Midwifing the Midwife

Lodz Joseph (she/her) is a certified nurse midwife (CNM) who works in Southwestern Georgia. We caught up with her to talk about her journey into midwifery, her experience being a midwife while pregnant during the COVID-19 pandemic, and her advice for nurses and midwives to be better patient advocates.

Note: small edits have been made for clarity and length.

 

To start, can you tell us about your journey into this field? What inspired you to become a midwife?

 

I was doing work overseas, and I was pretty much drawn to maternal and child health programming. Instead of designing big picture programs, I realized I just loved the one on one connection. So, I started getting exposed to experts in the field. Overseas, those experts weren’t necessarily the OBGYNS; they were highly educated midwives. So people who were trained at the doctorate level that could of course clinically manage, but then also design large-scale international programming. They were just amazing, and so I was like, “What are you guys doing?” I started hanging out with them and knew that midwifery was it.

 

And then I came back to the states, was a doula for a while, and then a breastfeeding consultant. Then I said, “Let me do the craziest thing I’ve ever done and become a midwife!”

 

What do you love most about being a midwife?

 

Patients. Hands down it’s the patients; it’s the people; it’s the stories. You walk into a room and you know that cliché: “if these walls could talk; these walls are sacred.” We joke. We also cry. I learn so much, and I hope that patients feel like they learn from me or that I advocate for them. I advocate hard. Sometimes post-call days aren’t enough to recover because you’re just so tired. So to me, it’s really just the patients and patient-centered care is what it’s all about. 

 

How has the COVID-19 pandemic changed the way you work?

 

One, COVID has become part of my spiel. You know, in the clinic I have a whole thing about COVID. It’s part of anticipatory guidance. If you want to have a conversation about vaccines or if you want printouts, we can talk about it. So COVID is forever there; it’s just what phase of the pandemic we’re in.

 

Then, in the hospital, depending on when I get that call, sometimes I definitely wait on a COVID swab result, especially because I’m pregnant. And at this point in my pregnancy, it’s a lot easier to not wear an N-95. I still have gear and everything like that, but we are allowed to wear a different mask. So for me, if you’re COVID unknown, I have to wear everything, even if my hospital says I don’t have to. 

 

The thing that has changed for me is laboring with patients and what their support looks like. But obviously, if someone is nine centimeters, I'm not going to wait for a COVID result before going in. If there are people who come in and they’re having their baby in the waiting room, we respond.

And has the experience of being a midwife changed throughout the past year during the pandemic?

 

For me it has. Once I disclosed my pregnancy, my colleagues I noticed were more like, “Oh my God, be careful! You have to go in there.” And I'm like, “Well, yeah, I’m on call today. You know, it’s not like I don’t have to see COVID patients.” So I think that’s a thing that people don’t realize: you’re still pregnant, and you still got to work. I think that’s another layer of stress. All I've wanted to do is keep myself, my family, and my unborn child safe. So far, I think I’ve managed to do that. But, it takes a toll on you because you want to be there for patients, but I also have to think about myself right now. And that’s just something that I think is more difficult. 

 

Has being pregnant shifted the way you approach midwifery?

 

Absolutely. Absolutely, without a doubt, I think that birth is this special thing. But, it [being pregnant] only confirms that, for me, this is not all I want to do. I knew it, but it solidified it for me. For me as a midwife, birth is not the only thing that’s in my job description or toolbox. It’s so much more expansive. 

 

People connect to me totally differently. But, you know, there are also people who have losses who see their provider still pregnant. 

 

We’re in a high acuity clinic, and we definitely are allowed to take care of very high risk patients as long as we are co-managing with doctors (just because the midwives take first call). And so as a result, I had a patient whose BMI was 80, and they were like, “Well how didn’t you gain weight?” And I was like, “Well let’s not focus on that.” A lot of people want to turn to my experience. I’m like, “I promise I will answer the questions after the clinic,” and my joke is, “I have pregnancy brain. I want you to ask all your questions and not waste your time on me.” And I think that makes them smile a little, and we can continue the visit. I just say that to say, people are looking at me with a closer eye.

 

And then, I criticize midwifery care a lot more. I have a lot more critiques of it because I am, as my spouse reminds me, already a statistic in many ways. 

 

And I’m getting my care from a midwife, of course!

Our theme for the month of April is trust. Could you speak to the importance of trust in midwifery?

 

It’s everything. Our patients trust us. I think what people don’t realize is that right now, the national standard for obstetrics is maybe like a D (pretty much an F), and so midwives kind of get a C. We’re like, “Midwives are so much better.” But we’re just barely passing. But, I do think when you are in a setting where the protocols, the space, the staff, and the team is here for what is best for the patient, patients feel that and they trust you. Because that’s what it’s about.

 

Patients are interviewing us. It’s part of my spiel as well. I’m like, “Don’t forget, I work for you. It’s not the other way around. I’m not the boss just because I have some letters behind my name. You’re always interviewing me, you know? My job is a lot harder than your job.” I try to tell patients that. That’s the foundation of what we have.

 

And, when we do wrong by patients, the first thing you gotta say is “I’m sorry.” I have zero tolerance for providers who say “It’s this patient’s fault. They’re high risk, they’re overweight, they didn't come to prenatal care, or they were uncontrollable when I was trying to do their repair.” It’s like, those are all excuses. Because I can tell you, there is a different way to do it. There is a different way to model. And once you commit to that, almost unlearning what you learned in your clinical education, you’ll forever see it. You may get tired. You may get fatigued, but once you know right, you do right by the patient. 

 

It’s definitely exhausting though.

April 11-17th is also Black Maternal Health Week. With this in mind, what tips do you have for midwives and nurses to step up and challenge white supremacy?

 

First, you gotta acknowledge it. That’s the first thing. Don’t go to all the training sessions when you’re like, “I don’t believe it; I just need the certificates,” because that’s just BS. First acknowledge it.

 

Two, you have to do the work, but you have to understand that there are people that are tired. Like, I want this solved yesterday, but there are people that are like “Just go slow. Just go slow. It’s OK.” And what we have to understand is that the maternal mortality crisis happened on white midwives’ watch. And the thing that is so unsettling is that no one wants to take responsibility. And yet, BIPOC midwives are held to this higher standard of like “how are you going to solve this crisis because it’s your problem?” 

 

Three, talk to your patients. I mean really talk to them. As a nurse, patients should love you because you’re spending so much time, definitely in the hospital setting, with the patient.

 

It’s going to work patient to patient. I think people want us to dismantle this whole system, which I totally agree with, but if you can’t treat the person in front of you with that dignity and respect that you do your colleague, or you do patients who come from maybe the private practices, you’re not doing the work. To me, it doesn't have to be so performative. It’s these small, consistent steps, and then it’s building on that. It goes from individual, then group, then community, then systems. But you have to want it, and that comes with acknowledging it first. 

 

How can nurse midwives be braver in advocating for patient’s health and safety in the event of a birthing related complication?

 

Being vocal! Again my experience is primarily in the hospital in a high acuity setting, and I think it’s really important not to use that as an excuse. I want you to understand the practice that I am at: if patients miss appointments at other clinics, they get dismissed and they are sent to our clinic. If they are underinsured, have Medicaid, or have no insurance, they are sent to our clinic. Providers won’t take them in the area. We cover over thirty counties. We also have patients from Florida, Alabama, and Georgia who come to see us, so it is a lot of patients! And it is not an easy job. 

 

One of my friends just sent me this quote, and I want to share it with you right now.

“If you’re not the truth teller in the room, you can at least be back up for them. If you aren’t going to be the first domino, be the second.” - Luvvie Ajayi Jones

 

She was like, “You’ve always been the truth teller in class and in what we’re doing.” It can’t just fall on one person to be the most vocal. We all have to be vocal, because that’s how we advocate for patients. 

 

And I think for me it is also deep thinking. When I have time off, I get to replay things in my mind, that’s just my personality. I get to learn from that. There has to be room in this, what Dr. Stephanie Mitchell says, the “medical industrial complex.” As a midwife, I need room to grow. I need room to support my patients, to protect and advocate for my patients. I also can’t be penalized for every single thing. That is where so many Black midwives are. We are responsible for BIPOC people, and that responsibility is not put on white midwives. We’re responsible for ending systematic racism, which is not a realistic goal. And then we’re responsible for bringing our A-game clinically, but we are not OBGYNs. We can’t be doing it all. It is unfair. 

 

Recently, at the end of the day (that’s the time I tend to talk to new and student midwives, they can call me while I’m charting in clinic), there was a midwife who was like, “You know I really don’t like conflict in the workplace.” And I was like “Oh, I don’t have that luxury. I just don’t have that luxury.” She was venting about stuff that our colleagues are doing, but she didn't want to deal with the conflict. I was like “I actually don’t think I can help you,” because you have to go through conflict or uneasy conversations for growth to happen in your practice.

 

What are some ways that nurses and midwives can better listen to and honor the lived experiences of their patients, especially for Black people and people of color?

 

Oh, this one is easy, especially as a pregnant person now. Stop telling me everything is normal. There is a very big difference between reassurance and dismissing. Sometimes that dismissing can come off as condescension. 

 

My midwife reassures me and assures that I feel comfortable and vulnerable to ask the questions I'm embarrassed to ask, even as a midwife. That’s what our patients are coming to us with. I think that’s a big one. 

 

I’ve heard nurses say the most ill things of patients, like, “Can you believe she doesn’t know that?!” But then that same patient is blamed later. There’s just this dismissal, and it’s so nonchalant.

 

I think the biggest thing is just listening. You will know when your patients feel vulnerable. If patients don’t feel vulnerable with you, that may be a sign that you’re doing the minimum. And there’s a pot for every lid. So it’s not like I'm going to get some award like all my patients love me. But what my patients can say is that “she listens.” There is really something about listening to people and helping them solve their problems. And reassuring them. So I think that’s really our role, because pregnancy is freaking scary. Even if you have ten kids. My one patient said, “It’s my seventh time, but I still got questions.” If she has questions as a seven-time mom, I know I’m not crazy as a first time parent.

 

Are there any last things you want to share?

 

Well there are so many resources....

 

Read:

Killing the Black Body by Dorothy E. Roberts
Medical Aparthied by Harriet A. Washington

Watch: All My Babies (film featuring Mary Cooley)

 

Follow:
@the.birth.sanctuary
@thevaginachronicles
@anayahrose
@blkbfingweek
@bridgemidwifery

And once you do those things, you won’t automatically be “woke” or all of a sudden be an “ally.” But it will show you how some people enter the medical systems. I think that is something people can’t lose or take for granted. That’s the nuance of being a healthcare provider. Because nuance is what’s going to tell you the difference between health - all these things aren’t going to be black and white, all these diagnoses aren’t going to be black and white. We want to believe that racism is black and white and sometimes it is, but a lot of times it isn’t. 

 

Do you have a story to tell? We welcome you to submit your story or blog idea to us so we can feature you in our newsletter or on our blog. Email us at [email protected] or message us on social media @NursesforSRH.

 

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