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.