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Is US midwifery open enough to everybody who needs to be included? - November 2013

The third destination of my fieldwork, which I am doing as part of my fellowship at ACNM, was the West coast. I was so lucky again. During one of the first days of my stay in US I found out that at the end of October there would be a big conference titled Birthing Social Change in Portland, Oregon. I immediately applied for a scholarship and after three weeks I learned that I got it. Wonderful! I was so happy because in I already understood that out of hospital midwifery is pretty different on the East and West coasts. I was really excited to explore the situation on West coast and I started to plan interviews with midwives in Portland, Oregon and Seattle, Washington.

In the meantime I had the opportunity to attend the AABC Annual Meeting in Minneapolis and conducted several interviews in New York City. This was also great and very enriching. It gave me insight into the practicalities of out of hospital midwifery practice in US. It was crucial to hear real stories from midwives attending mostly home birth in the United States. My main impression was that if the legislation in particular state supports independent midwifery practice (no need for a collaborative agreement with a physician and fair reimbursement rates for practicing out of hospital) midwives are happy, which means that mums, babies, and whole families are happy. This is happening, for example, in New York.

The end of October came so fast and the conference Birthing Social Change was about to start. Roanna Rosewood gave the opening speech. She is “just a mum,” as she called herself. She made a great point by stressing the importance of just mums who make the difference. One of her most important points was not to forget the mothers. She meant it in the sense of seeing mothers as activists, mothers as part of political engagement, and mothers as a crucial part of social change. Sometimes we forget to see them as strong and powerful forces, and there are so many!

Friday afternoon was really strong and it opened up the most discussed topic of the whole conference - the women of color or indigenous women, their needs, their disadvantages, and their ability to have equal access to midwifery as a future profession or as the primary care for them as mothers. The speech by Sheila Capestany was just incredible. She pointed out the main racial issues that are still present in US midwifery. The ability of women of color to locate midwives as care providers, or to even be able to study midwifery, is still unfortunately not the same as for white women. She also pointed out that we have been talking about the issue for a long time and, while she sees some changes, they are not fast enough.

There are still women and babies of color who are dying more often then white women and babies because they simply doesn't have the same access to health care as white women and babies. But she went even further. She claimed that it is a paradox, especially in the US where maternity care is quite bad even for white women, to have white women as the measure. She questioned the whole concept of comparing women of color with white women. She asked, “Why should the bad care, which is being provided to white women, be a measure for everybody else? Why we just don't have different measure, like evidence based quality care, which is affordable?” This topic was reoccurred during the rest of the conference.

On Saturday afternoon, there was great panel discussion about a very hopeful project called US MERA. US MERA is a collaboration of the six US midwifery organizations who are trying to make new vision for US midwifery, which is focused on education, regulation and association as crucial issues pointed out by International Confederation of Midwives. US MERA seems very progressive, especially after many years of tension between the different midwifery organizations in the US. All of the representatives were sharing their impressions of the collaboration thus far and all of them were pretty positive. They hired a mediator, which all of them agreed was a great idea and really helpful to the discussion.

This session sounded so successful and positive, but when it came to the discussion part it started to be tough. Women of color and indigenous women asked why, once again, are all of the representatives white? The moderator tried to explain that the main idea was merely to bring together the main US midwifery organizations, which are representatives of professional midwifery organizations, education boards and accreditation committees. But what stayed in the air was that none of these crucial organizations have women of color in the top management. This is one part of the problem, but the other one is that nobody even asked women of color to at least send a representative to this collaboration. If we see US MERA as a crucial effort for future of US midwifery, we need to have a voice from women of color.

My Sunday breakout session was the perfect ending to the conference. It was a lecture held by indigenous student midwife Wicanhpi Lotan Win Autumn Clevander-Wilson. She discussed the ongoing colonialism in US midwifery and she had several important points. One of the most crucial in my opinion was the critique of the US maternity care system as a source of power that is telling indigenous women how and with whom they can give birth. She called it continuing colonialism. She said that there shouldn't be anybody who is telling indigenous people what they can do, especially with their future generations.

The whole conference was really full of emotions because the race issue is still so present, even though we try to think that it is almost gone. Maybe I felt it too intensely because it is kind of a new topic for me. When I was thinking back over the whole event I felt so many positive emotions. It was wonderful to see so many midwives who are willing to open their minds and hearts to be able to give birth back to women -- to every woman, not just white, privileged and wealthy women. I want to really thank MANA, ACNM and all the midwives at the conference for that experience. It was really powerful.

Zora Javorská

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