!!!! AKA Science and Sensibility Takes on Gender Variant Pregnancy

With none other than the brilliant CNM Simon Adriane Ellis, who by the way recently did some incredible work helping the ACNM put together their progressive new position statement titled “Transgender/Transsexual/Gender Variant Health Care“.

When asked, many birth professionals will tell you that they’ve never cared for a gender variant patient. Many of us claim that we don’t have the skills or the knowledge to do so. Turns out we’re usually wrong, on two fronts. First, chances are many of us have served gender variant people, without knowing it. And second, we are competent, compassionate, and well-trained professionals who already have what we need to provide excellent care and services to our gender variant patients.

So do not hesitate, do not pass go, and most definitely do not collect $200. Go check it out. While you’re at it, make sure you read the rest of the posts in the Welcoming All Families series which so far has touched on lesbian families and women of size.

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Butches with Buns in the Oven!

ImageI opened up my Facebook today to see this fantastic picture and the words “Look guys! It’s our first butch + bun…in the oven!”

I could not be happier with this photo! First off, Chris in the picture has got all kinds of sass, which naturally I love. Secondly, pictures of people who look like me and who are pregnant!!! Someday, maybe I can add my picture(s) to the Butches + Babies blog.

I feel so happy and through the roof because it raises awareness that butches are carrying and birthing children (along with genderqueer and trans folks). When the public thinks of childbearing amongst gender non-conforming folks, my guess is the only image that (maybe) comes to mind is Thomas Beatie sharing his pregnancy on Oprah (or maybe Scott Moore if they’re really radical) as being THE transman who is also a birth parent. THE As in the one and only. A salacious circus sideshow for the public to consume and ponder about how this is even possible. This article announces that Moore is “[t]he world’s second known pregnant man”. This claim simply isn’t true. Trans and other gender non-conforming folks have been getting pregnant and giving birth since, well, longer than Oprah has had a talk show for sure. For sure.

But ay, there’s the rub. Yes I care that there is public awareness of these pregnancies. Yes, I want people to feel like they are not alone in their parenting decisions. To me, however, that’s not the most pressing issue. Most of all, I want there to be good, qualified, culturally competent, and sensitive care givers that gender non-conforming folks can reliably turn to for their GYN and OB care. I never want someone to wonder whether their healthcare provider will mix up their name and/or pronouns, never ever to worry if their body and embodied experience in this world will be treated respectfully or even competently. And part of the problem is that if there’s not public awareness of the pregnancies and births of gender non-conforming folks, then care providers will not feel the push to become competent in this area. To intentionally change their practices to become radically inclusive of all people who need their services. I want to applaud the ACNM for their recent position statement promising to work towards inclusive and competent care for their gender non-conforming clients.

Homebirth midwives, I think, could be ideal care providers for necessary sexual and reproductive health services for trans and gender queer clients as well as for pregnancy and birth. Imagine a homebirth for your beautiful family watching Baba push his baby out in the water into the waiting hands of his love and then snuggling up with their baby surrounded by care providers who know them for who they are and love and respect them. With no social workers coming in moments after the birth demanding to know who the birth parent is, removing the non-birth/non-biological parent from the room and making them sign second-parent adoption papers instead of bonding with your child in those precious first hours. Nobody using the wrong pronouns intentionally and derogatorily. Nobody giving anybody the stink eye, looking shocked, or being confused. And nobody talking about how ideal your breasts are for breastfeeding after you had a long conversation about with your care provider prenatally and explicitly stated that you plan to chestfeed your infant. Just you, your family, and your competent, inclusive care providers that you feel comfortable being your whole selves with.

I fully intend to serve queer and gender non-conforming clients in my (future) midwifery practice. I’m so close to that reality I can taste. Now we’ve just got to get MANA the general population of homebirth midwives on board and we’d really be heading in the right direction.

When the Baby is Born, it Belongs to Everyone

I’ll admit it. I’m a bit of a closet geek. Throughout high school and college I spent much of my free time reading webcomics. Lately, I’ve been checking out graphic novels from my local library (my local library is probably hands down my favorite place anywhere I live) and was thrilled to find the second book in a series about Aya, a young woman growing up in the Ivory Coast in the late 1970s.

In the appendix of this particular book, I found this absolute gem, talking about how new families are cared for in the immediate postpartum period and how, if you play your cards right, children are cared for on an extended basis by the entire community. It makes me think about life in the US and how many of my new families aren’t so lucky to have close friends or family close by to care for them postpartum and how incredibly important it is to have or build community in every time of your life.

In our country, we have a famous proverb that goes like this:

“When a baby is in they belly, it belongs to its mother. When it’s born, it belongs to everyone.”

The “it belongs to everyone” part is really great, believe me. And here’s why:

First, when you give birth, you only stay in the maternity ward for a day, unless you have a caesarian, in which case you go home the day after (not enough room and it’s expensive). But that doesn’t matter because as soon as you get home, you are welcomed like a “queen” by everyone. (Your family will take care of you and your baby for awhile, and that’s great, because you won’t have time to get those famous postpartum blues.) The baby and you are promptly looked after. Your mother heats some water and massages your whole body, especially the belly. Next she slathers you in shea butter and you go shower. Then she slathers you in shea butter again and wraps your belly (if you haven’t had a caesarian of course). Afterward, she dresses you and does your hair (you couldn’t get better treatment at a spa).

During this time, a team made up of your grandmother (if you still have one) and great-aunts takes care of your baby. They massage its head with a warm washcloth (so that its head becomes nice and round) and then its whole body (to make it nice and firm). When that’s done, the baby is washed, slathered in lotino and dusted with “Bébé d’Or” talcum powder or other things, then dressed in pretty clothes.

Meanwhile, another team made up of female cousins, sisters-in-law and tanties* makes a delicious meal, and then it’s time to sit down to eat! You come out of your room beautiful and glowing (thanks to the shea butter) and you enjoy the special meal (that you requested) under the happy gaze of your whole family.

When you have finished your meal, your beautiful baby is returned to you so you can nurse it (yup, that’s right, you’ve got to work just a little bit). After it burps, you put it down to sleep, and you can take a well-deserved nap and rest easy because your baby is being watched over by dozens of people. …

You’re helped in this way for some time. A few days before the aunts, female cousins, and sisters-in-law leave (your mother and grandmother can stay much longer), you introduce your baby to all the people in your neighborhood (even though they’ve all come by your house already to see you). This ritual is very important because you bring them your baby as a sign of respect and consideration. That’s how you get everyone to adopt your baby.

That’s how children grow up in this community. When your children are old enough to play outside, they’ll always be watched by someone and they’ll get scolded by a tantie* or tonton* the minute they’re up to some mischief.

Your children will invite other neighbor kids to come eat at your house because your children have had meals at theirs. They’ll learn about sharing and life as part of a community. You’re probably wondering about the “mother-father-child” bond. Don’t worry, because the others will never get in the way of that bond. Just because you give your children to others for a short time, doesn’t mean they’ll love you any less.

In any event, in our country, we don’t have to deal with those kinds of questions, because we don’t even think about them, and everything goes really well.

After all, we all want our children to be happy.

Excerpt from Aya of Yop City by Marguerite Abouet and Clément Oubrerie.

*tantie = auntie or older woman, tonton = uncle or older man

DONATE: Birth Workers of Color Conference Scholarship Fund

AROMidwifery is raising money for scholarships for birth workers of color to attend the 8th annual ICTC  conference this October in Florida. I cannot even begin to tell you how important this is. Scholarships and other funding for student midwives of color was one of the specific requests of the Midwives of Color working group in MANA (back before the MOC inner council resigned en masse). It’s a definite need. Frankly, it’s one of the single most important ways of combatting the racial disparities in the maternal and infant mortality rates in this country. We absolutely completely need more midwives of color working in this country and this is one of the ways we can do this.

From the AROMidwifery blog:

I want to be a midwife as much as I want to breathe. I know this is something I can do.  I have the resources and support I need to achieve my goal. I also know that when I am among a group of midwives, chances are, they will look like me, talk like me, and among them I will feel comfortable, welcomed, and safe. They will see me as a unique individual, rather than a representative of my ethnic group. They will accept me as one of them. This is my privilege – my white privilege; always present, even as a student midwife.

I also know there are many other people who want to become midwives as intensely as I do. Yet women of color who hear this call don’t have the privilege that I have. Generations of economic injustice mean that aspiring midwives of color often lack the financial support that many white student midwives can count on. Moreover, when students and aspiring midwives of color are among a group of midwives, there is a good chance that the majority of the people in the room will not look like them. They may not feel truly accepted, safe, or welcomed. If they speak in these groups, they may be expected to represent their ethnic group, rather than being listened to as individuals. They very likely cannot find preceptors or peers of their own skin color. This is institutionalized racism, and it is always present in the United States, even in midwifery.

Please donate. Give what you can. Give $5 or $500. Give more if possible. Think you can’t make a difference? Think again. Supporting student midwives of color is one of the single most important things we can be doing to change birth and midwifery in this country.

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Graduation!

At the tail end of June, I graduated from Birthwise Midwifery School! It was an incredibly proud moment for me, and represented the culmination of a lot of hard work. It was very sweet to stand there with these women, so many of whom walked this journey with me from the very first day. (Never mind that I’m still not quite done with all of my births, that will come with time.)

It was also satisfying and affirming to speak with several people in the Birthwise administration about important conversations happening in midwifery right now, including the recent MOC chair and inner council resignation from MANA. I have to say I have been impressed with Birthwise’s continuing commitment to these conversations and the ways in which they are changing to create a better program. Their classes are changing, their student population is changing, and all of this has been a lot of change in the last few years for this small institution in Maine. I see a really bright future for Birthwise under it’s current leadership. Honestly, I only see things getting much better in the years to come.

The ceremony itself was simple and touching. I was asked to be a speaker at graduation. I want to share the text of my speech with y’all. I took this opportunity to speak about some things very close to my heart and where I hope to see midwifery moving for these recent graduates.


Maternal Health is a Human Right

As we leave Birthwise today and head into the world as new midwives, we are tasked with the sweet privilege and honor of attending and facilitating the birth of families. We are also inheriting some incredible challenges and responsibilities. According to new data from the United Nations, women are more likely to die from pregnancy and birth-related complications in the US than in 50 other countries and its getting worse.

I have a hard time getting beyond those numbers. 50th place for maternal mortality. I cannot wrap my brain around the fact that we are in country where we spend more money (by a long shot) on medicine than any other country in the world and yet our maternal mortality numbers look like that. But then it just gets worse. In the US, black and Native American women and their babies die at rates disproportionate to their white counterparts. Black infants are 2.4 times more likely to die in the first year of life than white babies. Black women are 4 times more likely to die from pregnancy-related causes than white women. Frankly, these statistics are unconscionable. They are horrendous and abhorrent. And we HAVE to do something about it.

Fortunately, I think we have a piece of the answer. That answer is midwifery care.

As midwives, I think we’re doing a lot of things right. We provide competent, compassionate care to our clients throughout their entire pregnancies. We spend hours and hours in prenatal appointments getting to know women and their families, providing support when they have challenges, and giving excellent and often life-changing education. We facilitate their births start to finish cognizant of the many varied expressions of normal, holding space for our clients to navigate this journey however they need and want to as long as it is safe. Postpartum, we go above and beyond the care women get in obstetrical practices, doing home visits and multiple postpartum visits, catching things that are often missed by standard hospital care and lead to morbidity and mortality such as HELLP, infection, late post partum hemorrhages, and the list goes on and on.

And even still, we have a long long way to come. When you envision your future practice, are you serving the clients who need you the most? When you think about your preceptorships to date, are the women walking through your door an accurate reflection of the demographics in your area? Or do you serve a disproportionate number of white women?

In the 2011 update to Amnesty International’s seminal paper, Deadly Delivery, we learn that in addition to higher rates of maternal and infant mortality, “[w]omen of color are also less likely to have access to adequate maternal health care services. Native American and Alaska Native women are 3.6 times, African-American women 2.6 times and Latina women 2.5 times as likely as white women to receive late or no prenatal care.” We cannot provide the excellent midwifery care I know we all provide to women who are not even walking through our doors.

These galling numbers and statistics are beginning to come to the forefront of our thinking as midwives. I hear midwives talking about race disparities in obstetric care all over the country, both in person and online. I am so pleased that we are starting to have these conversations in earnest. Unfortunately, we have to do more than say we want to change outcomes for moms and babes. We need to get down to work to create real and lasting change. Maternal health is a human right and we need to work towards that truth. In doing so, we might have to stretch our comfort zones further than we thought we could and then keep pushing. But do it we must, because reducing infant and maternal mortality is more important than just about anything else we will do in our careers. Our very lives depend on it.

The challenge as I see it is combating racism and building a praxis of reproductive and birth justice. Racism is a central reason why these maternal mortality statistics are so skewed by race. When you rule out other confounding factors such as socioeconomic status, education level, geographic location, the race-based disparities remain. Personally, I believe unexamined institutionalized racism is the main factor why so many of our practices have a white-majority client base even if it doesn’t mirror the people who actually live in our communities. It’s why women of color are not accessing and utilizing the services of midwives at the same rates their white counterparts are. As midwives, we are failing families and their babies through our own inaction.

We need to examine our practices as we build or join them. We need to begin to have the difficult and uncomfortable conversations with our peers, mentors, teachers, and students. We need to talk about racism as a facet of midwifery and put our brains together about ways to eliminate it. Ask yourselves: When you have women of color in your practice, are you providing truly culturally competent care? Are you providing a welcoming environment where women are free from racism and racist practices, whether intentionally committed or not? If not, let’s fix it.

Here’s the real crux of the situation – we choose to make these changes out of love. I have decided to be an active participant in the work to fix these problems as long as I’m a practicing midwife BECAUSE I so love the work I do and I so love the clients I serve. I love my birth community, I love my peers, and I love each and every one of you and that’s precisely why I am willing to do this hard work. It is that love that pushes me on and gives me the strength to continue and it is that same love that inspires me every time I see change being made.

There are so many places to start:

  • Take a good anti-racism or anti-oppression training in your area. Attend relevant workshops at MANA conferences. Read books, websites, blogs, anything you can get your hands on. Do not ever stop learning.
  • Know your history as midwives and share it with your peers and clients. Make sure people know that what you do was built on the backs of immigrant women, black Grand midwives in the deep south, and Latina parteras in the southwest. Don’t let anyone believe the myth that Ina May Gaskin single-handedly resurrected a dead profession from the ashes. Not even she believes that.
  • Begin to get involved with reproductive justice groups.
  • Tap your local birth community for people you respect who are already engaged in this work. Find our how you can be involved.
  • Seek out allies to start having conversations about race with.
  • Find out ways to serve women of color and the organizations that support them in your community.
  • Advertise and do outreach to women of color in your community, make sure they are knowledgeable about midwifery care as an option. Make sure they feel welcome and included in your client activities. Begin to change your demographics and you will begin to change birth outcomes.
  • Seek out other birth professionals of color to collaborate with. Are the doulas, lactation consultants, ultrasonographers, massage therapists, chiropractors, and acupuncturists, that you refer to all white? Change that if you can. Add new referrals to your list. Be on the look-out for qualified and competent professionals of color to refer to.
  •  Join the national conversation. What changes can be made to MANA, NACPM, MEAC, the MAMA Campaign and your local and state organizations? Can you help them come to an awareness of the seriousness of this issue and begin actively working towards combating it?
  • Train women of color as midwives, because they are our future.
  • End the institutionalized racism women of color experience in the medical system and commit to making sure that women never experience those kinds of indignities and injustices in your practice. Ever.

I personally challenge each and every one of you to utilize your incredible skill, tools, and love as midwives to make significant change regarding race-based maternal and infant mortality rates in North America. I urge you to make solving this problem a significant focus of your lives and practices. My deepest hope is that you find the challenge and reward, and the joy that is there in this transformative work. My dream is that your soul will catch on fire with the need and drive to do this work out in the world and that it will sustain you in all the years to come. You are the next generation of midwives and through your actions, we can transform midwifery care into a profession that truly is for ALL women.

AROM: Letter of Support for MOC Chair and Inner Council Resignation

I’m a little late on the game posting this (it’s been a busy couple of weeks!), but you should definitely know about it. The Anti-Racism and Anti-Oppression Work in Midwifery (AROM) working group was formed very recently and has been especially active since the resignation letter to MANA from the MOC Chair and Inner Council.

Our work includes deepening our knowledge of, and developing ways to break down, systems of oppression and domination, including but not limited to racism/white supremacy, patriarchy/sexism, classism, ableism, heterosexism/homophobia/transphobia, and xenophobia based on perceived nation of origin and religion.

We have published a response letter on the AROM blog and we are looking for more birth workers to join in this crucial work.

We, the undersigned, express our unconditional support for the statement and actions of the former Chair and Inner Council of the Midwives Alliance of North America (MANA) Midwives of Color Section and all midwives of color who feel represented by these positions. We wish to acknowledge the experience of many, many years of devaluation and dismissal of midwives of color by the professional midwifery community. We acknowledge the interpersonal racism that has characterized the interactions in general between midwives of color and white midwives. We also acknowledge the deep institutional racism within midwifery in the United States as a whole, which characterizes our professional organizations, educational institutions, learning environments, conferences, and group interactions. We acknowledge that this situation has its roots in the systematic elimination of midwives of color over the course of the 20th century by the white-dominant health care system’s neglect, devaluation, and violation of the bodies, ways of knowing, and communities of people of color. We acknowledge that, in some cases, white midwives were complicit in this elimination. We acknowledge the fact that, among many negative effects, this institutional racism continues to exclude and marginalize students and midwives of color today. Moreover, in failing to confront this legacy and to actively work to transform it, the midwifery profession as a whole participates in limiting access to care for women of color, and perpetuates the structures of racial and economic injustice and inequity in maternal and infant health in the United States and internationally. Continue reading …

How can you help? Read the letter and add your name as a signatory. Join the AROM Facebook Group. Find other ways to get involved and get inspired by the work we’re doing. Pass the word, repost the letter, tell everyone you know who is involved in midwifery. Begin having discussions about anti-racism and anti-oppression in your community and find ways to work towards birth justice.

Institutionalized Racism, White Privilege, and MANA

Oh my goodness. If you haven’t been following along, there has been a tremendous amount of activity in the last two weeks within MANA, the Midwives Alliance of North America.

Here is a rundown of what has happened so far:

  1. On May 21, the Midwives of Color (MOC) MANA section chair and her Inner Council resigned en masse from their board positions within MANA and the organization itself, citing continued institutionalized racism and continued inaction on MANA’s part. The midwives who resigned are the MOC Chair Darynée Blount and the MOC Inner Council: Jennie Joseph, Jessica Roach, Ayesha Ibrahim, Claudia Booker and Michelle Peixinho. All of these are midwives and student midwives for whom I have nothing but the deepest respect and admiration. They are absolutely top midwifery leaders and activists and are at the forefront of reproductive and birth justice work in the midwifery world. MANA lost some of their best midwives when these women resigned. You can read the entire resignation letter here.
  2. MANA responded on their Facebook page by trying initiate conversations about what happened and where to move forward in the future (these can be an infuriating experience to read, be forewarned). They continue to write letters to their membership and the public at large explaining their position, stating the work they have already done and where they see their next steps, and making public a sort of apology that did not take any real ownership for racism and racist practices they have perpetuated through the history of MANA. You can all of these public statements here.
  3. Jessica Roach, one of the MOC Inner Council Members who resigned, wrote a response letter.
  4. Wendy Gordon wrote a letter of apology. This letter addresses her own shortcomings, examines her role in perpetuating racism in midwifery, and makes a commitment to move forward and make changes in the future. It looks a lot more like the apology letter I would have liked to have seen from MANA.
  5. Perez covered the resignation on the Radical Doula blog here and here. I think she really hits the nail on the head here:

    “Again, for me, the bottom line is this: we can no longer ignore the disproportionately high negative maternal and infant health outcomes faced by communities of color.
    “And it’s going to be damn hard to address those disparities if we can’t even address racism in our own organizations–especially if that racism means that providers of color choose to leave or are pushed out.

    “The needs of communities of color in maternity care can no longer be the topic of an interest group, or a caucus, or a breakout session. It has to be THE FOCUS. And my guess is that if we address the needs of communities of color, we’ll probably change maternity care in ways that benefit everyone.”

  6. There have been some calls for a resignation of the entire MANA board, a radical restructuring of the power systems within the organization, and a new board with MOC members committed to institutional change. Personally, I am supportive of this proposal. I think it’s going to take radical change like this resignation and other organizational restructuring to dismantle the systems of power currently in place and rebuild an organization that actually serves all midwives, parents, and children.

Frankly, MANA’s response it is too little way too late. A lot of it looks like white guilt and lip service to me, without any real sweeping change that will effect anything substantive. Within the past year, they launched a social justice agenda, brought some anti-oppression trainers on-board, and started to offer workshops at MANA conferences. What is needed is deep, sweeping institutional change and a strong commitment to undoing the the harm caused by racism in the past and in the future. We need to re-examine our priorities as midwives and own up to our own role in the racism inherent in white-dominated midwifery as it stands today. No ifs ands or buts. Each and every white midwife needs to learn about anti-racism and anti-oppression work and commit to continuing this learning process for the rest of their tenure as a midwife. They need to examine their own role in the racist attitudes, actions, and statements perpetuated by them, their fellow midwives, and their midwifery organization. It is each white midwife’s duty to learn about white privilege and own their own shit. Not only is this imperative for the profession as a whole, it is crucial that we do this in order to serve our clients better and all birthing parents.

I think midwifery has an incredible opportunity here to really effect the racial disparities facing Black and Native American families specifically when it comes to maternal and infant mortality. Will we let the opportunity slip us by? I sincerely hope not. I am done pussy-footing around here and I am sick of forgiving ignorance and racism as par for the course when it comes to midwifery. Our clients deserve better, our students deserve better, and we ourselves deserve better. I am fed up.

I want to state for the record that although I am a student midwife, I am not a member of MANA. I was considering joining my professional organization when I had enough extra money to do so although lately I have been re-thinking things. I already knew that MANA had a serious and long-standing problematic relationship with race and racism. However, watching how MANA has dealt with the resignation and the aftermath, I am less than impressed. I don’t know that I can, in good conscience and at this time, join an organization that midwives the likes of Jennie Joseph and Michelle Peixinho feel they can no longer be a part of.