I first started being appalled with what happens to women in our health care system in the 70’s when I was in nursing school. When I did my obstetrical rotation I’d leave my shift feeling as if I’d been in a torture chamber. There’d be four or more women laboring in one room with flimsy curtains between them, many of them screaming and alone. It was the dawn of allowing fathers (or any support person) into the delivery area, and only then when they had taken a required course. It wasn’t a widespread practice. I guess fathers were still pacing the waiting room reading magazines and smoking. I don’t know; I never saw them.
Laboring women were not allowed to eat or drink “in case they needed surgery”. The nurses, all in starched white uniforms and caps, were scolding many of them for sucking on their washcloths trying to moisten their mouths. I was horrified. I wanted to comfort those women somehow but had no idea what to do. If I was supposed to be learning from the nurses, it was about charting, drawing up medications, hanging IVs, opening gloves for the doctors, and I thought, “I am never going into obstetrics.” That was about the last place I thought I could have a satisfying nursing career.
Soon after graduating, I joined the Peace Corps and went to Malawi as a public health nurse where the nurses were also midwives. I watched Malawian midwives, with very few resources, care for women in a much different way than our system did. They gathered around women during labor and childbirth. The assumption was it was a normal process, and most of the time it was. It was so different from my experience in a health care system that was supposedly the best in the world. I realized that our system had no idea what natural childbirth really was. I went from thinking I was going to the developing world to bring our superior skills and left feeling like I had to bring reason and common sense back home. I wanted to become a midwife and help change things for women here.
As the women’s movement grew in this country, and women started demanding more humane treatment, midwives offering home birth offered an alternative to a medicalized birth. In my opinion, these midwives were incredibly brave. Home birth was illegal in most states and many midwives were prosecuted. These were (and are) skilled women, dedicated to other women, staying true to their values and beliefs, and offering women an alternative to, what I considered, barbaric treatment in hospitals. I thought I’d join the revolution and do home birth. I thought it was the only way to make a difference. I had no desire to be part of a system that seemed so intent on abusing women for money; scaring them into acquiescing to procedures they didn’t need.
In graduate school I had my my first exposure to nurse-midwives working within our traditional medical system. We had a variety of clinical experiences, some in big teaching hospitals where practices of denying women rights was widespread. I watched nurse-midwives advocate for those woman. I watched how hard they had to work to convince medical residents, attending physicians, and often nurses, to wait a little longer before going to surgery. I watched them care for poor women with the same tenderness they showed wealthy women. I saw their frustrations when their skill and expertise was usurped by someone higher up the food chain. I did not think I wanted a life of that frustration. I told my professors I wanted to graduate and set up a home birth practice where it all made sense. Where women are treated they way they should be. In my practice, women would be like-minded, agree with my philosophy, eat well, WANT their pregnancy, breastfeed. We’d all live happily ever after. That was the dream. And when I was feeling all self-righteous and spouting off this long term plan of saving the world by caring for a tiny select few, my professor said, “But Linda, it’s in the hospitals where midwives can make a difference. We can change the system from the inside.” Hmm. There was food for thought. I thought about the gratitude I saw in the women’s eyes when they had an advocate in a system that swallowed them. I remembered what women’s lives were like in obstetrics before midwives worked in the system. Perhaps it was a way to make a difference. Get in there, do a good job, show we are safe providers, read the literature, argue intelligently for changes in policy, show our outcomes are superior, and offer women an option inside the system.
That’s what I did. And it isn’t always easy. In fact, it’s been very difficult working in a system that is so (and I use this word deliberately) corrupted by money, power, and discrimination. But over the years I have seen tremendous progress in improvements for women’s rights within the system. It’s no where near where it should be, but it is a boatload better than where it was. Over the years nurse-midwives have been accused by some home-birth midwives of selling out; that we were just as bad as the medical establishment because we worked within it; that we had no idea what natural birth really was. We got that from one side while getting shit on by doctors on the other.
Do I have ties to the system? Of course. I got a paycheck. I got a retirement plan. I got paid vacation. I also got a ton of grief and frustration. But I was part of a profession that helped change things for women who chose to use that system. I’ve seen our profession go from an insignificant number who were marginalized and discriminated against, to running entire facilities. Nurse-midwives now teach medical residents, slowly changing the medicalized notion of birth. That is light years ahead of where we started.
Which brings me to Hillary Clinton. When I hear her being criminalized for having “ties to the system” my back goes up instantly. She’s condemned for trying to change things from within with liberals crying out that this is not possible. I think of having to fight for my own professional life in a different corrupt system, and I disagree. Yes, it takes a huge toll. Yes, it may take years. Yes, people will misrepresent you and misinterpret your motives. And yes, it will be worth it.
Do I wish we could dismantle the entire medical system and start from scratch where everyone is treated the way I believe they should be treated and the pharmaceutical industry is prosecuted for drug dealing the way heroin dealers are? Yes. Is that going to happen? No. Do I wish we had one single-payor health care system? Yes. No one wants that more than me. Is that going to happen overnight with one election? No. Do we have a candidate with ties to the system who can build on the progress we’ve made in that area? Yes. And it’s a woman with ties to the system.
I’m in awe of her. I believe she is the hope for women everywhere. I’m with her.