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.

Midwives Make a Difference (for everyone, not just women)

It’s National Midwifery Week! As a future midwife, it’s exciting to have a designated week to celebrate all that is awesome about midwifery care.

I will say, I wish they included more about our midwifery colleagues who are Certified Professional Midwives. This is a pretty CNM-focused campaign, which I think in the end, is a disservice to potential midwifery clients everywhere. Everyone deserves to know all their options regarding midwifery care, and nurse-midwives are just one piece of that picture.

I’m also incredibly disappointed that the Our Moment of Truth website continues to feature predominantly white, heterosexual imagery and language. Yes, midwifery care is for women, but really, it’s for everyone, no matter how you express your gender identity.

Let me repeat that. Midwifery care is not just for women, despite the language and images you’ll see on the ACNM website.

ACNM released a position statement about trans-gender care earlier this year, so I was hopeful that I would start to see that language reflected in this year’s National Midwifery Week campaign. Sadly, it is still very women-focused. As an example, on the bottom of the front page, the reader is directed to

CLICK HERE to download a new document, designed especially for women, which clearly explains normal, healthy childbirth.

According to the Transgender/Transsexual/Gender Variant Health Care position statement, ACNM has adopted the following goals:

  • Work toward the incorporation of information about gender identity, expression, and development in all midwifery educational programs;
  • Make available educational materials that address the identities and health care needs of gender variant individuals in order to improve midwives’ cultural competence in providing care to this population;
  • Support legislation and policies that prohibit discrimination based on gender expression or identity;
  • Support measures to ensure full, equal, and unrestricted access to health insurance coverage for all care needed by gender variant individuals.

But really, the first step is to publicly acknowledge that transgender people exist.

You do this by making your websites inclusive in language and imagery. You speak directly to the people you aspire to serve. I don’t see this happening yet.

I’m not trans, but if I were, and I were looking at the ACNM website this week because a friend recommended I check out midwifery care, I would not see anything that reflected my experience and my health care needs. And as a future midwife, that’s a huge disappointment. Because midwives do make a difference and not just for women.

Midwifery and Trans* Health Care

I woke up this morning to see this awesome piece of news:

ACNM has issued a position statement outlining their commitment to proving safe, culturally competent care for trans* people.

“It is the position of ACNM that midwives

  • Exhibit respect for patients with nonconforming gender identities and do not pathologize differences in gender identity or expression;
  • Provide care in a manner that affirms patients’ gender identities and reduces the distress of gender dysphoria or refer to knowledgeable colleagues;
  • Become knowledgeable about the health care needs of transsexual, transgender, and gender nonconforming people, including the benefits and risks of gender affirming treatment options;
  • Match treatment approaches to the specific needs of patients, particularly their goals for gender expression and need for relief from gender dysphoria;
  • Have resources available to support and advocate for patients within their families and communities (schools, workplaces, and other settings).”

The statement then outlines the ways in which they plan to ensure this care is possible:

“To facilitate these goals, ACNM is committed to

  • Work toward the incorporation of information about gender identity, expression, and development in all midwifery educational programs;
  • Make available educational materials that address the identities and health care needs of gender variant individuals in order to improve midwives’ cultural competence in providing care to this population;
  • Support legislation and policies that prohibit discrimination based on gender expression or identity;
  • Support measures to ensure full, equal, and unrestricted access to health insurance coverage for all care needed by gender variant individuals.”

I will be the first to admit that I still have a lot to learn about trans-health care…but I am thrilled to see ACNM take a stand and voice a commitment not only to providing quality care, but also highlighting the education gaps that student midwives currently experience in their training around trans-health issues.

As a future midwifery student, I am looking forward to scoping out opportunities to increase my understanding, compassion, and competence in providing quality midwifery care for any trans* people I may serve. I would love to be able to do a clinical rotation here, for example, or someplace providing similar care. I also really, really want to attend the Philly Trans-Health Conference in June…we’ll have to see how the timing works out, though.