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The Irony of Privilege

I shared this article on Facebook entitled The WHO calls for sustained investment to increase midwife numbers. As the title suggests, there is a huge push for countries to find the money to educate midwives so the horrific death toll of moms and babies might be halved. WHO being the World Health Organization.

All her life, Roya has known that her life was inextricably linked with her mother's death. Within hours of her birth in a small village in rural Afghanistan, Roya's mother had bled to death.”

“She was one of the thousand women who die each day in childbirth. In addition, every year more than 7 million babies are stillborn or die shortly after birth – the majority from preventable conditions.”

The article goes on to say, "Fragile states", such as Afghanistan, need particular attention. The number of women who die in childbirth in conflict countries is almost double that of women in non conflict countries. Fifty per cent of under-fives who die, live in fragile states. Yet very little of the funding received by fragile states is long-term or predictable.”

Finally, Roya, who is a new midwife, says, “’I have always wanted to prevent women from going through what my mother faced,’ she says. ‘Midwifery is so important to reducing the mortality crisis. If mothers are healthy, a country is healthy and strong.’"

Powerful stuff.

My comment with the posting, a pretty off-handed comment at that, was, "Ironic, isn't it... that the rest of the world is craving midwives and here, women are UCing?"

A UC is an Unassisted (Child)Birth a birth with no midwife or other trained provider in attendance. This birthing choice is highly controversial and I've written nastily about it in the past. I'm really trying not to be so nasty anymore, but it's a distinct challenge. I cannot, however, stop talking about my views on UCs; hence this post which almost wrote itself as I read the original article.

A comment to my Facebook posting came in from my friend and midwife Colleen Scarlett. She says:

"It annoys me to no end, having been raised and having birthed in the developing world, to hear Western women glorify birth in the developing world or birth in pioneer days as proof we should 'trust birth'.

"Every time I hear someone say, 'What did women do 200 years ago?' I want to say, 'Well, they DIED.
OFTEN.' If you have ever been to a cemetery in New England that has gravestones from the 16 and 1700's, you will see Old Farmer John's gravestone, interred at 70 years old, buried alongside his 5 or 6 wives, all dead in their 20's, oftentimes buried with their newborns.

"Or when I hear someone say, 'Women all over the world squat in the fields and get up and go back to work,' I cringe. First off, I don't know of any culture where women simply squat in the fields, birth, and get right back to work because that baby would have a dead or dying mother in a few hours. The real truth is, globally, where women birth without an attendant, it's because either there's very little value placed on her life, there's no money to pay for an attendant, they live too far away from an attendant, or the attendant doesn't carry hemostatic drugs. And in those countries, women go into their pregnancies and labours praying they don't, but expecting to, die."

Many/Most of us who birth in the Western World, unless we've been elsewhere for any length of time, cannot comprehend the luxury it is for women to say they want to UC. Constant refrains from UCers is the close proximity of hospitals in case something happens. Imagine if those hospitals were three hours away and you had to walk to it and they would only let you in if you had the money... all with a massive hemorrhage going on or a shoulder dystocia. Would you want a midwife in your village then? I'm betting yes.

Reader Comments (29)

Barb, what's also ironic/ sad is that in the US, access to midwifery care is nearly as limited as in impoverished ones... Just for different reasons.

January 18, 2011 | Unregistered CommenterLori

This is such a hot button topic for me, not so much UC, which I happen to think is NOT a very wise decision but, hey, they DO have safety nets (hospitals) close by, I suppose, if something went terribly wrong, someone recognized that something was wrong, and they made it in time.
The real issue for me is the glorification of birthing without attendants in developing nations as the gold standard. As in "All over the world women birth by themselves every day!" And everyday they bleed to death, or their babies die from obstructed labour, or they develop deadly infections and BOTH die.
I highly recommend everyone read the White Ribbon Aliiance's Stories of Mothers Lost for some perspective about how much midwives contribute to women's health and how women die from causes that are preventable, all because there was no midwife present. So sad, and so eye opening.

January 18, 2011 | Unregistered CommenterColleen, LM

Another post, because I'm all worked up now.

There's a sort of arrogance, as well, in thinking, THAT sort of thing only happens where women are undernourished, or have no running water.." as if shopping at Whole Foods and having a fridge full of groceries and a toilet and sink can stop you from bleeding to death. People who live without running water know how to keep their homes clean, too. My first 2 children were born in a home that had no running water, or electricity. All water had to be carried from a community stand pipe, or rain caught off the roof into recycled steel barrels. My second son was born by kerosene lamplight, my mother holding the lamp so the midwife could see.

My midwife had very specific instructions about how much boiled, bottled water she needed for the birth. She boiled her instruments on a wood fire my partner was instructed to make. She was hands off because she couldn't afford to waste her gloves on a non-necessary exam.

By the time my third baby was born, after a labour that lasted exactly 45 minutes, I was lucky to live in a house with both water and electricity, but I also suffered an immense postpartum hemmorhage. With the closest hospital being 2 1/2 hours away by car, and the closest hospital with the ability to offer me a transfusion 3 1/2 hours away in the opposite direction, I was glad she could give me pitocin and stop me from bleeding to death. Very, very glad.

January 18, 2011 | Unregistered CommenterColleen, LM

Monique and the Mango Rains is a must-read for perspective and humility.

January 18, 2011 | Unregistered CommenterKatie

UC is too much risk for me. Sounds great if all is well, I'd love to be able to be private and birth with just my husband with me. Reality is that birth is one of those things that a woman can only see from up by her shoulders, she cannot know what's going on down there unless there is someone else to hold the mirror. Sure, she can do her own internal VE, but gee, that's not easy with a pregnant belly. Sure, she might be able to see how much blood is coming out. I personally have this tunnel thing that happens to me in birth. I feel like I am 10 miles away from my vagina, and when the baby comes out I cannot even think of reaching down and pulling the baby up, so it's hard for me to imagine being all alone and birthing. And then once the baby is born, all focus is on the child and I would totally not notice the bleeding. I know twice I've had the comment, "a lot of blood here" and then pitocin and clots or something was pulled out of me. I would not have the presence of mind to pull a clot out of myself, and may not even be able to do it. My husband certainly is not going in there for that! Remembering to massage my own uterus would be enough, but if there was a real problem? No way I could handle that with just me and my husband. No way. And then if I did survive but my baby did not, I couldn't afford to move, so I'd have to live in the house with the memory of that child's death...on my hands. How horrible.

January 18, 2011 | Unregistered CommenterDawn

okay i am going to probably write about this more when i have the time/energy to do so but...
hi! i live in a third world country. where maternal and infant mortality rates are not pretty. and poverty rates are not pretty. and i witness births. and frankly i find this post ethnocentric, racist, and just ugh...
but then barb, im sure you know that i disagree with you on uc.
i am going to only speak of the places where i have personally lived which is limited to mexico, palestine, jordan, egypt and some significant time in east africa.
1. oh yes there are women who want to uc. oh fuck yes there are. there are actually a good number of women who for multiple reasons inc. their past experiences with doctors, sexual assault history, self-reliance, etc want to give birth by themselves or just with immediate family. some of whom had a midwife at their previous births and feel like they dont need one anymore having gotten the hang of birthing.
2. the racist/ethnocentric part comes in painting '3rd world women' with a broad brush.. where are you talking about? are you talking in urban areas where doctors can be inaccessible primarily because of socio economic issues. or rural areas where doctors are inaccessible primarily for distance? are you talking palestine where checkpoints make healthcare more inaccessible? or you talking about southern mexico where being indigenous and not speaking spanish is a barrier toward care? because in all of these places i have met women who chose to uc, women who were forces to uc, and women who uc'd for complex reasons that cannot be boiled down to...well if there had been a midwife there, she wouldnt have uc'd. actually i know of women who chose to uc even though there was a community midwife there. shit is complicated. intersectional. and its oversimplified analysis of folks complex lives that leads to birthing folks not receiving the kind of care that they deserve.
3. i am pretty critical of 'first world' women and how they approach birth in terms of race, geography, socio economic class, health care access, etc. but i cannot understand the logic of a woman in minnesota uc-ing is somehow detrimental to a woman in uganda giving birth. it really does come across as: you better eat all your vegetables, because there are starving children in china!
4. if you want to get technical, every woman i have sat with at birth uc'd since i am not a professional midwife, not a cpm, not a certified doula, dont carry drugs, or major equipment. so, are the women uc-ing? do these women get to exist? or are we just going to erase them from the discussion because they dont fit the stereotypical 'third world woman' image that the media and ngo's feed us?

January 18, 2011 | Unregistered Commentermai'a

I'm not sure why you've gotten so angry about this, but I can tell you feel very strongly about the subject. It's obvious I haven't lived in all the places you have, I haven't done research on UC in non-Western countries (nor would I want to) and I have a very different viewpoint than you do. It might seem/be ethnocentric to you, but it is my (apparently) feeble attempt at understanding why moms and babies are dying at such an enormous rate around the world.

And, silly me for reading the press and believing that WHO has any concern about the life and health of women around the world.

I'm old, Mai'a. I can't go anywhere else... *do* anything else beyond writing and living my life as it is... here and now. I learn from reading -I certainly don't *watch* the news! I do the best I can with what I've got. Instead of being so angry that I don't know what you know (and carry the assumption that I'm a jerk and an ass for not knowing), teach me. Write what *you* know. I know I'm not the only one listening.

January 18, 2011 | Registered CommenterNavelgazing Midwife

Funny that Mai'a should talk about racism and ethnocentrism, because that is EXACTLY what I'm talking about; Western women glorifying birth in the developing world (Third World is a term that is no longer socially acceptable, BECAUSE of it's racist and ethnocentric connotations, BTW) as if developing world women give birth effortlessy, gloriously, freely choose to give birth without attendants, and they all survive. Talk about stereotypes!

(I'm wondering how a random foreigner gains access to witnessing women birthing all over the world without presenting herself as some sort of birth attendant. And does not carrying "major equipment" mean she carries "minor equipment", like a doppler, BP cuff and stethoscope? Sterile instruments? Just curious.)

Which also leads me to another issue I have with the natural birth community, the attitude, however disguised by well meaning intentions, that women from the developing world are guinea pigs or lab rats that Western women can practice their birth philosophies on, with Western women traveling to developing nations with their own birth agendas, 'educating" the downtrodden and oppressed local women about their own personal ideologies of "empowerment" and "autonomy" as the gold standard. It's bullshit. All of it.

I don't know who Barbara is referring to, but I know I am referring to the woman who is not allowed to cross a border and get to a doctor and subsequently dies. I am referring to the woman whose family members will not allow her to visit a midwife or see a male physician when her pregnancy becomes complicated. I am referring to the woman who's traditional birth attendant is unable to stop her bleeding because she doesn't carry hemostatic drugs. I am referring to the woman whose baby dies of tetanus because the cord was cut with an unsterilized knife. I am referring to the woman who has to walk 2 days to get a life saving cesarean section.

There will always be women, in every culture, who will "choose" to birth unattended, and yes, it's complicated, when she's the Mexican indiginous woman who is so afraid of being treated worse than a dog because she's Indian and doesn't speak Spanish she chooses to stay with her family. Yes it's complicated when traveling to see a doctor she might get shot or raped attempting to cross a border. Yes it's complicated when her family cannot afford the admission fees to the hospital so they do their best with what they have at home. Yes, it's complicated when her culture dictates that she must birth alone to prove herself a real woman worthy of her husband. Yes, it's complicated when the family still owes the midwife money and can't pay her for this birth. But are any of those scenarios actually a "choice"? A free-will, well thought out choice? Isn't simplifying the issue by saying UC is a valid option for these women a little arrogant and a lot naive? Isn't inviting yourself into these women's homes, with your Western ways and privilidge, and attending their births thinking you can "show them a better way" a LOT arrogant?

No, a woman UCing in Minnesota isn't detrimental to a woman UCing in Uganda, until some one applies that experience to justify the other, believing that because that woman willingly CHOOSES to UC and has a positive outcome, the woman in Uganda doesn't need or deserve a skilled attendant. Don't women deserve a skilled birth attendant from their own communities and cultures, and not some foreign "untrained" birth attendant with a personal agenda and whose only knowledge of that culture is that of a transient visitor?

The arrogance astounds me.

January 19, 2011 | Unregistered CommenterColleen, LM

Colleen, and you don't haven't written an article about this, why?!?!

You make my last comment look like I'm a total dork trying to understand a different point of view! All I need to do is talk to you. Wow.

Thanks so, so much for that comment. I'm considering adding it to the original post it's so wonderful.

Just wow.

January 19, 2011 | Registered CommenterNavelgazing Midwife

Racism, ethnocentrism, intersectionalism, oh my! lol. Mai'a, Colleen has it exactly right. When I asked an older woman friend in the East African village where I lived for a couple of years where women went to give birth, if they were ever at home without a doctor, but with a midwife, her eyes lit up and she said, "You know how to deliver babies?? I'll come get you!" See, I'm white and educated, never mind at that time I was 22 with EMT certification and a degree in biology doing HIV/AIDS education. I asked because I planned to become a nurse midwife, which I now am. In that part of the world, if you're a Western foreigner, in most people's experience that makes you a missionary or a doctor. You know what I said? "No, no, I am not trained." Because I wasn't. If something had gone wrong, I would have been a tourist of death, uselessly performing CPR without ability to shock, provide aftercare, or administer medications. I knew IM pitocin should be given for PP bleeding. I didn't have any, had never given an IM injection, and had not been trained to recognize PP hemorrhage in the first place. But my presence would have given the illusion of someone there with KNOWLEDGE, with perhaps the ability to help. I could have witnessed a lot of births but they didn't need or want another useless onlooker, they needed and WANTED kind, lifesaving, competent help. They already had plenty of incompetence; not many completely UC'd, because there was a hack of a "nursing officer" in the village who attended births for money to supplement his government salary. He was legendary for striking and screaming at laboring women. They put up with his brutality because of the slight chance that he could do something to save their life or that of their babies in case death threatened.

I came back from my East African experience and studied my ass off, and put myself deeply into debt, so that someday I can return with SKILLS and experience to pass them on to women who want them, so they can help their neighbors. They already have poverty tourists aplenty. As I see it, if we're going to have an old-fashioned moral-authority-off, you have come to the wrong blog, because Barb has literally saved lives, privileged lives, white lives, brown lives, American lives, Mexican lives, LIVES, and as far as I can tell, you're in the business of pontificating.

January 19, 2011 | Unregistered CommenterKatie

Wow Katie. What a story. Poverty tourism, I can't believe I have never heard the term before. I had to google it. Yikes.

I can't see how recognizing that what is needed to reduce the pathetic maternal/infant mortality rates in the deveoping world is access to providers who are trained and skilled is bad thing, or racist, or ethnocentric, or painting all women with the same brush. I suppose if someone said, "We need to form an army of Western midwives to go to Jordan/Egypt/Palestine/Mexico and SAVE "those people!" it would be. But what we are advocating for, and what the WHO and White Ribbon Alliance are advocating for, is an increase of home-grown, well trained midwives, doctors, and hospitals, people who speak their language and know the culture, know the womens mothers and aunties, and can work around cultural beliefs and superstitions and still get magnificent outcomes, who can rescussitate a baby and give a shot of pit to stop a hemmorhage, who can recognize pre-eclampsia and can monitor a baby's heart rate. Clearly, Roya of Afghanistan, who never knew her mother, agrees as well. And she, of all people, recognizes the seriousness of her calling....she intends to save lives, in honour of her mother who lost hers.
The answer is not a bunch of Western women, with their US/Canadian/UE passports, their pockets full of travelors cheques, and the ability to leave as soon as the bullets whizz too close to their own privilidged ears, attending, excuse me, WITNESSING, their births, especially if that foreigner can't prevent her from bleeding to death.

Birth tourism......ugh. Now there's a blog topic.

January 19, 2011 | Unregistered CommenterColleen, LM

I've just popped in before dinnertime and don't have time to write a lengthy response. I can say, however, that after reading M'aia's other blogs, I feel you all have pounced on her and just dismissed what she's said as ridiculous without looking seriously at her critique. I think Barb's original post and M'aia's comment actually are in a lot of agreement with one another. But to just dimiss M'aia outright and not admit to where your racial and ethnic blindspots might me is truly disheartening, but not surprising. That is the TRUE irony of privilege.

M'aia, I'm glad to have discovered your writing and will keep up with it.

January 19, 2011 | Unregistered CommenterJoselle

yeah this is why i dont really engage with n american midwives. i try, but damn, they start off by making a huge amount of assumptions about me, my history, my background, my education, the way i present myself to others, my experience, etc. a whole lot of opinions and barely any facts. personal attacks that in relation to my real life honestly make me laugh aloud...like srsly, you dont even know *why* ive had to travel so much, or the type of work i have done, or with whom, but you know...whatever...make assumptions.
but there are years of me writing on the interwebs, so umm...yeah...i use the term third world woman very consciously. and have written extensively (look it up) on why i use it. and written extensively on racism in first world natural birth world (google is amazing, try it...)
and once youve actually got a handle on the pretty extensive and complex critique i have about birth, ethnocentrism, racism, privilege, globalization, and how i experience them as a black, multi ethnic, us citizen, immigrant, ex political prisoner mama, then maybe we can have a conversation rather than a bunch of scare stories that do more to obscure the reality of my friends (aka third world women, oh, women from developing nations, oh two-thirds world women, oh, just straight up black and brown women, who give birth), than to illuminate it.

ugh...why are there so many well meaning women in the world claiming to give a damn about racism and ethnocentrism while at the same time perpetuating it and erasing the voices of actual brown and black women who live the reality right now day in and day out. i mean the voices of women that dont agree with your pre-judgements about what is *really* needed.
i have a pretty extensive critique on the WHO as well and 99 percent of ngo world, but you know...google it...

*kanye shrug*

im going to post this now in case the elec goes out again.

peace and love.

January 19, 2011 | Unregistered Commentermai'a

This would be hilarious, this pissing contest of Who's The Most Enlightened, if it weren't such a serious topic.

Mai'a: your own prejudices are glaring; perhaps you could take a gander at those and deal with them before you engage with us "n american midwives" again. Your haughty tone that we are the scum of the earth is getting old.

And, perhaps someone needs to mention, we don't spend all our days Googling those who comment in our posts or to our comments. Most of us have better things to do than read every bloody post or comment you've ever written in your life. In fact, a *good* writer presumes no one has read ANYTHING we've written and OFFERS some back story to our sweeping claims. So, in the future, if you want to snicker and sneer at our seeming ignorance, don't offer back story. On the other hand, if you feel honest discourse is in all of our better interests, then share some of your magnificent history with the peon rest of us.

I rescind my former apology. I jumped the gun and didn't need to apologize after all.

January 20, 2011 | Registered CommenterNavelgazing Midwife

Well, I DID read your blog, as much as I could before I lost my taste for it, and before I posted my reply. I read about your path to midwifery (why did you say you weren't a midwife in your original comment about "witnessing UCs" all over the world?) about your decision to not carry pitocin (something along the lines of "it's only blood, only a body," pretty scary stuff to someone who nearly bled to death). That you fancy yourself as some sort of outlaw and revolutionary.
Your comments bring to mind two proverbs from my youth; "Empty barrel mek de mos' noise" and "Self praise is no recommendation".

As a woman who is actually from the developing world, (I refuse to use the term Third World, as those of us who are actually FROM developing nations find it extremely condescending, no matter how consciously you think you write about it), who was educated there, birthed my children there, and who plans to return with the further education I received from N America and practice there, I find it absolutely ridiculous that someone from N America, has the nerve to think she actually knows what's best for me and the women I played in the dirt with, went to school with, carried buckets of water on my head with, washed clothes in the river with,and sat in an underfunded, under-staffed clinic on 2x4's stretched across cinder blocks for hours waiting to see the only community midwife within a 90 mile radius while hugely pregnant with. And why we walked, in the sun, for miles, with our big bellies and cranky toddlers, to get our monthly pregnant woman allowance of a couple pounds each of milk powder, cormeal, flour, rice, bulgar wheat and sugar. Doesn't seem like much, but for us, it was enough to get us to our monthly check ups.

We walked for those free Depo-Provera shots, too.

I was waiting for the black woman card to be thrown on the table, I knew it was (predictably) coming, you totally manipulated the conversation with your crazy ass comments about N American midwives and their lack of understanding the issues just so you could (predictably) scream "racist!" as your trump card, But I'll tell you what, when you cross our border, and enter our country with your US passport, your US dollars, your laptop, and your ability to leave whenever the fuck you want to, we don't give a shit about what you write or how much you write. Reality speaking, we'll listen to you talk, we'll pretend to agree with you, we'll pretend to be your friend, we'll let you in our homes, hell, we'll even cook you dinner and show you the sights, we'll take you to our waterfalls and garrisons and ganja farms if you drop a few dollars on us. We were raised with manners, after all. But I'll tell you another thing.......

We'll take YOUR money, too.

Just as fast as we'll take Suzy Snowflake's dollas.

Because when you come from N America, with your nice clothes, your free education, your soft feet that never walked to school barefoot, your un-calloused hands that never chopped wood or dug a yam hill, spending more on your months rent than we spend on feeding our kids for a year, and try to tell us about how rough YOU had it in America, the only thing that keeps us from laughing in your face is our good, old fashioned "Third World" manners. And if it's a man, he'll hang around, hoping he can fuck you into falling in love with him long enough to get him a green card.

And, did I mention? we want your money.

Every year, people of all colours and denominations and idealistic zeal and revolutionary rhetoric, descend upon us, stay a few months or a few years, trying to educate and empower us with their own personal brand of enlightenment, and eventually, they all leave, throwing their hands up in exasperation because they just can't get through to us, leaving us with unfinished projects, half built schools, unstaffed clinics, and ambulances that sit deteriorating because there's no money to maintain them and paramedics that go back to selling drugs to the rich black, white and asian tourists at the all-inclusives because suddenly there's no one to pay them.

Now, take it, not from a world travelor, searching for a surrogate home and a place to fit in, a place where she can be at the top of the food chain for a change, with a chip on her shoulder, but from a real life, bona fide, "Third World" woman, who has experienced, not witnessed, actually EXPERIENCED, first hand, what happens when there's not enough midwives, doctors or nurses to go around.

From someone who watched a childhood playmate bleed to death, sloooowly, on the side of the road because there was no car to take him to the nearest hospital 3 hours away.
Whose 7 month old baby, nearly dead from cholera and so dehydrated they had to put an IV in her scalp because all her veins collapsed, shared a cot with 3 other babies dying from cholera in a "third world" pediatric ward, packed with babies 3, 4, and sometimes 5 to a crib, all puking and shitting on each other, while the only pediatrician for miles around worked round the clock for weeks while every morning more little bodies were wrapped in a sheet and carried away.

A mother who held her breath when she walked into that hospital every morning, passing those tiny shrouds lined up on the gurney en route to the morgue, praying it wasn't MY baby who died during the night.

Who held another woman's baby in her arms, because she was unable to find busfare to sit with her dying daughter, as she breathed her last breath and evacuated her bowels one last time.

Who watched her 18 month old choke on the worms that were crawling up his throat at night, knowing that the doctor wouldn't be at the clinic for another three weeks.

Who pulled the 5 inch nail out of her 7 year olds foot, beat the wound with an empty bottle, and poured hot, melted black shoe polish on it because that was the only first aid I knew.

Who, at 15, ended up fucking some dude I couldn't stand so I could have bus money and shoes to go to school and ended up pregnant at 16.

Whose sister in law nearly bled to death due to placental abruption on a 3 hour drive in the bed of a pick up truck, while my father in law frantically sold all his goats, way below value, to find the money to pay the truck owner and hospital so they would let her in the doors. Yes, the baby died.

Who didn't have running water or electricity till I was nearly 30 years old, who took a machete and chopped wood to cook my family's meals until I was 26, and had to learn how to use a washing machine at 34.

You want to tell me what I REALLY needed? What would have REALLY made a difference? Because, you know, it's complicated and shit?
Because it's more complex than simply having a hospital closer than 3 hours away may have saved my nephew's life when his placenta decided to detach itself?

Because it's more intersectional than throwing the 10 year old boy who fell from a mango tree in the bed of a pick up truck for 3 hours probably contributed to his death? Or that he was turned away because they couldn't, not WOULDN'T, help him?

Everytime a friend or family member calls me from home, they tell me news of someone else I know dead; shot dead by police death squads, murdered for a few measly dollars, dead from an illness that probably wouldn't have killed them if they were here in the US.

Your experience as a Black woman in America does not apply to my experience. It doesn't give you any deeper understanding than it does the upper middle class white woman with a need to assauge her white guilt with charitable missions of mercy. Neither does my experience give me the authority to even pretend I can understand where you're coming from.
Does it make me racist and ethnocentric to think that my women deserve more than an unskilled, half trained birth attendent misrepresenting herself as a midwife so she can have something cool to blog about?

Whatever, just don't decide to come save my country, ok?

January 20, 2011 | Unregistered CommenterColleen, LM

I'm sorry to see that such an important discussion has been derailed. Mai'a had some really, really good points about the empowerment of women in developing countries. I think she could have phrased these points without sounding so hostile, though. Mai'a, if you're still reading these responses, please know that at least from my outsider's eyes, I believe the women who responded negatively to you were responding only to your accusations of arrogance, not to the content of your words.

I have to say that I don't think it's arrogant to travel to other countries to teach midwives. If we were only teaching about feminine empowerment, I would agree with Mai'a that it is far beyond our ken! However, these traveling, teaching midwives aren't teaching the next feminist revolution! They are teaching sterile technique. They are teaching the matriarchs of the village about germs. They are teaching how to resuscitate a newborn who is not breathing. They are teaching how to save lives! Since when is it arrogant to save lives? I don't think those village midwives are worried about arrogance or the lack thereof! I think they're worried about the women who are dying in their arms because there is nothing they can do to stop it! I would so much rather be condescended to by someone who can teach me valuable skills than be empowered by someone who doesn't know anything. Then again, my self esteem doesn't stem from my Inner Woman or anything like that. My self esteem is built on my strong back, with my strong hands and my quick brain that is currently studying to be a midwife.

Anyway. Back to the content of the post itself. I was very struck by Barb's statement that women don't just squat in a field and go back to work the next hour. When I was in college I took several courses in Russian history. We had the opportunity, as we learned how to research, to direct our own studies. I studied the rise of female doctors in 19th century Russia, and was very surprised at the time (I was still pre-med then) that the movement actually arose from midwifery. The first female doctors were only allowed to study and serve that credential because they agreed to stay out in the countryside and help rural women . . . something no other doctors would touch.

Russian serf women really did go out in the fields and work until the baby popped out, and they had some horrible medical issues. The rate of uterine prolapse was astoundingly high, and the infant death rate enormous. Because of the culture, many of these women would give birth every single year, and with every birth they had less food left for themselves and a higher chance of infection and death, to the point where it was almost normal for mothers to smother their newborns because they could not afford yet another child.

Midwives at that time were illiterate and often had no idea what to do to help with these circumstances. They hired scribes to write letters to the universities, begging for doctors to come and teach them skills, but they were universally ignored.

Today I believe developing countries are often in similar situations. The people crave knowledge and access to medicines and doctors to save their women and children from death. These are the women that Barb is talking about. All women who deserve better care than they can get, for whatever reason. The broad brush encompasses all women who are underserved, no matter what the reason is.

It may be arrogant of us to hold these fellow women in our hearts and in our hands and to feel the unity of spirit that connects all women, everywhere. Personally I believe that is our birthright, to help, and hold, and love. Even when we can do nothing but write about it.

We have earned the right to love our sisters across the world.

January 20, 2011 | Unregistered CommenterEmily

In case it's helpful, I googled Mai'a and birth and found this blog. If this is you, Mai'a, you have my respect and my thanks for being a voice for the helpless. It seems to me like you and Barb are on the same side. Unfortunately, as happens so often in history, we fight among ourselves because it's easier than fighting those who would oppress us.


January 20, 2011 | Unregistered CommenterEmily

I think I probably have nothing to say which would be valued in this debate.

But I wonder whether, if Maia and Colleen met, whether they mightn't actually like each other. They both do actually care about women and have experienced conditions in countries less materially blessed than this one. Somehow I think they might want the same things on the whole.

I mean, good to work for training for midwives from women's own communities. Good to value where they are coming from when they make their choices, and not bad to sit with them when they are in labor if they really want you there and they don't have access to someone more skilled. I don't think Colleen has any reason to think that Maia is a "poverty tourist" or a "birth tourist." Or that Maia knows either how Colleen got to be living somewhere with no running water or electricity.

It isn't even clear here what the argument is about. Does Maia NOT think that women should have access to trained midwives in their own culture? Does Colleen NOT value the choices they make in the situations they really face now? So what exactly are they fighting about? The right to speak for these women? I don't think anyone can do that in any kind of universal way.

I'd like to see these two passionate women stop fighting and see if they can't see some common ground and maybe join strength to strength.
Am I too unrealistic?
Susan Peterson

January 20, 2011 | Unregistered CommenterSusan Peterson

I moved to Northern Africa over a year ago, and have heard several stories of women dying in birth here due to preventable circumstances or at least circumstances that could be treated like bleeding or a rupture. In fact, it's not just childbirth...

January 21, 2011 | Unregistered CommenterJennifer

I read that blog's intro until I got to the line about decreasing maternal mortality in developing countries by teaching the raw food diet philosophy. I couldn't go any further.

January 21, 2011 | Unregistered CommenterKatie

Hear hear Susan!
I have read all of this, I have read Mai'a's other blogs, and I am completely confused about what the fight is about...
Any chance you 3 can step back and breathe, then come back and find some common ground about helping women? I would LOVE to see the outcome of 3 such passionate women all pulling in the same direction..
just my 2 cents.

January 21, 2011 | Unregistered CommenterNicole

really simple: i made a critique of an IDEA and pointed out the racist and ethnocentric implications of the IDEA. and some ladies took that critique personally and in response attacked me personally.

that's the problem. that is the disagreement.

January 21, 2011 | Unregistered Commentermai'a

i agree with Joselle, Emily, and Susan Peterson - and i'm glad to have found mai'a's writing. i also don't get what the fight is about. i'm sure there's a lot more agreement between everyone commenting than disagreement and it's a real shame the disagreements are all that are focused on. what a waste of passion!

with that said, the pissing contest mentioned was definitely upped a notch by Colleen's lengthy examples - you win! you win! sheesh.

re: the actual blog post, i don't see the irony. sure, there's a general ignorance u.s./western people have regarding their lives and how different it is from the way the vast majority of the world lives. sure, people need to realize their privileges, look at why they have them, look at who doesn't and why, and so on. but how does that mean choosing a UC equals trampling over third world women's right to adequate health care and professionals? that's a leap i just don't understand.

January 21, 2011 | Unregistered Commenterandrea

I'll weigh in as the privilaged white UC mom (actually pretty darn close to minnesota ;) who has never traveled out of the US. A couple of points that stand out to me are:

1. I see a lot of birthworkers triggered by the term "unassisted birth." The word "unassisted" does have an arrogance attached to it that is not representative of me or most of the UC moms I've communicated with. I did not choose UC to disprove the value of what midwives do or stick my tonge at OBs with a "neener neener neener, I DONT NEED YOU!" I did it to best meet the needs of my family unit. not to make a statment about anyone else. I am completely aware that choosing UC is a privilage made safe by things many women don't have: the ability to transfer to a hospital, access to information and materials to self-educate (much of which is available because of professionals,) food, water and medicine available my entire life (just to name a few.) All of these things, are in many ways forms of assistance. I would absolutely re-assess the neccesity/value of a midwife's presence if I didn't have these privilages.

2. I think lori hit the nail on the head with the first comment here. Midwives are not available enough here in the US. Women having it worse across the globe doesn't mean we shouldn't ask for better here. If me going to the hospital and getting the intervention-heavy birth of my nightmares meant that the nightmares of a woman in poverty (far more horrific than what I can probably imagine) would not be realized, I'd go. But it doesn't work that way.

3. I too think that glorifying birth in developing countries and saying "what did women used to do XXX years ago?" are inaccurate, tired arguements. What I'd like to know more about is what birth was like Pre-Agriculture, when we lived as nomads more in touch with nature and perhaps respected birth, life and death a great deal more. That is closer to *my* ideal. and, yes I'm aware that respecting death often meant accepting it and no, I'm not willing to respect that circle enough to put my money where my mouth is and let my children die because I see a downside to the technology that provides emergency care, antibiotics, etc. What I do wonder, though, is if humanity had put more reverence on the QUALITY of life early on -- focusing on how to accept and understand nature rather than scrambling to be in control -- and developed our technology and ability to manipulate the natural order after we were more spiritually enlightened... I wonder where we would be as a species today... I think many people are just wondering the same thing under those arguements.

4. I have very little concept of what it's like to live in fear of sickness or physical danger every day. I don't pretend to. What I know is my life and just like every other mother I want a little better for my kids. I've experienced a depression so deep that I wrote letters to everyone I loved incase that last bit of 'me' that was left slipped away in the night and I could no longer talk myself out of suicide. To me, returning to that dark spot is a reality that I will do what I can to avoid, both for myself and for my husband and children. i considered this and many other things when weighing the relative safety of UC given my privileged life.

January 22, 2011 | Unregistered Commenterlia_joy

Amy Tuteur: *yawn* You're really boring and we allll know your "message," so, "anonymous" yourself into a frenzy and move on. You shan't find light to grow here.

January 23, 2011 | Registered CommenterNavelgazing Midwife

Oh wow THANK YOU FOR THIS. I totally agree. It's such upper-class privilege to declare that "the natural way is how those pooooor people do it!". It's always bugged me, but you put it into words. Thank you!

January 23, 2011 | Unregistered CommenterLaLa Makes A Baby

"Many/Most of us who birth in the Western World, unless we've been elsewhere for any length of time, cannot comprehend the luxury it is for women to say they want to UC."
Thanks for posting this. As a student midwife learning midwifery in a developing country and serving women living in poverty (and having been a birth activist/doula for the past 5 years in the states), I have had my eyes open to the fact that SO much of how we live/birth in the states is based in our own privilege. Privilege that we are largely blind to. Not that we don't have alot of work to do regarding birth rights in the states. We do. But, midwives are desperately needed in developing countries. TRAINED midwives. I think even in midwifery texts in the states there is a really idealized version of the "untrained midwife," and birth being so normal and natural (ie: woman birthing in a field and going back to work), because the pendulum is being swung (and rightly so) from intense medical model interventions and the medical hierarchy of a "doctor in charge," to an idea that birth is normal so it must not be dangerous. This will sound very un "midwifery PC," but birth *can* be dangerous, like anything else in life can be dangerous. And I have seen women bleeding out in front of my eyes and know that she would have died if she would have had her baby at home with a hilot (traditional midwife here, but is un-trained and practice some harmful traditions such as rubbing a woman's fundus with gasoline postpartum among other things). *But* there should be a balance...women are literally dying in developing countries for trained midwives, yes. But, if a woman can give birth herself in a country where there are abundant healthy food sources and a woman is eating abundant protein/iron rich foods every day, not totally stressed caring for 12 kids and her husband, living in poverty and dealing with all of the complex issues surrounding that, then go for it. I see both here. Some women have homebirths alone here for a variety of reasons. Some go fine, some not at all. But the danger as midwives is to say that ALL births should be UC. I could go on, but I'll stop :)

January 27, 2011 | Unregistered CommenterBeth Durden

Jennifer could not post (not sure why, sorry!), so here's her comment:

"@Colleen, I have a few very sincere questions for you. But first, let me say that I won't make any assumptions about you, and I respectfully ask you do the same for me.

My son was born last year a few days after the earthquake in Haiti. I remember sitting in my clean hospital room, holding my healthy son, drinking my clean water, and watching news coverage of the suffering of the Haitian people. The piece that got to me most was watching a news report on women giving birth in the street, in horrible conditions, without trained caregivers, because the hospital had collapsed and all the medical personnel were busy with severely injured patients. Later, after I finally made the decision to become a CNM (years in the making) and I was researching midwifery programs, I came across one that had a longstanding program in Haiti. They had posted information about sending aid to Haiti after the earthquake.

Now I have read your posts, and was struck by your story. When you wrote about "assuaging our white woman's guilt" I wondered what you would have us (at least me- white/American/middle class/educated/heterosexual woman) do to help? Do you not want my help? Should I just send money, and forget perhaps one day (in a few years when I am financially and physically able, as well as educated enough) traveling to a place like Haiti to help? What are the things you think will help, in the short term and long term? Do you not want the Red Cross/Salvation Army/Doctors Without Borders/etc to render aid? What's a woman who wants to be a midwife one day and wants to help somehow to do?"

January 27, 2011 | Registered CommenterNavelgazing Midwife

A privilege is a special entitlement to immunity granted by the state or another authority to a restricted group, either by birth or on a conditional basis. It can be revoked in certain circumstances. In modern democratic states, a privilege is conditional and granted only after birth. By contrast, a right is an inherent, irrevocable entitlement held by all citizens or all human beings from the moment of birth

April 27, 2012 | Unregistered Commenterwheelchairs

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