Hi everyone. My name is Dr. Mimi Niles. I am a midwife and midwifery care researcher. Most of my research is based in Canada and the US. My primary interest is in how midwifery care functions in disenfranchised communities. I've worked as a midwife in an urban public health care setting for close to ten years now, taking care of very diverse people from all over the world. I've also worked globally as a midwife in Haiti, Mexico, and Tanzania. I'm so happy to be here with you to talk about how midwifery work can be a way to impact and create change. Change in people's lives, change in their experience of care, change in our profession and change in systems and institutions of care. The title of my presentation is Midwifery Care as Justice Work. It's to encourage us to think about the ways our work and our distinct model of care can be a platform to advocate for the people we care for and for ourselves. The subtitle, Exploring Midwifery as a Feminist Ethic is a way to highlight how our profession is connected to fundamental feminist principles and to think through how our work can bring these feminist theories to life. The ethos of midwifery care must be considered as its own unique model with its own distinct philosophy that stands adjacent to medicine, not beneath or under it. Ethos refers to the character of our work, I use it here to think about what distinguishes the midwifery model of care. Our model of care is rooted in basic principles. Number one, pregnancy is a state of health. Being able to grow and birth a child is a function of your health. Number two, health is a dynamic process, meaning it changes over time and can improve, worsen, and improve again all through the same pregnancy. It's also very responsive and interactive with different factors, the environment, someone's social conditions, your physical health, your mental health. Number three, in our care, we value and invite our clients to think about their physical health as well as their social, mental, and emotional health. Number four, our care is rooted in principles that support a person's right to determine what they want from their own lives. We support autonomy through building relationships with our clients and families and we actively encourage informed and shared decision making and care. If as midwives, we think of ourselves as working towards justice and equity for all childbearing people. We can realize that our work is part of a larger movement of people who are working to make the world more just and equitable for everyone. This is why I encourage us to think of midwifery care expansively as a way to work towards peace and justice. Just as fighting against climate change is critical to the survival of the planet. Providing for safe and compassionate care for women is a way to fight against gender inequalities and racial health disparities. To really embrace our work as a way to support people's autonomy and health. It's helpful to start thinking about core feminist theories that can shape our work, our research and our care. The first theory I'd like to review is intersectionality. Intersectionality theory tells us that the human experience is made of overlapping identities of race, gender, and class. Theorists such as bell hooks, Audrey Lorde, Kimberle Crenshaw really support the use of this theory, particularly in health care research. Reproductive justice theory tells us that the right to reproduce birth and parent should be in alignment with one's own values and experiences. Not our values or the values of the state or the system. It can be very hard to advocate for our clients when there is this value mismatch. Third, Social Justice Praxis Theory. This reminds us that social, historical and political forces are always at play and they can limit or constrain human and ecological potential. This is what produces and reproduces injustice and inequity in many parts of our lives. Fourth, a smaller theory called the Ethics of Care by Carol Gilligan, reminds us that it is through relationships that we can achieve justice, not just by the rule of law. Why is theory important? Theory helps us ground our midwifery work in larger social discourse and conversation. For many of us in health care and science we're taught, me must be impartial and our work is unbiased. But that is simply not true. Biomedicine believes in measurement and positivism, meaning there's one singular answer or reality. On the other hand, feminist theories which emerge from the constructivist paradigm, suggests that people's lived experience also provides valuable information and data about their own health and well-being. It's our task to incorporate somebody's embodied experience into building that healthcare relationship. Can you imagine being in a relationship with someone who only tells you what to do and what to think. Instead of asking you what you want and what you think. Theory also asks us to think about how and why bigger systems and institutions impact the way we live, work, and move through the world. Feminist thinkers are not just suggesting that women can be the same as men, we are suggesting that rigid systems oppressed all of us and we need ways to assure that equality for people can be realized and celebrated, particularly those that are marginalized because of their identities. In trying to make these theories a part of our midwifery work, here are some examples of how our work can make care a tool for freedom and liberation. We can promote gender equity by thinking of ways to dismantle patriarchal structures, professionals and socio-cultural barriers within our own institution and workplaces. We can support physiological processes. This includes ensuring safe, effective, and appropriate use of interventions in our own midwifery practice and our own unit culture. We can think about increasing coverage and services, making sure that we reach all women of reproductive age, and that we are not imposing our own personal values or moral frameworks on those we care for. We can also think about providing a full spectrum of services that extend beyond the basic essential perinatal care services. This includes reproductive care, sexual health care, and primary care for all the people we serve. We can also think about task shifting. Skilled, supportive, and preventative care can be provided by a range of advance practice clinicians. Often we think doing more means more power, but that's not so. Sharing our work with other types of providers can also create better health care for our patients. Our care can offer a comprehensive approach to health care for everyone we interact with. It's made up of different skills, perspectives, and principles. We can think about not only what care we can offer, but how and why we offer that care. I encourage us all to continually reflect on what midwifery care means to you and how it can address the many factors that impact someone's reproductive and sexual health. Asking yourselves what respect looks like in your own life? Assessing what someone's social and mental health care needs are can be just as important as addressing their physical needs. Advocating for fair and accessible care for all people in your community and approaching collaborative care with physician and nurse colleagues are also ways in which we can realize the full scope midwifery care. Our work is expansive and generative. Though many think we only provide pregnancy, labor, and birth care, we can do so much more. When we empower ourselves, we empower others. Midwifery work is a tool for empowerment. I encourage you all to read through the suggested readings to gain a deeper understanding of how our work celebrates and realizes some of the core values and principles of feminist theory, and for us to realize that this is one way to think through how midwifery care can be a tool for liberation and equality.
