Rocking the Birth Dogma Boat

Something from last year

September 24, 2011
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I wrote this after a long birth and a long discussion with a good friend about what midwifery means, and whose stories are getting told.  I thought about it today when a student described another class where she was learning about how to improve “traditional birth attendants'” practices.   The literature she was reading and the studies she referenced were all done by men, men who had never given birth and men who presumed to speak for the TBAs, calling them TBAs and not midwives.  TBAs are midwives, and the realities of their practice often prevent their voices from being heard.  In light of my conversation, I would like to share it.

In the early morning hours I come home from a long home birth, a healthy baby, a safe passage, and all I want is sleep.  I’m hungry, and I can barely pour my bowl of cereal without spilling milk.  I eat as quickly as I can, and I crawl into bed.  Twenty-seven hours.  Twenty-seven hours of monitoring and supporting, whispering that it will be ok, nodding my head, thinking about safety and never breaking a woman’s gaze as she does the work of becoming a mother.  Twenty-seven hours receiving a new baby, watching over everyone’s health, cleaning blood off a brand new scalp, bringing baby to breast, smiling with my eyes always vigilant.  At the end of this night, sleep never seemed so good, and my bed is a haven.  I wake up as the sun is setting, having slept through the whole day, and I take out my journal and write this story.

I can write because I do at most 5 home births like this a month.  I consider this a busy home birth practice in Boston, in the United States, where there is so much infrastructure supporting my work, where I live down the street from my mother and my grandmother, whose house I go to for a real meal after this day spent sleeping.  I can write because after my long birth, I am not getting up for another one, not sleeping a few hours and waking up to a long line of women waiting for their prenatal visit.  I can write because if I cancel a prenatal visit to sleep, I know my client will still have access to health care.  I am not the only health care my clients have, so I can write.  I can spend the day writing if I want.

There were times in my life when I couldn’t write after every birth.  When I worked in a birth center on the U.S./Mexico border, and we had days with nine births in a row, and barely time to run to the restroom during a 24 hour shift, I couldn’t write at the end of those days.  My midwife friends in Haiti who go from birth to clinic to birth and joke that midwives never sleep do not write at the end of their endless days. My midwife friend in Guatemala single-handedly cares for the health care needs of three villages, spending endless days on the bus traveling down dusty roads to care for every woman who needs her; she does not write at the end of her long day, because she knows that if she sits down to write, she will fall asleep with her pen in hand, and her pen is a precious resource she uses to record all the births in all her villages, and all the deaths.

As a midwife myself, I know what it takes to write.  I know the feeling of staying up way too many hours to ensure the safety of mother and baby, only to sleep a few hours and do it again.  I know what it is to be running in 5 different directions at once, each direction a potential matter of life and death.  I know what it is to wish there was more of me, that I could somehow divide myself between everything that needs me without giving anything less than my all, knowing that even my all is never enough. I know what it is to feel that if I let myself sit down, I will sleep forever and to want so badly to sit down anyways, and to then have a woman walk in pushing with sky-high blood pressure at that very minute.  And while I am sure it is humanly possible to write at the end of that day, because I know that midwives have, I know that I need a different kind of day to write.  For me, it takes a break, time when no one is pushing, when my practice is slow, when no one needs me, when I can go the restroom without an ear out for that yell that lets you know the baby will be here very, very soon and that always seems to occur the second I close the restroom door.

Writing takes time, and writing takes support.  Writing my stories is something I can do now that my practice as a midwife is cushy and soft, now that the women I serve have other access to health care, now that I live down the street from my mother and grandmother who feed me.  Writing means no one is waiting for me to measure her belly or weigh her baby, and that I have the time to find words.  And knowing this makes me concerned about the midwifery stories that are reaching the world.  I am not the only midwife, and easier jobs like mine are not the only kind of midwifery.  I worry that telling the stories of only the midwives who have time to write paints an unbalanced picture, leaves out the midwifery stories that most need to be told.  Writing is a function of privilege, but midwifery means caring for every woman, everywhere.  I challenge us to honor the diversity of what it means to be a midwife, to make sure that the stories of the midwives too tired and overworked to write also make it into our collective story of what it is to be a midwife.  I challenge us to paint an inclusive picture of midwifery, to keep space for the stories that aren’t being written, because the midwife knows that if she sits down, she will fall asleep, and that the second her eyes close, someone will walk into her clinic, ready to push out a baby, and the midwife will need to be vigilant once again. And however we practice, this story belongs to all of us midwives, if we can make room to listen.


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“Because history left unaddressed becomes the present”

September 23, 2011
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This was a quote from my eighth grade history class, when we had a guest speaker come and talk about the holocaust.  So here is some midwifery history, a history we have not addressed:

NEJM ad

This is an ad from the New England Journal of Medicine at the turn of the last century.  Another ad from the same era showed a flattering picture of a clean White male doctor next to a stereotypical image of a dirty female African-American midwife, with a caption describing her as a former slave.  Bold text under the photos asked women who they would prefer to deliver their baby, with the obvious right choice being the male doctor.  This smear campaign against midwives was a prerequisite for moving birth to the hospital, and quite successful: In the late 1890’s, about 10% of births occurred in the hospital.  By the 1930’s, over 50% of all births, and 80% of urban births took place in hospital settings.

This was a huge shift, and moving birth to the hospital solidified the hospital itself as a real institution.  (This continues today, with birth representing over 25% of all hospitalizations, and providing a solid financial foundation that subsidizes all other hospital activities, and in many cases allows hospitals to keep their doors open.) Huge cultural shifts do not happen on their own, and in the classic telling of the story I learned in midwifery school, the demonized doctors wanted to make money off birth and gain control of women’s bodies, so they initiated a smear campaign against midwives, convincing the naive public in a matter of months to give up homebirth and midwifery care.  We love this mythology, that midwives were great and doctors were evil and we got screwed over, and it was personal.

However, the key element that’s been left out of the telling is the role of racism.  For birth to move to the hospital, women had to believe the smear campaign on a personal level, and that personal level was racism and anti-immigrant sentiment.  The U.S. at the turn of the last century was in the middle of a wave of new immigration in the north, cities filling up with “ethnic” immigrants who were considered dirty, impure, other, and certainly not White.  Reconstruction had done nothing to address the persistent racial tension and discrimination.  But our population was becoming more and more diverse, and it was not comfortable.

The smear campaign against midwives that moved birth to the hospital was effective because it drew up the racism, fear and anti-immigrant feels of the day.  Casting hospital birth as an elite “option”  with whiteness as a prerequisite allowed  privileged women to define themselves by how they gave birth.  Giving birth in the hospital was a badge of social standing, a statement of one’s worth.  Home was where the masses gave birth, attended by immigrant midwives from the old country, dirty Italians, Jews, Irishwomen.  Home was where women who couldn’t afford better gave birth, attended by ignorant midwives who were born into slavery and didn’t live much better once they were freed.  Midwives cared for everyone, no matter what.  Hospital birth became a way to prove one’s worth by distinguishing one’s self from everyone else.  Hospital birth meant you were not an immigrant, not African-American, not like everyone else, deserving of better.  In a country where being different from immigrants and from blacks was important, moving birth as a way of proving one’s whiteness and differentiating one’s self from the masses made sense. Racism made the shift possible.

And history left unaddressed becomes the present……..

So now we fast forward to our own time, when the natural birth movement is waging a less well funded smear campaign against hospital birth, and elite women are defining themselves by how they give birth, only this time it’s at home, away from the unenlightened masses “choosing” hospital birth.  We are more diverse than ever, and experiencing another wave of immigrants.  Race-based health disparities are our largest health problem, with discrimination determining the length of one’s life, and whose children survive childbirth and childhood.  But these are not midwifery issues-our issue is where women give birth, and we frame it as a choice, though very few women have access to all the choices.

In states like mine where midwives are not legally recognized, medicaid does not reimburse midwifery care, and midwives remain out of the reach of most women.  The hospital cares for everyone, not as well as the individualized care offered by midwives, maybe, or the spa treatments and supports offered by doulas, but cares for everyone nonetheless.  Except of course for the women who distinguish themselves from the masses by “choosing” home birth. To be different, better and above everyone else, women who can afford it “choose” homebirth, and look down on the masses-the rest of us who cannot afford midwifery care-as unenlightened and less deserving.

Watching the Business of Being Born, I noticed a sea of white faces in penthouses.  The message was clear-the granddaughters of the clean white doctor on the poster chose homebirth.  The granddaughters of the midwives in the poster, the former slaves and immigrant women who cared for everyone, no matter what, we give birth in hospitals, full of unnecessary intrusions into our bodies and our dignity, and somehow this is less of a midwifery issue than where the granddaughters of the clean white doctor give birth.  Great-grandchildren of the African-American midwives die at 4 times the rate of great-grandchildren of the white doctor, and this is less of a midwifery issue than where these great-grandchildren are born.

Birth and birth location has once again become a definer of identity in a racist age.  Birth has become a way to define yourself as more deserving, more worthy, better educated, and above all, different from the outsiders, the immigrants, the women of color, without quite saying it in those terms.  Homebirth, like hospital birth before it, has become an upper class white phenomenon, while the ideal of midwifery care for all falls to the wayside.

This is part of why I’m leaving this fight.  My heart is not in helping people with more than their fair share of the world’s power have empowered births, though I do feel everyone deserves an empowered birth.  But I do not want to repeat this history, and I welcome your thoughts on how to address history, how to stop history from repeating itself.


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Really leaving, not quite gone

September 23, 2011
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My last birth: I was sure she wouldn’t do it, wouldn’t go into labor, wouldn’t find it in her to give birth again when giving birth last time had been so traumatic.  I believed the objective evidence of my last vaginal exam, where her cervix was so posterior I could hardly find it, and so rigid I could hardly get a finger into the os to strip her membranes. I believed the weird blame-y new age psychology I am usually so suspicious of, that women somehow control their births (when birth is all about surrender, about learning you cannot control a damn thing), and she was choosing not to give birth.  I believed the false starts that ended in full stops would continue and slide into a big stall.  I believed that a woman who spoke in a little girl voice and refused to take the reins in her own life would not take the reins in labor, either.  I believed I would transport for another cesarean, and she would be mad and I would be mad and the doctor would be mad and it would end in one big fight.  It would end like it had begun, in one big fight.

And so she called me at 1 am a few nights back, and I went back to sleep, believing it would not happen.  And I drove to her house heavy-hearted, praying for the grace to transport gracefully, praying for the grace to know when enough was enough, the grace to leave gracefully.  And I prayed for safety, for hers and the baby’s and my own in this sad, sad legal climate and this awful, awful system, and I realized I felt I had escaped certain doom time and time again and it was probably too much to ask for my luck to hold, too arrogant to think I could escape certainty again.  I prayed my luck would hold.  I know, this is a negative statement about midwifery-I should be reassuring you that we are highly trained, and birth is as safe as life gets, and each safe birth is not a narrowly missed train wreck, a swerve exactly too soon, a phone call that keeps you in the house an extra five minutes before work, and out of the 10 car pile up that happened at exactly the time you usually enter the turnpike.  But I have spent the last years with too much responsibility for one set of shoulders laying squarely on mine, and every day has felt like a narrowly missed train wreck, a phone call that kept me in the house 5 minutes longer than usually as the cars piled up at my turnpike entrance, and so I prayed.  I prayed to once again narrowly miss the consequences of too much responsibility and too much arrogant faith in my all too human hands; I prayed to just once more answer the phone in time, to swerve my car at the last minute, to make it out without death and jail and loss that cannot even be explained, just felt.  I’m not a religious person, and I prayed.

And I got to her house, to her birth and she started pushing, and with every contraction she said “I can’t, I can’t do this any more.”  And she pulled at my arms and she pulled at my back and she dug her nails into my hands and pulled and pulled and pulled and I felt all the years of laboring women leaning on me and my injured back, and my slipped disc slipped further and my midwifery partner told me that my cortisone shots were doing lasting damage to my tissue integrity….and she started yelling for someone to get the baby out of her, and asking why no one would help her, and the only answer was that we couldn’t help, we would if we could, but she, and she alone, needs to get the baby out, and we will be by her side but it is all up to her, and her alone, and she yelled for us to help her, and she yelled for someone to get the baby out, and I looked her in they eyes and I said you have it in you to do this, _____.  You have everything you need to push out your baby. This is hard, and you can do this hard thing.  You are everything you need to do this hard thing.  And she yelled for someone to get the baby out,  and she begged for someone to help her, and no one could, because to give birth you need to walk alone, you need to know you are enough, you need to be your own island and your own planet with mountains and fresh streams, you need to stand up as just yourself, nothing more and nothing less, and answer to your own frailty and your own power, you need to climb your own mountain and push your own baby out and there is nothing, nothing I can do for you, except believe in you and let you tear my back to shreds.

And so I left her alone with my student, who will soon be a midwife, and my student said and did things I would not have done, so I know that I have been a good mentor and my student doesn’t need me anymore, and that was satisfying.  I sat in the kitchen with my midwifery partner, a woman I really love and respect, a woman I would want to catch my own baby if I ever had one, and gossiped, and watched my student come into her own.  I disagreed with her choices, but I knew they were valid, and I enjoyed the success of watching my student be her own kind of midwife, of watching her disagree with me.  I enjoyed the success of watching my student not need me. And still the baby didn’t come out and the mother yelled for someone to help her, for someone to get the baby out, please please someone get the baby out.  And no hero swooped in to rescue her from herself and her work, and there was no one stronger than her in the room, no savior except her own self, and no one else to do her work.  And she yelled, and she yelled, waiting for help, crying out that she couldn’t do it.

And finally I did the stuff I never do-I had her lay flat on her back and bring her knees up and her chin to her chest and push as I told her to while I felt the baby’s head move down and back, down and back with her pushes.  And it worked, she wanted the direction and the orders, gentle as I tried to be.  And the baby crowned and I switched places with my student, letting her catch the baby, and getting out of the way as best I could.  We put the baby on the mom’s chest and she cried, she sobbed, she said how it should have been like this with her first, who was born by (unnecessary) cesarean. And my student looked at her and said “you did it.”

If this was just a pro-midwifery blog, I would tell you that the baby was eight and half pounds, a pound heavier than the mother’s last child, born VBAC at home, born with a nuchal hand making the passage harder, born triumphantly, born letting the mother know that she can be powerful, that she can be an island and a planet with mountains and freshwater streams, that she is all powerful and worthwhile and strong.  And she is, she really is. And happy, she is so happy.  The depression that crippled her after her last birth has not sunk in, and she is grateful but distant to me, knowing that she herself pushed out her baby, she herself did it, she herself gave birth.

I want this to be just a pro-midwifery blog.  I want to celebrate what this woman did and fade into the background with my injured back.  I want to believe the cards and encouragement sent to me by my clients, telling me that I have changed the world, one birth at a time, one empowered woman at a time.  I’m not denying the work I have done, the way my client sobbed when her baby was born and she realized that she herself did it, the long night I spent telling her she had everything she needed to give birth, to be enough to push out her baby, herself and her alone.  I did all this, and she took that step partly because of the belief in my eyes.  Those triumphant sobs are something I have felt time and time again, though with things less tangible than a baby, watching a woman come into her own.  I, too, know the triumph of making something impossible feeling come into the light, and I know there is nothing more satisfying.  And yet, I am backing away.  And yet, this is the last time I will do all this, although I find myself midwifing friends through life and I have ultimate faith in my ability to stay up rubbing backs.

If this were just a pro-midwifery blog, I would be able to ignore the other side of this story, my injured back, my growing conviction that making myself invisible is a disservice to women,  that serving birth at the expense of myself hurts us all, the feeling of too much responsibility for only one person landing squarely on my shoulders, the arrogant faith in my all too human hands, the psychological tole of feeling like I narrowly missed a train wreck every day, the marginalization of our model, the blatant racism of my midwifery community, reliving history because we refuse to face it.  I feel weak for leaving and I wonder who will take my place: if I were stronger, wouldn’t I just stay up more nights, drive right to my turnpike entrance despite the 10 car pile up, flip my own car in service to the cause? If I were a good woman, wouldn’t I just believe that I don’t really count, that I should be seen and not heard? If I were a good woman, wouldn’t I ignore the racism and be content with narrowly defined and confining gender roles keeping me a servant? And I start to feel like I am justifying my choice, that I owe an explanation for wanting to leave, and I start to ignore my feeling that if I don’t get out, I will die, and I have to believe that I, too, am worth saving.  I have lost my ability to think clearly, and my life has just become avoiding the 10 car pile ups and train wrecks that but for the grace of god could have been me.  And not that life will ever be safe, but there is a pile-up on my entrance every day and my shoulders are not big enough to support all that weight.

I think about my client sobbing and saying how proud of herself she is, and I think I could stay here.  I could stay here forever, I could keep praying my luck holds, I could keep talking myself through the long nights. I could keep changing the world one birth at a time.  I could keep believing I am only enough when I am telling someone else she is enough.  There are no midwives surrounding me, telling me to climb that mountain, telling me I have everything I need to do this, to make this change, telling me I am enough, I am strong and worthwhile.  I am standing on a planet, on a mountain, and I am alone, and I am not sure I am enough.  I’m not sure I can justifying laboring out something that is not a baby, something that may never take life.  I continually swerve out of the way.

But I remember my student’s hand on the baby’s head as it crowned, and I remember my own triumphant sobs after bringing something less tangible than a baby to light.  I want a midwife to come along and do this change for me, instead of the sad wise voice saying only I can be this island, this planet with mountains and fresh water streams.  Only I can do this, and I will miss sitting on beds and floors and tub ledges and counters, giving my all to another woman, believing in her til the sun comes up and the baby crowns and she finds her own voice.  I will miss it.

I don’t know how to hold both-the worlds I have changed one birth at a time and the 10 car pile ups, my wavering commitment to myself, to becoming the kind of woman who is enough all the time and the triumphant sobs as another woman comes into her own.  How do I leave and take the nights like this with me, yet sleep through the night? How do I leave the fight without leaving the part of me that nods her head, satisfied, as her student comes into her own, the part of me that helps a woman become her own planet, her own mountain, her own freshwater stream? How do I hold it all? Is my planet big enough to contain both, and will I be able to avoid the traffic pile-ups once more, long enough to coast into this harbor on this island? If I am alone on this mountain, will I find my way down and past, when I am the only one who can do this, myself, alone?


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Enough Self Care

September 18, 2011
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I just read yet another blog about how being a birth worker is hard, exhausting and conducive to burn-out, and, predictably, it ended with the easy answer of self-care.  This answer upsets me more and more, because it personalizes a political problem, and lays the fault and responsibility for a systems-wide problem on individual shoulders.  Individual shoulders are too small to shoulder the burden alone, and asking them to, in my opinion, is a form of denial.  I can take all the bubble baths I want, and at the end of the day, I will still be a broken worker worn down by a broken system.  Until I have the political empowerment to see myself and my exhaustion in the larger context of gender-based oppression, I will continue to think it’s my fault.  Telling me to fix it with bubble baths and organic produce (which I can ill afford on a birth worker’s earnings) keeps an abusive system in place by making fixing it an individual responsibility. Worse, this focus on self-care keeps me in my place as a powerless woman who cannot effect real change, and who is solely and alone responsible for keeping a bad machine running.  Focusing on self care stops us from naming larger problems, and keeps us running around on a broken wheel.  Because I believe in the power of naming things, here is what I think will actually help:

  • Questioning the basic premises of our model through a gender lens.  Here is my take: our culture says that to be a good woman, you wear yourself to the bone serving men, who are inherently more worthy than women.  Now read that sentence again, only replace culture with the natural birth movement,  replace women with birthworker and replace men with pregnant woman.  To be a good birth worker,  you wear yourself to the bone serving pregnant women, who are inherently more worthy.  Yeah.  The natural birth movement, at least the natural birth movement started and continued by upper class white women, grew up at a time when these were the gender norms, and they didn’t really question these gender norms, thus inadvertently replicating them, though with different people occupying each role.  Because they didn’t question these gender roles too thoroughly, they also decided that pregnant women are the epitome of powerful womanhood, and that pregnancy is the time in a woman’s life when she should be celebrated, honored and supported.  As a woman who is more than my reproductive capacity, I find this offensive, though I can see how it grew out of a different era when things were even less equal.  Ending this premise, deciding that all women matter, whether or not our wombs are occupied, well, it might involve valuing birth workers, deciding that each member of the relationship has the same worth.  And knowing our own worth would involve changing the natural birth system, refusing to accept abusive and illegal working conditions, refusing to accept endless nights without sleep and the expectation of endless availability at the expense of ourselves. I would never date a man who expected me to be a ‘good woman” and serve him at the expense of myself, who thought that he was inherently more valuable than me because of his gender.  Why do I then accept a working model that asks me to serve my clients at the expense of myself, to be endlessly available, to consider pregnant women as worth more than me because of their condition? Let’s question the harmful gender roles we are perpetuating and move on to something better.
  • Taking a long, hard look at our working conditions, and realizing they are inhuman.  How many 30 hours births have I been the only doula or primary midwife at, staying awake the whole time? How many times have I told myself that the three hour nap I took yesterday is plenty of sleep?  Do I even know what a lunch break means? How many times have I been yelled at by hospital staff and sat meekly in the corner so that I take the brunt of it, and not my client? How many times have I driven home in a state of sleep deprivation worse than drunkenness? And how many clients have expected even more from me, bought the natural birth dogma that with the right attendant birth will be transformative, empowering, orgasmic, with no work of their own? (Like anything transformative, one must work for it, not expect it; one must be open to it, not try to control it) How many clients have blamed me for things beyond my control, and how many times have I apologized my ass off for it?  As immigrants and children of immigrants, my family worked for the unions, back when unions were new and things like 8 hour work days and safe working conditions were radical and hard-won.  I think sometimes that if my great-grandparents and grandparents could see my working conditions, they would roll in their graves and think I was turning my back on all their hard work as union members and organizers.  Let’s make the same kind of working conditions that the organized labor movement fought for standard within our industry.  We are worth it.
  • Questioning continuity of care, and our own egos in assuming women need it. When I ask birth attendants why they put up with the inhumane working conditions described above, they often say that they are committed to providing continuity of care, and that women deserve to know in advance who will be their doula or midwife.  I disagree. I imagine working in a practice group of 4-6 birthworkers who are all experienced, kind and compassionate, and giving women the security that on the day of their birth, they will get good care.  The woman with them will be awake enough to make good decisions, and to put her whole heart into supporting them.  No one in labor has ever cared if our kids go to the same school, if I voted as she did in the last election, or if I share her interest in scrapbooking, though these small connection points are often what make people hire me over someone else.  Instead, women in labor care if I know how to rub their butts exactly where it hurts most, if I am patient, if I am centered and present and calm.  This is how I am when I have slept, when I feel valued, when the relationship between me and my client is one of equally valuable individuals working together, rather than one of unequal gender based roles. This is not how I am at my third birth in 3 days, or at my third day of a long birth.  Birth workers who believe that women cannot give birth without them are just as dis-empowering as a maternity care system that believes women cannot give birth without careful monitoring, tubes, a doctor to tell them when and how to push, a giant light on their vagina, medications to start and stop labor and a cesarean room down the hall, for when the inevitable result of all this technology becomes “necessary” because a woman’s body clearly cannot do it on her own.  Women give birth with and without us, and, while I was good at my job, I never did anything that a trusted colleague couldn’t do.  So let’s cut the crap.  We are not as needed as we think we are-women need support, but not us personally.  And, perhaps, if we stopped feeding our egos by fostering dependence on us, personally, women might find themselves depending on their own strength, on themselves.  And the realization that one can count on oneself, more than the paid professional, more than the system, more than anything, well, that has carried many a woman through labor, and through life.
  • Committing to not tearing each other down, which means accepting that there is no one right way.  Maybe this means acknowledging our Christian roots, and recognizing the idea of a single true path as oppressive.  I hear so much gossip about who supports Vitamin K (and is therefore a bad person), who doesn’t transport for moderate meconium (and is therefore a bad person), who doesn’t refer to WIC (and is therefore a bad person), who does refer to WIC (and is therefore a bad person).  This is our gossip.  Let’s instead commit to gossiping about who’s getting a divorce, who is cheating on her wife, who is wearing a slutty outfit and who needs to buy some deodorant, and leave our practice decisions out of it.  There are many, many ways to be a midwife, and no hard and fast right and wrong-if there was, life would be easier to navigate, and we would come out on top more often.  Also, there is always someone who’s into some freaky sex thing if one truly needs to gossip.
  • Understanding and learning from the good parts of the health care system.  Mostly this lies in the fact that it is, in fact, a system, with many people working together.  When there is stress, it is distributed across 15 sets of shoulders, and when something goes wrong, the fault also falls to multiple people.  There are no lone wolves, and no one person walks around with the weight of the world (or at least the lives of this mom, and this baby) on their tired shoulders.  Humans are an interdependent species, and we did not evolve to stand alone.  Midwifery asks me to stand alone, time and time again, and that is enough weight to drown me, strong person that I am.  When transplant surgeons play god, they play god in a team, and when the president has a problem, he consults his cabinet.  Who are we to think we can play god alone? Let’s distribute the burden across a net of individuals, and let’s embrace systems that allow us to be interdependent, as humans are meant to be.
  • Commitment to mentoring and nurturing students, rather than being threatened by them, and putting a real system for making new birth workers into place.  We are getting old and burnt out, and so we make midwifery education out of reach for students.  We are marginalized and feel powerless, so we are abusive to our students.  We are territorial, and so we close rank and refuse to let anyone in.  We need students, and how we treat them says a lot about us.  We have power over students, and we abuse it.  But we are only as sustainable as the education we can provide, and only as kind as we treat those we have power over.  To me, our abuse of students says that we are not ready to grow our model, and we are afraid to become viable as a profession.  We will not, without students.  Maybe we are afraid to cede control, to open our profession to the different interpretations and ways of being that students bring.  Again, there is no one right way, and the only traditions that survive are the ones that can adapt and grow.  So let’s make room for what students have to offer.
  • Facing history, and growing our cultural skills.  Partly this would involve facing our history, and the racism at the foundation of our model, and I can see that this is threatening.  However, if we don’t face history, we become like the upstanding leader of my midwifery community who complained to me recently that women of color simply make bad decisions, and chose not to benefit from midwifery care, “and it is too bad they have such chips on their shoulders because their communities need midwifery.”  I tried to say that perhaps statements like hers are part of the reason that women of color comprise a very small portion of the women having home births.  And I sincerely question whether communities of color would benefit from this kind of midwifery.  The shame, to me, is that the natural birth movement has appropriated so much from communities of color, without giving credit where credit is due, and has tried to obliterate and forget so much history, retelling and obscuring stories to fit our own agendas, at the expense of women of color.  And then the natural birth movement sits back and wonders why women of color do not get involved! And not to say that there aren’t women of color involved in the natural birth movement, and having natural births-there certainly are-but as a movement, we lack understanding of history.  And in letting history lay, we repeat it.  Facing history is painful, but so is growth, and we need to grow our cultural skills if we want to be a viable profession.  Let’s at least begin to talk about cultural issues, and let’s acknowledge and address racism.  Let’s recognize racism as more harmful to women than induction, and fight racism in our community as hard as we fight the rising cesarean rate.

In summary, I want a job with humane working conditions that follow standard labor practices.  I want to spend a 12 hour day supporting women, and be on-call one or two weeks per month.  I want to share responsibility with a team of people, and I don’t want to shoulder more than is realistic.  I want to work in an environment that questions racism.  I want to create a version of midwifery that is viable and sustainable.  I want to address this as a community, rather than blaming (and thus isolating) individuals as they struggle with burn out and the de-valuing that is currently part of being a birth worker.

Scary as this sounds to say, I think I am a good midwife for questioning these things.  As I have said to countless women, you matter.  And I am committed to working for a system that celebrates the worth of every woman, pregnant or not.  I will be working from the sidelines because the vision I describe is so far away, and I am slowly learning to value myself.


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Almost there, and scared outta my little head….

September 11, 2011
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I have one birth left, a birth that is dragging out, a VBAC mom scared outta her mind, but determined, and I realize that I am also scared outta my mind.  My client has had start and stop prodromal labor for the last month.  She is not someone who wants homebirth for homebirth’s sake, which I appreciate; her last birth, by cesarean, was incredibly traumatic, unwanted and her epidural didn’t take.  She felt every cut, and is choosing homebirth with me mostly out of anger and fear, unaddressed trauma and the blind need to do something different, anything.

I see myself in her, my own anger, fear and unaddressed trauma overwhelming as I reach towards something, anything, new.  Like my client, I am simultaneously looking back with regret, though I try to replace it with compassion for myself, for the idealistic 20 year old I was when I started doing this.  It is hard.  I am angry and I am afraid and I don’t know where I am going.  My fear and my anger make it harder and harder to believe in myself as I try to learn a new way of being.  I have known for a long time that I need to get out,  that I need something, anything, new, and I have been on the fence, trying to find a way to honor this without having to undergo the big change that actually not being a midwife would entail.

Here is what changes when I am not a midwife, and here is why this prodromal labor stretches out so long: Since I was a little girl, I have learned and believed that being a good woman means scurrying around serving others, and that good women think of themselves last, always.  Shining as a woman means making sure that everyone else has enough food, and then bringing dessert to the table.  Good women go out on limbs for others, but never for ourselves.  Good women take their value from what they do for others, not for themselves.  The long nights of a midwife are exactly what a good woman does, endlessly rubbing backs, endlessly fighting uphill so that the woman in front of me can have her VBAC in a broken system, endlessly smoothing back laboring women’s hair and endlessly helping others be empowered.  Endlessly available and endlessly exhausted, endlessly smiling reassuring and endlessly marginalized.  Wanting an end to this is not something a good woman does.  Men, maybe.  But not good women.  And here I am, a good midwife doing all the things a good woman does,  yet wanting a new way to be a woman, wanting to write books that are all about my own voice and serve no one, wanting to stay up late thinking my own thoughts and smoothing back no one’s brow, wanting to matter as my own self, without serving anyone else.  Here I am, wanting to prioritize myself, and panicking, because if I am not a good woman, who will I be? After 30 years of only mattering if I am serving others, I am making the audacious statement that I matter no matter what, that I am enough, just on my own.  And I have no model for this, at least not female models, and I am scared scared scared, because being a woman has always been the biggest thing about me.

This has been a hard labor, and it has not even begun.  Like my client, I am scared to take that leap, scared to trust my body works/scared that I will be enough if I am not endlessly rubbing backs, scared to have faith in my ability to give birth/scared to have faith in my ability to write books and make it in a competitive world where my voice better be strong.  It is hard to be confident when I am questioning everything.  I need to be confident.

I hope that my client find it in her to take that leap, to trust herself, to give herself over to the change and limit-testing that is labor, to listen to her own voice.  I hope she finds a way to move past her fear and her anger and her unaddressed trauma, and jump into something new, find a way to make it hers.  I hope she takes me with her.  Once she gives birth, I will be done, I will be alone, in a new world where all I will have is myself, and the process of change.  I hope I can begin to believe what I have been telling women for years.  This jump is scary, and you have everything you need for when you land.  You can make it through.  You are strong.  You are enough.  Endlessly enough.  So many nights saying those words, and I wonder if my own voice is enough to guide me through.


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Honoring the Past, Continued

September 6, 2011
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I was reading over the last thing I wrote, about what I will miss, and I realized I was doing that thing I hate, glorifying midwifery, telling half the story.  It was stories like that post of mine that made me want to become a midwife, and I wish someone had warned, had cared about me enough to tell me that the magic isn’t only in birthing women, but in all women, all the time, and that dishonoring yourself as a woman, forgetting yourself as a person, is actually the greatest and only sin.  And midwifery, time and time again, told me I only mattered as a provider, not as myself, and asked me to leave myself over and over.  So in that spirit, I would like to amend my post, and, as much as I honor the beauty of birth, I honor myself.  Life is always more complicated than the beauty and glory of an abusive model, though the beauty and the glory also exist.  So while I honor the work I did and the beauty I witnessed, I also honor this, this other side to the story.  They both exist, just as strong:

I honor my ability to state uncomfortable truths.  I honor my ability to call it as it is, though it does not always make me popular, or sure of myself.  I honor my faith in people to handle the truth, and to make it better if we work together.  I honor my belief that it can change, and to go out on a shaky limb, to take the first step.  And naming it is the first step.

I honor my ability to start a conversation, to invite dialogue about the racism we’d rather ignore, or the crumbling foundation we are trying to live on.  The conversation might be a whisper, but it is there.  This model cannot go on as it is; it is crumbling slowly, and no amount of magic nights in the desert can stop it if we continue to ignore the widening cracks.  I honor my ability to invite talk of the rubble, as well as the possibility.

I honor the small still voice inside me that says I cannot empower women if I deny myself as a woman, if I try to make myself disappear, if I keep buying the party line that good midwives are those who give everything, and then some more, to their clients and to birth and midwifery as concepts.  I honor the voice inside me that says anything that tries to make me less is a not a good place to stay, that fights to keep my own voice alive.  I honor my instinct for survival as a woman. I honor myself for leaving.

I honor the infinite patience it took to sit through midwifery meetings full of thinly veiled racism and blatant classism, and to speak up many more times than I kept quiet.  I honor my courage to move beyond the black and white idea that being a midwife makes you a good person, and good people do not need to work to overcome their own demons.  I believe myself that this was common in the midwifery world, and that the midwifery model condones treating others poorly.  I believe that the modern homebirth movement was founded on very racist foundations, and I acknowledge the racism and discrimination I saw, and my inability to ignore it, or excuse it because it was perpetrated by “the good guys.”  I honor a world more complex than the midwifery vision of good guys and bad guys.

I believe my experience, which I am just now naming: Midwifery was more abusive and destructive to me as a person than the abusive man who once threw a table at me in a fit of rage.  It asked too much, and then it asked for more, while telling me that I was not enough, never enough, and that I didn’t count unless I was a midwife.

I honor my theory that midwifery took the harmful gender roles of The Good Woman who negates herself in service of the all-powerful male, serving him at expense to herself until she is gone, and simply replaced the male role with the pregnant woman, and the role of the good woman with the midwife.  I honor the generation of feminists before me who denounced these gender roles, and I honor my own drive to eliminate the roles wholesale, instead of just changing the players.

I honor the midwives and birth workers who publicly denounce me as not giving enough and privately thank me for my words, who respond to my posts questioning midwifery with worn out answers telling me-and the world-that all is fine, and call me later to say they are too exhausted to get out of bed most days, and too scared to say it.  I honor the fight for our livelihood, and for something better, that leaves us trapped and attacking each other.

I honor the two sides of this coin, that everything I’ve said here is as real as the magic of birth, and deserves as much voice.  The two sides exist together, and I honor the telling of both.

I honor the true friends who can let me move on, who encourage me and love me and remind me. Please keep reminding me.

 


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The Neutral Zone

September 6, 2011
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Going back to Mr. Bridges and his theory of transition as 3 overlapping stages, I now find myself in The Neutral Zone, the place where the old ends and the new has not yet begun, the place of change and letting go without anything new to cling to….It sucks.  I recognize the spiritual growth potential,  but all the times in my life that I look back on as spiritually important have sucked at the time, important though they have ultimately been.

As a midwife, I bought the strong midwifery ethic that being a midwife should be the sum total of one’s identity, or at least their most important piece.  I wanted so much to be a good midwife.  And the rest of my life always always came second.  I missed important family event after important family event because someone was in labor, stayed home from that trip because I was constantly on call, and slowly, slowly, midwifery became me.  I don’t know who I am without it.

The abusive underside to the midwifery model is that providers are made to feel disposable as people, to derive all their worth and self-value from their “service” to women, and to midwifery.  I have written about this before, but, more than anything else in my life, including an abusive relationship, midwifery has fueled the idea that I need to work myself to the bone serving others, because I am never enough on my own.  The neutral zone for me is all about learning to be enough, really to believe that I am enough, that just by being myself I am enough.  It is the hardest thing I have done in a long time.

Like a woman in transition, I just can’t get comfortable.  I feel worn down by years and years and years of sleepless nights scurrying around trying to be enough, trying to make a painful transition hurt a little less as women give birth.  And I am beyond worn down by the ever-present belief at the heart of the midwifery model that I do not matter as an individual and as a woman, just as a midwife.  It kept me sacrificing and sacrificing, and now it makes my blood boil.  This neutral zone is also about anger, as I slowly, slowly remember my inherent worth.  My anger makes it hard to let go of the past, and I am angry when people bring up the good times, the good things I did for them, because I know I did those good things at the expense of myself, that I let it happen.  I don’t know how to both honor the past and acknowledge the abuse, but I know I need to do both to move on.  I don’t want to be trapped here.

I have decided to make this a year about putting myself first.  Not in the sense of trying to be first in line and pushing others aside-I don’t want to hurt anyone-but in the sense of making decisions based on what makes me feel the most whole, the most happy.  It is terrifying.  I don’t know who  I will be, if I am not a midwife AND I come first.

I am trying to have faith.  I am trying to remember that this is a way station, and an opportunity.  I will not fight this year.  I am giving up my drive to fight at all cost, trying to learn a new way to work quietly and effectively towards a better world, without the constant beating, a way I can bring my whole self to.  I will not fight at the expense of myself any more.

I am a receptionist now, and I spend time with my friends and family.  I eat better.  I am afraid, and I am strong.  I am trying to trust.


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Why Ina May is not my hero

September 6, 2011
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Again, because history left unaddressed becomes the present:

There’s a lot of mythology to midwifery, and not just in sense of herbal medicine and holding the space, though those stereotypes are present, too.  Most of our mythology involves our history, and I am about to attack one of our giants, Ina May Gaskin. Ina May is a poster grandmother, if not a poster child, a white hippy who founded a back to the land commune in Tennessee in the 1970s, The Farm.  Ina May began doing births for the women of the farm, with very little training, teaching herself midwifery by reading obstetrics textbooks, and opening a birth center that women flocked to, avoiding the more restrictive hospital conditions of the day.  Ina May is often credited with founding, or at least re-discovering U.S. midwifery, but the truth is that midwifery was here all along, it just was not White.

At a time when the “first” U.S. midwives were studying obstetrics texts and going to Guatemala to learn/co-opt “Indigenous Midwifery”, the last of the Black midwives of the South were losing their rights to practice, bullied out of existence by boards of health, forced underground by the fresh out of school young White nurses sent to “train” midwives who had practiced for decades with never a baby lost.  Great-grandchildren of slaves, women who served their communities in an era of segregation, and separate but unequal hospitals, who, in the words of midwife Margaret Charles Smith “cared for every woman, no matter what.”

This was midwifery, summoned to birth after birth, educated and practiced in the art of seeing women and babies through safely, sitting with mothers all night long,  advising, welcoming, welcoming into a world of Jim Crow laws and family who loved you, caring for everyone, no matter what.  And enduring harassment from the board of health, the doctors, the health clinics, the nurses, a world that tried to say it knew more the whiter it was.  Margaret Charles Smith delivered thousands of babies, and was portrayed as an ignorant, unsafe Black granny unfit, actually harmful to women, who were seen as better off under the care of young white public health nurses, most of whom had never seen a birth.  She was stripped of her right to practice midwifery by a racist board of health in the early seventies,  and kept on delivering babies because her community needed her to.  A few states away, at the same time, White women on The Farm, were discovering birth as groovy, empowering and spiritual.  This was not a discovery to Mrs. Smith, but the very women bemoaning the disappearance of midwifery on the Farm did not know she existed.  Two worlds, sometimes only miles apart, and never the two did meet.

When I was in midwifery school, I was told that Medicine moved in and broke the chain of midwifery in this country, made it ripe for re-discovery in the 1970s.  Like all young midwives, I grieved the broken chain, the many years with no midwives.  And then I started reading biographies, stories of women who were midwives when supposedly there were none.  And I realized that the links in the chain of midwifery came over on slave ships, and those midwives who survived the journey midwifed enslaved women, found American substitutes for African herbs, and passed on their knowledge.  The chain continued through emancipation and sharecropping, and the chain continued up until midwives like Margaret Charles Smith were forced out of practice in the 1970s.  And I questioned what else I was missing, if I was told that only chains of white midwives are real.

As a white woman, I do not want to co-opt this history, and I do not want to talk about the struggle for reproductive justice as if it is just homebirth, or even includes homebirth.  Where and how privileged people give birth seems to me like less of an issue than race-based inequities in who survives birth.  Modern eugenics are flourishing, and medical experimentation on women’s bodies continues, while health is determined by socioeconomic status.  And I wonder why these aren’t midwifery issues, why day to day conditions that affect women aren’t given the same import as where someone gives birth.  And on cynical days, I think about Ina May Gaskin discovering midwifery while Margaret Charles Smith delivered babies, and I think I have my answer. I worry about history repeating itself over and over, until it is addressed.  I invite us to address it.


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Transition: What I will miss….

September 4, 2011
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I went to talk to the career counselor at school, a brilliant woman I really genuinely like.  She asked me an innocent and mundane question about my job search strategy, and I started telling her the story of my life, of being a midwife and finally now struggling to believe the message of empowerment I have been giving other women my whole career.  It was much beyond the scope of resume review and mock interview help that she offers, and she pulled a self-help book down off her self.  Transitions, by the aptly named Al Bridges, though I am not convinced it is not a pseudonym.

Anyway, Mr. Bridges talks about transition as 3 overlapping stages, the goodbye, the neutral zone where you are neither the new or the old, or any identity you remember or know, and then the beginning of the new.  I don’t usually go for self-help, but some things stick out.

Honoring the old-no one can be expected to leave without saying goodbye, and honoring what was.  I have been trash talking what was, the old, where I am now, still, in many ways, in an attempt to break free and stick to it, as it feels more and more like a trap, something I will inevitably return to, to my detriment.  I am thinking now that I should have more faith in myself, and in my friends who have promised to remind me not to return, to hold me up when I am weak, and not fight so hard against what was, and who I was.  So here goes, here is what I honor, and what I will miss:

I remember one of the last births I did before I graduated from midwifery school; it was a full moon and my laboring client and her mother paced the small back courtyard of the clinic, a glorified slab of concrete, really, fenced off from the alleyway where homeless addicts had dragged a mattress behind the dumpsters, and sometimes fought.  The moon shone magic on the hot Texas night, and the slab of concrete really was an alter, a holy courtyard to a palace in the middle of the desert, and anything was possible when she walked back into the clinic to give 3 pushes and hold her second son in her arms.  I will miss this transformation, these holy eyes making Texas concrete shine and the world seem possible and new.

Long nights staying up with another midwife, sleeping in shifts if we sleep at all, and getting to the point of no return, sleepwise, where everything is funny and you feel so close and loved and easy with each other

Sitting down to a cup of coffee and a quesedilla after being up all night at a birth, barely keeping my eyes open to eat, knowing that a new mother is resting, sure of herself and content, with her baby snuggled up and her heart in her hands, overflowing, amazing, exhausted, and stumbling into bed contented and sure that at least one thing is right in the world

The unexpectedly funny, the partner reaching to feel the baby’s head as it crowns, saying “wow, this is gross but amazing”, the cat that tried to get in the birth tub, the lady who showed her sons the IUD that fell out when I checked her, warning them never to trust a girl who says she has one, the stories client tell

The recognition in another midwife’s eyes when someone points us out to each other, saying the word for midwives in each of our languages, connecting us through the common language of long nights, pushing noises and stories

The intensity of birth, the way women cannot hide behind others, social conventions or expectations, the way labor forces a woman to her knees, forces her to be herself, no less, forces her to her limit, and then some, only relenting when she realizes she is strong and stops hiding her strength for the comfort of others

Days and night spent right up against God, and the immensity of life, the complexity and expansiveness of the universe, and the daily reminder that there is always more

Pointing out which baby part is which as I touch a woman’s belly and seeing a look of recognition light up in her eyes

The opportunity, every day, to tell women they are strong, and the evidence that women are strong

Belief, often misplaced, in yet another broken model’s ability to change the world

Myself, at 20, passionate and dedicated and sure I could change the world with enough work, and enough faith. I felt everything so deep, every unnecessary cut to a woman’s body was a cut to my body, and was so dedicated to fighting it.  My 20 year old drive to fight, my willingness to go out on a limb.  I am trying to remember that I am still as compassionate as I always was, and as dedicated, but that I am older now, with the experience and skills, and hopefully the wisdom to see that I can be more effective if I am not fighting out on a limb, or fighting at all.  I want my compassion to win out over my fight, in a way it couldn’t when I was 20.  But I miss my optimism and idealism, and all the energy I had.  I honor my fight, one VBAC at a time, one woman, and my exhaustion does not negate the work I did, nor does moving on.  I tell myself this.

Myself at my best, stepping back, with confidence and talent, slowly rubbing hips in small circles as a woman does her work, knowing that when she looks in my eyes, she feels belief in herself…..

There is a lot I will miss, and I am grateful.  I am also strong, as strong as a woman pacing and transforming the concrete in the Texas night, and I will go forward through this transition, walking towards something I can hardly see…..


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Unfeminist as it sounds…..my man and my sanity

September 4, 2011
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I am with a really good man, someone who looks me in the eyes and sees me clearly, someone who I trust will always value and respect me as me, as the person I am for better or for worse, and will always make me laugh til I pee myself.  And while there is so much good to him, this is not a blog about my romantic life, so I will keep it to this:

I have watched so many colleagues go crazy, slowly, backed up against a corner, exhausted and broken from fighting so hard, slowly losing touch with reality and clinging to dogma as a defense.  They are a little off, and then further and further, and I wake up in the middle of the night worried I am next.  My brain is going; I am not as sharp as I used to be, and I trust myself a little less.  My sanity feels closer and closer to the edge, worn down by years of constant marginalization and constant fight. I question myself more and more, and have moments of paralyzing indecision about the smallest things, times when I want to leave the grocery store in tears because I can’t decide between lemon or vanilla yogurt, reduced fat or regular cheese, but it feels like the fate of the world’s women are riding on my dairy aisle purchases, watching me with desperation in a world where real choice is hard to find.  I watch colleagues battle each other over the small potatoes, stop talking over minor clinical disagreements, tear each other down and invest all of themselves and then some into online battles about lemon vs. vanilla, and I no longer shake my head in bewilderment.  Instead, I am just sad.  I surprise myself by craving the certainty of black and white thinking that I can do to bat for, of missionary-like zeal for the one true way that will magically heal us all, or at least for a clearly defined battleground with no nuances.  I want a comfortable and predictable corner to fight from, easy answers, evil villains, innocent damsels in distress and an ideology free of subtlety,  but one that I will fight to the death for, an evil nemesis to slay before it slays me.  My world is much less complex, and I don’t feel like myself.

I have been a midwife and a fighter for as long as my boyfriend has known me, since years ago when we were friends and roommates, and he loves me partly because I am passionate, and dedicated and everything else that I often wish I could be in smaller doses.  And a month ago, we were laying in bed reading, and I looked up from my book and said “I think I don’t want to be a midwife any more, because I am afraid it will kill me, if not literally, I am afraid I will go crazy, too.  I am afraid it will push me over the edge.”

And he looked up halfway from his book and said “well, then you shouldn’t be a midwife any more.” Just like that.

And words came tumbling out, starting with “just like that?” Who will I be, and what will I do? And am I good enough if I am not fighting this fight? And what about all the women I will leave in the lurch? And am I a cop out, and will you still love me if I am not a midwife and a fighter? And will I still love myself if I am not a midwife and a fighter? What will become of me? What if I am as disposable as the model says? What right do I have to leave this fight? Who am I to think I can act for my own sanity when there is so much to fight for in this world? What makes me think I matter as much as the last repeat cesarean I helped prevent?

And his answer was that I matter more.  In the way that only a man can, he broke it down: “Being a midwife is making you crazy and you don’t want to do it, so you shouldn’t be a midwife.  I don’t want you to be crazy.”  Again, just like that, without even putting down his book.  As in, without even thinking about it, my worth comes from me, from who I am, not what I do for women and the cause, no questions asked, no nuances.  Just plain and simple, I matter as a woman and a person, and fighting this fight is secondary, not the essence of who I am.  Take out the fight and the fear, and I will still be me.  And I am what matters. I am what he loves.

I let him keep reading.  I couldn’t describe how earth-shaking that simple sentence was, because in his mind it is not a question.  In his mind, I am me, first and foremost, and being a midwife, and everything I fight for doesn’t even come close to defining me.  His statement boils down to belief in my worth,  unquestioning belief in my worth. I put my arm around him and picked my book back up,  feeling light and free and loved.  I am trying to keep the simplicity  and immediacy of this statement in my mind.

“Well, then you shouldn’t be a midwife” (and you are enough how you are, you are more than enough.) Someday I would like to love myself as immediately, value myself as unquestioningly and as simply.

Just like that.  Just like that.


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