One Rural Midwife’s Story: Care in the Form of Accompaniment

by Laura Card…

My Women’s Studies Senior Capstone Project was intended to focus on the role of midwives as crucial providers of woman-centered care, particularly in rural care settings. This project was a culmination of my interests in healthcare and feminist theory, a seed that was planted during my FSEM The Biology of Women that has continued to flourish throughout the years. When the effects of COVID-19 inevitably reached Colgate and cut our spring semester short, it felt like my project was being uprooted from beneath me and I feared that there would be little left to salvage. 

After spending some much needed mourning time over my project (and with support and encouragement from Sarah Wider – thank you Sarah!) I decided to continue on with the work that I had been looking forward to. Lucky for me, I had previously had the pleasure of connecting with midwife, Julie Carlson, at the Good Nature Tap Room during a local activism event last semester and knew that she would be the perfect resource. Although my project was put on hold, conversation could continue.

What I had imagined would be a series of discussions over coffee in Hamilton Whole Foods became a virtual Zoom call from my secluded basement-bedroom. Despite the miles that separated us and the occasional WiFi lag, the hour long conversation I shared with Julie about her work as a midwife left me with lots to reflect on. The main takeaways that I have chosen to share from our conversation come as fragments, separate and incomplete, perhaps – much like how I’ve been feeling these days. And yet, these fragments are a part of a larger whole, as they represent the conversations that continue to take place to connect our feminist community despite our physical separation during this global pandemic.

Much of my initial research focused on the quality of maternal care and the birth experience in the hospital setting as compared to the home-birth setting, so I was excited to learn that Julie had worked in both. Julie took her start in midwifery in the hospital setting, as she knew that this would allow her to reach the greatest number of people. However, the structural power dynamics that are inherent to the hospital setting, an institution birthed from patriarchy and white supremacy, prevented her from practicing the radical, empowering care that she believed in. The mere image of a hospital birth – a woman laying on her back with her knees forced open to the side surrounded by people shouting commands – uncoincidentally resembles a gang rape. Julie expressed feeling, “a regular sense of complicity in a system that promotes violence against birthing people,” that was so draining after eight years that she believes she would have had to stop practicing had she not begun working on a Navajo reservation and eventually as a home-birth provider.

Outside of the hospital setting, Julie was able to create a physical, mental, emotional, and spiritual space where she could focus on wellness and develop trusting relationships with her clients. Finally, she felt like she was practicing what she called “authentic midwifery.”

As we shifted our discussion to the home-birth experience, I asked Julie to describe the birthing options that are made available to birthing parents in the home-birth setting as compared to the hospital setting. What I hadn’t realized in asking those sort of questions, and what Julie was quick to point out, was the language that I was using. By using words such as allow and options, I was placing the provider in a position of power over the birthing parent without even realizing it. That, in and of itself, made me realize not only that the culture of care that exists in our country is rooted in power dynamics, but also that it is extremely pervasive and internalized. In a conscious effort to move away from this paradigm, Julie noted that, “one of the few requirements that I have when people enter care with me is that they’re actively engaged in their care and that they take on a central decision-making role about every aspect of care that there is.” 

What I appreciated the most from our conversation was the quality of care that Julie provides to her clients, focusing on their unique, individualized needs. Drawing on my own experiences, both as a patient in gynecological care as well as a student-shadow in the hospital setting, I noticed drastic differences in the level of support that is being offered. In the OB/GYN clinic I worked in this past summer, women coming in for their prenatal visits generally saw a nurse for five minutes to collect vitals and then a PA or OB for another five minutes to check the ultrasound. The same routine for each patient: vitals, ultrasound. Ten minutes total. On the other hand, Julie’s hour-long (or more) prenatal visits look different every time, not only dependent on the client, but also on their needs at that given time.

Thanks to the development of a close, consenting relationship with her clients that is nearly impossible to achieve in the hospital setting, where staff rotate with every shift and patient authority is negated by medical expertise, Julie’s role as provider is completely adaptive to the needs of her clients. She recalled many visits in which the best form of care and support she could provide at that time were as simple as making a meal or a cup of tea for her client. “I think self-care and prioritizing self-care is probably the main conversation I have with people.” By offering support in the form of accompaniment rather than control, this type of radical care empowers women to claim agency over their birth experience, from prenatal to postpartum. 

I leave you with these fragments and invite you to share in my reflection. Change cannot occur without continued conversation, and it’s in our power to ensure that these conversations never cease.

Stay Well.