Owning the Shadow: White Patriarchal Culture in the Preceptor and Student Relationship

Midwifery, Midwifery students, Reflections on racism and oppression in midwifery

by Anonymous

I wish I were writing a happy fluffy blog about how great my apprenticeship was and how wonderfully supportive my preceptors were on my journey to becoming a midwife. Instead, I am writing this heavier piece. Hopefully it can shed some light on a problem and therefore help the movement along so that more people of color can more easily become midwives, and in turn serve populations who are currently not widely served by midwives of color, or the midwifery model of care. If we want to eliminate racial disparities in birth outcomes, we need more midwives of color, and culturally competent midwives in general.

I am a Chicana apprentice midwife. I recently worked at a birth center run by two white midwives, serving mostly white pregnant people. I am fairly accustomed to working in majority white spaces, and attending majority white institutions. I am comfortable in my skin and able to navigate many spaces, including majority white spaces. This navigation includes exiting those spaces when need be. I am grateful for the opportunity to attend births and apprentice with seasoned midwives. I mostly had great experiences and learned so much in my time there. And, with these preceptors, I also experienced a series of hierarchical and racialized interactions, which I call everyday racism. It is most often unconscious, rife with micro-aggressions, and subtle and overt displays of power-over. However unconscious, the role of everyday racism is to maintain the racial status quo. It eventually cost me the apprenticeship, and it cost me the opportunity. There will be other opportunities, but I point this out because this is something that people of color (POC) have to face again and again when we enter majority white spaces, with white supervisors, professors, and employers. What we face is to swallow the racist injustice and stay, or leave the opportunity, or to take-on the racism directly — all of which come with a cost to us personally and professionally.

I am writing this as an alternative to silence. While I chose not to address this on a personal level with my former preceptors, I write this to address a systemic problem that I see as pervasive in many institutions, of which midwifery institutions and birth centers are not immune. Upon reflecting on the problematic interactions with my preceptors, I decided it was going to be best for me to resign from my apprenticeship. Leaving was better than to stay working in the stress of those conditions. Leaving was definitely better than to stay and to take-on the massive unpacking of the everyday racism in their communications and behavior. It would have been a nasty job to unpack, and it could potentially have long lasting and far reaching negative impacts for me in the small community where we live. Unpacking racism with white women, especially ‘progressive’ midwives, is a massive job. It is painful, unrecognized, and unpaid work, and it’s a job that I will not volunteer myself to do this with these women. It is sad, but true. I reserve the right to not put myself through this kind detrimental action, because let’s be honest, however gentle you may be in your communication, how many people are actually thankful when you point out their participation in white supremacy and patriarchal culture? These people are rare. And if the person is your instructor, employer, or any person in a position with power to compromise your grades, employment, or apprenticeship, then the stakes are high.

Everyday racism is an issue which must be addressed in the wider community of midwives. I have witnessed everyday racism before and know it well. Most people of color know it well and have experienced it. We have experienced everyday racism in schools, university, at our places of employment, in hospitals, on the street, in our interactions with police, in our government, in businesses in which we are patrons, and in birth centers with midwives. As people of color in these situations where our livelihood or our very lives are at stake, our confidence becomes viewed as arrogance, disrespect, or worse, is viewed as a threat. Most of us have learned when we may need to dampen that confidence for appearances, to be “humble,” speak in whitewashed tones, keep our heads still, our faces without too much expression, and apologize when we have nothing for which to apologize. Most of us have played the game at some point or another. But where has that gotten us? It may temporarily save a grade, a job, but what life is that? I suppose it depends on what is at stake.

I know that my experience is not an isolated event in midwifery culture because of the mostly white landscape of midwives, and the smaller percentage of midwives of color in the U.S. I know from speaking to other students and midwives of color that they have had similar experiences. Until we commit ourselves to unlearn the lifetime of learning racism, then we are doomed to repeat and reproduce it. Unless these uncomfortable conversations are being had, and the inquiry, study, and practice to unlearn racism is in place, then we can be assured that the structures of patriarchy and white supremacy are being replicated. We all have implicit bias, and it is past time we get to know these unconscious biases really well. This is our work. It is your work. It is my work. It is our work together.

I am glad to see that this years 2017 MANA-CAM conference, “Collaborate,” is addressing some of these issues. Among other very important workshops, there are break out sessions entitled: “Whiteness and Racism in Birth in the US,” and “How to Use a Racial Equity Toolkit for Decision making in a Predominantly White Organization.” There are sessions centering women of color: “Indigenous Gathering: Ancestral Knowledge Keepers,” “We are the Gardeners, Leadership Training,” “Black Women Birthing Justice,” “Reclaiming Indigenous Midwifery: Stories of Honoring Ancestral Knowledge, Resisting Medical Colonization and Returning Birth to Native American Communities,” “The Giving Voice to Mothers Study: Communities of Color Speak of Disrespect and Inequity in Access to Birth Options,” “Centering Collaboration to Improve Equitable Birth Outcomes,” and “Birth Justice 101.” This is a wonderful line up of workshops and it makes me hopeful of real change.

The topic of racial equity in midwifery is vitally important, especially as it pertains to women of color working unpaid apprenticeships for white preceptors. This dynamic is fertile ground for historical trauma, and current racial patterns to be repeated and reproduced. That being said, it could also be a great opportunity for ever growing awareness, education, creating and sustaining equitable structures and relationships. Midwives need to be having trainings and making policy to address racial equity in midwifery culture and midwifery institutions. However, until this culture changes, for my following apprenticeships, I will be seeking out midwives of color for preceptors, and consider white preceptors only when they have truly made racial equity explicit in the student/preceptor relationship, and in their midwifery practices.

The following demographics matter because they illustrate the landscape of the midwifery field in which apprentices of color are entering. While the statistics I found do not wholly represent the midwifery workforce, they do offer a general picture of the racial make up of midwives in the United States. The department of Education released demographics in Race & Ethnicity by Degrees Awarded in Nurse Midwife for 2015. Here is the breakdown: White 250 (76.7%); Black 21 (6.4%); Unknown 19 (5.8%); Hispanic 18 (5.5%); Multiracial 8 (2.5%); Asian 7 (2.1%); Hawaiian 2 (0.6%); Native 1 (0.3%). While this is the racial demographics of Nurse Midwives for 2015, it offers a general picture of the racial make up of midwives in the U.S. We also have demographics from NARM. While it is not comprehensive, because only 33% of the CPM’s sampled, (that is 706 of 2,106 CPMs) completed the survey, it is still informative. From the 2016 NARM Job Analysis Survey Comprehensive Report:

Question #26: What is your ethnic background:

614 of the 706 respondents (approximately 87%) identified themselves as white or Caucasian. Of the remaining 13%, 31 respondents identified themselves as multi- ethnic, 18 respondents identified themselves as Hispanic and/or Latino, 9 respondents identified themselves as Black/African American, and 5 respondents identified as American Indian, Alaskan Native, or Hawaiian. This was an optional question, so 18 respondents declined to identify their ethnicity.

I bring the issue of everyday racism in midwifery forward because it needs to be brought into the light, understood, and dismantled. Everyday racism is not as easy for white people to see as compared to the more obscene racism, which many consider to be ‘real racism,’ or the real threat. Racism is often seen as ‘out there,’ not right here in our very own unconscious thoughts and actions. Everyday racism is often more subtle. There must be dialogue, but even more importantly, there must be a commitment by white midwives to reflect upon implicit biases and educate themselves, otherwise these dynamics will continue to unconsciously persist. If we are to have more midwives of color, if we care to serve pregnant people of color with cultural competence, and ultimately to effectively address the problems of racial disparities in birth outcomes, then the dynamics of everyday racism of preceptor to apprentice in midwifery culture must cease to exist.

Following are some examples of the how these dynamics have seeped into and are embedded in midwifery culture of today. The dynamic is present in the hierarchical culture between preceptors and students of any color. It is present in the bullying that is pervasive. It is present in micro-aggressions towards student of color. Often there are unspoken expectations of apprentices, which can change on the whim of preceptors. It is present in the replication of the racial status quo and historical tropes which are repeated. It is present in the centering, and directing of the narrative that some white midwives do when there is disagreement or conflict with a student of color. It is present in the white centering, or derailing of conversations about race. It is present when problematic behavior is called out in writing or in conversation and is met with claims of being “attacked.” (For example, this essay could be construed as an “attack” on white midwives.) It is present in the displays of power that preceptors hold over students if they should want to keep their apprenticeships. It is present in the implicit bias that is not acknowledged, and actively denied. It is present in the projection that racism is a problem of people of color, and not a problem of white people. That’s a radical idea: racism is a problem of white people.

There have been research papers and discussion of bullying in midwifery culture, (See the work of Marivette Torres and Marina Valenzuela Farrell). I understand that white student midwives also experience patriarchal hierarchies with their preceptors. To make a distinction, what makes these interactions racialized is the white history and current day of whites oppressing people of color. While white students and students of color both face the bullying and hierarchal structures of patriarchy, students of color are also confronted with the racial hierarchic structures of white supremacy. White people can no more easily extricate themselves than people of color can from the history and current day structures of patriarchy and racism. Just because one does not see their participation in actively reproducing these structures, it doesn’t mean they are not participating, or responsible. Without the tools and implementation of oppression, there is no oppression.

I’m exhausted by the conversation always being about how POC are wronged. We know. And if you’ve been paying attention, you know too. As Erna Stubble puts it, “Even when the history of POC is told, white violence is erased, and the consequences of historical injustices is minimized. White people do not connect themselves to [the present, or] history.” I’m ready to move on to the next phase of the conversation which centers and addresses the wrong doing, the wrong doers, and the silence — let us address the deafening silence. Part of this silence is because, as I mention above, many white people do not see oppression as their problem, and so they are not invested to learn how they contribute. While white supremacy is prevalent, it is pushed so deeply into the collective shadow. It is disgusting, and yet, as Robin DiAngelo says, we are ALL swimming in its waters. While some are burdened by it, others unconsciously benefit from it, and so they are not as inclined to do anything to change it, nor do they see their silence and inaction as collusion. If we do not take responsibility and actively practice racial equity, then we most assuredly are replicating unequal structures. Let that sink in. Midwives do not consciously choose this, so let’s not unconsciously choose it.

Maternal mortality rates in the United States have been on the rise. Do we blame the mothers? Not unless they are Black or brown, (see Ina May Gaskin). When we have the dire situation where Black mothers are dying from pregnancy related causes in rates of up to 4 times more, (and in some places 12 times more), than that of their white counterparts, and regardless of income or education, the problem is not because of Black women and Black people. When Black babies die at rate of 2-4 times higher than that of white babies, the problem is not because of Black people. So where does this devastating problem arise from? There are so many layers of this crisis, and they all have roots in the devastating effects of white supremacy.

NARM and some midwifery schools acknowledge the problematic dynamics when Westerners, and more specifically when white students go to Black and brown countries to study midwifery. In the same way, so must we acknowledge the problematic dynamics that can, and do arise when Black and brown American students work apprenticeships for white midwives. Even though we are all Americans, the legacy of colonialism, and the inherent hierarchies are residual and present in these relationships today. Let us make this dynamic explicit so that we may address the problems with honesty, transparency, and policy. The midwifery schools and organizations that oversee students and preceptors can make policy to address this issue, advocate for students, and ensure racial equity and access to midwifery education, and apprenticeship.

Midwifery is about women being with women, it’s about midwives helping pregnant people and their families. If there is any group of people that has the capability to actively address this issue, I hope it would be Midwives. To eliminate racial disparities in birth outcomes, we need more midwives of color, and we need culturally competent midwives in general. We need the path to becoming midwives to be accessible for all women, and without racial obstacles. Importantly, white midwives need to become conscious of their positions in white supremacy, to commit to not participating unconsciously, and to consciously take this on as their individual and collective work. We have to fully own all of the layers of this problem to get out of this dire crisis.

Racial Disparities Persist

Healthcare in the US, Reflections on racism and oppression in midwifery

Despite the national Healthy People objectives established every ten years for the last three decades by the Office of Disease Prevention and Health Promotion, maternal and infant health indicators in this country continue to demonstrate a significant need for improvement, particularly among racial and ethnic minorities (Mathews & MacDorman, 2006).  In their call to action to the public health profession, Garcia and Sharif (2015) commented that “the health consequences of living in a racially stratified society are illustrated by a myriad of health outcomes that systematically occur along racial lines, such as disproportionately higher rates of infant mortality” (p. e28).

Two areas of concern, in particular, have been identified as leading health indicators with regard to maternal and infant health in the US: all infant deaths and total preterm live births.  These two health indicators, in addition to many others, provide clear examples of the health disparities faced by people of color in the US.  The rate of infant deaths (within the first year of life) is more than doubled for black or African American babies when compared to white infants (10.8 per 1,000 vs 5.1 per 1,000 in 2013).  Infants of persons identified as American Indian or Alaska Native are also disproportionately affected (7.6 deaths/1,000 live births in 2013) (Mathews & MacDorman, 2006).  While overall infant deaths have been decreasing, the health care disparities outlined above have persisted since at least 2006, the earliest year analysis by race/ethnicity is provided publicly by HealthyPeople.gov.  Preterm birth rates (before 37 completed weeks gestation) are also consistently found to be higher for mothers who are black or African American (16.0%), American Indian or Alaska Native (13.1%), and Hispanic or Latina (11.3%) when compared to white mothers (10.5%) in the US  (data from 2013).  While the causes of health care disparities and inequities are multifactorial, racial disparities are a well-documented factor.

NOTE: The phrase ‘maternal and infant health’ is used above due to its widespread use and recognition in public health literature.  The use of this phrase is not intended to exclude or ignore the health issues faced by transgender and genderqueer persons who may not identify as mothers.

References:

García, J., & Sharif, M. Z. (2015). Black Lives Matter: A commentary on racism and public health. American Journal of Public Health, 105(8), e27-e30. doi://10.2105/AJPH.2015.302706

Mathews T. J., & MacDorman M. F. (2010). Infant mortality statistics from the 2006 period linked birth/infant death data set. National Vital Statistics Report, 58:17, 1-31. Hyattsville, MD: National Center for Health Statistics. Available from: https://www.researchgate.net/publication/46146499_Infant_mortality_statistics_from_the_2006_period_linked_birthinfant_death_data_set .

If All Lives Really Mattered

black lives matter, Healthcare in the US, Midwifery, Reflections on racism and oppression in midwifery

The main strand of the alternative birth movement in the US which has been lead primarily by white, middle class women since the 1970s often conceptualizes their work as a pursuit of liberty and happiness.  Publications and participants characterize the movement as ensuring a woman’s right to an empowering pregnancy and birth experience.  The concepts of one’s rights are inexorably tied to notions of liberty, but much like the historical roots of freedom (and lack thereof based on race and gender) in our country, rights have been granted by the powerful only to those deemed fully human and deserving of happiness.  Happiness and rights are permitted by the systems of power currently in place only in forms still confined within the status quo.

Oparah and Bonaparte (2016) point out the ways in which the birthing consumer’s right to empowerment narrative has emerged and succeeded in public discourse precisely because it doesn’t challenge the deeper social and economic forces at work which serve to subjugate and ignore the most vulnerable pregnant people (15).  Indeed they argue that “legislators opposed to feminism…and to left-wing countercultural tendencies have found it possible to support the consumer right of (white, middle-class) mothers to ‘purchase’ the birth experience they desire”  (14).   

Empowerment is presumed by many in the modern white, middle class midwifery movement to be a desirable goal leading to happiness and therefore to be pursued in the name of all women.  The tendency in the second-wave feminist movement to claim to speak for all women while not taking “black women’s concerns seriously” (13) has emerged throughout the movement for reproductive rights.  In 2003, the Feminist Majority Foundation and others agreed to change the name of the protest march they were planning in response to criticisms from diverse stakeholders that the movement needs to broaden its perspectives and goals.  Black women and others on the margins, it was argued, are not available to simply protest for their right to safe abortion.  Instead, the diverse organizations courted wanted recognition that they are literally fighting for women’s lives.  As a result of the broad coalition formed, the March for Women’s Lives (2004) was one of the largest protests of all time in Washington, DC.  I see this example as illustrative of the ways in which the birth justice movement is more about life than about liberty and happiness.  Interestingly, life is the banner taken up by the inspiring present day grassroots movement Black Lives Matter.  Of course this second Civil Rights movement is also about liberty and happiness (in the form of dignity and respect), but who has time to espouse liberty when you and your loved ones are so busy fighting for your lives.    

An ignorant response to the Black Lives Matter movement has been “#alllivesmatter.”  If “all lives matter”ed as much as the lives of white wealthy people, particularly men, then the health care disparities in the US based on race could not possibly exist to the extent that they do.  Reforms to the US healthcare system have consistently benefited racial and ethnic minorities less than their white counterparts and this trend continues today.  US statistics on maternal and infant mortality and morbidity demonstrate that babies and women, especially black and brown babies and women, do not fare nearly as well as whites.  While the US healthcare system is in many ways failing women and infants in general when compared to other developed countries, women and babies of color are dying at alarmingly higher rates than white women and babies.  The statistics on which my above claims rest have been around since the previous century.  Despite awareness of health care disparities and social determinants of health in some sectors of the US health care non-system, meaningful changes that affect peoples’ lives on the ground have been slow to develop.  

So what do we do with this information?  Where do we go from here?  Visit our blog post titled Plugging Into this Important Work

Reference:

Oparah, J. C., & Bonaparte, A. D. (Eds.). (2015). Birthing Justice: Black Women, Pregnancy, and Childbirth. Routledge.

http://www.blackwomenbirthingjustice.org

Attempting to Measure Diversity and Inclusion

Reflections on racism and oppression in midwifery

The term “diversity” is widely used in health care literature.  The term “representative workforce” has more positive connotations than “diversity” as a condition towards which professions are striving as opposed to something white people are trying to do for or give to people of color.  The term diversity can be seen as problematic because it can connote diversity as a gift that white people and institutions aim to give to people of color.  Diversifying one’s profession, for example, allows whites to receive praise for their generosity and their role as actors in diversification.

What do you think about the term diversity?

Whether we like the term or not, it is commonly used.  Diversity, at its best, cannot be achieved or sustained without inclusion.

What do you think about the term inclusion?

Considering these terms are likely here to stay for awhile, what do you think about the idea of trying to measure diversity and inclusion?

Provided below is a list of institutions that have nurse-midwifery programs and have been granted the only national award recognizing institutions for their outstanding campus-wide diversity and inclusion efforts at the college and university level.  This recognition, titled the Higher Education Excellence in Diversity (HEED) Award, is announced annually in INSIGHT Into Diversity magazine, the largest and oldest diversity publication in higher education.  The HEED award “measures an institution’s level of achievement and intensity of commitment in regard to broadening diversity and inclusion on campus through initiatives, programs, and outreach; student recruitment, retention, and completion; and hiring practices for faculty and staff” (Insight into Diversity, 2016).  The 2016 HEED award was just recently conferred on the following institutions that have nurse-midwifery programs:

  • The Ohio State University, College of Nursing
  • Stony Brook University School of Nursing
  • SUNY Downstate Medical Center
  • University of California San Francisco
  • University of Cincinnati College of Nursing
  • University of Minnesota School of Nursing
  • University of New Mexico College of Nursing
  • University of Pennsylvania School of Nursing (Insight into Diversity, 2016).

Insight into Diversity. (2016). About the HEED award. Retrieved from http://www.insightintodiversity.com/about-the-heed-award/

Implicit Bias

Reflections on racism and oppression in midwifery

Implicit bias when unacknowledged by health care providers has the ability to manifest as contempt for the otherness they will necessarily encounter in many of their patients (Bridges, 2014).  In Reproducing Race: An Ethnography of Pregnancy as a Site of Racialization, Khiara Bridges (2014) wrote:   

When we understand that culture can be used to signify fundamental, insurmountable, difference (i.e., radical Otherness), then the cultural stereotypes and assumptions about the way people from/within certain cultures ‘just are’ may produce the same effects produced by racial discrimination. (p. 135)

Unexamined implicit bias can morph the racial stereotypes in which we have all been immersed our entire lives into cultural stereotypes which are more acceptable to utter at present.  Chapman et al. (2013) examined the phenomenon of implicit bias and found that “research suggests that implicit bias may contribute to health care disparities by shaping physician behavior and producing differences in medical treatment along the lines of race, ethnicity, gender or other characteristics” (p. 1504).  These authors not only provide evidence of the existence of implicit bias among physicians but they also highlight studies that demonstrate implicit bias in clinical decision-making (Chapman et al., 2013).  

Have you encountered implicit bias as a client or patient?

If you are a white midwife, what have you done to learn more about your own implicit biases?

References:

Bridges, K. (2011). Reproducing race: An ethnography of pregnancy as a site of racialization. Oakland, CA: Univ of California Press.

 

Chapman, E. N., Kaatz, A., & Carnes, M. (2013). Physicians and implicit bias: How doctors may unwittingly perpetuate health care disparities. Journal of General Internal Medicine, 28(11), 1504-1510. doi:10.1007/s11606-013-2441-1

Revised: Plugging into this important work

Midwifery, Reflections on racism and oppression in midwifery

To find out more about how to get connected to this important, ongoing work, visit the following sites describing more active initiatives, committees and task forces:

AROMidwifery Facebook page

Equity in Midwifery Education for educators, administrators, staff, and students

National Association of Birth Centers & Clinics of Color Facebook page (NABCC)

Social Justice and Birth by NACPM (National Association of Certified Professional Midwives)

ACNM’s Diversification and Inclusion Initiative (American College of Nurse-Midwives)

Black Mamas Matter: A Toolkit for Advancing the Human Right to Safe and Respectful Maternal Healthcare

The National Association to Advance Black Birth (NAABB) formerly known as International Center for Traditional Childbearing (ICTC)

Changing Woman Initiative Native American-centered women’s health collective

National Latina Institute for Reproductive Health

An Open Letter to the MEAC Board of Directors

Midwifery, Midwifery students, Reflections on racism and oppression in midwifery

The National College of Midwifery is encouraging preceptors and alumni to write letters to the MEAC board of directors using the following language:I am writing to voice my strong opposition to your proposed ban on all out of country clinicals for MEAC students.” Their suggested letter template is not only inaccurate in calling this a proposed “ban,” but this act by NCM is also divisive and fails to acknowledge the careful process that has led to MEAC’s proposed moratorium.

The suggested statement is divisive in that it forces an unneeded dichotomy of extremes. One “camp” decries all out-of-country service learning activities as unethical and the other “camp” assumes that these activities are mutually beneficial for students and the communities they serve.

We are arguing for a third “camp”, one in which MEAC, MEAC schools and other stakeholders including potential host countries/ sites, approach this complex issue with open minds and hearts, and agree to thoroughly explore the concept of culturally competent and ethical care in the context of service learning, whether here in the US, abroad, or both.

We commend MEAC for recognizing the complexity and multi-layered nature of the problem:

“It is clear from the evidence presented by the workgroup that, due to language and cultural barriers, disparities of power, wealth, and privilege, and the difficulties of obtaining informed consent when students are practicing upon a vulnerable or disadvantaged population, many out-of-country clinical placements for student midwives have caused significant harm to the mothers and babies being cared for, to host communities, and to the students themselves. The MEAC Board is deeply concerned about the possibility of students from our member schools perpetuating or being involved in ethical violations, abuses, and exploitation in pursuit of their clinical education.”

We look forward to a creative and collaborative exploration of these complex issues while ensuring that we are not currently engaging in potentially harmful activities. The moratorium proposed by MEAC affords our profession this opportunity. We applaud the MEAC leadership for this bold and appropriate action.

  1. Kathryn Haines, LM, CPM
  2. The Rev. Patricia Ross, OSL, CPM
  3. Marijke van Roojen, LM, CPM
  4. Makeda Kamara, CNM, MPH, M.Ed
  5. Erin Ryan, LM, CPM
  6. Claudia Booker, LM, CPM-PEP process
  7. Wendy Gordon, LM, CPM, MPH
  8. Krystel Viehmann, LM, CPM
  9. Jaqxun Darlin, student midwife
  10. Laura Marina Perez, CPM, LM
  11. Shauntée Henry
  12. Silke Akerson, CPM, LDM
  13. Audrey Levine, LM, CPM
  14. Anne Hirsch, LM, CPM
  15. Kelly Milligan, CPM
  16. Amy Rae Zimmerman
  17. Maria Teresa Noth
  18. Dionne Corcoran, CPM, LM
  19. Annie Moffat
  20. Meg Novak, CPM
  21. Brooke Casey, LM, CPM, IBCLC
  22. Jennie Joseph, LM
  23. Rachel Zazlow
  24. Brenda Burke, CPM, MSW, RN
  25. Grace Hannon, CPM, LM
  26. AnnMarie RianWanzeck, LM/CPM
  27. Kayla Quinlan Frawley, LM, CPM
  28. Cheryl Clearwater, LM
  29. Tiffany Shank, student midwife
  30. Angelique Chelton
  31. Connie Wakaluk, student midwife
  32. Lorrie Leigh, RN
  33. Joelle Ceremy, LM
  34. Nicole Morales, LM CPM
  35. Neva Gerke
  36. Rachael Cook
  37. Helena Wu
  38. Racha Tahani Lawler, LM
  39. Janine Stiles, CPM
  40. Angelita Nixon, APRN, CNM
  41. Jeanette McCulloch, IBCLC
  42. Susan Smartt Cook, CPM
  43. Holly Arends Murphy, CPM
  44. Mary Helen Ayres, CPM
  45. Donna Mitchell, CPM, CLC
  46. Angela Miller, LM
  47. Amy Jo Rist, CPM, LDM, LM
  48. Treesa McLean, LM
  49. Katherine Bramhall, CPM
  50. Michele James-Parham, Traditional Midwife
  51. Kristin Kali, LM, CPM

An Open Letter from Vicki Penwell

Reflections on racism and oppression in midwifery

An Open Letter: Mercy In Action’s commitment to stand against

oppression and racism within midwifery in developing countries

By Vicki Penwell, LM, CPM, Masters in Midwifery, Masters in Inter-Cultural Studies

Mercy In Action, the non-government organization (NGO) providing maternity care in the Philippines that I founded, has sought to be a leader in the provision of ethical, respectful, and evidence-based maternity care.  Open access services are provided to all who come to our door. We seek to provide up-to-date care specific to the developing country we are in, according to World Health Organization (WHO) protocols and the International MotherBaby Childbirth Initiative (IMBCI) standards, while actively removing barriers to care.  These barriers include addressing cost by having no user fees, addressing distance by building maternity waiting homes, and addressing race and culture by opening our hearts fully to be deliberate about seeking to be culturally competent and relevant in all we do.

Like so many, I am outraged at the unethical practices that go on in birthing sites around the world, including the recent charges against Midwife International, but I am not apologetic for the work of Mercy In Action in the Philippines.  And I cannot feel bad because the color of my own skin does not match the color of the skin of the women our birth center serves; because that is something I cannot change. The skin of our staff does match the color of the women having babies… which of course may be important to the individual woman giving birth, but I believe the heart matters, too. My own grandmother felt very fortunate to have a wonderful midwife assist her home birth in the Ozark Mountains in the 1920’s… a Black midwife helping a White woman.

As the founder and director of Mercy In Action, I give full disclosure that I am a White midwife working and living full time in the Philippines, with a staff and advisors that are multi-national–Asian, African-American/Asian, Hispanic, and White. My family came to the Philippines in 1991 because we were invited by Filipinos to help be a solution to the high maternal and infant mortality rate in this country. We went to the poorest (people living in graveyards, slums, garbage dumps and resettlement camps) and have served among them for the past 22 years. We have not always done everything right, but we are deliberate in our attempts to be evidence-based and culturally appropriate, and the mortality rate for newborns within the walls of Mercy In Action’s clinics has been 4 times lower than the country we are in, the maternal mortality rate is 8 times lower. According to a survey we conducted asking why they come, they say because we are kind.

In Mercy In Action, we work as a team, each with strengths and abilities and cultural understandings complimentary to each other and helpful to women in crisis. We have been able to create a safe, well-stocked and beautiful first class birth center where women feel privileged to give birth.  We train and give scholarships to local indigenous women in midwifery, and update skills for local health professionals. Foreign visitors only assist the indigenous midwives; foreigners never give primary care. How we conduct ourselves is all explained on our website.

Because of the responsibility we felt after being chosen for a chapter in Robbie Davis-Floyd’s book Birth Models That Work, we have tried to be generous with our advice to those who have asked over the years. So when Sarah Kraft of Midwife International wrote to me earlier this year, asking me to be an advisor for a new organization that was going to work in developing countries, I said yes.

I apologize for inadvertently being a part of anything that wounded another human being. I admit it was unwise to allow my name to be put on any organization’s website when I knew nothing at all about them. Nor did I ever at any time have any power at all as far as decision-making or policy. In fact, I have never met Sarah Kraft, and I never attended any advisory board meetings before resigning (Sarah tried to get me into a proposed board meeting on conference call, but only one other person came on the call.)

I wrote one long letter of advice to Midwife International, which they did not take, asking them to use the International MotherBaby Childbirth Initiative as a guide to keep them respectful and medically safe, and then I got busy and did not pay any attention to this organization… until September 2nd when a friend wrote me about the campaign against Midwife International, and asked if I knew my name was associated.

I have wished a thousand times in the last few days that when asked to give advice to Midwife International, I had said yes to giving advice but no to being put on their advisory board. You see, I cannot apologize for offering to give them advice, because I have so often complained loudly about unethical practices I see happening surrounding birth, so I feel it is only right to be generous and share my hard-earned experience when asked. But as I was way too busy to research or find out anything about them, I should have never said yes to being an advisor on an actual advisory board, a role I indeed never even served in.

Here is what I am doing now:

1. I have already contacted Sarah Kraft in private emails asking her to refund all students who ask, and pay the sites what is owed. She has not answered. I have written to the other former advisory board members to ask them to contact her also.

2. If Midwife International refuses to refund Shauntée Henry, I will personally donate to a fund to help her recoup her losses, and gladly offer her an alternate intern position free of tuition fees at our birth center, if she should so desire.

3. I will also offer to mail a box of medical supplies to any clinics affected by loss because of the actions of Midwife International. I have supplies to share from our clinic here because God has been so generous to us and just this week we received a large box of gloves and syringes and baby hats.

Finally, I want to acknowledge and thank the brave and wise Women of Colors who have been my mentors and counselors these past few years as I found my way to a place where I realized I could work to affect change in the shameful disparities in American birth outcomes, even as I lived and worked as an expatriate in Asia, namely Michele Peixinho, Claudia Booker, and Jennie Joseph. Thank you for being my friends and speaking truth to me. You have all helped me have endless “aha” moments and encouraged me greatly as we launched the Mercy In Action scholarships and the Scholarship Solution and Grand Challenge.

Humbly,

Vicki Penwell

An Open Letter from Makeda Kamara to Midwife International and the Midwifery/ Birth Communnity

Reflections on racism and oppression in midwifery

An important statement from Makeda Kamara, midwife, and signed in solidarity by over 20 midwives of colors, regarding the actions of Midwife International, their advisory board members/ staff/ preceptors, and the broader midwifery community and leadership.

http://ethicalmidwifery.org/open-letter-from-makeda-kamara/

Please feel free to add your points of solidarity, learning and/or appreciation in the comments section below.

Letter to Midwifery Today: Real talk about midwifery and racial oppression

Midwifery, Midwifery students, Reflections on racism and oppression in midwifery, Social Justice
This letter was collaboratively drafted in response to an article posted in Midwifery Today’s E-News on February 13, 2013, comparing the current-day US obstetrical care with chattel slavery and the midwifery movement with the 19th century US abolition movement. Although the piece was removed and the author apologized in a thread on Midwifery Today’s Facebook site, this letter hopes to use this incident to initiate a deep discussion about US midwifery and our history of racial oppression, which is very much alive in the present. The letter has been sent, but we welcome additional signatures here; we will update the list from the comments section at the end of each day. We also welcome criticism and dissenting views from readers interested in deepening the discussion. The original text of the article, as well as the author’s apology, are appended here below the signatures.
 
 

February 21, 2013

Dear Jan & the team at Midwifery Today:

We would like to start by expressing our appreciation for your efforts to educate midwives over the last 26+ years through your books, magazine and conferences.  Midwifery Today provides an important service to midwives all over the world, and your reach is broad.  It is for this reason that we are writing regarding the February 13, 2013 “Jan’s Corner” piece in your online E-News, formerly entitled “Childbirth Abolitionists” then retitled “Childbirth Freedom Fighters,” which drew a comparison between the contemporary midwifery movement and the movement for the abolition of slavery in the United States.

After many comments from readers on the Midwifery Today Facebook page, this article was at first slightly edited, and has now been removed. Jan, you also apologized in a thread on Facebook. We applaud the removal of the article and appreciate your apology. But we are asking you to do more. You write that you regret your words, and we can all relate to that; we have all said and done things that we wish we could take back. And the intent of this letter is not to make you feel ashamed. Rather, it is to use this incident as an opportunity to open what we hope will be a deep and ongoing discussion about a very serious problem.

The publication of this article highlighted the failure of the US midwifery profession’s leadership to integrate its advocacy for humanized birth with concern for the crisis in maternal and infant health in communities of color, especially African American communities, and to understand this crisis as the legacy of enslavement and racial oppression and violence. While the article is gone from the Midwifery Today site, the discussion it has engendered is too important to disappear without a trace. It is important to us that your readers understand why the comparison between the anti-slavery struggle and the midwifery movement is wrong and profoundly hurtful. Even more than this, however, we hope to show that the struggle to provide a full range of birthing options must address our history of racial oppression if we really want to change birth in this country.

We can all agree that in many areas across the United States, there is an egregious abuse of power in hospitals; laboring women (and women in general) are oppressed; there is a lack of informed choice for the interventions that are being used; and midwives are putting themselves at risk of hostility, large fines, and even criminal prosecution and jail time for making sure that mothers and families have evidence-based, safe, holistic and informed choices about how they bring their babies into the world.  The devotion and personal sacrifice of midwives has changed the lives of many women and families.

The work we do as midwives and birth workers needs no comparison to other struggles to be validated. But it should never be compared to the abolition of the horrors of enslavement.  There can be no comparison between the meanings of “freedom” and “choices” between these two contexts.  People from Africa were forcibly kidnapped, removed from their homes and families, transported across the ocean in the bottom of cargo ships where many of them died, then sold as property to white landowners who beat and whipped them to maintain control over them. Enslaved women were beaten and raped as part of everyday life; some were subjected to experimental surgeries on their reproductive organs with unsterilized instruments and no anesthesia. If they did manage to make it to the end of their pregnancies, their babies were often taken from them and sold to someone else. This short catalog of horrors does not even begin to scratch the surface, but it should help to illustrate why current birth care practices do not compare in their scale, violence, or power differentials to the atrocities of slavery or to the legacies left behind by such brutality.

When we talk about slavery, we cannot avoid bringing along the whole history of racial oppression, violence, and exploitation that came with it, whether we intend to or not.  The impact of slavery runs very, very deep in the families of those who were enslaved.  It is a massive wound that was inflicted over hundreds of years and several generations that continues to impact the health and well-being of African Americans today, even though the practice of what is referred to as the chattel enslavement of African people within the United States has ended. This enslavement was an atrocity carried out by white families over black families.  That is simply a historical fact.  It does not mean that any of us were personally complicit in what our ancestors may have done.  But it does mean that when we talk about slavery, we must realize the gravity of what we are about to say and how it may land with those who carry those deep generational wounds.

The same must be considered when we make references to the colonization of the U.S. and the brutal taking of lands from the Native Americans, Mexicans and First Nations peoples; the Holocaust; the Japanese internment camps; and so many other historical abuses of power by people of European ancestry.  To make analogies between these events of extreme violence and the very different modern-day struggle over birth choices honors neither.  Rather, it co-opts an ongoing intergenerational experience of trauma and oppression that does not allow people to heal.

Midwives have always been part of the fabric of communities. Native American peoples had midwives.  The European colonists brought their midwives.  African midwives were forcibly brought here along with other people who were enslaved.  Every population that voluntarily or involuntarily immigrated to this new “melting pot” had their midwives.  And the midwives provided excellent care to the women and families all of their communities, often extending far beyond the childbearing year.  They were our healers.

When the medical establishment took birth into the hospital in the first few decades of the 20th century, an emerging public health profession simultaneously sought to end the rich legacy of midwifery knowledge and expertise through the gradual elimination of these community midwives across the country.  The medical establishment succeeded in substantially reducing the number of community midwives in practice; those who remained continued to serve all women but were absorbed deeper into the fabric of their respective communities.  As your readers are well aware, some of us still remain underground to this very day.

As the 20th century continued and the occupation of medical obstetrics grew, those populations who had access to hospital care (middle- and upper-class white women, and later, women of various ethnic groups) began to embrace the move toward the “scientific” management of labor in hospitals and the promise of pain-free childbirth.  They were not shackled and dragged into the hospitals.

Today, we must be clear that the vast majority of women in the U.S. choose to birth in the hospital setting.  We are still in the early stages of our midwifery resurgence and many Midwifery Today readers are working tirelessly to improve access to midwifery and safe homebirth as we restore these options to our communities.  And to some extent, it’s working!  The rates of homebirth and midwifery care are increasing — but only for white women. This is meaningful and concerning, especially because there are decades of research that continue to show that women of color are being harmed and dying from maternity-related causes in far greater numbers than white women, and babies of color are sick and dying in far greater numbers than white babies.  Many of us share the belief that the midwifery model of care might make a difference in these gross disparities.  However, reducing disparities requires in part that all of us work to understand the full history of how this came to be and why it persists today.

In order to effectively do this, it is imperative for the midwives in leadership positions to be at the forefront of this education, as well as leading action to ensure that all mothers, all babies and all families have access to safe, family-centered, culturally-relevant care.  Our leaders are charged with inspiring midwives to keep fighting the good fight, but not at the expense of reopening the painful wounds of midwives and peoples of color.  Our leaders must actively and continuously examine their areas of privilege in this society — whether they be privileges of skin color, sexual orientation, citizenship, wealth/ class, religion, education, ability, age or gender identity — and it is vitally important that they do their work with a consciousness of the power that these privileges bestow.

It is incumbent upon our leaders to be aware of and to fully support those midwives of color who today are creating highly effective models of care that build upon their legacies of community-based midwifery and are essentially eliminating disparate rates of preterm birth and low birth weight.  In fact, this work represents what is perhaps the only valid comparison that might be made between the anti-slavery movement and the struggles of birth workers today: the resilience and creativity of people of color in fighting for the survival of their own communities.  Midwives and families of color have had to proceed on their own while the major midwifery organizations struggle to understand what is needed.

Midwives are putting themselves on the line in many areas of our country to address an egregious lack of access to safe care and choices for women and babies. But when we isolate the legal struggles of midwives from broader health injustices — such as outrageously disproportionate rates of unjustified interventions, increased surgical and infection rates, and deaths of women and babies of color, as well as growing lack of access to decent basic health care for working people of all colors — we drive a wedge into our own community that hurts us all.  There is an increasingly urgent need for a deep conversation about how midwifery is currently failing women of color.  Babies are dying, and mothers are being harmed.  At the same time, midwives of all colors are being persecuted.  We cannot afford to create further divides amongst ourselves or leave groups behind in any of this work.

Jan, you have a wide audience, which comes with large responsibilities. Many midwives and birth workers look to you and Midwifery Today as an important voice in this profession.  Because of that, we ask that you take the lead on furthering this crucial discussion. The removal of the article and the apology on Facebook were important first steps. We ask that you publish this letter in the pages of Midwifery Today’s print edition. We also ask that you publish your apology on the E-News site where the article was posted. We further ask that Midwifery Today devote an entire issue to the theme of racial disparities in birth outcomes, highlighting the highly effective ways that midwives of color are using midwifery models of care to heal their communities’ mothers and babies. Most importantly, we ask that this issue not stand alone, but initiate an ongoing effort to make the ways that social justice issues intersect with pregnancy and birth–such as racial disparities in health, disability, poverty, incarceration,  LGBTQ oppression and concerns, immigration, and homelessness–central themes of Midwifery Today publications and conferences.

For Midwifery Today to redress this incident publicly would show great courage, and would serve as a sorely-needed example for our professional organizations. This is a crucial opportunity for Midwifery Today to foster a substantial discussion in our profession about racism and other forms of oppression. And given the urgency of these issues, Midwifery Today’s willingness to be a venue for this difficult but necessary conversation could not be more timely.

We also invite you and your readership to join with us in our efforts to learn and to work together to end all forms of oppression in midwifery and the childbirth professions, by first reading the resources we have compiled on the AROM blog (aromidwifery.wordpress.com) and then joining us in our Facebook group:  Anti-Racism and Anti-Oppression in Midwifery.

Sincerely,

  1. Wendy Gordon, CPM, LM, MPH
  2. Annie Menzel, CPM MA PhC
  3. Jeanette McCulloch, IBCLC, RLC
  4. Jessica M. Roach
  5. Claudia Booker, Midwife, CPM
  6. Jennie Joseph
  7. Nechama Greenwood, CPM
  8. Lena Soo Hee Wood, MEd, CD, nursing/nurse-midwifery student
  9. Thérèse Greenhow Robinson, CMT, LST, CEIM, CD, BPC, BPCA LLI
  10. Neva Gerke
  11. Annie Kennedy, Director, Simkin Center for Allied Birth Vocations at Bastyr University
  12. Marijke van Roojen, LM, CPM
  13. Danelle Aurilio
  14. Elias Kass, ND, LM, CPM
  15. Monica Basile, PhD, CPM, CD(DONA), CCE(BWI)
  16. Audra Phillips, CPM
  17. Brooke Casey, LM, CPM, IBCLC
  18. Gretchen Spicer, CPM, LM
  19. Chloe Raum, CPM
  20. Meg Novak, midwifery student
  21. Amanda Heffernan RN IBCLC SNM
  22. Jennifer Linstad
  23. Dionne Corcoran CPM LM
  24. Racha Tahani Lawler, CPM, LM
  25. Emme Corbeil CPM, LM, CD(DONA)
  26. Kristin Kali, LM CPM
  27. Annie Moffat
  28. Megan Hill, CPM
  29. Beth Ebers , RM, MH, Squamish, British Columbia, Canada
  30. Rachel Zaslow on behalf of Mother Health International
  31. Olivia Kimball of Mother Health International
  32. Audrey Miles Cherney
  33. Grace Hannon LM CPM
  34. Danny Scar, The Prison Doula Project
  35. Aly Folin, CPM, LM
  36. Brynne Potter, CPM
  37. Autumn Vergo, CPM, NHCM, RN
  38. Janelle Lucido-Conate, Future Midwives Alliance
  39. Tracy Hydeman, SMW, Canada
  40. Muneera Fontaine, CD
  41. Michelle H. Kinne IBCLC RLC ICCE CD(DONA)
  42. Anne Hirsch, CPM, LM
  43. Kathryn Haines, CPM
  44. Joelle Ceremy LM
  45. Sarah Davis, LM, CPM, IBCLC
  46. Judith Goldberger RN
  47. Devorah Herman, CPM, sWHNP
  48. Makeda Kamara DEM, CNM, MPH, M. ED
  49. Marnie Cockrill, student midwife
  50. Marie Carnesciali
  51. Toni Hill, CD, CBE, student midwife
  52. Nikki Plaskett, CD, LLLIBPC, RYT, CNA
  53. Aimee Fairman, CPM
  54. Jaqxun Darlin, student midwife
  55. Nicole Morales, LM, CPM
  56. Tehmina Islam, CPM, LM
  57. Kristin Effland, LM, CPM
  58. Krystel Viehmann
  59. Eve German
  60. Erin Tenney
  61. Dana Churness
  62. Suzy Myers, LM, CPM, MPH
  63. Savita Jones
  64. Brenda Burke
  65. Emi Yamasaki McLaughlin
  66. Kirsten Pickard, RN-C, BSN
  67. Susan Smartt Cook, CPM
  68. Jess Kreuger
  69. Sharon Muza BS, CD(DONA), LCCE, FACCE
  70. Lora Hart, Student Midwife
  71. Melanie Parsons, LM
  72. Susan Hodges
  73. Rebeca Four, IBCLC, CD(DONA), LCCE
  74. Asteir Bey
  75. Lora Clem
  76. Sherry Payne SNM
  77. Ananda Phoenix, apprenticing with birth
  78. Alisha Wilkes RN, BSN, Student Midwife
  79. Elizabeth S.K. Reiner, CPM
  80. Gretchen Ryerson LMT, Doula, Student Midwife
  81. Stephanie Lynn Tanner, CHW
  82. Brenda Francis, LPN, SM, CCE
  83. Traci Palagi, LM CPM
  84. Laura Whitley
  85. Heather Chorley, LM
  86. Margy Porter, CPM, LDM
  87. Dr. LaVonne Moore, DNP, CNM
  88. Annique Sampson, CPM, LM, NHCM
  89. Lorie Seruntine, student midwife
  90. Audrey Levine, LM, CPM
  91. Lashaan Everett, RN, BSN, SNM
  92. Mary Lawlor
  93. Geradine Simkins, CNM, MSN
  94. Elia R. Cole, BA, MPH(c)
  95. Elezya Lane, Doula, Student Midwife
  96. Michelle Maisonville, CD(CBI)
  97. Arya Pretlow
  98. Nicole Deggins, CNM, MSN, MPH
  99. Laura Perez, Student Midwife

_____________________________________________________________________

Original article in Midwifery Today E-News February 13, 2013; Vol 15, Issue 4
Jan’s Corner

Childbirth Freedom Fighters
Did those of you who live in the U.S. see the PBS three-part series on the abolitionists? I hope you did or that you can get hold of it. As I watched, I realized how this anti-slavery movement parallels our movement to free women in pregnancy and birth from the jaws of the medical establishment. This plays out all around the world with some countries being worse than others. The treatment of motherbaby is often abusive—horrendously so. Perhaps nothing is as horrible as slavery and I don’t mean to downplay it in any way by this comparison, but the effects of pregnancy, birth and the first year of life affect both mother and child for their entire lives.
The abolitionists spent 40+ years working to free the slaves. First they appealed to the slaveholder’s reason—just like we are trying to do now with medical practitioners. For the past 37 years, ever since I first became a midwife, we have fought this fight. I first thought, “Okay, once they see how wonderful birth can be from the evidence coming out, they will change.” But this change hasn’t happened—things have only gotten worse. This was the same for the slaves. For us, when I first started midwifery, they hadn’t even invaded the uterus and the prenatal period. Prenatal care was simple and very good with no routine ultrasound(s).
The anti-slavery fight was magnificent, consistent, strong and dangerous—our fight is, too. More and more midwives are getting thrown in jail, persecuted and prosecuted, especially in the United States. We have so many voices and we are unrelenting in this activism. The slavery abolitionists had battles within their movement—we have these, too. Some of us want to be law-abiding and see the bottom-line as mom’s right to choose. It is, after all is said and done, her birth and her baby.
Then the Emancipation Proclamation by President Lincoln freed the slaves. The movie “Lincoln” is about his fight to make emancipation a constitutional amendment. He knew it wouldn’t hold if Congress didn’t change the Constitution. Even after 150 years, the battle for black equality is still going on. Martin Luther King took the freedom fight to another level, but peacefully. Were it not for these milestones in history, imagine where we would be.
We who work in birth are not even at the point of an Emancipation Proclamation, but we are in the abolitionist phase. We are Childbirth Freedom Fighters. Shall we take up this new terminology? It is powerful and has a huge successful movement behind it.
— Jan Tritten, mother of Midwifery Today


Apology in thread on MT Facebook page (2/18/13  1:42pm PST):
I was so passionate in writing about birth freedom and mothers being abused – an issue close to my heart – that I got carried away and didn’t use words and images as carefully as I should have. It was unwise on my part to make this comparison. My sincere apologies to all I have offended. I ask you to please forgive me. The article has been taken down and we at Midwifery Today have again been reminded to be more careful with the content we publish. -Jan Tritten

The article has now been removed from the E-News.