PREGNANT, TESTED POSITIVE: BOOK EM DANNO

ANOTHER HAPPY LEGISLATOR IN TENNESSEE
UPON PASSAGE OF A NEW BILL TO SEND  "THE WORST OF THE WORST' MOMS TO JAIL

Earlier this month Tennessee went ahead and criminalized pregnancy, well, certain pregnant women anyway   The new law modifies the Tennessee criminal code to allow for criminal assault charges to be brought against women who use illegal narcotics while pregnant.  These charges carry a penalty of up to 15 years in prison.  But the bill is so badly written, it could affect all pregnant women in Tennessee, whether or not they use drugs, should something go wrong during their pregnancy.  In effect, SB 1391 threatens to criminalize pregnancy in Tennessee.   Further, the Tennessee law also sets a dangerous precedent that women should be held responsible and even criminalized for any problems that occur during their pregnancies.

The chief sponsor of the bill, said not to worry though since it only targets   "the worst of the worst"

As reported on ColorLines:

...this type of prosecution of pregnant women goes back decades. The first incidences can be traced to the beginnings of the war on drugs in the 1980s and ’90s, when the attention was primarily on the over-hyped and misinformed “crack baby” epidemic. In that era, mostly black women were being targeted for using crack cocaine during pregnancy. Back then, they were often charged under existing laws that hadn’t been written with pregnant women in mind—such as child abuse laws, or laws prohibiting the sale of drugs to a minor. Tennessee has taken things a step further with a law crafted specifically to criminalize pregnant women with drug problems.

There was little evidence during the initial crack baby hysteria that in-utero exposure to the drug actually had long-term negative consequences. But a longitudinal study published last year proved outright that children exposed to crack cocaine during pregnancy did no worse in life than their peers from similar neighborhoods. The study showed that, in reality, the thing to blame for the often poor outcomes of these children was not drugs, but rather poverty. Scholar Dorothy Roberts, in an appearance on “All In with Chris Hayes” this week, recounts this history.

It didn't take long for the results of the new law to begin to appear.

In early July, 26-year-old Mallory Loyola gave birth to a baby girl. Two days later, the state of Tennessee charged her with assault. Loyola is the first woman to be arrested under the new law.  The new mom had tested positive for meth.  Interestingly though, the new law said nothing about meth.  Meth is not considered to be a narcotic, which is a legal class of drugs that refers to opiates like heroin and prescription painkillers. Tennessee’s new law was passed specifically in response to fears about babies being exposed to opiates in utero.  Loyola was separated from her child and thrown in jail.  You may not like meth.  I may not like meth, but it needs to be pointed out here according to the American College of Obstetrics and Gynecology, there "is no syndrome or disorder that can specifically be identified for babies who were exposed in utero to methamphetamine."

Lynn Paltrow, the executive director of National Advocates for Pregnant Women (NAPW) told ThinkProgress:

This law was sold as if it were just about illegal narcotics. But sure enough, the first case has nothing to do with illegal narcotics — and nothing actually to do with harm to anybody. There’s no injury. There’s just a positive drug test.

This view of pregnant women essentially means that as soon as you’re carrying a fertilized egg, you’ve lost your medical privacy and your right to make medical decisions.    But all matters concerning pregnancy are health care matters. Pregnancy, like other health issues, should be addressed through the public health system and not through the criminal punishment system or the civil child welfare system.

Paltrow also says that while Tennessee may be the only state with a specific law like this,  multiple states arrest pregnant women anyway, simply by classifying fetuses as children.   Earlier this year, Alabama's supreme court ruled that women can be charged with "chemical endangerment" of a child if they use a controlled substance while pregnant. The definition of pregnancy is so broad, Paltrow says, that a woman could smoke pot with her boyfriend one night, have sex, get pregnant, and under Alabama law, face 10 years in jail for using marijuana just that one time.

Every major medical organization — including the American Medical Association, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the American Public Health Association — has come out against efforts to arrest pregnant women who use drugs. 

Laura Bassett writes:

Advocates for pregnant women say the bill will only scare women away from seeking prenatal care and addiction treatment, and that it does nothing to help low-income mothers who may not be able to take time away from their families and jobs to seek treatment. According to RH Reality Check, only two of Tennessee's 177 addiction treatment facilities provide on-site prenatal care and allow older children to stay with their mothers.

By the way,   this, coupled with the state’s failure to expand Medicaid under the Affordable Care Act makes treatment difficult to access, especially for poor women living in rural areas. 

Rebecca Terrell, chair of Healthy and Free Tennessee, told ThinkProgress via email,

 Our state chooses to waste tax dollars locking up women instead of getting them the health care they need. We are already receiving reports of women seeking out non-licensed health providers to avoid having a medical record and risking arrest. This is extremely dangerous.

And, by the way,  African-American women and their newborns are more likely to be drug tested than are other women, even after controlling for sociodemographic and clinical factors, according to a study published in a 2007 issue of the Journal of Women's Health.     "There was no association between race and a positive toxicology result," investigators determined.

 Again from ColorLines:

A study by NAPW of the arrests and prosecutions of pregnant women from 1973 to 2005 found that African-American women were “significantly more likely to be arrested, reported to state authorities by hospital staff, and subjected to felony charges.” Part of what influences this bias is the fact that there is no consistent policy regarding drug testing of pregnant women, which means it is left up to the discretion of hospital personnel. Often, a trigger for testing is a complication with the birth, such as a low infant birth weight or premature delivery. These are things for which women of color, particularly black women, are already at higher risk. As a result, black women in particular face higher levels of scrutiny than white women—leading to more prosecutions under these types of laws. 

Farah Diaz-Tello, a staff attorney at National Advocates for Pregnant Women, told RH Reality Check:

I can almost guarantee that this [law] will be used disproportionately against African-American women because, even though we know that fewer African-American women than white women use drugs, they are more likely to be blamed for the outcomes of their pregnancies.

Tennessee’s American Civil Liberties Union is challenging the new law, which targets low-income women of color disproportionately.

Obviously, laws like those in Tennessee are nothing more that   a short-term, punitive measure with no positive lasting impact that will simply ensure pregnant women who need drug treatment and prenatal care won't seek either of those options, for fear of having their children taken away from them.  But then, such treatment is not exactly readily available to those who need them in states like Tennessee anyway.

Paltrow says targeting drug-using women is just the start. "This is about making pregnant women—from the time an egg is fertilized—subject to state surveillance, control and extreme punishment."

What if, asks Jessica Valenti, a woman decides not to take prenatal vitamins?  Or has a C-section against her doctor's advice? (That one is less hypothetical: a woman in Utah was  charged with murder because she delivered a stillborn baby after her doctor advised against a vaginal birth.)  Should we toss them behind bars, too.  God, will will throw nice middle and upper class white woman in jail who happened to get caught having a glass of white wine?  White women, middle and upper class...the horror.

Valenti asks, referring to something she  wrote in her book she authored a while back:

As I reported in my book the government has long been on a mission to reduce women to vessels for pregnancy. In 2006, the Centers for Disease Control and Prevention released guidelines instructing all women of childbearing age—whether they were pregnant or not, whether they even had plans to become pregnant or not—to care for their "pre-conception" health. Starting as soon as girls got their first period until they hit menopause, the CDC said that women should take folic acids, not smoke or "misuse" alcohol, refrain from drug use, avoid "high-risk sexual behavior" and maintain a healthy weight. (There go my 20s!) What could happen if a woman  didn't follow these guidelines and had a miscarriage or stillbirth? Could she be sent to jail, too?

Uh, it does seem unlikely that any men will be prosecuted.  Whew...

The following is from the Florence Johnson Collective.

Criminalization, Crisis and Care:  Tennessee’s S.B. 1391 and Attacks on Reproduction

Recently, Flo Jo has been paying attention to Tennessee,  where the State now has the authority to criminalize women for potentially harming their newborn children with drugs.  Last week, the first woman was arrested under this new law. We have been working on a two-part series on the law, an analysis of what it means, and what we think care workers should do in response.  Below is the first article in this series.

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Tennessee recently passed a law, S.B. 1391, making it the first state to prosecute women for criminal assault if their fetus or newborn is considered harmed due to illegal drug use during pregnancy.  Criminalization of pregnant women and mothers is one side of the various ways the State attempts to control reproduction and discipline womens’ bodies.  This is an attack against working class women of color not unlike those we have seen in Texas, California, nationally and globally.  All of these measures will impede women’s access to health care and efface women’s reproductive skills and knowledge.  But unlike abortion restrictions and forced sterilization, the Tennessee law is an attempt to divide feminized workers under the guise of “protection” of women and children, a strategy we are likely to see more frequently as the economic crisis deepens.

S.B. 1391 and the Crisis.

Today’s crisis is manifested in the inability of the class to take care of itself, or reproduce itself; it is a crisis of reproduction.  Wages are so low that the class cannot afford to get everything it needs to go to work every day.  Of course, “everything” we need is a relative term based on time and place; workers in America need a smartphone and cable TV after years of changes in living standards.  The class has supplemented this crisis of reproduction with personal debt.  We get credit cards to buy clothes and pay our cell phone bills and we take out student loans we will never pay back to make an extra $3/hr.  This is what life looks like for the working class today.

For the ruling class, there is another type of hustle.  It is a general law of capitalism that profits must always increase.  So capitalists make changes to the workplace, by introducing more and more machines and pushing workers out of the production process, to ensure an increased profit.  However, this catches up to them.  Since workers are the only ones capable of creating value (there is always a worker somewhere in the production process!), the more capitalists push workers out of the production process, the more the profit margin weakens.  Couple this phenomenon with the working class’s increased dependence on debt and loans and we find ourselves in today’s economic crisis.

On top of this, because so many workers are pushed out of the production process (consider Detroit’s 23% unemployment rate for example), a surplus population of workers makes it possible for capitalism to pit people against each other in competition for jobs.  In this sense, the ruling class has an interest in controlling the actual number of workers there are in the world at a given moment, based on the needs of capital.

Silvia Federici describes this phenomenon in the early days of capitalism, when disease threatened to wipe out the emerging waged working population.  Federici argues that the State implemented a reproductive policy in the interest of capitalism by criminalizing abortion and contraception and all forms of non-reproductive sexuality, punishing such crimes by death.  While the measures the rulers use today are not this extreme, it is clear that there is still an interest in controlling women’s bodies and reproduction in general, in order to manage population levels and discipline women’s knowledge and control over reproduction.

Furthermore, a large surplus population and competition for jobs means that workers are extremely replaceable.  Workplaces have been reorganized so workers are increasingly non-unionized and in precarious working conditions.  Additionally, from a capitalist perspective, the working class is not as motivated as it was in the past.  In the 1950s it might have been ok if you didn’t find a job right after graduating high school or if you did not go to college; there were many jobs to choose from and your meager earnings could take you pretty far.  Today, it is a real problem if you are out of work for an extended amount of time and wages are so low, so many workers are forced to rely on welfare benefits to supplement their income.  However, the crisis and capitalist restructuring has meant intense austerity measures.  Increasingly, there is no safety net for unemployed and low wage workers, and it is becoming harder to find a job with benefits.  It becomes clear why some capitalists have pushed policies that increase criminalization of welfare recipients, most recently around drug testing, and have traded the carrot for the stick in order to ensure a generalized desperation around keeping a steady (but sporadic) wage.

It is no surprise, then, that the latest round of attacks against poor women of color occurred in Tennessee, a state that refused Medicaid expansion alongside the implementation of the Affordable Care Act.  It is more clear than ever that the rulers are not interested in actual health of babies or the welfare of society.  They simply want the most efficient, interchangeable, disposable workers at the lowest possible cost.  This means cutting the cost of reproduction in the form of the Welfare State and access to medical care.  Concretely, in Tennessee this will look like criminalizing women who give birth in hospitals.  In New York, this will look like hospital closures and mergers.  In Texas, this will look like shutting down women’s health care centers in rural areas.

Finally, we cannot ignore the gendered and racialized form the crisis is taking.  A crisis of reproduction means health care, education, feeding, cleaning, and other forms of care work that has increasingly become paid work (thanks to the contradictory struggles of the women’s liberation movement), will be pushed back into the home.  And since women still do most of the domestic labor in the home, working class women of color will have to take care of their young, elderly, and sick family members on top of working 2-3 jobs to pay the bills.  It is frightening to think that on top of absorbing the reproduction of other members of the working class, women are being discouraged and physically blocked from obtaining care for themselves.

Divisions within feminized labor.

In Caliban and the Witch, Silvia Federici describes 16th century Europe, where medical professionalization began.  She argues that in the process of primitive accumulation (the need for the new capitalist system to absorb as many resources, including land and labor power, as possible and force peasants into the wage system), the medical system became “professionalized.”  Concretely, this meant that midwives, who were largely organic female healers in the community, were forcibly replaced by male doctors.  Concomitantly, largely feminized (waged) professions around health care,  including nursing developed.  Federici describes this process:

“With the marginalization of the midwife, the process began by which women lost the control they had exercised over procreation, and were reduced to a passive role in child delivery, while male doctors came to be seen as true ‘givers of life’… With this shift, a new medical practice also prevailed, one that in the case of a medical emergency prioritized the life of the fetus over that of the mother.  This was in contrast to the customary birthing process which women had controlled; and indeed, for it to happen, the community of women that had gathered around the bed of the future mother had to first be expelled from the delivery room, and the midwives had to be placed under the surveillance of the doctor, or had to be recruited to police women.

“In France and Germany, midwives had to become spies for the state, if they wanted to continue their practice” (89).

The world that Federici describes is not too far off from the context we now find ourselves in.  Hospitals are highly feminized workplaces; over 90% of RNs are women and 73% of other medical and health service providers are women.  Further, S.B. 1391 will force a majority female workforce to act as reproductive snitches and spies for the State.  This division will no doubt have a severe racialized component as well, since about 81% of nurses are white and S.B. 1391 is expected to target primarily working class women of color, as has historically been the case for drug offenses in the US.  More than anything, this is another step toward the State’s absolute control over reproduction and female bodies.

The Myth of “Protection.”

The State has spent the last 50 years slowly chipping away at the gains of the women’s liberation movement of the 1960s and 1970s.  While the movement itself, and therefore the demands that accompanied it, was contradictory, some of the women’s accomplishments included (some) access to abortion and contraception, increased financial independence from men and diminished isolation through an increase in the Welfare State and access to higher paying waged labor, and a generalized increase in liberatory expressions of female and queer sexuality.

Over time, many of these gains have been incorporated into capital or reversed in some way.  The most obvious example is theslow, state by state repeal of reproductive rights.  Another strategy is the liberal patriarchy of the State that attempts to “defend” or “protect” women and our children by expanding the prison-industrial complex.  One side of this process is the hyper-incarceration of men of color who are said to be a danger to our communities.  The other side is the increasing arrest, detention and incarceration of women and transgender people (the women’s prison population increased 646% between 1980 and 2010, and trans people are routinely policed for their gender transgressions who are a supposed danger to the families they care for.  (Note that 62% of incarcerated women are mothers.)  Passing S.B. 1391 is another of the rulers’ strategies for increasing state repression of women and queers under the guise of “protection.”  In reality, women and people of color don’t need the State’s protection!  In fact, police and prisons increase the danger within our communities, since police and corrections officers areknown to regularly police gender, sexually harass, beat and rape women/queer/trans people.

Furthermore, a provision of S.B. 1391 will allow women to escape prosecution and incarceration by participating in the drug court system.  This is similar to an initiative in Dallas, Texas, that allows sex workers a “treatment-based” ultimatum.  Such methods simply reinforce the patriarchy of the State.  Forcing individuals into treatment does nothing to build their self-confidence and capacity as subjective actors in society (for more on forced treatment see this statement from a comrade and the(de) Voiced videos).  Additionally, drug courts failed to significantly reduce recidivism.  But clearly this is not what the U.S. government is going for.

Finally, and here’s the kicker…41% of all neonatal abstinence syndrome cases (meaning a baby is born with some level of drug dependence and suffers withdrawal) in Tennessee last year involved doctor-prescribed medications.  So  the State of Tennessee is actually criminalizing and incarcerating women for taking drugs that its healthcare system is encouraging them to use.  Clearly, women’s and children’s protection is not what is at stake here.

41% of all neonatal abstinence syndrome cases in Tennessee last year involved doctor-prescribed medications.

Why people use drugs.

Many of the liberal voices objecting to S.B. 1391 argue that the bill does nothing to actually encourage women to seek drug treatment/help, and the State should look for the root causes of drug abuse instead of targeting pregnant women.  While we agree in principle that people should have options to get off drugs if they wish to do so, to us the issue is far more complicated than increasing access to 12-step programs and treatment centers.  For us, the root reason people abuse drugs is the State and capitalism itself (and not the moralistic, individual failure of the individual abusers/addicts).  Many of us are overworked, and feel alone and unhappy most of the time.  We are abused by our bosses and compete and fight with our coworkers.  We have antagonistic relationships with our partners, children and parents.  We are harassed in the streets.  It is no wonder that millions of women seek to numb the misery of capitalism, patriarchy, racism and homo/transphobia through pain medications (causing the CDC to declare a “pain killer endemic among women”).

This is not a social problem we can overcome through more programs.  “Treatment” itself is a complicated idea.  On the one hand, we agree that there are some advances made by our capitalist society that benefit us, for example, hormone therapy and surgery for transgender individuals or brain and heart surgery.  However, on the other hand, the majority medical technologies that simply increase harm to ourselves, other people, animals, and the environment, all in the name39 of ever-increasing profits.  This is why, Flo Jo believes that through struggle, we need to retain what is useful, but completely reorganize and reinvent how we care for ourselves and others.

Some Possible Solutions.

We do not purport to be experts on this issue.  While many of us work in healthcare, we are still learning what it truly means to care for ourselves and others.  Furthermore, we do not believe that we can simply invent the answers out of thin air.  We need a movement, millions of people coming together for an extended period of time, in order to clarify what it means to be fully healthy human beings.

But absent a movement, we believe there are some things we can do to start building the world we want to see.  The first is socializing knowledge and regaining control of reproduction.  Flo Jo has been studying groups like the Jane Collective as a model for self- and community-led care and democratic use of technical skills.  Specifically, the Jane Collective offered a holistic approach to abortion services and socialized skills for performing and assisting with abortions.  As health care workers, we believe there many things we do daily that could be done by people without professional training.  We also believe that since we were trained to do our work, we can just as easily pass on those skills.  Relating specifically to S.B. 1391, we should socialize the skills to bear and birth children, so we no longer rely on the State or the professionalized medical profession that clearly do not have our interests in mind.

Alongside socializing skills, we must always engage in work that will build up women’s self-confidence and capacity for subjective action.  This means taking risks in feminized workplaces, struggling for small gains and welfare reforms, and transforming “care work” into useful and enriching social relationships in the process of struggle.  These acts will build up our self-confidence, strengthen our skills, and give us practice for the longer term fights we will wage against capital, patriarchy, racism, homo/transphobia, and the State.

Immediately, healthcare professionals should boycott S.B. 1391, socialize their grievances and start building grassroots, worker- and patient-led groups that will build our confidence and ability to struggle against attacks on women of color and other oppressed layers of the class.

Another Care is Possible: Pt. 2 of Reflection on SB 1391

Here is part two of our analysis of SB1391 from a medical worker deeply acquainted with people with addiction and in recovery. This piece further articulates the relationship between medicalization and the history of anti-drug legislation, and lays out a series of mandates/demands for healthcare and society.

Another Care is Possible: Thinking Beyond Criminalizing Substance Using Mothers

Kristen was 19 when she took her first Percocet at a party, and for that moment, all of her depression and anxieties disappeared. But it also set off a decade of addiction to pills and eventually intravenous heroin. She dropped out of college and plunged from one crisis to another. It wasn’t until Kristen realized she was pregnant that she finally reached out for help and enrolled into treatment at a New York City public hospital where doctors provided her with treatment and helped her deliver a healthy baby boy.

Kristen’s story is not a miracle – recent findings have demonstrated the effectiveness of treatment for mothers with illicit substance and alcohol dependence. However the recent passage of Tennessee’s SB 1391 has dealt a blow to women’s rights and the autonomy of healthcare workers to provide quality care.  The law mandates healthcare workers to report substance abusing mothers to the police, who face misdemeanor charges if babies are deemed to be harmed by the mother’s substance abuse. Despite evidence demonstrating the effectiveness of substance treatment, cuts in education, public housing, and healthcare services have crippled efforts to support women in recovery and diverted public funds to incarceration.

Such events are not incidental and are linked to dominant historical, ideological, and economic forces that shape how healthcare is provided.  We must beyond such events and rethink our autonomy as healthcare workers and how we can collaborate with marginalized communities to launch more lasting alternatives. We must open spaces in and outside the clinic that can launch conversations that allow us to listen and collaborate with marginalized communities in order to launch new modes of reproducing care.

Nixon, Reagan, and ‘Just say no’
In the 1960’s, organizations such as the American Indian Movement, Black Panther Party, Young Lords, and Brown Berets rattled the core of the American establishment. In the wake of the Civil Rights Act and weakening Jim Crow era laws, Nixon’s ‘War on Drugs’ re–escalated the government’s disciplinary apparatus in communities of color.   Spaces and social bonds that could produce non–capitalist alternatives were nearly annihilated, including radical organizations, unions, and eventually family and neighborhood networks with the waves of foreclosures, gentrification, and rising incarceration (particularly in communities of color). A new mode of economic production would come to dominate poor communities – the sale and consumption of illicit drugs.

Reagan’s assault on social services in the wake of rising unemployment and aggressive enforcement approach destroyed the lives of millions of Americans. The state abandoned the unemployed, the mentally ill, and those suffering from addiction – and were diverted to the care of families, non-profits, prisons, and even homelessness. America was transformed, from the state with a market, to a market state. The poor were now forced to participate in a new ‘market state’ of life in the tragic form of the drug trade.  The sale of illicit drugs monetized personal relations and converted urban spaces that were once rallying points for radical organizations into the sale and consumption of drugs, with the state obsessed on an endless spiral of greater surveillance and incarceration.

Mothers in Care, Not in Handcuffs
In this context, the state has all but abandoned poor and substance using pregnant mothers to the mercy of hostile district attorneys and prison wardens. Many trends observed among pregnant mothers of color are parallel to national trends as well: 1) most mothers tested and incarcerated for substance use are women of color even though most addicted mothers are white; 2) substance treatment for pregnant mothers are tragically inadequate despite the promising outcomes of specialized clinics for substance using mothers ; 3) when forced into prison in order ‘to protect the health of the fetus’, substance treatment is nonexistent further hurting the health of the mother and baby; and 4) nearly half of detained mothers were tested positive for a physician prescribed substance (i.e. Percocet, valium, etc).

The mother has no voice in the clinic, courtroom, or her community –  she is decontextualized from the dominant economic and political forces, vilified by the media, state, and scientific community, and left vulnerable to recurring witch hunts. For instance although Black mothers made up a fraction of the national crack epidemic, they became the replayed media image of a reckless wave of mothers poisoning a new generation of ‘crack babies’. Medical journals caught on and more often published data exposing the alarming impact of crack/cocaine on fetuses.  This spectacle resulted in a moralistic subjugation, reducing the woman’s role in society to an organ (i.e. uterus) responsible for delivering a healthy fetus, whose legal rights superseded the mother’s.  On the pretext of ‘saving the fetus’, many states have favored aggressive sentencing and incarceration of mothers rather than securing more equitable access to housing and healthcare.

Where Should We Stand?
To reflect on our autonomy, we must explore our relation to our institutions (clinics, hospitals); and our relation to the state, communities served, and existing economic and political forces.

This process requires that we have the space, time, and resources to define our relations based on social justice and scientific evidence rather than profit, power, and popular sentiment.  To abandon our autonomy, our desire to care, and relapse into a disciplinary function.  The disciplinary function leads to two tragic consequences for the mother, the obvious being that she is left in handcuffs rather than any form of care, and the more implicit and equally tragic is that we censor her from using a presenting illness as a point of departure to collectively respond to her concrete experiences.  The mother is lying alone in the exam room, her ´complaints´, physical exam, and laboratory results are organized in a linear series of codes that neutralizes her from any desire to articulate a more concrete response to the broader socio-economic context with other mothers and allies. This process is done within minutes, and we are off to ‘manage’ the next case.  To engage in this process ‘productively’, we internalize these contradictions, remaining complicit with the existing disciplinary forces (police, hospital administration), and feeling more bitter than ever.

The close proximity of our complicity in this process raises another question – how have we reached the point in our profession, education, and ethical framework to be placed in such close proximity with the police? Does such an intimate complicity and abandonment of our role as care workers call for a more intensive self-examination of a perhaps more discrete disciplinary function we fulfill in society? Similar to calls by psychologists to expel colleagues from professional societies that participate in state organized torture, can we draw a similar argument here? More importantly, can we organize our clinical practice, the layout and organizational flow of the clinic, to better care for mothers, and collaborate with collectives of mothers.

A Clinic Without Organs
After recuperating our autonomy, we offer several suggestions for collectively affirming our role in expressing the alternative.

1.    We must cease to be the paternalistic intermediaries of the state when working with pregnant mothers or any other vulnerable populations.  We should open spaces in the clinic and beyond that nurture bonds based on mutual aid, reciprocity, and collaborations with collectivized patients in order to launch new alternatives. The desire to collectivize with patients will require an exhausting, at times challenging, process of confronting our own paradoxical position of privilege within the hospital (and society) that has been instilled in our education, profession, and even union practices.  But is nonetheless an absolute necessity in the struggle to deconstruct power and recuperate care and autonomous forms of socialization.

2.    We must identify spaces and mechanisms that can allow us to sustain our collective expression, be it in the form of assemblies, committees, or radical organizations. This is perhaps the most challenging but necessary responsibility in protecting our historical significance

3.    In the realm of public health, the legitimacy of those who claim to represent or speak for us (such as unions, politicians, academics, and media) repeatedly comes under question. Its not a matter of blaming – but a matter of unleashing our potentials. We must move beyond opposing positions that simply react and expire after a certain point. Our opposition should be directed to institutions and hierarchies that when effectively challenged, finally create an open space that unleashes our desires, collaborations, and alternatives.  We must make our voices heard:
1)    We will not report substance using mothers to the authorities. Platforms may include petitions, public letters to the media, and protests
2)    Academic societies, healthcare workers, and organizations of pregnant mothers must inform healthcare workers that notify the police how they´re complicit with a broader trend of economic and political oppression, and explore other alternatives to help pregnant mothers.  This process allows us to move beyond becoming fixed on a single legislation or co–worker, and to take collective responsibility for launch new subjectivities
3)    In collaboration with marginalized pregnant mothers, we must expand research and implementation of specialized clinics that address the gambit of medical, substance, and social needs. Lack of access to primary care treatment drives patients back to ER’s and criminal justice settings, further perpetuating cynicism and disempowerment (of mothers and healthcare workers)
4)    And beyond these few immediate demands and efforts, we refuse to prescribe any further alternatives until we´re able to collaborate non– hierarchically with mothers, in spaces that are open and able to sustain a longer–term conversation.

4.    We must not shun ourselves from injustices perpetuated in the communities we serve, including unemployment, gentrification, racism, and other catastrophic events. We must have protected time from our places of labor to engage with community organizations in order to participate in efforts that respond to ‘upstream’ structural inequalities that result in worsening health outcomes seen in our facilities.  In other words, every effort must be made to expand education, prevention, and treatment practices to prevent mothers from further worsening health outcomes requiring clinical intervention. These spaces will allow us to nurture new political subjectivities that move from the antagonistic, to the affirmative.

5.    We must reclaim and transform existing healthcare infrastructure, technologies, and resources in a mode that allows our new political subjectivity to address local contextual experiences.

Conclusion
Tennessee’s legislation is more than a mistake, requiring an antagonistic approach confined to a profession, time period (i.e. the outcry and the win of removing this legislation), and self-assuring sentiments that the present is working, and capable of self-resolving future mistakes.  Rather, such events must serve as a rupture to produce a period of interruption in which the law, complicit institutions, power dynamics, and ideologies are recognized, deconstructed, and materializing collectively affirmative forms of alternative building.  We, the healthcare workers of the world, are drowned in concrete experiences, too much, to the point of becoming disillusioned, depressed, internalizing the cries of the oppressed, and we too, becoming oppressed in our cocoons – the unions don’t hear us, the state doesn’t hear us, but our patients do, our colleagues do – grab a concrete experience, embrace the rupture, collectivize, and articulate the alternative.