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

Birth Workers of Color Scholarship – Phase One

Reflections on racism and oppression in midwifery

BIRTH WORKERS OF COLOR SCHOLARSHIP

Matching scholars to scholarships to reduce disparities in birth outcomes

Dear Sisters and Brothers in Birth,

Last week, we posted an Open Letter to remind us all of “A Scholarship Solution and Grand Challenge” issued by Vicki Penwell of Mercy in Action for midwifery schools and programs to provide more scholarships to students of colors.

We birth workers know that racial and class disparities are killing our babies and harming our mothers; we know that part of the solution lies in quality midwifery and birth services care and we firmly believe in ‘a midwife for every pregnant person who wants one’, “a birth worker for every pregnant person who wants one”. We must come together to increase the numbers of students and practitioners of colors in all of the professions that can have a direct positive impact on the maternal and infant outcomes in this country. This includes doulas, childbirth educators, and breastfeeding educators and consultants. This Grand Challenge is for all!

The web site, http://wocmidwifescholarship.com/, has been launched and the sign-up sections for mentors, preceptors and programs are open!

This website will serve as the Clearinghouse and Resource Center for schools, programs and trainings for birth workers, focusing on those that offer scholarships for students of colors. Most of us do not know all of the schools, programs and trainings that exist, far less how many of these currently have such scholarships. So we are going to build that database, and then we are going to make it grow. We need your help!

We can have a great impact on increasing the number of scholarships for students of colors to attend schools, programs and trainings for birth workers. It calls upon all of us (students, birth workers, parents, midwives, school and program officials, reproductive justice activists, and folks who believe in what is right), working in a concerted, cohesive order together in teams to accomplish this. We will need five small teams for this first phase of the project.

Phase One – Building the Clearinghouse and Resource Center

We are completing “The Open Letter” to be emailed to all midwifery, doula, childbirth educator and breastfeeding counselor/ consultant/educator training programs. The letter will ask if the program has already designated a scholarship for students of colors (or a similar designation) and, if so, what are the parameters of the scholarship. If they do not already have such a scholarship, the letter will invite them to join The Grand Challenge.

Vicki has selected Jeanette McCulloch to manage and update The Grand Challenge web site. Jeanette has developed a master spreadsheet that will contain all of the information collected via web site and team member input. She will populate this master spreadsheet so that all of the data is consistent and add the information to the web site.

This is where we need your help. We are assembling five teams to collect information about every existing program that can be found on the internet that trains U.S. students in the birth worker professions. The first four teams will collect, using the spread sheet provided by Jeanette, the following information:

    • Name, address, phone number, web site, contact person, email address of the school, program or clinical site;
    • Name and contact information for the person in charge of financial aid or admission; and
    • If there is a scholarship listed on the web site for students of colors, briefly list key features of the scholarship

This information, and any other pertinent information will be submitted by team members, to Jeanette who will enter it into the master spread sheet for updating the web site.

The teams will be organized as follows:

Team #1 Midwifery Schools and Programs and Overseas Clinical Programs

Team #2 Doula Training Schools and Programs

Team #3 Childbirth Education Programs

Team #4 Breastfeeding Counselor/Consultant/Educator Programs

Those schools, programs, and trainings that have already established scholarships for students of colors will have their names added to The Grand Challenge web site. In addition, a badge, “We Support The Grand Challenge” will be made available for supporters to place on their web sites.

Team #5 The Open Letter Email:

Once this information is compiled and entered into the master spreadsheet, then this team will email The Open Letter to those schools, programs, and trainings that have not yet signed up for The Grand Challenge. The letter has instructions for completing The Grand Challenge form online. This letter will not be modified in any way – a consistent, clear message is our goal.

For the schools and programs who have submitted the form online, a follow-up telephone call will be made to get additional information such as: the required book and supplies list for students in the programs, and information on faculty of colors.

I am hoping that once again you will join us in accepting Vicki’s call to action and sign up for one of the teams. Please contact me by email at: TGrandChallenge@aol.com if you want to sign up for a team.

Who wants to be a Team Captain??? What students from which school or program want to take on a Team project? Since the first four teams (Midwifery, Doula, Childbirth, Breastfeeding Teams) are charged with compiling information mostly from the internet, I anticipate they could complete their tasks in less than 2 weeks.

Please let’s do The Work!

Claudia Booker, Midwife

Birth Workers of Color Scholarship

Reflections on racism and oppression in midwifery

Birth Workers Of Color Scholarship

In the Spring 2013 issue of Midwifery Today magazine, Vicki Penwell of Mercy in Action issued “A Scholarship Solution and Grand Challenge” to midwifery schools and the midwives in general and understood, perhaps for the first time, what was at stake. One of the main components of this call to action is for midwifery schools and programs to provide more scholarships to students of colors. But few schools and programs have actually instituted these scholarships and other programs that will facilitate students of colors in becoming midwives.

Sadly, nothing much has changed – women and babies from communities of colors continue to be disproportionately affected by poor outcomes. Likewise, an increase in the number of training opportunities for the practitioners best set to help and support them has not changed this year either.

Can we count on you and your institution or organization to be the change and join in actively supporting the Grand Challenge?

We birth workers know that racial and class disparities are killing our babies and harming our mothers; we know the solution lies in quality midwifery care and we firmly believe in ‘a midwife for every woman who wants one’. To that end we must come together to support the diversification of midwifery and we must increase our numbers of students and practitioners of color. But our goal is not limited to the practice of midwifery; we are committed to increasing the numbers of students and practitioners of colors in all of the professions that can have a direct positive impact on the maternal and infant outcomes in this country. This includes doulas, childbirth educators, and breastfeeding educators and consultants. This Grand Challenge is for all!

How can you actively support the Grand Challenge?

Our first focus is on increasing the number of scholarships for students of colors to attend schools, programs and trainings for birth workers. There is a dire need for more diverse practitioners who represent the communities of color and other marginalized communities. The current system is not working; for decades, America’s healthcare system has had no impact on reducing disparities in communities of colors and low income populations. Midwives and birth workers may be part of the answer, but we must reflect the communities we wish to serve.

Mercy in Action has had an informal scholarship program for years, but since issuing this Grand Challenge, Mercy in Action has awarded over a dozen scholarships to its various programs to midwifery students of colors! As Vicki has said “… now we want to make our scholarship program formal to impact the ‘at risk’ populations in America as well as the rest of the world.”

Let’s pull together and join with Vicki as she leads by example, once again. We are compiling a list of all of the midwifery schools and programs, doula trainings, childbirth educator programs, mentors and midwifery preceptors that have answered the Grand Challenge.

We hope that others involved in midwifery and birth worker education will take our ideas, replicate them and scale them up to whatever will help to eliminate the racial disparity in birth outcomes. Vicki and her team continue to show us that anything is possible; where there is a will, there’s a way. We can do better! We can be the change!

If you currently provide scholarships specifically designated for students of colors (or a similar scholarship designation) please let us know! If you would like to precept or mentor a student birth worker of color, please sign up on the web site! We would like to place that information on the Grand Challenge web site (http://wocmidwifescholarship.com/) so that more will know of this opportunity. Please visit our Grand Challenge website often to witness the ever growing list of change agents, like yourself, and championing institutions who are making a difference.

Sincerely,

Claudia Booker and Jennie Joseph

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