Black Midwifery Shows a Way Forward for Abortion Care Despite Brutal Suppression

[Jilly_in_VA]

By Sarah DiGregorio

Just after lunch on a Wednesday in June, 64 midwives and midwives-in-training were assembled in a classroom at the Columbia School of Nursing in Manhattan, performing abortions on dragonfruit. Tools were laid out on sterile sheets, just as they would have been if the patient were an actual person and not an exotic fruit. There were forceps to stabilize the “uterus,” a long plastic dilator to open the “cervix,” swabs, “iodine” (soy sauce), lidocaine syringes, and the manual vacuum aspirator, which is used to provide the abortion. The aspirator is made up of a thin plastic cannula that goes into the uterus, and at the other end, a fat plastic syringe, with a plunger that is pulled back to create suction. Seven trainers, both midwives and physicians, watched carefully as the trainee midwives worked in pairs, each taking a turn to hold the fruit steady while the other inserted the long cannula and sucked out the black-speckled pulp.

Michelle Drew, of Ubuntu Black Family Wellness Collective in Wilmington, Delaware, was the workshop’s lead instructor. A certified nurse-midwife with a doctorate in nursing practice, she circled the room to offer feedback on technique, then stopped to help a participant, taking their dragonfruit in one hand and the aspirator in the other. “A lot of times you see people going straight in,” she said, demonstrating how one might insert the cannula into the center of the uterus. “But when you are going in for the first time, go at an angle. So I’m going upward first. Gently, I feel the fundus,” she said, referring to the farthest wall of the uterus. “And then I’m pulling back,” she said, showing how to bring the cannula back towards the cervix. “Now I’m going to change my angle and go downward. Now I’m coming back, and then back in at 9 o’clock, and twisting, twisting. And if you do a good block with the lidocaine, you can relieve the uterine pain as well.” This methodical approach ensures an abortion is thorough, not leaving any pregnancy tissue behind.

Training of this kind is much harder to find than it should be. By New York state law, midwives are able to provide procedural and medication abortion, but they must have extra training for procedural abortion—both classroom instruction and practice, and then clinical training with real patients under the direction of a mentor. But most midwifery schools do not provide that training, partly because it is considered an advanced skill and so is not on the midwifery licensing exam, and partly because there are not enough abortion providers to be clinical mentors. What slots are available are often taken by OB-GYN residents, for whom it is a required part of training. Abortion is not accessible if there aren’t enough providers to train more providers—and that would be true even absent the other factors that make abortion care hard to come by, like restrictive laws, stigma, and suppression. It’s a vicious cycle.

Here is what happens when there are not enough abortion providers: Drew told me the story of a woman named Precious. (“And she was. She was a wonderful young mother, just beautiful and sweet,” Drew said.) Precious acquired a heart condition during one of her pregnancies; she lost two-thirds of her heart function and was advised that she shouldn’t get pregnant again. But she did, and at first she felt fine. But by 14 weeks, it was clear that her heart was not going to make it through this pregnancy, and she needed to terminate. Drew, who at the time could not legally perform abortions, tried and tried to get her an appointment with a physician who could. But the few physicians who could do second trimester abortions were fully booked, partly because they were also providing so many low-risk first term abortions—exactly the kinds of abortions midwives could have safely performed. Drew called and called and Precious waited and waited, her heart function deteriorating. There were no appointments available before Precious crossed the 22 weeks and six days mark, after which Delaware prohibits abortion. She was not yet sick enough to qualify for an exception—at least not until 28 weeks, and by that time, the question became when to deliver instead of when to have an abortion. In the end, Precious gave birth to her baby at 32 weeks and then she died of heart failure. Drew went to her funeral.

https://jezebel.com/midwife-abortion-care-1850631246

I have begun to believe that Black midwives are the future.

[brer cat]

1. Good read. K&R

[FakeNoose]

2. K & R This gives me hope for the future