I apologize for the harm created by my words in the President’s Report, published in the MANA Newsletter on January 19, 2021. It has since been revised. I spoke with the privilege of being white when interacting with people who actively worked to propagate the violence of neo-Nazi ideology based on a belief of white race supremacy and anti-semitism. My words trivialized that evil which resulted in pain to the people who have been most impacted by it. I am grateful for their admonishment and deeply apologize for the injury. My words trivialized the violence which caused pain for the people most impacted by that violence.

Midwifery is cross cultural because physiologic birth is, well… mammalian, and therefore, universal to the human species.  My personal journey, like many community midwives, has been quite an exercise in anthropology–working sometimes within populations that can look homogenous yet have many nuanced subcultures within, as well as working with families from a diverse array of populations. I understand how important it is for communities to “grow their own” and for birthing families to have midwives who are respected members of those communities.  I also know that we are experiencing—globally, nationally, and for too many areas, locally–the impact of the disappearance of community midwives.  Only a century ago, the systematic march towards legal containment of community midwifery and the completion of obstetrical colonization of childbirth in the United States made an unfortunate leap forward through the Sheppard-Towner Act of 1921. While the alleged goal was to “reduce maternal and infant mortality” through “scientific mothering” principles, the impetus for the outpouring of government funds into maternal-infant public health programs arose from the large numbers of young men who were unable to pass physical exams required for military service during World War I.  In other words, the government needed strong babies to be able to have enough strong soldiers for future military duty.

I don’t have to tell you where creating barriers to community midwifery and replacing it with “scientific mothering” has landed us.  The poor outcomes of our maternity care system where 98%+ of births occur within an obstetrical hospital model speak for themselves. Especially – most especially – for vulnerable populations. Instead, I want to tell you about one of my anthropological experiences as a community midwife and family practice physician.

I was working as an emergency room physician in a 23-bed critical access hospital owned by the rural county where I grew up. On a typical chaotic Saturday night in early 2001, I entered a room where two elderly men in three piece suits with little red crosses on their lapels were sitting. One of them introduced himself as William Pierce, a well-known national leader of the neo-Nazi movement and author of the book “The Turner Diaries” which is credited as being a blueprint for domestic terrorism beginning with the Oklahoma City bombing in 1995. Mr. Pierce was living on a nearby neo-Nazi compound with the goal of growing the far-right movement by uniting all of the scattered hate groups around the country.  A number of his followers, including young families, lived on or near the compound until Pierce’s death in late 2002.  Over a two year span, I found myself providing healthcare to many of those women and children including one childbearing couple.  As it goes, I learned about their lives, mindsets, ideologies and plans, not so much as individuals, because that wasn’t important to them – but rather, about what it meant to live the neo-Nazi doctrine. It was clear that they represented a global movement.

Twenty years later, I watch as the plans Pierce envisioned unfold on every media outlet.  The message was clear in the 2017 Charlottesville invasion and became louder in the halls of the US Capitol in 2021; the level of destruction possible when hatred and division are allowed to flourish in an environment of institutional racism is undeniable. 

The midwifery profession and the organizations that represent it in the USA have not been immune to that same destruction brought by the cultural normalization of institutional racism and oppression. 

Where do we go from here?  As a country, as a profession, as an organization, as a people?  How do we love ourselves enough to find the strength to draw healthy boundaries?  How do we balance autonomy and obligation?

Over the coming year, MANA board members will continue to look deeply into old processes and relationships that contribute to inequity in the organization’s foundational power structures.  Membership engagement, leadership development, accessible and affordable continuing education opportunities, and returning to a regular schedule of board position elections are priorities.

The MANA Board is proud of its 2020 accomplishments, especially the ability to pivot when the pandemic hit to create MANA’s first online CEU conference.  It has been the unseen work, however, that has brought the most satisfaction. 

Developing a transparent relationship with the Foundation for the Advancement for Midwifery (FAM) required finding new FAM board members who were willing to work within the legal framework of the MANA/FAM relationship. While this seemed overwhelming at first, amazing people stepped up to assume essential FAM board positions.  With much appreciation, the MANA board is excited to work with this diverse powerhouse of midwifery supporters in future collaborative projects and to support them in their own equity work.

Transitioning the MANA Statistics project continues to be ongoing.  Concerns grew through the months of 2020 as communication from the Division of Research became non-existent.  A decision to prioritize taking appropriate steps to regain access to the MANA Stats project began in August 2020, with the process accelerated by a public communication sent by the DOR Director of Data Collection to MANA Stats contributors in October.  Board members appreciated being able to access the objectivity of the FAM board members who have experience with public relations, conflict resolution, and cybersecurity as they worked collaboratively to craft a response to the DOR’s inflammatory statements.

Basic communication with the Director of Data Collection has been re-established and the board is awaiting the fulfillment of a commitment to work collaboratively. Unfortunately, the Board continues to receive reports from midwives needing to establish or edit existing MANA Statistics accounts who have been unable to get responses from the Division of Research. As the established legal governance authority for the MANA Statistics project which is owned by the MANA organization, the MANA Board is committed to following all state and federal codes; expanding physical control of the database beyond one volunteer to maintain the project integrity; and working mindfully with the midwifery community and research experts to improve and expand the influence of the database while maintaining complete protection of the contributors. I am grateful for a friend’s gift of this TED talk by Karen Eber, and encourage you to watch it as part of the conversation about what stories the MANA Stats data can tell. 

According to the chaos theory, when you change the initial condition, you change the outcome exponentially.  As a midwifery leader, I am honored to be a member of the current MANA board and its commitment to address “initial conditions” that have led to inequity within the organization. As a citizen, I am committed to addressing the “initial conditions” of racism and oppression in our institutions while I continue to identify and address my personal implicit biases.  My goal is to remain steadfast in my journey to protect the wild nature of birth, to combine the “melody and harmony of bringing data and storytelling together”, and to love fiercely so that our grandchildren may thrive.