This letter has been delivered to Marinah Valenzuela Farrell, President of the Midwives Alliance of North America. Thank you to all those who signed-on. Thank you to MANA for accepting our letter. And thank you to all who read, considered, reacted, felt, cried, expressed, raged and reflected on the letter’s intent.
Anyone who would still like to sign-on to the letter please feel free to email your name, credentials, and city to: womancenteredmidwifery@gmail.com and we will add you. Thanks.
Open Letter to the Midwives Alliance of North America regarding the recent revisions to the organization’s standing Core Competencies document:
August 20, 2015
Dear Midwives Alliance of North America Board of Directors and MANA Membership:
We are writing in response to your revisions of the MANA Core Competencies. MANA’s attempts at inclusivity are commendable in today’s complex world. We are concerned, however, by accelerating trends in our culture to deny material biological reality and further disconnect ourselves from nature and the body, and about the ways in which the revisions may support these trends. Midwives have long practiced the precautionary principle, counseling against the adoption of technologies and theories that have not been proven safe or beneficial to mothers and babies, and by extension, the entire human community. We respectfully ask the MANA board to reverse the 2014 revisions and consider the ways in which the attempted changes may have harmful implications for women.
We are concerned that, except for in the trademarked section from the Midwives Model of Care, the word “woman” has been erased from the MANA core competencies document and replaced with “pregnant individual” and “birthing parent.” We recognize that the words maternal and motherbaby were not removed from the document, implying that the reviewers maintained a mutual and shared respect for the sanctity of the motherbaby unit in midwifery. But women are now all but missing from the language, as if we can separate woman from mother from baby. Woman is recognized now only in relation to her baby. This is harmful to female adult humans; we women have fought long and hard to be recognized as autonomous beings.
Adopting this language change in the context of midwifery and human reproduction is based on either or both of the following assumptions. 1) That MANA and the midwives MANA represents believe that it is biologically possible to change one’s sex. Or 2) That we deny the material basis of biological sex and acknowledge gender identity as primary. We know as midwives that biological sex occurs at the level of our DNA and the gametes we produce, and is immutable. By embracing the idea that any human other than those in a class called women carry offspring to term, give birth to them and nurse them, we are prioritizing gender identity over biological reality. We are also contributing to the cultural erasure of women’s wisdom that the physiological power encoded in our female bodies is what creates, nourishes, and births live offspring and transmits culture. Maintaining this understanding of women’s unique power to give birth does not preclude practitioners from taking into account how individuals in their care prefer to be identified.
We believe that it is a mistake to define the experiences of pregnancy and childbirth though the lens of gender identity. The very few gender-identified males that have given birth or accessed an abortion have only done so because they are female-bodied people, and that scientific fact cannot be erased. We are allowing gender identity to be the primary way that we refer to one another, even for a biological process like birth. Pregnancy and birth are distinctly female biological acts; only women and female-bodied people can give birth. The whole concept that a man can give birth is premised on the supremacy of technology over women and nature, and the primacy of ideology that is detached from our animal, natural selves. Yet midwifery doesn’t only thrive, but survives, on the health of the biological process. We as midwives believe in the inherent wisdom of biology.
Human beings, like the majority of other mammals, are sexually dimorphic. i.e. there are two distinct biological sexes, female and male, with each having particular primary and secondary sex characteristics that allow us to make a distinction between the two. Sex is natural, biological and objectively factual. Gender refers to societal roles and expectations placed upon members of each sex. Gender is cultural and gender norms vary across the globe. Gender is in fact synonymous with what not so long ago were called sex-role stereotypes. Today the word gender is frequently used to stand in for sex but this is true only on a superficial basis. Gender often now refers to the sex one is perceived as or wants to be perceived as. Gender, as used today, also refers to the results of consuming powerful steroid hormones to change secondary sex characteristics, and therefore the perception of one’s sex.
The root of female oppression is derived from biology. Patriarchal systems arise out of male attempts to control female sexuality and reproduction. Female liberation from patriarchal oppression, including brutal and demeaning birth practices, cannot be achieved if we are forbidden from mentioning female biology. Women have a right to bodily autonomy and to speak about their bodies and lives without the demand that we couch this self-expression in language which suits the agenda of others who were not born female. Gender, sex and sexuality should not be conflated. Sex and sexuality are based upon biology whereas gender is a socially constructed concept. We do not give birth with our gender identity but with our biology. The document refers to the midwife’s need to be knowledgeable about the “anatomy and physiology of the birthing parent,” as if the anatomy and physiology of birth were not distinctively female.
The existence of intersexed people does not negate the reality of female biology. Intersex conditions are based upon the biology of the body and not an abstract identity adopted by any particular individual. We have not changed the biological definitions of male and female because of the existence of intersex individuals, just as we have not rewritten embryology texts to delete any mention of human beings having 46 chromosomes in order not to offend those people born with trisomy conditions. Why would we now change the biological definition of woman because a tiny proportion of the population change their gender identification?
We wholeheartedly endorse inclusivity, which above all requires midwives’ provision of the particular care that transgendered people need. Toward that end, we see the need to gather more information on the ways in which body modifications, puberty blockers (Lupron), and long-term synthetic hormones may affect midwifery care in pregnancy and birth. Midwives are well aware of how body dysphoria can negatively impact pregnancy, birth, and breastfeeding. Before uncritically supporting gender transitioning, MANA should be calling for evidence precautionary to its long-term effects, especially in light of the younger and younger ages at which it is occurring. Before rushing into “inclusivity” we need to focus on the clinical needs of transgendered people and an open reflection of whether and how these particular needs fit into the scope of practice for all midwives.
Birth transcends and goes deeper than the western capitalistic concept of the individual. We live in the time where the dominant narrative is of the rights of the individual. We must be careful to examine how individualism harms healthy human society. We must fight the forces destroying the living material world and telling us that cultural distractions are more real than life itself. There is life-giving power in female biology. As midwives we protect the lives of the life-givers: women, mothers, females, and their offsping. We must not become blinded to the biological material reality that connects us. If midwives lose sight of women’s biological power, women as a class lose recognition of and connection to this power. We urge MANA to reconsider the erasure of women from the language of birth.
In sisterhood,
MaryLou Singleton LM, FNP, Albuquerque, NM
Michelle San Buenaventura Peixinho LM, CPM, IMH-E Española, NM
Katsi Cook, Traditional Midwife, Mohawk Nation
Barb Pepper, LM Albuquerque, NM
Makeda Kamara, DEM, CNM, MPH, M.ED, APRN Christiansted, St Croix
Ina May Gaskin, MA, CPM, PhD (Hon.) Summertown, TN
Laura Marina Perez, LM, CPM San Francisco, CA
Sora Colvin, CPM Davao, Philippines
Erin Sweeney, LM, CPM ID
Elsie Kemmons, CPM (retired) Eugene, OR
Mary Sommers, CPM, IBCLC, MPS Chicago, IL
Vicki Johnson, LM, CPM Loves Park, IL
Andrea Bukiewicz, CPM, LM Grayslake, IL
Sarah Kellog, CPM Windsor, Maine
Dusty Marie RN, BSN, CPM (retired) Albuquerque, NM
Louse Self LM, CPM Albuquerque, NM
Miriam Khalsa LM, CPM Comptche, CA
Hilary Schlinger, CNM, MS Albuquerque, NM
Tai Carson, BA, DEM (retired)
Karen Quigley-Trejo LM,IBCLC Albuquerque, NM
JayVon Muhammad, LM, CPM Marin City, CA
Corrinna Edwards, DEM, PT, CBS
Asasiya Muhammad, CPM Philadelphia, PA
Tianne (Cole) Varicak, CPM Mancelona, MI
Basia Klincewicz DEM (CPM 1996-2002), IBCLC
Irene Ann Garden, CNM Albuquerque, NM
Judy Luce, LM, CPM Berkeley, CA
Patrice Bobier, CPM
Joanne Gottschall, CPM, LM RNC Charleston, SC
Jenee Ohrvall, CPM, LM
Lisa Byrd LM, CPM, CLC
Erin Reynoso, LM, CPM Bryan, Texas
Beatrice Arzt, CPM, Hebron, CT
Alexandra Wagner, LM, CPM, South Carolina
Lisa Riell, LM CPM
Barbara Parker, CPM St. Joe, IN
Elizabeth Gaby, ND, NHCM Concord, NH
Marlene Waechter, CPM OH
Marla Hicks, RN-BC (Perinatal), CPM, LM
Carol Downer JD, Life-long women’s health activist Los Angeles, CA
Susan Hodges, MS, South Strafford, VT
Cindy Sheehan, Mother, Activist, Author. Vacaville, CA
Miep Rowan O’Brien, Carlsbad, NM
Lierre Kieth, Crecsent CIty, CA
Nicole Bessent
Jennifer Hall
Susan Smyth, RN, Vancouver, BC
Mindy Brandt
Katie Stone, Albuquerque, NM
Liz Waterhouse, Australia
Raeleen Redzuan
Drena McCormack, Powell River, BC
Karen Mazur
Susan Hyatt, Moab, UT
Sylvia Black, Atlanta, GA
Charmae Bartlett, Terners Falls, MA
Suraj Kumar
Janice Dunlop
Kathy Scarbrough, PhD, mother, feminist, and reproductive biologist
Jennie Balise
Laura Mikles
Ellen Grogan, RN
Elizabeth Pickett, LLM Ontario, Canada
Meike Matarrazo, Oakland, CA
Amy Pancake, Austin, TX
Ness Fraser, Full-Spectrum Doula
Cindy Morrow, student midwife, Woodstock, GA
Lisa Trost, Ontario, BC
Natalie Arsenault, Moncton, NB
Laurie Fuchs, Cedar Grove, NC
RadFem Collective, UK
Maria Bartlett, MSW, LSW, Neptune, NJ
Sabine Ehrenfeld, Northridge, CA
Laura Rifkin PhD, Emeryville, CA
Suzan Atwood AB, MS Atlanta,GA
Melissa Howard PEng, RHN, RYT Fredricton, NB
Kristen Dolgos MT, ASCP Iowa City, IA
Melody L. Griego, Woman Santa Fe, NM
Tara Rado Oakland, CA
Simone Snyder, NJ
Kate Ater, DOM Albuquerque, NM
Anita Stewart Ridge Manor, FL
Ali Psiuk, MA, MFTI Berkeley, CA
Elizabeth McNamara Colombia, SC
Cathy Brennan JD Baltimore, MD
Danielle Bojckuk
Nora Calhoun, RN Chicago, IL
Deborah Burns
Rachel Fabbi, DC Geneva, IL
Charmine Mallipudi, LMT, NTS Anchorage, Alaska
Max Dashu
Cindy Kane, Mother Aurora, CO
Pat Gargaetas, Woman Crescent City, CA
Maggie Middleton, Homebirth Mother and Aspiring Midwife Kansas City, MO
Peggy Luhrs, Former Executive Director Burlington Women’s Council, Burlington, VA
Carolyn Hammack, Homebirth Mother, Albuquerque, NM
Amy Lesario, Homebirth Mother, Albuquerque, NM
Magdalena Zawojska-Smith, Dallas, TX
Stina Selander, Homebirth Mother, Albuquerque, NM
Melissa Coffey, Homebirth Mother of 10, Hephzibah, GA
Nancy Crase, Seattle, WA
Marc Angelo Cummings, (FtM) Transitions Radio, Silver City, NM
Lynna Arielle Cummings, (MtF) Transitions Radio, Silver City, NM
Giovanna Capone, Librarian Oakland, CA
Suzanne Cheryl Gardner, Artist of the Sacred Feminine, Kingston, WA
Mary Scully, Feminist Activist McAllen, TX
Cynthis Wease-Cebuhar, Homebirth Mother of 10 Chandler, AZ
Nicki Harris Los Angeles, CA
Linda Conroy, Woman Sheboygan, WI
Claudia Susana Vico Buenos Aires, Argentina
Ruth Barrett Los Angeles, CA
Falcon River Los Angeles, CA
Karen Cayer Los Angels, CA
Helen Harwood Oxfordshire, UK
Fran Luck, Executive Producer, Joy of Resistance Feminist Radio NYC
Ellen Mateer, Breastfeeding Counselor, W. Yorkshire, UK
Lorene Custer, Mother, Activist Cotchogue, NY
Molly Johnson, Mother, Grandmother, Great Grandmother, Woman San Miguel, CA
Thistle Pettersen Madison, WI
Lisa McLeod Sahuarita, AZ
Rosita Libre de Marulanda, Brooklyn, NY
Kaitlyn Lindsay Johnson, Black Mountain, NC
Terre Spencer, Atlanta, GA
Joanna Jiriden
Ruthanna Barrett
Peg McCuaig, Canada
Mindy Gerken
Elizabeth Levin
Monika Beatty, Manitoba, Canada
Kerry Noonan, PhD Burlington, VT
Lucy Johns, MPH San Francisco, CA
Deborah A. Gerson Ph.D, RN (retired), Doula
Katherine Denison, Rochester, NY
Julia Long, London, UK
Sareyeh Hadian, London, UK
Simone Watson, Australia
Lynn Schirmer Seattle, WA
Bronwyn Williams Hobart, Australia
Elizabeth, Concerned woman
Amanda Fischer Doula Miami Florida
Evetta Fitz, Mother, student birth worker
Diane Mullican, woman, mother, grandmother, RN
Asian Women Coalition Ending Prostitution
Victoria Vanasco, mother
Diana Boston
Margaret Smith, IBCLC Vashon Island, WA
Sebrina Parker, Birth Doula, Edinburg, TX
Virginia C. McClary, Certified Labor Doula Chattanooga, TN
Carol Hanisch
Cheryl Biren, Feminist, Mother, Pennsauken, NJ
Alicen Grey NYC
Victoria Norvell Kennesaw,GA
Marina Strinkovsky Swindon, United Kingdom
Kitty Garn, Columbus, Ohio
Cheryl Bergen BSW, RSW Prince Albert, SK
Margaret McCarroll Londo, Ontario
Bo Novak, Bath, England
Mickey Z. Astoria, NY
Jessica Silverman, Mother Ontario
Elizabeth McKeown, natural childbirth advocate and author
Shoshana Handel Albuquerque, NM
Trina Weaver
Elizabeth Cholet Paris, France
Noel Muscutt, Pastor, Newcastle, Ontario
Regina Muscutt, Teacher & Homemaker, Newcastle, Ontario
Ruth Muscutt, Mother Wyoming, Ontario
Julia Gatina, Burnaby, BC, Canada
Karla-Ann Reycraft, Homemaker and Bookkeeper Sarnia, Ontario
Hilary Killam, B.Sc. Toronto, Ontario
Molly A Patterson CD (DONA)
S. Perry Davis, CA
Trish Oliver, WoLF, Toronto, ON
Carmen Malcolm, CBE, CBD, CPD, CBC Michigan
Xan Sam Joi
Kirsten Weems Tracy, CA
S. Grace Skrobisz, Birth Doula, Reiki Practitioner Pensacola, FL
Jennifer Green Colorado Springs, CO
Angela Geurts, NCTMB, student midwife Pocatello, ID
Linda King, Doula CD(DONA), Child Birth Educator, RN; SLC, Utah
Hannah Proctor, Birth Doula and educator, Washington, DC
Rita Vlinder, Lisbon, Portugal
LisaAnn Young, Certified Labor Doula, Birth Assistant/Montrice, CEP (retired)
Cat Thompson
Allana Dutchak-Galvin, Richer, MB, Canada
Kathy Parks, Staff, University of Toronto, Canada
Paula Schmidt, Vernon, BC
Angie Conroy, Activist Cambodia
Stephie Smith RN CRRN, Colchester, Vermont
Kaitlyn Peake, Doula, Oakland, CA
Raeleen Redzuan
Woman-Centered Midwifery 