Midwives of the Revolution

Explorations, analysis, and reflections on women's health, midwifery, and politics from a feminist, marxist lens


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Transition

It has been so long since I have put anything in this space. So much has happened over the last year for reproductive rights, workers, immigrants, healthcare access, the political mood and movements, and my personal and professional life has not let me keep up with it here. Though I have had my best work-life balance of my professional life so far over this last year, I’ve had a hard time squeezing in time for writing about my experience or my thoughts about what’s happening in the world.

A lot of what is hard is that my dear mother has really been on my case about protecting my professional identity, and about being ever so careful about how I present myself on the Internet, in spite of my attempts to remain as anonymous as possible here. It’s incredibly hard, as someone who has so many damn opinions and for whom my profession is a major passion of my life, to figure out how much I can say about what I think about things, while preserving myself professionally. Are there enough disclaimers in the world to cover me and protect me from losing my job, or offending my clients, or not getting some job in the future? Probably not. So I hold a lot of ideas in my mind and wrestle with what is appropriate enough for me to put into print.

Hopefully this is.

Well, I’m doing it. I’m transitioning. A very welcome, but also a terrifying change, from intrapartum care only in the hospital to not only full scope (GYN and OB) care but to homebirth. I have been working over almost the entire last year mainly in a very large private academic medical center that I previously thought of only as my city’s “baby factory” because so, so many people deliver there. I have also been moonlighting in a similar role in a small Catholic community hospital in my neighborhood that primarily serves Black and Latinx patients. These were both very welcome changes from the major challenges I encountered at my previous position, and my life over the last year has allowed me to settle into a fairly reasonable routine that works well with my family and activist lives.

But now my dream job has started, and my world is being uprooted, but for the better.  in the most delightful ways. champagne

Why am I making this change? I’m giving up a 36 hour workweek with hardly any stress about my job, for being on call 20 days a month for a position that I care about deeply and find spiritually satisfying. I’m giving up about 100 miles a week in bike commuting (often schlepping my daughter on the bike trailer) for having to always be close to my car and driving all over a large metro area to I can get to labors and births in a timely manner. I’m giving up a position that allowed me to make a midwifery stamp and positively impact my patients during their labor, as I provide physician extender service as part of a resident team, for one in which I will partner with a team of midwives to develop relationships with our clients, who have invited us into our homes for the most intimate moments of childbearing. I’m giving up watching how the medicalization of childbirth, while “evidence-based” and in highly skilled and talented hands, so often leads to much higher rates of complications than one should see in otherwise healthy people, for a birth setting in which emergencies can still happen, and the operating room or assisted delivery or complicated resuscitation is still a 9-1-1 call away.

Sure, I’m giving up some personal comforts (and admittedly, proximity to emergency help), but I am leaping into what I am hoping will be a tremendous adventure that will train me to be so much more skilled in what I care about: normal birth with healthy people. It’s a tremendous honor to be seen for my skills and potential, and to have been chosen for this practice. There’s only one way to know if this is my perfect fit, and it’s to try! So, here’s to doing my best at trying!

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Getting ready!

image

Spending this beautiful Sunday afternoon practicing surgical knots and perineal suturing. Took me a minute to remember how it works, but then it all came back to me. Next, rehearsing OB emergencies and mechanisms of delivery.

This week, I start attending deliveries! Looking forward to being there for my mamas inpatient, finally.


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Updates Galore!

I have made it past the 3 month mark…it’s hard to believe it’s only been three months. Almost four now, but still…

Here are some highlights and lowlights from my world these days…

1. Looking forward to the Socialism Conference.

It’s this weekend — an extended conference this year, it started today. But I can’t take any days off work until my six month work anniversary, so I’ll only be attending Saturday and Sunday. Here are some talks and featured events this year that I’m looking forward to:

Special Education & Disability Rights

Marxism and indigenous feminism

Women, race, and class: A history of Black feminism

Who needs gender? A Marxist analysis

Capital’s missing book: Social reproduction theory and the global working class today

Who cares: Work, gender, and the repro­duction of labor power

From criminalization to “rape culture”: Re­thinking the politics of sexual violence

From restrictions to criminalization: The fight for reproductive rights today

Capitalism, socialism, and mental illness

What should socialists say about privilege checking?

Microbes and Marxism: Capitalism and public health

“Obamacare” as neoliberal health care reform

…OMG there is so much! Obviously won’t be able to make it to all of those sessions, but those are some of the ones I thought might be of particular interest to readers, and which speak to some topics I’ve been thinking about/excited about lately.

2. I’m sick of the judging.

I feel like everyone I work with is burnt out and cynical. I’m sick of victim blaming, slut shaming, poverty-ignoring, moralizing attitudes coming from people I work with. Especially the OB I work with. It’s poisonous, and trying to figure out how to respond with fierce compassion. Patients and staff deserve to feel human. 

3. Getting into the hospital…

This will of course bring new challenges. Now, I kinda have it good. Getting used to being in clinic full time, getting to know my patients, learning what basic and expanded skills I need to have for clinic. But it will be nice, come September (fingers crossed!), to have hospital privileges so I can actually start to be present with my patients in the hospital. I still have to have a bunch of deliveries supervised by the aforementioned physician, and hopefully by some midwives I’ll be working with, but it’s good to know it’s on the horizon. 

4. Got a rad shout-out by the fabulous Feminist Midwife!

My friend, mentor, and trail-blazing hero over at Feminist Midwife gave me and a fellow red midwife a lovely mention in her recent post here, honoring the work of sharing the journey via the blogosphere. Thanks, FM!

5. Feeling appreciated

Though every day is emotionally and clinically challenging, it is also rewarding. I am feeling every day that I make a difference when I provide good care, and I can see it in my patients’ faces and in their continuing to come in for care and opening up to me. Another perk is outside of clinic — being known among friends, fellow activists, and family, as someone who knows some things about reproductive health — and who can be trusted to ask about it. Maybe it’ll get old one day, but I doubt it. I love those calls/texts/FB messages about family planning, pregnancy, and sexual health. So, thank you to those folks who have come to me with those questions, and I hope I have been helpful. 


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Why You Should Choose a Nurse-Midwife for Your Pregnancy/Primary/Well Person Care

When I started on this path, I was in my mid-twenties. None of my close friends had ever continued pregnancies or chosen to parent. This is partly why midwifery had never occurred to me as a career at that stage in my life — none of us were in that place in their lives. But now that we are approaching “AMA” or “advanced” maternal age, or the ripe old age of 35 (haha), many of my friends are now starting families (or trying to). Lucky for them, they now have a midwife friend! 

So, this is an open letter to all my baby-making (and aspiring baby making) friends and family. 

My basic advice/message is:

Choose a nurse midwife for your pregnancy care!*

Here are 5 reasons why many pregnant people should consider using a certified nurse midwife (CNM) as their prenatal care provider and birth attendant.

1. Client education and counseling

Nurse-midwives aim to spend time with our patients and get to know you. We want to know what is important to you and meet you there. If you want a provider to listen to you and to openly and without judgment respond to your concerns about pregnancy and birth, you have a pretty good chance of finding this in a nurse-midwife.

2. Supporting physiologic processes

This is a hallmark of midwifery care. Take initiation of labor, for instance. A midwife will take a holistic approach — to ensuring your due date is correct, to providing physiologic means of helping you go into labor on time, and choosing not to admit you to the labor and delivery unit until you are really in labor. All of these are part of an approach that supports the pregnant person’s ability to have a baby when it’s time. It may also mean helping you push your baby out to minimize trauma and tearing of the perineal muscles, and certainly avoiding cutting your muscle to make room for baby’s head or shoulders (episiotomy). 

3. Evidence-based practice (EBP)

From my first semester in nursing school, EPB was drilled into my brain. I can’t tell you how many papers I wrote about EPB…but I’m glad I did, because it instilled in me a drive to provide care that is based on rigorous review of current evidence and is patient-centered. What does this mean? A good provider (social worker/doctor/physical therapist, etc.) draws upon current research and literature reviews to determine how they practice. I am very proud that this is a centerpiece of nurse midwifery education and culture. Not that seeing a CNM is any guarantee of this, but it certainly something that most CNMs should be familiar with. The CNM professional organization put together this fabulous resource compiling data about how we use EBP – Midwifery: Evidence-Based Practice. Our practice is not (or at least should not be!) based on expert opinion, tradition, convenience, fear of malpractice lawsuits, or other provider-centered philosophies — but rooted in solid evidence and a patient-centered approach. 

 

4. Labor support!

The best midwives will support you while you’re in labor — not just leave you to labor on your own and then show up at the end to do the delivery. In some busy practices, that may not be possible, so I always encourage pregnant people to find out what their provider does. Midwives are trained in labor support, meaning they can help keep you active and can provide comfort measures that can help you out throughout the process. Unfortunately, many physicians do not (but should!) receive training in normal birth, and often do not know what to do to promote your comfort during labor other than offer drugs. Midwives understand that labor is hard work and can support moms through it. 

5. Greater chance of normal birth

According to a recent survey of research on midwifery, you are more likely to experience the following when getting care with a certified nurse midwife: 

• Lower rates of cesarean birth,
• Lower rates of labor induction and augmentation,
• Significant reduction in the incidence of third and fourth degree perineal tears,
• Lower use of regional anesthesia, and
• Higher rates of breastfeeding. (Newhouse, Stanik-Hutt, White, et al, 2011)

These are not reasons you should not use a nurse midwife

1. I want an epidural

If you choose to have your baby in a hospital, your nurse midwife can still order you an epidural, if that is the anesthesia/analgesia option of your choosing. 

2. I want to have my baby in hospital

No problem – the vast majority of midwife-attended births are in hospitals. You may not even realize it, but there may be midwives at your local hospital. 

3. Midwives don’t know enough stuff

So you may have heard that terrible slam Bill O’Reilly made about advanced practice clinicians (APCs, formerly known as mid-level providers, yech!) — worried that the increase in care by folks in these professions aren’t qualified be good healthcare providers. (Yeah, I know, my readers are big O’Reilly fans.) “Lenny from community college” couldn’t possibly be my provider, he said of physician assistants! (See the response from the American Academy of Nurse Practitioners here.) Even so! Many people don’t know what training we receive. O’Reilly’s ridiculous comments (among thousands he’s made over the years) aside, becoming a CNM is no joke. I’m proud to say that I have attended many community colleges throughout my education, but I also will report that CNMs are required to have a bachelor’s degree, be a registered nurse, hold a master’s degree, pass a rigorous certification exam, and become licensed through the state they live in as both a registered nurse and an advanced practice nurse. We are very well prepared to take care of people when it is within our scope of practice.

4. I want someone I can see always, not just when I’m pregnant

No problem! Loads of midwives work in settings where they can provide well woman, gynecologic, family planning, and even primary care. It depends on how the midwife’s practice setting works, but in many cases, you may be able to see your CNM across the reproductive lifespan. 

5. Doctors know best

Haha, I know no one reading this blog would think that. But I really ran out of reasons why you should not see a midwife. 

***

So…if you are low risk (not diabetic, chronically have high blood pressure, etc.) you may be a great candidate for working with a midwife! Get out there and FIND A MIDWIFE!!! And if there isn’t one in your area…well, shoot. Maybe you should get on the path to become a midwife, or tell someone you know who would make a great CNM to get on that path. We need more great women’s health providers. If you are feeling the call…better answer!

 

Reference:

Newhouse RP, Stanik-Hutt J, White KM, et al. Advanced practice nursing outcomes 1990-
2008: a systematic review. Nurs Econ. 2011;29(5):1-22

*Or your well person/family planning/gyne/primary care. More on “women” later…


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Abortion should be available on demand, without restrictions, for everyone who needs it. I believe that while society still places limits on what a woman may or may not do with her own body, while women’s sexuality and reproduction are still in effect controlled by the state, any discussion of equality or empowerment is a joke. – Laurie Penny

Sums it up.

http://towardfreedom.com/51-global-news-and-analysis/global-news-and-analysis/3542-abortion-should-be-free-safe-and-legal-for-everyone 


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Happy Mother’s Day!

Happiest of Mother’s Day to all you mamas out there. When judging mothers is something of an American pass-time, I hope you can enjoy this day and be celebrated!

***

Throughout the history of the women’s movement, there are been elements that have used an appeal to womanhood, to motherhood, to build movements for peace and justice. I’m not one to celebrate essentialist notions of gender, or to presume there is anything innate to women that should make us more peace-loving than other genders. But my political stance on that withstanding, I do want to take a minute to share some history from that side of the feminist movement — the radical anti-war mamas who started the tradition that is now known as Mother’s Day. 

Here’s a poem that serves as a rallying cry to mothers to oppose the Franco-Prussian war:

A Mother’s Day Proclamation
Julia Ward Howe, 1870

Arise then…women of this day!
Arise, all women who have hearts!
Whether your baptism be of water or of tears!
Say firmly:
“We will not have questions answ
ered by irrelevant agencies,
Our husbands will not come to us, reeking with carnage,
For caresses and applause.
Our sons shall not be taken from us to unlearn
All that we have been able to teach them of charity, mercy and patience.
We, the women of one country,
Will be too tender of those of another country
To allow our sons to be trained to injure theirs.”

From the voice of a devastated Earth a voice goes up with
Our own. It says: “Disarm! Disarm!
The sword of murder is not the balance of justice.”
Blood does not wipe our dishonor,
Nor violence indicate possession.
As men have often forsaken the plough and the anvil
At the summons of war,
Let women now leave all that may be left of home
For a great and earnest day of counsel.
Let them meet first, as women, to bewail and commemorate the dead.
Let them solemnly take counsel with each other as to the means
Whereby the great human family can live in peace…
Each bearing after his own time the sacred impress, not of Caesar,
But of God –
In the name of womanhood and humanity, I earnestly ask
That a general congress of women without limit of nationality,
May be appointed and held at so
meplace deemed most convenient
And the earliest period consistent with its objects,
To promote the alliance of the different nationalities,
The amicable settlement of international questions,
The great and general interests of peace.

Here’s a great post outlining the story: http://www.thedailybeast.com/articles/2014/05/11/the-radical-history-of-mother-s-day.html 

***

And on a lighter note, I’m looking forward to spending today with my Mother, who is ever my hero and my inspiration. I hope you, dear reader, have a restorative and beautiful day. 


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“Cool, you’re a midwife! So does that mean that you, like go to people’s houses?” Or: What Is a Nurse-Midwife Anyway?

The number one most frequently asked question of midwives in casual conversation or upon doing the whole “what do you do for a living” thing has to be about home birth. This piece is to set the record straight for the less informed readers and friends out there who may have some interesting ideas about what modern midwifery is about. 

International Day of the Midwife is around the corner (May 5), so in preparation, I invite you to learn about midwifery so come the 5th, you can show off your knowledge and love for women and midwives!

1. The vast majority of midwives who attend birth do so in hospital or out of hospital birth centers.

According to the American College of Nurse Midwives, a 2012 survey showed that only 2.5% of all certified midwife or certified nurse-midwives (CNMs) attended births in the home. Home births comprise a tiny minority of all deliveries — according to the CDC, only 1.36% of all births were not in a hospital setting, and that includes birth centers. 

Now…if you ask me, there are probably loads of people who would do well in out of hospital or even home birth. And I would *love* to attend home births one day when I’m more experienced. But nurse midwives would be in real trouble if we only attended home births, since these are such a small number of the births overall. Now, we capture 10% of the deliveries, which is great and probably will only increase. 

Anyway! Most of us are employed by hospitals or physician practices, and you are likely to find us as an option for prenatal care or delivery if you look. We are often listed as “under” a physician — for instance, if you were to look under your medical insurance for a provider, you might not find us independently listed, but we might be in the office as well. 

Imagemidwifery today is not like this.

 

 

2. Home birth…

Studies have shown that for low-risk healthy women, home birth is as safe as hospital birth. We are not nearly as healthy as a society as we should be, so many women risk out of home birth. But as a feminist, I believe that women’s bodies are capable of normal birth (that’s how we survived as a species) and support the appropriate use of technologies that can help lower risk (like fetal monitoring or c-section when medically indicated). 

But for now, most women have their babies in the hospital, and that has its own risks in this country. But that is where you will find most of us midwives.

3. Labor

Unlike nurses working as RNs, most nurse midwives are not in a good position for collective bargaining. Once you get to the “professional” or health care provider level, you are likely to be in a position to negotiate personally for your working conditions, wages, and benefits. Many midwives do work for themselves in private practice in a physician office or doing home birth, but the question most people ask when they find out I’m a midwife is if I have to drum up my own clientele and run my own business. And the answer is no, that’s why I work for a clinic and not as a homebirth midwife. And even though I’m not in a position for collective bargaining, at least I have coworkers, someone to do billing for me, malpractice insurance, and an office I don’t pay rent on. 

4. One Day

I want to have hundreds of births under my belt before I venture out to be a homebirth midwife. There is so much to see, so many different experiences, good and bad, that I feel I need to be prepared to attend births in patients’ homes. Unfortunately, in this country, we’re not set up to get experience this way unless we want to have our own practice/small business. 

Image

 

I love this piece. Can someone please buy this for my office?

5. In the Meantime

What do midwives do? Of course, we attend births. We take care of (usually healthy, low risk) pregnant, postpartum, and lactating mamas. But what most people don’t realize is that we take care of women across the lifespan. Yes, most of us focus on gyne issues — family planning, sexually transmitted infections, menstrual or other reproductive system issues, menopause management, cervical and breast cancer screening and prevention. Others may train to do more advanced stuff like primary care management of chronic health conditions or do more complicated procedures like colposcopy or dilation and curettage or even surgical assistance for c-section surgeries. Much like other advanced practice nurses like our nurse practitioner or physician assistant colleagues, nurse midwives manage many of the same patients our physician colleagues may also attend to. We may consult or co-manage care with physicians for more high risk stuff (diabetes or high blood pressure in pregnancy, or preterm labor), or refer to physicians for surgical care like tubal ligation, fibroid removal, or cesarean section. 

6. Science and Stuff: Or, How We Practice

For historical reasons, “midwife” does conjure up the lay healer, and that experience or association is often degraded, even among midwives. Traditionally, the lay midwife’s science was her knowledge of her own experience and that of her mentors. She learned about the wisdom of the body from attending to women’s reproductive needs from contraception to abortion to birth and postpartum care. The advent of modern medicine and the revolution in obstetric care has in many ways contributed to loss of critical knowledge about normal lifecycle events. Though midwifery wanted during that revolution, it is back and stronger than it has been in decades.

Midwife means: “with woman.” We are present with the woman (or female bodied or female identified person) for everything. Midwifery means respecting the body and helping the body and mind be healthy. Midwifery draws on traditional knowledge of women’s bodies, and modern nurse midwifery is demands evidence based practice to wed experience with science.

Midwives, like providers in any care field, practice with a wide variety of styles. Wherever we practice, whatever our style, being a midwife is not about where we deliver care to women or their babies — the hospital, public health clinic, private practice, home — but about bringing our knowledge about and respect for women’s experiences and choices. Wherever we are, whatever our job title, we should be found working with women to achieve general, reproductive, and sexual wellness goals.

No, I don’t do homebirth (yet). Most of my day is not that glamorous…I’m usually in the office assessing women’s health needs and trying to help them manage issues like unplanned pregnancy, menstrual disorders, STIs, sad vaginas (see earlier post), alcoholism and smoking too much weed, parenting while father of the baby or boyfriend is incarcerated, depression, overweight and obesity, family planning goals, and pregnancy. Promoting breastfeeding, teaching about the menstrual cycle, and most of all, trying to get women to understand and love their own vaginas–and yes, the smell that comes with it!

And sex. Mostly, my day is spent talking about sex. That’s why midwifery is awesome.