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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[Some] Breastfeeding Moms Can Now Do More!

There has been much jubilation this week in the women’s health and lactation (and tech) worlds this week as a brand new “smart” breast pump that will be hitting the market this Spring got the tech world excited at CES 2017. While the Scary Mommy blog and Association of Women’s Health, Obstetric, and Neonatal Nurses were beside themselves with joy over the new Willow breastpump, I believe a healthy dose of skepticism about this type of product is in order.

What’s the big idea? It’s quiet and discrete–you can wear it under your bra, it’s wireless, and it has some cool tech features. It’s being pitched as a way to multitask while pumping. Imagine easily commuting, going to the movies, making dinner, or cleaning the bathroom while pumping! Great for busy nursing parents, right?!

willow-breast-pump

Willow has a beautiful design,and if such technology was developed and made available in order to actually improve working parents’ lives, including, say, being a covered benefit under state Medicaid programs that would actually help working class and poor women meet their breastfeeding goals, that would be great! And, you know, if it came with gains for our side like the Fight for 15 movement is fighting for, it would be even more meaningful.

Don’t get me wrong–as a supporter of human milk for human babies and a former (and possibly future) pumping and working mama, I am for easing the burden of expressing milk when needed. For instance, as a nursing mama, I did bring my electric pump to the opening night of Star Wars: Force Awakens last year–went straight from clinic to the movies and plugged in during the previews and opening credits! This pump would have indeed made my expression of milk easier. The critique that follows is more about lower wage women than about professional workers such as myself that could likely afford the Willow. In regard to the Willow, we must consider the following not just about our own potential personal use of the pump but about what it represents.

  1. Moms are under pressure more than ever to Do More. You’ve heard that cute phrase “mother’s work is never done”? Or perhaps are familiar with the concept of the “second shift” of women* having two jobs–one (usually under-) paid at work, then going home to be mainly responsible for housework and childcare? With the devaluing of care and women’s work generally, nursing mamas are producing even more value for the economy by making food for their infants that doesn’t have to be paid for (unlike artificial milk for babies, which can be exorbitant but is paid for by programs like WIC). This product allows the pumping parent to Do More while pumping. Sure, that may be convenient and beneficial for many mamas struggling to feed their children, whether working outside of the home or not. However, it strikes me that this product is a symptom (not a creator) of the general societal expectation for mamas to be Super Mothers. In this time of neoliberalism and very few social resources that would actually help parents raise healthy children like, say, socialized high quality daycare/other childcare, postpartum in-home nurse care, excellent local public schools, accessible healthy food for families, walkable safe neighborhoods, paid maternity leave (for at least 12 months like a civilized county) etc.–mothers are still expected to Do Everything to raise healthy children by: breastfeeding in spite of all odds, prepare homemade meals for our kids every night, and sacrifice everything to be the right kind of mother who balances career and parenting. No such standards are ever applied to men/fathers because Sexism.
  2. willow-working-mom

    Ah, the working pumping mother! She’s so efficient and beautiful and productive! You hardly notice she’s a working mother! Makes you wonder if the manufacturer looked at the federal laws on pumping before launching this marketing campaign, or if they are directing it to capital. 

    Let’s be real. While mothers who can afford it (see point #3, below) would likely benefit from a pump like this to get more done at home–though most pumping moms I know do most of their pumping while at work, except exclusively pumping mamas–the real and direct beneficiary of products like Willow are the corporations that don’t really want to support their employees’ right to undisturbed pumping time on the job that is (for now) guaranteed under the Affordable Care Act. Makes you wonder if the creators of Willow have just been waiting for the ACA to be closer to repeal in order to promote this product. In every circle of breastfeeding parents I have been part of, there are constant questions about workers’ rights to pumping time. Many people resort to working through pumping time (though not as discretely as they would with the Willow) because it’s just not practical to take proper breaks to pump (I myself usually did charting while pumping because there’s always charting to be done, and the extra charting time lessened my time staying late). This will only get worse if nursing protections are lost with the almost inevitable upcoming ACA repeal. Bad news for maternal and child health–and workers’ rights. But here’s Willow, and ready to accommodate your upcoming loss of rights! Wouldn’t you like to see your midwife while they express milk for their child?! Or have your latte prepped by a properly productive multitasking discretely pumping barista? Or groceries rung up by a pumping cashier?

  3. Retailing at over $400, plus and astonishing $0.50 per single-use milk storage bag, Willow will be cost prohibitive to the vast majority of working mothers. For a product that will make it easier to make pumping parents work through their pumping session, the least capital could do is subsidize this product. In a rational world, corporations would be made to bear the burden of the cost of such a product, rather than consumers. Sure, eventually, Willow would benefit under the current ACA requirement for health insurance to provide lactation benefits. But until then–or after, if/when ACA is repealed under the next Administration–Willow will be a privilege of a small minority of wealthier professionals who can afford it. I wouldn’t consider Willow a “game-changer,” as it’s being touted, unless and until it is free to all pumping parents who need it in order to meet their breastfeeding goals.
  4. Finally, one question about this product that I’ve seen raised by lots of mamas on breastfeeding forums has to do with the actual science of milk production. Willow claims that it senses letdown and then switches to expression mode (not far off from Medela’s technology), but many pumping parents have expressed (um, sorry) concern that it can be hard to actually produce more milk while focusing on things other than nourishing the baby you love. That’s why many people don’t like pumping–you are always having to measure your output against your baby’s nutrition needs for the next day, and for many, the pressure of making enough makes this a stressful rather than satisfying process. The pressure many of us feel to pump enough in our stressful parenting and working lives does more harm for milk production than good. Some may feel better getting things done while pumping rather than staring at the pump as it fills up, but I question the physiologic good of hooking a mama up to a pump so she can be disconnected from the thing her body is doing (expressing milk) while her mind can be focused on doing something else. This seems to suggest that our nursing bodies are just machines for milk output. Most of the writing I’ve seen on increasing milk production (and I have ear a lot of it while struggling with it personally) suggests focusing your mind on your body and your baby–prety much the opposite of what Willow encourages. I am reminded of the pumping women in Mad Max: Fury Road, who I swear must have all been taking domperidone–making milk for the society and able to do little else. They needed Willow to up their capacity as contributors to the patriarchy!

    fury-road-pumping

    Imagine a post-apocalyptic world with human milk a major source of sustenance and Willow at the ready to integrate pumping people into other productive endeavors!

  5. I hope the next phase of the women’s and reproductive justice movement will fight for paid maternity leave, and more collective solutions to infant nutrition and maternal health than are currently on offer under capitalism, and more specifically, neoliberalism. I hope we will be fighting for more leisure time for workers, so that we could start to imagine technology not to benefit the bosses and the war on women, but solutions for the common good and public health. Willow seems to me a symptom of a particularly American problem, whereas a society that actually values maternal-child health and in which mothers and workers actually have rights, would produce, say, workplace-based nurseries where nursing parents can feed their babies on demand and not be shackled to a pump during the workday at all. Or, say, hospital-grade pumps you could just hook up to (BYO parts), and more lactation lounges at your workplace or public locations like cafes, libraries, bars, etc. De-stigmatizing and promoting breastfeeding is not about individual decisions to nurse or breastfeeding in public, but must be part of changing the infrastructure of our society, and fighting sexism at every step, so that women’s reproductive work (pregnancy/parenting/nursing) can be separated from her life in a healthy, holistic way (yes, nursing parents and other mothers do need to get out of the house/be away from their nurslings sometimes).

    Some of these solutions exist in social democracies, and many of them have not yet been won anywhere, to my knowledge. Let’s not lower our horizons to hoping a product like Willow will lift busy nursing mamas from our drudgery, but use this as a way to vision a better way to integrate the needs of nursing dyads into society.

    *I am using “mother” and “mama” and “women here for linguistic ease. I do recognize that not all breastfeeding parents identify in these ways, and I seek to honor that in my writing. Most of the theoretical work about social reproduction and the second shift focuses on the care work of “women,”  and sexism has generally underpinned the war on mothers specifically. In the framework and sense of solidarity that I would like to put forward here, I do generally refer to women/mothers, because an attack on women and mothers generally underpins the war on parents of all genders, including gender non-conforming and trans* parents. I hope that as the movements for reproductive and gender justice grow in the coming years, they will help us develop more useful and inclusive language that helps capture the shared and also distinct experiences of sexism, misogyny, etc. of gendered oppression. And I hope you will read my piece with understanding and generosity toward my linguistic limits.


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How I Got Here; Or: Why I Am a Nurse-Midwife

Now that I’m here, I’ve jumped through the hurdles of getting my degree, passing boards, getting licensed, and becoming employed, I thought it would be nice to reflect on how I got here. It’s easy to take for granted sometimes, now that I just wake up and go to work every day. But I’m doing what I set out to do! I’m midwifing! So…how did that happen?

Back in the day…

My background is in languages and literature. I studied English and Spanish in undergrad. Like many undergrads, I had no idea what I would do when I grew up…Like many women, I thought I was “bad” at science and hadn’t really taken myself seriously in that regard. When the nursing shortage blew up in the mid-2000s, my mom suggested I look into nursing. I didn’t really think it was for me. I had the old-school pre-feminist movement (and very middle class) idea about nurses as doctor’s handmaidens and couldn’t see myself doing it. But then I started looking into it, and taking my prerequisites for nursing school (adventures to tell of another day), and more and more found it seemed like the right next step for me. Hands + heart + science + possible unionism + healthcare activism…that I could get into.

I originally planned to be a WHNP. When I started nursing school, I had never attended a birth, and I really didn’t know much about midwifery. I liked the idea of working with women, but I didn’t want to try to get into a program/field that I wasn’t as passionate about. I knew folks who were planning to be midwives, and they were excited about Ina Mae Gaskin and doulas and home birth. But I was in my mid-twenties, and no one I was close with had had a baby yet, and these topics were remote from my experience. The abortion world was more my bag, and I knew that as a WHNP, I could possibly train to provide early aspiration abortion or at least do lots of cool family planning work.

Trust Women Tiller

Then, I fell in love with birth and also realized that, as I later saw expressed beautifully in the documentary After Tiller, trusting women and being pro-woman/pro-abortion was midwifery. The issues of birth and family planning and abortion are inextricably linked. And, from a practical standpoint, I realized that it made sense for me to provide pregnancy and birth care as well as the other family planning and gyne care I would do as a WHNP. Why hand off patients to another provider to attend the birth, when I could actually be the one to be there for the whole lifespan? So, during nursing school I asked the women’s health department if I could switch to midwifery. They OK’d me.

An Alternative Route

For a variety of reasons, my path to practicing midwifery has not been traditional, at least how it’s done “typically” by CNMs. According to tradition, an RN works in labor and delivery, then goes to midwifery school, then works as a CNM. When I finished my nursing program, nursing jobs in labor and delivery were hard to come by. I got one interview on a hospital unit but did not get the position. I applied to dozens of others. I also had put out my feelers for work in abortion care and managed to get a position through a student colleague connection, at the abortion service in the county hospital.

My first nursing position was a nightmare, but it paid the bills for my first semester of midwifery school and gave me valuable insight into the lives of women seeking abortion in fairly desperate situations. I then got a scholarship so I didn’t have to continue working as a nurse during my program, but it required me to complete it in two years. I babysat for a wonderful family and watched their family grow throughout my graduate studies. Then, as I was completing my final semester of my masters program, I landed another position in abortion care, which eventually turned into a broader family planning nursing role. That is the last job I held until beginning this current job.

After I passed my boards (got certified by the American Midwifery Certification Board), I again looked for jobs around my city. This time around, I had more interviews and got a lot more interest, but still, employers and even my mentors questioned if I could work as a full-scope (meaning: catching babies, not just working in the office) CNM without having worked as a nurse in labor and delivery. Some suggested that I should swallow my pride and try to get such a position and then try again in a year or two for a full scope  job. It was a full six months between my initial interview and my start date for the position I landed, and there were times that I considered this option. Luckily, this position came through, and I got to do things the way I originally thought I could (more or less).

Acceptance

What is midwifery? Is it only possible to be a midwife if you’ve been a nurse during hundreds of births, many of which were probably complicated or high risk? I don’t think so.

It’s hard being one of the handful of people who graduated from programs like mine, that allow you to graduate without having to work labor and delivery, having to prove that you belong and that you can hang with the more experienced nurses. But I am not alone, and I’m grateful for others who blazed the trail before me — whether they intended to or not.

Midwifery is a whole lot of things.* True, the only births I’ve attended are the ones where I was doing the baby-catching (or doing labor support in a few instances). I haven’t seen a ton yet. My career is young. I am humbled by all I have to learn. But I have also worked in women’s health for over six years, and have learned compassion and to not judge women’s lives and choices. Midwifery is trusting women, it’s listening to women, and it’s being present with women. You can’t learn that from a textbook or demonstrate that on a board exam, but you can show it in the type of care you give. I am confident that, as one quarter of women in the United States will have an abortion before the age of 40, my background in abortion provides a ton of useful clinical and emotional skills to be a good midwife. Good midwifery care has to include all phases of the reproductive lifespan, including abortion. (And hopefully one day CNMs will be legally allowed to provide spontaneous and elective abortion care in all states!)

Now

Tomorrow will mark three months as a practicing CNM, but I think I’ve been practicing the midwifery model of care for more than that. I respect that other midwives took other paths — and they may have done so out of their own necessities. I hope that as I enter the birth setting again in a few months, when I get my hospital privileges, I can continue to safely develop my labor and birth skills and humbly continue my journey with new mentors and teachers.

 

*There are, of course, other paths to midwifery outside of nursing. I respect direct-entry or certified midwives, but I don’t claim to know much about their paths. I can only speak as someone that went the CNM route, and know that non-nurse midwives have their own contributions to women’s healthcare that may differ from where CNMs might be coming from (e.g. Ina Mae Gaskin).