The Women Teaching America About the 'Fifth Vital Sign': Periods

After caring for pregnant people who lacked basic knowledge of reproductive health, nurse Kelsey Knight and doula Emily Varnam created a course using menstruation as a measure of health and taught it across 43 states.

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Dec 28 2017, 7:14pm

Kelsey Knight (L) and Emily Varnam. Image by Broadly. Photo (L) courtesy of Fifth Vital Sign; by Audrey Shtecinjo vis Stocksy.

The United States is among the most expensive countries in which to give birth to a child, yet has the highest rate of maternal mortality in the developed world. Kelsey Knight, a labor and delivery nurse, and Emily Varnam, a reproductive health educator who has worked in hospitals as a doula, felt that Americans were in dire need of educational resources to better understand their healthcare choices in regards to pregnancy, birth, and menstruation. So, they took it upon themselves to provide basic, evidence-based reproductive health information to people across the country by creating a course, driving through 43 states to teach it, and starting a grassroots network of educators eager to help them spread useful information that hospitals aren’t providing.

Knight and Varnam met at a lecture given by Ina May Gaskin in New York City in 2014. Gaskin is the author of Spiritual Midwifery, which was originally published in 1976, and considered to be a classic work on home birth. Both Knight and Varnam had birthwork experience in traditional hospital settings, and found that they were both concerned about patients’ lack of knowledge about their own reproductive health. “We were witnessing people who weren’t familiar with their bodies, out of no fault of their own, but out of the fault of the system for not sharing that information with them,” Knight told Broadly. “Teaching people about their bodies when they’re in labor is not the right time to do it. We need to start a lot earlier.”

Over the following year, Knight and Varnam became roommates and co-wrote a two-hour reproductive health course called “The Fifth Vital Sign”—that “vital sign” being the menstrual cycle—which debuted in 2016. The course’s title was inspired by a committee opinion, published by the American College of Obstetricians and Gynecologists in 2006, that recommended using the menstruation cycle as a vital sign in girls and adolescents. Centered on this idea, Knight and Varnam argue that along with body temperature, pulse rate, respiration rate, and blood pressure, menstruation is a central indicator of health. Their series of classes—designed to be taken either in-person or online—provides information on anatomy, including phenotypically female, male, and intersex reproductive systems, along with an overview of the endocrine system, key hormones, and fertility awareness. It also offers instruction on weighing the risks and benefits of different birth control methods, how to choose menstrual care products, and how to discuss options with health care providers in order to give patients more agency over their bodies.

“We talk about knowing your rights in the hospital,” Varnam said. “It comes directly from how we witnessed health care providers speak (and not speak) with patients. People have the right to say ‘no,’ the right to ask more questions, the right to a second opinion.”

Emily Varnam (L) and Kelsey Knight. Courtesy The Fifth Vital Sign.

Varnam and Knight also made a conscious effort to offer inclusive representation in their diagrams and imagery, including varying skin tones and genital appearance. “[In research,] we could only find images of white people, and that’s not OK,” said Varnam. “We couldn’t find images that normalized the fact that variation is normal in terms of genitalia and how it looks. We couldn’t find anything that talked about intersex, that talked about phenotypes rather than this gender binary. We have to be able to find ourselves in education. If you don’t see yourself in something, how is it for you?”

Varnum had taught the first version of their course in Brooklyn. While the foundational principles of the course have remained the same since its development, Varnam and Knight view its implementation as an ever-evolving collaboration with communities across the country. Last year, they underwent a crowd-funded three-month driving tour across 43 states. During the trip, they held over 60 classes in middle school, high school, and university classrooms, homeless shelters for women and children, and postmenopausal women’s groups.

“We wanted to go into communities and listen, to hear what people were saying and what was going on nationwide,” Knight said. “We had this emphasis on sharing stories as part of the medicinal practice.” Throughout the tour, the pair stayed in students’ and other supporters’ homes. They were surprised by the generosity of their reception, and the willingness of others to support their mission. “I had such a different idea of what it would be like,” Varnam said. “I was surprised by how trustful and open people were. We were blown away.”

When someone broke into their car and stole everything, the friends they made rallied around them. Within a day, they’d raised $2,825 on GoFundMe to fix their car’s smashed windows and reorder class supplies. They drove through the night and made it in time to their next class at a Forest Grove, Oregon center for women escaping domestic violence.

Inspired to empower leadership within the diverse communities they visited, Knight and Varnam revised and expanded their course based on questions and feedback they received on tour. Then, after the November elections, they invited people to “resist and respond” by learning how to teach the Fifth Vital Sign curriculum themselves for free, through group phone calls and a Facebook group. Knight and Varnam spent over 200 hours on four-plus-hour group calls to train over 50 facilitators from 20 states.

After the first round of trainings, Knight and Varnam decided to create a nine-month online course called Conversations in Community, which would train facilitators even more thoroughly. Launched this past August, the program teaches instructors to create and lead reproductive health curricula based on their communities’ needs, which may differ based on factors such as income, ethnic make-up, and location. “We trust that people know their communities, just like we trust that people know their bodies better than we do,” said Knight. “We wanted to give evidence-based information and inspire people to center their curriculum on human rights, but let them take flight with how they wanted to present this material.”

Twenty-nine participants are currently enrolled in Conversations in Community, the majority living in the US. Some are planning to integrate the course materials into their established roles in public health and social work organizations. Others enrolled with an interest in personal development.

The course includes six months of bi-monthly modules and discussions led by Knight and Varnam, who are currently based in Brooklyn and Detroit, respectively. It begins with the foundational overview on anatomy and fertility that they toured with last year, then moves on to human rights within the context of reproductive health, language of consent and self-advocacy in medical settings, self-reflection, and self-care.

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After the first six months of Conversations in Community’s coursework, Knight and Varnam will offer three months of one-on-one mentoring to help each facilitator develop a curriculum tailored specifically to their community. “Facilitator training gives people the tools to think about reflection, to think about business, and then to trust them,” Varnam said. Conversations in Community will end in April, and the new facilitators’ classes will be announced on The Fifth Vital website. At that point, they’ll also announce sign up information for their next online course. Knight and Varnam also offer in-person classes, and current Fifth Vital Sign facilitators already teach regular classes in Troy, New York, San Francisco, and Austin.

While Varnam describes reproductive health in the US as being in “a state of emergency,” she believes that by empowering people with the knowledge and resources to educate their communities, she can improve the situation. “We’re having bills being rolled out that are preventing people from sharing this information,” she said. “So we’ll do it in our homes, we’ll do it online, we’ll do it by any means necessary. We made this together, and it’s an act of collaboration that we even are this far.”