHING POSITIONS THAT COULD HELP YOU THROUGH LABOR:

CIRCLE THE LABOR POSITIONS THAT LOOK MOST COMFORTABLE TO YOU. TRY THEM OUT BEFORE YOU DELIVER!

Source: http://www.better-childbirth-outcomes.com/support-files/laborpositions.pdf

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Birth Bag CONSIDER TAKING A BIRTH BAG WITH YOU TO YOUR BIRTH.! YOU MIGHT WANT TO INCLUDE: * Your birth plan

* Outfit to go home in (your body has changed)

* Extra undies

* Baby outfit

* Extra-long absorbent pads * Nursing bra or tank top * Travel toiletries like shampoo, conditioner, & lotion * Nipple cream * Lip balm * Slippers or socks * Snacks!

* Your own pajamas or comfy clothes (you don’t have to wear the hospital gown) * Music (relaxing/something to distract you) * Movies (sometimes when in labor a long time, resting and doing something like this distracts from the wait time)

What do you want in your birth bag?

What to Expect that Others Don’t Tell You: WHAT’S UP, DOC?� If you’re giving birth in a hospital, you may be surprised by the amount of alone-time you will have.

For most of your labor, you will see nurses, staff doctors, and the faces of pretty much all of the medical staff but your own doctor. Staff will come in and check on you and make sure your labor is progressing as anticipated, but they may not be there for too long. Often times your doctor will come in closer to the end of the labor process to help with delivery. This experience may be different depending on where you are giving birth and with whom. Giving birth with a doula or a midwife could look very different. Ask your doctor when they will be present, for how long, and who you can 21 have in the delivery room with you.

OH, THE TECHNOLOGY!

Large, obnoxious beeping machines! Needles and tubes! A variety of medical devices and technology are used in hospitals as a part of labor and birth. These machines can be overwhelming, intimidating, and even just annoying. So what can you expect?

Catheter: If you choose to get an epidural, you won’t be able to get up to pee (and epidurals are given with about a liter of water). As a result, you will likely also receive a catheter - a thin tube that is inserted through your urethra so that you don’t have to get up to pee. Don’t worry! An epidural numbs the lower half of your body, which means you won’t feel a thing. (Though you might feel something when it is removed sometime after delivery.)

Heart Monitor: During labor your doctor may be monitoring your baby's heart, meaning you’ll have little sensors stuck to your belly. Some people find the machine’s beeping to be overwhelming, but you can ask your doctor or nurse to turn the volume down or off.

IV: Keeping in mind that different hospitals have different policies, there is a chance you will receive an IV during labor. The IV is used to prevent dehydration and can contain different medications and/or hormones to help with pain. Talk with your healthcare provider about their hospital’s IV policies and practices and your own desires. You can definitely specify in your birth plan whether or not this is something that you’ll want.

HOOKS, VACUUMS, AND FORCEPS, OH MY!�

Similar to the technology that you may encounter, sometimes doctors use tools to assist with delivery. These tools can look kind of scary, but they are all used to help with the safe delivery of your baby.

Amniotic Hook: Sometimes your water doesn’t break in the early stages of labor in which case

medical staff may need to break it manually. This hook is used to do just that!

Vacuums: If pushing the baby out is proving difficult, the doctor may use a vacuum to help suction the baby out. Because newborn baby-heads are pretty squishy, the suction can sometimes leave your baby’s head looking a little cone-like. This can happen with or without the vacuum and your baby’s head will return to its original shape soon.

Forceps: Forceps may be used to help shift a baby’s position or help guide their head out. They can be pretty scary looking but they’re only being used to get your baby out safely!

POOP! Poop is talked about a whole lot in preparation for birth, and it can sometimes be a source of anxiety for pregnant people. But no worries, it is neither as gruesome nor as likely as you may expect! If it does happen, #NoShame: your nurses and doctors are used to it!

EPISIOTOMY An incision made in the tissue between the vaginal opening and the anus, also known as the perineum, but not all the way down to the anus. Your doctor would numb you with a local anesthetic, then take surgical scissors and increase your vaginal opening by a few inches. You can talk with your healthcare provider about the regularity with which they do this, what it entails, and the typical healing process.

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Birthing Bill of Rights * As a pregnant young person you are legally a “mature minor” and have the same legal rights as a

person over 18: “A married person who is a minor, a parent who is a minor, a pregnant woman who is a minor, or any person 18 years of age or older, is deemed to have the same legal capacity to act and has the same powers and obligations as has a person of legal age” (410 ILCS 210/1; The Consent by Minors to Medical Procedures Act). This means you have the right to refuse any medication or procedure that may occur during delivery.

* That said, while you have the legal right of refusal, the realities of adultism - the oppression of youth by an adult culture of power - mean that you, as a young person, may have to fight a little harder to be heard. Some processes may not be presented as a choice, but if you’re uncomfortable, you can always ask whether certain procedures or medications are mandatory. A doula may also help ensure that your voice is heard. Furthermore, in the case of a medical emergency during birth, the doctor may not ask your permission if something not previously agreed upon needs to be done – they will do whatever needs to be done to keep you and your child safe.

* If you’re looking to work with a midwife, Certified Nurse Midwives (CNMs) are legally able to practice throughout the country. In Illinois, only CNM’s are able to deliver a baby without an OB-GYN present. There are also other types of midwives, such as Direct-Entry Midwives (DEMs) and Certified Professional Midwives (CPMs). In Illinois, DEMs and CPMs working with you outside of a hospital context can be arrested for assisting births without a medical license, so be sure to ask what credentials your midwife has.

* If you’re looking to give birth at home you will have to check your state’s laws. Home births are legal nationally, but only with a CNM in Illinois. Most CNMs work in hospitals and can be hard to come by for home births in Illinois.

* If you are undocumented, going to the hospital can be scary. Home births and birthing centers can

be an option, but lacking health insurance could make it a costly decision. Because childbirth is considered a medical emergency, any hospital emergency room is required to help you regardless of whether you have health insurance and regardless of your immigration status.

I loved my entire

pregnancy, but if I had to choose one thing it

would be the excitement I

got everytime my baby grew

more and more. I loved that I could feel her kick and

move. T he best thing was being able to feel my child grow.

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7

Chapter three

After Delivery

7

po st p a r t u m

Care

After Delivery Alrighty! You’ve labored for hours, you’ve had your baby, and you’re all done right?... right? Not quite…

Even once you’ve given birth there’s a lot that still needs to be done. After a vaginal birth, you will need to deliver the placenta, have any tears stitched up and receive a fundal massage (see definition below).

Placenta: After you’ve delivered your baby, you’ll need to deliver your placenta – which means more

contractions and more pushing. The placenta is the organ that helped feed and nurture your baby for the past nine months. After the doctor cuts the cord, they will gently pull the cord and ask you to push the placenta out. While the process can be emotionally frustrating – especially after delivering a child – it is generally more irritating than painful.

Stitches: In the case of tearing, doctors will use this time after birth to stitch up your perineum. It

likely won’t hurt, but after all the action around your genitals, stitches can be an extra, post-birth annoyance.

Fundal Massage: After the delivery of the placenta, your doctor will massage your uterus through your abdominal wall so as to reduce the chances of a postpartum bleeding.

NOW THAT THAT’S TAKEN CARE OF, GET READY FOR THE FUN STUFF! After birth you can ask for immediate skin-to-skin contact with your baby, you can ask that your baby spend the night in your room instead of the nursery, and you can ask for a lactation consultant to help with the first time you chestfeed. There are a range of things you can ask for, but be sure to put these requests in your birth plan and discuss them with your doctor in advance. If you have a family member, friend, or doula there with you, tell them about these preferences too – you may be tired and not up for reminding your healthcare provider – they can remind them for you…“Hey! Bring that baby back here for some skin-to-skin!”

AFTER A C-SECTION Medical processes after a c-section can look very different than a vaginal birth. After delivery, the doctor will remove your placenta and check your reproductive organs before stitching you up: this whole process can take 30 minutes or longer. The time you spend in the hospital can also be longer than vaginal birth recovery. The average stay in the hospital after a vaginal birth is 24-48 hours, but after a c-section you may be in the hospital up to 3 to 4 days. Other than that, you can make many of the same requests that you do after a vaginal birth, including skin-to-skin contact (even while you're still in the operating room) and 25 chestfeeding as soon as possible.

DESCRIBE THREE THINGS HERE THAT EXCITE YOU ABOUT GIVING BIRTH AND/OR PARENTING

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Chestfeeding There are advantages and disadvantages to both formula feeding and chestfeeding.

Chestfeeding can be hard work, but has many health benefits for both you and your baby. Formula feeding offers an alternative, but is likely to be more expensive. Talk to your healthcare provider about what method works best for you.

If you choose to chestfeed:

CHESTFEEDING BILL OF RIGHTS! YOU HAVE A UNIVERSAL RIGHT TO: * Accurate information about the advantages and disadvantages of chestfeeding and alternatives (e.g. formula feeding), as well as chestfeeding best practices;

* Written information about chestfeeding in your first language; * Be assisted by knowledgeable and supportive caregivers to:

a. begin chestfeeding your baby within the first hour of life; b. begin pumping immediately when needed; c. be informed of the care, procedures and medicines that may impact chestfeeding;

* Limit visitors and separations so that you and your baby can get to know each other without distractions;

* Hold and comfort your baby during tests and examinations by healthcare providers; * Be shown how to express and store the milk; * Be informed of the chestfeeding laws in your state.

Source: Adapted from illinoisbreastfeeding.org

IN ILLINOIS, YOU HAVE A LEGAL RIGHT TO: * Chestfeed in any location, public or private, where the parent is otherwise authorized to be,

irrespective of whether your nipple is uncovered during or incidental to the chestfeeding, as protected by 740 ILCS 137/10. If you’re in school, talk to an adult ally about accommodations the school can make to allow you to chestfeed or pump.

* To sue either public or private institutions – other than a private residence or place of worship – if these institutions have denied you your right to chestfeed at their locations, as protected by 740 ILCS 137/15.

* Express milk at work during your break in a private space other than a toilet stall, as protected by 820 ILCS 260/10,15

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Postpartum Care Having a baby can be a life-changing experience, and there are physical and emotional ways to take care of yourself after you've given birth.

PHYSICAL!

Your body is going to be doing a lot of healing over the next few months! Your uterus will be healing, which can lead to vaginal discharge for a month or more. Your perineum will also be healing, meaning you should keep it clean and make sure it has healed before having sex. If you had stitching for a tear, peeing can be painful.

Sex After Birth: The standard waiting period after birth to engage in sex is six weeks. Postpartum hormones can also cause vaginal dryness. If this is the case for you, consider using lube. Even with lube, sex can be painful, so be sure to listen to your body and let your partner(s) know.

There are other pleasurable sex acts besides vaginal and anal sex that you can engage in that might feel better. Or, you might not be interested in sex at all for a while. Explore your feelings and communicate to your partner(s).

(Check out Buzzfeed's "45 Secrets No One Tells You About Having Sex After Birth" http://www.buzzfeed.com/morganshanahan/secrets-no-one-tells-you-about-having-sex-after-giving-bi #.ol1P56B1K6)

EMOTIONAL! You've given birth to a new tiny human! There can be a lot of pressure to fall in love at first sight: we see parents in movies and television shows instantly falling in love with their child, being driven to tears by the overwhelming affection they have to their offspring, but this is not always reality. Your body has just gone through a lot of changes and the prospect of parenthood can be very overwhelming. It's okay; you and your baby have just met; it can take some time to get to know them and to know yourself as a parent.

Your body has just gone through significant physical and hormonal changes and you’re learning how to parent. If you're feeling depressed for more than a two week period after you've given birth or within 12 months, you could have what is called Postpartum Depression. If you find yourself feeling this way, you're not alone. Contact your healthcare provider or doula to learn about postpartum depression and treatment options.

See postpartumprogress.com for a list of comprehensive resources and services related to postpartum depression.

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ICAH knows that you may receive countless messages and information related to your pregnancy, birth, and postpartum care. While we hope that this guide serves as a seed for growing a healthy baby and healthy you, we also encourage you to find a healthcare provider you trust. With the information here, you can go to your doctor visits informed and curious! ICAH has your back throughout this journey.

What are your hopes and dreams for you and your child?

A special thank you to everyone that helped put the toolkit together, especially the youth leaders and adult allies of ICAH’s Change Heal Act Together (CHAT) Network. We hope this toolkit helps more young people feel safe, affirmed, and healthy today and always.

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A Glossary of Terms Adoption: when a person chooses to have a child and allows someone else to raise it.

Adultism: the oppression of youth by an adult culture of power.

Amniotic hook: a long plastic hook used to break your water in the early stages of labor.

Birth bag: the bag you take to the hospital with the items you need or want to labor, birth, and recover more comfortably.

Birth center: a healthcare facility designated for childbirth that is staffed by nurse-midwives, midwives and/or obstetricians who assist in the birth of your child.

Birth Justice: exists when people of all ages and genders and their partners (if applicable) are empowered during pregnancy, labor, and postpartum to make healthy decisions for themselves, their babies, and their families.

Birth plan: a simple, clear, one-page statement of your preferences for the birth of your child.

Catheter: a thin tube that is inserted through your urethra after receiving an epidural so that you don’t have to get up to pee.

Cesarean (c-section): a surgical procedure used to deliver a baby through incisions in the pregnant

person’s abdomen and uterus.

Contractions: intense menstrual cramps that usually mean you’re in labor.

Co-pay: a flat fee you pay for medical services.

Doula: a person trained in childbirth who provides continuous physical, emotional, and informational support to the person who is pregnant before, during, and after birth.

Epidural: a medication given through a tube placed into the lower back, which numbs your lower

body after 20 minutes, causing you to not feel contractions.

Episiotomy: an incision made in the tissue between the vaginal opening and the anus to increase your vaginal opening by a few inches.

Forceps: a tool that may be used to help shift a baby’s position or help guide their head out during delivery.

Fundal Massage: a massage usually done by your healthcare provider to your uterus through your abdominal wall so as to reduce the chances of postpartum bleeding, after delivering the placenta.

Heart monitor: little sensors stuck to your belly to monitor the baby’s heartbeat during labor

and delivery.

Home birth: delivering your baby in your own home instead of in a hospital, done with the assistance of a Certified Nurse Midwife (in Illinois).

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Hospital birth: delivering your baby in a hospital.

Inducing labor: Starting labor using medicine or other treatments.

In-Network: refers to a list of doctors and hospitals that a plan has contracted with to provide medical care.

IV: given through a needle or tube that goes into the vein.

Medicated delivery: birth where pain medication is used to limit the pain you feel throughout delivery.

Midwives: healthcare professionals trained to give the necessary support, care, and advice during pregnancy, labor, and the postpartum period; conduct births; and provide care for the newborn.

Natural birth: birth without any type of pain medication.

Neonatal Intensive Care Unit (NICU): a special area in a hospital for babies that need special

medical attention.

Obstetricians (OB-GYN): doctors who deliver babies and are in the medical practice of obstetrics — the art and science of managing pregnancy, labor, and delivery.

Out-of-network: outside of the predetermined list of doctors and hospitals, usually not fully covered

by your insurance.

Parenting (single or co-parenting): the financial, emotional, and supportive care and upbringing of a child at any point during that child’s life.

Perineum: the tissue between the vaginal opening and the anus.

Placenta: the organ that helps feed and nurture your baby throughout your entire pregnancy.

Postpartum depression: depression following the birth of your child up to 12 months following birth.

Prenatal care: a type of preventive healthcare with the goal of providing regular check-ups that allow doctors or midwives to prevent and treat potential health problems throughout the course of the pregnancy while promoting healthy lifestyles that benefit both the pregnant person and the child.

Prenatal tests: medical tests you get during pregnancy that provide information about the health of

you and your baby.

Prenatal vaccinations: vaccinations offered during pregnancy that can help protect you and your baby from certain harmful infections.

Safe Haven Law: states that up to 30 days after the birth of a child, a parent can leave their

unharmed baby at any hospital, fire station, police station or any site with the Safe Haven logo with no questions asked, under the Safe Haven Act in Illinois.

Skin-to-skin contact: the act of placing your baby, naked, on your chest following birth.

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Stitches: if the perineum tears, it will likely need to be stitched up after delivery.

Vacuum: a tool used by a doctor to help suction the baby out.

Water birth: a birth in which the pregnant person spends the final stages of labor in a birthing pool, with delivery taking place either in or out of the water.

Water-breaking: when the fluid-filled sac that surrounds your baby ruptures.

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llinois Caucus for Adolescent Health Email: info@icah.org Website: www.icah.org

Phone: (312) 427-4460 Fax: (312) 427-0757

Facebook: Illinois Caucus for Adolescent Health Twitter: @ICAH Instagram: @icahgram T his toolkit was designed by: Rachel Hennessy

rachel.a.hennessy@gmail.com

T he cover of this booklet and each chapter page are copies of postcards created by ICAH young people.