Who do you hope to serve?

In the Holistic Midwifery leadership class this quarter, students were asked to reflect on who they hope to serve as midwives, and what they think it will take to make their vision a reality. Read midwifery student Rebecca Kolowé’s thoughtful response as she shares how she intends to be an equal partner with the underserved women she works with, from Africa to homeless shelters in the United States.

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Q: Who do you hope to serve? Is there any additional training or education that you will need to seek out to serve any groups? How are you planning on serving this population? How do you plan to work with them rather than impart your agenda? Will cultural competency be needed when providing care? If so how do you plan on going through this process?

I have so many answers to these questions! These questions also create additional questions. I hope to serve all kinds of women. But, I started my midwifery path in the first place because of my desire to live with and serve women in Sub-Saharan Africa. Since that initial interest, I have also thought a lot about the people who I have worked with in my pre-midwifery career in the United States. I used to run a homeless shelter. And, I have just started a job as Executive Director of an organization that provides food and emergency financial assistance to people in need. Thus, I realize that there are many marginalized and underserved populations in the U.S. whom I would also feel privileged to serve as their midwife.

I really want to answer these questions in two parts: I want to talk about serving women in Africa, and I want to talk about serving underprivileged women in the United States. In both cases, I think that the way to learn about how best to serve these women would be cultural immersion. Now, I know that I will never be an African. And, I can spend all day with underprivileged people, but at the end of the day, I have my expensive high-rise apartment to go home to, with my cat, my heating and air conditioning, and any food I want to cook. In my house, we make car payments and eat salmon and have the option of putting money into a savings account. These are not the realities for many of the people I’m talking about serving. So, true cultural immersion would not be possible. However, I expect that at some point, I will live in Africa, since my husband is Cameroonian. And, I already do serve among underprivileged people in the United States. For me, what is most important is being vulnerable with people so they know I am a real person, and being honest about my own situation. That is way better than pretending I am like them, when I’m not. It’s also better than setting up an “us/them” paradigm, which just creates walls to keep people separate.

As far as serving women in Africa, my husband and I have talked quite a bit about opening a clinic to provide all sorts of care for women—from contraception, to well-woman care, to general education for women and men, to prenatal, postnatal, and birth care. These kinds of care, in the places we are familiar with in Africa, are not the norm. I would need to spend a lot of time in the community first, in order to understand the need and how best to meet it. I would spend a lot of time building relationships with women and talking with them about birth. The thing about many places in Africa is that birth is the most important thing that women do. Even just this afternoon, when we talked to Pierre’s mother and we told her how much we miss her and love her, she said, “If you loved me you would have given me a grandchild by now.” Ha. So, birth is central to women’s identity and worth in many of these cultures, and I would need to spend time gaining understanding about that in order to know how best to serve these women. I would also need to build a team of practitioners, many of them local, who I could rely on to help me provide care.

As far as serving underprivileged women in the United States, I will surely have an opportunity to do this as well. I think if I am going to be providing reduced-fee and/or pro bono services to women in need, I would also need to have a thriving practice among women who could pay for my services. This would allow me to serve some women for less.

I think that I would need to partner with an organization that already provides services for people in need, or make myself available for referral to as part of a county-wide or city-wide intake service. This is becoming more and more the norm in both urban and rural areas. For example, in Fairfax County, Virginia, anyone who needs something is referred first to the “hub,” which is a centralized intake system. The person talks with a social worker over the phone or in person. This social worker has access to all available services and determines how best and where to refer this person who needs help. Most of our food pantry clients come to us from central intake. This also means that the county financially supports the work that we do. It might be possible for me as a midwife to get connected to a service like this, and maybe even to receive some grant money to provide care for low-income women and families.

Building trust and cultural competence among poor people in the United States is challenging. For example, women in the homeless community are generally invisible. Often this is because they need to protect themselves and their children. Partly because they are invisible, homeless women are very vulnerable to abuse or rape by men. Plus, if the county learns that they are homeless and have children with them, it is likely that their kids will be taken away from them by child protective services. Many times these women stay hidden so that their kids can stay in school. They provide the address of a relative or a shelter so the kids can be in school, even though they might actually be living under a tarp in the woods. It is hard to gain access to homeless women unless they specifically make themselves known. And, they take great risk in doing so.

Women who are not homeless but need assistance, like the ones who visit our food pantry, I might be much better suited to help. I think it’s about building relationships. Maybe that’s naïve, but that’s pretty much what I rely on to get things done. Talking to women, hearing their stories, understanding their hopes, dreams, and needs, and being vulnerable with them about myself as well can help bridge gaps created by income and privilege. It’s going to be hard to know until I actually start. But, I have faith that this is the best step forward, especially if I can tap into a referral service or work in partnership with other service providers who meet the needs of low-income families.

In both cases, I would like some additional training. I am interested in things like herbal remedies that women without health insurance could afford and have access to. Also, the available herbs and natural remedies would be different in Africa. What would those be? I might need to research that myself or learn from a local healer. It would be great in Africa to partner with a local griot or healer to gain buy-in from the community, to learn what the acceptable practices are, and to understand local traditions around natural medicine. Even my mother-in-law uses natural herbs to heal common ailments. I have been subject to some of those! I remember one particularly nasty-tasting drink she gave me once to cure a head cold. I would need to learn these remedies from the local people.

In the end I want to channel a colleague whose favorite motto is, “Relationship, relationship, relationship.” Relationship with God (whatever you conceive that to be), relationship with each other, and relationship with your community. This applies to midwifery in any context! Have faith in the divine that you are doing what you were created to do. Build relationships with other midwives and practitioners who you can partner with. And, be in relationship with the community of people you are called to serve. Be an equal partner with women. Be “with” women. I have to believe that if I do these three things well, the rest will work itself out.

Would you like to serve women?

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