Stories on Birth and ParentingReflections on Motherhood: Lenea Kalima Salde-Azzam (11/18/17) Lenea: Heavenly Flower (Hawaiian) Kalima: Speaker; Mouthpiece (Arabic); “The formal declaration of faith” in Islam. The Huge Decision We prepared as much as we knew how to. My partner and I are community organizers, and we know how to plan! We know how to put together outlines and benchmarks and work lists, etc. We had binders of research, and tracking forms, and food and exercise plans. We documented midwife visits, came with questions, did acupuncture, took the herbs, went to birth education class. And yet, the only thing we were pretty sure about was that we weren’t really sure what we were doing. Even with all the support, love, and care from Marea, our midwife, there was really no way we could have prepared for this beautiful chaos. The process was hard. I had had a miscarriage in 2017 and when I got pregnant six months later, I was afraid to be excited. My partner and I went to the hospital the first time around for an intrauterine insemination (IUI) procedure, and when we went back the second time around they were no longer doing IUI’s. We were totally heartbroken because we thought that that was our only option. We sort of stumbled upon midwifery, did our research and called one midwife and asked her a series of questions and then decided to work with her for the the IUI procedure. We were shocked at how different the experience was and how grounded we both felt during the process. When we found out that I was pregnant, we immediately called our midwife, who then talked to us about home birth and invited us to a movie screening and roundtable discussion. We decided to “entertain” this idea, but were definitely not sold until we watched The Business of Being Born and talk to other midwives, doulas, and pregnant women at the screening. We both agreed that night that we felt we could provide the space in our home to bring the baby into the world the way we wanted — in a calm, warm, musical environment. After deciding to work with a midwife and have a home birth, our midwife informed us that she too was pregnant. So, she referred us to Marea Goodman, whom we grew to love very much. Marea held space for our family to go through this process in such an incredible way. She not only provided the knowledge and medical support that we needed, but she did it in a way that was thoughtful and caring. She upheld our rights when we hadn’t even realized that we had had experiences in healthcare that were both humiliating and traumatizing. Marea treated us with dignity and supported us through worry and fear. Our family is eternally grateful for the love that Marea helped bring into our lives. Reflections on the Labor This was the most intense “moment” of my life. What I remember now, four months later, are shades of memories. I am reminded of the time we spent in our beloved space at home, so carefully arranged so that we might bring life into it. The lights are dim and my partner is looking deeply into my eyes, waiting for me to tell her what to do, how to help. But, I gaze back at her and without words she knows that her presence and the ways she is squeezing my hips is enough. I look at her and think, “everything is about to change my love.” The words won’t come out, but we both know the moment is upon us. My last day of work was Wednesday; I remember I also had a meeting that evening. I checked in about how excited we were and how nervous I was to have 2 weeks off before the baby would be here. But she had her own plans. That night I woke up to contractions. I felt a little sick and felt sweaty while going through each one. By the morning I was only experiencing some tightening, so thought whatever it was, had passed. I drove my partner to work in the morning and went home. I started to have more contractions, so tried to get in touch with Marea to see if it would be okay to go to get acupuncture. I went to see Marea that evening and she confirmed that I was in early labor. We went to eat and then went home. That night the contractions intensified, coming every 6 minutes. With each surge, I felt more empowered to get our baby here. I felt ready and aware of all that was around me - every ancestor and every candle lit for the welcoming of our little one. Around 3:00am, the contractions started to spread out to every 8 minutes, and then increased in time to every 20 minutes by 7:00am. I felt disappointed and tired. The next day was difficult. My best friend and partner stayed with me in our bedroom. I remember the smell of mom cooking spaghetti in the kitchen and the sounds of Jeanelle and Nikki sitting on the bed talking about how the night had gone. I hadn’t slept more than 20 minutes at a time the night before, so Nikki went to get me Benadryl so that I’d be able to get some shut eye. I buried my face in the pillow and felt comforted by Nikki’s lingering smell. 4:00PM approaches and by now I’m getting scared. The contractions are starting to get closer together and it makes my heart beat faster. All of sudden I’m overwhelmed by fear. I’m afraid that I won’t be able to do this, so I tell Nikki to call Marea and tell her I want to go to the hospital. Marea gets on the phone and talks me down and says that she’s going to come over. I pray that she will get to the house soon, and help me. I can barely keep half a banana and a bite of spaghetti down as the contractions start to get closer together. They have stayed at 8 minutes apart for hours and hours. I’m so exhausted and now Nikki and Jeanelle are talking about putting on Star Wars. I stand next to the bed so that I can watch too — but the surges are just too strong. I can’t concentrate on anything but the baby. Marea comes behind me and rubs my back and gives me water. Hours have passed and the lights have been dimmed. I look up and see the prayer flag that my community has given us. I look around at the confirmations that Nikki and I have written: “God is with us.” I rock on my bouncy ball, head in Nikki’s arms, thinking about the women that we met in the Philippines, who gave birth in grave conditions, women who were taken from their babies when they became political prisoners, women who died giving birth at checkpoints. I lift my eyes to the sky and breathe. In this moment I’m overwhelmed. I feel like my heart is going to fall out of my chest. I pray that my own mother and mother figures in my life know the love we share. I feel their life in my veins.
I climb into the water, but am too exhausted to keep myself up. I stay there, laying back in the water to rest, and come up to the side, embracing each surge as it prepares me to bring forth life.  I struggle through each one. But, I can’t anymore. I climb onto the bed and the women around me hold me as I push. I trust when she tells me to push. I trust when she tells me to push down. I trust when she tells me not to be afraid. And then. Then she is here. “She’s healthy.” WHAT?? We had a girl? And then the tears come. The hyperventilating silence and awe. I am feeling her on my skin, breathing and looking up at me.   When I think of how I might be as a mother, I hope that my daughter knows that she was raised collectively, and that she is a product of hundreds of years of resilience and strength that she might know in her lifetime, collective liberation. I hope that she knows the love of community and works for the good of the people. I pray that she will have a spirituality that connects her to God and all that is beloved. I hope that she stays connected to the earth and the water and loves to be in the water as much as she loves to splash around during bath time. I hope that she has passion for what she loves and uses her voice in the same way she takes her pacifier out to say what she wants to and then puts it back in by herself so that she can rest more easily. I pray that stay connected to her mother/father/parent figures so that they may give each other life. 
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The Revolution Will Be Midwifed! Midwifery care is not only for pregnant people. Midwives perform basic health checks for people of all ages and sexes, offer screening for sexually transmitted diseases, order labwork, and provide our children with thorough, accurate, and compassionate sexual education. Throughout history and across cultures, midwives have held many different roles in societies. We have cared for people through the generations- from birth to death. We have helped to support everybody, regardless of age, sex, and gender, to be healthy and connected to themselves.
For centuries, humans held control over our own healthcare. We used food and herbs and different traditions to help keep us healthy and to nurture future generations. Midwives were, in most cultures, some of the most appreciated and respected for our practical and spiritual knowledge of health and wellbeing. As community members, our roles were to empower others with the knowledge of what they needed to be healthy and well, so that they in turn would become their own best caretakers. Today, in American society, we have lost the collective ability to care for ourselves. We are trained to look outwards for health: to doctors, to pharmaceutical medications, and to ever-changing technologies aimed to make us healthier and happier. Low-income and communities of color are the hardest hit with limited or no access to fresh fruits and vegetables, increased exposure to environmental toxins, and a lack of preventative healthcare options. As a culture, we no longer revere midwives as bedrocks of community healthcare, and we have lost the trust in our own bodies that we once had. This decline in respect for midwives and autonomy over our own healthcare is entirely intertwined. In the United States in the early 1900’s, the newly formed American Medical Association began gaining power. They conducted a smear campaign against midwives, painting us as dirty, untrained, and inferior, and introduced the culture of looking to (male) doctors and hospitals for care. Not only did they dishonor midwives: they sowed the seeds of fear and mistrust in our own bodies. A new culture of medicine was born. One in which we thought that we needed doctors to tell us when we were healthy or unwell. Where we thought that we needed obstetricians to keep us and our babies safe during childbirth. Where we needed machines, professionals in white coats, and medications to keep us alive. Western medicine has created this absurd idea that the female body would not be able to give birth without doctors to keep them safe. If that were true, how could we have possibly survived as a species? There have absolutely been some important advancements in birth that the Western medical system has offered. Antibiotics have protected babies and birthing people from infections, anti-hemorrhagic medications have saved countless lives, and cesarean sections have allowed many babies to live when they would not have been able to be born vaginally. Unfortunately, we often take the benefits of Western medicine too far. We have gotten to the point in our society where we have overused antibiotics for humans and animals resulting in the creation of super-bacteria which are resistant to all of the medications we have. In the US, we perform major surgeries for the births of 32% of our babies, where only about 10% are considered necessary by the World Health Organization. Almost 10% of our children between ages 6-17 are on some type of psychiatric medication, with proportions increasing for low-income children of color. When hospitals and doctors took the place of community healthcare and midwives, we forgot how to care for ourselves. We began to fear birth, even though our ancestors had done it successfully for thousands and thousands of years. We began to control and regulate the female body, to conceal sexual knowledge from our children, and to insist that everything be treated with pharmaceutical medications. We lost autonomy over our own healthcare, because the power of our autonomy was more that our patriarchal society could withstand. Imagine we lived in a world where children grew up knowing about their bodies and how they work, where they learned about the local plants that could help keep them healthy, and where they had healthcare providers who had known and cared for them since before they were born. Imagine we lived in a world where men took it upon themselves to teach young boys about consent and intimacy, and where all children had community members they could talk to about their changing bodies and sexualities. Imagine women and other people with uteruses knew how to strengthen or restrict their own fertility. That when they decided to have a baby, they could be supported and accompanied by someone in their own community who knew best how to care for them because of their longstanding and trusting relationship. Imagine that when people died, they could be surrounded by the friends and family they were closest to, cared for by loved ones with a sense of connection and whole-ness. This reality is not so far-fetched. In today’s modern world, where the internet connects us globally like never before, we have access to unbelievable quantities of the information we need to take back our healthcare. Online health forums, medical blogs, and high-quality research is accessible to anyone with curiosity and basic technological skills. The internet is packed with online parenting groups and discussion boards for people considering unassisted homebirths or attempting to heal cancer naturally. We need to learn the critical skills to sort through various qualities of information and determine what actually applies to us and our communities. The knowledge is here: both through written knowledge and ancestral wisdom, ready and ripe for us to remember. In this moment in US history when our collective access to healthcare is being threatened to an even greater extent than it already has, we need to re-learn how to keep ourselves and each other well. We must take our healthcare back into our own hands. I am not advocating to disregard Western medicine and the tools and technology we already have. I am, however, arguing for a change in our collective paradigm of healthcare. We need to re-create a culture where we are connected to our bodies, our babies, the earth, and our humanity. We need midwives to again become central parts of our communities’ healthcare systems, and to teach us how to care for ourselves and each other. No doctor can save us. Let’s support each other to save ourselves. Do you have ideas on how to create and support community-based healthcare that is accessible to everyone? Please comment below! The Power of Undisturbed BirthWe welcomed our little boy, Nadir Aviv, at 2:39am in our home on Sunday October 1st, 2017. I labored all day Saturday with contractions that had no clear pattern. My partner and I ate delicious food throughout the day and watched a couple movies. I would periodically waddle around the house or bounce on my birth ball while he rubbed my lower back. By the evening I didn't feel like anything was progressing. I spoke with Marea on the phone and she suggested that I have a glass of wine and take a bath to see if it would either slow things down and allow me to rest or get things moving along. The sun set, I had my glass of wine, and I got in the bath tub to see if anything would change. And boy did it! The hot water allowed me to relax and breathe through each surge more easily. I felt Nadir shift in my belly and suddenly the contractions became stronger and consistent at 4 minutes apart. I couldn’t lay down anymore so I went to the shower. Very shortly they were coming every 2 minutes. I told my partner to call Marea over to our house, and she arrived soon after. After laboring in the shower for an hour, I moved to the bed. I was on hands and knees leaning over a stack of pillows. The candles, essentials oils, and rebozos became obsolete. I didn't want to be touched or talked to. I just needed to go within. Swaying and letting out deep, loud moans was all that could help me at this point. I started to hear that voice in my head tell me: I’m done. But I knew there was only one way through this. So I just focused on this moment and breathing through it. Though I was so disconnected from anything going on outside of me, I was intensely connected to what was happening inside. I felt so clear as my body transitioned through each phase of labor. Soon I turned over onto my back and I could hear the sounds coming out of my mouth shift into pushing sounds. I was bringing him down the birth canal. Marea asked me to go empty my bladder before he got too low so I went to the toilet and tried to pee. Then POP went my amniotic sack. She came over to me and said calmly that it’s probably going to get more intense now. She was right! Within a couple minutes my body was uncontrollably pushing. These contractions didn’t hurt so much because now the sensation was in my bottom. I could feel his head from inside. It was actually amazing being so present to what was happening inside me. But I was also scared and saying that I don’t think he would fit through me. It felt like so much pressure! I got up off the toilet after a few contractions. By this time I was actually yelling through each one from what felt like a deep place in my throat. Somehow I was able to cope by being as loud as I felt the contraction was in intensity. I went to hands and knees on the floor. Every contraction I could feel his head coming lower and lower. It was stretching me and it burned for a moment. Between them, I could feel his head go back in and it was such a relief. I remember thinking, yes just stay in there! By the last contraction, it was so strong, I just had to go into the pain. I knew it was the only way to get to the other side. I felt his head emerge and it was a relief. I had a breather finally while my partner supported his head. I didn’t really have a strong contraction after that but I needed to get his body out because he was a little stuck with the cord wrapped over his shoulder. I let out the absolute biggest most powerful sounds I’ve ever heard come out of my body. I felt Marea’s hands go inside me to help pull him out. And holy shit it was the biggest relief ever to feel the rest of his body leave mine. Papa caught him and held him while I took a few breaths and then flipped over onto my bottom. I was suddenly holding my baby and all the pain washed away. I could not believe what just happened. It was pure bliss after that. I have such an appreciation for home birth midwives. Many people think home birth is not safe. And I ran into some obstacles like losing more blood than usual. But I was totally taken care of with the skills, supplies, and support of my midwife. She is so badass. In addition, Marea gave me the space to labor in peace and let my body guide the birth. I didn't have any cervical checks. The room was quiet, dark, and cozy. And my baby was born into such a calm, loving space. I could not be happier with my birth experience.
  Birth Story from Oakland, CaliforniaJune 23rd, 2017, was not only the birth a baby girl, but also the birth of a mother: Me!
I had always envisioned pregnancy to be such a joy, just like in the movies. Although I felt happy to be a mother, my first trimester was extremely difficult. Let’s just say “morning sickness” was an under-exaggeration. It forced me to drop everything: all with zero support from my OBGYN. In fact, a direct quote from her was “everyone gets morning sickness.” I soon found myself completely disconnected and disgusted by the medical system. I started to toy around with the idea of going to a well-developed city in Mexico to give birth to my child, all to avoid being here. After weeks of research I realized that was too far-fetched. Plus, nobody understood or supported that idea. So back to square one I went, trying to do research on a new doctor that would accept me at 22 weeks pregnant. I found myself feeling helpless because either I couldn't find someone to accept me and or they wouldn't take my insurance. So one day I decided to tell everyone to go to hell. I started doing research on midwives in the Oakland area. I have to admit that even then, I didn’t really know what I was doing. All I knew is that I needed someone who cared! I found Marea through Yelp. At first I felt attracted to her because I read that she spoke Spanish and that she had done a lot of her work in Latin American Countries. Immediately after doing a phone chat, I knew this was the way to go. I have to say I was not opposed to medication and or an epidural in any way. However, after meeting Marea I suddenly found myself doing way more research around birth than I could have ever imagined. I was determined to work hard to make my birthing experience MY experience. Marea has always given me amazing bedside manner. I always felt like she legitimately cared about me, my unborn child, cared about meeting my husband, my step-kids and my closest friends. I was always free to ask as many questions at our hour+ appointments. I always talked about how excited I was to give birth. I felt like it would be the only time I would feel fully in my body and my experience. Although I knew it was going to hurt, I was not scared one bit! I looked forward to it very much. Marea gave me confidence and reassurance. I felt like: "I can do this! I will do this! Everything will be fine! ...and if we have to go to hospital, we will just get in the car and go.” So the morning of my birth day I went to whole foods and ate a terrible breakfast, yet I remember the day being so perfect. It was beautiful and sunny. Around noon Marea came over and she gave me an amazing castor oil massage on my belly. She told me to watch a funny/happy movie to release the oxytocin. I started a movie, and about half-way through I started feeling some activity. I was home alone, so I reminded myself of all the tools I had to prepare myself for the big experience that was building. Within a few hours I was completely in labor. With my team by my side, I stayed focused. In fact it's like I went into a different world. I barely remember anyone being around. When I think back I just see myself, my labor, my breathing, my baby. When I started pushing, Marea was concerned that the baby’s heart rate was dropping with the contractions. She monitored for a while, and had me try some different positions to see if that helped the baby. After a while, she very calmly looked at me and told me she was going to call an ambulance to transfer me to hospital. Although for a second I felt like I failed, I knew she was doing the right thing. Yes of course I envisioned my perfect water birth, the flower petals and the essential oils, the perfect playlist and the birth of my baby on video. But at the moment the best I could do was take the words of affirmation I had previously taped in my bathroom along the ride with me. Being inside an ambulance going so fast down the hill can be nerve racking, but I remember constantly looking into Marea's eyes to find reassurance once again. Never once did she worry me. Once we arrived at Highland Hospital everything happened so fast. It felt pre-meditated. Within a couple of hours I held Colette in my arms. I did it. I really did it! When asked I always say I couldn't have asked for a better birth story. I still don't think it was bad at all. Marea gave me positivity, she prepared me fully for this day. I most definitely could not have done it without her. I would have been just another number, numbed from the waist down. I thank her and my support team very much. I encourage everyone to “feel” what its truly like to give birth. Feel it!!! I did and I have zero regrets. Racial Justice in Midwifery To be a part of the out-of-hospital birth community in the United States means that we must constantly wrestle with complicated race dynamics in the midwifery world and in our own communities. Most of us are aware of the staggering inequities that exist in this country when it comes to maternity care. In the United States, black birthing people are 4 times more likely to die of pregnancy-related complications than white birthing people, and black babies are 2.5 times more likely than white babies to die in their first year. Rates of maternal morbidity and mortality for Indigenous and Latinx birthing people are about 3 and 2 times higher than those for white birthing people, respectively. Even when controlling for class and access to health care, people of color have higher rates of complications than white people. This is attributable to the experience of racism and the impact this has on their bodies and souls. As white midwives living and working in the United States, we must also acknowledge that we are benefitting from the past and present genocide of the people indigenous to this land. So how can we, as white midwives working in out-of-hospital birth, become better allies in the struggle for racial justice? What can we do to address these inequities? Below are some suggestions in becoming more reliable accomplices in the fight for birth justice. 1. Educate ourselves (and each other) about racism. Everybody raised white in the United States has been indoctrinated with racism. It is our inheritance from living in a racist society. Our racism is not our faults, but it is our responsibility. And we can absolutely undo it! Below are some resources specifically for white people who are working on unlearning racism. 1. Books: i. Uprooting Racism: How White People Can Work for Racial Justice by Paul Kivel ii. Understanding and Dismantling Racism: A Booklist for White Readers 2. Articles: i. White Fragility: Why It’s So Hard to Talk to White People About Racism ii. I’m Not White, I’m Jewish. But I’m White: Standing as Jews in the Fight for Racial Justice 3. National organizations: i. Safety Pin Box https://www.safetypinbox.com/ ii. Black Lives Matter http://blacklivesmatter.com/ 2. Understand the internalized and institutional realities that families of color face in maternity/midwifery care. We have to educate ourselves about the actual experiences of birthing people of color in this country and in our communities, without expecting people of color to educate us. Pregnant people of color in the United States face many barriers to accessing health care, due to racist and classist institutions and a systemic lack of care providers who understand their experiences. Show up for events put on by people of color in your area that address these issues. Check out the following resources that educate around the experiences of people of color and their struggle for birth justice in this country. Become members of these organizations and compensate people of color for the concrete and emotional work that they do. 1. Birthing Justice: Black Women, Pregnancy, and Childbirth 2. International Center for Traditional Childbearing (ICTC) https://ictcmidwives.org/ 3. Ted Talk: Miriam Zoila Pérez: How racism harms pregnant women-- and what can help 3. Understand models of care already created by people of color that are addressing these issues in your community. Don’t try to reinvent the wheel! Chances are, birth workers in communities of color have already created amazing organizations that are addressing their communities’ needs. Build meaningful and authentic relationships with these birth workers and ask them if you can support their work in any way. Follow their lead. Here are some examples of models by and for people of color that are successfully empowering communities of color around pregnancy, birth, and postpartum: 1. Jennie Joseph and the JJ Way. http://www.commonsensechildbirth.org/jjway/ 2. The Community Birth Center in Los Angeles, California http://lacommunitybirth.com/ 3. Black Women Birthing Justice www.blackwomenbirthingjustice.org 4. Changing Woman Initiative http://www.changingwomaninitiative.com/ 4. When working with families of color, check our privilege. It’s not enough to say that our practices are open to people of color. In order to be good midwives for families of color, we need to do the lifelong work of dismantling our own racism. When caring for clients of color, we need to remember that they have had to deal with racism their whole lives (in particular around their bodies and the healthcare system). As white people in the US, we can never fully relate to the experiences of people of color; we can hold space and listen with an open heart. 5. Consider referring clients of color to midwives of color. Often, pregnant people of color want the option of having a care provider who looks like them. When interviewing with a client of color, consider referring them to a local midwife of color so that they can meet each other and have the option of working together. It may sound scary to risk giving up a potential client, but it’s actually a reflection of understanding and allyship that will inevitably support your midwifery practice and the wider midwifery community in your area. 6. Support financially. One of the realities of out-of-hospital midwifery in the US is that a large portion of our clients are white and reasonably well-off. Consider donating a percentage of the fees that you charge to organizations in your area that are directly working with these communities. Or, ask your clients to donate to a community fund that supports birth workers of color in your area. 7. Say no to midwifery tourism. There is a phenomenon in the birth community of white birth workers traveling to foreign countries to gain experiences. It is a heartbreaking reality that birthing people and babies all over the world are dying unnecessarily and generally receiving inadequate care. Of course we, as caring midwives part of an international community, want to help however we can. However, we need to check our white savior complexes and acknowledge the power dynamics involved in birth tourism. Our white, American identities carry with them centuries of oppressive history and complicated social dynamics. Although so many international communities need more resources, they don’t necessarily need us. Instead of going abroad, consider donating money to organizations that are training providers in those communities so that they can be self-sustaining. If you do go abroad, make sure that you are responding to an invitation coming directly from the community you plan to support. 8. Talk to your white clients about race and racism. Midwives have the immense pleasure and responsibility to accompany new families during this beautiful time of growth and transition. We often build close, intimate relationships with our families and are therefore well-equipped to have these important conversations with our clients. Consider sharing resources around parenting in anti-racist ways with your white clients, or organizing a support group for new parents around raising anti-racist children. Below are some resources to share with your clients.
9. Avoid culturally-appropriative names for our practices. One of the ways that racism functions is that it allows white people to feel entitled to consume aspects of another culture or ethnic group without much thought or context. Make sure that your practice’s name does not appropriate language or values from a culture that isn’t your own. This also goes for avoiding cultural appropriation in our language, logos, the ways we dress, wear our hair, etc. 10. Teach midwifery skills to students of color. The US has a disproportionate number of white midwives to midwives of color. In order to help address these inequities, we need to prioritize educating student midwives of color. If you are a midwife, consider becoming a preceptor for student midwives of color, or support doulas of color in their practices. Make sure to care for the power dynamics at play in these cross-race, preceptor-student relationships. 11. Build relationships with birth workers of color in your area, and follow their lead. Being an effective white ally and active accomplice in the fight for birth justice means following the lead of birth workers of color. As midwives, we come from a long history of serving our communities with humility and devotion. These are the same qualities required of us in this struggle for racial justice so that every parent and baby in the world can have the care that they deserve from providers within their own communities. 12. Continue to do active anti-racism work in your life, for yourself. White people need to do active anti-racism work for the benefits of our own lives, not out of a sense of guilt or obligation. Racism hurts us, by dehumanizing us and separating us from the majority of the people in the world. Unlearning racism and becoming an effective accomplice is a lifelong process that will inevitably make our lives more rich, beautiful, and connected. Consider this the start of early labor. ***Author's Note: I by no means consider myself an expert in this work. I am constantly learning, growing, making mistakes, and trying to be a better person and ally than I was yesterday. I am deeply grateful to all of the people in my life- friends, family, ex-partners, and colleagues- who have spent their valuable time and emotional energy educating and teaching me. Special thanks to Sumayyah Franklin for editing this article. *** 7 Reasons to Support Midwives in the Age of Trumpby Marea Goodman Originally published by Everyday Feminism 02/19/17 We are in a time when our goodness as humanity is being questioned. Borders are militarized and becoming stronger, refugees are denied access to needed resources, and hate crimes are on the rise.
In this country, we are unquestionably seeing the results of generations of trauma and segregation. For about a hundred years, humans have routinely birthed our babies in hospitals. During this time, the medical community, as an oppressive institution, has been interfering with many of the physiological process of birth, performing often unnecessary, misogynistic interventions and separating babies from their parents. These practices have laid the foundation for many generations of traumatized and isolated human beings. Fortunately, midwifery care offers a much-needed contradiction. Imagine: dim lighting, the familiarity of your own home, and care providers who you trust medically and emotionally and who have spent your entire pregnancy getting to know you and what you want for your birth. Consider a world where all pregnant people are treated with the utmost autonomy and respect and the bond between children and parents is passionately supported. Where babies are born with trust, connection, and safety. Of course, not everyone has access to homebirthing. Many factors – including disability, income and access to health care, and even cultural acceptability – affect a person’s access to and desire for homebirth. And we would never want to suggest that this is the only, or even the best, option. The best option is always the one that makes sense for you. We do want to make space to talk about how midwifery can be a radical choice that rebels against an oppressive institution, especially in a world where more and more, we’re realizing that our day-to-day choices make a difference. The way we’re born is one thing that can be considered in our movements of resistance. As we fight against the inhumane policies of the current administration, our work to reclaim our humanity is both personal and political. So here are seven reasons why homebirth with midwives is one human(e) and anti-oppressive way to give birth. 1. Homebirth Is a Contradiction to Oppression In today’s world, the forces of capitalism, racism, sexism, and classism work to isolate us. Oppression functions by disconnecting us from our bodies, each other, and the natural world. When we are fully in touch with our own humanity, it is easy for us to see the humanity in others. Homebirth is a contradiction to oppression because it supports our humanity above all else in a way that the medical industrial complex often doesn’t. Homebirth can be a safe haven. It offers the opportunity for pregnant people and families to craft the experience of pregnancy and birth that they most want and deserve, where consent is the highest priority and safety is not only physical, but emotional and spiritual as well. Homebirth offers an opportunity to experience birth outside of the institutions of society that all too often cannot see or respect us in all of our human complexities. And for those who want to choose this option, it can be incredibly powerful. When a cis woman chooses midwifery care, she can opt out of the culture of patriarchy that insists that her body should be manipulated and controlled. When a person of color chooses to birth with a trusted provider in their own home, they can carve a space for themselves outside of the racist institutions that have never cared about the wellbeing of their bodies or their babies. When a trans or gender non-conforming person chooses a midwife who is a true ally, they might feel free to experience their bodies and babies as they are, outside of pervasive expectations of sex and gender. 2. The Way We’re Born Affects Us for the Rest of Our Lives There is substantial evidence that the way we’re born affects us – mentally, physically, and emotionally. In the US, medical interventions have taken over our evolved physiological process of birth. In some ways, we can argue, this is a good thing: After all, we’ve seen a huge dip in childbirth mortality rates. But with one in three babies born through cesarean section, 60-80% of pregnant people birthing with epidurals, and astronomically high rates of use of synthetic oxytocin, it’s worth questioning whether or not all of these procedures are always necessary. Many studies are now proving that the way we are born correlates with our physical health later in life. There is some evidence linking cesarean birth with health conditions such as asthma, type 1 diabetes, and other chronic health problems. The concerns are not only physical. Babies need caregivers, physically and emotionally, to transition into extra-uterine life, so the immediate separation following a cesarean birth can have profound effects on babies’ nervous systems. Research shows that our early imprints of attachment have lasting emotional and psychological effects in later years. The important question to ask ourselves as a society is: What are the results of all of this meddling with the physiological process of birth? Are the interventions common in the birth industrial complex inhibiting our own production of bonding hormones and affecting our capacity to love and bond with future generations? These questions are necessary now, more than ever, while our president enacts policies that promote separation and isolation in the name of “safety,” building walls and anti-immigration policies that are inhumane and ineffective. 3. Isolation Is the Main Foundation of Oppression Human beings have an innate physiological need for connection. Compared to other mammals, human babies are born remarkably premature, and we remain extremely dependent on our caregivers for years (physically and emotionally). When we interfere with the vitally important process of connection between babies and caregivers, we are denying each baby’s innate need for connection and negatively affecting their normal growth process. The way the institution of medicine manages birth in this country can be isolating to our children. And this matters now more than ever because totalitarianism itself is a result of isolation. Despotic, divisive leaders are elected when anger and disconnection abound and anything “other” is seen as a threat and an enemy. A sense of isolation causes people to feel hopeless about their lives and the world, allowing power-hungry dictators to capitalize on their vulnerability and gain control. People in the US have become deeply disconnected, from ourselves and from each other, and the result is an epidemic of xenophobia, racism, and fear. The result is a president whose entire campaign was based on slander, fear-mongering, and verbal abuse. There are many different interwoven threads of history that have brought us to this political moment. One of them, I think, and arguably one of the most important and the most often overlooked, is birth. Because being born is the most fundamental experience that we all have in common. And in this culture so prone to mistrust, fear, and disconnection, we rarely acknowledge the systemic issues around the birth industrial complex that perpetuate these dynamics. 4. Rates of Morbidity and Mortality in the US Are Distressing – And Racialized The US ranks 33rd in the world in our rates of parental morbidity and mortality (last among all other developed nations), and 26th in our statistics of neonatal morbidity and mortality. Although we are the wealthiest country in the world, we are not, in general, taking good care of our pregnant populations and our future generations. The statistics are extremely racialized as well. Pregnant people of color (specifically Black populations) suffer the poorest outcomes. According to data from the National Center for Health Statistics, Black babies are twice as likely as white babies to die within the first year of life. They are twice as likely as white babies to be born with low birth weight and three times as likely as white babies to be born very premature. This discrepancy still holds when we control for differences in class and access to healthcare. It is clear from the research – and, of course, people of color’s experiences – that racism and white supremacy play a major role. Too many people are coming away from birthing in the hospital feeling disempowered and disappointed by their birth experiences – and then dismissed for those feelings. Too many parent/baby dyads are being separated at birth, and too many major surgeries are being performed unnecessarily. Too many people’s desires and needs around their birth experiences are being systematically ignored, which can result in disappointed or traumatized new parents and families. The institution of medicine could learn a lot from midwifery, in terms of how to create a system more respectful of people’s needs. Because even when folks (and especially marginalized folks) choose hospital birth, shouldn’t they leave that experience feeling safe? 5. Western Obstetrics Arose From a Violent History It’s not that hospitals are inherently bad places or that medicine is malintentioned: It’s that the system was never built to treat birthing people as self-directed individuals. Modern obstetrics has a harrowing history. James Marion Sims, considered the “father of modern gynecology,” gained his knowledge by conducting experiments on slaves, often without anesthesia. In the mid 1800s, ether-based anesthesia was introduced into the delivery ward, resulting in unconscious birthing people, lethargic babies, and the implementation of forceps to pull babies out when their parents were unable to push. People giving birth were often strapped to a bed and partners were denied entry into the delivery rooms; all the while, in the public sphere, the Association of Obstetricians conducted a very successful slander campaign against midwives and nurses, effectively orienting the future of birth towards hospitals. This history matters. 6. The Statistical Differences Between Hospital Birth and Homebirth Are Striking While a direct comparison between homebirth and hospital birth statistics is not entirely accurate – because homebirth clients are, by definition, healthy and low risk – the disparate trends are significant:
For babies, immediate and constant skin-to-skin contact and a calm environment help them transition into this world with a more relaxed nervous system and, potentially, an unbroken sense of trust in their connection with their birth parent. As midwives, our primary goal is to guard the health and safety of the pregnant person and baby while protecting the physiological intimacy that occurs between parent and child at the moment of birth and immediately after. Our aim is to do as little as possible to disturb this bonding process. In the midwifery model of care, we see the birth process as an everyday – albeit miraculous – part of life. 7. Homebirth Offers an Opportunity for Liberation and Healing For the low-risk pregnant people for whom out-of-hospital, midwifery care is appropriate, homebirth can offer an opportunity to birth their families with fierce and loving self-determination. Homebirth is a potential alternate option for people who are marginalized by this country’s major institutions and for anyone who wants personalized and intimate care. When people have a trusted midwife with them as they go through the intensely transformative processes of pregnancy, birth, and postpartum, they may feel better equipped to lay the foundations for healthy, connected, and radical relationships with their children and with themselves. Assata Shakur said, “Love is contraband in Hell, because love is an acid that eats away bars.” We need to break the bars that keep us isolated from one another and cultivate trust and intimacy as our first step in our movements of liberation. While there is much to do in the next four years to protect ourselves from – and thrive in spite of – the hungry forces of oppression, we must weave trust and connection into the foundations of our work. Where better to start than at the moment of birth, if we have the option and the desire? Homebirth is not just a trend. It is not a chic movement or a badge that proves how naturally minded or alternative one is. Homebirth is, and has always been, part of our nature. It is so much more than the location where a baby is born, or the credentials of their birth attendant. It is, in fact, the expression of our deepest humanity, allowing for early imprints of intimacy and connection – which are not only our birthrights, but our greatest hopes for change. A homebirth for our sweet Ruby Lou Life was a little different during the holidays in 2016. We were a family of three, getting ready for Christmas, and excitedly anticipating the arrival of a baby boy or girl, due on Christmas Eve. We were also eager and anxious about our first homebirth experience. About five years ago, we attempted a homebirth with our first daughter, but after 30+ hours of labor and leaking meconium, our midwife made the smart decision to transfer us to the hospital only to find out that she was breech. While it wasn’t our “plan,” it was out of our control at that point, and we did what was in the best interest of our unborn daughter. Right afterwards, I couldn’t help but feel a slight letdown, like I had failed. That feeling, however, was pretty short lived once the doctor handed me our sweet baby girl. She was perfect and healthy, and everything we could have asked for. I smile looking back at her birth, and I like to think of it as the perfect introduction to parenthood; in that, sometimes, you can’t control everything, and that’s OK. During my second pregnancy, I was planning on a hospital birth in the event that something unforeseeable would happen again. But I had a change of heart at 37 weeks. After attending Rachel Yellen’s birthing class, I left the most empowered I had ever felt, and I knew I wanted to give birth at home. Considering I was at 37 weeks, my husband looked at me and thought I was nuts. He said, “You could seriously go into labor tomorrow.” But I listened to my gut and was determined to find a midwife that would be willing to do a VBAC at home on such short notice and, SO close to the holidays! I emailed about 15 midwives and Marea Goodman was the first midwife to respond. I was ecstatic with her response and felt an immediate connection in just our few email exchanges. We scheduled an interview with her and Morgan West and were sold after the first meeting. To say it was love at first sight sounds cheesy. To say it was meant to be sounds cliché. But to say it was the best decision I’ve ever made is an understatement. Once we began our initial meetings, I instantly felt a huge weight lifted. I could talk openly about how I was feeling, discuss MY hopes and dreams for giving birth and connect on a more natural and holistic level that was consistent with my personal beliefs. Both Marea and Morgan were so incredibly warm, compassionate, smart, and personable. By Christmas Eve, I was ready…but baby wasn’t. Marea and Morgan were there to assure me everything was fine, and encouraged me to get a prenatal massage and try acupuncture to get things moving. By the evening of December 27 I was feeling more consistent contractions on the massage table and they continued throughout the night. By 11:30 p.m., we knew it was GO time so we called our wonderful doula, Lauren Miller to come assist. She helped fill up our birthing tub, held my hands in between contractions, rubbed my back and coached me along. By 2:30 a.m., I was progressing fast and Marea and Morgan showed up. I had my eyes closed the entire time, but I knew by Marea’s touch, she was there. She put her hands on my belly and used the Doppler to listen to baby’s heartbeat. Once I heard the heartbeat, healthy and strong, I started to cry and my entire body started shaking. My emotions were high and Marea was right by my side, comforting me and welcoming my vulnerability. Next thing I knew, I was in the shower and my water broke. Marea told me that my contractions would start picking up, and I just thought to myself, HOW could my contractions get any stronger?? But they did… I stayed focused and transferred to our bed, laying in fetal position. As the pain intensified and seemed unbearable, I was the most present I’ve ever been. Before each contraction, I would squeeze my husband’s hand tight and concentrate on each breath, breathing in through my nose and pushing out through my mouth. I didn’t know how much longer I could last, but soon after, I started making what my husband later described as deep, guttural howling sounds and subconsciously, I started pushing baby out. Marea was down in between my legs and grabbed my hand to put on the baby’s head as I was crowning. There was so much excitement in the air and I knew I was close. Marea, Morgan, Lauren, and my husband kept encouraging me along the way and Marea used a warm compress against my perineum to help with the pressure and tearing. After baby’s head bobbled a few times, it emerged, and then I pushed one more time and the entire body released. It was the biggest relief I had ever felt. My husband was there to catch baby, and said, “It’s another girl!” Marea immediately handed her to me so we could be skin to skin. With tears in my eyes, and in a TOTAL state of shock, my husband and I snuggled her gently and she instantly breast fed. We got to enjoy this moment for at least 10 minutes before Marea coached me to pull out my placenta. Afterwards, Marea and Morgan checked the baby’s vitals, weighed and measured her and then made sure I was OK. Throughout my entire labor, never did Marea “check” me or tell me how far along I was. She gave me the space to be present and allowed me to birth my own baby safely and peacefully. The entire experience was flawless, and I am so beyond grateful to have had such a powerful and special homebirth. I owe everything to her, and the entire team who was there to support me, including my dear husband. Baby Ruby just turned one, and she has been the best addition to our family! 
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