Midwifery Wisdom

We have been having some incredible and not to be missed quotes flying around Birthwise lately. Too good to pass up and not share some of them with you.

Starting with “put your puss in the sun,”oft repeated advice on how to heal your perineum after receiving sutures, tears, skid marks, or an episiotomy.

My class was reminded earnestly today that “we’re on the fringe. I hope you all know that.” Just in case some of us weren’t paying attention.

Which I guess follows the next anecdote (and my personal favorite) which is to let you know that midwives are like pirates – we do hard and dirty work for very little pay, but at the end of the day we still get to tell people we’re midwives/pirates, which is really cool. Maybe I’ll just decide to be a pirate in the end – it was my first love after all.

Why I ♥ Jay Smooth

HT to Mom’s Tinfoil Hat for reminding me how much I love Jay Smooth.

Having Faith and Ovulation

I have long been a fan of Sandra Steingraber. I read Living Downstream my very first semester in college and it opened my eyes to an incredible world of government and industry disregard for our very human and fragile lives as evidenced by the chemicals they continued to pump into the air that damaged us and made us sick. Now, we have read Having Faith for this current semester in midwifery school and again I am in love.

Steingraber’s writing about the most complex ecological and biological facts is nothing short of poetic. Last semester, I spent a lot of time learning all sorts of things about human ovulation that I had never learned before. It was fascinating. The way Steingraber tells it, it is nothing short of an epic symphony orchestrated on a grand ecological scale:

At the end of a period, the lining of the uterus is thin and bare – like a layer of silt left behind after flood waters have receded. The ovaries, too, are smooth and quiet. Then, high in the brain, the pituitary gland begins to drizzle into the bloodstream a substance called follicle stimulating hormone. True to its name, the hormone awakens in one or the other ovary a whole choir of follicles. Like bubbles, they rise to the surface in unison. Each one is a sack that holds a single human egg. Typically, only one follicle will ultimately surrender its singular possession, but all participate in the task of turning testosterone into estrogen, and it is this collective effort that makes the next step possible.

The assembled estrogen seeps from the follicle-studded surface of the ovary and swirls around in the bloodstream. Some reaches the brain, and, in a second round of call and response, the pituitary gland replies by releasing back into the blood another substance called luteinizing hormone. Like the initial hormone that set the whole process in motion, this, too, is received by the ovary, and it induces one of the swollen follicles to break through the ovarian surface. An egg is delivered out into the headwaters of the fallopian tube. Ovulation. All this in less than two weeks.

If you haven’t read Having Faith yet, you should. Maybe you will fall in love too.

Money Matters

I’ve been mulling over my own ideas about money, class, and the choice to save, spend, or give away what we earn. No complete, coherent thoughts yet, just a bunch of ideas and possibilities.

Perhaps it’s because I’m in a place in my life right now as a student where I don’t have to make that choice – any money I earn that doesn’t pay for basic things like rent and food goes towards school and my future midwifery practice in one way or another. I don’t have the luxury like I did last year of deciding what to do with the money I earned above and beyond my basic and immediate needs.

Perhaps it’s because of the spot I heard on NPR the other day. They were interviewing a woman who started a money and debt service modeled after Weight Watchers – the idea is that you budget what you spend not on a monthly basis but on a daily basis. She offhandedly made a comment about how for her family, after they took out money they couldn’t help spending (food, bills, etc.), they had roughly $3,000 per month to spend.

$3,000? I was floored. I barely heard her continue on to say that it can be easy to spend a lot of money when you think of it as a large chunk of $3,000, but when you think about the fact that you only have $100 to spend each day, you might be more careful with your spending habits. Wait, did she just say $100 per day? What would I do with that kind of money? What could I do with that kind of money? Would I ever want that kind of extra money?

Which of course lead me into the thought that one day I will not be a struggling student. I will be, Goddess-willing, a successful midwife with a successful practice. I will hopefully be living in community and sharing some basic needs/expenses with others which would make my personal needs lower than they otherwise would be. So I begin to think about where the importance of savings (for fixing the car, for college for the kids, for personal pleasures and travel) intersects with need and what is left over in the end. And what justifies as a need or as a luxury – is money for college a need? Is taking time and money to travel a need or justifiable? How much? These aren’t questions I presume to be able to answer for everyone, but I’d like to figure out a little more about where I stand on them for myself.

As I continue to think about this, I am delighted and humbled by the organization Bolder Giving. Bolder Giving highlights and celebrates individuals who give away substantial amounts of their money. We’re talking 50%, 75%, and sometimes more. To give away that percentage of your assets floors me and strikes me as radically anti-capitalist. I certainly don’t think everyone needs to give away that much money, but if there was ever any time in my life where I was making substantially more than my needs, I would certainly be inspired by Bolder Giving’s example and give away as much as I felt I was able or alternatively choose to focus on providing my services to clients who could not afford them if they had to pay full-price (or any price) for them. To be radically anti-capitalist, especially when it means giving away the extra, feels like a mandate to me and in my life and for my own personal ethics.

By the way, I was alerted to Bolder Giving through a blog post on Enough post about one member profiled on Bolder Giving’s website, Tom Hseih.

Look What I Got for Yule!

A new yoni!

I am now the proud owner of a brand new Wondrous Vulva Puppet. My friend E. who is currently down in Peru happens to know the woman who makes these incredible puppets.

My personal new vulva comes complete with labia majora made out of a traditional Peruvian fabric (instead of the delicious red in the picture to the right), a beautiful pink rosebud where there urethra sits (complete with leaves of course), and very cleverly placed ridge of fabric inside the vaginal opening for the urethral sponge/G-spot.

What a great present for a midwifery student! I can’t wait to show her off to all of my friends.

Dreaming in the Language of Midwifery

The other night I dreamt I was pregnant and laboring. With twins, actually. I remember specifically when my water broke, because I then suffered from severe dream-induced oligohydramnios, I remember specifically talking with my midwife about the timing and intensity of my contractions, and when I transitioned from pre-labor to active labor (as if that’s possible to tell someone exactly) and then worrying afterwards whether I had given her the exact correct information or whether I had messed up the timing of contractions and cervical dilation for when someone transitions into active labor. I remember considering checking my own cervical dilation but deciding not to because I was so busy, and going for long walks to bring the babies down. I remember frequently performing Leopold’s Maneuvers on myself to check the position of the babies worrying that with one transverse twin, I might only get to vaginally deliver one of my babies.

Whew! When did dreams get so complicated? I admit to having a couple of pregnancy dreams prior to starting midwifery school, but this one was so different! It was like I was living my periodical exams in person, worrying about all of the correct answers and making sure I remembered every part of everything. What an exhausting (but totally fascinating) dream!

Is this what midwifery school does to you? I’m so curious to find out what happens next.

The Language of Midwifery

On a side note, we spent a good deal of time this first semester learning abbreviations and medical language. I feel like I’m learning a whole new dialect when I write things on my test like “At 18 wks the FH is 2 FB ↓ U.”

Whew!

Classes are finished, assignments turned in, presentations made, and final exams completed. Wow am I exhausted. But I am very excited about everything to learn in the coming year and the progress to be made. Time to hibernate a bit, love family and friends, and do lots of good and hard thinking about my role in midwifery and where I’m heading. Very exciting. And I’m thrilled to have enough time and brain space to actually do some deeper thinking about things and not just memorizing the frequency and timing of contractions in the various stages of labor.

Racism and Birth Outcomes

Please go and read this brilliant post by Guerrilla Mama Medicine –> Sick and Tired: How Racism Impacts Pregnancy Outcomes. This is the first time I’ve seen the impact of racism on health laid out so clearly in relation to birth and pregnancy outcomes.

Anti-Oppression Work and Midwifery

Anti-oppression work, diversity work, and a open-eyed look at our own areas of privilege is a crucial part of midwifery education, not only for working with clients across the board but for forging successful ties with fellow midwives and other colleagues. In the direct-entry midwifery world I feel that it’s a topic that is not often explicitly talked about, which leads to problems. When we don’t talk about it, we assume it doesn’t exist. If it doesn’t exist, why would we need to examine ourselves and our own beliefs, behaviors, and interactions with others?

And when that happens, you get a situation like we currently have. Direct-entry midwifery in the US is the domain overwhelmingly of white, middle class, straight women serving largely white, middle class straight women. How can we pretend that we serve all women when this is the case?

To be fair, some of this is beyond our control. Until we have a healthcare system in the US that allows for insurance reimbursement for the services of direct-entry midwives, we will be understandably limited in who we can serve based on their incomes and financial status.

But when it comes to who feels comfortable, safe, and welcomed in a homebirth midwifery practice we start to get into questions of race, racism, and privilege (not to mention class and heterocentrism). Serving all women is not just making yourself available to them, but also means working to make sure that your practice is actively inclusive.

I don’t have the answers, but I do have some ideas on what needs to happen:

• We need to serve more women of color
  • This means that we need to have practices that feel welcoming to women of color
  • This also means we need to understand and practice cultural competency
  • We need to help women of color view direct-entry midwifery as a valid choice for their prenatal and intrapartum care. This is a big hurdle in some locations particularly because of some shady and racist dealings beyond our control – like the government providing midwives (largely white CNMs) in the rural south to poor Black women because they believed midwives to be less well trained (and therefore cheaper) than doctors. Or the government giving depo provera to Black women as a form of temporary sterilization because it viewed these women as A) unworthy of reproducing and B) not competent enough to make their own choices about their own car. Shitty things our government has done that may not be our fault but that we nonetheless need to actively work to combat in order to stop being complicit with these actions. Start by learning about the reproductive justice movement.
• We need more midwives of color
  • One of the first ways we can change this is by being more inclusive of the way we educate direct-entry midwives.
• We need to radically change our midwifery education system:
  • Raise the levels of women of color enrolling in midwifery education programs
    • I look around at the class pictures of previous classes at my school and am shocked to see almost entirely white women (or women of color passing as white, hard to tell from just a photograph). I know my class is more diverse than previous classes, but only just. And while Maine is no Los Angeles, it’s not as white as you might think.
  • Raise the levels of women of color graduating from midwifery education programs
    • When I can count on one hand the number of women of color the oldest direct-entry midwifery school in the nation has graduated, we’re talking about a serious problem. One that is insidious in midwifery education and has been a problem for a long time.
  • Ensure that all midwives graduating from MEAC-accredited institutions participate in in-depth anti-oppression training by trained and skilled facilitators. Most of the trainings currently available are insufficient, poorly taught, and/or irrelevant to the work we need to do. This needs to change so that we can:
  • Turn (white) midwives into anti-oppression activists. Get them involved with the reproductive justice movement. When midwives understand oppression on an institutional level and can examine their own privileges, they will understand why it is so critically important that we tackle this issue as a group.
  • Help midwives understand that by becoming radically inclusive, they are putting one more chink into the armor of the allopathic, western medical system that works on an oppressive sexist, racist, top-down power structure. To be a midwife in the US is to be an activist. Period. To be a midwife should also include being a reproductive justice activist.

So those are my few ideas. I hope to continue to deepen and flesh them out in the coming years of my training and practice. I hope to be able to make some real change in the right direction. What do you think? What are your ideas? How can we come together to make a better and more inclusive Midwifery Model of Care for all women?