On Baltimore

Over the past year, each time another story emerges of police violence leading to the death of yet another black man, I’ve found myself at a loss for words. What can I possibly say that hasn’t already been said?

Partly out sheer anger, frustration, and overwhelm, I sat back quietly on this blog and social media, listening carefully and appreciating the voices of others who somehow seem to be able to give words to the outrage that I know many of us are feeling as a new name rolls across the ticker on the bottom of the news screen: Garner, Brown, Scott, Gray...

Watching the media coverage of the recent protests in Baltimore has once again brought back this feeling…and the questions I keep asking myself are, “What is it going to take to create a cultural change in this country? When will there be enough outrage over the unnecessary, violent deaths of black men and women in this country that it boils over not just into protests, but into policy, into research agendas, and into a universal understanding that it is unacceptable? When will people stop dying at the hands of the very people who are supposedly working to ‘keep us safe’?

This morning I happened across this incredible call to action within the medical community by pediatrician Rhea Boyd:

In the wake of Sandy Hook, the response from physicians, and pediatricians in particular, was astounding. The tragic deaths moved doctors to address gun violence and its health consequences.

But week after week, as black boys who could be my sons and black men who could be my father, are shot and killed by police, doctors remain silent. As a pediatrician, I’m appalled.

We are watching a public health problem unfold in front of us and we aren’t doing anything to stop it.

These words stopped me in my tracks.

We are watching a public health problem unfold in front of us and we aren’t doing anything to stop it.

Yes.

As a future midwife, I place my work in the context of reproductive justice: my role is to serve my community, to help ensure that women and their families are healthy, as individuals and as members of their community. My role is to help reduce the institutional barriers that prevent equitable access to healthy outcomes. Yet we know that rates of preterm birth are higher among African Americans, and that there have been links made between chronic stress and preterm birth.

As Boyd writes, “Like the trauma experienced by war veterans, living under the threat of unprovoked police violence triggers intense emotional and physical stress, even in moments of relative safety. The chronic stress that fear generates may place African-Americans at increased risk for health problems like heart and lung disease, and depression.”

I simply cannot fathom what it must be like right now, or ever in US history, to be an African American mother. I think about my own unborn child, who will come into this world with privileges they did not ask for. My child, for simple virtue of the appearance of their skin, will not have to fear driving in Portland, among the whitest of white cities in America, and being pulled over by the cops for no reason at all.

My child, by virtue of appearing “Asian” in heritage, will be assumed to be intelligent, well-spoken, “safe.” My child will not be unduly punished for minor infractions in school, nor will they face increased risk of being suspended or expelled simply because they cannot sit still and learn quietly.

My heart will only have to bear the average amount of anxiety as a parent when my child starts wandering around the city independently…but I will not have to fear that my child might “accidentally” be shot by police. Such an occurrence would be an outrage, it would be unthinkable.

And this only scratches the surface of privilege that my child will experience.

Yet it’s not what many parents in this country live with every day. As a future parent and a future midwife, I find myself unable to breathe sometimes, I am so angry at the injustice of it all.

What keeps me going is knowing that as a midwife, I will have an opportunity to connect with people during pivotal moments in their lives, especially during the child-bearing year. I hope that I can be a supportive presence for all the pregnant people I serve, no matter what stresses and injustices they are facing during their pregnancies. And beyond the level of individual care, I want to use my voice and skills as a midwife, researcher, teacher, and activist to help shape policy that improves the health of families and communities.

I believe that the midwifery profession can and should be doing more to speak out the public health consequences of race-based violence. I intend to do everything I can to ensure that my professional organization, the American College of Nurse-Midwives, plays a role in moving our country in a direction in which all families can raise their children in safe communities.

 

A Safe Passage

“It is part of our task as revolutionary people, people who want deep-rooted, radical change, to be as whole as it is possible for us to be. This can only be done if we face the reality of what oppression really means in our lives, not as abstract systems subject to analysis, but as an avalanche of traumas leaving a wake of devastation in the lives of real people who nevertheless remain human, unquenchable, complex and full of possibility.”

~Aurora Levins Morales, Medicine Stories

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I just spent a transformative two days in a workshop for birth workers, exploring the dimensions of providing support to survivors of abuse during pregnancy and their transition to parenthood. My heart and mind are stretched wide open and I am flooded with gratitude for the space that was created by this amazing circle in two short days.

When I tell people I am on the path to becoming a midwife the response is usually some variation of: “Oh, wow! That’s so amazing! What a joyful way to spend your days, welcoming babies into the world!” Or, more to the point: “Oooh, I love babies, that sounds so fun!”

I haven’t yet figured out a gentle, graceful way to reply that it wasn’t just the babies that called me to midwifery. I do love babies, and the thought of being able to attend births as a midwife fills me with delight and excitement.

And yet…

Again and again, I am reminded that my calling to midwifery is different.

It’s about supporting the people who are deciding whether or not now is the right time to become parents, who may be struggling with their ambivalence about being pregnant and feeling invisible in that struggle.

It’s about sitting with the thirteen year-old who showed up for her first annual exam, who’s terrified of what she’s about to experience, prepared to feel humiliated and ashamed of her body. 

It’s about discussing birth control options with the person who’s never felt truly seen by their health care provider because their legal name doesn’t “match” the way they look to the over-culture of gender binary. 

My calling to midwifery is driven by the deep, desperate need for more health care providers to be holding space and offering compassionate care for the stories and experiences no one else wants to hear about: abortion, adoption, loss, domestic violence and abuse. It’s about affirming the spectrum of potential experiences of pregnancy, acknowledging that while one family may be ready to welcome a baby into their lives, another is confident that now is not that time. I want to be the midwife who compassionately provides care in both these scenarios.

These aren’t necessarily the things that most people envision when I say I’m becoming a midwife. But this is how I envision spending my days.

This weekend was another one of those affirmations of my calling. It came at just the right moment, too. As hard as it is to believe, it’s been nearly a year since I started nursing school. The last few weeks of the term are always a period of reflection on my learning, while setting goals for the term ahead. This particular transition has raised lots of questions for me about how to intentionally move forward to not only meet basic skill competency, but also how to build my own practice, or way of being, with those that I will serve.

What I gained from this weekend was more than a checklist of indicators for abuse, or evidence-based guidelines on routine universal screenings, or a cheat sheet of “Things to Say When Someone Discloses a History of Abuse And You’re Caught Off-Guard and Would Rather Go Hide In the Bathroom Because What They Shared Was So Enormous.”

While there is value to the “concrete take-homes,” I also carry with me the space that was created to reconnect with the reasons why I felt called to become a midwife in the first place. It was an opportunity to reassess what I bring to this work, in terms of both skill as well as underlying assumptions. It was a reminder to critically examine how I take on the privilege and power of being a “licensed” health care professional, and the unintentional harm I might be causing in that process.

It was also a pretty harsh reality check. For the first time since moving away from my doula practice and starting nursing school, I have to come to terms with the fact that my role, scope, and responsibilities are shifting. In just a few short weeks I will begin my 10-week integrated practicum in labor and delivery, the final step of my nursing education. It will be my first time at a birth in over a year and a half, but I will be coming back in a very different position than when I left…a position that affords me a different status and level of access to institutional privilege.

This weekend was not just an invitation, but an obligation, as Audrey Levins Morales so eloquently writes, “…to be as whole as it is possible for us to be” and to “face the reality of what oppression really means in our lives.” For better or for worse, I am choosing to become a part of a system that has marginalized and oppressed generations of people–and continues to do so–in often insidious ways. No matter what I say or do, assumptions will be made about me because of the position I occupy in that system.

It is a daunting task–some days, indescribably, breathtakingly painful–to knowingly step into a role that will require bearing intimate witness to the pain of those who are both systemically and individually oppressed. But as a midwife called to “deep-rooted, radical change” I find great hope in our collective capacity to be present for each other. The most precious thing I gained from this weekend was the courage and wisdom of the stories shared–it is the stories that I carry closest to my heart as I continue my journey to become a midwife.

Creating More Inclusive Midwifery Communities

Birth Workers Of Color Scholarship 1

I’ve been thinking a lot lately about inclusion in the midwifery profession. Of course, this is not the first time I’ve written about this. Those of you who know me know that I think about issues of inclusion and diversity all the time.

For me, midwifery has never been simply a matter of supporting individual choices in birth, although certainly that is one aspect of it. In fact, I often hesitate to blindly associate the concept of “choice” with birth, as it assumes that we all have equal access to knowledge, support and empowerment to advocate for our preferences. It doesn’t take long to realize that the illusion of choice in birth doesn’t extend very far when we’re still privileging some people as parents over others.

On a broader level, I see midwifery as a public health tool to address major disparities in birth outcomes and family health in our country. However, one big stumbling block is that the midwifery community currently does not reflect the broader community of those we seek to serve. While race is only one of many components of diversity, I do believe it is an important one. As an Asian-American woman, I rarely see myself reflected in either the general media covering empowered birth choices, or in my chosen profession. Some days I can be lulled into thinking that something as simple as seeing other Asian midwives is almost trivial, and yet, there is a substantial body of research on ways in which people of color, especially Asian-Americans, are made invisible in the Black-White racial paradigm of the United States.

In 2011, 6.6% of CNM’s who responded to ACNM’s triennial membership survey identified as people of color. Out of 2,230 total respondents (about a third of the membership that year), a whopping 4 midwives identified as Asian or Pacific Islander. Granted, a total 4% of midwives did not answer the question at all or had missing info. However, 91% (2,034 respondents) identified as white. Only 2.6% of CNM’s who responded identified as Hispanic. The last census placed the Hispanic population of the U.S. at 16.9%. The report notes that these numbers have not changed much between 2009 and 2011. Looking at the 2006-2008 report yields similar results.

So, what are some solutions?

As in any of the health care professions, addressing pipeline issues and lack of funding support are key.

How are we supporting the development of a strong, qualified applicant pool? What programs are being put in place to connect potential midwives with good mentors? How are midwifery organizations connecting with young students to introduce them to the option of midwifery as a career path? What financial supports are in place to support students who come from disadvantaged backgrounds?

This is why I’m so excited to see leaders within the CPM community take it upon themselves to make concrete changes that will support more midwifery students of color. Spearheaded by CPMs Vicki Penwell, Claudia Booker, and Jennie Joseph, they have created an opportunity for midwifery programs to commit to providing a full scholarship each year to a student of color.

And so, our Grand Challenge is this: What if every midwifery program in America, big or small, non-profit or for-profit, were to offer one FULL scholarship per year to a qualified candidate who was a woman of color?

If every school or program now in existence were to offer one full scholarship per year, the burden will not be too much on any one school’s budget. We will all share the responsibility and privilege of addressing a grave injustice in our own time and country. Within a few years we could see this imbalance shift and begin to see many women of color serving their own populations with quality midwifery model care.

It’s one step towards making our community more inclusive. What other ideas do you have? I’d love to hear them! Let’s keep this conversation flowing!

Thoughts on the 41st Anniversary of Roe v. Wade

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Growing up, January 22 was not a day I thought of as any different from other days in January. However, as I learned more about the history of reproductive health politics in the United States, this day has transformed into both a celebration and a yearly opportunity to reaffirm my vision of the kind of health care provider I want to be.

Today, on the 41st anniversary of the Roe v. Wade case that legalized abortion in the US, I’m thinking about all the recent hype around the Korean “Baby Boxes.” In theory, they provide a way for “desperate young mothers” who “can’t” parent their infants to “safely” and anonymously give away their children. I’m thinking about what the sanctioning of anonymous abandonment means for the very fabric of Korean society. What does it mean for the human rights and dignity of Korean children, who are suddenly cut off from their families, their birth story, their medical history, and if adopted, their cultural lineage?

As a Korean-American adoptee, I think every day about my birth mother, who became pregnant with me against her will.  I wonder how much of her pregnancy, the continuation of her pregnancy, and the process of my adoption felt like a “choice” to her. What options were truly available to her? What would she have done if she had had access to the kind of contraception and family planning care that I believe is a human right? How might her life–and mine–have been different if single-parenting in Korea were a real choice, not a guaranteed sentence to a life-time of stigma and shame?

It should go without saying that I am grateful for my life. Yet at the same time I am deeply troubled by the fact that given what I know of Korean history and politics, it is highly unlikely that my birth mother felt any kind of true agency or empowerment in her decision-making around her pregnancy.

Today I stand with the many unwed Korean mothers, Korean adoptees, activists and leaders in Korea who are voicing their concerns with the Baby Boxes and working to offer real support for all parents, not just those that fit the mold of “appropriate” parents.

I stand with those who refuse to pit abortion and adoption against each other as moral opposites. Adoption is not a more “noble” decision than abortion, nor is abortion immoral. They are simply two of the possible three outcomes of a pregnancy.

I stand with all the leaders in the adult adoptee community who are advocating for more ethical practices in the domestic and international adoption industry.

I stand with the courageous health care providers–the nurses, nurse-practitioners, nurse-midwives, physician’s assistants and physicians who provide compassionate, supportive abortion care every day. I aspire to be among them in the future.

I stand with all the people of the world who have experienced a pregnancy–intended or not–who have felt judged, stigmatized, or ashamed for the way they feel about their pregnancy.

As a Korean-American adoptee, future nurse-midwife, and reproductive justice advocate, I affirm my commitment to be a leader in the realm of full-spectrum reproductive health care. There is so much at stake. We need all of us to create the kind of world that supports all families, regardless of who they are, how much money they have, or what others think of them.

The Next Generation

Minneapolis

Mill City, Minneapolis: site of the first annual NSfC Activist Summit!

No, this isn’t a post about Star Trek (although, I may have watched it from time to time with my dad).

It’s actually a post (finally) about my amazing weekend in Minneapolis for the first annual Nursing Students for Choice Activist Summit. It came at a great time–I really needed a reminder of why I’m subjecting myself to the stress that is otherwise known as an accelerated nursing program.

It’s so that I can become a full-spectrum nurse-midwife who provides comprehensive reproductive health care.

Right. Check.

There’s something so powerful in being in a room full of your people. Do you know what I mean? It’s that feeling of walking in, and recognizing yourself in the people that surround you: We are all here because we are dedicating our lives professionally and personally to ensure that everyone has access to quality health care, including abortion. We’re here because we believe that nurses are leaders in this work.

I’ve been at other conferences related to reproductive health and justice, but always as the younger, not-yet professional. At those conferences I see where I would like to be in ten years. I see the communities that can be built when we network across the country to collaborate together. But that’s not quite the space I’m in yet. I’m hungry to connect with others who share my experience, who are in that messy phase of becoming the kind of health care provider they want to be.

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Practicing MVA during the “papaya workshop”

What made this weekend so rich was that it was geared specifically to where I am in my professional development as a nursing/nurse-midwifery student. The workshops spoke to the particular challenges that nursing students face in getting the education and clinical training opportunities they need to become competent providers. We learned strategies from each other about how to  advocate for more reproductive health material in both undergrad and grad nursing curriculum. We practiced our decision-assessment and counseling skills. I also really appreciated the chance get hands-on and practice both an MVA and an IUD insertion.

But beyond the specific skills and strategies is something even more valuable to me. What I carried home with me and continue to draw upon is the sense of community we cultivated. There is a new generation of nurses rising up. We’re eager for change. We see ourselves as leaders in the expansion of full-spectrum reproductive health care. It’s incredibly exciting to be a part of the culture change within the world of nursing that will lead to more nurses being involved in abortion care and family planning. Who says we need to wait until we’re RN’s, or CNM’s, or NP’s to start advocating for change? Not us! I look forward to staying connected with the new friends and colleagues I’ve met and continue to support each other in our work.

(Hats off the entire NSfC team that made this gathering happen–you folks are amazing and wonderful and made this first summit an awesome experience!)

 

 

After Tiller

I had the opportunity to view this documentary for the second time tonight…it’s an incredibly powerful exploration of the four known physicians who perform late-term abortion care in the U.S. Both times, I came away inspired by the work they do and the strength and courage of the women they serve.

The documentary is a thoughtful reflection of the complexity of the human experience–it moves beyond the black and white of abortion rhetoric and into the messy, sometimes uncomfortable realm of uncertainty and ethical questioning–all of which makes it a rich and moving experience to watch.

One of the things I was struck by on watching it the second time was the warmth and compassion and very human grapplings of each of the four providers. These are four unique human beings who come to their work out of a deeply-rooted passion for women’s choice and autonomy. Yet they clearly struggle at times with their own ethical limits. None of this causes them to doubt the foundation of their work, but it does give us a window into the nuances and challenges that come with doing this work.

There’s a lot I’m still pondering about this documentary…in particular, the juxtaposition of my identity as a reproductive justice activist and my understanding of disability justice and its intersections with abortion…there are no easy answers here, but it’s definitely something that I’ve been thinking a lot about lately.

Check out the trailer or find a showing near you.

[Friday Wrap Up]: 30

So many articles this week! Some of the highlights: exciting news for APC’s in California, one woman’s experience of a later-term abortion, new trends in prenatal screening, a call to action to end the shameful shackling of laboring patients in prisons, and an awesome, awesome story about transgender parenting from Canada. Read on!

California Expands Abortion Access!

Gov. Jerry Brown on Wednesday expanded access to abortion in California, signing a bill to allow nurse practitioners, midwives and physician assistants to perform a common type of the procedure, an aspiration abortion, during the first trimester.

Oregon, Montana, Vermont and New Hampshire allow nurse practitioners to perform such abortions, which use a tube and suction, while several other states, including California, permit nonphysicians to provide drugs to terminate pregnancy.

But the new California law goes further, allowing a wider range of nonphysician practitioners to perform surgical abortions. While other states have passed a tide of laws restricting abortion access, California has gone against the political tide.

It Happened to Me: My Late-Term Abortion Was a Nightmare, But It Didn’t Have to Be

Stories like this break my heart…and make me angry. As an aspiring abortion provider, I can’t fathom how anyone involved in abortion care would let personal judgment get in the way of providing compassionate care for their patients, especially in situations like this. I want to believe that all health care providers bring good intentions to their work…but experiences like this remind me that we have a long ways to go.

Was I expecting too much, some special treatment because I wanted my baby, because I felt like my situation was particularly emotionally fraught? Maybe I expected the clinic to feel sorry for me, and they treated me like any other woman having a “regular” abortion. Except no abortion is a “regular” abortion, and no woman having an abortion should be treated with suspicion and disrespect. Every woman having an abortion for any reason deserves a little kindness and warmth. It could make a world of difference.

Breakthroughs in Prenatal Screening

“Breakthroughs”…but with a lot of nearly impossible ethical dilemmas to ponder. I so admire the work of thoughtful genetic counselors–it’s not an easy job and the growing number of tests makes this one of the more dynamic professions in health care today. Unfortunately, this article doesn’t really delve into the ethical questions of what it means to have more testing available, however, it does touch on some of the financial aspects of testing–which really, is another ethical dilemma of its own.

In the nearly four decades since amniocentesis became widely accepted, new techniques have gradually improved the safety and accuracy of prenatal diagnosis. Prenatal tests for more than 800 genetic disorders have been developed. And the number of women who must undergo amniocentesis or C.V.S. has been greatly reduced.

We Need to Stop Shackling Women in Prison–Now

The headline says it all.

One of the first women who shared her story with Birthing Behind Bars was Linda Rosa. She learned that she was pregnant with twins after entering jail in 2008. Linda Rosa recalled being shackled each time she was taken to see the doctor: “They used to shackle my hands and my legs. I would have to walk with the shackles on my legs, which would leave cuts on the back of my ankles.” Linda had to undergo a C-section and was shackled while recovering in the hospital. She recalled having stitches and staples from her c-section and shackles on her wrists and ankles when she visited her newborn babies in the ICU. “Everywhere I had to go, I had to wear shackles,” she said.

Transgender Pregnancy: The last frontier in assisted reproductive technology

Loved. This. SO. Much. We need to hear more stories like this. It’s so important.

It took nine rounds of intrauterine insemination for Heller to become pregnant. The first four experiences at a Montreal fertility clinic had been quick and impersonal. But their fifth try was worse than usual. The doctor rushed in, never said hello or gave his name, never looked at the women. He asked “insemination?” and they said “yes.” He was quick and rough, Heller recalled, and she bled afterward, something she’d never experienced. He left the lamp on between her legs as he rushed out of the room, they say.

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.

The Shadow of Thalidomide

As an undergrad student, I studied geography. I was drawn to the idea that there might be some semblance of a systematic framework to understand the intersections between people and the places in which they live, both physically and metaphorically. As a transracial and transnational adoptee, I have always been fascinated by the ways in which people connect with space and place, the ways in which identities are constructed, and the economic interchanges that underpin the movement of people and goods around the world. I continue to be fascinated by the weaving of threads between micro and macro levels of interaction among communities in space.

One of my biggest aha moments came the semester I took a class called Women and Environments. We read Sandra Steingraber’s Living DownstreamTerry Tempest William’s Refuge. We read about the beginnings of the environmental justice movement. We read about Love Canal and Three Mile Island, we read about communities of color around the country and the world demanding that those in a position of privilege see the ways in which oppressions intersect.

We also talked about the ways in which pharmaceutical companies have intersected with the environment of the human body and in particular, with the female body. We learned about the racialized history of medical research and the limitations of drug safety testing for women. It was the first time I had been introduced to the idea that research, however “objective” it may strive to be, is still ultimately funded by “subjective” sources. The stories we read about drugs like thalidomide and pesticides like DDT and their specific effects on male and female reproductive health haunted me. At the time I never imagined I would one day be a student of the health professions, but I can see now, perhaps, how some of the seeds for my future work may have been planted in that class.

Finding this recent RetroReport on the history of thalidomide brought me back not only to my initial shock and disgust at the utter disregard of the pharmaceutical company involved, but also to this time in my life when understanding these intersections of power and privilege were new and empowering. I’ve thought about this a lot over my first term of pharmacology. So many of the drugs we’ve been learning about are classified as Category B or C, which leave a lot of room for unknown:

Category B: 

Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women OR Animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester.

Category C:

Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

I’m sure I will continue to learn more in our second term of pharmacology, as well as in the advanced courses I will take as a midwife, but as a woman of color, there is still a part of me that harbors a great level of skepticism about the rigor of oversight in the drug approval process. Pharmaceutical companies wield a great amount of power and influence and have a primary incentive for profit, despite whatever else they might say. It took the manufacturer of thalidomide fifty years to issue a formal apology for the thousands of lives and families they devastated.

As someone who came to nursing school without a lot of faith in the pharmaceutical industry, it’s been interesting to set aside some of my own biases enough to truly learn the details I need to learn to become an RN. I have been surprised though, that’s it’s not always been as difficult as I imagined it would be. If anything, I believe knowledge can be translated into power and I want to know as much as I can about the myriad drugs that my future patients might be prescribed. I still find it slightly terrifying to think that I will one day be able to prescribe certain drugs (well, depending on where I practice)…but I am grateful that I will not be moving into this role with the kind of blind faith in “the numbers” that I think many healthcare providers rely on.