Repost: Maternal Health as a Human Right

K. Heron, of the student midwife blog Bloody Show, recently posted her marvelous graduation speech. It is a perfect example of the expanded vision of the new generation of midwives that are currently training and starting to practice. I apprenticed and went to midwifery school in from 1999-2002, and while I considered myself politically radical (though looking back I am sorry to say that this “radicalism” was heavily amalgamated with self-righteousness, white ignorance and entitlement, and brash naivete) I wasn’t able to bring midwifery together with what I was learning about the histories and actualities of racism and American imperialism. The curriculum at my school, Maternidad La Luz, didn’t emphasize this crucial articulation either, even though most of our clients stood in line (sometimes for hours) to cross the highly militarized geopolitical border between Juarez and El Paso, and there was a power differential of race and/or language as well as citizenship between the clients and the students, in most cases. Some of us talked about it, some of our more politicized teachers talked about it, but it wasn’t official. I haven’t been back to MLL since 2003, and I hope and am guessing that the conversation has shifted in a similar direction. It warms my heart to know that it definitely has at Birthwise. Kudos to Birthwise and to K for this lovely articulation.

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. 50^th 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.