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 care. 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?

6 responses to “Anti-Oppression Work and Midwifery

  1. Wow, well-written and to the point. I agree completely with all your points, except I have a better idea of how this plays out in the social work field, and even so, my program has an “urban” mission, which basically means it addresses oppression and racism, sexism…you name it. There is still a lot of work to be done, but you are right that the work starts within. Thanks for an inspiring post.

  2. Great post. The midwifery program where I trained has a high enough volume (our state requires the reimbursement of DEMs) that it can offer very inexpensive classes and proctoring. Medicaid also reimburses for deliveries with DEMs, so the patient population has a wide socioeconomic, racial and ethnic mix.

    It’s proof that if you lift the economic obstacles, it makes it a lot easier.

    • Exactly! I have a lot of hopes riding on the MAMA Campaign as a good place to start. It is not the answer to everything but it certainly would remove a huge barrier.

      If you don’t mind me asking, what state did you train in? I’m just beginning to think about finding a preceptor for down the road and it’s so important to me to find a practice that is serving a diverse and representative population.

  3. Excellent blog! We hope to address some of these topics amongst our staff of volunteers here in NY. We have some amazing nurses, doulas, childbirth educators and breastfeeding educators volunteering with our group Sarah’s Tent, however no midwives yet. We serve low income communities which consists of mainly black and hispanic women but have no midwives. As a doula, i have found that midwives and birthing centers is not an option for many of the women in our communities. This is one reason that i personally am considering becoming a midwife. However here in New York, it is extremely difficult. (you must have a bachelors degree in order to get into a school tht offers a degree in midwifery) We will be working on getting funding to contract midwives for women who cannot afford to pay themselves so that they may have this beautiful option.

    Thank you again for this blog. It’s great to see that others care about these topics as well.

    P.s please excuse any typos i came across your blog while surfing the net on my iphone. In other words my view is quite limited, lol.

    Keep up the amazing work!

    • Aliyah,
      The work you are doing in NY sounds AMAZING. I look forward to hearing more about it in the future. I wish it was legal to practice as a CPM in NY, I think it’d help midwifery reach a much wider group of women who really need care from and access to midwives especially in NYC. Just out of curiosity, why do you think the women you serve do not the option of midwives and birthing centers? Is it primarily financial? Are there barriers due to race, language, culture, etc.? Not enough knowledge of these as options? Funding is SO important for creating access to midwifery for the folks who need it the most.

      Best of luck to you on your journey to becoming a midwife. You should consider joining the MANA Midwives of Color YahooGroup. Those folks are incredible and offer a lot of great and much needed support to folks no matter where you are on your journey.

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