Midwives of the Revolution

Explorations, analysis, and reflections on reproductive health, birth, and midwifery from a feminist, marxist lens


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An Actual! Nearly-Realistic! Homebirth! Scene! On TV!

If you’re not a birth worker, and you’ve ever watched any narrative on television/in a movie that involves birth, you know the drill. You know it’s coming — your birth worker friend is about to give the laundry list of every lie about birth that depiction has unleashed through its powerful platform!

Ugh! It’s never like that! No one’s labor progresses like that!

Can you believe it? That midwife didn’t even call in an assistant!*

For real? Her water broke, and the baby was born 5 minutes later?

Why is the OB the star of the birth?!?!

Anyway, I’m used to being that bitch that ruins movies for my boo/child/friend with such comments. I mean! I’m sure oncologists can’t stand most cancer diagnosis/treatment segments, and cardiology and other acute care nurses probably cringe over all the inaccuracies of heart attack scene…but this is birth!

The portrayal of birth in popular media has pernicious effects on how people understand this major event. Of course, people who have had babies can recognize the lie, and many people can just see birth scenes as the plot device they actually are. Birth scenes in mass media contribute to weaving the fabric of fear around birth and pathologizes labor pain — often justifying the medicalization of birth.

But for those of us that are invested in the power of birth and horrified by the perinatal health crisis in the US, particularly for BIPOC birthing people, unrealistic birth scenes usually represent so much more than just a way to move along a story, and we want to have a say in the cultural narrative around birth.

A Real and Powerful Birth — at Home, to Boot!

photo downloaded from: https://alexusrenee.com/the-chi-recap-season-4-episode-5-the-spook-who-sat-by-the-door/

…Which is why I was blown away by the unexpected turn toward home birth and how well it was treated in one of my favorite shows, The Chi. Seriously, if you’re not watching it already, catch tf up on it!

Look — it’s not everything. I can still give loads of critiques about how The Chi tells the story of Kiesha’s pregnancy and eventual home birth, so I’ll get that negativity out of the way! Like with most birth scenes you get on TV (etc.), Kiesha’s contractions appear to never give her any breaks — adds to the drama of the scene, but in reality she would have breaks to catch her breath, doze, take a sip of water, cry, whatever. It’s also not clear how she went from being pretty unengaged with her health and prenatal care during the pregnancy (made sense, given her character and the circumstances of her pregnancy) to being prepared to roar her baby into the world at home.

But that’s exactly what happens, where she is surrounded by loving women, including a badass midwife (and apparent midwife assistant, who is not really introduced). It’s beautiful!

I don’t know who the show used as a midwife (or other really smart) consultant on the episode (none is cited on the episode’s IMDB page), but clearly the writers knew some key elements of physiologic birth — and about Black birth in particular as a family event. The calm, confident, and loving midwife centers Kiesha in a way that recognize that the birth is not a medical emergency, and that the work Kiesha is doing is part of a legacy of millennia of childbearing people (“women” in the show). This is a powerful intervention to reclaim the power of a Black birthing woman, who an episode earlier nearly consented to a what turned out to be an unnecessary medical induction of labor with a white obstetrician resident.

We are never privy to the negotiations around the adoption plan other than Kiesha’s choice to name Octavia as the adoptive mother (and apparently work on birth intentions with her and invite her to the birth). When the birth assistant whisks off the baby to Octavia after the birth — without clear consent from Kiesha as the birthing parent — the shift to silence in the birth space felt as eerie to me as that immediately following a stillbirth. Both the baby and Kiesha would have benefited from immediate skin-to-skin time together in the tub, and in real life, the birth team would have been involved in making a plan around these details. The omission of this step forecloses a step in Kiesha’s grieving of the motherhood she seems to wrestle with losing — something I of course wish the midwife had played a role in.

Black Birth Matters

There’s such a myth of home birth as a bourgie choice for white people and hippies** — a myth that erases a powerful history of BIPOC midwifery, while naturalizing the disparity in access to culturally concordant home birth care (stay tuned for more from me about this). I love that this episode highlights a Black family (headed by strong queer women, at that) choosing a birth provider and setting that makes them feel safe, out of the hospital.

This show is continuously responding to various aspects of the movement for Black lives***, and by demonstrating the power of Black midwifery, they also seem to be uplifting the voices of BIPOC birth workers around the urgency of increasing access to culturally concordant care for birthing people. Research points to the life-saving ability of concordant care, in contrast to the harms of racism and implicit bias in perinatal health care. The perinatal health crisis will be solved in part by increasing the numbers of BIPOC birth workers, so that birthing people like Kiesha can access quality, concordant care — with a critical impact on the health of the next generation as well.

The work of reproductive justice also means addressing so many of the social issues that this show engages (in sometimes cheesy ways, but usually pretty thoughtfully) — education access, food justice, housing justice, community safety, sex workers’ rights, and of course, policing and the prison system. The writers’ choice to showcase an empowered birth — and for a young woman whose pregnancy is a result of rape and who plans an adoption — feels in line with their commitment to portraying and building Black resiliency.

Kiesha’s home birth not only does not involve any of the emergencies (including the emergency of racism) that too often cause severe morbidity and trauma for, not to mention take the lives of, a disproportionate number of BIPOC birthing people. It also helps her be fully part of the process in a way that she wants to be.

And for all that, this birth snob is delighted to have a labor and birth scene to celebrate for its contribution to shifting the narrative around birth. Let’s keep making Black birth matter.

-QMM

*Actual and incredibly upsetting account of home birth in Netflix’s atrocious midwife-fuck-up film, Pieces of a Woman. (Critiqued well with input from health professionals here, but without any engagement of the midwife’s utter unpreparedness, which would be highly unlikely for a professional midwife.)

**To help combat this myth, consider supporting badass birth worker China Tolliver by purchasing and rocking one of these rad shirts she designed: “Homebirth Isn’t Just for Hippies.”

***I really cannot stop swooning over Lena Waithe for this and all the reasons.


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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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Reflections on Birth and Immediate Postpartum Life

Well, this is now six months late…but I’m a new mom! And a full-time working nurse-midwife! I’m finally ready to dust off the keyboard and start blogging again! So, to kick it off, here’s a post I started right after the transformative experience of welcoming my baby into the world and finally polished off this week. It was fresh when the birth smells were deliciously enveloping my newborn, and fun to revisit now. Enjoy.

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My daughter is now just over a week old. The heat of late summer has broken,  and the kids are back in school at the elementary school across the street. Her umbilical cord stump has just detached, and my bottom and other muscles are gradually returning to normal. I’m generally following the advice I so emphatically dish to my patients: sleep when baby sleeps. Now, I’m taking a breather and making note of what this whole birth thing was like.

Empowerment: I made labor and birth affirmations so I could hear my own midwife voice assuring me during challenging times. My partner drew on this principle several times during labor a few times by asking what I would say to a patient at that phase, when needing reassurance or guidance.

One of the inspirations I had in the week before birth was to make myself affirmations to look at when things got hard during labor. I had been thinking of turning to my friends who had had natural or home births and asking for advice I could use to prepare. While I did receive some good advice (both solicited and not) from such sources, it started to feel strange to me — after all, I’ve attended dozens of births as a student and as a certified nurse-midwife: I know what to expect! Granted, many of the births I’ve attended since beginning professional practice have been in a highly medicalized environment, and few of my patients choose unmedicated birth — fewer have the resources for prepared childbirth.

Yet, I knew the chief thing for me to be successful was not just hearing positive birth stories — and I have read and viewed many — and connecting with the friends and family who were there at my Blessingway, provided beads for my labor necklace, or who were lighting candles for me both near and across the country during my labor. Even having the best labor team possible — which I was fortunate to have — was not a guarantee that I would be okay. No, what I needed more than anything was to be able to hear it from the most authoritative voice I know, my own from my heart as a midwife and my own strength as a woman. For what good is a labor team if the mama isn’t the most willing and capable member?

Though I didn’t look too consciously at the pictures I created, they helped promote a good birth environment — my support team would recite the mantras I had written: Ya mero! Fierce mamas believe in you! You are going to get huge! Yes, yes you can. Trust your body, and so on…And more than anything, I was grateful for the opportunity to make them in the days I was “overdue” and making my nest and heart ready for my baby.

The days after birth, I kept reliving the experience. I was so exhausted and overwhelmed with love and sore in ways I never thought possible. Tears would flow every time I remembered how I felt when my little girl was wet and warm and just screaming her little head off, fresh out of the birth canal on my chest. I had heard and taught women about the “baby blues” on countless postpartum rounds. This was more like a spiritual high, of connection that nourished the parts of me that had been longing for this moment of readiness for years.

I also woke up this week in a panic, realizing that I am probably at high risk for postpartum depression. So I called up my doula, who had mentioned that she does placenta encapsulation, and I ordered up an edible form of the afterbirth to ward off the very real possibility of falling prey to the dark side of new mama life.

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Tree of life: placenta print

I had been hearing about placenta encapsulation for a few years, and knew it hadn’t been studied much. Searches in scientific literatures brings up little of substance, mostly concluding that more research needs to be done. But I also knew that loads of mamas and midwives swore by its powers. I had been planning to plant the placenta in the garden, but when I had a major panic thinking of returning to a very challenging work environment just 10 weeks after the birth, I thought why not give this a chance? Most mammals eat their placentas (seemingly more for survival reasons relating to evading predators), and the power of the oxytocin and progesterone gave me hope it would do more good than harm to try it out. So my lovely doula came over and picked up the placenta a couple days after the birth, and generously returned two days later with a beautiful jar of the capsules and extra home-made herbalist goodies.

In spite of my fears of impending depression, I mostly can’t help but think about how lucky I am to have experienced the birth I did, and how well this network of birth and postpartum support is setting up my little family for a bounty of love, patience, and joy. I had one of the most highly skilled midwives in my area at my birth, who worked with me through a fairly long labor and helped me achieve a normal birth. In almost any hospital, I am certain I would not have had such a nice outcome. Being denied freedom to move and oral nourishment, while being strapped into continuous monitors, I imagine my baby and I would have become very stressed, and a surgical birth would have likely ensued.

Since even before deciding I wanted to be a midwife, I knew home birth would be for me, and now having done it, I feel so strong and powerful as a mama, but also even more convinced of the importance of preserving normal, natural birth. At no point would drugs have helped my labor. At every point, my preparation and support team — my mother, partner, doula, and the midwife assistant — helped me more than any drugs normally administered during labor could. Every laboring woman deserves this type of set-up. How much better for me and my baby (therefore also for public health) that neither of us was too stressed physically during labor, so that we could have such a good, non-interventive birth?!

I know that not every laboring person desires unmedicated birth, but if given the tools and support, it seems many more might at least feel they could make that choice. It seems likely that this could be so helpful in lowering our national rates of surgical births, now more than a staggering one third of all births.

Yet birth is only the beginning. After bringing new life into the world, you have to keep sustaining it! And protecting it for many years!

People have asked me how pregnancy, and now how birth, has changed me as a midwife, but I think that piece, the postpartum and parenting piece has been the most humbling as a women’s healthcare provider. Now, I have pushed this baby out into the world, and now I am responsible for her. I am lucky that I have experience with babies and that I feel so confident in caring for her after this magical birth experience. But if it weren’t for my mother staying with us the first week, the meal train organized by other parent friends, and living in a supportive community, I don’t know I would feel capable of doing hardly anything this week! And I have mamas I care for who have hardly any such support — single mamas, teenage mamas, and mamas with unhelpful or unavailable families. It hardly makes sense to leave new moms alone as a society to figure out recovery from birth and caring for a vulnerable newborn baby.

And then there’s breastfeeding! What a major

BFing linocut

Image borrowed from Rachel Epp Buller’s book cover Have Milk Will Travel

commitment! And I knew it was something I wanted to do, and in fact had literally had dreams about for years. But then doing it is another thing all together. So far, so good. I love how it feels to snuggle this little person and I love how cool it is that my body is making the only food she needs now. I also love how my midwife and doula prepared me to deal with the pain in my nipples the first few days, with ointment, exposing them to air, and the homeopathic medicine. But again, how humbling to have worked with dozens of women to initiate the process immediately postpartum, and then realize how hard it is in real life to keep it up, all hours of the day and night. And a crying newborn. How much patience and calm it takes to keep on loving and caring for a needy newborn. No wonder, with such little support from friends, family, and healthcare providers, so few women in this country actually do commit to breastfeeding for any length of time.

I guess that’s it. Just sharing my thoughts on being a new and breastfeeding mama of a beautiful baby girl that I’m head over heels in love with! And of being a transformed midwife with a new appreciation for birth, the yoni, midwives, doulas, and mothers of all kind everywhere and of every time.