Cultural Humility in Birth Care #026

In this episode we are discussing Cultural Humility in birth care.  We talk about the differences between cultural competence and cultural humility, the impact of "professionalism" on how we engage with those in our care about their cultural preferences and needs, and the growth and hope possible within our system.

Transcript

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Maggie, RNC-OB  0:06  
Welcome to Your BIRTH Partners. We're here to break down barriers and cultivate community as we discuss issues that impact pregnancy, birth and postpartum. We welcome you no matter what your background is, and are so excited to learn together. Today we are discussing cultural humility in birth care.  We are going to dive into some of the differences between cultural competence and cultural humility. And we're going to talk about what it looks like to create culturally competent care spaces and to elevate our own practices so that we can cause less harm as we're taking care of everyone. So I welcome you on to this conversation with Dr. Angela Mike, Certified Nurse Midwife, Ray Rachlin, Certified Professional Midwife, Pansay Tayo, doula, and Dr. Abby Dennis, MD.  Onto the show! 

You know, cultural humility, and how do we show up for people recognizing all of the different systems of power and oppression, and the roles that we have, the power that we have to, you know, kind of two weild for, you know, good or for evil. And I think that's one of the things too, that I think when, because of the way our like, academic medicine, and you know, nursing and midwifery, and a lot of the trainings I've done, try to break down into like, connecting with people who aren't like you into, like, it's a box, it's a chart, you know, on the page that just says, like, oh, if the person looks like this, here's the way they're gonna feel about it, if they've got this ethnic background is how they're gonna respond. Which is just it's so incredibly off base, it's, it's remarkable, you say it out loud. And it just sounds insane. And it's insane that these are still like the way textbooks are being printed now for medical and nursing education, you know, I think there's that whole piece we've talked about about like, how do we go from cultural competence, this idea that somehow magically, I as one person, am going to understand the culture of everyone who comes in front of me and be able to care for it appropriately, versus cultural humility, where I am open to the fact that I don't know anything, I don't know plenty about each of your cultures, whether we look the same, or we've lived in the same areas, and we've had some of the same experiences, like, I can still learn so much more about that. And so I wonder if we could speak a little bit to, you know, how do we kind of get past some of those barriers and create in ourselves that ability to be open to people who look like us who don't look like us who have some major experiences, who have no shared experiences, and still be able to provide care for them?

Angela, CNM  2:45  
I think I mean, you said it, Maggie, it's just being humble, you know, ourselves. And acknowledging, you know, I don't know. But being genuinely open without judgment, and not tolerating, but accepting people for who they are, where they come from, and what they believe in their philosophies. Because at the end of the day, I'm here to provide a service, and they chose me. And I need to be respect that respect needs to be parallel, you know, and I think that as long as we just remain open to differences in make ourselves aware in each individual's space, then that helps to create that balance. Because you're right, there's no way I can be culturally competent. When everyone's situation, I don't know, your background, I don't know your story. It's different from mine. Even if we do look alike, it's different than mine. And you just have to be willing, willing, and just 100% open without judgment.

Ray, CPM  4:03  
Yes, to all of that. And I think something I learned in like doing trans health care that's been really helpful and like, serving people with different backgrounds and me, is giving people opportunities, like how to correct me, you know, like at the beginning of care asking, like, both for, like, "Are there things like you know, culturally, religiously, that you think is important for you to know about caring for your family," and that, you know, I'm not a perfect midwife. And if I'd say or do anything that doesn't work for you, like I'm a New York Jew, so I respond really well, to direct communication. So you can like, tell me up front that like, I messed up and also, if that is totally uncomfortable to you, shoot me an email and I'm happy to like, address any ways that like, I'm wrong. Like in trans healthcare, a lot of what we know is that trans people typically have to educate their health care providers about their own needs. And you know, when I'm caring for someone who's like black or brown, you know, although like over the years, I'm getting more experience, I'm like, still, like, I'm never going to understand. So acknowledging that that exists and that they're going to be my teacher and like, some of my trans clients have been like after things like you want me to, like, read or learn about to better care for you, please let me know. And it kind of goes, you know, there's different ways to ask that question to be like, "how can I like learn to be a good care provider for you?" and acknowledging that that power dynamic exists goes a little bit towards building trust? 

Maggie, RNC-OB  5:29  
Yeah, I love that. Just that reminder that we don't know everything, I think so much of how like medicine was set up is that that feeling that we all have that we're supposed to write that if we admit that we don't know something, it you know, if we open that up, that it opens up this idea that maybe we're not a good provider, maybe we don't know enough to keep someone safe. And so I think sometimes our ego prevents us from wanting to engage on that, and admit that we, you know, we don't know something and I do, I just, I love that idea of really like starting that just opening up with like, "Hey, I don't everything about you, but I would like to know more about you so that we can be in this relationship together. And you know, we can do this." And just having that moment of just like authentic connection and breaking down role walls that we put up, you know, that keeps this bizarre power, dynamic at play.

Abby, MD  6:24  
There's something really beautiful at birth, when you do really get to that point where you feel like you, as a provider, and a patient are just like, completely present, and you're communicating well, and you're doing your best to get one another. It's one of the moments for being in a healing profession, it can feel really magical and wonderful and right. But it's, it's hard. We're all learning, like you said, we're all learning and we're trying to be better.

Angela, CNM  6:55  
I think there are parts of medicine, too, that just does not allow you as a professional, you know, as a profession historically, anyway, to admit that you don't know. Maggie, I can't even tell you how many times in my young career as a, as a nurse, I was just so afraid of like being wrong or my ego, would just be in the way. So often, it prevented me from being able to learn and grow my practice. And thank goodness now I've become more of my own person where I have zero problem saying, you know, what, "I just don't know, I've not experienced that before. I don't know what that is, let me get one of my colleagues to come look, I have no clue." You know, and, and being okay with that, you know, I'm really good at a lot of things. And sometimes I just don't know, and I think in medicine, gosh, we need to give each other permission to not know to not have all the answers so that we can protect our clients and do what is absolutely best for them. You know, we're just human, you know, we're just human. Several brains work way better together than one sometimes.  We need to, to allow for that, and I think that would break down. So many barriers that we've already discussed today. Specifically, when it comes to trauma and birth, and cultural awareness, all of those things, even when it comes down to like the different professions within the birth community. You know, that would be at least the beginning portion, in my opinion of healing, and making things better.

Abby, MD  8:58  
We've focused so much on gaining people's trust that we've I think tend to that whole phenomenon of not being able to be like I need help, I don't know.  People, there must be some maybe subconscious thing that we're doing. We tend to repress I don't know if it's ego, or if it's just feeling like that's a barrier to gaining anybody's trust, which is so important.

Maggie, RNC-OB  9:23  
Pansay, I feel like you do that so beautifully. And I've watched you do it in circles with people. And I don't know how much of that you have... I don't know how much that is just because you're an incredible person. And that comes naturally for you or if that's something that you would really, you know, kind of cultivated, but I've watched you really I don't know if you can speak to the way that you engage with people and both acknowledging their experience and then being able to offer yours in just a really, like genuine and heartfelt way.

Pansay, Doula  10:00  
I approach all women, you know, and especially in, you know, when we're in circle or even a client, I'm looking at my past, right? And how I was treated and things that happen, the amount of judgment that was put on me for what, whatever reason, and or why did I feel blocked out of certain groups or, you know, situations. So, a person, no, no judgment, no assumption, just the person. And when I create sacred spaces for that, there are some things that I know for sure that this is a haven being having a spiritual experience. And I want to provide a space for this being to feel safe to be able to let the walls fall, and just connect to source. And when I do that, they feel at all all they all they fill is love, and support and safety. So I'm not assuming from the color of your skin, or you know, how you dress, or whatever. But you're human being in spiritual experience, like we all are. And that's that, that will be my hope, that how we treat it when we go into any of these facilities, any doctor that we see if that we had treated and respected is just that.

Maggie, RNC-OB  11:30  
I feel like that's another one of those things, you know, that it feels like, that should be human nature. Right? It's just so sad that that is something that needs to be fully said, It's sad that that is that is not what happens, for way, way too many people way too many professionals, birth workers who they're not prepared to, to see the whole person. And, you know, to get past some of those assumptions, I think it's one of the things I know when, when we talk about like, cultural competence, it feels like it's often just being broken down into again, we're just we're trying to put people in, in boxes, and rely on those stereotypes about what we've assumed, or the last person we cared for, who looked or seemed similar about this person, but you know, on based on, you know, race or class, or any of the ways that we kind of can quickly assess people. It's just incredible how much we miss doing that, and how much we miss it, what we bring, you know, as ourselves to, you know, when we just tried to be in this, you know, false professionalism piece that, you know, that is that is driven by white supremacy, and what you know, what the expectations are around how we are all supposed to behave in these situations. And we've completely created this, you know, false dichotomy where people feel like they can't connect from a human being to another human being, and that we have to put on all of these, these airs around who we are so that we can establish credibility, what a different world it would be if we really were able to do that, everyone. 

Ray, CPM  13:09  
Yeah, I think both in this and in the trauma-informed care conversation we had, you know, the thing that prevents us from having a healthcare system that centers, the needs of like marginalized people is profit, you know, in capitalism. And as long as we have a health care system that is for profit, you know, people are going to continue to die and suffer and be treated badly. You know, and because I think, you know, that idea that, like experts know, everything, and it's top down and power over versus power with, and like, is a product of healthcare being a for profit system. I so wonder, like folks in other healthcare settings had the ability to practice slower, and have more relationships and have more conversations about the nuances of care and like what we do and don't know, or like, getting to know the person in front of them, and like learning the skills to do that, instead of learning the skills to code to go to let your you know, to be able to keep seeing more people? What things would look like, and I don't, you know, I don't think there's any easy answer. I do think, you know, with, like, the black maternal health conversation and like, you know, the fact that people are dying from racism in this country, the answer often comes back to midwives. And like, it's not midwifery is not the answer to all of it. But having longer appointments with a provider that you know, and have a relationship with and is more likely to act as an advocate for you is a big part of the answer. And having more providers that look like you and prioritizing that is a big part of the answer. All of this, but as long as we're in for profit health care systems, like we're we're going to continue to fail and like in all these different ways. 

Maggie, RNC-OB  14:51  
Yeah, absolutely. I think I mean, I was just looking at some of the stats about kind of the some of the racial breakdown around you know, who provides care, who receives care and, you know, the recent census data was showing that from, you know, for our youth, so zero to 16, so that people that will be childbearing in the next couple decades, you know, we have in our country now like about 50%, identify as non white. And then our, the breakdown of our care providers. midwifery is about 90%, white. OB-GYNs are about 75 to 80%, white, you know, nursing is somewhere in that range as well, you know, and so we are going to keep running into these issues. If we don't, you know, both for people like me, who, you know, are white, and have been ensconced in kind of this completely unearned power and privilege, to not care about someone else's culture, because ours has been the dominant one, we are just going to see more trauma, and more harm, and continue to see excessively high deaths for black and indigenous, and you know, all people of color, if we're not able to let go of that there needs to not be a dominant culture, there needs to be an acceptance of all of these different cultural backgrounds everyone's coming from. And I think so many of us in, you know, in healthcare, because our health care providers professionals remain so white, it is hard to drop some of those things that come along with white supremacy culture, and to step out of that, and to let go of some of this, you know, the excessive the professionalism piece, the needing to be right, and being the expert, and some of these things that all come along with it, so that we can actually engage with the people in our care. And I'm saying this as a white person who, obviously I don't have the answers for exactly how that looks. But, you know, I will certainly link in the show notes, some trainings that I've taken around, you know, cultural humility and understanding how our role can play into that. I think those are, you know, that's really helpful.

Pansay, Doula  17:15  
Is there ever like a, Maggie I can ask you, within your trainings that you've taken, you know, in the hospital, do they ever have classes for you all, as far as cultural humility? Feels like me, wait, it's a part of, like, any type of any type of training or you know, anything dealing with birth, pregnancy, anything like that? No.

Maggie, RNC-OB  17:37  
So I think there are some health systems who are probably a little bit more, you know, whatever you want to call it forward thinking progressive, who are recognizing this as something that needs to start from us in, you know, that we, as the birth professionals need to change the way we're interacting, I would say, the trainings that I've taken, you know, over that have definitely been outside of, you know, hospital setting that I've done some, you know, there's some organizations who, you know, who could have done it more within the system in terms of being able to, you know, earn the CEUs, continue education credits that we need to like, renew your license and stuff like that. So they're, you know, some of them are kind of within that space. I've seen a way more about it in like doula trainings, I've done, you know, as of late and way more in kind of like community offerings, I'm sure it is like regional and some places are, you know, doing more than that. But I would say most of the kind of like formal from, you know, nursing education and health care settings, systems that I've worked in, most of that comes more in the kind of like, check the block cultural competence. This is what you need to know about people who look like this...have not dive more deeply into the work that we do internally. But Abby, I don't know if you've seen more?

Abby, MD  18:43  
I've seen some of this working curriculums at medical schools, which I think is really great. I know, as somebody who's several years out of training, the place that I've seen this coming the most is the National Organization of Family Physicians, where I feel like I've seen a couple things on training courses for cultural humility and sort of ways to communicate with patients and, and just be a better provider. We're not doing it well enough yet, obviously. But I feel like there is at least a movement to be better. 

Pansay, Doula  19:13  
A lot of work that needs to be done. And, you know, when you look out at the numbers, the statistics, you know, we could could feel a little, you know, overwhelmed and you know, is this going to end, but I see light, just one woman at a time, tons of education, you know, tons of healing spaces for us to do the best that we can in positions that we have in a community, knowing that if we're caring for them properly, she's going to tell our children about this wonderful care. She's going to tell you know, her daughter, her sons, how she was respected, how she was honored because beautiful experiences are setting the tone for the next generation. So for every woman that I've got in journey through, you know, pregnancy and birth, and they, you know, they hear that healthy baby have, you know, they've had a magnificent experience. This is now my prayer, my hope and you know, warm, so this family and the generations to come. So woman at a time,

Ray, CPM  20:22  
I do feel like I have hope and like the newer organizations in the birth worlds, like the National Association of Certified Professional Midwives has made children ability and racial justice a priority and a forefront, they have a formal scholarship program for midwives of color. You know, I think the older guard organizations are not making those same, like choices and changes that we need. But I feel like I have some hope in like midwifery futures, I think I have less hope and like how we're actually going to create, like, shifts the healthcare system to one that's going to, like be able to adequately provide and also, like,  who's going to get trained and who's going to run these systems, you know.

Maggie, RNC-OB  21:06  
There is. There is hope in you know, the future. And it you know, and I hope us all in, in having these conversations and, you know, working through these, that it's something all of us can kind of dive more deeply into the roles that we can work in, in creating the birth care world that we want to see that we want to be there for, you know, for future generations, and that we're, you know, we're continuing to work at one birth at a time. 

Pansay, Doula  21:28  
Well, I thank you all for the work that you have done and are doing it for, you know, all the women that you care for. And for even, you know, coming here to this platform, and giving us insight, you know, in your position, and in your roles for us to learn more about, you know, your process in caring for women.  And I appreciate it, and I learned so much.

Abby, MD  21:52  
The feeling is very mutual. I feel like this is this is a subject that I feel like right now my job is to be a little bit quiet and learn because I realize I've been doing a lot of things really wrong for a long time. And I appreciate this forum to do that. 

Maggie, RNC-OB  22:10  
Yeah, absolutely.  Grateful to grow and learn alongside all of you.

Thanks for tuning in. We love to talk birth and would love to talk about it with you. Please join the conversation by finding us on Facebook, Instagram or Twitter; we're Your BIRTH Partners on all platforms. And we invite you to join our Facebook community group, Your BIRTH Partners community, where you have a chance to dive more deeply into the topics we discuss on the podcast and a diverse community of professionals looking to change breath care for the better. As promised, you'll find some resources for cultural humility courses on our show notes this week. And we'd love to hear from you another resource you've had helpful as you continue to grow in this work. Till next time!