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.

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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.

“It’s Not Acceptable”: Midwives Address Health Disparities

This.

“It’s not acceptable that African American women, regardless of their educational and economic background, still have a four times greater chance of dying in the childbearing year than their white counterparts… It’s not acceptable that three to four times more Native American and African American babies die than their infant white counterparts.”

This is how the incredible Geradine Simkins opens this new film in MANA’s new I Am A Midwife series. I love this short film. None of these midwives are beating around the bush here. They give you the facts and make it clear just how serious of a problem racial inequality is for maternal and infant mortality. This film features some of the most brilliant CPMs today working on reproductive justice within a midwifery context including not only Geradine Simkins, but also Katsi Cook, Claudia Booker, Umm Salaamah Abdullah-Zaimah, Tamara Taitt, and Arizona’s own Marinah Farrell. I can’t even tell you how honored I am to be joining a community of midwives that includes these women. I feel like they and other midwives and birth professionals like them have been laying and continue to lay the groundwork and foundation that will allow these crucial changes to take place and transform maternity care as we know it in this country.

To that end, I leave you with this quote by Tamara Taitt:

“I feel like health disparities is really the battle ground on which midwifery will be proven to be the gold standard.”

 

Once Upon a Time in Western Washington

Hello! It’s been a long time, nice to see you here again. I realize I haven’t posted since, well, I left Austin. There are a whole lot of reasons for not the least of which were adjusting to a new state/new midwife/new clients/etc. as well as healing emotionally for the reasons I left my preceptorship in Austin so abruptly. I’m working through it all and have several posts planned to touch on those subjects.

In the meantime, I thought I’d tell you a story. It is a story about a bizarre convergence of events, touching on mysterious Pagan ways and midwifery. It begins in the usual way, like so:

Once upon a time, a young baby dyke was growing up in the woods of a placed called western Washington. She made friends with a Very Tall Family. This Very Tall Family was so tall, in fact, that they did outlandish things like keep their microwave on top of the refrigerator where the shortish baby dyke could not reach without standing on a stool. The Very Tall Family loved to go backpacking, and the mother in this family talked frequently about how she used to go backpacking with her former best friend, Teddy. The baby dyke heard lots of stories about her escapades and adventures backpacking with Teddy and though she never met the woman, felt like she kind of knew her anyway.

Skip ahead a few years, and the baby dyke finds herself attending a women’s gathering called Longdance. The mother and daughter from the Very Tall Family go, and apparently Teddy used to go too. She learned all sorts of wonderful things, including songs like We Are Sisters On a JourneyShe thought these are purely Pagan chants and delighted in teaching them to her circle mates in her college Pagan/Wiccan Collective.

Fast-forward several years later when the baby dyke (not such a baby dyke anymore, btw) decides to become a midwife (called to be a midwife, really, in an undeniable way. But that’s a tale for another place and another time). She travels a great distance to a far away land called Maine to attend midwifery school. There, she learns about MANA and how it was formed, and also about a woman named Teddy Charvet who was instrumental in founding the Seattle Midwifery School and was the first president of MANA. And then she had an epiphany that this Teddy Charvet was the same Teddy Charvet who used to go hiking with the mother of the Very Tall Family all those years ago (who, btw, now goes by Therese and still loves being in the forest). And she found out that We Are Sisters on a Journey is not just a Pagan song, but a beloved song for MANA as well. In fact it was sung at the very first MANA gathering brought, I like to imagine, directly to MANA by Teddy herself from the bosom of the women’s Pagan circles that later formed Longdance.

And it is in this roundabout way that I feel like I have always, somehow, had a connection to the rebirthing of midwifery in the US and the creation of MANA, although I didn’t realize it until very recently. Curious, no? It does seem strange to me that I’ve seemed to narrowly avoid meeting this woman my entire life.

MANA! by Nicolle Littrell

Nicolle Littrell put together this charming film about MANA (Midwives Alliance of North America) filmed mostly at the MANA conference in 2008. She gets some great interviews with some of the most influential founding folks of MANA including Carol Leonard and Sister Angela Murdaugh. She talks with newer movers and shakers like Betty-Anne Daviss. She also gets some time with important non-midwives including Ricki Lake and Abby Epstein, Jennifer Block, and Barbara Katz Rothman. Littrell just barely scrapes the surface on ongoing MANA controversies such as the tension between CPMs and CNMs or the often swept under the rug issue of race and racism amongst homebirth midwives. Despite this, however, it is a well put together film and worth a viewing.

Littrell herself is pretty fabulous. She’s been spending her time filming homebirths here in Maine and documenting the thus far futile struggle for licensure in Maine. I met her because she came and filmed a birth I attended. Her short films featuring homebirths are very sweet and quite inspiring, if I do say so myself.