Midwifery Revolution: A Day (or Two) Off-Call

October 13, 2017

I'm so excited to be sharing a guest post today from student midwife, Gloria González Campise.

Gloria reached out to me months ago after seeing my video online and the things that she had to say were so poignant, I just knew I wanted her to write something to share with you all here. Her perspective is that of a current student and she has written her perspective so wonderfully well. My mission here is to spread the word and let everyone know that you are NOT ALONE with your feelings about this topic. We all want to be able to take care of ourselves and our families and our clients, so little by little we're going to help eachother do that.

Without further ado, here's Gloria.

“If I can’t dance, I don’t want to be a part of your revolution.” - Emma Goldman

When I first started my midwifery apprenticeship, I was super enthusiastic and willing to forgo dance, both metaphorically and literally. Because I feel passionately about midwifery and healthy families, I initially accepted the myth that this sacrifice was what was required in order to do this labor of love. The quote above by Emma Goldman, has always spoken to me throughout the years. It reminds me to do our revolutionary work, and always create space and time to dance, to be with our children, our loves, and to do the things that refill our spirit. For what is my passion for families if my own family is compromised by the 24/7 on-call lifestyle? What is my dedication if the very families we serve are compromised because we have been awake for an unreasonable amount of time when we come to serve them?

I am a student midwife entering my second year of midwifery school. The last year of apprenticeship has been amazing, and I am grateful for the many experiences. And, after a year of being on-call non stop with only two days off-call and one 5 day vacation, I have a very different perspective than I did when I first started my apprenticeship. I am still totally committed to midwifery, but I now know there has to be more options for students to apprentice, to practice midwifery, and be in balance with the rest of our lives, and very importantly, to offer better care to our clients.

What I am sharing is not unique to my experience, because what I have witnessed is integral to midwifery culture and practice. There are countless blogs, FB posts, and conversations we’ve all participated in where students and midwives alike tout the sacrifices that just have to be made to be a midwife, and especially as an apprentice, unpaid and all. There is a kind of gloating some do, as if their measure of sacrifice is a sign of their commitment and true heart of a midwife. If you have ever questioned or challenged the ‘self-sacrificing at all costs’ current model and culture of midwifery, then you have most assuredly heard something like, “It’s just part of the job. Maybe you’re not cut out for it. If you become a midwife the responsibility is even greater. Maybe your family is not ready for you to be a midwife. Maybe midwifery is not for you.” These statements are so counter productive to creating and sustaining new midwives. Surely we can imagine scenarios where we support one another and create structures that support both being an apprentice or midwife, and being in balance with the rest of our lives.

Some apprentices are fortunate to be in a practice where the preceptors value regular scheduled time off for their students, though this is rare and certainly not the norm. Can you see the value in an apprenticeship where you can schedule regular time off-call? Would it benefit you to have even one day off-call per week in order to have a paying job, or sleep uninterrupted, or recover after a long/traumatic birth, give undivided attention to your family, or do what ever you choose with your time off-call? Some preceptors do not allow for regular scheduled time off. It varies from preceptor to preceptor, and agreement to agreement. Often the attitude I have encountered is that the 24/7 availability is what is required of you as a student, and as a midwife. As if someone else can determine how you set up your own practice when you do become a licensed midwife. As if the current model is just how it is and will always be.

The current model of apprenticeship is problematic, and not wholly conducive to making more midwives. In many situations, students enter the private sector to work apprenticeships and there are no external limits regulating the amount of consecutive hours and days of work, breaks, and time off, and remember it is all unpaid labor. It’s quite absurd actually. We are riding on good faith that our preceptors will be fair, and that students will be able to stand up for themselves, and be able to negotiate positions on a so called ‘level playing field,’ when let’s be honest, the playing field is not level. There are few job place protections in an apprenticeship, and there is essentially very little to no oversight. Depending on where you live, apprenticeships are not always readily available. We are lucky when we have opportunities close to home in our own communities, but often students have to relocate to fulfill this part of the training. From many students’ positions there is not much room to negotiate regular scheduled time off if you want to secure an apprenticeship.

Currently there are general guidelines and requirements regarding apprenticeship from midwifery institutions, such as from MEAC, NARM, MANA and each midwifery school, but none addressing time off or time off-call. Most birth centers and independent practices have an apprentice-student agreement stating the duties and responsibilities. Even if the forms and documents that we sign have great ethics, values, a seemingly fair exchange, and requirements for the apprenticeship, it is not as simple as this. What the apprenticeship is in actuality is often different than how it appears on paper. Ethics and values are up for interpretation. Expectations and duties can change, and often do without negotiation. There is virtually no oversight by the institutions making the requirements for apprenticeship, and what is in place (for example, grievance mechanisms and conflict resolution), is not functioning to uphold the agreements and requirements of preceptors. Apprentices have little leverage or protections, and perhaps this is why bullying is such a pervasive issue in midwifery culture. This is a whole other issue, but it is very much related and is worth mention.

There are important questions we must address going forward. I ask, what is the legacy of midwifery that we want to live, and pass on? Are we willing to change how it has been done, and create more sustainable structures? Are we willing to look at different ways to practice midwifery that can still offer excellent personalized care? Must we forsake our families, or be so exhausted that we risk endangering our clients and ourselves? Do we care to make apprenticeships, which can last 3-5 years, more workable for students? Essentially, do we want midwifery education and apprenticeship to be accessible, or exclusive? The 24/7 availability structure of apprenticeship limits who has access to midwifery training, and we cannot afford this exclusivity.

Speaking on exclusivity, as a student midwife of color this model is complicated even further when working under white preceptors. This deserves its own essay, but I state it here because as a woman of color I cannot separate myself, or race from this how this model affects me, and other students of color, and our success rates. Within the current structures of the 24/7 on-call, unpaid apprenticeships is a framework in which damaging historical tropes can easily reproduce themselves, and they do. This is yet another reason why we need to reconsider this current model of midwifery and apprenticeship.

I feel more enthusiastic for the future of midwifery after watching a talk on YouTube entitled, A Return to Women Helping Women: Advancing Midwifery for the Next Generation. I know the collaborative structures midwife Madeline proposes for a more balanced midwifery are so simple, yet revolutionary. Two students assist prenatal exams, and clients are guaranteed that one of them will attend the birth, thus ensuring a day off per week for the students. Only if we work together and collaborate can we achieve sustainable change. Not only does taking regular scheduled time off-call not compromise the midwifery model of care, it actually enhances it, makes it even better because you have healthy, well rested, and well adjusted midwives serving families. And importantly, it offers a model of apprenticeship that is more attainable for students. There is so much to be gained, for starters- more midwives, and more midwives of color. I know we can organize ourselves to do the work we love and create time to be present and in balance in the rest of our lives.

- Gloria González Campise

Thank you, Gloria!! I hope others enjoyed this as much as I did. I hope you will read, relate, and share.





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