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.

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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, 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.

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.

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?

Palpating Pregnant Bellies

Palpating pregnant bellies is incredible. Today we were given the privilege and honor of practicing palpation skills on the bellies of 4 pregnant women ranging from 12 weeks to 31 weeks gestation. It was awe inspiring.

We practiced Leopold’s Maneuvers today, felt for the fundus and the rest of the uterus, felt for position and lie, listened to fetal heart tones with our new and shiny fetoscopes, and measured the uterus. I was able to work my way from the woman with the earliest gestation in order up to the woman with the latest gestation. It was surprising how much of a difference there was between even 1 week gestation difference or between women who were pregnant for the first time versus those who had given birth before.

And I haven’t even begun to tell you what it is like to feel a fetal head in a woman’s pelvis, to touch the butt of a fetus and feel the fetus kick and move away, or to know for sure that this is where the back is and here is the shoulder. Like I said, it was awe inspiring and I am entranced. I can’t get enough of it all.

I can’t wait to practice and improve my skills, to get to the point like my instructors who can place their hands on a woman’s belly and know right away what they are feeling. Our instructor likened it to learning how to read. Remember back in the beginning when you had to sound out each letter before your brain learned how to recognize a whole word at once? I’m having to think “What is this part? It’s rounded and hard, but does it move side to side? Is it a butt? Is it a head? And I totally wrong and it’s just a shoulder? If this is the head, that means the butt is over … here. Got it. Oh, NOW I can feel the back, it was there all along ….”

All-Mother, my hands are truly yours. These hands that heal, that will one day catch babies and that are currently learning how to feel life moving within the womb truly belong to you.