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.