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Midwife to Doctor to Activist

June 27, 2021

I came to Medicine 10-years after practicing midwifery and delivering babies at home.

I am a physician, and my specialty is Obstetrics and Gynecology.

I have the honor and responsibility of providing care and skill when a new person takes that first breath.

I have always loved the tableau of birth, the tearful and happy momma and dad’s uninhibited emotional release. The unfledged being is slippery, wet, and in the perfect process of becoming.

If you have the privilege to be in the birth room, you will have witnessed the elemental work a woman’s body performs to give birth to her child.

That first breath is precious; a lifetime begins amid spontaneous welcoming cheers of joy celebrating “great pure effort”, hard work, and the reality of birth.

The tiny person immediately begins the work of living, processing data, and making sense of the new, loud, dry environment.

In the beginning, the world is entirely open for interpretation as the person (baby, infant, or newborn) begins receiving information about their new tangible reality. The infant’s heart, no larger than a walnut, must assist the function of the lungs. The oxygenated blood leaving the heart travels a new route once the placenta is no longer required.

It takes a while to coordinate the complex organ system, which must function as a team. The entire body depends on the brain’s orchestrated activity and coordination of the nervous system, heart/lungs, blood flow, gastrointestinal function, muscle, and bone — the rhythmic pumping of that tiny heart (once the umbilical cord is cut. The first breath initiates a complex process that has taken millions of years to perfect.

Some behaviors are ‘hard-wired’ ‘reflexes.’

Mother’s milk rewards suckling, and the essential learning is positive feedback. The smell of mother’s breast, the sound of her heartbeat, and the voice she uses to soothe and nurture the new person are vital cues for making sense of the world.

I have seen hundreds of new people making their first debut. I am intimately familiar with birth behavior and fully recognize that everyone has a role to play. Perhaps Abuela will count those tiny fingers and toes-but only after confirmation of gender. “It’s a boy!” “It’s a girl!”

Family surrounds mommas from the Pueblo. The work of birth is rewarded and applauded. The deep, post-delivery sleep is restorative.

Momma’s from Sierra Leone, Kenya, Senegal, and Bangladesh, repeat the drama. An estimated two hundred and sixty-seven people are born every minute. One hundred and thirty million babies are born each year. In the U.K., Europe, and Central Asia, twenty-one babies are born every minute.

The activity of birth transcends language. We have all (midwives, Labor, and Delivery nurses, physicians, and doulas) experienced the mime and drama of encouraging a woman whose language of origin is unfamiliar to us. We speak with our eyes, hands, and bodies- different forms of communications, same coherent process.

Families of all nationalities respond instinctively. I never tire of the energy of those moments. My experiences as a midwife (first in Michigan and later in Tennessee with Ina May Gaskin and the Farm Midwives) taught me to view birth with respect and reverence. My work as an Obstetrician-Gynecologist of color provides me with different experiences and insight.

Based upon my observations, acquired over many years, I urge us to continue the existential conversations centered squarely within the context of ‘race’ and cultural conditioning.

Babies born in hospitals are wrapped and swaddled in identical inexpensive industrial newborn ‘receiving’ blankets — each tiny person is precious and priceless. As I have described, all babies are born and begin their sweet innocent lives the same way.

Why are some birth-giving women treated differently? To me, the answer is painfully clear. I have worked in the United States, New Zealand, Ethiopia, and New Mexico. In the USA, black and brown mothers are valued less, receive casual care, at best, and dismissive care, in general. Mothers of color, black, brown, and indigenous, are heard less, ‘seen’ less, more likely to become invisible to care, and three times more likely to die in childbirth than white mothers. How can this be? is a rhetorical question. Maori mommas in New Zealand have a similar struggle to be seen and taken seriously. In Ethiopia, the tribal/regional differences affect compassionate care. The state of New Mexico has yet to acknowledge the racialized problems for women from the Pueblo, black women, and brown mothers.

Race-based care is a historical reality in American and continues forward into the future.

Communities of color were refused care, were treated in the ‘colored’ part of the hospital, and disregarded by physicians, nurses, and the American Medical Association. In August of 2020, the American College of Obstetrics and Gynecology published a joint statement –Obstetrics and Gynecology: Collective Action Addressing RacismMea culpa with the refrain: Betsey, Lucy, and Anarcha, the names of slave women who underwent surgical procedures to repair birth fistulae. In the throes of appearance versus commitment, Dr. Marion Sims, the surgeon who performed the procedures, the surgeon whose name appears on a large plaque at Ethiopia’s Fistula Hospital, shares a problematic past. What is to be done for the (www.who.int) estimated 50,000 to 100,000 women who suffer from birth trauma each year? More than two million young women live with untreated birth fistula in Asia and SubSaharan Africa. Birth fistula rarely occurs in economically advantaged nations. However, for the two million women leaking urine and feces through the vagina, ostracized for the smell and incontinence, who will chant their names?

I have repaired birth injuries many times. The importance of re-creating a functional vagina cannot be over-stressed. As I sit on my little chair at the end of the bed, the mother’s legs are supported, and she has received a local anesthetic to facilitate the repair and cause less pain. It becomes quiet in the room, and conversations begin. The discussion which causes me the most existential torment goes like this: “Oh look how light the baby’s skin is!”

Women of color are programmed by society to hope their babies are blessed with as little pigment as possible. Perhaps, their child will be seen, heard, receive proper care (the best care), more respect, and deserved recognition, culturally speaking.

We (the collective we) fail to admit the perpetuation of institutionalized disregard for cultural differences, specifically; for non-white mothers. While the ACOG Joint Statement is revelatory, the ACOG Diversity, Equity & Inclusive Excellence (DEIE) commitment is more so. The DEIE Workgroup wants to know about diversity, equity, and inclusion…among the ACOG staff. As an institution, the institution responsible for training physicians who will, ultimately, provide care for all women, the DEIE stops alarmingly short of the target.

Healthcare institutions have recently adopted politically correct language and published statements that include ‘inclusivity,’ ‘equality,’ and ‘diversity.’ The question now becomes, “so what are you prepared to do about it?” Lip-service without meaningful action or change with integrity?

I love my profession. I worked extremely hard to share in the future of healthcare. I have a duty to future generations to call out racism in medicine. Where ever it exists.

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