From the clinic: How we make choices about birth providers

So I’ve been volunteering at a clinic, helping a midwife with translation (and other odd tasks) with her mostly Latina immigrant client base.

I’m really loving it, working with pregnant women again, doing direct service with latinas. I’ve missed being in a healthcare provider setting, and I miss doing doula work too. I’m working on it.

The women who come to the clinic get to decide where to give birth and with what type of provider. Her options are:

1) Hospital birth at teaching hospital with residents

2) Birth Center birth with Certified Nurse Midwives (CNMs)

3) Birth in the teaching hospital, but with care from CNMs from the birth center

This third option is really cool and not one I’d heard of previously. Most of the time, CNMs that deliver in hospitals are staff of the hospital and have a practice based there.

So the majority of the women this midwife sees choose hospital births. Now that midwives are an option in the hospital, it’s presenting a new possibility. But many of these women (like all women) have LOTS of preconceived notions about midwives. One woman who is almost due illustrates this really well:

Maria (not her real name) is from Honduras. She’s a spanish speaking immigrant and is pregnant with her third child. When we presented the possibility of having a midwife attend her birth in the hospital, she told me (after a little prodding) that her partner was really against her having a midwife. She said that he was born to a midwife at home in Honduras, and that the midwife dropped him on his head during the birth, which caused him to have a permanent eye deformity. Maria didn’t think it was worth it to fight with him about it, even though she was open to having a midwife there instead.

Ok, a few things about this. First, obviously the power dynamics between mom and partner are intense. Second, immigrants bring with them to the US all sorts of preconceived notions about how people should give birth. Some of it is based on life experience, like this, some of it is based on hearsay, feelings about class and health care models, a ton of things.

It’s very possible that her partner was delivered by a midwife at home. It’s also very possible that he was dropped at birth. It’s not necessarily true though, that it caused his eye deformity. The point is, it doesn’t matter, because this is the story he believes. And it’s informing his choices now. That’s a lot for providers here to contend with.

My main take away from all of this is that the issue of educating people about their birth options is so complex. It’s not just about what we’ve seen on tv, what we’ve heard from our families. There are layers upon layers of knowledge and preconceived notions we have to unpack to change the choices people make about how to birth. For immigrants we have to deal with a whole other cultural context, role for midwives, medical system and structure. Understanding this is the just the beginning of culturally competent care.


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