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.

 

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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

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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.