A midwife speaks about the world's other other health crisis we need to confront.
Reading a headline about a mother dying hits me square in the chest; trapping the air next to my heart, aching, as my soul quakes with rage, fear and pain. I read her name—Amber Isaac, Sha-Asia Washington, Dr. Chaniece Wallace—and I try to create an image in my mind of who this person was, the family she left behind, and the life left un-lived in her stolen hopes and dreams. Another woman of color, dead. All because of a broken system with even more broken providers.
As a midwife, what makes me hang my head in grief, shame and defeat is the absence of the provider's voice in the conversations regarding the maternal morbidity and mortality epidemic happening in this country.
We are the only global north country where the maternal morbidity and mortality rate is rising; where it is now less safe to give birth for women than it was a generation ago.
The maternal health crisis exists because we have come so far away from the normal physiological process of birth. We practice from fear and intervene in order to control the bodies of birthing people. We do not cry out against the racism embedded in our birthing system where people of color are five times in the US, and eight to twelve times in New York City, more likely to die compared to a white person. We have failed to acknowledge or accept that there is something called obstetric violence being practiced under the name of "standard of care" and that the language and expectations we put on birthing people are so judgmental and narrow it ends up being another form of suppression.
We hear from public officials, NGOs, family members, doulas and hospital administrators, but the care providers (midwives, nurses and doctors) remain silent. The lack of validation of this being a crisis from those who are actually providing the care to pregnant people gives permission for the rest of the world to move past another senseless and preventable death of a mother quickly and without awareness of the scale of this crisis.
And though the aforementioned parties have a right to a voice and to holding us accountable, they don't have the perspective of the clinicians who could speak fully to the breadth of the problems; this limits the scope of the solutions. It's easy for the rest of the birth community to scrutinize and judge decisions we providers have made because they have never had to make life-saving choices and live with the weight of that decision; and we've allowed for only their voices and perspectives to be heard.
I acknowledge it's nearly impossible to speak up as providers. There's the crippling judgment that comes from the rest of the birth community, the fear of implication by acknowledging our own mistakes, the secondary trauma endured and the threat of litigation that we are in fact to blame for all of it. I have heard us being painted as dismissive, indifferent at best, nefarious at worst, negligent care providers who cause serious harm to patients, which has stunned and shamed me into silence. However, I cannot stay silent anymore while women continue to suffer the consequences of our failing birth system in America.
Some birth care providers stay in the shadows of fear or indifference of this maternal health crisis and vary in their degree of acceptance that the system is flawed, racist, misogynistic, suppressive and dangerous. We participate in perpetuating the maternal health crisis by subscribing to the fear-based rules and practices of the current system. Some days, us simply doing our job hurts more than it helps the people we set out to take care of. But we cannot keep accepting silence and indifference: We cannot accept the status quo of our unconscious biases, the normalization of obstetric violence, the dearth of birth workers of color and a broken system that causes harm any longer. We will continue to exacerbate the problem if we do not accept our responsibility to speak up and do better for the people we serve.
I will in no way defend those who are negligent, racist, misogynistic providers, those who refuse to acknowledge and unpack their implicit bias, or those who do not think there's anything wrong with our current system of care. I am willing to estimate, however, birth workers who came into this profession to be healers, are not showing up everyday to harm pregnant people knowingly or intentionally, but the implicit bias we all carry and the systemic racism built into this current system is harming pregnant people. Implicit bias is real. Racism is real and largely what the current practice of OB/GYN was founded on. Misogyny, patriarchy and hierarchy are real in this system of birth—I have seen it firsthand.
We providers want to take good care of people and we put so much energy, effort and emotion into keeping our patients safe and well. We must realize though that good intentions and being "nice" to patients is not anti-racist work, and it is not enough to dismantle the pernicious nature of this system built on racism, misogyny, patriarchy and hierarchy. The provider problem is that our energy is misdirected based on the trappings of how "safe" and "well" are currently defined in the birth environments, policies and practices of our current, oppressive system. We are pouring ourselves into the wrong beliefs and practices and the burnout we feel is a symptom of a failing system, which perpetuates the genesis of the obstetric violence and trauma we never intended to commit.
We need to have urgency without blame. Our good intentions need to bring us to do the hard work; the heart work. The work that requires we acknowledge our own unconscious bias, unlearn it and hold others and the system accountable so that we can best care for the birthing people in our communities.
Part of healing is being honest about the past traumas we have lived through as providers and not letting the fear surrounding them lead our current practices. I can start with what traumas I need to work through to be a better provider in order to start the conversation: being a midwife—undermined, disrespected, disregarded and thought of as a "physician extender"; every person I feel I have traumatized in the name of "doing what's best for them and the baby"; being complicit in a racist and misogynistic system; being a white, cis-gendered, heterosexual able-bodied provider; being judged and made to feel inadequate by other birth workers; burnout.
Now, what are yours?
I encourage us all to be honest about where we are emotionally in our practice and what's holding us back from showing up for our patients in the way they deserve. I understand, especially with the strain of a global pandemic resting square on our shoulders, it feels impossible to give more of yourself, but our mothers and the current state of maternal health require us to.
Ask yourself, "If this system was actually functional and safe, why would we be working this hard only to be failing the people we care for?" What's even more shocking about this birth crisis is that it's been a large-scale epidemic for generations, yet we have not met it with the same urgency and response as the pandemic we are currently facing. Why? What about mothers, especially people of color, dying is less offensive than COVID-19? Why have we not met this maternal health crisis with the same swift action and collective awareness to what we are in right now?
There is no one-size-fits-all solution to the social construct of birth and subsequent birthing crisis we have created. Most times the conversations around the solutions are biased, myopic and redundant: midwife versus doctor, home birth versus hospital, vaginal birth versus cesarean birth, epidural versus no pain medication, etc. We get nowhere on the merry-go-round of "who has the answer" because we lack the audacity to think bigger and more alternatively about the problem and solutions of this crisis. And make no mistake, I am not placing blame for the failings of our current system on the providers alone, but I want to make clear that this system and its failings will hold no immediate solution if we wait for it to come from within the very broken system of birth and stay silent in the process.
So let's start speaking up and advocating for our patients on a different stage and through our honesty, self-reflection and unwavering commitment to "do no harm." We are part of the multi-dimensional web of birth work orbiting around the pregnant person, and when we stay silent when another person has died in our hands, the precarious process of healing, accountability, action and solutions dies with them. And while I don't feel birth, in general, belongs within the confines of the medical institution, we must learn from the example being set forth now in the midst of this pandemic that, as care providers, our healing, our work and our voice, matter. In fact, us using the power of our voices might be the only thing that can save the lives of our mothers—the people we are committed, whole-heartedly, to serve.
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