Tuesday, October 6, 2009

A Man’s Perspective on Midwifery and Gender

by Peter Johnson, CNM, PhD, FACNM

As a man who has dedicated his career to midwifery, I frequently answer questions like “How can you be a midwife?” “Aren’t you a mid-husband,” and “Don’t you want to be called something else?”

When I answer these questions from family, new friends, and acquaintances at parties, I give a simple answer. Midwife means “with woman.” The gender of the person with that woman is not the relevant factor. What is relevant is that the midwife—regardless of race, ethnicity, religion or gender—is practicing midwifery. The hallmarks of midwifery, like the belief that birth is normal, that skillful communication is a necessity, and that women benefit from the sustained presence of another caring human, are what make our profession unique.

Recently, however, I was approached with a thought-provoking ethical dilemma: How does midwifery guard against gender discrimination toward midwives who are men while simultaneously honoring the rights of women who prefer female care providers?

There are circumstances where women for religious, cultural, or personal reasons desire the care of another woman. Of course, this desire must be honored. I have, however, seen job ads saying “All-female OB/GYN practice seeking midwife” and hospital policies forbidding male nurses or midwives on labor and delivery. These practices make the dangerous assumption that all women seek women for their care, and these practices are discriminatory and dangerous.

Right now far more women are entering medical obstetrics than men, and many of those women are not delivering midwifery care. It is important that midwives and their supporters recognize that the care we know women deserve is not directly related to the gender of the care provider.

Midwives, what are you doing to encourage men in midwifery to join your practice, office, or university?

Women, does the gender of your midwife matter to you?


LCCNM said...

Great topic Peter. Seems ripe for the application of cultural humility principles. I am not sure that it is ONLY an assumption that women seek women for their care.....I find it to be true of myself and my friends on many (but not all) occasions. That does not make it ethical, however to discriminate in hiring or education.

Years ago, I had a much stronger preference for female providers than I have today. I had some surgery, woke up unexpectedly in an ICU and was cared for by a male nurse. Wow, was I unhappy....at first. Then after experiencing his skilled care, compassion and advocacy, gender no longer mattered.

Currently we have a "guy" colleague on our midwifery faculty. At first, the administration of the clinic to which he was assigned were unhappy and thought their patients would flee to other clinics. And, at first, a few patients refused to see him. But the same qualities that I experienced post-op were those that my colleague embodies and soon his schedule was full to overflowing!

My answer to your question is that I don't look for or do anything to encourage men to join our practice or faculty. We strive to encourage all folks who possess the qualities of an exemplary midwife to apply.

The fact that some female midwives are not delivering "midwifery" care is a far more complex issue than gender and does little to prove or disprove your stance that more men OUGHT to be midwives.

Sexism, racism and the resultant power differentials are still alive and well. Individuals as well as groups continue to express those inequalities. I hope that you can give a bit more time to those of us who still feel the impact of centuries of oppression before expecting us to always be fully evolved... and therefore able to extend the ethical driven fairness to others that was not extended to us.

Discrimination is wrong and I do not think 2 wrongs make a right. But "it takes as long as it takes" to learn to live ethical principles daily.

Janey said...

During my 25+ years as practicing CNM, this question came up frequently. Many women who came to our collaborative practice (2 or 3 male OB/GYN's, 2 part-time female OB/GYN's and 4 CNM's (who were all female) thought they wanted "the female Doctor because she'll listen to me." I am still friends with both female docs, but we are not the same. What women really wanted was midwifery- going thru residency changes many women into "just another one of the docs" as far as practice. Midwifery, when practiced according to our stated values, is NOT gender based. I have been teaching OB nursing to undergrads and CNL students for 7+ yrs now and some of my male students have been wonderfully caring at the bedside and some female students have been "that C/S was great- I love surgery and when there are emergencies." I once had 2 male students labor sitting with a 14 yrs old whose mom "threw her out of the house" and was all alone in the labor room. When eventually lack of progress and flat FHT became need for C/S, the female OB MD said "I don't care that only 1 nursing student is supposed to be able to go into the C/S room- these guys gave up their lunch and have been sitting with her for hours and they are BOTH going in!"

It should not be about gender, but about really BEING WITH THE WOMAN!

Peter said...

The experiences that you share reminds me of a story from my past when working as a midwifery service director for a large HMO. We had a practice with about 7 midwives and an equal number of OB/GYN physicians. Clients were allowed to self select for midwifery or medical care. In the midwifery practice, we encouraged women to see more than one midwife so that they would be confident in the midwifery care that they received by the on -call midwife they were with in labor. In this practice, we did promote midwifery over gender and my colleagues did a great job of supporting me in my role. I do remember however a women coming to me for a prenatal appointment a bit disappointed with the care that she had received, saying that "there was just something not right about that midwife that I saw last week". Upon further explorations, she had seen one of the female physicians in the practice and not a midwife.

Joy said...

Never really thought about it. I've never come across a male midwife. I've only been able to find women midwives. I don't see why having a male midwife is any different from having a male OBGYN compared to a woman OBGYN.

And personally I have found male doctors to be far more gentle and compassionate with me, as a patient, then their women counterparts.

Ciarin said...

One of my initial preceptors, when I was a midwifery student, was male. I was disoriented by that initially but kept an open mind. He was a fabulous preceptor and a great midwife. His compassion and kindness for patients transcended gender.