Why am I a midwife? and other important questions.

I am a midwife. This picture is from my seat at work today, doing "my midwifery" in lots of ways. I prepared for an upcoming Board meeting for the American College of Nurse Midwives, contributed to conference planning for this year's Nursing Students for Choice conference, finalized a powerpoint presentation for students at the University of Illinois at Chicago to learn about national provider organizations for midwives and advanced practice nurses, talked with a student midwife about what's next for her in midwifery beyond clinical practice, and thought deeply about my own work.I am a midwife with intention and love and a soap box for every aspect of my work. I feel incredibly honored and humbled before this work, as well as impassioned and invigorated by it on a daily basis. There are so, so many reasons why I am a midwife and why I choose to geek out exponentially over the world of sexual and reproductive health. To answer a lot of questions I have received recently about why midwifery, why nurse-midwifery, why reproductive justice, why abortion, why queer health, why leadership, etc., I have come to realize that for me, the answer to "But why are you a midwife AND this other thing too?" my response is, "To me, that's midwifery!" So, here are some answers to "Why are you a midwife and..." to give perspective to all of the questions underneath and around and above and supporting what is "my midwifery."In summary: I am a midwife on purpose and with purpose. I am a midwife because I believe caring for women is the most important work in the world right now. I am a midwife because I believe that sexual and reproductive health matter to people's lives, and the midwifery model of care is one that seeks to empower people through that lens. I am a midwife who believes that reproductive justice is vital to each and every movement, feminism and midwifery included. I am a midwife who believes that queer and trans sexual and reproductive healthcare should be brought to the forefront of the sexual and reproductive health conversation, because great midwifery care should mean great midwifery care for everyone. I am a midwife who believes abortion is healthcare and a human right and it should be available to anyone on demand without apology*. I am a midwife who believes in midwifery.Now here's some longer (-ish, but still brief because each question is a lifetime but that's not how blogs work) explanations.Why did I study midwifery?I first heard the word 'midwife' in a women's studies class at the University of Michigan (shout out to the awesome Lisa Kane Low and Joanne Bailey!). Like many midwives, I started out pre-med and learned, for a variety of reasons, that the medical model's approach to teaching, learning, and patient care and individual empowerment did not align with my personal belief system. I switched to studying global health and medical anthropology, and by the time I sat down in a women's studies class and learned about midwives, my mind was already in love with the world of public health (still is), and I wanted to ride that love train and work to support the globe on a broad scale for a while. So I did, working in microbicide research and HIV prevention methods for women. I quickly learned, after working abroad in multiple countries, that midwives run the show globally when it comes to caring for women. I loved public health's approach to community care, but wanted deeper connections with individual people as a clinician and direct care provider. Midwifery was the one and only path that aligned the stars of all of my worlds: trusting other people to know what's best for their bodies, caring for women because ultimately that means caring for everyone, engaging an empowerment model that elevated voices of both care providers and care seekers, and mobilizing within a global community of strong voices. So I went back to school to, in my mind, join in the community of kickass people doing the best job in the world: full spectrum reproductive and sexual health care for women.Why did I choose nurse-midwifery?Public health provided an amazing foundation from which I learned about how systems and infrastructures functioned in regard to people's health. Working abroad showed me that if I were to continue to be internationally-focused, or have a home-base in a high need setting of any sort, that nursing would be a critical foundation for that work. As I looked further into the scope of practice for midwives of different types, I realized that I wanted to have the option to provide primary care, abortion care, sexual health care, and care for women throughout their lifetimes: nurse-midwifery fulfilled that for my own interest areas. Importantly, I wanted to be a midwife who would bring midwifery care to people who would not necessarily seek it out, including socially disadvantaged populations, uninsured people and families, immigrant and refugee communities, and those choosing care based on ease of clinic location or insurance needs and not necessarily a health literacy or knowledge base from which to know that midwifery care might be the model for them. Additionally, to maximize my ability to pay off my student loans, I wanted the most flexibility of job location, and the CNM designation worked the best for hospitals, birth centers, or home birth options. Ultimately, I attended the accelerated RN-MSN program at Yale University School of Nursing, choosing to await the route of a doctorate (I'm PhD-bound for research, rather than the DNP) until I had been in practice a few years. (Note: I fully support those who choose other paths to midwifery and I investigated those options for myself as well - in no way am I saying my choice is the right one for everyone!)Why did I choose to become an Advanced Practice Nurse instead of a Physician Assistant?As a feminist, I intentionally chose a path into my life's work that would give me independence as well as collaboration, historical backing as well as future potential, and one that would embody revolutionary principles in my lifetime, including models of teaching Residents, expanding scope of practice, and working in care models as experts in certain types of care for women, and midwifery had it all.I was taught in my MSN program that the APN model was borne out of nursing seeking to expand its own scope of practice and demand financial and educational recognition of their work. Conversely, my instructors taught that the PA model of "assisting" medical care was the physician response to that revolution, in other words an attempt at a physician-controlled restraint on the limits of nursing care. Nurses declined this physician-owned model, and each group continued forth with their intention. Thus the two models exist today. I love that story and its further justification of my chosen path, though am unsure of its truth - does anyone have sources for that?!?Why am I a midwife in a federally qualified health center (FQHC)?I work, and have worked continuously since graduation, in a federally qualified health center (FQHC). This is a clinic type that is subsidized by the US government, as these designated clinics are recognized to be in areas of high need for care but with few providers available. I currently work in a clinic where I serve individuals who are largely uninsured or on public insurance, immigrants, Spanish speakers, and Black families and communities of color on the South Side of Chicago. I am honored to be present, humbled to provide space, and emotional at the opportunity to offer midwifery in these neighborhoods. I also feel beyond lucky to, every so often, come across people who are seeking out midwifery care, and am thankful when those moments and days and births happen as well.Why am I a midwife who works at a university?I believe in the power of precepting, teaching by example, and being in an environment where education and evidence are the foundation of care. I love my profession and I feel so fortunate to be with students, showing them the excitement I have as a new provider, and encouraging the next generation of midwives to get into practice as quickly as possible. With each shift I am proud and invigorated by the awesome students who come through and challenge me at the same time as I work to challenge them. The university environment encourages constant thought about what could be different, how collaboration facilitates growth for all provider types, and ideas about what is next in sexual and reproductive health care for all people. I love learning and growing and collaborating: students and universities help me to keep doing all of those things.Why am I a midwife who works in a hospital?Hospitals are institutions that are able to accept a variety of insurance types, have support systems in place for diverse language speakers, and can handle large volumes and levels of care. I became a midwife to serve populations of high need but of possible low knowledge of midwifery: the hospital setting, in my city, is currently my preferred place of practice. I was fortunate to work with a homebirth midwife in Connecticut while I was in school (Thanks Vicki Nolan Marin!), and unfortunately have not had the opportunity to work in a birth center. However, I am currently beyond thrilled to be at a university hospital, at the only midwifery program in the state, and with a historical midwife practice in the midwest. For now, I'm right where I need to be, and where I feel my midwifery heart the strongest. (I absolutely love the birth center model, and am enamored with midwives who give themselves wholly to the work of home birth. I argue constantly over the rights for people to choose their preferred location for birth and for improved collaboration and transfer systems. Shout out to all the midwives who work in birth centers and the home! Thank you for doing midwifery right where you feel your midwifery heart the strongest!)Why am I a midwife who is a member of my national organization?Midwifery is a community, first and foremost. No midwife exists on an island: we are attending birth alongside the parteras in Mexico, we are negotiating full scope recognition nationally, we are talking about how the best utilize the midwifery model with our fellow midwives in the UK. Our community is organized and our voices are elevated by the work of our national organizations. I am thankful for the work of everyone who has served in leadership, continues to serve in volunteer roles, and for new midwives creatively thinking about where our policy and activism and research and diversity work will lead us next. Our voices are strongest when they are together.Why am I a midwife serving in midwifery leadership?I am fortunate to have had, and continue to have, incredible midwife mentors, who encouraged my interest and participation in leadership (Thanks Amy Romano and Francie Likis!). I do my best to represent the voices of those midwives who I feel I was elected to represent: new midwives, queer midwives, pro-abortion midwives, reproductive justice midwives, and midwives seeking an organization diverse in all of its regards. I am proud to be a part of an organization that welcomes the intensity of my voice and of those whose voices I seek to elevate through serving in my role. And I am thankful for the seasoned midwives who midwife me in my leadership role, and continue to encourage me as I learn all of the things I see, and do not see, that I am still learning. (Thank you to everyone who voted for me, and for those who reach out to let me know what you love / what bugs you about midwifery right now: I'm listening and working hard!) Now, onto questions that are foundational to me as a person, and I bring that foundation into "my midwifery."Why am I a midwife who supports abortion?I believe abortion is healthcare. Fullstop. Midwives are trained (or at least all should be, as per the ICM Essential Competencies for Basic Midwifery Practice), and have the scope of practice, to provide medication abortion and manual vacuum aspiration for abortion and miscarriage. I will talk about a person's right to abortion, and midwifery and advanced practice nurse involvement in abortion care, ALL DAY LONG. Why am I a midwife who believes in and supports reproductive justice?Reproductive justice is a movement that acknowledges the complexities of race and inequality and social and political structures that impact health. I feel that Sister Song's definition most resonates with the midwife model of care:"Sister Song has defined reproductive justice as the human right to have children, not have children, and parent the children we have in safe and healthy environments. Over the years, we have expanded RJ to include the human right to bodily autonomy from any form of reproductive oppression."If midwifery as a whole doesn't embrace that, midwives are missing the entire point of creating healthy people and communities and a healthy world.Why am I a midwife who talks about queer and trans health?I identify as queer. To me, people are people. Thus, trans people are people, in need of sexual and reproductive healthcare just like everyone else. Midwives take care of trans people. Many midwives identify as trans. Many midwives have family members who are trans. For many, this question answers itself. For others, there are further questions, and that's fine. I'm happy to answer them. Here's the easy answer:If someone's body and identity and concerns fall within my scope of practice, it's my job to care for them and create a safe space and empower their world just like I would do for anyone else who would "traditionally" fall within my scope.Why am I a midwife who blogs?I just can't freaking help myself. And thankfully there are people who read. Keep questions coming, y'all.Why did I become a midwife?In my mind, I am still becoming one. * thank you Jessica Valenti for that language