More Thoughts on Expanding Midwifery: Action Steps

On Sunday, I blogged about my thoughts on the ways in which National Midwifery Week is being publicized. Here’s the one sentence summary :

I love midwifery and I aspire to collaborate with other midwives to expand the midwifery model of care to be more inclusive and reflective of the communities in which I will serve. 

Since Sunday, I’ve been thinking about what I would like to see in the midwifery community. It’s been a good exercise for me to move beyond articulating the problem towards envisioning and enacting solutions.

Historically, I would argue that midwifery has been a women-centered profession. It’s in the name, for sure: “to be with woman.” It is still considered by many to be “women’s work” and often we talk about “women-centered care.” There’s the assumption that midwives are about “mamas and babies.” When we talk about the midwifery model of care, we’re generally talking about women’s reproductive health–by which we mean people who were born as females and fit into the gendered binary ideal of female. There’s also an assumption (at least here in the U.S.) that the people providing the care are also women. All of these assumptions add up to a partial truth. The whole truth is, ironically enough, is more simple than that: midwifery care is for everybody and can be provided by anybody, regardless of gender, race, sexuality, etc. Period.

As a woman of color, I think a lot about my positioning and the ways in which I am seen and not seen in the culture I live in. I am a college-educated woman with a lot of resources at my disposal…but I have to work hard to find myself reflected in the broader culture of this country. I also have to work really, really hard to find myself reflected in the world of nursing or midwifery. Because of the resources I have access to, this experience ranges from a mild inconvenience to sometimes an uncomfortable dissonance, and at times more intense frustration and anger. I don’t think I’ve ever experienced true disparity in my health care or education. Sadly, I can’t say the same is true for many of the marginalized communities in this country.

When I think about potential steps that major midwifery organizations can take to walk the talk of inclusion, I dream big, but also recognize that sometimes the small steps mean a lot. Here are a few of my ideas at this moment in time.

Show more images of diverse families.

I think many organizations are getting better about this, but images matter. They are the reflection of an organization’s values. When only certain types of families are portrayed, the underlying message says “We only serve this kind of cliente.”

Show more images of diverse midwives. 

It’s a bit of a chicken and egg question, to be sure…but the way to truly connect with a diverse clientele is to have care providers that reflect the diversity of those they seek to serve. As an Asian-American, I don’t see myself reflected anywhere in the midwifery community, as a potential parent or midwife. Likewise, where are the images of male midwives? What about queer midwives? They’re out there, doing great work! You can see it here, and here, and here. (And check out this article from Vanderbilt’s School of Nursing for more on the history of male midwives.) When we limit ourselves to the narrow mindset of midwifery = women, we’re only speaking to one community.

Make the shift in language to be more inclusive. 

My friend K wrote a short sweet post about language three years ago that I still love. Language, like images, is a powerful change agent that instantly can open or shut doors.

Speak up as an ally, loud and proud during Trans Awareness Week

At every opportunity, collaborate with ally organizations committed to anti-oppression work. There is definitely value in the quiet, behind-the-scenes work of culture change within institutions. But there is also incredible power that comes with using one’s voice, whether as an individual or as an organization, to speak up for justice.

Make real, concrete changes to the core competencies of midwifery training so that midwives graduate with the skills they need to be able to provide not just competent, but quality, skilled, compassionate care. 

This action step is especially near and dear to my heart. As a current student, I want to know that when I emerge from the cocoon that is midwifery school, I will be able to provide quality care to all my patients, no matter what their anatomy or gender identity may be. Right now, I am not convinced that midwives are getting these skills without having to pursue supplemental training outside the core curriculum.* This seems like a huge gap that needs to be narrowed before midwives can practice inclusive care.

[*Case in point: Varney’s Midwifery (fourth edition), considered by many to be the “Bible” of midwifery textbooks, includes one paragraph on transgender issues. It can be found towards the end of the 13-page chapter (of a 1,386 page text) titled “Health Issues of Lesbian and Bisexual Women.” The paragraph itself focuses on MTF transgender individuals who identify as lesbian. Two references are cited, dating back to 1996 and 1997. Obviously, not all trans people are gay or lesbian. And a lot has changed in LGBTQ health care since 1996.]

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I don’t think the process of making midwifery care will always be easy or simple. I imagine there will be some struggle and conflict and discomfort as patterns of thought shift. But the responsibility is ours and I am eager to connect with other healthcare professionals, especially midwives, who are ready to do this work together.

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