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Continuation Still on Race & Midwifery

Jumping from the complete post here from Minority Midwifery Student:

I appreciate Minority Midwifery Student (whose words are italicized below) taking so much time to question and answer this issue. By the lack of comments, I wonder if it doesn’t interest people as much as other, more “fun” topics like birth stories… but I want to let those that read regularly know – these types of topics are infinitely important. Please continue reading, digesting, formulating your own ideas, opinions and then DO-ing what you feel is right in your own world. (I was traveling and birthing for a couple of days, so didn't see that there were comments, but still not as many as I'd hoped. The comments are phenomenal. Read them if you haven't!)

I am not saying that it is problematic that (new) midwives practice in communities other than their own. But ask yourself, why do they do this? Are there not any patients in their communities that need care?

Some of what I wasn’t able to say is that I know many women in the (wide) middle class swath are included in this “clinic” culture, finding themselves in that place of not having enough money for insurance, but qualifying for government programs that ensure prenatal care for most (who seek it).

Are there crowds of white women sitting in waiting rooms needing prenatal care? Absolutely, and the midwives take care of these women just as I am speaking about being a provider for women of color… these might just be the women of different culture (socio-economic… are we considering that a different culture? I didn’t distinguish that initially… perhaps I could/should have?).

Is that people in their community would rather be cared for by someone with experience?

Doesn’t everyone prefer to be cared for by someone with experience? (Antagonistically) Perhaps some cultures are more able to demand what they want than others – and get it. Perhaps generations of servitude has brow-beaten women into accepting what is given instead of believing they deserve more… or imagining a possibility were more might be theirs. Perhaps entire cultures of women are standing naked in hospital gowns with their asses bared to the room as choice after choice slips through their fingers and all they are left with is a vaginal birth to call “normal.”

It’s part of what I was trying to say about how maybe we aren’t the worst. Maybe we can elevate our own status by proving how wonderful we are as students. Let me move on….

Is that they feel drawn to help communities other than their own because they see that a need exists and they have the skills to fill the need?

You and I both know that answer varies. Ideally, yes. Realistically, not always.

Are they coming to this community to stay, or to get their numbers?

Or are they coming because they are assigned there by their school, preceptor or their state licensing that requires them to obtain a certain level of skill.

I don’t just see that as “numbers,” but as experience. I think when midwives speak about “getting numbers,” it is incredibly offensive and I move we all stop saying it now. I’m just as guilty as others of using the term, but it is highly offensive to the women who graciously allow us to work with them during their pregnancy and postpartum period.

So, is it a horrible offense to have to go somewhere where there are a great deal of women in need and be there to help out for a limited amount of time in trade for gaining a great deal of experience that will go on to make you a better midwife so you can move forward and help many, many more women along the way? I don’t see it as such. Maybe that is my own justification, but it is my view and my experience with working in a different culture than my own.

Why is there such a need in the first place? Why is that there aren't any providers/leaders from this particular community available to fill the need?

I don’t know the answer to these questions. Where are the leaders? I don’t know. Where are the leaders in the midwifery world? Who would we turn to as a bonafide leader if we had to pick one? Suzanne Arms? Ina May Gaskin? Ricki Lake? Each of them has their moments, but if we were going to think “Leader,” it might not even be easy for us and damn, don’t we want to get some things changed, too?

I'm a midwifery student; if it's helpful to get practice in communities other than your own...how come aint nobody ever sent me to the ritziest part of town to practice for clinical?

Well, that would have to be out-of-my-element, too, then! I’ve had a few clients make more than 5 figures, but I’ve had far more make less than those 5 figures. My own “class” range (I believe) falls squarely in the middle. (I’m probably delusional, though. I always thought my dad’s income was upper middle class and then I learned we were actually lower middle class. Isn’t “class” such an amazing concept? A topic all its own.)

NM asked: "If we didn’t move outside our own communities, isn’t that forcing women to travel outside their own neighborhoods to obtain care?" Can I say something radical? Withdraw your care. Maybe if you did, our community would find another way. I mean, we wouldn't have a choice, would we? When doctors and nurses would not care for us in the past, we cared for our damn selves. (we built the institutions to train and provide care) When we could not go to "your" schools, we educated ourselves (again, we built the schools and educated our children), and contrary to popular belief, we did a better job at it.

So, you never want me to serve a black woman again? (And I am not being a smart ass, I am trying to clarify.) You are asking midwives to not see the women sitting in the waiting rooms at clinics so they will figure out what to do on their own? Will there be a mad dash of the black midwives to “their” communities, the Latinas to “theirs” and the whites to “theirs” so women can immediately begin their apprenticeships and the pregnant women don’t lose continuity of care?

What if I consider the Mexican community “my” community? Did I have to be born in it to qualify? Who makes the rules? What if the Mexican women consider me “theirs?” Do I qualify then?

This gets sticky now, doesn’t it.

But I'm not convinced that what we have right now is any better, especially if you're already thinking that if you don't do it, no one will. (forcing women to travel out of their communities for care...maybe instead of coming to find you, I would support my local 18 year old who wants to apprentice, or my soon-to-graduate-college neighbor for a CNM program)

THEN DO IT! Don’t wait for some hypothetical day when whites aren’t in your neighborhood. Support her now! I don’t believe if I don’t do it, no one will… I believe there is an army of others behind me who will. They just might not be the color you want them to be. Why, I don’t know.

NM asked: "Wouldn’t it be a much kinder and more respectful move to get off our asses and set up shop in their areas of town, acclimate to their culture and offer them the fabulous care they deserve?

My answer: NOPE. What I want is a way to give this "fabulous" care to my damn self. I want midwifery/medicine to stop being this barely attainable career path for people like me. I don't want to have to wait until you feel inclined to give me care. After I have managed to make this possible for people in my community, then YES, certainly, come join me. Let me learn from you, and you learn from me. You're more than welcome to set up shop, but it shouldn't be because the system that leads to this possibility is rigged in your favor. When most of the providers are from one background and most of patients are from another...the learning exchange doesn't feel quite equal...

Okay, so I (we) are to just sit on our asses and see a need and wait for someone to start something before we go in to help? Isn’t this a little… um… unrealistic?

If a community of women need maternity care and the community can’t find the resources to take care of them, why in the hell should outsiders just sit idly by waiting for someone to make some move towards doing something? What if those leaders mentioned above don’t give a whit about midwives? What if they think all the women should be shipped over to Cesarean Central Hospital and be happy about it? Have you not seen or heard about these examples in your midwifery school yet? I think it’s quite idealistic of you to think people should wait out self-help, but sometimes – many times – sharing resources is a gift and not seen as a negative. (And I don't mean that us white people's "gifts" should be accepted without question. I don't mean that. I really do mean a sharing of resources from both communities. That sharing is a gift we both offer each other.) It’s sad that you already see so much negativity in the joining of resources and experiences – I hope you can find a more gentle vision of what I meant in my post.

NM, do you know how very few of us there are? I mean really.

Yes, I do. I know there is one black face in my own community. I know the black midwifery community is so small they have their own conference. I cannot fathom what it would feel like to be the only black person in my entire midwifery community.

I can tell you with absolute honesty that when I was a child, seeing someone of color in a particular profession absolutely made that profession seem more feasible for me.

I am thrilled, then, that you and other blacks, Hispanics, Asians, Filipinas, etc. are joining the ranks – so you can inspire those that sit in front of you. It must make you beam with pride to know how much you are affecting change! How wonderful is that?

NM would "like to believe that [we] can leap over the color/race/culture hurdle all on [our] own without someone leading [us] by the hand."

It's not a hurdle. It's my existence. There's no getting over it NM. I might be able to work something out by going around it, but that's about it. And I'll tell you, it damn sure ain't no ways easy to get around it without some help. Someone did lead me (through this racial identity process) by the hand, and I intend to lead as many as I can by the hand, too.

Reading this, I selfishly thought of my own hurdles. We all have them, don’t we. I wore my fat (wear my fat) and it straddles me tightly to this day, affecting everything I do. I tried to make it come off, but yet, it remains. I think about being lesbian, Jewish, when I was disabled, sick… none of it even compares to the issues a black woman has to endure in this society. (Tack on lesbian or Jewish or or or… and it gets even more complicated!)

I really do appreciate this dialogue. It’s been one I’ve had for years about a variety of topics. (Once you get to be nearly 50, the topics just rotate around and around, I think.) It’s a great one that bears on-going discussion.

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Reader Comments (3)

I agree with a lot of what you have to say. Here I will just comment on what I don't for the sake of not repeating the whole thing!

Clarification: Of course I (nor you) did not invent this "get their numbers" term and I agree that it is offensive as a description of people. I doubt it's going anywhere, but I'd join the badwagon to remove it from my own vocabulary.

I think a fundamental issue that we won't be agreeing on is the "going where there is a great deal of need for a limited time to make you a better midwife" issue. I just think it's SO MUCH MORE than that. You asked if it was a "horrible offense to have to go" but I don't think everyone who's doing it "has" to do it...I think LOAN REPAYMENT plays a huge role in why people have these 2 year stints in low income areas.

In response to my ? about getting practice in a community other than your own, you replied that the ritzy neighborhood "would have to be out-of-my-element, too, then!" So, great, now I'm still asking- "how come no one ever sends/sent us there to practice?" My point is simply that we sometimes use people who have very few resources, and the people with the fewest resources are disproportionately minority...not ONLY minority (I never said that) but disproportionately minority, which is why when talking about class I find it very hard to separate race.

Do I want you to never serve another black woman again? Of course not. My statement is a reaction to how I felt reading your statement about coming to provide me care so I don't have to come find you...it is as though there's you and there's you. At what point do we try to answer the question of why there's only you, and more importantly, how we can change that? The rest of that comment/paragraph pertains to my frustration with this whole "wait for others to do something for you, help you, give it you" mentality that permeates my community...so, that wasn't all about you; it was a call to folks in my own community to remember that we have what it takes to be self-sufficient, but maybe we need some folks to step out of the way to help us remember that. Or maybe we don't. It's a thought though, and I've had this same conversation with some other folks about similar things. Like wishing that one day all the teachers at certain schools just wouldn't show up, just to see if we would be more proactive about the education our children are receiving, and similar topics.

And, no, I don't think it's sticky at all- you can claim any community you want. What's sticky about that? If you claim to be part of the community in question, I'm not talking to you when I ask those who came to "rescue" us to withdraw. And if you're part of the community, it wouldn't occur to you wothdraw anyway, right?

Of course I'm supporting people in my community so that they can in turn support the next person, but that doesn't change the fact that sometimes a fire is lit under your ass when no one's there to hand you what you're looking for.

I don't think my view about your idea of "sharing resources" is negative. I just call for a joining of resources after *BOTH* sides have more equitable resources to contribute, and I don't think my body, our bodies (whoever makes up the community) should be the resource that I'm contributing. Did you have other resources in mind? Maybe if there were a little more talking/listening I'd feel like I was contributing more than just my body to your (my, as a student) learning experience (myself included as I learn on those don't have much choice but to get care from me or no one at all). When I was patient in this setting, I didn't feel like there was an equal exchange of anything going on. Maybe your experiecnes have been otherwise.

"It’s sad that you already see so much negativity in the joining of resources and experiences."

I don't quite know what to say to this. I have taken/continue to take all that I have been dealt (and dealt to myself) and work with it to the best of my ability. We all get tired sometimes. Tired of trusting that every one who reaches out is doing so to help us when a million times that hand that has reached out has, in fact, hurt us. I admire those of you who forgive and forget over and over again, trusting over and over again. I don't think my view of the situation is sad, I just think it's different than yours on a few points.

Not sad, just different.

September 28, 2007 | Unregistered CommenterLoving Pecola

I am formulating my own comments on this issue at my own blog, but i just wanted to say here, wow. hanks to both of you for reminding me that there is so much more in my brain and my soul than the minimal stuff I have been doing so far. My baby blog (cause it is only wee and new) is developing in my brain at least as i form my own views on the issues raised here and the comments shared.

Here in NZ, we have different issues, but they are also the same: our minorities are deprived of midwives and HCP's of their own race, and yes, the hospitals that serve those minorities are the teaching hospitals which we are sent to as green newbies to get numbers (agree, this phrase needs to vanish into the ether and not remain in our vocabulary!)and practice before being sent to the more "affluent" hospitals in other areas.

I am white, but like Barbara, I consider my socioeconomic status part of my culture: including my history as a teen mother (single, of course) and high school drop out. I totally get LP's comments about her experience as a minority being not a hurdle but her very existence: All my adult life, i have been reminded that I screwed up my options at sixteen, and that as a result I should accept my station as resident screw up, within my family, within my social cirle etc. when I announced I was going to university for a midwifery degree the silence was resounding. My family made noises of support, but I know they doubted my ability. when i graduated, as a straight A scholarship winning student, my mother and sister just about broke their arms clapping... but they had doubted me. And they had recognised the likelihood of my failure, or they wouldn't have been so resoundingly proud.

So when I was sent to practice on lower socio economic women who often presented as teenage pregnancies to be "dealt with" I struggled with the judgements laid on them. Now, working as an independent midwife, I am trying to seek out the clients ho come from MY culture: lower socioeconomic teen parents. And I feel that I can offer them an empathy that was missing in experiences I saw as a student. More comments to follow on my own experiences on my blog... but thank you for sparking my fingers to activity and my brain to thoughtful reflection.

October 3, 2007 | Unregistered CommenterTrin RM

I wrote something that is adjacent to the stuff the midwives are tossing around about race. It's specifically about genital circumcision and originated from a post student midwife over at belly tales sent me. I know you're away. Not sure if you're away from computers, too. In any case, feel free to read and/or weigh in when you can.

October 9, 2007 | Unregistered CommenterDark Daughta

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