Category: Anti-Oppression

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Anti-Oppression Anti-racism work Equity Health Care intersectionality lactation LGBTQ2S+ surrogacy understanding bias

Reflections on Trans Inclusion in Birth & Lactation Support

Response re Inclusive Language

Miriam Main, one of the directors of La Leche League Great Britain (LLLGB) recently resigned because she objects to the organizational directive to be inclusive of all people who lactate, regardless of sex or gender identity. Her open resignation letter explaining her decision echoes much of the feedback we’ve heard in recent years from birthworkers who disagree with our use of language such as “chestfeeding”, “birthing person” and other terms aimed at ensuring that all people who birth babies and feed infants from their mammary glands feel included and supported with the resources required to meet their feeding goals. 

Her objections to trans inclusivity include:

  • Women cannot be physically and emotionally open with “men” present
  • Men will make LLL meetings unsafe
  • It might be dangerous for men to feed babies
  • Men feeding babies separates them from their mothers, causing damage to the mother-baby dyad.

November 20 is Trans Day of Remembrance. The day was founded in 1999 in protest of the murders of two Black trans women, Rita Hester and Chanelle Pickett. There is heightened tension regarding this day this year because of the US election outcome. Trans people in the US and elsewhere are deeply afraid that emboldened transphobes will be incited to violence. Further restrictions on trans people’s ability to access affirming care is likely coming. The inability to access gender-affirming care increases suicidality among trans people. While Main claims that she is not anti-trans rights, unfortunately, rhetoric like Main’s fans the flames of fearful and hateful myths putting trans lives in danger.

The Confusion About Main’s Objections

Main is against the presence of “men” at LLL meetings. Confusingly, she includes transmen and non-binary people in a list of types of “women” she has effectively supported at LLL meetings in the past as a leader. When she uses the term “men” she could be referring to trans men who gave birth to their babies or trans women using the lactation induction protocol to assist with feeding their babies. Through this confusing use of language, Main appears to be asserting that trans men are “women” and that trans women are “men”.

Main’s view is rooted in an idea called “gender essentialism”. This is the belief that there are two genders, that gender and sex are the same, and that the characteristics of the genders are an innate, hardwired aspect of our biology. While many people subscribe to this normative view, there is a growing body of evidence that it is scientifically inaccurate. Since the dawn of recorded history, in cultures around the world, there have been people who don’t fall into the binary sex and gender categories of “man/male” or “woman/female”. Many cultures have acknowledged more than two genders. Now science is catching up with these age-old lived experiences. 

Main’s statement recirculates several myths that we as birth workers need to dismantle:

Women Cannot be Physically & Emotionally Open with “Men” Present

Main argues that it would be impossible to maintain the open, honest environment of LLL meetings if men were present. How could women feel comfortable talking about things like chapped and mangled nipples, or nurse in front of others if men are present? Main doesn’t realize it, but she answers her own question. She notes that breastfeeding is “the great leveler”. She observes that LLL group participants put aside differences regarding race, religion, income, politics, and sexual orientation. They are united in their shared goal of feeding their babies from their bodies. Whether participants are cis women, trans men, or trans women they are all dealing with chapped nipples, sleepless nights, and internal and external pressure to use bottles. Imagine the world we’d be living in if we developed our ability to focus on what we share rather than what divides us.

Men Will Make LLL Meetings Unsafe

She also fears that women may not feel comfortable coming forward about domestic violence if men are present, noting that 1 in 4 women have experienced intimate partner violence. A Canadian study of trans people conducted in 2019 found that 3 in 5 trans women had experienced intimate partner violence. Contrary to some of the rhetoric surrounding the recent US election, trans women are not usually the perpetrators of violence. They are in the population that is at increased risk of experiencing gender-based violence. Cultivating the erroneous belief that trans people are a source of violence is a significant inciter of violence against trans people. This needs to stop immediately.

Damage to the Mother-Baby Dyad

The letter raises safety concerns that are fear rather than fact-based. She posits harm to mothers and babies caused by ripping babies from their mothers’ arms so that men can feed them. Like much of what is fueling the current trans panic, this is a total red herring. Babies are not being ripped from their mother’s arms so that men can feed them. In the case of trans men, they are usually the gestational parents of their babies. Non-gestational parents with breast tissue can induce lactation. This includes cis women, trans men, and trans women becoming parents through adoption, surrogacy, or their partner carrying the baby. The protocol to induce lactation is rigorous, involving high doses of hormones and domperidone for several months before the birth. In cases where nursing is shared between a gestational and non-gestational parent, this is with the consent of both parents. For anyone who has fed a baby with their body, it should be easy to see why sharing the load of this labour might be desirable. 

Regardless of the exact nature of the situation, it’s safe to assume that anyone showing up to feed a baby at a La Leche League meeting is a parent to that baby. That’s really all that should matter.

It Might be Dangerous for “Men” to Feed Babies

She asserts that it might not be safe for babies to be fed by a “man”. She cites no evidence of any safety concerns. This is because there is none. Aside from universal precautions regarding substance use or infectious disease, If milk comes from your nipples, you can feed it to a baby. Where supply is inadequate to meet the baby’s nutritional needs, this can be addressed as it would be for anyone. We all know how frustrating and overwhelming supply issues can be. Parents experiencing this challenge need more compassion and support, not less.

There’s no reason to believe that trans lactators are at increased risk of under-supply or babies that are failing to thrive. In response to Main’s open letter, IBCLC Ashley Pickett has shared some helpful research. She notes that “When people take hormones, they can still breastfeed. It hasn’t been shown to be dangerous. Many AFABs [assigned female at birth] are entering menopause, and breastfeeding while on HRT [hormone replacement therapy]. Some trans women have taken estradiol and domperidone and their breastfed babies thrive.”

The potential for trans women to lactate and nurse is a new phenomenon, and as such, bound to raise concerns. Ashley Pickett, IBCLC addresses this with the best available evidence also. She cites two articles showing no cause for concern at this time:

https://pubmed.ncbi.nlm.nih.gov/37138506/

https://pubmed.ncbi.nlm.nih.gov/7462406/

Drawing from the articles she cites, she also provides evidence to allay fears that hormones are crossing over into the milk supply and causing harm to babies:

“Spironolactone is poorly excreted into breastmilk and there are no reported adverse effects on infants.

Cyproteone Acetate (used for [male to female] transitions as well as more commonly for acne and hirsutism, alopecia, etc) in people [assigned female at birth] transfers at 0.2% of the parental dose. However, in trans HRT uses high doses. Switching to an injectable Estradiol Valerate may be enough to elevate estrogen and not require an anti-androgen, and safely breastfeed. Breast development would remain, but she may grow some unwanted hair.

GnRH treatment has been used in postpartum contraception for decades, and in this time, has been shown to be as low as undetectable in milk and up to 1-2 micrograms per feed at max. The amount ingested had no biological activity in the infant (would be destroyed in the gut before entering the system). When taken throughout pregnancies, as it has been for many many experiencing fertility care since the 1990s, there has been “no specific hazard observed” among newborns exposure.”

 ~

The REAL issue

Evidence has nothing to do with Miriam Main’s underlying fear. It is the same as that of our members complaining about our use of gender-inclusive language. She is afraid that she and her fellow cis women are being erased from spaces that should feel like home. While this fear is an understandable conditioned reaction to change, it is unfounded. Cis women continue to comprise the majority of people who birth and lactate. Our use of inclusive language is an action to begin opening the door for trans and non-binary people who birth and lactate to receive affirmation and support. For cis women reading this, take a moment to imagine what it would feel like to walk into an LLL meeting knowing that there will probably not be anyone else in the room who is like you, but you need help feeding your baby all the same. Would you be brave enough to walk into that room? Would you be grateful for any gesture that made it a little easier?

Letting trans folks in doesn’t erase us as cis women. It is not usually presented this way, but trans inclusion and acceptance create more freedom for cis women. As we dismantle rigid, binary gender constructs and break down boundaries regarding what a “woman” can or should be, we are all freer to express ourselves authentically. I was raised in a family of women who couldn’t leave the house without “putting their faces on”. Now, I wear makeup when I feel like it. I speak truth to power without hesitation because I’m not limited by the belief that being a “woman” requires passivity. Every day I engage in numerous actions that I take for granted that would have been unthinkable for a Black woman a century ago. I owe a huge debt of gratitude to racialized trans ancestors, like Marsha P. Johnson and Sylvia Rivera, who started the Stonewall Riots, and with them, the queer liberation movement in North America.

If we let go of the fear of erasure, we can invite in the potential for trans people to enrich birth and lactation spaces. We may discover that the experiences of trans people add an important perspective on issues affecting all of us who experience gender oppression and gender-based violence. Community support and mutual aid are not finite resources. We don’t have to worry that by making space for trans people, cis women will be squeezed out. There is room in the circle for everyone.

 

About the Author

Keira Grant

Keira Grant (she/her) Inclusion and Engagement Lead – Racialized Communities

Keira brings a wealth of experience to the Online Community Moderator role. She is a Queer, Black woman with a twenty-year track record in Equity, Diversity, and Inclusion (EDI) education, projects, and community building initiatives.

Categories
Anti-Oppression Anti-racism work collaboration community decolonization national indigenous peoples day Trauma

National Day for Truth & Reconciliation: Action is Our Collective Responsibility

[vc_row][vc_column][vc_column_text title=”National Day for Truth & Reconciliation: Action is Our Collective Responsibility” css=”.vc_custom_1727115223782{margin-bottom: 0px !important;}”]In 2015, the Truth and Reconciliation Commission of Canada announced that its investigation into the inter-generational trauma caused by the “Indian Residential School” system that the Federal Government of Canada operated in partnership with Christian Institutions between about 1880 and 1996 was complete. The commission published a final report that made 94 Calls to Action. Many Indigenous experts believe that completing these Calls to Action is an imperative aspect of rectifying the harm that settler colonialism has done to Indigenous people.

It’s been nine years since the commission published its report. The concept of Truth and Reconciliation is that repairing the damage can only be achieved with honesty. The truth is that the federal government has not done much to change outcomes for Indigenous peoples since the report’s publication.

On the 8th anniversary of the final report’s publication, the federal government issued a statement claiming that 85% of the calls to action were either complete or well underway. Indigenous Watchdog paints an entirely different picture. According to their analysis, only 66% of the Calls are completed or in progress. Twenty percent of the calls are stalled, and 20% have not yet started.

At the time of this writing, Indigenous communities across Canada are mourning and speaking out about injustice. Over 2 weeks this month, 6 Indigenous people were killed by police, with the RCMP responsible for 4 of the deaths. This overt violence at the hands of the police is a stark barometer for the level of violence Indigenous people are subject to in other institutions, including health care.

When it comes to the federal government’s action on the 7 health care calls, it is slim to non-existent. None of these urgently needed calls have been completed. This lack of action shows in the numbers. A 2023 study found that 18.6% more non-Indigenous women had a regular healthcare provider during pregnancy than Indigenous women. This was connected to statistically lower access to primary and specialized care. This applied to rural and urban settings, and disparities remained when socioeconomic status was controlled for. Similarly, the infant mortality rate is twice as high for Indigenous babies as for non-Indigenous babies. The studies’ authors conclude that racism and the resulting deep mistrust of the system are to blame.

Given the ongoing violence that Indigenous people face at the hands of institutions, mistrust is entirely justified. If our government were serious about establishing trust, it would be honest about its accomplishments on the Calls to Action and get the work done.

The Call to Action that has the most direct impact on how we should practice as doulas is number 22, which calls upon us to recognize the value of Indigenous healing practices and incorporate them in healthcare delivery. When engaging with Indigenous clients seeking perinatal support empowering and facilitating their reclamation and implementation of Indigenous teachings if desired is essential. For non-Indigenous birth workers, this looks like making referrals to an appropriate Indigenous doula where possible and doing the work of managing our colonial unlearning proactively and independently when not. We should also listen deeply and with humility to the teachings the client would like to impart.

As a training Institution, we are committed to enacting the 24th call: ensuring that all students who will be working alongside the healthcare system take Indigenous culture and awareness training. The goal of our Truth & Reconciliation module is to ensure that all program graduates are prepared to fulfill the 22nd call in their practice. We recognize that the module is a work in progress and we are paying close attention to feedback from our Indigenous students on how the module can be made more relevant and impactful. As our program grows to include students from more and more countries, we are exploring ways to connect the oppression of Indigenous people on Turtle Island to experiences of colonization, displacement, and resistance around the world.

We know our work is far from complete and that our spheres of influence are small. However, each small organization’s actions to fulfill the Calls to Action is an example and a challenge to our Federal government and other powers to step up and honour their commitments. We trust our actions will ripple out, and we look forward to continuing this essential work in our community.

 

Keira Grant (she/her) Inclusion and Engagement Lead – Racialized CommunitiesKeira Grant

Keira brings a wealth of experience to the Online Community Moderator role. She is a Queer, Black woman with a twenty-year track record in Equity, Diversity, and Inclusion (EDI) education, projects, and community building initiatives.

 

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Anti-Oppression Uncategorised

Disability as a source of strength

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Often, when we think about disability, the focus is on what an individual is unable to do. However, given that 22% of Canadians live with some form of disability it’s clear that people with disabilities are capable of quite a lot.

Disability Pride Month has been observed in July in the US since the Americans with Disabilities Act was passed in 1990. It is now observed around the world, including in Canada. It creates an opportunity to highlight the strengths and contributions of disabled people and dismantle limiting beliefs about the nature of disability.

The term disability is designed to acknowledge that a person’s ability is limited by social and structural barriers that disenfranchise them and limit their participation.

In order to survive, many disabled people have to be ingenious in navigating a world that isn’t designed for them and which frequently doesn’t account for their existence. A strength-focused disability lens emphasizes the things the disabled person can do, using this as a starting point to reduce and remove barriers. It takes the view that what we construct as disability is simply natural variation among individuals and something to be celebrated rather than stigmatized. It’s a person-centered approach that prioritizes the disabled person’s right to self-determination and trusts that they are the expert on their strengths and limitations.

A strength-focused lens is a constructive framework for birthworkers supporting disabled birthers and new parents. These clients are up against many limiting beliefs regarding their ability to give birth and care for their newborns. For example, many prenatal healthcare providers believe that wheelchair users cannot push to deliver a baby and therefore must have early scheduled c-sections. This is not always true and there’s no evidence-based reason for that belief. A couple of years ago, we hosted a panel discussion of disabled parents, two of whom were wheelchair users who had birthed vaginally. One of them birthed precipitously. They both had to resist limiting beliefs on the part of care providers to realize the empowering births they deserved.

Several of the parents on that panel described intense surveillance in the hospital after their babies were born. The feeling that they were being watched and that people around them were waiting for them to fail rather than offering support was widespread.

Encouraging people to take pride in their bodies and their ability to birth their babies is at the heart of our calling as doulas. Disabled people have so many reasons to feel proud of what their bodies have achieved. We can remind our clients that they have already come up with countless life hacks to get things done. These are all skills that they can transfer to the new situation of childbirth and infant care. We can let them know that we know that they’re a lot stronger than most people think they are. And where they are not strong, that’s okay, we’ve got their back if help is needed and wanted. We can be that person they remember as someone who didn’t make assumptions about what they could do, but asked questions instead.

With such a high proportion of the population being disabled our birth work practices will inevitably include disabled people in the form of clients, colleagues, and ourselves. We see every one of you who provides long hours of birth support despite your chronic pain, or mental illness that requires regular sleep to stay in remission. We see all of you who tap into an extra reserve of energy to soothe a colicky baby or extend compassion to a new mother with postpartum depression. Your effort and your sacrifice matters. You deserve to take pride in the strengths of your body and mind that you share with your community each day.

Keira Grant (she/her) Inclusion and Engagement Lead – Racialized Communities

Keira brings a wealth of experience to the Online Community Moderator role. She is a Queer, Black woman with a twenty-year track record in Equity, Diversity, and Inclusion (EDI) education, projects, and community building initiatives.[/vc_column_text][/vc_column][/vc_row]

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Anti-Oppression Anti-racism work Canada decolonization

Emancipation is a collective State of Mind: Birthworkers need to talk about slavery

[vc_row][vc_column][vc_column_text css=”.vc_custom_1717529438169{margin-bottom: 0px !important;}”]As a child, I loved the “Heritage Minutes” on CBC. These memorable 60-second spots about Canadian history stand out more in my mind today than most of what I learned in Canadian history classes. One of the most notable stories was the Heritage Minute about the Underground Railroad which chronicled the moment when an escaped, enslaved African American family realizes they have successfully made it to freedom in Canada. “We’s free! We’s in Canada” exclaimed the family as they embraced each other tearfully.

Like many Canadians, I was unaware of Juneteenth until a few years ago when President Biden proclaimed it a national holiday. June 19th is a significant date in US history because it is when the last group of enslaved people were emancipated approaching the end of the Civil War. As a nation with a strong tendency to congratulate itself for being the nation that American slaves escaped to, it can be difficult to see what this emancipatory celebration has to do with Canadian history or society.

In fact, slavery was a normalized way of life in the colonized territories that eventually became known as Canada for over 2 centuries. In the early days of the colonial process, Indigenous peoples were enslaved, along with Black people brought to the Americas by the trans-Atlantic slave trade. It ended in Canada in 1807 when slavery was abolished throughout the British Empire. In contrast, Juneteenth commemorates June 19, 1865, fifty-eight years later.

So why is it important to talk about slavery today, and why is it relevant to birthworkers? To enslave people, you must first dehumanize them. The transatlantic slave trade codified beliefs about Black people that can’t be eradicated as easily as laws. These beliefs are alive and well, and responsible for much of the suffering experienced by Black people globally today. For example, on May 25, we commemorated the 4th anniversary of the brutal murder of George Floyd at the hands of a police officer. This is despite the many years the Black Lives Matter movement has raised awareness of similar incidents.

This is relevant to birth workers because this dehumanization is enacted in the health care system as well. We shared an article about “The Mothers of Gynecology” in February. The dehumanization that these enslaved women experienced as they were experimented on without anesthesia is the direct ancestor of the horror stories described by prominent Black figures such as Beyonce, Serena Williams, and Tatyana Ali. Their stories represent the stories of countless others who don’t have the same kind of platform, including many Canadian Black women and birthers.

As health researchers and policy-makers in the US struggle to combat the Black maternal and neonatal mortality crisis, growing evidence emerges that culturally competent doulas have a significant positive impact on Black maternal health outcomes. This evidence has led to an ever-increasing number of US jurisdictions providing public funding for doula care to ensure that this support makes it to families that need it most.

These strides forward are connected to a broader trend in US culture of acknowledging its racist past and that racism is still a part of the fabric of its nationhood.

Frankly, my observation as a Black woman who has lived in Canada for over 40 years is that as a nation, we are still stuck in denialist whitewashing. For example, while I had long since debunked the mythology of the underground railroad heritage minute, I had no idea that Indigenous people had been enslaved in Canada until I started researching this article.

We know that reconciliation cannot exist without truth. The path to collecting the same level of data that has made publicly funded doula care possible in the US begins with acknowledging that racism is as baked into our history and as prevalent in today’s social fabric as it is in the US.

Canadians observing Juneteenth can use today to learn about the history of Black and Indigenous enslavement in Canada and reflect on how it impacts the modern day. I highly recommend looking at the work of Black Canadian scholar and historian Dr. Afua Cooper. In particular, her book “The Hanging of Angelique: The Untold Story of Canadian Slavery and the Burning of Old Montreal” is a great read.  It chronicles the tragic tale of an enslaved Black woman in Lower Canada (now Quebec) who was scapegoated and tortured into confessing to the great fire of 1734 in Montreal. Cooper’s prodigious research captures the nightmare of Canadian slavery and the early colonial period. Drawn largely from copious trial records, Angelique’s words are considered the earliest known first-person account of slavery in the New World.

 

Keira Grant (she/her) Inclusion and Engagement Lead – Racialized Communities

Keira brings a wealth of experience to the Online Community Moderator role. She is a Queer, Black woman with a twenty-year track record in Equity, Diversity, and Inclusion (EDI) education, projects, and community building initiatives.[/vc_column_text][/vc_column][/vc_row]

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Anti-Oppression Anti-racism work Canada collaboration community decolonization Equity indigenous doula intersectionality national indigenous peoples day

Land Back, Bodies Back

Indigenous standing on the dock of a lake and greenary

[vc_row][vc_column][vc_column_text title=”Land Back, Bodies Back” css=”.vc_custom_1717529147132{margin-bottom: 0px !important;}”]Many settlers (i.e. all non-Indigenous residents on Indigenous land) are resistant to the Land Back Movement. Misinterpreting “Land Back” as a call for all settlers to “go back where they came from”, they often get scared, then angry.

I am a Black settler on Turtle Island and I support the Land Back Movement. I certainly have no intention of “going back where I came from”. Aside from the fact that this would split up my interracial family, my ancestors hail from a Caribbean island wherein there are more of us in the diaspora than there are living on the island. If all of us who are now settlers elsewhere suddenly “returned” this would lead to social chaos and economic collapse.

Land Back isn’t symbolic either. It is about restoring the stewardship of this land and its resources back to Indigenous people, ensuring they have self-determination. It’s about changing the narrative such that Indigenous ways of knowing and doing become the status quo.

I am ride or die for a Turtle Island stewarded by Indigenous leaders. Climate change is heating up quite literally, with “wildfire season” starting earlier with bigger outbreaks each year. There is growing talk of returning to Indigenous “controlled burning” practices to mitigate the devastation. Indigenous communities were forced to abandon the practice because their colonizers thought controlled burns were “barbaric”. It’s one of countless examples of traditional resource stewardship practices that were abolished to the detriment of all.

The Canadian state has a long history of interpreting its treaties with Indigenous nations in bad faith. Settler-colonists spuriously interpreted the land as meaning nothing more than the ground we are standing on. Where treaties have designated the land to specific nations, the state and its agents have still felt entitled to help themselves to the resources on that land, including plants, water, minerals, and animals.

Indigenous nations have a more holistic understanding of the land. Everything the land produces is part of the land and the Indigenous elders representing their people signed the treaties with that pragmatic worldview. Seen in this way, our bodies and families are also part of the land. As such, reproductive and perinatal health and services are significant arenas for the Land Back movement.

Indigenous midwives and doulas are at the forefront of actions to decolonize and reclaim birth. Here are a few examples of their initiatives that are bringing Indigenous birth back to the land:

 

  • Konwati’shatstenhsherawi’s means “Women are Giving Each Other Power” in the Mohawk language (Kanien’kéha). This collective trains Indigenous birth helpers to support birthing people using ancestral worldviews and practices. Since the grassroots program’s inception in 2017 demand has been high and the 4-person training team is busy teaching new cohorts all the time.

 

  • Call Auntie is an Indigenous-led sexual and reproductive healthcare clinic operating weekly at Toronto Birth Centre, and as a pop-up at other locations around the city. They offer a holistic suite of services rooted in traditional Indigenous knowledge, including mental health, primary care, and social support programs. Their service model emphasizes problem-solving, removing barriers, and community-led care.

 

  • Pauktuutit Inuit Women of Canada is making important strides forward in expanding access to traditional midwifery in remote northern communities. Their position is that this access is a health and cultural right for Inuit people. They recently published a report finding that governments do not provide adequate financial support to culturally safe sexual and reproductive health care. They advocate for an end to forced birth evacuation and a return to traditional birthing practices on the land.

 

  • Mālama Nā Pua o Haumea is a collective of Hawaiian traditional midwives who are working to reduce maternal mortality rates which are higher in Hawaii than in the continental US. Recently, legislation governing midwifery care has changed and they are now required to become certified nurse midwives (CNM) or certified professional midwives (CPM). Pale keiki (traditional Indigenous Hawaiian birth attendants) experience multiple institutional barriers to completing this certification, including cost and relocating to an urban centre. In contrast to these 4-year certification programs, pale keiki train with a mentor versed in intergenerational knowledge for over a decade. Some pale keiki are continuing to provide culturally safe care in Pidgin, despite these legislative changes. (US)

 

  • Kehewin Cree Nation has launched a program to train traditional midwives and has received federal funding to open a birth center on its territory. The nation aims to see more Cree babies born on their land and to honour sacred traditions such as placental ceremonies. Trainees in the program learn the knowledge of their midwife ancestors alongside Western medical knowledge. Four women are in the inaugural cohort and the program will take up to 4 years to complete. Kehewin Cree Nation anticipates these 4 trainees will be the first of many.

 

 

Keira Grant (she/her) Inclusion and Engagement Lead – Racialized Communities

Keira brings a wealth of experience to the Online Community Moderator role. She is a Queer, Black woman with a twenty-year track record in Equity, Diversity, and Inclusion (EDI) education, projects, and community building initiatives.[/vc_column_text][/vc_column][/vc_row]

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Anti-Oppression birth Canada community Equity fear intersectionality LGBTQ2S+ pride reducing stigma sexual health shame

The Importance of Being Seen: Trans Day of Visibility & Pink Shirt Day

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When I was a kid, we were taught that not seeing differences, or being “colour-blind” was the right way to be “tolerant” and “accepting” of diversity. We hear echoes of this sentiment when we hear “They can do whatever they want behind closed doors, but why do they have to flaunt it in our faces?”

March 31 was Trans Day of Visibility and April 10 was International Day of Pink. Both observances attest to the importance of being seen as an integral dimension of human rights and inclusion. People who can only be their authentic selves behind closed doors can’t hold their same-sex partner’s hand during the anatomy ultrasound, or tell their care team that they want to be called “Papa” after they give birth. People who are forced to hide their identity behind closed doors are at risk of getting beaten up in bathrooms and dying by suicide behind closed doors. Trans people need to be seen so that kids like Nex Bennedict can go to school safely. Behind closed doors is exactly where abuse and violence hide.

Having safety to be seen means being able to fully participate in society. It boils down to countless everyday things that people take for granted when their identities are not contested. Being able to use public washrooms without risking confrontation or violence. Accessing information on reproductive health that normalizes your body and healthcare experiences. Not being asked to explain where your partner is at prenatal appointments when they are in the exam room with you. Being able to find pregnancy attire that aligns with your usual style.

Trans and queer people need to call for visibility and wear pink to get noticed so that we can lead normal lives.

As birth workers, here are some things we can do to help queer and trans folks feel seen in the reproductive and perinatal wellness sphere:

  • State explicitly in your promotional materials that you welcome and affirm queer and trans people
  • Use gender-neutral language in your promotional materials and handouts
  • Have open conversations with clients about their preferred pronouns and terms for their parenting roles and body parts.
  • Become familiar with resources in your community that support queer and trans families so you can make great referrals.
  • Educate yourself on health inequities faced by queer and trans birthers
  • Challenge queer and transphobia in yourself and others

You can find out more about Trans VisibilityVisibilty Day here

You can find out more about International Day of Pink here

 

Keira Grant (she/her) Inclusion and Engagement Lead – Racialized Communities

Keira brings a wealth of experience to the Online Community Moderator role. She is a Queer, Black woman with a twenty-year track record in Equity, Diversity, and Inclusion (EDI) education, projects, and community building initiatives.[/vc_column_text][/vc_column][/vc_row]

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About Us Anti-Oppression Anti-racism work birth Canada

EDI Year in Review 2023

[vc_row][vc_column][vc_column_text css=”.vc_custom_1709738042033{margin-bottom: 0px !important;}”]A river may be so still that you can see your reflection, but its current is always in motion. This year has been a time of great change for Doula Canada as we have welcomed renewal in the form of new leadership. We have taken advantage of this transition to reflect on revitalizing our commitment to equity, diversity, and inclusion at DC and in the birth sphere. Our goal is to ensure that Doula Canada alumni have the necessary tools and frameworks to meet the diverse spectrum of birthing people, families, and communities with compassion, affirmation, and allyship. In the coming year, we will continue to apply the lessons learned from all of your insights to realize policy, curricula, and continuing education that sets doulas, reproductive health educators, and birthworkers up for long-term success in an ever-changing world. 

Here are some of the highlights of our actions in 2023 and our plans to advance our journey towards achieving social justice in our learning community and perinatal social systems in 2024.

 

Content & Communications

One of our goals is to ensure that DC alumni have access to a wealth of information that offers insight into the experiences of equity-seeking birthers and families, and tools to empower effective support. This year, we accomplished this by creating and publishing original articles, position statements, downloadable resources, and live-streamed discussions.  

Articles and Position Statements 

Our blog provides ongoing equity, diversity, and inclusion content that situates reproductive justice in the context of social issues, and that supports our learners to cultivate a deeper understanding of the social determinants of reproductive health. In 2023, our blog offered articles on trans inclusion, domestic and gender-based violence, truth and reconciliation, poverty, black maternal health, and many other essential perinatal health equity topics. 

We also endeavoured to be responsive to the impact of current events on community well-being by providing a statement on the Israel-Hamas conflict that offered comfort to our members and practical strategies for preserving emotional stability and community connectedness.

Downloadable Resources 

In 2023, we created three downloadable resources to provide practical guidance for birth workers. The first was our Advocacy Toolkit. The toolkit continues the work done in 2022 to develop an advocacy framework for Doula Canada. The Toolkit works through examples of the ingenious strategies that birthworkers use to promote client self-advocacy and advocate on behalf of clients in a manner that affirms their autonomy and right to informed consent.

Additionally, we created two resources to support human milk feeding. One is an infographic on human milk sharing that provides information on the risks and benefits of milk sharing, as well as safety guidelines that support families to make informed choices about their feeding options. The second is a curated Lactation Recipe Box with meal and snack ideas that are packed with ingredients that gently encourage milk production. 

Live Streams

We continued our tradition of hosting great conversations with experts and thought leaders from within Doula Canada and the broader birth world. Our guests offer insight into how they’ve applied their training and lived experience to facilitate clients’ access to equitable care. In 2023, topics included empowering teen birthers, debunking fatphobic reproductive health myths, barriers to fertility care, what we need to know about birthers who use testosterone, and the experiences of black families with more than “2.5 kids”. Content ideas were generated from discussions with our members at live events and online and from suggestions made using our anonymous feedback form. Our audience can access this content at any time from our Facebook page or our YouTube Channel.

In 2024, live streaming content will shift to a virtual, guest speaker Q&A series, opening with Support Men’s Lactation Like a Boss on February 29. 

Programming 

Doulas for Reconcili-ACTION

Committing to our Truth and Reconciliation Action Plan, we launched the Doulas for Reconcili-ACTION program. The Doulas for Reconcili-ACTION program aims to include non-Indigenous doulas in important conversations about the impacts of settler-colonialism, and build cultural humility skills in an applied workshop format. Our first workshop was held for National Day for Truth and Reconciliation, and focused on the historical traumas imposed on Indigenous communities, and the role of doulas in mitigating risk factors for Indigenous families.

In 2024, the Doulas for Reconcili-ACTION program will be running on a monthly basis. 

Webinars

Recognizing a need for community healing and dialogues in the aftermath of the disturbing events culminating in the arrest of Kaitlyn Braun in March of 2023, we hosted a session aimed at providing a safe container for community members to unpack the feelings arising from this distressing incident. The session was facilitated by Elizabeth Evans, RSW, and Psychotherapist and generated a presentation for community members on collective healing after traumatic events.

In order to provide practical support to our members regarding the implementation of ethical practice as defined by the law, we also hosted a webinar on understanding the legalities of your doula biz facilitated by Ane Posno, LLB, an expert in health and contract law at Lenczner Slaght. The first webinar of its kind at DTC, the live session provided vital information on documentation, confidentiality, and reporting obligations for doulas. 

Organizational Development 

Census

For the first time in its over 20-year history, DTC undertook a demographic census of its student and alumni population to learn more about how we can ensure that our content is responsive to our existing population and target our recruitment efforts to attract equity-seeking communities that may be underrepresented at DTC or in the birth work field. 

154 members completed the survey and the findings were illuminating. DTC’s population is highly diverse, with DTC members being more likely to be equity-seeking than the general population across several categories including Queer people, and some racial groups (e.g. Black, Indigenous). Other equity-seeking populations, such as disabled people have representation that is similar to the Canadian population.

One challenge with analyzing this data is that 6.5% of our sample are international but Canadian data has been used for comparison. Other limitations of this data set include categories not always being exactly aligned with the categories used by Statistics Canada, and questions that should be further segmented to create clarity, most notably education. 

On the whole, it appears that organizational efforts to ensure that equity-seeking members feel included and represented have been effective at attracting diverse students to our programs. In 2024 we should conduct an evaluation of the EDI climate to learn more about the quality of the learning experience for equity-seeking students, focusing on learning more about the experiences of underrepresented groups. In the case of underrepresented groups, DTC could also consider key informant interviews with individuals external to DTC to learn more about their needs in a birth worker training program and successful recruitment and retention strategies for their community.

Roll out of advocacy framework 

In addition to sharing the toolkit mentioned above, we are in the process of ensuring that the lessons learned from the advocacy initiative are incorporated into the anti-oppression module in our courses. The revised curriculum was piloted during the live session on anti-oppression for the fall 2023 cohort of the holistic doula program. The new content includes introducing learners to the 3 soft-advocacy techniques used by doulas as codified by S.S. Yam, namely 1) creating deliberative space, 2) culture and knowledge brokering, and 3) Spatial maneuvering. Live session attendees have the opportunity to discuss examples of how doulas use these advocacy techniques to benefit clients.

TRAP module

In 2023 we launched our truth and reconciliation module, which focuses on educating students about colonial violence toward Indigenous communities. This module was inspired by various universities that have mandated Indigenous Credit Requirements (ICR) to show respect to Indigenous communities, and foster reconciliation between settler and Indigenous groups. In 2024, applications will be open to students and alumni wanting to participate in a review of the Truth and Reconciliation Action Plan, including the module. This committee will also focus on creating a template for a wider five year TRAP outline.

 

What’s Next

In 2024, we will continue to grow equity, diversity, and inclusion within DTC by undertaking a review of our policies and curricula, developing original video content and offering a mix of new and remounted webinars that build reproductive justice facilitation capacity within our birth work community. 

 

We’re grateful to our alumni community for always inspiring us to continue this important work. [/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_single_image image=”534490″][/vc_column][/vc_row][vc_row][vc_column][vc_column_text css=”.vc_custom_1709738266702{margin-bottom: 0px !important;}”]Keira Grant (she/her) Inclusion and Engagement Lead – Racialized Communities

Keira brings a wealth of experience to the Online Community Moderator role. She is a Queer, Black woman with a twenty-year track record in Equity, Diversity, and Inclusion (EDI) education, projects, and community building initiatives.[/vc_column_text][/vc_column][/vc_row]

Categories
Anti-Oppression Anti-racism work community

The Mothers of Gynecology

[vc_row][vc_column][vc_column_text css=”.vc_custom_1707747263915{margin-bottom: 0px !important;}”]Anarcha, Betsy, and Lucy’s gynecological advancements have undoubtedly saved and improved countless lives. Yet they are not celebrated in most textbooks on gynecology or its history. Lucy, Betsy, and Anarcha were not medical researchers. Their ingenuity was a matter of survival. They were among the enslaved Black women that physician Marion Simms tortured and butchered by experimenting on them without anesthesia in the name of medical research.

Marion Simms is regarded as the “Father of Gynecology”. Not only is he remembered in the textbooks, but there is also a statue in his honour in his hometown of Alabama, in front of the clinic where he tortured Black women. He invented the speculum and the position of lying on one’s back with feet in the stirrups, that most birthers are expected to adopt in medicalized deliveries is named after him.

Simms believed that as a result of being less human than white women, Black women did not feel pain. He had no ethical qualms about conducting his “experiments” without anesthesia, despite the need to restrain the screaming women. When his medical assistants did and quit, he trained Lucy, Betsy, and Anarcha to perform this role. The three women perfected many of the procedures he was developing to save each other’s lives. Simms took the credit of course.

In 2022, a sculpture by Afrian-American artist and activist Michelle Browder finally began giving these women the recognition they are due while raising awareness of the suffering that was inflicted on them without their consent or free will. “Mothers of Gynecology” tells the stories of these heroes visually. 

All three women had suffered painful pelvic floor injuries during childbirth that affected their bowel and bladder control, making them unfit for hard labour on plantations. Now useless to their owners, they were leased to Dr. Simms in the hopes of him finding a cure that would restore them to productivity. His first experimental surgeries were failures. Undaunted, he continued his experiments, training the women to function as his assistants after his white assistants quit. They each became skilled medical providers in their own right. Simms experimented on a total of 12 enslaved women, but only Anarcha, Betsey, and Lucy’s names are preserved in his reports. To make his research more palatable, his reports state that the experiments were conducted on white women with assistance from white nurses. 

Browder’s arresting sculpture manages to convey the details of this horrific story in a way that transcends words and restores power and dignity to these exploited women. The sculptures are intricately fashioned from found metal. The three women are towering in this commanding piece, with Anarcha standing at 15 feet, Betsy standing at 12 feet, and Lucy at 9 feet. While the viewer’s emotional reaction to the piece is immediate and visceral, the symbolism possesses such a wealth of detail that you’d need to stand in front of it for at least an hour to pick up on everything. This Smithsonian article describes the symbolism like this:

“The statues incorporate meaningful—and painful—symbolism. Anarcha’s abdomen is empty, except for a single red rose where her uterus would be. Her womb sits nearby, full of cut glass, needles, medical instruments, scissors, and sharp objects intended to help viewers feel the women’s pain and suffering.

Medical scissors are attached to one woman. Another wears a tiara created out of a speculum—a device Sims invented for vaginal exams. The names of Black women [civil rights heroes] are welded to the statues.”

The figures have no arms or lower legs to represent the women’s lack of bodily autonomy.

Michelle Browder uses art as one aspect of her reproductive justice work. In 2022, she bought the land on which Simms conducted his experiments and is working on opening a clinic and museum for Black women’s health on the site. 

Simms’ racist belief that Black women had a higher pain tolerance than white women is still prevalent among healthcare providers. In perinatal health, this means Black birthers’ pain goes under or unmanaged, and pain that should sound the alarm regarding complications goes ignored. Black birthers know this and the main reason we seek birth doula support is to ensure we have an observer and advocate making sure our pain is being taken seriously and treated appropriately. 

Learning more about the mothers of gynecology is one activity that you can do to observe Black Future Month. You can find out more here:

 

Artist Works to Correct Narrative of Gynecology’s Beginnings

https://www.anarchalucybetsey.org/ 

 

 

[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_single_image image=”534490″][/vc_column][/vc_row][vc_row][vc_column][vc_column_text css=”.vc_custom_1707747309073{margin-bottom: 0px !important;}”]Keira Grant (she/her) Inclusion and Engagement Lead – Racialized Communities

Keira brings a wealth of experience to the Online Community Moderator role. She is a Queer, Black woman with a twenty-year track record in Equity, Diversity, and Inclusion (EDI) education, projects, and community building initiatives.[/vc_column_text][/vc_column][/vc_row]

Categories
Anti-Oppression Anti-racism work birth community

Respecting All Life: Reflections on International Holocaust Remembrance Day and National Day of Remembrance and Action Against Islamophobia

[vc_row][vc_column][vc_column_text css=”.vc_custom_1706563078413{margin-bottom: 0px !important;}”]That horrible day in 2017 when for no reason other than hate a 6 Muslim Canadians were killed at a Mosque in Quebec is still haunting. In a society that claims to love peace, equality, and freedom, the level of hate that spawned this horrific attack should never have been able to arise. What’s almost as haunting is that in the intervening 7 years, we’ve learned very little about the thinly veiled hate that is clearly pervasive in this country because we haven’t learned how to have an ongoing, brave discussion about it.

This year, Holocaust Remembrance Day (Jan. 25) and National Day of Action Against Islamophobia fall as a very deadly conflict in Israel-Palestine has raged on for over 100 days. While Jewish and Muslim Canadians are no more complicit in the conflict than any other Canadians, they have been forced to endure an unprecedented increase in hate-motivated attacks against them. I wish I was more surprised.

We’re too polite to talk about hate until people are getting killed, and by then it’s too late. We hold the guilty party accountable when the van attack and similar crimes happen, but we don’t hear the call to examine the society that created the van attack.

As birthworkers, we see and snuggle many brand-new babies. Every single one is special and they all deserve to grow up and live the lives they create for themselves based on the values that were cultivated in childhood. The presence of hate in the world makes this right impossible to realize for all children, so hate must be eradicated.

To our Israeli, Jewish, Muslim, and Palestinian alumni and audience, we know this has been an unbearably distressing last few months within your communities here in Canada and internationally. As birthworkers in your communities, you have had to process your own feelings while supporting birthers in your community who are under incredible strain. We know that extreme stress can contribute to complicated pregnancies and challenging outcomes. We see the vital work you are doing in your communities at this time and we are continuing to extend our compassion and support.

As doulas, we will continue to shine a light on hate in the healthcare system, institutions, communities, and ourselves. Only when hate is diligently brought out into the open and swept away can we have communities where all life is truly respected and it is safe for all children to grow. 

If you are looking for guidance on how you can support your community and access support for yourself at this difficult time, please visit our blog post “Our Hearts Are With You” from November 10, 2023. [/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_single_image image=”534490″][vc_column_text css=”.vc_custom_1706554746991{margin-bottom: 0px !important;}”]Keira Grant (she/her) Inclusion and Engagement Lead – Racialized Communities

Keira brings a wealth of experience to the Online Community Moderator role. She is a Queer, Black woman with a twenty-year track record in Equity, Diversity, and Inclusion (EDI) education, projects, and community building initiatives.[/vc_column_text][/vc_column][/vc_row]

Categories
Anti-Oppression birth community

Facilitating Accountability

[vc_row][vc_column][vc_column_text css=”.vc_custom_1706107261056{margin-bottom: 0px !important;}”]As birth workers, we often see things or hear things from our clients that should not have happened. It could be an ultrasound tech sharing an interpretation that is later contradicted by their primary care provider, causing the patient confusion and anxiety. It could be membrane sweeps, AROMs, or episiotomies performed without the client’s consent. Or nurses disclosing information to family members while the client is unconscious, leaving the patient to receive a broken telephone story from their family later. 

 

These incidents range from irritations to serious breaches of practice standards, and things are more likely to “just go wrong” for systemically marginalized people. Clients are usually at a loss as to how to seek accountability or believe they can do nothing to address the harm they’ve experienced. 

 

Some may be aware of complaints processes that exist, but concerns about outcomes on either end of the spectrum – nothing will happen, or the worker will get fired – are often a deterrent. And of course, our clients who have just had babies or experienced a loss may simply not have the time and energy to engage with a complaints process.

 

In truth, there are far more opportunities to address what happened than most people think. Speaking up can lead to many positive outcomes, including a faster return to well-being for the client, and learning and improved practice on the part of the care provider. The processes focus on restorative justice, learning, and growth, rather than punishing the provider.  There is an understanding that the vast majority of workers in the healthcare system care about people and want to help. The options outlined below are suitable depending on the context and seriousness of what happened.

 

Speaking with the Care provider directly

For my clients who decide to speak up about their experience, this is usually the option they go with. This is especially true of midwifery clients who have an ongoing relationship with their care provider. 

 

We can support clients in this process by clarifying the concerns and rehearsing the conversation to make sure key points are captured and that the client feels empowered to self-advocate. 

 

I’ve seen improved treatment relationships and greater client well-being arise from these conversations. Especially in the case of complex births, creating a safe environment to debrief the experience with the provider is essential. Debriefing a traumatic birth with the care provider is a protective factor against birth trauma.

 

Engaging the Care Team

If multiple people are involved in a client’s care, sometimes a care provider with whom the client has a positive relationship can be a liaison between them and a provider with whom the client is having challenges. For example, in the case of the oversharing ultrasound tech mentioned above, it might be appropriate for the midwife or OB’s clinic to reach out to the ultrasound clinic to let them know about the impact this had on a client. This leverages the clinics’ mutually supportive relationship that should incorporate giving and receiving constructive feedback. 

 

Patient Relations and other “in-house” processes

Talking with the provider directly isn’t always the right option. This is especially likely to be true in a dynamic where the client felt intimidated or belittled by the provider, such as a discriminatory incident. Our debriefs with clients can explore their level of comfort with the various options.

 

Depending on the setting in which the care took place, there is usually an internal process for raising concerns. For example, most hospitals have a patient relations department that can work with you to resolve issues. There is often a mechanism for the hospital to anonymize information raised with the provider. Staff within patient relations will investigate the complaint and decide on the best way to address it. This could include seeking an apology from the care provider, supporting them to learn from what happened, or more serious action depending on the nature of the complaint.

 

Regulatory Body

Suppose a client has a serious concern about someone involved in their care who is a member of a regulated health profession. In that case, they have the option of filing a complaint with the care provider’s regulatory body. In Ontario, these regulatory bodies are called “Colleges”. They may be called “Boards” or “Associations” in other places.  If you’re unsure of the system where you live, I recommend searching for “regulated health profession [your province/state]” and finding out more about health professional regulation where you live, especially for the professions providing perinatal healthcare, such as nursing, midwifery, medicine, pharmacy, and diagnostic imaging.  

 

Professional regulatory bodies fulfill a range of functions including setting educational requirements, registering members, setting professional standards, and investigating complaints and reports. 

 

Anyone can go to the College with a complaint about one of their members. When health professionals work in settings where they have oversight, such as a hospital or clinic, management is legally required to report certain types of information to the regulator. It’s one of the reasons why it’s always best to take the complaint somewhere internal first. 

 

A range of things can happen, such as a letter with recommendations, reflection exercises and activities to support professional development, and a meeting with an expert in an area where more learning is needed. In some instances, the regulator may take no action. In some situations, the College can pursue an internal prosecution of the member. Again, a range of outcomes is possible, including having their license to practice their profession removed. This outcome is very infrequent.

 

Complaints Commissioner, Ombudsman, etc.

Provinces in Canada have arms-length government bodies that ensure the quality of public services such as healthcare. In Ontario, complaints regarding healthcare can be taken to the patient ombudsman. In Quebec, complaints can be made with the Complaints Commissioner. This 2022 case study explored the advocacy potential of many individuals accessing this complaints process. In 2019, “Obstetric violence” became a focus of media attention in Quebec due to a series of articles published in La Presse about experiences during childbirth, including inappropriate comments, procedures performed without consent, and being separated from babies. In the weeks following these publications, the Complaints Commissioner received an influx of complaints that spoke to a systemic pattern. The Commissioner is well placed to liaise with government policymakers and she produced a report with recommendations aimed at improving perinatal care. This led to several outcomes, including workshops for service providers on communication, information sharing, and consent.

 

“It’s me, hi! I’m the problem. It’s me”

Transparency with our clients about accountability includes making sure they know what their options are if they have concerns about us! Keeping the lines of communication open so they feel comfortable coming to us with concerns is ideal. If a client has a concern about a certified doula or perinatal educator that can’t be worked out, the client can go to their certification organization. In Ontario, If clients have concerns about how their personal information was used or shared, they can file a complaint with the privacy commissioner.

 

Seeking accountability has the potential to be healing and empowering for clients, while providing a learning opportunity for the client. When working with diverse humans at a sensitive time, hearing critical feedback compassionately and receptively is integral to our ability to grow in our practice. It may not always feel great in the moment, but if we reflect honestly on constructive feedback, it can be a wonderful catalyst for deepening our practice.[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_single_image image=”534490″][vc_column_text css=”.vc_custom_1706107304539{margin-bottom: 0px !important;}”]Keira Grant (she/her) Inclusion and Engagement Lead – Racialized Communities

Keira brings a wealth of experience to the Online Community Moderator role. She is a Queer, Black woman with a twenty-year track record in Equity, Diversity, and Inclusion (EDI) education, projects, and community building initiatives.[/vc_column_text][/vc_column][/vc_row]