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.