The following interview was originally posted in May of 2019 by the California Association of Midwives, which is working to make sure families have access to a licensed midwife for their care in pregnancy and birth.
Interview with Jocelyn Dugan and Tanya Smith Johnson:
How will new leadership affect the ways CAM educates families and expands access to licensed midwifery in California?
Jocelyn Dugan, former CAM treasurer, took on the role of president in January. Tanya Smith Johnson stayed on as Vice President, while former CAM President Rosanna Davis stepped into the treasurer position. CAM’s new president and vice-president duo sat down (something either leader rarely does given their busy lives!) with Jeanette McCulloch, CAM’s communication consultant, to share their vision for CAM and midwifery in California.
“In school, I’m being told about birth and what it’s like from people who’ve never done it and with students who don’t get it”
Jeanette: It has been three years since CAM became what it is today: an organization focused on education and access to midwifery, a sister organization to CALM (the professional organization for California licensed midwives.) Tanya, tell me about the role that CAM plays or will be playing in access to midwifery in California.
Tanya: I think CAM’s role in increasing access to midwifery is about educating and informing the public at-large about what midwifes do, who midwives are . . . and how great their work is.
Midwives affect families and their general well-being in the reproductive year and beyond. From conception to birth, midwives are an integral part in that transition in a family’s life.
The relationship a family has with their midwife, though, goes beyond that period. Often, the care between a midwife and a family may be the first time a family has received care that is deeply respectful, that centers the family’s values and preferences. The relationship with the midwife then sets the standard for how they go about getting their care for themselves, their children (who have witnessed the positive care), and so on and so forth.
By informing and educating the public at-large about how important the midwifery model care is, we are also contributing to our society’s well-being. One family receiving midwifery care affects the individuals receiving care, their children, and their children’s children.
Jocelyn: There is a micro and a macro in this world. The micro is the person having the baby and the experience that they have and that their child has and their partner has, if they have a partner, through the process of birth. And then the macro is how you apply that to, like Tanya said, the well-being of the population of people. If we look at the evidence that we have about midwifery care and how it can help the maternal healthcare crisis we are suffering from in America, you can apply that to the individual and then you can apply that to the macro.
And if you look at the outcomes that midwives provide and improve on, especially in communities of color, relative to the number of people actually receiving midwifery care, there is tremendous work to be done. What if more midwives of color were available to provide care within their communities? There is a way to fix the problem of the impact of health disparities on pregnant people of color and their babies.
Jeanette: How is this different than what CALM does?
Jocelyn: In one important way: we are very similar: both CAM and CALM exist to advance midwifery in California. But we serve very different audiences.
CALM is a professional organization for licensed midwives. As a professional organization, they provide much-needed benefits to their members, like clinical training opportunities, advocacy around legislation and regulations that impact midwives, and other tools to support their practice as LMs.
Our work at CAM is complementary, but different. CAM exists to engage families and to support, ultimately, the families in California who would want the care of or to learn more about licensed midwifery.
Jeanette: I know you both have these amazing stories of how your births have impacted your decision to be engaged in this work. Is it okay for me to ask that question of one or both of you?
Jocelyn: Yes, go for it.
Tanya: Yeah. Jocelyn can go first since she has fewer births to think about and talk about.
Jocelyn: True. And my two births are polar opposites. I’m going to try to say this in the least negative way possible for the medical establishment. My first birth was traumatic and many interventions that could go wrong, did. And I did not feel like I had any level of autonomy, and I knew that I wanted more.
There was a lack of support and knowledge of who I was and what I needed from my birth attendants. And I came through that depressed and unable to bond with my child and unable to feel any joy about what happened. Having a C-section, and not just having a C-section, but all of the other things that happened along the way or after the fact . . . my first recollection of holding my baby, I was high on morphine and I didn’t even know that I had a morphine IV.
When I realized that I wanted to have another child and I wanted to feel that autonomy, that respect, that trust. I started researching midwives and I found the group of midwives that I had Quinn with. From the get go, my care was different. They met with me in my home. They talked to me about nutrition. They talked to me about my relationship stability. They talked to me about what I wanted out of my birth. Questions that people had previously not even included me in. So having the autonomy and the ability to express my voice about my own medical situation was hugely liberating. And I had a difficult and challenging birth and still came out the other side thinking it was so much better, and I would do it all over again the same way.
So when there was a need for someone who had used a midwife to step into an organization that needed accounting help, I was like, “Yes, I will do this.” I think everybody should be able to feel the difference or to feel the way it is to have care with someone who cares about you, ultimately. Having the experience that’s such a juxtaposition of one really terrible and one really difficult but amazing experience made me think that everybody needs to at least know this is an option for them. And if they choose to do something else, great. But if they don’t even know about it, they can never make that decision.
Jeanette: Tanya, how about you?
Tanya: I had a completely different experience. And even though I’ve given birth six times, all of them were great in their own way. They got increasingly better. But my first two were with a doctors/nurse midwife team. In my mind, I thought that I was doing a thing where I was really informed, where I was choosing care providers and this maternity care that was “natural” . . . as natural as it could be. I thought that was what I was choosing.
I had this great birth. The first was with the doctors. The second was with the nurse midwife. The way the practice ran, you rotated between the two and you chose who was going to show up for you in the moment. It was great and amazing. What I didn’t like was how I was treated after I had the baby. It was little things that, in hindsight, were big.
The birth itself was great, but how the nurses treated me … how once I had my daughter they whisked her off and literally my legs were still up in stirrups. Everybody was over with the baby and I literally remember whispering “Hey, is somebody there?” I’m like, “I’m cold,” or … I am completely exposed and my husband is having to advocate for my wishes in the room with the nurses in regards to what we discussed in our plan. For instance, I was a first-time mother and being told, “Oh, your birth is going to be longer” than what it was. My first birth was just three hours, but they’re like, “Oh, you can’t be moving this fast,” and all these things. And, “Oh, do you want pain medication?” My husband is literally having an argument with the nurse trying to advocate for me and say, “No, we’ve discussed this. She doesn’t want an epidural. She doesn’t want these things.” They’re arguing in the corner while I’m trying to birth.
Those little experiences made me be like, “Huh, I don’t want to be here after I have my baby”, to where, literally, I advocated for leaving as soon as possible from the hospital after having my baby. And of course, the doctor’s like, “Absolutely.” So it wasn’t the doctor and it wasn’t even the midwife. It was the care I felt I was getting afterwards. I had to ask for a bar of soap. My husband’s grandmother had to go into the hall and go to the closet to get a wash towel. These little things … I was like, “I don’t want that.” I wanted to be able to feel at home wherever I am. I want to be comfortable.
I just remember the little things about how scratchy the plastic mattress was and just literally not being able to sleep in the midst of this ravenous newborn on my boob. I just like, “I want to be comfortable. I want to feel at home.”
When my son was just 6 days old, I started med school, where I was planning to become an OB GYN. Most med students have not had children yet. In school, I’m being told about birth and what it’s like from people who’ve never done it and with students who don’t get it, and I was informed in a different way.
Midwifery was just kind of whispering to me. I thought, “There has to be something else other than this,” … even other than nurse midwifery. I didn’t know that CPMs even existed. I knew they did in the past. I didn’t even know there was a option to birth outside of a hospital. I knew you could birth at a birth center, but just completely at home, I thought those were rogue people who were just doing something that was completely against the law. I didn’t know.
So then by the time I was pregnant with my third, I had left med school. I decided we were absolutely birthing with midwives. But we’re military. So we’re moving to different states with different laws about who you can birth with. So we were in a place where there weren’t CPMs. We were in Hawaii and CPMs were illegal and you can’t find them, so I chose to birth in a out-of-hospital birth center, and it was great and amazing. I was like, “Okay, we can go even further than this. We can actually birth at home. I’ve completely birthed this way. We got this. We can just do this, right?”
Then, by our fourth baby, I definitely know what I’m looking for. I know what kind of experience I want. I know that I’m in California where I can have the midwife. So California and my fourth baby was the first time I had a home birth. I had that baby on Stanford’s campus. I found my midwife at 36 weeks, which is late in the game, and it was great and amazing. Even in that short period of time of me meeting my midwife and connecting with her, beat out the entire nine months of being with a different kind of care provider. It was instant. She got me. She heard me. And I had the birth of my dreams.
At that point, I was like, “Whoa, where do I sign-up? How do I let other people know that this exists and how do I help this?” And that’s how I got involved from that point on. Just me coming from it from all the angles … as a former med student, as someone who was going to be a doctor, someone who has birthed in the hospital, someone who’s birthed in the birth center, even, and then now, someone who’s actually had a home birth. I had all these experiences with different providers in different settings, and nothing compared to my experience with a midwife in my home.
I never went back. My last three births have all been at home. That was the only place where I felt like I was completely comfortable. I was not only in my home but felt at home in my body. I felt at home with the people around me. I felt that they knew my wishes and they actually did them. It was the first time and only time where I felt that I had complete informed consent from start to finish, I knew what my choices were and whether or not I could refuse.
I feel like I’m fairly informed about what’s out there because I’ve actually experienced it. I can say honestly from my heart and soul that the midwifery model of care is what everyone needs and deserves to know about.
I then also thought about how I’m a fairly educated woman, who has gone to college and hold masters degrees. I was on track to become a doctor. And if I didn’t know about these options and what they meant for my births, imagine how little others know about their options.
I realized I wanted to make sure people know about and have the option of the midwifery model of care, whether they choose it or not.
Jeanette: What challenges did you face choosing midwifery care?
Jocelyn: It was really hard to be pregnant and vulnerable and trying to argue a case that midwifery care was ok for my family. I felt like I had to really battle people around me, like friends and family, to even explore this option because nobody knew what it was, and they were all so scared. If I could eliminate that for one other person by letting it become more normal and less fringe, I’d feel like I’d done something.
Tanya: I got the most criticism from people who were in the medical profession and other medical students. “You know better than this. You’re smarter than this. Why are you choosing this?” It’s a hard argument to be in, explaining that “Well, you all know me. I’m right in school with you. You know that I wouldn’t make a decision that I didn’t think was a good one and I wasn’t informed about.”
I can’t imagine the push back other people get. Even if they have a support system, they have to go up against what their support system thinks and whether or not they can still stand by them in their choice.
It’s not just even educating the person who’s birthing, but their entire family and their entire support system so they can do it. I’ve been in births where family was on-board but the in-laws and mothers who were going to be at the birth weren’t. And it made it so stressful for them, and it was so tense to where it changed how that birth went just from having people there who didn’t believe and didn’t know and weren’t informed.
It’s bigger than just the individual family. It’s like who’s actually birthing, but everybody else who’s around. So if you could change all of those people’s minds and inform all of those people about the choices that are out there and the choices that a loved one has made or choices a particular family member has made, it’s changing so much. And those people go out and tell other people, and so on and so forth.
My children are telling me now that they know nothing else. This is what they think birth is.
Jocelyn: It’s redefining culture.
Tanya: It’s a whole paradigm shift.
Jeanette: When you look ahead to the next year, what are CAM’s top priorities?
Jocelyn: First, the JumpStart Program. Our goal is to get a cohort through the program this year.
We are also defining CAM as an organization that values all people, and centers people of color and those from nondominant cultures in everything that we do.
We are continuing to work on things in ways that make us stand out, even if they’re small, like a whiteboard video that educates families about midwifery care.
Tanya: And we are doing it intentionality from the beginning. Everything that we do, it’s not in hindsight, it’s not about optics, it’s not about this new wave of diversity and equity that everybody’s on so they’re just picking people based on how they look to place them in their organizations just for the look of it, but not because they really care about their voices and how they’re being heard and how those voices are affecting what happens and what organizations do.
CAM is not just saying we hear you, we want to include you. CAM is making a table where the seats – and the power – are held by all the vulnerable and marginalized voices we can find. These voices are speaking to every decision we make.
That’s what different. I think lots of people, lot of organizations they ask a person of color once a product is finished to give their feedback, as opposed to engaging them from the jump.
Then, we see an end product that at best doesn’t speak to our community, and at worst is offensive. And we ask, “Wait, how did they get past so many eyes and so many people and no one thought it was a problem?” Because the right people aren’t in the room from the beginning.
I think that what CAM is doing can be modeled by other organizations on a state level and a national level. And I can say that because as Vice President of CAM and as someone who’s actually sitting at the table, it’s what I feel and it’s what I know to be true. I know the effort that is taken to get the right people in the room and to get the right voices heard. That’s huge and it takes a lot of trust-building. It takes a lot of time to do that from jump, but I think the end result in what we’ll see with the project, the very concrete project that we do, you’ll see that represented in those things that we put out, in the programs that we push, and in the whiteboard that we put out. That’s, I think, what we’re about.
Jeanette: You two have a very collaborative working style. Can you tell me a little bit about your style of working together and what makes it work, and what makes it work for the two of you, and what makes it work for CAM?
Tanya: I was the president of another organization. I left it because I didn’t feel, as leadership, I was being listened to and heard. I thought I brought a lot to the table and after a point, I didn’t feel like I wasn’t being heard in the way I should be. So from the beginning, when Jocelyn even approached me about possibly being a part of CAM, I was a bit skeptical because I didn’t want to do that same kind of thing again with another organization, especially one that was pretty much white and white-led. I didn’t want to be tokenized. I think what made the difference was Jocelyn was genuine in building a relationship with me, Tanya, not me as a black person who will be great for CAM, but me, Tanya, who I’ve seen, who I think would be great for CAM, who I would want to be here. She took the time to get to know me and also took the time to give me the space to feel CAM out, give me the space to decide and see that they really were about what they said they were about, and that is what made the difference.
And that enabled me, as a person of color, to reach out to other people of color and say, “No, this organization is different. Jocelyn means what she says. You want to be a part. I trust her. This is the relationship that we have. From everything that I know and have been shown, it is authentic and true and real, and it’s done with integrity. That gives other people the same trust and the same willingness to become a part of CAM.
That’s what most organizations need: to try to build relationships. It takes more time that way, but I think in the end, we get rid of a lot of the shenanigans that happen otherwise.
Jocelyn: Jeanette, you ask us all the time if we want to do “relationships first.” I feel like that’s what we do here. For Tanya, specifically, having her be skeptical of me, as a white person, was a good wake-up call. And having her still talk to me even though I was white and she was skeptical was amazing and a gift. I’ve learned more from Tanya in two years than I’ve learned in my whole life.
Tanya’s fierce, and I’ve developed so much love for her that I feel like our relationship sort of defines the board … that we provide people space to think about things or take time off or confide in us in really deep ways. And I don’t think that could happen if we didn’t have that fierce love for each other and that safety net with each other to say, “Hey, I’ve had a really rough day. Can you help me with this?” We set the example, and we lead by example, and I think people feel it.
Tanya: I think as women leading an organization, me as a woman of color and her white, this is one model for how you do this. This is a model for how you can juggle all the hats that you’re wearing. This is a way of truly diversifying a board. This is how you give up power.
Jocelyn reaches out to me when opportunities come to her, she says “People are pinging me, but they should be pinging you. Do you want this project or opportunity?” Always, always, and that is a show of giving up power, giving up whatever because she doesn’t have to. It’s a way of paying homage to me in what I do. And just me, as a black woman, as a woman of color, period, that is all that we ask of organizations and of people and of spac