February is LGBTQIA+ history month. In this powerful article Dr Alys Einion, FRCM, Assistant Professor, Northumbria University and Editor-in-Chief, The Practising Midwife Journal, calls for promoting justice for all during pregnancy and beyond and the importance of the role of the midwife.
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Our Shared Fight: In Celebration and Commemoration of LGBTQIA+ History Month
The theme of February’s LGBTQIA+ history month is Behind the Rainbow: Demystifying LGBTQIA+”. It seems strange that, after so many changes in law, culture and visibility in the UK and the global north, we should need to demystify anything. Yet our history, in midwifery, and our professionalism, requires us to take up the challenge to better understand the people we work with and care for. From a professional perspective, working effectively with colleagues across the multidisciplinary team and across different agencies has become more important than ever. The independent review of maternity services at the Shrewsbury and Telford Hospital NHS Trust highlights the need for improved communication across professions, within teams, and with the mothers and parents receiving care. Communication comes from and supports better understanding. Better understanding of people’s identities and the ways in which these might affect their subjective experience of pregnancy, birth, parenting, and engagement with healthcare providers, can only enhance the potential for a positive experience, for midwives and for parents.
Writing this, I have to acknowledge first, the limitations of my own perspective – I am a white, middle-class, Western/European midwife and academic, with all the privilege of that position – and I am a lesbian midwife, and a lesbian parent. I don’t know what midwifery looks like for heterosexual people, trans people, men, or other people of diverse gender, sex or sexuality either as parents or as midwives. But what I do know is that I have devoted a proportion of my career to promoting equality and working towards justice and equity – for women, for LGBTQIA+ people, for people affected by marginalisation, domestic violence, poverty, racism, sexism, misogyny, misandry, homophobia, transphobia, disability and ableism, sizeism and healthism. And for midwives to be midwives. Both of my identities are more closely related than it might seem. As midwives, our fight to retain our identity, our person-centred philosophy, never stops. As midwives, therefore, with our own history of persecution and marginalisation, we are ideally placed to improve the wellbeing of many marginalised people of diverse gender, sex and sexuality through our work, as colleagues and as caregivers.
“Lesbians shouldn’t be midwives.”
“If a lesbian wants to be a midwife, women should have the option not to have them as their midwife. Or they should have a chaperone.”
It is fitting, therefore, as we celebrate LGBT+ history month, to reflect on how we can make midwifery a more inclusive profession. Has our history always been inclusive? When I was a ‘lowly’ student midwife, my sexuality hidden, the two comments above were made by one of my student colleagues in my hearing. When I did ‘come out’ in the workplace, I was informed by a senior colleague that ‘we all know you people can’t be trusted.’ It was my civil partnership to my co-parent that forced that public profession of my relationship. From that point on, it became evident that there were two fights. The fight for justice and equity, and improved quality of care and experience, for LGBT+ people, and the fight for safety, equality of opportunity and full inclusion of LGBT+ midwives. I have seen lesbian midwives leave the profession, trans people attempt to enter midwifery and leave before completing their education, and midwives treat lesbians and people of diverse gender, sex and sexuality (colleagues and parents) with disdain, discriminatory behaviour and biased assumptions. I have witnessed the extreme polarisation of opinion, perspective and debate on the use of inclusive language in midwifery.
However, in this LGBT+ history month, I still consider myself lucky. As a midwife, I have devoted my work to promoting gender equality because I am a staunch feminist, and I believe the roots of homophobia and transphobia lie in sexism and misogyny. And as midwives, the one thing we ALL understand is misogyny. But the legacy of LGBT+ history is as terrible as it is wonderful. It is wonderful that we have rediscovered role models in our history, that we have achieved better legal recognition and protection, and greater visibility and social acceptance of diverse gender and sexuality, but terrible that we forget, all too often, the wholesale discrimination against queer people across the world that has historically criminalised, killed, marginalised, disenfranchised and dehumanised them, and which still persists in many countries.
Midwifery has a long history of being a marginalised profession, sharing a whole world of discrimination with many other marginalised identities. And yes, midwifery is an identity, not just a job. We have a history of horizontal violence and internalised misogyny, much as the LGBTQ+ community have a history of internalised homophobia which is used as one of the (arguable) reasons for why we often do not support each other. Our history and our present reality demonstrates shameful inequalities in the experience of people from minoritized ethnic groups (excluding the white minority group) as midwives and more powerfully, as maternity service users. These oppressions and inequalities are not the same, but they offer a shared language and an opportunity for change.
Midwifery is in crisis, it is said, and, as evidenced by the changes of the Covid19 pandemic, we still have work to do to reclaim our core values of woman-centred and person-centred care, our role as advocates for women and parents, grounded in our history of feminist activism. This means working for better workplace cultures, and better standards of care for the women and parents we support. The history of LGBTQ+ identities is both personal and the story of an ongoing fight for justice and freedom. In this we are as one. LGBTQ+ people have the right to reproductive justice, including the right to choose to be a parent, or not, and the right to parent children in a safe and positive environment. Heteronormativity, lack of understanding, and ongoing stereotypes of the LGBTQIA+ community can undermine these rights and affect the experience of parenting. Midwifery is as much a part of the solution as it is a part of the problem.
This call to action is simple. It does not matter whether we fully understand each other’s fight. It does not matter if we agree with each other, or each other’s identities and philosophies. I do not have to agree with you to respect you. What matters is that we share a common goal – justice for all. Justice for every mother, every parent, every family. Justice for every midwife. An inclusive service embedded in inclusive workplaces where inclusive practices support ALL women and ALL parents and ALL families and where we recognise that for many of us, colleagues and parents, life is made much more difficult when we carry a personal and collective history of stereotyping, bias, prejudice and discrimination which does affect how we engage with each other. If the public health role of the midwife is paramount, then we must work to redress all inequalities of opportunity, access and experience, for ourselves, for each other, and for mothers, parents and families recognising the commonality in our histories, the individuality of our experiences, and co-constructing a future of mutual respect and better shared understanding.
Dr Alys Einion, FRCM,
Assistant Professor, Northumbria University and Editor-in-Chief, The Practising Midwife Journal
February 2023