Continuing the Conversation, Getting Our House in Order with Pat Loftman at the NYC Midwives meeting 9/24/18 

Last Monday, Pat Loftman spoke some much needed truth to our community about how we are responding (or failing to respond) to the racial disparities in the maternal health crisis. She used an example of a patient who perceived her midwife was being racist by inquiring about what she wanted to use for birth control postpartum.  As Ms. Loftman relayed it, the woman perceived this line of questioning as racist.  She interpreted the question as the midwife’s implication that she should not have more children. That the number of births she had needed to be controlled because of her race.

I wonder if other white midwives in the room initially felt defensive for the midwife in the above example.  “But, that questions is a part of the Chart/EMR”/ “But, we ask everybody that question.” and/or “But, wouldn’t it be racist if I DIDN’T ask about what she wanted to do for birth control postpartum?  What if she DIDN’T want any more kids and ended up getting pregnant soon after giving birth because we didn’t talk about it? And, especially if she has many children and closely spaced pregnancies, don’t I have an obligation to share with her the purported benefits of spacing pregnancies?”  And with that, we privately and uncomfortably conclude that the midwife in the example above wasn’t really being racist- it was probably just a misunderstanding. (Or worse, we think the patient may have been an “overly sensitive black woman looking to find racism where it doesn’t exist.”)

I wonder because those are my initial thoughts/ reactions, or at least would have been before I started taking seriously the work of understanding and dismantling white and male supremacy by seeking out the voices, listening to and taking seriously the things black women have to say.  I want to share the insight I have gained with other white midwives so we can do this work better together.

As health care professionals we know that pain is whatever the patient tells us it is because we aren’t in their body, haven’t had their experiences, and therefore are not in a place to know better or contradict.  For the exact same reasons, as white people, racism is whatever people of color tells us it is. When a person of color tells us they had a racist experience, it is NOT our job to look for details in their story that prove them wrong (even if we feel it is with the “best” of intentions).  It is our job to dig deep into our hearts and our history to understand why they are more-likely-than-not right.

So, in response to, “But that question is just apart of the chart.”  Who wrote the chart? Who tied the chart to reimbursement giving it undue importance and centrality in our patient interactions?   Why don’t we have health care systems that allow midwives to provide continuity of care from menarche to menopause? Why don’t we have the time we need to spend with patients to establish report? Why don’t we have the time to explain how the questions we ask are relevant to their health and well being?   The answers in order: White men, white men, because white men established a health care system with no regard to the the ways women have traditionally cared for each other, that does not properly value or fairly compensate female professionals’ time, and that does not center the experience of women or female patients’ well informed consent.  Obviously, charting is not inherently a white supremacist activity. But reading questions verbatim off a chart does not exclude us from perpetuating white supremacy if that chart comes from and is read allowed within a white supremacist system.

In response to “But, we ask everyone that question.”  Well, the patient in this scenario isn’t “everyone.”  She is herself.  Being “color blind” just means you haven’t yet seen the white supremacy all around you.  Asking all patients the same questions in the same way is antithetical to the personalized women-centered care we say is a central tenet of our profession.  White health care professionals have the responsibility to educate themselves on the history of how black women’s reproductive autonomy has been controlled by the state and predominantly white health professions.  As recently at the 2010s California was forcibly sterilizing carceraly involved women.  I did not learn about the history of these government policies until I attended an event put on by reproductive justice advocates after midwifery school, and immediately regretted the chipper way I discussed various forms of birth control during midwifery school, tools that have repeatedly used through history for my patients’ oppression.  So in our original scenario, even if this midwife was truly supportive of the woman having as many kids as she would like, an approach that does not anticipate historically relevant suspicions harms black patients and is racist. Another way to think of it, expecting that all women will interpret our questions the way a white woman would interpret the questions centers the experience of white women over the experience of others, and is therefore white supremacy.  

In response to, “But, wouldn’t it be racist if I DIDN’T ask about what she wanted to do for birth control postpartum…”  Well, obviously. The answer to racist care isn’t no care. The answer is the doing hard work of dismantling internalized and institutionalized racism.  Clearly, there are ways to discover and support a woman’s reproductive goals without unintentionally insinuating she shouldn’t have more kids. Clearly, there are ways we can advocate for change so patients can see a provider of the same race, or the same provider from adolescence, or one of the many other structural components that would make this racist interaction less likely to occur.  

Lastly, let us not forget that 52% of white women voted for our current president, and some of them were midwives.  “Racists” in the classical sense do exist and are feeling empowered. There is a non-insignificant chance that the midwife in the original scenario really didn’t think the black woman should be having kids/ having more kids and was pushing postpartum birth control for eugenic purposes.  We did not see her facial expression or hear her tone of voice. So again, stories like this should cause us serious introspection as to whether we have inadvertently perpetuated white supremacy ourselves, NOT doubt the interpretation of those who have experienced it and are willing to share those experiences with us.  

Twelve black women die to every one white woman in our city of pregnancy related causes.  All of these women were cared for either by us or our colleagues, in the institutions where we work or were trained.  We must examine ourselves and the systems we participate/ hold power in if we hope to be part of the solution.  Let us listen humbly, think deeply, act boldly, and do better.

Katy McFadden graduated with her MSN-Midwifery from SUNY Downstate May 2017.  She was trained as a midwife and currently works as a NICU Nurse in the segregated hospitals of central Brooklyn.