To stand in opposition to: why trans exclusion in birth is the antithesis to midwifery.
The word "midwife," is as old as time. It means "with woman." Some would argue this means it explicitly excludes gender diverse people. I would argue, it explicitly calls for quite the opposite.
With women. With woman. With her.
We get this drilled into us in our undergraduate degree, the importance of the words we use, the damning nature of some of the phrases that have been used in obstetrics: incompetent cervix, failure to progress, non-compliant. The most important words: Woman. Midwife. Our professional call: to be with.
The history of midwifery is long. Very long. Midwives are thought to be one of the oldest professions: you can trace the history of midwifery back to the Palaeolithic era - that is: a really long time ago. The Palaeolithic era was roughly 44,000 BCE. In contrast prostitution which gets touted as “the oldest profession in the world,” is first mentioned in historical texts around 2400 BCE. Midwives practiced lay-medicine in the form of birth attendance before doctors even existed. Midwives were doctors: treating the whole family for various ailments (Ehrenreich & English, 1973; Retief & Cilliers, 2005). The word “midwife” comes from the Latin “mid” - with and “wife” - woman. However there’s actually conflicting arguments about who the woman in “midwife,” is referring to. Our colloquial understanding that we tout all the time is that it’s the birthing woman who the midwife is with. However some ancient texts actually talk about midwife meaning “a woman who is with” - with it being implied that they are with whoever is doing the birthing. Or whoever is needing medical care in the case of ancient practice that included the whole family. Amongst this conflict - one thing remains steady - the with: the togetherness of carer and cared for.
In contrast the etymology of the word “obstetrician,” lacks any concept of togetherness. The word comes from the Latin “obstare,” that is, the same root word of “obstacle,” - “to stand in opposition to.”
Over time both of these terms have been conflated - for a period of time midwives were referred to as obstetricians or “obsterix”, until medicine took the title for its own and barred women from being involved. The understanding of these words goes a long way to understand the history of birth and birth attendants as a political space. Few things so neatly sum up the difference in the models of care between midwifery and obstetrics as these differing concepts of togetherness, and opposition to.
We also know that words can, and do, change meaning over time. They get lost, found, reclaimed. “Mid,” does not mean “with,” in modern English - it means middle. “Wife,” does not mean “woman,” in modern English, it means “married woman.” If you ask somebody on the street what a midwife is, they won’t say its a “with woman.” Likewise if you ask somebody on the street what an obstetrician is they won’t tell you they’re an “obstacle.” Words change - this is ok. Sometimes they change organically - “queer” from meaning “twisted,” or “oblique,” in ancient German, to being used as an insult against homosexuals in the 1920’s to being reclaimed as a statement of both protest and belonging in the late 20th Century. Sometimes they change consciously, and with guidance - the intentional use of the word “birthed,” over “delivered,” springs to mind. We were instructed to never talk about babies being “delivered” when I was a student midwife - babies are born, they aren’t pizzas.
If we look back to the foundations of midwifery, and our understanding of the importance of the words we use to describe the role of midwives, it makes perfect sense to the philosophy of midwifery that we include all people who need our care. If we actually don’t have concrete evidence about who the “wife,” in midwife is referring to, that leaves us “with” as the steady notion of midwifery. We know that men can, and do become and make wonderful midwives, and our profession is richer for their presence. We know that women can, and do become and make wonderful obstetricians - and obstetrics is richer for their presence. We could argue that I am not a midwife - since I am not a woman, and I sometimes care for people who are not women. When I am a transmasculine nonbinary person caring for a transmasculine birthing father - am I still a midwife? The $750 I paid to midwifery council two weeks ago to have my name on the register would argue yes. When a male midwife is caring for a male baby when the birthing mother is still waking up from general anaesthetic - is he a midwife? When we tangle ourselves up in this obsession with definable and measurable concepts of womanhood and its ties to midwifery, we lose something - the togetherness.
When we start to try and narrow and define who is worthy of having their existence honoured by care providers - we get into dangerous ground that echoes past atrocities of exclusion and segregation in societies. There is a growing body of research that shows that recognising people in language, in resources, in public facing signage is vital for their care (Ellis et al., 2015; Veale et al., 2019). The argument that we only refer to cisgender people at a public level but allow transgender and nonbinary people affirmative language at a personal level (i.e., not where people with either overt or internalised transphobia have to acknowledge gender diverse people’s existence) is stunningly similar to the DADT or “don’t say gay,” bills. We know the lack of adequate language, representation, and education leads to poorer health outcomes for gender diverse people (Ellis et al., 2015; Hoffkling et al., 2017; Malmquist et al., 2019; Veale et al., 2019). A system in which 1 in 5 gender diverse people are denied healthcare is not a system that is working. To say we should only have affirmative language at a personal level is a commitment to perpetuating these inequities, and ultimately it is an act of supremacy: Cisgender people at the top of the hierarchy of who deserves good quality health and perinatal care, and everybody else below them. Midwifery was never about supremacy - everybody receives midwifery care. Midwives, or traditional birth attendants can be traced back in every society, amongst every race, and every class level (Mangay Maglacas & Simons, 1986; Towler & Brammal, 1986). Midwifery has always been about including all people.
To be with is the foundational concept of midwifery. To work in togetherness as opposed to in hierarchy is what separates us from other annals of medicine. It is with this understanding that midwifery makes the perfect soil in which to sew the seeds of radical inclusion for all birthing people and their families. We honour midwifery, the etymology of the word and the history of the profession by continuing to include every single person who needs our care. We walk with them, through pregnancy and birth and into parenthood - and perhaps in doing this, we can teach other professions how to hold togetherness at the centre of their care ethos - and how togetherness strengthens us all.
Referenced
Ehrenreich, B., & English, D. (1973). Witches, midwives, & nurses: A history of women healers. The Feminist Press at CUNY. Chapter 2, P31
Ellis, S. A., Wojnar, D. M., & Pettinato, M. (2015). Conception, Pregnancy, and Birth Experiences of Male and Gender Variant Gestational Parents: It’s How We Could Have a Family. Journal of Midwifery; Women’s Health, 60(1), 62–69. https://doi.org/10.1111/jmwh.12213
Hoffkling, A., Obedin-Maliver, J., & Sevelius, J. (2017). From erasure to opportunity: a qualitative study of the experiences of transgender men around pregnancy and recommendations for providers. BMC Pregnancy and Childbirth, 17(S2). https://doi.org/10.1186/s12884-017-1491-5
Malmquist, A., Jonsson, L., Wikström, J., & Nieminen, K. (2019). Minority stress adds an additional layer to fear of childbirth in lesbian and bisexual women, and transgender people. Midwifery, 79, 102551. https://doi.org/10.1016/J.MIDW.2019.102551
Mangay Maglacas, A., & Simons E. (1986). The potential of the traditional birth attendant (WHO Offset publication no. 95). World Health Organization.
Retief, F. P., & Cilliers, L. (2005). The healing hand: The role of women in ancient medicine: the Graeco-Roman world. ActaTheologica, 2005(Supplement 7), 165-188.
Towler, J. & Bramall, J. (1986). Midwives in History and Society. London. Croom Helm. P9
Veale, J., Byrne, J., Tan, K. K. H., Sam, G., Ashe, Y., Nopera, T. M.-L., & Bentham, R. (2019). Counting ourselves: the health and wellbeing of trans and non-binary people in Aotearoa New Zealand.