To Help or Empower? Midwife at a Career Crossroads — Leftist Ethicist, September Edition

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September 25, 2013

The Leftist Ethicist is an advice column for Zeek readers who envision a more just world and act to create it. With a commitment to justice and progressive Jewish teaching (and a loving nod to the Bintel Brief), the Leftist Ethicist provides a space to raise questions, without judgment, and receive sensible solutions.

Birth Justice Quilt, courtesy of Mobile Midwife

I am a white Jewish woman finishing up a certification as a nurse midwife. I am committed to racial and economic justice and to providing quality care to all women. Poor women of color have limited access to choices about their pregnancy and birth experience. They often get care in large bureaucratic hospitals where the medical model rules and midwives have limited ability to provide true midwifery care. The majority of women who give birth at home are white, educated, middle- to upper-class women. If I choose to be a home-birth midwife I can provide empowering care, but I sacrifice in my commitment to racial and economic justice. If I work in a hospital, I compromise my commitment to quality care and may perpetuate racism and classism in what I am told I must do to women as a part of the larger system. What should I do?

What you seek is simple: a way to use your skills to provide empowering midwifery care for low-income women of color. Sadly, even this low bar might be difficult to reach. Ninety-nine percent of women in the US give birth in hospitals, although the number of home births is inching up. The nation’s worst hospitals care for twice as many minority and low-income people as do the best hospitals. Outside of hospitals, restrictions on midwifery and Medicaid funding vary dramatically by state, limiting accessibility. At the same time, about one in every 90 births for white women is now a home birth, especially common among white women over 35.

In hospitals, women of all backgrounds have reported feeling disrespected and even abused while in labor. By prioritizing racial and economic justice in your definition of quality care, you are committing to treating every birthing mom, regardless of whether she’s in an under-resourced hospital or a well-off home, with dignity. Start there, and you’ll be a force for change. Beyond that is working for birth justice, helping people feel “empowered during pregnancy, labor, childbirth and postpartum to make healthy decisions for themselves and their babies.”

The Leftist Ethicist asked Anjali Sardeshmukh, home-birth midwife and member of Mobile Midwife, to weigh in. She said that as counter-intuitive as it might seem, the first steps toward birth justice involve emphasizing birth justice over “catching babies,” a term modern midwives adopted from Southern black midwives to describe being at a delivery. This approach — originally inspired by Jennie Joseph, a midwife whose work has reduced infant mortality rates in her community – is key to providing empowering midwifery care.

Here are some ways Anjali suggests midwives work for birth justice:

Start a community-based doula training for low-income women. Team up with a community organization, so low-income women and women of color can learn to be doulas with friends and family. The support of a doula can positively impact birth outcomes.

If you work in a hospital, work toward integrating doulas into the system. This includes providing low-income/Medicaid patients to access doula care during their births for free or on a sliding sliding-scale.

Offer free or low-cost prenatal care to low-income women and provide education about their birth options, including home birth. Ultimately, you may not catch their babies, but you can connect them to resources and doula support that prepares them for the birth in the hospital.

Support midwives of color. Women of color want to see themselves in their midwives, but they rarely do. Low-income women and women of color face lots of barriers to starting careers in midwifery. Anti-Racism and Anti-Oppression Work in Midwifery raises funds for midwives of color to attend national conferences. If you decide to work with wealthier women, host a fundraiser to support a midwife of color organization.

Support the diversity of midwifery training. This includes traditional apprenticeship, direct entry midwifery, and recognition of the certified professional midwife. Supporting different kinds of midwifery training allows for more midwives of color to practice.

Bring a birth justice training to your hospital. Get a captive audience talking about issues like best practices for working with low-income women or how racial justice in health care can reduce the infant mortality rate in communities of color.

Organize to expand access to midwifery care in your state. In 2012, in Texas, Mamas of Color Rising organized and won a rule change to expand Texas Medicaid coverage to include licensed midwives as healthcare providers. Efforts like this are happening across the United States, so join in!

Your career is just beginning, and the quest for birth justice is as ancient as Exodus. Do your work well. Care about your clients, no matter what their background, and make sure that whatever path you choose, you’re doing what you can to leave your mark!

Thanks so much to Anjali Sardeshmukh for her great advice on this column. Please check out the community-created birth justice framework used by Mobile Midwife.

Send questions about ethical dilemmas to The Leftist Ethicist is not intended as a replacement or substitute for financial, medical, legal or other professional advice. It’s just my opinion! What’s yours? Talk back in the comments!

Editor’s Note: Want more? Read Zeek contributor Chanel Dubofsky’s great Q & A with Miriam Zoila Perez — aka the Radical Doula — at the Sisterhood blog.

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