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Today's post is written by our very own barrelofrain!
As I mentioned in a MMMMonday post on safe space a few weeks ago, I had the opportunity to go to some pretty great workshops at the Philadelphia Trans Health Conference this year. Another one that I knew y'all would be interested in was one about midwifery!
Here's the workshop description that caught my eye:
utilizing midwives and doulas to build health care access for trans and gnc communities
This workshop will engage participants around the midwifery and full spectrum doula care- including abortion care, birth, intrauterine insemination, pelvic self exam, sexological body work, and more! An affirming space for trans and gnc people and families to feel less isolated around their health care experiences. Learn how to advocate for what you want in health care, particularly in reproductive health and pregnancy spaces. Our health care system is broken, and for trans and gnc people, it can be an even bigger struggle to get what we need. Learn how doulas, midwives and self-help practices can help you get the best care possible.The facilitators will share our experiences as trans and gnc midwives, doulas, and healers who are working in many different contexts to improve care for our communities. One of our goals is to share strategies and tips on how to navigate medical care that emphasizes self-determination, agency and holding providers accountable. This workshop will discuss how empowering health care experiences, both as clients and current and future birth workers, can transform our lives and facilitate deep healing.
The workshop was presented by Miriam Zoila Pérez, Pati Garcia, Ryan Pryor & Kimberly Murray, and Abigail
We started off talking about what different terms mean so that we were all on the same page. The panel members used "birthwork" as an umbrella term to encompass all sorts of people like lactation consultants, OBs, doulas, and midwives.
What's a midwife? A person who comes to the house to take care of the birth; a knowledgeable helper to assist with the birth, in addition to or instead of a doctor
Who has seen a midwife and for what? People in the room had been to midwives for pap smears and other routine GYN care.
Who is a doula? A doula provides emotional and informational support to a laboring person, and can also be involved in postpartum care.
What is a sexological body worker? A body worker who has training in working with the genitals. They can address things like trauma, arousal, and sexual function.
History of Midwifery
If we go back enough generations, our ancestors were all born with midwives! The current medical model of birthing is something that's relatively new.
Traditionally, a midwife was the wise woman in the community who people would call when they were in labor, but they were also were healers, carried plant medicines of the community, and learned from generations back. There was more of an understanding that birth was a normal and natural way of life.
In the USA, the Native communities had midwives, and when European colonialists came to the states, they brought European midwives. African slave midwives were important to their communities because the slaves weren't permitted to go to the hospitals. In the South, the "Granny Midwives"/"Grand Midwives" delivered most of the babies in the South until 100 years ago.
The shift to medicalization of births started mostly with white, wealthy women. The shift primarily happened because there was a profit to be made. Quickly, the medical model started funneling everyone to to the hospitals, even the poor women, who were the ones that the medical students practiced on.
Campaigns began that called midwives dirty and ignorant, and propaganda and legislation made it harder for midwives to practice. From 1900-1945, the USA went from 95% homebirths to 50% homebirths; by 1955, that number had reduced to only 1-5% homebirths. Homebirths almost became extinct in the USA.
People who didn't get good care from the obstetrical model began to turn back to midwives in the 60s and 70s, and some US states started to license midwives. "Lay midwifery" is still illegal in some states. Nurse midwives, however, go to nursing school, get a masters degree, and can work in hospitals or at home, and nurse midwives are legal in all 50 US states.
Midwives have been put on trial for many different things, including practicing medicine without a license, particularly if something goes wrong with the birth and there is a transfer to a hospital. Midwives of color are scrutinized even more than white midwives.
More on Doulas
Doulas were created to address a modern role in the 70s. Their goal was to improve and intervene in hospital births. Studies in the 70s showed that having someone in the birthing room improved the birthing experience, even if that person wasn't actively giving support. It also found that when support was more active, it improved the overall experience and even lowered interventions (like C-sections).
Doulas usually go through a weekend process to get trained in things like massage technique, birthing positions, and what a doula doesn't do. "Full spectrum" doulas (sometimes referred to as abortion doulas) provide the same type of support during abortions or miscarriages. Doulas are generally not covered by health insurance, but some believe that the regulation and certification of doulas may eventually lead to health care reimbursement for doula services.
Some of the birthworkers in the room talked about the pressure they felt from their midwifery schools to be more gender conforming; there was a real expectation that a midwife should be "womanly." There also tends to be a lot of gender essentialism, especially with language about "mothers" and "female experience," that can exclude trans* or gender nonconforming folks. Many of the birthworkers didn't even have much experience with queer clients because many queer families use fertility interventions, which puts them on the medical track for the birth.
How can we make healthcare access easier for trans* and gender nonconforming people?
- Think about the language and space we create. (Don't assume the client has a partner, don't assume pronouns, let people name their own parts, and ask how they conceptualize pregnancy and birth.)
- Have open ended conversations, and allow sexuality to have a space in the care model.
- Better/more inclusive training for midwives so that they can talk to queer/trans* folks outside of the gendered ideas of "beautiful birthing powerful woman lioness goddess!"
- Put less focus on the sex/gender of the child, and also make space for sensitivity around intersex conditions.
- Recognize who the client wants or doesn't want at appointments and at the birth.
- Provide psychological care where needed (post-partum, etc).
- Be aware of intersections with disability, fatness, and cultural competency.
Superstars, have you/do you use a midwife for some of your care? Is it pregnancy related care, or routine GYN stuff? Any midwives or doulas who want to add to this conversation?