race and birth issues
spamelita on Sep 14 2007 at 4:46 pm | Filed under: birth activism, midwife practice, political, race
I’d like to hear from all of you but specifically Minority Midwifery Student and LaborPayne in regards to this:
In my midwifery school, it was VERY rare to see a woman of color. In my experiences in the birth activism/lactivism world, again, not only is it nearly all white women but the class issue plays a big piece, too.
A woman of color once said to me, “Midwifery is a rich, white girl’s hobby”. Hobby in terms of the fact that so many women shell out thousands to attend midwifery school, only to never be a midwife. They usually move on to other things/jobs, which is fine, but many young women right out of high school or college have some sweet funding by their parents for midwifery school.
(I know, of course that this is not the majority, but there is a huge gap in funding for midwifery school since most schools do NOT have grants or student loans that pay for the entire education like a CNM program - I know that there are women caught in the middle of all the financial issues. But seriously, if an education costs you $30-40,000 and only part of that could be funded through student loans or grants, how does this serve women from less privileged homes, white or of color?)
I guess what hits me most is that if black women make up for some of the worst outcomes in birth, is the inaccessibility to midwifery schools (especially homebirth) to blame? Or is there a lack of awareness re: options in birth? Are we, as white women, keeping the role of midwife in our own privileged community and not taking it further (and I honestly believe that communities are best served by people that come from that community, though it’s not always the case if there’s no other options*).
I admit that I’m coming from a place of white privilege and ignorance about what the issues are. That’s why I’m inquiring. I’d like to have a dialogue about this and to be taught about what I see or perceive.
I know that Shafia Monroe, a midwife in my state is working on alot of these issues.
* - I have negative feelings about white people going into other countries and cultures, telling them that how they live and heal is wrong and then try to teach them the “white way” of doing things (when we are messing up so much stuff in our own culture)..I guess I feel the same about missionaries converting indigenous people from their native spiritual beliefs.
This male midwife is from the US. He drives two hours down to Mexico to serve poor Latina women. However, his attitude is misogynistic at best and since he’s married to a Mexican woman, there’s this assumption that he can get away with racist judgments about these women’s lives. Why is it necessary to have a male midwife (whose own practices are sometimes questionable, but not included in his website) go to those women to help them? There are midwives there, but “not enough” he has said. Are we to believe that none of these women would want to be a midwife, to apprentice under one of the other midwives? Do the women in this Mexican community find him more skilled than their own parteras because he is a white man coming from the US?
And the pictures of him with the women - the paternalistic poses seem odd to me, but that’s a whole ‘nother subject. So are the graphic birth photos taken of these women, many under age and likely few realize what the ‘internet’ is or how widespread these pictures will get.
Then there are places where mostly white women go to get their “numbers” for midwifery school…and they train on minority women. How do other people feel about this? I mean really feel about it, not just “well, I went there to train and it was really helpful!”.
Am I off my rocker here? Please, help me understand this because I cannot talk about it at all with most white, progressive women.
Less than ten midwives are not ‘white’ in our Province. At least a dozen women who have trained in other countries as midwives… all of them NEEDED! I did a small group presentation on Islam to a group of midwives after my own midwife asked for some guidance (I studied Western Religions in university) when taking on some newer immigrant clients. One of the clients was a midwife in her own country, but the cost of upgrading her training (nnr, intubation etc…) and taking the p.l.e.a.’s just wasn’t something they could afford.
Makes me so sad.
So many women, with so much knowledge! Breech? blink… this is a problem?
Oh I just sat and cried when I heard these women talk at a meeting last summer. How much we could all benefit from them… and yet…. the almighty dollar (and their own personal restrictions in some cases) keeping them from practicing.
Yeah. Hear you loud and clear. Had some people ask me today if I knew who might be ‘gay friendly’ midwives. I hope that whomever they get (IF they get a midwife) is. It never occured to me someone might not be. Such naive girl am I!
This program http://www.canadianmidwives.org/AMEP.pdf
has taken off beyond what anyone could have imagined! I’m very proud of it. Sorry, the link to the actual college page seems to be down… this is the best link I could find today.
These are also issues that I’ve been trying to start to deal with–as a white, middle class, hopeful midwifery student (I’m the one who’s been emailing you for a while about possible apprenticing). I’m so glad that you want to deal with this stuff too! I’ve been talking about some things on my blog, and with One Tenacious Baby Mama, who is great at just cutting to the heart of these issues. I think I’ll go back and put up some more stuff that I erased last night because I felt it was too edgy. Would love to have you come read.
This is a question that plagues all areas of health care, not just midwifery. As a current midwifery student (a minority one at that) I have become accustomed to being the only person of color in my class…but enough about me. I feel that while money is a major factor, (the cost of my program is $983/credit hour + fees) our culture is also a hindering factor. There were times not so long ago when people of color could not see doctors, we had no choice but to use midwives. I feel, as in my own humble opinion, that our grandparents have equated being “allowed” to see physicians as “moving up” in society. They see the use of a midwife as moving backward in time. This attitude has been passed down to our parents, and our generation is just now beginning to appreciate the work, dedication, and skills of the midwives of our heritage. Our parents are proud that their children can become doctors and lawyers, they have difficulty understanding why we would want to choose a profession that in essence shuns the modern technology our grandparent or our grandparents’ parents yearned to have access to. It is difficult to be willing to go hundreds of thousands of dollars in debt, without the overwhelming support of our families. This really is only my opinion and I am more than open to the opinions of others. This is just the only rationale I can come up with. I know my people of color are just as capable, even though at times society tells them otherwise, so it has to be something much deeper, right?
I’ve often wondered how many midwives there are amongst us doing our toenails, cleaning our houses or selling us fruit at the corner store. Just because the woman can’t speak our language doesn’t mean she isn’t a midwife. What is she unable to teach us? What women, even in her own community, are able to benefit from her knowledge simply because she is unable to take the state exam in her native language?
Yet, I know from talking to the women at the nail salons that those particular women and those in their particular communities would never dream of going to a midwife and having homebirths. They want American hospital births with American doctors and all the status that comes with those words. Even in their own community, the midwives are shunned.
I am one of the women who went to El Paso to “get numbers” and work with the migrant Mexican women that came in droves through the doors at Casa de Nacimiento. First, the women who come there know the providers are students and are informed of that at their first appointment. They understand that they might get a couple of exams sometimes in case something is amiss or if a midwife needs to check after a student. They agree to it. Do they totally understand what they are agreeing to? Probably not, but do any of us signing a contract understand 100% what we are agreeing to until after the fact? And, at any time, the women can refuse any procedure (and do) and that is totally respected.
Secondly, I found it difficult when the students who came made zero effort to learn Spanish. When I went the first time, I spoke some OB Spanish… pretty bad conversational, but my OB Spanish was okay. But when people know they are coming for 4 months or whatever and take no initiative to learn, that bugged the crap out of me. By the time I went the second time (7 years later), I was fluent in Spanish and the whole gig was a delight and I had a blast with the women and their families. There was no issue with cultural divisiveness (my Spanish is Mexican Spanish and my knowledge is Mexican knowledge) and when there were moments of my American goofiness, I always made it my “duh” moment and they were very gracious and forgiving of my ignorance.
Thirdly, I never saw what I did as “practicing on” anyone. I think if I had done that, I would have, right there, been guilty of some horrid Anglocentrism. Instead, I was a care provider… a midwife… and I gave the women phenomenal care. Better care than many (most) might have gotten in Mexico. There weren’t any parteras that we knew about in Ciudad Juarez… we looked for them. I love the Mexican women. Loved the women I served in El Paso. Many of whom I can still remember by name and face. I have wanted to move to El Paso for years, but my Sarah won’t have any part of it; that makes me sad. I know I might be in the minority… the “not practicing on the women” type, but let me tell you, when I spent the year plus there, I was crazed with overseeing that nobody treated the women disrespectfully. I know Linda (the owner) works hard to do the same.
It’s easy to pass judgment on somewhere you’ve never been, but I’ve been there and I wouldn’t have stayed two seconds if the women weren’t seen as beloved human beings.
Great topic.
Thanks, Barb, for your comments about the border birth centers. I never went there because it never felt right to me, but I do think it’s helluva weird that women who DO go there won’t learn Spanish.
I can appreciate your experience there.
Oddly enough, when I studied midwifery in the UK in the mid=70s, nearly all the students I encountered when we went to London for our viva (oral) exams were either Black or Asian, mostly from Commonwealth countries. In the introduction to the midwifery textbook we used (”Maggie Myles”) the author claimed that certified midwives were a “major British export” to the developing world. So perhaps the situation you see is a particularly American one, where midwifery, particularly certified nurse-midwifery, is still pretty limited to those who can afford it, or who are under midwife care in hospital.
SageFemme you touch on many things in this post. It’s almost too much for one post! When I look at a few of my classmates (I am in a CNM program at an ivy league institution - and I qualify this because it pretty much describes the student population - “white and upper class”) I can relate to why someone would call this a “white woman’s hobby.” It’s very…weird…because some are very passionate - but it almost seems like they’re passionate about midwifery, but not necessarily *women* and their rights, choices, etc. It’s like midwifery is a cool thing TO DO, a midwife is cool thing TO BE, if that makes sense? Basically, it’s all about them instead of the women they serve.
Funding definitely plays a major, major role - even (and I would argue, especially) in CNM programs because the cost is astronomical. People will leave the program with nearly or OVER $100,000 in school loans. But not everyone qualifies for these loans…who do you think gets left out? Us. Why? Because a large % of these loans are credit based and you need either good credit or a co-signer with good credit to qualify, which is hard to come by in the hood. So the assumption of equal access to these programs is an illusion, and I found out the hard way. And as far as non-federally funded programs, poor people can just forget that all together. Pay how? With what? And then there are some cultural issues surrounding money that make it harder… simply the *act* of taking out this amount of loans is foreign…it’s hard to wrap your mind around it. The first year of school I went to the dean in tears for many reasons, one of which was the money. I said “people don’t understand…this first year of school is more than my mother and father make combined in a whole year.” It’s overwhelming.
What is to blame for the disparities in health for black women? That’s loaded. I will do a seperate post about it. But mainly, I would say it’s a combination of the following: history, resources, and education.
The issue about keeping midwives in your own communities is not true in regard to CNMs. They have traditionally worked in underserved communities (and we know that because of the requirements to become a CNM, these women have not traditionally been of color) so they are not “guilty” of staying in their own communities, but I don’t have the facts to answer the same about other midwives. I would venture to guess though that if a provider is not able to accept insurance plans, medicaid, or does not have some kind of sliding fee scale, they are not doing a lot of work in my community. ..but that can be good or bad because at this point I wouldn’t want the women in my class to come anywhere near my neighborhood.
I am really struggling with the Casa (and similar) issue. I was supposed to go to Oaxaca this past summer and learn some medical spanish and work with the midwives there, but I couldn’t pull myself to do it. I really don’t think it’s ok, but I keep trying to justify it in my mind. I have a similar issue with teaching hospitals in the middle of poor communities. My program also has a very global focus, and they provide many options (often funded) to go abroad and practice and this too bothers the shit out of me, not because I don’t think women around the globe should have equal access, but because I keep thinking “but my people, your people, right here in *this* country are living in third world-ish situations…aren’t they worthy?” People have said to me (similar to the Oprah excuse) “but I want to go somewhere where my help is *appreciated*” and to that I respond, “no, you want to go somewhere where people will value you like a god simply because you’re white or American.” For a whole host of reasons, people in my community may not react to you as simply someone who wants to help them. Reason number one, they know that you’re the newest teacher/nurse/doc and that you might be gone as soon as you hone your skills by practicing on them. The same thing happens in public school systems of low income areas. Not to mention the earned distrust people in my community have for the medical establishment. This distrust is what makes me believe that if we had more midwives, especially of color, AND if non CNM midwives could accept medicaid (can they????) we could drastically improve health outcomes of minority women…I think they’re just waiting for another option…we certainly aren’t committed to the establishments we currently use - evidenced by our lack of prenatal care. It’s not that we don’t care about our unborn children. People never ask these women why they didn’t get care. Let me tell you ONE of the answers: we (some of us) don’t get care because we dont trust the care, or the people providing it…but most women would never say that…that’s an insider’s truth. The rest of the reasons are obvious, like lack of resources/transportation/education etc.
There’s so much I could say, want to say, and I will, but on my own blog. Maybe first I will gather some of the posts about race and health that I already wrote and post those in a convenient place on my blog. Then I will dive into each of the major issues I mentioned here in an elaborated manner….
Thanks for making me write down some stuff that I’ve been carrying around in my head!
In Love,
minority midwifery student
Sage,
Sorry for the delay, but I’ve spent two days contemplating your questions. There are so many layers to the questions you ask.
HISTORICAL: The black granny midwives of old were systematically disreputed then outlawed. It is that ‘legacy’ that remains to this day- the image of the midwife of color being the dirty and ignorant granny midwife.
GENERATIONAL: My mother and her 8 siblings were all born at home. I found this out completely by accident while have a casual conversation with my nearly 90 year old grandmother only a few months ago. Of course my mother had 1 vaginal hospital birth (me)followed by 3 cesareans. Why aren’t my grandmother’s birth stories common knowledge? Why aren’t they valued? How have her stories gotten lost by the next two, possibly three generations?
ECONOMIC: Class does play a huge role. There are women who are would-be midwives who don’t even know what a midwife is- but they are the community caretakers. There are also middle class women of color who won’t choose nursing or midwifery as a vocation because their choices are so much broader now. Why not become a physician instead where thy think they can effect more good? I’ve written on my blog about creating pathways to midwifery for women stuck at the CNA (certified nursing assistant) level. These are low education, low wage, bottom of the wrung jobs, but many low income women of color see it as their only place in the healthcare system. Even nursing school is too lofty of a goal to shoot for.
EDUCATIONAL PATHWAY: The granny midwives of my grandmother’s day learned their trade by apprenticeship. Why can’t this again become a viable and respected means of pursuing midwifery for those for whom financial constraints may be an insurmountable hurdle?
COLOR and CULTURE: I know firsthand how difficult it can be to be the only or one of a few women of color in the class or on the hospital floor. The majority culture assumes their way is the best way of doing things and don’t have much of a sense for taking into account cultural differences. You always stand out, and your words and deeds are made to represent the entire race. You live in a glass house, always under scrutiny. Black folks are like all other folks, most would rather stay safe and warm in their own little cultural enclave and not venture out into broader unknown where they know they’ll be on constant display. Unless you attend a historically Black college, any higher education represents this “venturing out” There is an unrelenting psychic weight to being surrounded by members of other classes and cultures who may assume that you don’t measure up, aren’t as smart, aren’t even as attractive, aren’t there on the same merit as them, etc…
GENDER: Double whammy for the woman of color. Nursing and midwife roles have taken a beating for being seen as ‘traditionally female roles’ Neither role gets the respect it deserves- and both midwives and nurses are subject to bullying behaviors on the job by male and female physicians who denigrate those roles.
MY OWN VIEWS: When I look all around me, I see birth and breastfeeding issues tied to racism, classism, and sexism. Yes, black women have worse outcomes, and yet NO ONE is standing up and saying black women need MORE help and encouragement to breastfeed successfully or black women need FEWER techno interventions in birth. I’m not hearing it on the local landscape or the national. No one thinks this is worth talking about in the public discourse and I see this and think HAS THE WORLD GONE CRAZY?? More and more I see this as my role. I have to be the one to stand up and say- if black folks are dying in higher numbers from diabetes, obesity, heart disease, etc. and breastfeeding impacts those numbers- shouldn’t someone be saying to black women that the stakes are higher and they need to breastfeed even more??? These are life and death issues. Its not just a feeding choice for your baby- there are life long implications to that child’s health. Its not just a woman’s ‘experience’ when it comes to birth, her choices have implications for the health and wellbeing of herself and her child. The healthcare system poo poos women’s choices without acknowledging that those choices have huge health implications. If its important to all mothers, its doubly important to black mothers. Like I always say, if white folks sneeze, black folks already have the full blown cold.
I spent my time working at an IHS facility. I am in awe of the Native American women I worked with there - they taught me so much. I admire their grace and beauty, especially during labor. I never felt I was ‘practicing’ on them as Barbara mentioned. It would make me sick and pissed off to see how these wonderful women were sometimes treated by nursing staff though.
Anyway, interesting topic - I always enjoy talking and learning about cultures. Being in a interracial relationship, from which three beautiful babies have srpung, I love to have my eyes, ears, heart, and mind opened up at every opportunity. And I try to share that with the nursing students I teach.
As for the male midwife - I went and looked at hsi website and it gave me the creeps to be honest. Prior to moving to Arizona, I started my midwifery clinicals in SC. One of my preceptors was a male midwfe and i thought it was a great guy. I was unsure initially about how I felt about a male midwife and really haven’t come to a firm decision on this subject yet. But this guy really gives me the heebie-jeebies. Also an interesting point made regarding the pictures he has on his website.
Will continue to ‘listen’ to this discussion as it goes on.
“There is an unrelenting psychic weight to being surrounded by members of other classes and cultures who may assume that you don’t measure up, aren’t as smart, aren’t even as attractive, aren’t there on the same merit as them”
Yes m’am. Preach. And it’s taking its toll on me.
This post made me write a post about why I think maternal health disparities exist, which I posted on my blog yesterday. BUT, today my blog identity was discovered by classmates. I’m a little devastated right now and trying to figure out what to do/how to handle it. So my blog is closed to the public until I figure it out.
But SageFemme, if you don’t mind, I’d like to cut and paste a portion here to add to the conversation?
LP
It’s always interesting to me to think about issues of race and class as it pertains to healthcare. I know the discussion is about midwifery, but I think allopathic medicine is right there with it. I did my residency training in the inner city, and definitely experienced that element of “practincing on” folks from less advantaged backgrounds.
Like a couple of posters above, I feel that I was always kind and compassionate, truly tried to learn about cultural differences, and really cared what happened to my clients. I’m still in touch with one client, especially, who I became close too in the 3 years that I was her doc, starting with the first week I had that “MD” after my name.
Also interesting to me to read those of us from the advantaged backgrounds talking about how it wasn’t like that, we weren’t practicing on poor folks, we really care, blah, blah, and then see the perspective of someone from that background saying their truth - that we aren’t trusted, that clients of color and poverty who go to the teaching establishments know that we are only there to get training and then move on. Maybe we provide good care - likely better care than anything else that’s available, but the clients know why we do it.
I think it is absolutely vital to hear these opinions as truth. It doesn’t matter what my white, middle class self feels about my training in the inner city. It doesn’t matter that I had only the best intentions. What matters is how the people I served feel about it. I think many of us who come from a place of privilege just do not see subtle racism and classism and tend to discount it when we do see it. We don’t understand the additive effect of living with it year after year after.
I am forever grateful for my training, for the few years peek into a different culture, a different world. I’m grateful for the opportunity to learn, but also feel sort of eternally guilty for having learned with clients who mostly had no choice. Please don’t misunderstand me - I’m a lovely person, really, and in many (maybe even most)cases I’m sure I was the best provider available to my clients during my training, but how shameful is it that the best they had available was a small-town white girl just out of med school?
I’m not sure what the answer is - how do communities become empowered to provide their own midwives, their own healthcare providers, their own wise women? Would taking training programs out of these communities help, or make it worse? Is there anything we, as outsiders, can do to encourage leaders to rise up within a community?
Good questions you raise, sagefemme, and I hope to see more folks joining in this discussion.
Loving Pecola,
I’m so sorry you’ve had to close your blog, I hope it works out that we can have the priviledge of viewing it again. (Hope your classmates don’t make too big a stink!)
DoctorJen,
Your words are a healing balm. Its good to hear you say these things. I was a teen mom and had my first baby (29 years ago) at the public city hospital. I remember all too well how I was treated. I was basically ignored. Even though I had taken Lamaze and did very well through my whole labor without drugs, at the time of delivery the resident gave me a pedendal block. (He needed the practice and his attending told him to do it.) Now I had no idea what it was at the time, I was just laying there thinking, “Did that white man just give me a shot in my coochie- even though I told him not to do it???” Many years later, after I became an L&D nurse, I purposely returned to the same hospital to work, because “I wanted to make a difference” How naive of me. I’m glad you tried to do the best you can. Frankly, so did I. I saw many many residents move through that hospital in my four years there. Some gave a damn, some were just doing their time. I like to think that having been in the client’s shoes, I could give them a better quality of care. I was wrong. The system only allowed me to give them comfort as I continued doing things they didn’t want done. The whole system is such a mess. You ask an excellent question. If the ‘babydocs’ as we called them weren’t there, who would be? Probably no one- like the rural poor have it. Part of me says at least care is available, the other part says its mostly crappy care because the patients are just there to be taught on- even though I was only 15, I knew it. Funny, but because of this system, the urban poor are more likely to get OVER TREATED which is still just as bad.