Monday, October 18, 2010

Midwifery and Public Health: A Sisterhood

Posted by Katy
There is an old fable told in the Public Health world that has been on my mind this week:

The villagers of Downstream lived peacefully by the river until one day, many years ago, a single man was found floating in the river. Good people, the villagers jumped to their feet, dragged the body from the river and were able to save the man. After the first bodies, many turned up in the river and quickly the rescuing mission became the primary work of many of the villagers. The villagers grew better at rescuing the bodies, swifter and wiser, and the village was very proud of their work. Despite their prowess at life saving, the number of people drowning in the river continued to increase until the villagers were not able to keep up and the numbers of dead bodies began to pile up. The villagers worked harder, learned more, trained more rescuers, put more resources into rescuing, but higher still the bodies piled. Until, one day the granddaughter of a wise old woman finally took the time to listen to her grandmother and began to hike upstream. The other villagers shook their heads at her and told her that people were dying while she chose not to help. It pained her to do nothing as the bodies floated by, but she was faithful to the wise woman and continued her journey until she reached the village of Upstream.

Midwifery in America has long been hip-to-hip with Public Health. Mary Breckinridge founded the first American midwifery service, the Frontier Nursing Service, in 1925 in the mountains of Kentucky and began a steady fad of midwifery being employed as an important tool to improve the health of communities. In New York City, the Maternity Center Association, now Childbirth Connections, was developed as an organization to improve the health of the people living in poverty in New York City. MCA started the first Nurse Midwifery program in New York in 1931.

Reflecting back on the personal statement I wrote to get into the nurse-midwifery program, public health was at the core of my deciding to be a midwife. Aside from the multitude of more soulful pulls to midwifery, I recognized midwifery as an opportunity to affect health on a larger scale. Pregnancy heightens the awareness of many women to the importance of healthy living. Pregnancy offers an opportunity to help women begin to make good decisions for their families, to teach their kids how to make healthy decisions, and to let that penetrate into the societies in which they live. Midwifery is directly engaged in the empowerment of women that has been shown in the history of development to drastically improve the health of communities.

Yet, clinicals often feel a far cry from this ideal. This week my preceptor and I saw patient after patient-- depo, IUD, 28 week visit, 6 week postpartum-- even moving as quickly as I could, the number of patients in the waiting room started to pile up. The visits were brief. The bare minimum was covered. A girl came in pregnant at 15, regressing into childhood in the face of pregnancy, she began to suck her thumb. A 40 year old came in, pregnant again, after she stopped taking the pill when the side effects got unbearable.

As I struggle to embrace my clinical experiences, that sometimes feel so much like rescuing bodies, I rest with the image of those frontier midwives in my mind, the wind blowing through our hair as we ride, horseback, to a birth; sit beside my sisters in New York; and remember that the roots of this profession lie nestled beside public health and the two have grown together in ways that I will see if I keep my eyes and heart open.

I will close with a quote:
"Courage doesn't always roar. Sometimes it is the quiet voice at the end of the day saying, 'I will try again tomorrow.'" --AA Milne via Christopher Robin via Melissa, a beautiful fellow midwifery student who brings courage and passion to my life.


  1. hopkins.debra@gmail.comOctober 18, 2010 at 8:48 AM

    wait.. what happened to the girl who reached the village of "Upstream"?

  2. I feel like the ending is implied, but I can give you some options of what happened:

    When she arrived at the village, the girl found a beautiful bridge spanning the river with intricate woodwork spiraling around the hand rails, clearly an ancient masterpiece. As she drew near though, it became clear that several of the boards were missing and the bridge was rotting. As she watched, a woman crossing the bridge with a pail of milk for her lovely family fell straight through the bridge and just barely grasped the wooden rail as her pail fell crashing into the water below. The girl, ran to help the woman and pulled her up. She began to question the woman about the bridge and discovered that the art of bridge making had been forgotten by the villagers when the old bridge maker had grown old and blind and stopped making bridges. Ever since, she explained, the villagers risked their lives daily to cross the dilapidated bridge to get food for their families. The little girl made sure the woman was alright and then went on in search of the old bridge maker. On her way she met a young man looking sullen by the side of the road. She inquired about his unhappiness and listened with all the warmth in her heart as he told her the sad tale of his father, a carpenter, falling through the bridge to his death, leaving the young man not just without a father but also without the mentor who was teaching him the trade of carpentry. The young girl suggested that the young man join her on her journey and away they went. Soon, they came across a stunning log cabin with the same woodworking designs as the bridge. They knocked on the door and the old blind bridge-maker let them in. The bridge-maker was so happy to have visitors and he quickly suggested that he teach the young carpenter how to apply his skill to making and repairing bridges. The young bridge-maker was a fast learner and in no time he set to work fixing the bridges around town and making new ones. The village of Upstream flourished and the villagers were happy! The young girl returned to her village of Downstream a true hero. And everyone lived happily ever after!

    Alternate Ending: As the young girl traveled, the villagers of Downstream realized that they might find themselves in competition for the opportunity to rescue all the people in the river. So they schemed and began charging those they saved. A hefty sum for the rescue, a little extra for the pudding they served at the fancy new hospital they built by the side of the river, and if you couldn't pay, well back in the river and hope that you can swim! The young girls brother was bright also and he schemed an even grander scheme and went running to catch his sister. Breathlessly he told her his plan. When they got to Upstream, the little girl and the little boy told all the villagers of Upstream about the villagers of Downstream, who had become well known by the villagers of Upstream as many of the rescued returned with tales of the noble rescuers. The villagers of Upstream were worried, however to hear that they would now be charged for the rescue services. Fear not, the little boy and girl said and began selling insurance plans. Anyone who wanted could pay a little bit of money and get the swiftest, most skilled, and most luxurious rescue imaginable! Business flourished. Pretty soon everyone who could afford it bought the insurance and the little boy and the little girl grew exceedingly rich. The rescuers from Downstream were happy to have a steady stream of rescues to keep them busy and well paid. and... almost everyone lived happily ever after.