Birthwork is Activism

‘Birth work is activism’- we’ve all heard the phrase, and it’s true that in so many different ways as midwives and student midwives this is our role. It’s one of the most rewarding and important parts of this work, and I hope that we never forget that.

But how do you go about becoming an activist in the field of birthwork? First let’s start with some definitions. Activism is defined as an intentional action to bring about change. And I believe that in the birth world the most effective way to do that is by being an advocate. An advocate is someone who argues the case for something, or someone who argues the case for another; an intercessor. One way of looking at it is that advocacy is listening to the voices of those affected by injustice (in our field this is generally mothers) and expressing the need for change, while activism is taking action to create change. They’re two sides of the same coin. Yes, we catch babies, but more than that we advocate for informed consent, for options, and for respectful maternity care. We argue the case of the mothers that we serve: that they have the right to make their own decisions and to be treated respectfully. We also end up interceding for them in a medical system that oftentimes, intentionally or unintentionally, ignores these rights.

Respectful maternity care in many different settings all over the world, is still a work in progress. As midwives we are both ‘with women’ and we are healthcare professionals; we have a foot in both worlds so to speak, which puts us in a unique position to advocate for the mothers we serve. We’re activists for respectful maternity care in so many different ways, and for many of us this is our why behind why we do this work. Every day we are called upon to be advocates for mothers- to listen to them, ensure informed consent, and respect their decisions. You won’t be a part of this world for long without seeing the birth trauma that comes when mothers’ decisions are ignored, when they aren’t given autonomy, when there is no one there to advocate for them. Good listening skills and the strength to stand up and say something are so important for students to develop, as chances are you will be called upon to use them to stand in the gap and advocate for these mothers.

I’m going to take this a step further though and say that in order to be a good advocate for mothers, you have to be a good advocate for yourself. If you don’t know your own limits and let a preceptor walk all over you because “at least you’re getting numbers” do you really think that you’re going to be able to advocate for mothers and help them stand up for themselves? How are we going to advocate for mothers and their rights to be respected, if we don’t even respect ourselves? It just doesn’t make sense, and while I’m absolutely not blaming students for a system that believes in ‘eating your young’, the reality of it is that right now that is what the system is like. 

And if anything is going to change, and this next generation of students is going to become healthy midwives who advocate for what’s right, then we have to be willing to say something. Even if you’re not the student being bullied, are you going to stand by and watch your peers (often newer students) get eaten alive? If we justify it with “well we experienced it too when we were new”, or “that other student is our competition”, who else are we starting to sound like but the very midwives we swear we won’t turn into?

How are you going to advocate for your clients if you can’t even advocate for yourself? If you won’t stand up for yourself, how are you going to stand up for anyone else? Burnt out students who let themselves be walked all over don’t generally become healthy midwives who stand up for themselves and for others (no matter how much they intend to). After all, how do we think we ended up with so many burnt out midwives who don’t know their own limits and end up hating this work and walking all over their students and clients? (Hint, it’s not that they started their apprenticeships planning to become bullies.)

This is one of the many reasons why I question the ‘no matter how badly you’re treated, just keep your head down to get your birth numbers done’ mentality that I’ve too often seen in the student community. I sympathize with students who are in a position where they feel like their options are to either get walked on or lose their preceptorship. But while I understand the sentiment to just get done and be able to license, I also know the importance of activism in birthwork and so much of that is learned during apprenticeship.

We accept that when it comes to skills like blood pressures and blood draws, they’re developed through practice and doing them over and over again. And yet when it comes to activism, which I think we can all agree is an equally important skill, we act like the moment we license we’re going to magically go from rundown students to healthy midwives who stand up for ourselves and our clients. And I just don’t think that’s realistic. After all, would you expect that the moment you license you’re suddenly going to be able to set IVs when you weren’t able to during apprenticeship? Of course not. Apprenticeship is supposed to be the time that you’re developing those skills, and you cannot develop the skill of being an activist if you spend apprenticeship being your preceptor’s doormat.

Even if it takes us longer to get our numbers because we won’t work with midwives who don’t respect their students, it’ll pay off in the future when we’re healthy midwives who can stand up for ourselves and our clients.  Just like any other skill: blood draws or blood pressures or IVs, being an advocate in the birthworker community is something that comes with time and practice. And if we really believe that activism is as important in birthwork as we say it is, we can’t afford to have it wait until we license. If we’re going to be midwives who stand up for what’s right and create lasting change, it has to start now. Being an activist, creating change, and breaking unhealthy cycles doesn’t start when we become midwives; it starts when we become students who stand up for what’s right and advocate for ourselves, for other students, and for the mothers we serve.