Submission to the NZ Midwifery Council

In which I object to the removal of the words woman and mother

Context

So, Te tatou o te Whare Kahu | Midwifery Council is the body that regulates all midwives in Aotearoa New Zealand. It just published its proposed Revised Scope of Practice for midwives. In it the words women and mother are removed and replaced with the word whānau.¹ Ex-midwife and health researcher Sarah Donovan responded to this. Dr Donovan is concerned about the removal of these words given, as she states, midwifery is “arguably the most woman-centred and mother-centred of all health professions”.

While arguing that the changes are made to better support Māori women not all Māori are in agreement. In this interview Michelle Uriarau, from Mana Wāhine Korero argues that the Māori women chosen for consultation were handpicked and are far from representative of all iwi in Aotearoa. Uriarau also considers that Te Tiriti o Waitangi² is being used to justify changes actually wanted by key transgender advocates who are big fans of degenderising language³.

It’s a great interview where Uriarau refuses to comply with the entirely theory-based gender woo that would try and take biology out of even the most visceral embodied experiences.

“When you give birth it’s not a philosophical act” said Ms Uriarau. Gold.

Chief Executive of the College of Midwives (note this is the professional body for midwives and different to the Council), Allison Eddy questioned the move, and said woman and mother would not be removed from their organisation’s literature. It’s an interesting and sound move from the College given their previous lack of spine in standing up against those wishing to control the industry. The Council has been somewhat captured by individuals that consider candid, factual information about motherhood and women’s body is, in itself, hateful and transphobic. Milli Hill, author and part of the birthing movement, has written The story of how I was 'deplatformed' as keynote at an international conference which documents how the College caved into transactivists, amplified messages that Hill was hateful and disinvited her to a NZ national conference.

I write a submission

Within this context I wrote a hurried submission to the Council who, after a year of deliberating, have allowed two weeks for public feedback. You can read the guidelines and submit too, but it’s due by the 21st of November. I think there’s a whole lot more to say about these guidelines than I have written here, and I hope other people write submissions as well, this was what was top of my mind. It’s no great prose, written in a hurry and is a bit rambly. Go write a better one.

My submission focuses on just one area of concern I have about the proposed changes. When you stop centring pregnant woman in your care, you are putting the locus of power into the hands of someone other than a woman and that undermines women’s right to choose. Under that logic women do not have the right to control decisions around abortion, contraception, choice of healthcare, or when and how to have children. It is dehumanising and attacks women’s mana, dignity and sovereignty. It considers women’s fertility the domain of others. From a once feminist profession it’s a right shocker.

In my submission I focus mostly on point the second point in the draft. This reads:

(b) The kahu pōkai | midwife is responsible for providing culturally and clinically safe care, in any setting, for whānau who are planning a pregnancy, pregnant, birthing, and postnatal.

My submission

Dear Te Tatau o te Whare Kahu, 

I had two births with wonderful NZ midwives, one in a hospital and one at home. I have always been a huge fan of midwives. I believe that their women-centred practice has been fundamental to improved birthing outcomes for mothers and children. I believe midwifery has been an important counterweight to health practices that are unsafe for women and babies and breach women's dignity.

I am deeply committed to reducing disparity, ending violence against women and women's right to controlling her own reproduction, sexuality, pregnancy and childbirth. I am pro-choice, pro-lesbian, and pro-diverse families, I have worked and led feminist organisations, studied and worked in a variety of ways on preventing violence against women, and have been actively involved in human rights movements.

I am very concerned about the removal of the words women and mother from the new scope of practice. This removal would, as a woman using midwifery services, make me feel unsafe and unsure of the commitment of midwives to support me. I also have other concerns: 

1. Your revised scope of practice centres pregnancy as an issue for whānau rather than the pregnant woman (see (b)). This has mammoth policy implications and undermines the rights of women to control decisions about their own fertility including the right of women to continue or terminate a pregnancy. Your wording very clearly subsumes the rights of wāhine beneath the rights of whānau. Your commitment to providing safe care for the whole family implies that other people may be appropriate decision-makers about a women's own body. This goes against the principles of women being able to choose. A midwife tasked with safe care for the whole whānau will not have scope to prioritise a women's wishes with regards to terminate a pregnancy above perhaps her parents' wish for grandchildren. A midwife should of course be prioritising the wishes and needs of the woman. 

2. As you know domestic violence is a terrible problem in New Zealand. By far the most overwhelming nature of this violence is male violence against females. Again looking to section (b). By stating the midwives have allegiance to the whānau, midwives are denied the ability to focus solely on the safety of the pregnant woman. If a violent partner or family member is using the characteristic tools of control and coercion, they are given a clear path with which to control a women's decisions about birth. A midwife, whose scope shifts from supporting women to supporting whānau may be in a position where they are forced to compromise the safety of mother and child and acquiesce with the wishes of abusive partners or family members.  

3. Section (b) appears to breach the UN Sustainable Development Goal target to improve the rights to reproductive and sexual health rights. From the SDG website:  "This means the freedom to make choices about health care and the use of contraceptives as well as to say no to sex with a husband or partner.  The backslide on women’s rights currently underway threatens to reduce this number further. "  The logical conclusion of your words, that fail to centre women, is that it may be appropriate for a male partner to make decisions about when and whether to have sex, whether to use contraception, and the kind of care that the women may choose to access. This is a fundamental breach of women's right to self-determination. It absolutely undermines their dignity and mana.  

4. If none of the above is your intention then you need to change the wording of the scope. We live in a country which has very low levels of written literacy and which has a wonderfully diverse range of people who have English as a second language. Plain language is fundamental to public health. The removal of women and mother is confusing, will be off putting to many people, and makes your commitment to women unclear.

5. There may well be a need for whānau advocates within birthing processes but it is not the role of midwives. Power dynamics within families/whānau  can be healthy and wonderful or they can be disastrous. The role of midwife should be to be a fierce advocate for the woman negotiating their wider whānau. This with-women role can not simply be shifted to a with-whānau role leaving a gaping hole for women to have the support she deserves.  

6. If the removal of the words women and mother are in fact, not motivated by te Tiriti, but rather to ensure that the tiny number of biological women who identify as a different gender feel included then you are subsuming the needs of the vast majority of women in order to cater for a handful. This is not inclusive or welcoming to most women in Aotearoa but rather deeply offensive and confusing. It also does not use the plain language necessary for good public health communication, obscures your messaging and undermines the lived reality and common understanding of most of the country's population. 

Thank you for considering the points raised in my submission. 

Best wishes for continuing to be a body that support thriving whānau by focusing on the needs of the women you are tasked with caring for. 

Garwhoungle

Mother, Aotearoa. 

1. This te reo Māori word has no exact equivalent in English but may be close to family or extended family.

2. For non NZers, te Tiriti o Waitangi is an 1840 agreement between Māori and the Crown, seen to set the legal framework between indigenous people and others living in NZ.

3. For example Ms Uriarau points to trans advocate Dr George Parker who has already been busy advocating for a family-based approach to midwifery (to make it more inclusive). A co-incidence? I think not.