thru the pinard Podcast
a conversational podcast with @Academic_Liz with midwives & other birth professionals about their studies/ research & how it's changing our practice globally - email thruthepinard@gmail.com
thru the pinard Podcast
Ep 83 Mimi Niles on Transforming Midwifery and Advocating for Women's Health in New York City
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Ep 83 (http://ibit.ly/Re5V) Mimi Niles on Transforming Midwifery and Advocating for Women's Health in New York City
@PhDMidwives #research #midwifery @nyuniversity #publichealth @nyumeyers @BirthPlaceLab @NACPM
Research link - http://ibit.ly/dJvtO
https://www.deviwomen.com/bio
How does one woman's journey from rural Gujarat to the bustling streets of New York City shape her into a beacon of hope for women's health? Join us as Mimi Niles, an inspiring midwife and assistant professor at NYU, shares her extraordinary story. From witnessing her mother's midwifery practice in the challenging conditions of rural India to her own transformative experiences in the U.S. healthcare system, Mimi opens up about the cultural dynamics, social inequities, and personal encounters that kindled her passion for midwifery and justice. Her reflections offer a unique lens on how deeply personal experiences can drive a lifelong commitment to serving marginalized communities.
Ever wondered about the diverse paths to becoming a midwife in the United States? Mimi recounts her own journey, starting as a community health nurse in New York City, to earning her Certified Nurse Midwife credentials while balancing work, study, and family life. Hear about her pivotal time at a busy public hospital in Brooklyn, where she honed her clinical skills and deepened her understanding of underserved populations. This episode also explores the various certification routes for midwifery in the U.S., emphasizing the critical role that varied experiences play in shaping a well-rounded midwifery practice.
Discover the transformative power of higher education and advocacy in midwifery. Mimi narrates her academic pursuits, from tackling the burnout of public health work to embracing a systems-thinking approach through her Master's in Public Health and PhD studies. We dive into her research on the evolution of midwifery, the importance of addressing systemic inequalities, and the impact of implementation science on advancing midwifery practice. Mimis' journey is a testament to the resilience and dedication required to push the boundaries of women's health and social justice. Tune in to be inspired by her unwavering commitment and innovative vision for the future of midwifery.
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Thank you very much for joining me, as per usual. Can you introduce yourself, please?
Speaker 2:Sure, dr Mimi Niles and I am a midwife based in Brooklyn, new York in the USA, and I'm also an assistant professor at New York University.
Speaker 1:Cool. So how did you get into midwifery?
Speaker 2:I became a midwife. I trace it back to my mother. My mother was a midwife in India and so I really I grew up, you know, around the kitchen table listening to her stories. Unfortunately, when we immigrated to the US she couldn't. Her license didn't immigrate with her, so she was no longer able to practice midwifery. But she had so many stories from working in rural India she worked for UNICEF and I think they just kind of infused in me, although I remember my brother and I always always sort of cringing when she would tell these stories of these horrendous labors and people hemorrhaging. But then about when I was 24, I became pregnant and I decided to terminate that pregnancy and I had probably one of the best healthcare experiences I've ever had in my abortion care and it happened to be with a midwife and it just was like that experience catalyzed something in me and I thought I want to do whatever that person is doing. I want to do what they're doing. So that's how I would trace it.
Speaker 2:I feel like that's the origin point, almost like two origin points meeting so whereabouts in India did she um practice so my mom, we're Gujarati, we're from the state of Gujarat, so she practiced in a very rural area of Gujarat so she would have been like the sole provider of care for the women.
Speaker 2:Yes, where they they have. I don't know if it's similar in all the Commonwealth countries where they have, like these district centers, and so she was working one of the small rural district centers where she was the primary provider, you know, for childbearing women. Yeah, and so she'd have to. I think they had a Jeep too, and she would have to drive If somebody needed emergency care. They had to drive about almost an hour and a half to two hours to get to that level of care.
Speaker 1:So your experience really was the whole scope of midwifery practice, from all of that preconception care, but also the family, because of being part of the community, she would have been the person they trusted to ask the questions to and support them she would have been the person they trusted to ask the questions to and support them.
Speaker 2:Yeah, for sure, I mean she.
Speaker 2:Yeah, I think she, you know, she india's, you know very a caste system, and so she came I mean I'm being very, very honest here like she's from the upper caste and so she was taking care of people in a different caste system, and so I think there was still some of that politic difference and rural women having no access to contraceptive care.
Speaker 2:So really, you know, like grand multips, but like grand multips, you know, like in the 11th baby, 13th baby, 14th baby, tradition of and and for my mom, I think in some ways although I don't think she would say this of and and for my mom. I think in some ways, although I don't think she would say this, I think it radicalized her in terms of contraception and how important it was to be able to control your own contraceptive or your own, you know, reproductive capacity. Yeah, became really important to her. I don't think she would say it that way, um, but she made her own decisions about how many children she would have and the way she would talk to us about raising families and childbirth. I think it did impact her perspective.
Speaker 1:Can you look back now and see if that cemented in you part of your desire to that now became your career in that pathway for looking after marginalized and kind of non-mainstream support?
Speaker 2:I think so again, without it being explicitly spoken about at the dinner table or the kitchen table. I think a part of that too is being an immigrant, like third culture kid in America, in a very diverse city, in New York city, and going back to India. So we would go back to visit our, our family, and just the stark difference in terms of really wealth and class differences were even to me.
Speaker 2:I think the first time I went I was six or seven and it just if you've ever been it really it blew me away. You know, just like I remember, I viscerally remember getting out of the airport driving to my grandma's house. We, I grew up very middle-class, even in India, very middle-class, and just being struck by the level of poverty that I had never, I hadn't even seen in New York city, you know, and so and and really women, the kind of work that women do in India is very laborious, like physically laborious. So you see women like as bricklayers and brickmakers and, you know, with children tied to their backs, so like this very kind of visceral, embodied sense of what it meant to be a childbearing woman and the kind of almost the burdensome feeling of that versus this kind of like celebratory, joyous. You know, like the other part of that was also that this was like true labor, like this was true work, and that there was real disparity and there was inequity. And I will say even on a personal level, you know, my parents were educated but they treated my brother differently than they treated me, and so there were even these kind of gendered roles that we were put in that I could feel, you know, and so I do think all of that cultural upbringing as well all just kind of shaped the way that I was thinking about.
Speaker 2:You know women's health and you know I wouldn't say I'm a, I wouldn't say like I'm the cream of the crop clinician. You know I'm going to have a good clinician but it's not what drives me in my care. I don't get into the weeds about. Like you know, there are some of those midwives who love, love the biologic and the scientific. You know you get that patient with, like the rare condition and they're totally have dove into all the literature around that I was never one of those midwives and continue not to be one of those. I mean, you know I will seek out support and collaboration and learn about what that condition is as far as it impacts care. But I'm more interested in people's social well-being. I'm more interested in people's. You know their. How do you soften the experiences of oppression for people in the childbearing relationship? That's always been where I've been more interested and more focused.
Speaker 1:Now in America. It's a different pathway to what's in some countries is. You can't become a midwife straight away. You've got to go through the nurse kind of program. Yes and no so. Yes and no. So your pathway is a nurse first for midwife.
Speaker 2:Yeah so we have three different kinds of midwives. We have the CNM, which is the nurse midwife, which is the bulk of the profession in the US, which is the pathway I chose. We have CMs that are certified midwives. They don't go the nursing route but their clinical training is with us in our graduate programs. There's not many states that have that. And then there's the CPM and those are the ones that are trained outside of the sort of institutionalized structure where they're in their like independent midwifery schools. They're learning through more of the community based or apprentice based models and are not including like more allopathic pathways, are not really part of their practice. But I'm the nurse midwife, so probably more in line with like the global type of midwife, the nurse midwife, so probably more in line with like the global type of midwife, the nurse wife.
Speaker 1:But yeah, absolutely so. Where did you do your initial midwifery? Um education, then.
Speaker 2:I did my midwifery education first. I finished my nursing education and then I got a job as a community health nurse, which, which I loved Still one of the best jobs I've ever had. Just going home to home and in New York City, imagine like apartment to apartment, you know.
Speaker 1:Very different yeah.
Speaker 2:Yeah, totally different. But you know, liz, I had always thought I was going to do home birth and so I remember. I don't know if it's like that this Australia, but for us, after becoming a nurse, the advice was for many people was do labor care, nursing, because we have labor nurses on our maternity units.
Speaker 2:We mostly have nurses, you know. But everything in my body thought I do not want to do that. I don't want to do that type of nursing. I want to learn how to be in people's homes, yeah, and so this opportunity came up to do be an apprentice in a visiting nurse program for a community nurse, and it was a very small program and I was so excited because I got it and you get very intensive support, very intensive training, because you're you're in people's homes by yourself.
Speaker 2:You know so, and you're a brand new nurse. You you really don't know what you're doing, but very supported. I had actually an old Irish trained nurse. She was just so great, you know very, very old school, but also just so solid and authentic in everything that she did, got really well trained and that job paid for my master's degree. It's a graduate. It's a master's graduate degree in midwifery, um, and so I was very strategic. I was like I can't spend more money, you know, um, and so that job paid for my midwifery masters. And I did my midwifery masters at a school called frontier yes, and frontier. I don't know if you've heard of frontier. Maybe you've interviewed some frontier graduates.
Speaker 2:Um, it's a distance program, so we're really doing all of our training. This was like way pre-COVID, they were doing all their virtual-based learning. You have cohorts that you're learning with and you go to their site two or three times over the course of your training just to get your hands-on skills. You know, attempt to build some community, but I think we're pretty good about building community virtually and I happen to have a colleague who was in with me in New York City at the same time, so I had somebody actually physically for me, and at the time I had very small children, so for me I would go to work during the day and then at night I could do my all my learning and my reading and my exams and everything. So it was for me it worked, you know so was that a coursework or a research master's?
Speaker 2:That was all clinical coursework. Yeah, our master's is all clinical.
Speaker 1:Yeah, so from there you stayed working in community or you expanded out.
Speaker 2:I stayed in the community until I finished my master's, which for me took four years because I was going part-time, because I had going part-time because I had small kids. And then I really, like I said, I thought I would join a home birth practice, because in the States we don't cross settings. Many of us in our practices, like people, either do home birth or people do birth center and home birth, or people just do hospitals. So I really wanted to do home birth. Both my children were born at home and the midwife that I had for one of my births she agreed to take me on as her student and it was really amazing and really wonderful. And I remember she said before I take you as a student, you have to go work in a very busy hospital before I will take you, because you know, at least in her practice she didn't do a lot of invasive things, you know. So she felt like you're not going to get enough cervical exams and you're not going to get enough you know, like releasing the membranes and all those kinds of technical things. You're just not going to get enough. You're not going to learn how to read the heart rate monitor. And so she said I want you to go to a hospital.
Speaker 2:So I went to a very busy public hospital in New York city, in Brooklyn, um, which was very huge midwifery practice, which is not common in New York city, um, but it had about 14, 15 full-time midwives fully covering the floor. 90% of the births were with midwives. It didn't matter whatever risk condition you had, you still were catching the midwives were catching the babies, you know. And so I went there and like within a month I had like 40 births, you know. So it was like really very, very high volume. And then I went and did the home birth training and as much as I loved the home birth training, it was so physically exhausting. I I don't, I think I had written a narrative in my head of I had romanticized it really, you know, but then the physicality of it with the two small children, I thought I can't do this right now, you know, like I just couldn't. I was, I was gone for days sometimes from them, you know. And so I ended up getting hired at that practice where I trained in that public setting.
Speaker 1:Oh good, yeah, it's interesting because we have. I think it's hard to make a generalisation about the states, because it is a combination of 52 states and all the healthcare in each state is very, very different and the midwifery care and midwifery options are very different in each of the states. So to kind of to us coming from outside, it's like you assume that home birth doesn't happen unless it's happened by by accident. So to see that there are birth centers around and you, but it's in the capital city.
Speaker 1:But if you go south to other country and cities and it's um, it's like 50 different little countries, yeah yeah, and so and it's hard when you're looking at because we've been looking at global health and looking at maternal rates and it's like people going, you can't use america as an example, as one just maternal rate, because it's so different in so many different areas for a lot of political reasons and funding reasons and access reasons yeah, yeah, yeah, and I you know it definitely is a structural contributor to our very poor maternal health outcomes.
Speaker 2:So you know, some people frame it as a positive, like each state can create their own, can you know, refine to their own populace, and really I think it's a way to control women in a way that is really problematic. And what you see, I would imagine overseas around our dysfunctional politics around abortion, is related to this kind of feudal system. Your little state, you get to decide, the federal government can make certain provisions, but then each state is designing on its own in some way that has been protective because, for example, in New York, we have our own state laws around the protecting the right to abortion, even as the federal law changed.
Speaker 2:New York was codified it in our law books. But ideally the federal law would be a protective mechanism and the states would have to comply with that federal law. And so you see, a lot of people kind of would be calling, like abortion refugees right now, where people are going to different states to try to get their care, which is not a way to take care of your populace. You know it's burdensome, and it's more burdensome to people who don't have the resource to even do that. For wealthy people it never really mattered. Anyway you go to the Bahamas and go on a vacation and get your care, you know. But for people without resource it is a significant, I would say violent, barrier to getting care.
Speaker 1:And there's even, like some of the newspaper well, not necessarily newspaper articles, but some of the articles I've been reading people are so concerned about this lack of ability to have healthcare in their own areas that needing to drive that we've got reports that there are some states that are trying to put laws in that actually make it illegal to drive someone across the border for an abortion, not only for the medical care and medical personnel, but also there's a lot of people that are coming up and saying, telling women to take away all the apps from their phone that track their periods, that kind of any type of that like. That's the level of concern of tracking, especially because the health care system is also interrelated to employment yeah, yeah, it's, it's, it's nefarious, it's malevolence.
Speaker 2:You know it's nefarious, it's malevolence, you know it's just it is. If you watch the Handmaid's Tale, people say like it is the Handmaid's Tale made real. You know, like this completely restrictive surveillance approach to women's health care is a mechanism to control, you know, control uterus, people with uteruses, bodies, you know. Know, it's just sort of like it's pervasive. So I mean that's why I think a lot is riding on this election too for us. You know now a candidate who has been historically pro-abortion, you know pro-protection of people's body autonomy, is the candidate. It could significantly change things.
Speaker 1:How did you get into your PhD? What made you do a PhD?
Speaker 2:Oh, I mean, I, I, I'm going to give you just the real version I'm, I'm in the real season of my as I I'm about to 50. So I'm like I just got to keep it real. So when I was working in the public hospital again I mentioned it's high volume hospital there were plenty of nights where myself and I would work with always worked with another midwife just myself in 12 hours maybe would have caught five to seven, would have attended five to seven births oh my goodness, kind of like they were not.
Speaker 2:They weren't, you know, they weren't every night of every shift I've worked, but they were common enough. Yeah, they were common enough that I would go into a room and I would just not even know who I was with, or I would think that I was with somebody I was with an hour ago, you know. So it was. It was the intensity, the level of intensity, um, the lack of resource that is in the public system in the US that you could imagine in a place like New York as well um where the the public private wealth gap is huge.
Speaker 2:it's so huge in New York it's it's it's monumentally huge. You know, um, I was burnt out. I was really burnt out. It was. I didn't go again. I, like I said, I went into midwifery to do home birth. Home birth is the opposite of that right. You might be with someone for hours and you might be exhausted, but it probably was just one person, one person that you were with, right, and this was really the opposite of that intention of really truly deeply getting to know people and being genuinely, authentically being with people in a very, I think of a very sacred spiritual transition that people are making. I mean, I was running. I was running on that floor you know, running.
Speaker 2:I was running on that floor. You know, and I will say also you know midwifery in the US is not I mean in other places too, but it's not what it is in other countries. It's only about 10% of births is with us, so one out of 10 people.
Speaker 2:It's not a common enough profession that we have the what I think of as like the epistemological infrastructure around it doesn't really exist for physicians or nurses yeah there are colleagues, but they don't understand what we do because they aren't necessarily exposed to what we do in their training and I think people don't think about that, like they don't know what we. I work with physicians who still cannot define what I do, and I work side by side, you know and so I was starting to feel the burnout from all of that, not just the physical burnout, because like I really started going gray you know your listeners are not going to see, but like I'm very, very gray and I used to have like a full hair, black hair, you know.
Speaker 1:It's not, it's right around the edges Very endearing.
Speaker 2:I wasn't sleeping, like my thyroid was, you know, in a disequilibrium, like everything. I could just feel my body kind of breaking down on me and I thought I had, where I was working, had this employee benefit where it was, for I was working for a university and you could get a degree, like it was just part of your benefits package.
Speaker 2:So if you want to you get a degree in whatever you wanted. It could have been like I could have gotten a degree in ceramics, I could have gotten a degree in German, you know, and they paid for that degree for my, for my family, for my husband, my, you know, and they paid for that degree for my family, for my husband, my, you know any. But those close family could have gotten paid for it. So I thought, okay, education has always been an escape for me because I thought, okay, I can manage this job If outside of this job. I don't know what I was thinking. Actually, I was so physically exhausted, I was pursuing something else or I was learning something else. So, to be honest, I thought, okay, I'm either going to get a master's in divinity because I'm interested in those things, or my, my brother is a physician and I talked to him he's my older brother and I was go to him for advice and he was like, why don't you get your MPH, you know, like it kind of feeds into the work that you're doing, you're really interested in sort of the public health system and this will help you understand health systems, and I thought it didn't sound as sexy as a master's in divinity. I probably.
Speaker 2:Yeah, I was like you know what he's probably, and I was actually confounded by the system that I was working.
Speaker 2:I couldn't understand why, no matter how solid my care was, how attentive, how authentic, how, you know, evidence based, it really wasn't making a dent in the outcomes of the people that I was taking care of, which are predominantly Black women, immigrant migrant women, refugee women, non-English speaking women, very, very newly migrated women.
Speaker 2:Still with these poor outcomes, you know, relative, I mean, we were doing better as midwives, but still over the course of their lives they weren't doing as well. Yeah, so public health felt like, okay, I'll do public health, you know. And so I would go to work and I would take I literally took two classes every term, just to kind of slowly at first, as a diversion from the burnout, to be honest, and then I was learning things that I thought, oh my God, this is making I would go to work and I thought, God, everything is kind of starting to make a little bit of sense or not sense. But I started what I would say I started to become a systems thinker, which I know. You know, I think a lot of clinicians were not trained that way.
Speaker 2:We're very individually trained, we're very trained on, especially midwives, like the relationship is so sacred that one-on-one relationship and to my detriment, to it in a way right, because I wasn't we don't always understand the ecosystem that we're working in, and so this master's in public health was like we're going to explain to you what that ecosystem is and we're going to help you understand where you fit in that system and where these people that you're caring for fit in that system and the impact of the system on those people, so that you stop believing that if you would just be a really good midwife, things would be better for you know, because we I think we do, we are we do we internalize it to ourselves absolutely?
Speaker 2:yeah, and I think also as women. I think we're taught to believe that if you care enough, that everything will be okay yes that is just not true.
Speaker 2:It's just not true, I mean it's good to be caring, but for these huge generational, oppressive traumas it's not enough. I always tell myself you cannot love someone out of racism. You can't. It's like it's in people's bodies. To a degree. You can be a really good provider, you can be really authentic, grounded, well-informed, respectful, loving even, and still have a bad outcome, you know. And so, anyway, that's what the MPH did.
Speaker 2:And then, along the way through the MPH, I had to do an internship and I happened to do it with someone with a PhD in the nursing program, and so she was like hey, you're really smart, why don't you get your PhD, you know? And honestly, I didn't think about it very much and I asked her I was like well, if I do my PhD, does that mean I can do research, you know? And she said, yeah. I said, can I be a social scientist? And she said, oh yeah, absolutely, cause I wasn't interested in clinical, you know, biomedical research.
Speaker 2:And she was like absolutely, you could do any, everything under that degree. You could do whatever you want, you could do everything both. This little bit of this little bit of that. And I thought, okay, I'll just, I'll just keep going, you know. And I got, you know, I got the funding and I just kind of kept going and I kept working as I went through the program and I thought, god, I really love qualitative research and I really love critical social theory, and it was just like where else, where else could I put those together at midwifery, you know? And so it was like the perfect space for me to create what I, my vision of what midwifery was, was getting the PhD.
Speaker 1:So what was your PhD focus on then?
Speaker 2:Yeah, so my focus was on me. Really, it's very egomaniacal. Um, I was really autoethnographic, oh, okay, okay, you call it that. I was really, really, really interested in understanding how midwives who work in the public system are able to operationalize the midwifery, the ethos of midwifery. Um, nice, there is a lot of, I would say, in the midwifery community. I think there's tension around, like what is real midwifery?
Speaker 1:Oh my goodness, there certainly is. I think that's a global thing.
Speaker 2:Yeah, yeah. And so I thought, well, wait a minute, I'm. I know I'm practicing midwifery. It's not the kind of midwifery care I had as a pregnant person with a midwife in a home birth, um, or even the kind I was giving as a a midwife in a home birth, um, or even the kind I was giving as a student midwife in a home birth practice, and I worked in a birth center for a little bit. But I thought, but I know, this is midwifery. Even on those nights, liz, when it was like seven births, you know, I was like this is still midwifery because I'm doing this differently than the physicians do do this, I just it bring.
Speaker 2:I'm bringing something different. How can I this what we're doing and give it language, and give it theory, and give it sort of shape and, yeah, and try to push midwifery into thinking that the model is not fixed? You know, if we keep thinking of the model as fixed, then where is our growth, where's our flexibility, where's the fluidity and where's our capacity to work in different settings? Because that is key to me. I'm not the only home birth, only birth center, non-medicated. Mine is midwifery everywhere, for everyone and everywhere. You know, um, that's the ideal I have in in in my spirit is like everybody gets to have a midwife, you know, and that's saying I can't remember who said it. And some people need a physician, you know, but you still get free care, you know.
Speaker 1:Yeah, so when you would kind of, you've done your PhD a few years ago. Now, when you think back to that, what's something that surprised you going through that process, about your results or what you learnt, either about kind of what people thought or how you thought in that process.
Speaker 2:That's such a good question. A couple of things. One thing is how you know when I think of cause I teach in the PhD program now, and one thing that really strikes me is it is it's a different way of thinking through problems, which I had a lot of resistance towards when I entered the program because I thought, man, I've been a clinician for 15 years, there's nothing you're going to be able to teach me that I you know, like I've been. I mean, it was, it was a very uh, it was a dogmatic stance of like I have, you know, I have stopped people from bleeding to death. I have caught on alive fetuses in my hands. Like what are you going to tell me? I don't already know?
Speaker 2:You know, like, so there was a bit of a, there was an ego, like a really big ego formation in front of me that thought there's really nothing that is going to be new to me, you know. And and you really do have to let that ego dissolve a little bit and I honestly almost think, like the older you are and the more clinical practice you have, the harder that is to do, because it's so well formed, because my colleagues were not, they weren't my age, they were 10 to 15 to 20 years younger than me, you know, and I would see them just moving in a very different way, you know, like their tango looked very different than my tango, because I think they didn't have those fixed ideas. They didn't have that.
Speaker 2:Well, this is how it is in the real world kind of mentality I think with. For me, I should say that PhD was an ego dissolution or an ego death in a way that I had to really have that beginner's mind. And for me it took two years, you know, and for us the first two years are all coursework, Okay, and I was very strategic in the coursework that I took, and I think that it was the coursework that I took that really started to chisel away at this idea that I already knew what I needed to know, you know, the exposure to for me, particularly the exposure to other disciplines, the exposure to for me, particularly the exposure to other disciplines the exposure to like radical critical theory which we don't get.
Speaker 2:I don't know if you get that in Australian clinical programs or we definitely do not get it here in the America. In America was really really it like rewired my motherboard.
Speaker 2:I always say like just please, because it felt like this is my language and these are my people and this is my tribe and, if you know, like social scientists, like hardcore sociologists, anthropology they're also very esoteric and very abstract, sometimes like, sometimes I would read a paragraph it would take two hours to try to get through, like like reading Foucault took me months and months to read Foucault and it would like a year later it would all click. So it was like just that way of thinking is so, so different and I think the value that clinicians bring to that work because we don't do enough of that work is bring in, like the pragmatics and bring in the embodied. Because I remember one course I took in particular. It was called, I think it was either reproductive anthropology or it was some. No, it was the anthropology of healthcare. That's what it was, oh nice.
Speaker 2:So there were all these like young 20 year olds, brilliant, absolutely brilliant, and me and me, and it was a very small, tight seminar and the way they would like go at the jugular of like the all the healthcare monographs that we were reading, you know, and I would think, oh my God, I would never think and write about clinicians in this way. I just have, like it's writing about my own people, you know, with such ferocity and criticism and um, it really kind of I feel like it was a place for me to kind of merge and integrate these really two very different ways of thinking in into my own, into my own way of thinking. And I still learn, I'm continuing to learn in the theoretical, theoretical tradition and I really really value it. But sometimes I think it's so heady that how do you communicate these ideas to clinicians, how do you communicate these ideas to nurses and to nursing students and to medical students? Because if you don't all that criticism, all those challenges, they don't really change people's minds and hearts, you know.
Speaker 1:Especially when they're trying to cope with five to seven births a night. And where's the cognitive space to allow any of that to sink in? It's a very kind of like skill. Did you pick your supervisors, or were they kind of then allocated to you?
Speaker 2:um, I didn't pick initially. I didn't pick my supervisor. I was given a supervisor who was just so busy and they had so much grant funding and they really did not have time for me, you know, not because they didn't value me or respect me, but because they were just so freaking busy, you know. And so then I was reassigned to somebody else who had knew nothing about midwifery at all. At least, my first advisor was a midwife herself. The second one didn't know anything about midwifery but was a qualitative researcher. And that's the other thing I tell. The other thing I wanted to share when you're going into the PhD student studies. I tell my new students, because I get the first year PhD students and what I teach is that you're learning how to do research.
Speaker 2:You think you're learning like the breakthrough in your field or your discipline, but you're actually not. You're learning how to be a good basic um scientist that has integrity, like that is your job. So being shifted over to a qualitative researcher, which is the kind of research I wanted to do. My first advisor was a midwife and an epidemiologist. It just was like it didn't mix, you know, um, but the second advisor I had was a qualitative researcher and it really just kind of opened me up to so many other possibilities.
Speaker 1:Yeah, yeah, it's a. It's a very mind you. Midwifery epidemiology seems to be an interesting combination. I know a few of those kind of around there. So you're going, you're going through your studies, your kids are a little bit older, but how did you balance your work and your study? Because you were saying you're already working kind of, you're in a physical and mental kind of like burnout zone. You've still got a family. How do you balance that and keep your sanity?
Speaker 2:I had at the time. I'm not with this partner anymore, but a very supportive partner. I think that was huge. I live close by to my family so they would chip in when they could. That was super helpful.
Speaker 2:I would say that my kids were probably forced into an independence earlier than, but I think a lot of midwife kids are like that, you know, just a little more independent because they have to be, you know, um, looking back, I don't regret that. I think I see my kids are older now 20 and 17 and they do so much for themselves that I'm like trying to make up for time and, you know, try to make them dinner feels like an accomplishment and I don't know I don't think I really have to be honest achieved balance. I really just feel like it was all just trying to get to the finish line. Yeah, and it wasn't really balanced. Everything was like just trying to get that next thing done on the list, you know, and absorb as much as I could. Sometimes, to be honest, in some of my courses I couldn't do all the readings, you know, because maybe my peers could go home or they had study groups and I was like I got to get home and like get dinner on the table and I have to work the night shift or you know, things like that for me.
Speaker 2:I don't regret it, you know, I think it brought a lot of depth and complexity to my research that maybe if you didn't have that, you know, you'd have a different depth and complexity if you didn't have that, maybe if you didn't have that, you know, you'd have a different depth and complexity if you didn't have that. But I have a particular kind of depth and complexity that really in the end in my dissertation really spoke to the to midwives and I thought that's what really what I wanted it was. It was almost an ode to to midwives. It was that's how that work felt. You know, it was really kind of honoring the kind of work that we do and I feel like I achieved that, you know, and so that was like okay, this is.
Speaker 2:This is good, this is my metric. I met my metric for success, you know, and that felt good.
Speaker 1:Do you know of any impact from your studies or any changes that happened because of your studies?
Speaker 2:Yes, big changes actually and I, you know, I really thank you for asking that because I have had this kind of humility in me that maybe, like two years ago, I would not have said this, but now I say this with you know, a lot of love for the work that I did and all my mentors who helped me do that, Cause I don't I don't do it alone. But so my work was specific to the New York city public health system.
Speaker 1:The New.
Speaker 2:York city public health system is the largest public health system in the country of the United States. Okay, biggest it serves the most people. It serves the most people who are uninsured because we don't have universal healthcare.
Speaker 2:It serves the most, like newest arrivals to New York, you know it's a really rigorous system and unfortunately it doesn't have midwifery across the entire system. So my goal was to get midwifery into every hospital system that is within that public network and when I started there were midwives in seven of those systems and now there are midwives in nine of those systems.
Speaker 1:Oh, well done.
Speaker 2:And so being able to be part of the conversations and having the relationships with, like, high level C-suite management and administrators and CEOs and CMOs, exposing them to my work, exposing politicians to my work. So I've taken my work outside of the ivory tower. I've really, like, pounded the pavement with my work and have really become an advocate for midwifery in my city and in my state. And it hasn't been perfect. No, I think physicians trying to create midwifery is just a recipe for disaster. It doesn't make sense. It's like asking a pizza maker to, I don't know, make paella.
Speaker 2:I don't know what the metaphor is, but it has not been perfect. There's been some bruises and battering, but there is now, I think, again with my group of mentors and elders and midwives, they have something they can show and say like look at this work that Vini did and how do we build on this work? After I finished my dissertation, I got a very big private foundation grant to continue the work, you know, and so that's been helpful in terms of moving this work into the national conversation. So, you know, when there's conversations nationally about midwifery, I get invited to give input, and so that feels really good too, again for my community. It feels.
Speaker 2:So we just we're excited about that you know, and again it feels like I don't feel like I'm in it alone. You're like, I have a council of people who are like, okay, if you go talk to so-and-so, make sure you tell them this. You know, and it's humbling, because they're senior midwives, they're elder midwives that feels really good. You know, again, it has not been unicorns and roses, you know anything, it's been like thorns and rhinoceros, you know. But again, getting that midwifery model into other systems was the whole point, you know.
Speaker 1:And so, yeah, it absolutely has had impact beyond my, you know, 300 page dissertation which I think something that one of the aims of this podcast is to try and get some of that out and to look at what people have done and the impact. It's done because it's so easy to be dismissive of people's research and oh, it's only a phd. But the one thing that I've kind of found is that, yes, it may just be a phd but it's already changing lives, like we know that the translation of research can be anywhere from 10 to 17 years for bigger stuff, but we know that every single research we do will impact on somebody's life and already has that intergenerational potential. Um, yeah, and I think being able to celebrate that is important, especially within midwifery, because we do not tend to celebrate that sense of ourselves, as you said. We then out kind of struggle, um, because if we're not catching babies, we're not a real midwife, which is unfortunately totally.
Speaker 2:You know, I haven't been. I haven't been in clinical practice now for like six months, um, and I was just having this conversation with somebody about like, oh my god, I yesterday I was talking to somebody and I got teary because I thought was that the last birth I was with? And I didn't even know that that was the last birth I was with.
Speaker 2:I wish I had known, and I don't know. If that's the case maybe because I do think more and more midwives are understanding our work in terms of the capacity to potentially impact issues around justice and equity then your work has to actually push itself. You have to push your work outside of its own self right, and that is a skill set that we need to learn. You know we're we're not great at it, and I could tell you a lot of midwives can be.
Speaker 2:We've been accused of being navel gazers, and I think that's true of any profession you know, um, but I think, especially in the U? S and I think in other countries too, where you have indigenous populations or, you know, formerly colonized people are migrating to your place, or people with forced migration or forced displacement, uh, there's a real reckoning that certain countries are gonna have to do around their people's health care, um, the impact of, like, climate change and what that is. You know really getting to the root of that and how midwives are going to fit into that, and I think midwives are going to have to like really very quickly develop the capacity to speak about those things intelligently and in a way that doesn't demonize this institution of health care as it exists, because it's what people have access to right now.
Speaker 2:Is it perfect? Absolutely not. Is it perfect, absolutely not. Is it violent? Yes, it is violent, you know. And what are the ways that we're going to call that out? First in ourselves, though, you know, because I think midwifery has been quick to call it out in, like physician culture and medicine, but we really got to call it out in ourselves first. That's going to be where we make our own changes. So, even with my students, I tell them rigorously, like really think about what research you're doing and what. What impact does it have? And how is it going to look outside of this classroom? What is it going to look like outside of this? You know?
Speaker 1:with you dealing with first year phd students, and midwifery students in particular. Are you finding when are they starting their PhD programs? Are they starting it a lot earlier, after less clinical placement? Are they feeling they need to do clinical experience before they do, or are you finding them continuing on from bachelor's honours and going straight into a PhD? What's the trend that you're seeing over there at the moment?
Speaker 2:Trend is the bachelor's straight into the PhD.
Speaker 1:Right.
Speaker 2:Some without any clinical practice.
Speaker 1:How are they formulating their questions and their research topics?
Speaker 2:I mean they have their clinical training right, yep, and I think for many of them they're already coming in with a lot of questions right, and they are at least in. I mean, I'm in new york, I know we're an outlier, but kind of already radicalized. If you're coming into midwifery us in particular because, yeah, we're such a marginalized profession we tend to get more radicalized students anyway. So they're already asking big questions, right, they're. You know. They may not know that somebody has already answered some of these questions or there are already groups of people that are really working hard, have been working for decades on some of these issues, you know.
Speaker 2:But yeah, I find that they're coming in younger, I find that they're coming in with less clinical practice and that has some bent pluses and minuses. I see both. I see brilliant, brilliant students who have very little clinical experience and I'm thinking, god, these people are brilliant and because they are thinking about things differently, because they haven't been jaded or tainted by a very medical model you know that most of us are if you're working in a hospital, you're working a very medical, absolutely yeah and so for those students, I really encourage them to like their team around them.
Speaker 2:Their mentoring team has to be super strong in terms of filling in some of those gaps for them, or, you know, when they're thinking through their research, ideas like understanding what their own gaps and their own biases are, so that they're going in with a more honest assessment of what they need to know and what they're going to learn, you know.
Speaker 1:I think that you made the comment before of the multidisciplinary experience that you had going through yours and that, as midwives that want to make change, it's actually critical that we do have that ability to communicate with other disciplines, because you can't sit there and talk about emotions because people just turn off. They don't want to know about that. They want to know return of investment, they want to know how much kind of clinical hours they want to know. We need to change our language. That still puts forth what we want to do, but in whatever group we're talking to, we need to be able to address them.
Speaker 2:So that ability to change your communication style because of experience, multidisciplinary um is critical for the future yeah, absolutely, absolutely, and I think in some way, you know, again, it depends on the kind of health system you work in.
Speaker 2:But for midwives in the us, like we are very good at collaborating because we have to collaborate yep, and I'm doing a study right now on collaboration like how midwives understand or narrate collaboration, it's so different than the way physicians do. Right, because, because the because the power, where the power is held, is different, and so I feel like the less power you have, the more strength you have in collaborating, you know. So it's sort of like, how do you look at these, what we think of as weaknesses, and say, actually we've turned these weaknesses into our strengths, because I know I graduated nursing school knowing how to collaborate because I have to, you know, versus when I'm training medical students and they are just don't have that skill set, because the system has made it so that they don't need to right that there's a hierarchy and they're at the top and what they say goes like that's not collaboration.
Speaker 2:You know, so, um, like I say, let's use that as our. We're not gonna have the same powers and strength, but let's use the powers and strengths that we do have. Celebrate them, instead of saying, like, I want to be as powerful as that person. It's no sort of like, let's, let's. Let's churn through the power that we have and understand what it is that we have. You know and I don't think midwives have done that globally yet to even the power of the clients that we take care of I mean, how many people is have you taken care of, have been like? This is the best care I've ever had. And you know, you're amazing and I named my child after you, like all sorts of things. You know, like, I've had people I've taken care of, I've caught their, their babies, and now they're wanting to become nurses and they're wanting to become physicians and they're wanting to become midwives.
Speaker 2:To me, that is the greatest compliment that you could give me, because that's how I started right like I had amazing care and I thought I want to do what that person's doing. You know that. What could be better than?
Speaker 1:that, or it's the reverse. They've had such horrific care. They want to make sure nobody else has that level of care, so you've got that. That seesaw of it. How did you celebrate completing your phd?
Speaker 2:I slept, I really did. I slept so much I will say that and I've heard this but, like after the PhD, the numbness that you feel and the on me that you feel is real, like you really feel somewhat purposeless, right, because all of a sudden you're not grinding, you're not completely constantly fixated on all the stuff that you have to do and read and write and and you know, I had, right after I'd finished my, even my defense, like the next day I was negotiating my postdoc. So it just felt like I had that. I defended on June 24th 2019. And I started my postdoc in like the last week of August 2019. So I had the summer, you know. Um, I don't think I did anything big or major, but it felt really freaking good and fantastic. It's like exercising when you're doing it, you're not happy yes, I'm not but then when you finish, you're like I'm so glad I ran five miles. So that was the feeling. It was just this kind of lifted feeling, but also this kind of what do I do now? Feeling, you know.
Speaker 1:So what's next for you? What are you doing now?
Speaker 2:I am an assistant professor. I'm on the tenure track, so I am grinding as a professor really and trying to get major funding to continue to pursue really midwifery focused research. I haven't really veered from that. Other people are like you're not going to get funded doing midwifery research, but I went into this again to study midwifery in and of itself as a discipline. I am not that attracted to patient outcomes. It doesn't mean I haven't done research in patient outcomes. That attracted to patient outcomes it doesn't mean I haven't done research in patient outcomes.
Speaker 2:I am just fascinated by midwives and midwifery in the complexity of our work and I want to keep. I want to keep doing that research on us, you know, and like who we are as a profession and what we bring to health systems. I really want to understand this from a systems perspective and I really have been now starting to talk about our work as a public health intervention, like we are interventions and I'm moving into implementation science to really think about. Okay, like what if we thought about midwifery just not being translated into practice and if I just shift my frame into saying we have evidence, I'm not doing more evidence about the value of midwifery care I know it know it.
Speaker 2:How do we implement now all this amazing evidence we have? Let's shift into implementation, science, translational science, you know, knowledge, translation, whatever you call it, in whatever country you're in, and like, let's push on that end and say, okay, we know it works like, so why aren't you using it? Why?
Speaker 2:isn't it working and that sort of breathed or given new life to my work and new direction. So I've been doing more training and implementation, science and learning the language and the lingo, yeah, so really I feel like I'm just a wee little professor in a very giant universe, you know, very giant university and I get excited doing stuff like this because again, I I'm like a midwife's midwife is what I call myself, you know and yeah, I just hope I can generate some tools and some language that other midwives can use to advance this like ancient, ancient and modern tradition, you know.
Speaker 1:Thank you so much for your time.
Speaker 2:Thank you. Thank you for doing this podcast.