This past Friday I celebrated my fifth International Day of the Midwife. Reflecting on these five years in practice prompts waves of memories: first hearing the word “midwife” in an undergraduate women’s studies class; coming back to midwifery after years of working in global health; learning how to be truly present with and care for others, in tactile and soulful and mental and physical ways; my first years of practice wracking my heart and my body but opening up my mind to all that midwifery would do for me; starting this blog with a fire in my fingertips that felt explosive; joining Boards of Directors and considering how my role could be both in a clinical and leadership capacity; finding the reproductive justice community and reading everything I could find to determine how to best ally and support and join the passionate and historical fight women of color started decades ago; wholeheartedly taking students every day and every shift possible to learn from them and share what I’ve learned and believe to be midwifery truths; and continuing to understand the degrees to which my clinical practice is fulfilling and where/why/how I seek midwifery fulfillment outside of my scheduled hours, in writing and leadership and friendship.
All that being said, midwifery affects my personal life and my internal being in ways I did not entirely anticipate. I could not quite name what drew me so strongly to this work, but the “calling” that many describe is perhaps the best language to use. That internal push/pull should have been the first indication that there would be something more than “just work” about midwifery for me, but I am still learning the depths of its impact. I speak frequently about what I hope to bring to midwifery: as an advocate, a feminist, a humanist, an empathic person. I speak less frequently about what midwifery gives back to me, and honestly, I would never have anticipated how my day-to-day profession as a midwife would ultimately return full-circle: the community and the passion and the way of being a midwife, eventually, midwifed me.
Talking about healthy relationships and meeting people “where they are”: Not a clinical shift passes without conversations with people about their lives and their care illuminating the need for a conversation about healthy relationships. Usually this conversation would be prompted by hearing about how a partner was acting in an unhealthy way: jealousy, emotional or physical abuse, contraceptive manipulation, sexual manipulation, economic power, among many other concerns. For years, I talked about what a loving and supportive relationship looks like. Sometimes I frame these conversations by encouraging people to “imagine your perfect relationship, and how that partner might love and support you. now describe your current relationship and how that partner loves and supports you. how do the lists match?” These stark differences can help people see what they might work toward, or what differences might not be able to be surmounted in their current dynamic. Sometimes I encourage people to keep a relationship diary, writing down moments where they feel like their partner exemplified love and support, and moments when they felt the opposite, so we might talk about it again at the next visit in exact circumstances rather than generalities, the latter of which can be hard to critique from their perspective, and harder for me to consider and evaluate from my perspective. And sometimes people want to talk about everything that’s wrong and aren’t in a place to consider their relationship in concrete way, and that’s okay too.
Two and a half years ago, I began to realize that something in my life wasn’t right: those were my best words to describe my uncertainty. I started therapy for the first time in my life, feeling silly making the appointment, thankfully referred by a friend, thinking that if something was wrong and I couldn’t name it, that it must not be important. My first two therapy appointments I could not even speak: I sobbed uncontrollably. My therapist helped me realize quickly that if there was something I could not name, perhaps it was because it was an incredibly important thing, rather than something to be pushed aside. After a month of therapy, it was ultimately during one clinical conversation with my own patients in talking about healthy relationships that I felt overwhelmed with a wave of emotion and realization and power that my relationship was incredibly unhealthy and had been for a long time. Emotional abuse is a powerful tool. In my case, over years, I was convinced I could not survive alone, that my opinions did not matter, that my queerness was unimportant, that my feminism was overwhelming, that abortion was a topic to be kept quiet, that I was not attractive, that sex was not an important part of a relationship. It took a long time for me to unwind myself from all of that, and truthfully I still am. There are moments when I still feel stupid, or second guess the beauty of my body, or question the value of my opinions and shake when I state them (I shook two weeks ago stating an opinion at an abortion conference, an opinion I knew to be true to myself and those I care for, but still felt the weight of my historical experience in devaluing what I might say). I took me over a year to be able to leave my ex. It took years of talking about healthy relationships for me to realize the chronic malaise that was my own. It took establishing new friendships separate from my ex, sustaining an incredibly loving and caring and intimate relationship with someone I now consider an incredible friend, and taking the bravest leap I could have ever imagined to change my life. To midwifery, I am grateful for saving my heart and my love and my life.
My own experience of a complicated, unhealthy relationship also now brings me more compassion and understanding for others in similar scenarios. I bring more patience for someone’s timeline to leave an abusive partner, I bring more compassion for their desire to keep trying, and more kindness for decisions other than the, perhaps, “right” one. My midwifery is strengthened by how I have been midwifed myself.
Questioning power differentials and making space: I cannot remember if it was one class or a collective of classes in my midwifery training (or also from the nursing training of my program) that evaluated the myriad ways that healthcare visually and physically enacts power over people. When a provider stands and the care seeker sits while speaking with each other. When the provider begins with their list of concerns and the patient’s are asked for last. When the provider controls the speed / time of the visit and the level of importance of to-dos, without prioritizing according to the patient’s needs and rescheduling non-emergencies that might be on the provider’s list. When the patient says something hurts or is uncomfortable and the provider continues regardless, under the guise of “almost done” or “you’re okay” or “this is important to me as your provider even if it hurts you.” When the provider uses fear tactics to facilitate the patient to choose what the provider deems best, rather than the provider providing objective facts and allowing the patient to choose their own path with full unbiased information. And all the ways that we might challenge that power, or call it out, or give it to the patient to be used by them rather than by us. I think about this power differential all the time in my clinical practice: some days I succeed, some days I realize after the fact that I could have done more, some days I fail completely and try again the next day, or reach back out to the patient to check-in on how they’re doing and offer power back to them depending on the scenario. The nurses I work with are incredible at addressing power with patients and, skillfully, with the provider in the room, reminding me and others of questions / ways to re-engage people with their own power as part of their care. Many midwives and physicians are also skilled at acknowledging power and breaking it apart gracefully; many are not. Learning to bring our own historical experiences and personal biases to the forefront and re-learn how to be with others is not necessarily a linear process: I validate that for myself often, and for others as well.
I was secretly married. For over four years. This was one part of the emotional abuse. Ultimately, I got secretly divorced, as my ex explicitly wanted to keep the divorce from family and friends. I started to “out” myself as married and undergoing divorce to allow my support system to know, without oftentimes my going into further details, that my life was incredibly dysfunctional for a long time and they didn’t know. Divorce is incredibly dis-empowering: held to the laws of the state about how long the couple must wait to be able to divorce, what actions each person must undertake to prove reconciliation is futile, and cost of the process itself. I continue to be financially indebted to my choice to rebuild my life and divorce my ex, but continue to be overwhelmingly grateful to it. The most notable power differential I experienced as part of that process was in the hearing itself. I had my two closest friends with me as divorce doulas, which was possibly the next best decision I made second only to the divorce itself. I had been working with an attorney referred to me by a friend: she was unable to attend last minute and sent a colleague. The white male lawyer showed up late, had not read my file, had me fill out a stressful form last minute, and never explained exactly what would happen during the process. Apparently all divorces are scheduled at the same time. Everyone getting divorced shows up, the door closes, and are heard in a pre-determined order. I was second. The first woman was called to the front, and her attorney read aloud her reasons for getting divorced. Everyone else in the room could hear easily the complicated facts of her relationship, and her desire for the divorce. The female judge, sitting feet above the standing desired-divorcee, asked questions, interrupted parts of the answer she felt non-contributory, asked three different ways if she was pregnant (because in IL you cannot get divorced if you are pregnant, even if the baby is not of the spouse from whom one seeks divorce), and decided if she felt there were grounds. Then the woman was excused. I was next. I stood next to my lawyer, heard him read my case for all to hear, stared up at the judge who did not look at me. I was asked three different ways whether I was pregnant, and the judge ruled in favor of my rationale. I was shaking uncontrollably for most of this time. I remember all senses being heightened but someone only hearing a slightly muted version of my life being read aloud.
Divorce was one of the most emotional experiences I have ever been through. (I realize the incredible privilege that this was the hardest time in my life so far, and am grateful for that.) There were so many steps along the way that those in power could have made it easier, but seemingly did not. I acknowledge that there are moments of my care provision that are possibly of similar impact for those in my care, during which people might have heightened/muted sensual experiences: birth, cancer diagnoses, fetal death confirmation, pregnancy confirmation, bimanual examination. I approach each conversation with attention to people’s facial expressions, body position, and response. I seek to ensure understanding, from a health literacy and numeracy standpoint, but also emotional understanding. I offer to pause and wait, to be silent, to allow moments for people’s emotions to catch up with their brains, or vice versa. Power differentials oftentimes leave little space for emotion, I’ve learned, and for many the emotional response is the most important part.
Engaging allies: Midwifery is an inherently ally-building profession. We interact in all sorts of ways with other people, and view provision of our care as elevated by building community: first and foremost in building a relationship with the care seeker themself, with families and partners, in consultation with other midwives, in consultation / collaboration with fellow providers including nurse practitioners/physician assistants/physicians, in support of and supported by nursing, and alongside doulas. Part of our academic training involves how to have difficult conversations with patients, while our clinical training is meant to be more real-time experience in having difficult conversations with fellow providers. Midwives, as with any provider, function within a scope of practice that may encounter needs outside of our training, and lead to the need to engage others in our work, whose scope and training are more expansive and higher than our own. Thanks to multifactorial systems of privilege, oppression, racism, misogyny, capitalism, educational and leadership opportunities, and blatant social bias of the minds of men over the minds of others, often those with whom we interact at “higher” levels of training, are men. Looking at publications, references like up-to-date, attending provider educational conferences, and “expert opinions” on topics, often these are led, written, voiced, and acknowledged by men.
Now that I am no longer in a relationship with one, I associate infrequently with men. In one way, this is a natural change in the nature of my friendships and interactions: my girlfriend and I have few male friends, I care for mostly cis-women as their midwifery provider, I care for mostly people of color and their partners of color, and most of my family members are women. In another way, I am not actively choosing these interactions. This change in frequency now causes me to notice in almost breath-taking and crippling ways when men overpower women and others in interactions. This catches me off-guard frequently, and I’m not sure I handle it gracefully (not that I have to, but to facilitate improved interactions and improving male knowledge about their roles in engagement, I’d like to keep working on this). I’ve mostly noted this with white men, but now I am constantly evaluating their engagement in conversations. How many times they interrupt. How often they start by seeking opinions from others before stating their own. How often they use their privilege to elevate the voices and work of others rather than accepting offered opportunities immediately for themselves. In what ways they support the world experiences of women and impacts on communities other than their own. I know I am currently in a space of struggling in my interactions with white men, and, truthfully, have for a long time. Naming this is new to me, but experiencing it is not. I find that I’m annoyed and respond as such, often shutting down the male voice and the conversation as a whole. Judging their engagement from the start due to my feeling on the defense by their presence, assuming that they aren’t aware of themselves and their privilege in the conversation.
Recent interactions with men, and mostly white men, have been with physicians who are my colleagues, and these conversations are not going well. I find myself pushing back, hard, with little patience for the power they are openly wielding at me and at patients, and struggling with the best language and ways to respond. Midwifery is helping me not only make space for myself to continue to work through these interactions after-the-fact, to practice best “scripts” for these conversations going forward, and to allow myself and understand the ways in which I could do better, but also giving me strength to stand strong with my opinions (known more importantly as knowledge) and my role in upholding my patient’s wishes and care (known more importantly as advocacy). I recognize that my bias in these interactions is important and fuels my passionate responses, but that to find ways to engage fellow providers in these conversations is incredibly important, rather then pushing people away. Midwifery will continue to be my filter, thankfully, and will continue to guide me through.
Five years of this profession. Five years of my own midwifery care of and for others. Five years of my own personal transitions, and midwifery caring for me. Here’s to another five of all of it.
Sending you all love.