Your BIRTH Partners

Professionalism, Activism, & Politics in Birth Care

December 14, 2020 Season 2 Episode 13
Your BIRTH Partners
Professionalism, Activism, & Politics in Birth Care
Chapters
Your BIRTH Partners
Professionalism, Activism, & Politics in Birth Care
Dec 14, 2020 Season 2 Episode 13

How does "professionalism" stop us from showing up as activists and advocates for change in birth care?
In this episode, Katy Cecen, NICU nurse & midwife, turned whistleblower, activist and full-time community organizer shares her journey and growth in stepping up to face the challenges and inequities of our birth care system.
She details how professionalism is a tool of white supremacy culture, the privilege inherent in operating as an "apolitical" birth pro, and 3 steps you can take now to change your practice and step into activism.

Support the show (https://www.paypal.me/yourbirthpartners)

Show Notes Transcript

How does "professionalism" stop us from showing up as activists and advocates for change in birth care?
In this episode, Katy Cecen, NICU nurse & midwife, turned whistleblower, activist and full-time community organizer shares her journey and growth in stepping up to face the challenges and inequities of our birth care system.
She details how professionalism is a tool of white supremacy culture, the privilege inherent in operating as an "apolitical" birth pro, and 3 steps you can take now to change your practice and step into activism.

Support the show (https://www.paypal.me/yourbirthpartners)

Maggie, RNC-OB  0:00  
Welcome to Your BIRTH Partners. I'm your host, Maggie Runyon, birth nurse, educator and advocate. And I invite you to join us as we break down barriers and cultivate community, discussing issues that impact pregnancy, birth and postpartum. We welcome you, no matter what your background is, and are so excited to learn together. And today we're going to talk about activism. And what does it mean to be an activist as a birth professional, we're going to touch on issues of professionalism, what our history is with that word, and what it means, how it limits us and our beliefs around our role within first and healthcare, and society at large. We're going to discuss some of the particular issues that are really relevant right now, both in our political landscape. And as we work for better birth care for all birthing people. We have a special guest joining us today, Katy Cecen, will be telling us more about her work as a nurse and a midwife, turned whistleblower, activist and community organizer, she'll share some of her personal journey with us and how she got there. She'll be serving up some tough love and encouragement, as we all work to examine our practices, and find the ways we can truly lead as birth professionals dedicated to improving the health of all those around us. Onto the show! 

All right. Well, welcome Katy. I am so excited to have you here on the podcast to chat with us today. And I'd love it if you want to just start out by introducing yourself to our audience and tell us a little about yourself and your work.

Katy, Midwife & Activist  1:39  
Sure. I name is Katie CSUN. I am a midwife, former NICU nurse, a community doula and a full time organizer and activist working on issues around medical racism and reproductive justice here in Brooklyn, New York.

Maggie, RNC-OB  1:54  
Yay. Awesome. Well, I am really excited to have you on here. We wanted to do this episode to talk about a couple of different things primarily, where does our role as birth professionals, birth workers fall within kind of the greater conversation about reproductive justice and health care legislature and all of these things, because I think some of us feel that, you know, one of our roles have to be kind of like a political, you know, as a health care provider. So I invited Katie to join us all today, because of her current work as a community organizer and activist, but particularly because I wanted her to be able to speak to what she saw out as a birth professional working in the field that really prompted her to take action in this bigger way. And Katie suggested that we share a testimony that she gave to the New York State Senate. And she delivered this in October of 2019, reflecting on preventable maternal deaths, at our workplace in 2017. And I invite you to listen to her testimony here to gain greater context about what is happening right now in birth care in our country, and why we feel it is so important for all of us to be more active as we work to change it.

NY State Senate  3:15  
We have Katie McFadden, midwife from Brooklyn, New York.  Thank you for joining us. One sec. And you swear affirm that the testimony you're about to give is true. 

Katy, Midwife & Activist  3:25  
I do. Okay. Chairman Rivera, Chairman Godfrey, members of the Senate and Assembly health committees. Thank you for taking the time to listen to our testimony today. My name is Katie McFadden. I am a midwife and a registered nurse certified in neonatal intensive care.  I recently resigned from my position as an as a staff nurse in the neonatal intensive care unit at SUNY Downstate Medical Center in East Flatbush Brooklyn, where over 90% of our patients are black.  

On August 9 2017, I emailed my supervisor to ask when we could expect more nurses describing unsafe patient care conditions in the unit caused by understaffing. There seems to be a lot of consequences for a nurse who doesn't do everything she should in a shift and no consequences for the administration that asks us to do more than we ever could. I wrote 20 hours later that Echo florman a mother of six who had just given birth to her twins, who are being cared for in our neonatal intensive care unit died of preventable staffing related complications. In the months following Mrs. Foreman's death, I sent four more emails to increasingly higher levels of the hospital administration, trying to raise the alarm of of the imminent peril our patients faced due to understaffing, including the warning It is only a matter of time before another serious event occurs. On November 28 2017, four months later, another black mother Tunisia Walker died of preventable causes shortly after giving birth to her first child at SUNY Downstate. What I was too busy and traumatized to put together at this time, were the headlines in the news published the same weeks, I was sending frantic emails, detailing how Governor Cuomo chose to unlawfully withhold disproportionate share hospital payments, huge sums of federal financing to reimburse hospitals for services they had already provided, which sends public hospitals into hiring freezes. The mechanisms to improve safety and prevent another maternal deaths were obvious to us in the fall of 2017. But the resources needed to implement those improvements had been intentionally with been withheld from us by the governor of this state from the hospital, the state runs in the neighborhood the state itself segregated black breathing people are 12 times more likely than white breathing people to die of pregnancy related causes in New York City. Research shows us that that disparity would drop by 47.7% if black women gave birth at the same hospitals as white women in this city. In other words, half of the black white disparities in maternal outcomes is due to the lower quality of care provided at a concentrated set of quote unquote minority serving hospitals, many of which are public, therefore run by the state run by the government and systematically disadvantaged by our separate and unequal system of health financing. Quality is worse at these hospitals because staff and services are missing. Staff and services are missing because we cannot afford them. We cannot afford them because reimbursements from public insurance are considerably less than the true cost of care. And we care for a disproportionate amount of patients on public insurance because of historic and ongoing racial segregation and economic disenfranchisement. Funds intended to compensate for the inevitable budget for shortfalls at institutions serving a disproportionate number of patients on public insurance, instead, go to private, disproportionately white serving facilities because of laws passed by this predominantly white legislative body and upheld by our white governor. Even in neighborhoods with better funded and safer private hospitals. Widespread insurance discrimination causes de facto racial segregation. And while insurance discrimination is illegal, then Attorney General Cuomo refused to prosecute the last case that was brought against it to challenge this practice. Racial health disparities have existed since race itself was created as a tool for socio economic socio economic domination during chattel slavery. In 1850, our constitution counted most black people as three fifths of person and the white black infant mortality was one to 1.5 in 2019, the public insurance covering the majority of black birthing people pays half as much as for obstetric care as the private insurance covering the majority of white birthing. Yes, please. And the white black infant mortality rate is worse at one to two to three, private and public insurance represents a separate and unequal system. And their disparate reimbursement rates reflect the hierarchy of human value our society has pathologically carried with us since slavery ended. We've never stopped having racial disparities and health because we've never started valuing the lives of all people equally. A single payer system eliminates the funding disparities that drive racial health disparities in New York, for this and for all of the reasons presented before you today. I urge you to pass the New York, New York Health Act. Thank you for your time.

Unknown Speaker  9:34  
Thank you, Miss McFadden.

Maggie, RNC-OB  9:36  
So Katie, we have just played the recording from your testimony in front of the Senate. And I want to go from there into one of the first questions when I reached out to you was the idea of professionalism and where is that rub between "is it professional to speak up and challenge the system that we are a part of" and what are the steps we have to take to get into that mindset?

Katy, Midwife & Activist  10:05  
When I hear that question, and I first want to really break down a couple of the components of, of what we're talking about, because I think like if we really understand kind of the premise of the question that answers itself. So the first like the first concept I want to introduce to help us understand this is the idea of the afterlife of slavery. And that is a framework that was developed by Dr. Saidiya Hartman, to describe the continuing presence of racialized violence in American society, that is an unbroken chain from slavery until today, and essentially posits that the way that racial violence and racism have manifested itself has changed significantly since chattel slavery was the law of the land until today, but what hasn't changed is the underlying white supremacy and anti black racism that causes for there to be hugely on equitable landscapes for black and white Americans today. And I think it's really important. So I want to answer the question like, essentially, is it unprofessional for healthcare professionals to be political, with the understanding that we are currently living in the afterlife of slavery? And so when we, when you ask that question, we have to think about American history and ask like, well, who made politics who determined what professionalism is, and who created the American health care professions? Because the like, we know that, like, we know that those things developed in politics is a, you know, we have 400 years of political history, professionalism is culture that has been developed over 100 or 200 years since the Industrial Revolution. And so to zoom in and answer that question today, as if the policies have not been created by white supremacists, as if professionalism has not been created to support and uphold white supremacy. And as if segregation and medical racism, were not foundational to the establishment of the American health professions. So like, who determined what is professional, white men who explicitly wanted to hold on to power and keep other people from obtaining that power, the white men who had power normalized the things like their culture as being the professional culture, and then as more explicit racism starts to fade in American society, you we don't say you have to be white to work here anymore. But we do say you have to be professional to work here. And all of the standards of what makes you professional, are predicated on those eight men with power, who were creating that culture to exclude people and hold on to power. The, you know, the policies like is it okay to get involved with politics or to talk about politics at work? Well, those you know, it used to be legal to, to own other humans in America, like that was an American policy, like you would have been you, you know, and then like the same people who created lot like the same constitution that upheld slavery is the constitution we are living under today. Our founding documents wrote in that, that most black people were three fifths worth of a human. Lastly, healthcare professions, a lot of what makes a profession a profession is the ability to exclude other people from doing the things that you do. So the profession of nurses, you know, we put in IVs we put in catheters and like, that's something we do you know, that's a nurses aides don't do that and those skill differentials by holding on to those skills. That's what helps us establish as a distinct profession of nursing. And where we do learn those skills, but school and then if and thinking again, to American history, you know, it was legal to racially segregated schools up until the mid 1960s. In America, we create healthcare professionals. So there's an in and an out, we create schools so that people can get to the end. But we say you can't come to that school if you're black. So like we explicitly made these professions predicated on whiteness on white supremacy on the actual exclusion of black people and other indigenous people and people of color.

So I mean, so I suppose in some ways, it is the most professional thing to not discuss politics as an American health care worker, because it's been set up to benefit us conforming to those professional expectations there for allows that white supremacy system to continue on, on challenged, I became a nurse, not because I wanted to uphold an established the honorable profession of nursing, nursing, because I wanted to help people and I wanted to help take care of people. And so you know, to phrase it differently, if, like me, you got into health care, because you primarily wanted to help people in people that you want it want to help is anyone who needs help, regardless of skin color, then there is essentially no other option than to become political than to push back on established professional norms. Because we know the status quo as is, is killing people, and is hurting people and is a system of violence. And so if the if the true goal as a healthcare professional, or as a health care provider is to promote health and well being, then the only way that we can do that is by deeply questioning the the harmful practices that we have inherited politics now is the creation of 400 years of mostly white domination and oppression. But politics, like the word in the dictionary is essentially collective power, fundamentally change what policy and politics looks like in America so that it no longer continues to uphold the racialized violence that started in slavery. That is only if we become incredibly involved in the politics and policies surrounding us. really consider the amount of privilege you must hold to right now 10 months in to an out of control pandemic, not see the need to fight for policy change to save your own life. So like so many Americans, you know, so many of my friends and neighbors in central Brooklyn, need to get involved in politics, because they're about to get evicted. And that's the only, you know, the only avenue of recourse is to work with other people towards systemic change. So if you are somebody who not only is not in already involved in movements or actions like that, but didn't even see the need to, I would really encourage that person to check themselves and examine the ways that they are upholding those harmful systems, that that you may not have realized, because the concept of the afterlife of slavery is something we teach in school. And because we, you know, we've been actively taught to consider current American history as if we're the greatest nation in the world that like made a Whoopsie on race, but that that we fixed in the 60s and not as a country that essentially found different ways to continue the same forms of racism that benefited those with power does indifferent and easier to hide forms.

Maggie, RNC-OB  18:23  
Yeah, absolutely. I mean, that that exceptionalism piece, it absolutely does, can you kind of hurt us, and probably the way we the way we position ourselves in the world, the way we position our collective moral compass. And I just wanted, I really appreciate you like spelling all of that out, because I do think...I'm sure for many of our listeners, like those are things that they've thought about, they've maybe like, put some of those pieces together. And some of them were like, absolutely just nodding along with you, because they know all of that. But I think for like you said for many of us who've had a lot of privilege in this life, it's easy to just not pay attention, right, because it hasn't been pushed in front of you. And I think sometimes too, within the birth world, we get in these bubbles of kind of what are what is our role? What is our place? What are we actually doing? And another theme that has come up as we have, you know, several conversations on the podcast this year, is when are the times that people step forward and take action. doulas see themselves as as advocates, you know, are they able or should they be stepping up for people who don't have a voice in the situation? And that's one of those things that we have talked about? Because, you know, our belief is obviously that we all need to be collaborating together to create more inclusive equitable care spaces where everyone's opinions are respected. And so by necessity, yes, sometimes you do have to step up because absolutely, not everyone is treated equally based on race based on class based on 8 million others ways that we categorize and other people. So, you know, okay, one of the things that I think people feel like they just don't even know where to go from here. So you know you're a birth pro, you're in that the grind of day to day, how did you know maybe you can share a little bit about your own story how you transition from, you know from a nurse at the bedside midwife and then now you're you know, full time organizing activist and that's where you're really seeing your purpose.

Katy, Midwife & Activist  20:25  
So like the punchy answer I have to the question of, of why I'm doing the work that I'm doing now in the way that I'm doing it is because I'm not a sociopath. You know, in the in the testimony that I presented, I talked about how like I emailed, I emailed my bosses 24 hours before a woman died of preventable causes. I escalated up the entire chain of command at the hospital to say that there were safety issues and what could we do about it, and no one responded and things did not get better. And we had another preventable maternal death. I spoke to the press about the ways that understaffing we're putting our patients life in danger. And then they published an article that didn't use the word understaffing once and then later the same reporter published an article praising herself. That's her first reporting thought state intervention. And like, because of her first article, the state initiated maternal health program. Well, the maternal health program was to teach the nurses at our hospital to be less racist, even though the nurses at my hospital are almost exclusively black and Philippine x people who for decades have been protesting that we are not given the resources necessary to provide safe and efficient care to our patients. And so if they are not receiving safe and effective care, it's not because we don't want to provide it to them, and we are being racist towards our patients. It is you the state that has continually failed to give us the resources necessary resources that we need, that is causing the the care issues here, again, like I became a midwife, because I wanted to help birthing people. And so I kind of was faced with these options of, well, I can keep working as a nurse, and watch people die, I can get a job as a midwife, and make a little bit more money in the system, and keep watching people die from the same things from the same policy decisions, or I'm gonna get involved in changing the policies that are causing people to die. And that was not an easy decision. That was not a quick decision. That was a decision made, after almost two years of knocking on people's doors, talking to organizations and sharing what was happening at my segregated black hospital, and asking for help and support and essentially getting a lot of like, That's terrible. We would love to support you if you want to fix that problem. But we don't have the capacity right now to work on that. And so, you know, I had these options. I knew that if I left the policy work alone, that there there were not a lot of other people to pick it up, continue to draw the connection between low care quality and segregated putting this in air quotes a high minority serving facilities, and the population level health disparities. And so knowing that and having the privilege to take some time out of the paid workforce to be able to focus on that, I really thought that was the only kind of appropriate response as a human as a as a human and as a member of my community. Yeah, like, morally, I didn't see a lot of other ways to go. I think it's very easy, particularly for doulas and midwives, who see themselves as somewhat outside of medical industrial complex for them to see these huge systemic issues and to think well, like at least I'm providing good care to the patients when I see them. Well, that's true. I mean, that is essentially the definition of white saviorism to think that you as an individual in your individual interactions are going to be able to make up for for centuries of systemic oppression, you know, I really tried hard to give excellent care to the patients I was caring for in the neonatal intensive care unit. And I was working there I pursued all sort you know, check my CV, I've all sorts of NICU-related certifications. And there's like very few hats in the birth world I don't wear and I like did all of those trainings to become an infant massage instructor and a neonatal developmental care specialist because I wanted to provide the best care possible to the patient in front of me. And still probably I think it's eight babies that died of preventable causes in the five years that I worked at at downstate. Because one well intentioned nurse does not make up for the fact that we couldn't afford a physical therapist or an occupational therapist or a pediatric interventional radiologist. And so if you are seeing problems in front of you that are bigger than that What you can solve? In the time you like, between when you punch in and punch out at work? Well, who else is going to tackle those problems and try to solve them? If not you? And if not us who are in the birth world? Like I think us, you know, folks in clinical roles have some kind of notion that they're like people behind the curtain, who like really care about birth justice, and are tackling it from a policy angle? And the answer is like, they're Yes, there are a handful and I don't want to discount their work. But compared to the number of doulas and midwives who think they're having a huge change, but are in no way plugged into those organizations are working with others towards systemic change. We're really just continuing to, you know, we're doing violence management, obstetric violence management, instead of ending obstetric violence. And when we get paid to do that, when that is our profession, when we benefit from that, it is incredibly insidious. And it is and when you if you are a white person who is getting paid to benefit from a system that hurts other people, like you, the even it though, obviously, it was not your intention, probably it was the opposite of your intention, when you got into health care, it does not change the facts on the ground, that the you are benefiting while other people are hurting. And if the things that you have done so far in your career have not affected any kind of real or systemic change, they, it is unlikely that they will in the future. And it is it is time for us as white people to take responsibility for the ways we benefit from that system. You know, if you're a middle class person living in like in a nice house with your leased car, and you're going on vacation once a year, like you are living a nice, blessed privileged life. And the money that's paying for that is coming from a system that abuses people, we have to take this step, take steps back and and examine that system. And whenever possible, take steps to extract ourselves from things that oppress other people and participate in. So we need to have access to dismantle those systems and continue to take steps to build new and liberated systems in their place. Like when I say I'm not a sociopath, I just I want to highlight specifically the work of Fannie LeFlore, who is a licensed social worker who wrote a series of essays, one called the sociopathic roots of racism, why history repeats itself. And she pretty much describes in that piece, how white people have adopted sociopathic ideologies, essentially, as a way to deal with the cognitive dissonance of being raised in a country, we are told is amazing and super great, but that has also actually abused and violated the rights of a portion of its citizens. And so essentially, by not thinking about it at all, who is the is the easiest way to deal with that? Like the easiest way to deal with the cognitive dissonance is not to be cognitive...

Maggie, RNC-OB  28:24  
Just ignore the whole thing....

Katy, Midwife & Activist  28:25  
Yeah. So you know why? She says white privilege gives incentives to collude in maintaining a system that gives us unfair advantages. This is why racism represents the nation's shadow, it requires massive denial for the white population to collectively pretend that racism no longer exists, even while we benefit from it. This points to the realization that white supremacy ideology demands people to pour a building block of lies that require the blunting of their consciousness. So as maternal health providers in a country where black babies are three times more likely to die before their first birthday than white babies, black British people in my city are 12 times more likely to die of pregnancy related causes than white people. And I think it's super important here to to highlight the work of Dr. Joia Crear-Perry, Dr. Dorothy Roberts, who have talked extensively in their work about how this is racism and not race that causes these health disparities. So if anyone's thinking, well, maybe people with African ancestry or with African genetics, maybe they're more likely to get diseases that kill them before they turn one. No.  A. it's absolutely not true. B. the science, any science that would support that is totally bunk and like, been disproven. When we see racial health disparities, it is not because there is anything wrong with black people it is because there is something profoundly wrong with how we treat black people. in this country are nowhere so pronounced than here and infant maternal health outcomes. So like, if you are a white health care where you know, a white maternal health care provider and you cannot right now articulate the way in which you are benefiting from a system that oppresses people, let me invite you into the work of anti racism and into the work of starting to understand that and, and really caution, and it mohnish you from non participation because you don't think it's relevant to you. And if racism, you know, if the way black people are being cheated in this country is not relevant to you, it is almost it is 100% a result of the past racist actions we have taken to segregate white and black people so that those issues would not affect you. And and you again, choose to adapt this sociopathic ideology to understand the world around you on a premise that really is a false American history or a no American history.

Maggie, RNC-OB  31:06  
Absolutely.  I mean, we've and we've talked about it, we've touched before on other episodes about, you know, white fragility and white freeze and the fact that our, you know, our health care system is majority, you know, white, especially with it, you know, nursing and know, you know, what we do and physicians and midwives, you know, it's about 70 to 90%, you know, made of people who identify as white. And so there is, you know, there's a huge discrepancy there. And one of those things that happens as people and I say this, again, as a white person who certainly has had this, as I've, you know, worked through these as well, it's that sense of recognizing how much wrong has been done things that you have done wrong, feeling a lot of guilt and concern about that, okay, like, where do I go from here, that will not also just cause more harm, because of, you know, my ignorance. And so I, you know, in your work, as you work to kind of get people organized, and start hooking people up, are there, you know, maybe some key steps that you can give to birth workers who are, you know, who are hearing this and are feeling really called to take action, but are just feeling like, completely overwhelmed by all that is wrong in the system. One of the things we've talked about is really this play between the system. And again, there is much that needs to change in health system and our birth care system, and weighing that with still the personal responsibility and autonomy that each of us have to take action in our immediate, you know, area. And I know you've touched on that already in this. So I think if there's a way to give kind of people idea for like, what are the either just personal actions they can take and or what are the things you can be bringing up with your hospital management, your community organizers, you know, which which level you want to be on?

Katy, Midwife & Activist  32:45  
Absolutely. My first thought in response to that question, essentially, like how, how do we make this quick and easy for people who are overwhelmed is, is essentially instead of me trying to make the action steps quick and easy. Is there any way we can make you less overwhelmed. So one of the things I've learned while organizing is one of the probably the biggest gap right now, in the maternal health landscape is people who understand health policy well enough to be able to turn the ideas and the the research of what we know, helps improve maternal health outcomes, and turn that into actual legislation that we can put up and try to get passed and implemented. And the I think those gaps exist, because everybody thinks somebody else is going to do that. I'm learning to write bills right now myself. And what I know is that it is not impossible, you know, if you got through nursing school, you can write a bill. It's not more than a, like a certain kind of essay does take time, and it takes commitment, and it takes kind of seeing something's, you know, sticking with an issue, and seeing it through for a while, you know, to really get into that deep structural change that we need. And so thinking about how can I make this easily accessible for people overwhelmed my first eyes again, like, Can we make you less overwhelmed? Are you one of those nurses that has like 500 hours of PTO saved up? And it hasn't been on vacation in years? And like, could you take a day off a week, and for the next couple of months, and that's the day that  you commit to your, your personal growth and learning and so and like, that's the day where you're going to read the books and catch up on the news and reach out to your Congress person. And you're not trying to fit in to the million things that you're already doing. You're choosing to let go of things in your life that either don't serve you or don't serve you as well or that maybe you have the privilege to be able to move around to be able to have time to focus on this. I go back and forth because many healthcare providers do not have the option to work less or to make less money but also a lot of health care providers do, a lot of us could make less money could work part time and still pay our bills could meet all of the necessities in our life, if we worked less, to have more time to spend on other things.

Unknown Speaker  35:15  
And to spend working in thinking about structural change, I'm about to get to all of the quick things, like all of the easier ways for people to start to get involved. But I guess I just want to start with the premise that like, if you really, if you really don't have time, time in your life right now, to participate in building a new world, the world is crumbling around us 300,000 Americans are dead, because our health system did not serve them well. So like, if you can keep a roof over your head and food on your table, and work less to have more time to dedicate to this, please do please think about how you can structure your life in a way where you aren't fitting this in, in the in the margins. And where if you have the privilege to focus on this in a in a more holistic way. And to go deeper that you that you do that? I think the you know, something I say about privilege is that like essentially the only appropriate thing, I the only thing I felt comfortable of doing with my privilege is using it to create a world that would no longer confer to me privilege because of my race or my family's economic standing. You had said before like, you know, speaking for those who don't have a voice and not, you know, my thought process is let's go beyond that and dismantle the system that makes some people voiceless, like, I don't want to speak on behalf of anybody else. I want to say, well, like what are the barriers? And then how can I dismantle how participate in dismantling those barriers and that is something that will probably take you starting to use your PTO, or making significant changes to you know, the book I've read, the things I've listened to the conference I've been to that have helped me that have been so fundamental in my anti racism journey. And so fundamental for me understanding, you know, the things that I'm able to articulate now, were only because I chose to work part, like, instead of getting a full time midwifery job, I stayed and work part time as a nurse, you know, a lot of what I've been able to do, I've been able to do, because of this decision to stay part time in my job, and to work less to make less money, so that I would have the time to put towards this. You're like, okay, definitely, but it's going to take my boss months to approve the change. Yeah, or that is not economic, you know, you would lose that roof over your house, you know, like you aren't in a position to be working less. I think the some easy, some easier ways to get plugged in to working towards this systemic change. I'd say first off, is look up who your elected officials are, and follow them on whatever social media platform you use the most often. So I think many people know who their congressperson is, who represents them and Washington, but not necessarily who represents them at their state's capital and at the state level. And for, for me, you know, the hospital that I worked at where all this was going on was a state run hospital. So like, and that's kind of when I realized, Oh, I don't both, I guess I have to work with the state government to fix things that are happening at the state hospital. And I don't know anything about state government.  So again, like this, that wasn't unintentional, like this is kind of an intentional decision. I've been going to New York Public Schools my whole life. And the my teacher for participation in government when I was in the 11th grade was a football coach who didn't know who our congressperson was. So the fact that I'm like, that you may feel lost, interacting with, with government, government on all its various levels, like, that's that, probably an intentional decision for us disempowered, and for us to not realize how to most effectively use our political voice. But the I think the best easy the best quick way to start countering that is to really familiarize yourself with the people who like who in a literal way represent you at your state and at the state, local, local, state and federal government and start paying attention to the things they say the things they're doing the policies they support, and ask yourself, do those align with what I you know what i what i value is, are they representing me well, and if the answer is no, then to start getting involved with the with other people in your area to change who represents you for years the there 63 state senators in New York, and for years, almost all of them voted to approve a budget that gave 15 years million dollars to the two white serving State University of New York hospitals and upstate New York and Long Island, but not to the black serving State University of New York Hospital in central Brooklyn. So, like, every senator who voted to approve that budget did so in the name of their of their constituents in New York. And if you are a New Yorker, and you're thinking well did my like, do my senator vote for this? Well, if you don't know who they are, you don't know yet. So let me first get to know who your representatives are, start following them to start clueing you into what's happening locally, then the second is to start making relationships and start looking for who is already doing the work in my area.

Unknown Speaker  40:50  
And get connected with them, to learn from them learn what they've been doing in the past, what hasn't haven't worked to work towards the issue that you care about, and then support the work that the are, that support the work that they're doing. And, you know, start finding where your place is in the community of people who, who long before you realize this was an issue realized it was an issue and started working on it. So second, I'll get connected with organizations that are already doing this work, learn from them support the work they're doing. And I guess here I'll plug some of the or like the specific organizing work that I do. Often, like when I say that I'm a birth worker like that I organized birth workers, I almost mean that in like the most literal way possible, in that I have a database with many birth workers in New York who I've met who have come through teachings of mine, you know, who are reproductive, just who are Reproductive Justice League minded, and I have them in a database by their constituency of who their congressperson is, and who their state representatives are. And so when somebody new comes through, and they live in a district where we need that Senator support on a specific bill, I can say, Oh, we need your senator support on this specific bill. And here are the five other birth workers who live in your district, who you can work with together, getting that support, I So reach out to the organizations that already exist. Also, check out follow me on Instagram at Brooklyn grows, fill out the form in my link tree for the movement to birth liberation. And then wherever you live in New York, or like in other states, if you live in other states, I'll just email even say whether or not have other people in your state and let you guys take it from there. And if you are a New York, there's a lot more going on in New York than other states, because that's where I'm based, but kind of start to loop you into the work that we're doing. And really, one of our main goals by organizing this way is so is to make it easy for doulas in between births for nurses in between shifts, you know, for midwives in between appointments to be able to have like, okay, people who have more time wrote the bill. Got it here. And now we just need support. Here's the two minute script and the number of my person. I've met with them before on these other bills. And I can just dial in and say, support this.

Maggie, RNC-OB  43:14  
And we'll link to that and your your site and everything in our show notes. Everyone can find it easily.

Katy, Midwife & Activist  43:19  
Oh, great. Thank you so much. And then lastly is just to start reading. So revolutionary black activists, Assata Shakur, who said, "No one is going to give you the education you need to overthrow them." And I think that is really important for us to remember, like, who made the nursing schools, who determined the nursing curriculum, who determine what you did and did not learn when you are on orientation. And the answer to many of those questions are, you know, the nursing curriculum originally was determined by hospital administrators and white women with privilege who essentially wanted to profit off of the on paid labor of nursing students, which is like the only thing of value hospitals had to offer to their communities when they were opened, because there wasn't like surgeries or medical procedures that you specifically needed to be in the hospital for, like the thing the hospitals had to sell was nursing students free labor. And then after you finished your nursing school, which was three years of uncompensated, working all the time, if you are a rich white woman, you would become a nursing professor. And if you were a working class person, you would usually go into private duty nursing, but there weren't like experienced nurses working in the hospitals. There's a great book I read on this: Hospitals, Paternalism, and the Role of the Nurse, which came out in like the 1970s. They get into, like, kind of the economic exploitation of women being the foundation of American hospitals. So anyway, that is to say, like, there are a lot of very important, very factual things that many white adults do not know. Because it has for, for whatever reason, probably intentionally left out of our education. And it is our responsibility to go out and seek that information and to learn it as professionals, as as people who care about the work that we do. So if you are in the birth field, and you're not regular read, like regularly reading a couple books a year about birth, like, what's what's going on with you, like, you know, if you don't like it enough to be reading about it in your private time, then like, anyway, and also add, if you if you really don't have the time to to read extra, then how can you be advocating for yourself to have more continuing education time built into your job responsibilities, right, totally inappropriate for you to be go year after year after year without you know, a significant investment into your into developing your understanding of how to support birthing people, oh, you asked for quick things. And I just talked for a long time [laughter]: look, look up and follow your record your representatives, look up and get in touch and start working with other people who are represented by the same people by the same elected officials, so that together you can push them and work towards change. And lastly, start reading. So you know what kind of change you're you're working towards, and are better situated to participate in the movement towards our collective liberation. And I'll put out that Efe Osaren, who is at the Doula Chronicles, she has a blog post "25 Books every birth workers should read" and they really are 25 bucks, every birth worker should read. I'm about halfway through and working on it for two years now. Right? If you're wondering where to start, I'd send you there.

Maggie, RNC-OB  46:57  
Awesome. Well, we I will check that out. And I'll link it in the show notes as well. So everyone can find this because I'm sure that's a great list.

Katy, Midwife & Activist  47:02  
You had asked previously about specific policies that people can be working towards. And I really, I really want to put out and emphasize Medicare for all there, there's, you know, a position paper just came out that's like oh, it outcomes would improve and mortality would lower if we extended postpartum coverage from 60 days to a full year. And it's like, okay, yes, that's true. Also outcomes improve, will improve, and mortality will lessen if we give everybody health insurance all the time, similar to many of the things that we've talked about today, like the decision not to go to Universal led to universal health care in the night, you know, between the 1940s to 1960s, when many other industrialized nations were making that decision decision in America to go to instead of private public system was almost entirely informed by interpersonal racism. With the American Medical Association, which was segregated to be white up until like the mid 70s, the white doctors who made up that organization did not want to have to take care of black people. And they knew that if everybody was on the same insurance, there would not be a legal way for them to sort who they could who they would and would not take care of. But if instead, we have private insurance that you get through your employer, and remember, almost all places of employment at that time, practiced racial segregation. And then we only require the the types of employers who employ white people to offer health insurance at their jobs. And everybody else is just going to have to go uninsured or deal with a public system that reimburses at a significantly lower rate and, and basically guarantees inequitable access to care. Because if you pay two different if you reimburse doctors, you know, two different prices, right for caring for patients. What else are you doing besides saying these two lives are worth different? There is a heart hierarchy of human value, pay more attention to the people that were spending more money for you to care for? So I think like no, a Medicare for all has over 100 co sponsors right now, on the national level. And the way we get more co sponsors is for folks to look up and see is my Congress person on this bill, and if not pushing and organizing locally to get them on that bill. And if your congressperson is not somebody who would get on that bill, then you have two years to find somebody who would and vote them out in 2022. And in New York State, we have a state level Medicare for all bill that for the last two years has been one vote away from being able to pass. So if you are a New Yorker forget about Medicare for all and zoom in on the New York Health Act. Because if and when we pass the New York Health Act and prove that single payer works in America, that state level program can be a model for going to a national program, I didn't want to end without plugging like, yeah, healthcare is a human right. And we there, there is a policy out there that actually would make that true would actually make that a lived and embodied value in our society. And that is Medicare for all, or improve Medicare for All. So please get involved in that fight being somebody who cares about people's health should be synonymous with wanting everybody to be able to have access to that health care.

Maggie, RNC-OB  50:36  
Well, and thank you, Katie, I really appreciate you speaking to all of this. And I hope for all of our listeners that this really serves as an opportunity to be called into this work. And to, you know, take the time to reflect on your practice, reflect on your privilege, reflect on what it is that we can all do to create a future where we do actually provide exceptional birth care in our country to create a birth care system that is not rife with racism, and structural inequalities. And when we as birth pros truly feel that we are taking part in helping someone to be their healthiest self, where we feel part of a system that honors and respects the autonomy of those in our care where our birth activism can grow and push boundaries. Thanks so much, Katie. 

Thanks for tuning in. We love to talk birth, and we'd love to talk about with you. Please join the conversation by finding us on Facebook, Instagram or Twitter, we're Your BIRTH Partners across social media. And in particular, we invite you to find us in our Facebook group, which is Your BIRTH Partners community. There we have a chance to talk a little bit more about the topics from this week's podcast, and get a chance to work through some of the difficult parts of applying these concepts and change your practices out in the real world as we all work together for more collaborative, inclusive and equitable care. As a reminder, you can check out our show notes for this week's episode to find links to the articles that Katie shared with us, and we'll also link to the book listing or the 25 books that every birth pro should read. Thanks for being here with us. Till next time!