Ina May Gaskin and medical colonialism

17149617 - abstract word cloud for colonialism with related tags and terms

It’s not up to me to accept or reject Ina May Gaskin’s apology for her racist comments:

…[M]y answer to a Texas Conference Q & A question has caused a great deal of hurt, and was insulting and demeaning to many, especially Women, and People, of Color. While the intent behind my answer was anything but racist or demeaning, I understand that impact is more important than intent, and I personally offer my genuine and deepest apologies. I have spent a great many years of my career shining the spotlight on the massive racial disparities in maternity care, and my comment at the conference is not a true reflection of my belief, and what I know to be true – that racism, and its denial, are the true root of the egregious inequalities in maternal and infant healthcare for people of color…

It seems to me, though, that it’s a non-apology apology. Why? Because Gaskin failed to apologize for, indeed did not even mention, her entire career of medical colonialism.

Gaskin stole the midwifery knowledge of indigenous women and presented it as her own.

Colonialism is the practice one country occupying another country or region and exploiting it for the benefit of the occupier. Medical colonialism is the practice of gaining control over black bodies, knowledge and practices and exploiting it for the benefit of the white majority.

Classic examples of medical colonialism come, not surprisingly, from medicine. The Tuskegee experiments, when black men with syphilis were deliberately left untreated, are the most egregious example, but medicine has plenty more including the story of Henrietta Lacks and the use of her HeLa cells for research, and the work of gynecologist J. Marion Simms, who practiced on female slaves to perfect his techniques for repairing obstetric fistulas.

But midwives have enthusiastically embraced medical colonialism, too. As I wrote yesterday, Ina May Gaskin has built her career on it, including:

1. Her embrace of the racist foundational lie that indigenous women have painless labors

2. Her shockingly cynical exploitation of high rates of maternal mortality in general (her Motherhood Quilt), and black maternal mortality in particular, to critique modern obstetrics without doing anything to address it.

3. The profoundly disturbing trend of white homebirth midwives learning their trade (getting “catches”) on the bodies of women of color in developing nations.

4. Gaskin’s appropriation from Guatemalan midwives of a shoulder dystocia maneuver that, in the tradition of Columbus “discovering” America, she named for herself.

Considering that natural childbirth is a philosophy of white privilege, it comes as no surprise that many white women are acting as apologists for Gaskin. Their defense is that she isn’t racist and either didn’t mean what she said or is being deliberately misinterpreted.

As Arthur Chu has written, that’s the classic defense of “Mighty Whitey.” Chu was not writing about natural childbirth advocates, but he could have been:

We repeatedly tell stories about a white protagonist who goes on a journey of self-discovery by mingling with exotic brown foreigners and becoming better at said foreigners’ culture than they themselves are…

The frustrating thing about being annoyed by the Mighty Whitey trope … is that it’s so frequently employed by the well-meaning “good guys.” The whole point of “going native” is that the familiar Western civilization is portrayed as inauthentic, ugly, broken, flawed…

But when it comes to the tragedies of black maternal (and perinatal) mortality, it’s hard to see how Gaskin is one of the “good guys.” It’s not merely that she failed to understand the implied racism of her own comments; it’s that she has made a career of medical colonialism, exploiting the knowledge, practices and fantasies about black women for the benefit of privileged white women.

The tragedy of black maternal mortality puts Gaskin in a bind for a variety of reasons. First, it threatens the fantasy that “unhindered” birth in indigenous women is inherently safe; obviously it’s deadly. Second, it involves racism, which Gaskin’s philosophy has never bothered to address. Finally, it is not a tale of too much intervention in childbirth, but too little. Black women die from lack of access to the very lifesaving technology that Gaskin routinely decries. That’s not something that she wishes to acknowledge.

As I said above, it’s not up to me to accept or reject her apology, but as a bystander I seriously doubt her sincerity. No doubt she is not intentionally racist, but her career is built on medical colonialism. If Gaskin wants to show that she understands that, she could offer a meaningful gesture — going forward she could insist that the Gaskin maneuver be renamed the Guatemalan maneuver in acknowledgement that she stole the knowledge of indigenous women and presented it as her own. But that’s a sacrifice she is very unlikely to make.

  • Paul R

    You do not understand the motivations of Kelly brogan . I’m successful , educated, have no mental illness , and certainly not vulnerable. I have paid for one of her programs and gotten a lot out of it.

    I have little doubt she is making a very good $ out of me and others, as is the case with good on line education , but I don’t have an issue with that . Why. ? You only have to listen and read more to realise her main motivation is to get to the truth and to share & help others. And she is helping me .

    As a make I clearly don’t understand the intricacies of child birth and am no way qualified to comment on that topic but as for branding KB a quack you are away off the mark.

    • Who?

      Do her motivations matter?

      Good on you for finding what works for you, and having the money to pay for it, and the confidence to be sure you did well in your choice.

      Others have had a different experience.

  • FFL

    Like I said in other posts, I just don’t understand what is your intention to spread all this hatred? I don’t understand why you have to now criticize Suzanne Somers and Ricki Lake and people who spend money on “worthless books and seminars.” I just don’t understand your seemingly singular mission to engender hatred towards one woman. Your intent may be to champion traditional medicine; but if you really cared about people getting well, I do not understand why you would criticize other legitimate paths to real lasting wellness, including “worthless books and seminars” in the wellness industry–which if you have not noticed, is a huge burgeoning movement that deeply resonates with millions of people throughout the world today. I do not believe in Kelly Brogan’s extreme views, but I know I have spent a lot of money on books and seminars to better myself, ones that you call “worthless” and “stupid” and “crap.” Who are you to judge me?

    • Who?

      I wonder what is your intention, with all this tone-trolling-of the author(!)-on old posts?

      If you don’t like Dr T’s writing about KB, then why draw attention to it by commenting on posts that haven’t been looked at for months?

      That’s all.

      • FFL

        My intention is to point out the obvious– the spewing and rallying of hate among broad readership, and wondering how that serves people who may be sick and want to get well? I have no connection with Dr. Kelly Brogan and was led to this page when I learned about her only recently. If you take offense to my “tone-trolling” a post of an author, then I could frame the question the same way — why is this author life-trolling the reputation, career, and livelihood of another woman? That’s all.

        • Who?

          I’m not offended, just curious. Curiosity now satisfied, thanks.

          What a fine knight on a white steed you are, defending a total stranger about whom you claim to know nothing.

          • FFL

            I don’t know Dr. B, but I recently found an interview of her and found her admirable and was led to these pages. I know bullying and I would be horrified if a google search of my name led to these kinds of posts directed to ruining my reputation and life’s work.

      • FFL

        To better describe my intention… I know that the posting of these types of — as another reader put it — “savage” attacks towards other professionals are harmful and can often can cause more damage than good. Dr. B invites criticism with her extreme views, but then Dr. T should also expect reaction to her mean comments. They are mean. Do you disagree? Mean comments inspire certain reactions. And your comment that I am “tone-trolling…(!)” indicates that you think I should automatically hop on the mean train. But even in my comments, I do not call Dr. T. pathetic, stupid, or ugly, as she does others. You really sanction that? I know I am wasting my time even engaging in this dialogue.

  • Sue Brownfield

    This was interesting to read. I also read Dr. Brogan’s post with interest and wanted to read some opposing views. I find Dr. Brogan’s work fascinating concerning depression. This post, however, seemed a departure from her usual fare, but I found it interesting, nonetheless. I wouldn’t consider myself a misogynist, and chose a unmedicated birth in a birthing center. I had a wonderful experience, and I’m happy to share my experience and thoughts with those who might be interested in taking that path, as well. I think the most feminist thing to do is to be aware of options, avail yourself of all the information about those options and then make a choice that suits your values and belief systems. With that said, it’s hard to find balanced thinking when reading opposing views. It appears neither side can find anything worthwhile about the other’s viewpoint. I found this is Dr. Brogan’s post, as well. The tone was as if she’d reached such a level of enlightenment in this realm that to adopt any line of thinking that didn’t align with hers would be sacrilege and misguided, at best. I think that is a dangerous regardless your ideology, and I happen to agree with a lot of what she says! It’s difficult for anyone to divest themselves of their ego and not take things personally. Thank you for sharing your thoughts, Dr. Tuteur. I’ll be back to read more of your thoughts at another time.

  • KQ Not Signed In

    What happened to the comments on this article?

    • Amy Tuteur, MD

      I’m in the process of upgrading the server. I hoped not to lose any comments, but that might not be possible.

      • KQ Not Signed In

        No worries, it happens. I was just curious, since I know you don’t delete (and anyway, the conversations weren’t even trolly that i saw)

    • Nick Sanders

      Dr. Tuteur posted recently that she had to change servers over the weekend. I’m guessing that has something to do with it.

  • Blair

    Applause to Dr. Amy for what she does. This weekend on call for one of the hospitals. They had 2 abruptions. In one, mom left a giant pool of blood in the elevator and a blood trail that looked like a slasher movie. I wasn’t there,but would have loved to have a photo. Baby and mom fine after crash c section and mom receiving 3 units of blood. 4 hours ago another urgent c section for tracing– tight nuchal cord, apgars 1,4,8. Baby doing well. Birth is normal and natural except when it goes horribly wrong

    • Sue

      Human bodies. So much for “the incredible artistry of their design”.

  • myrewyn

    OT for this post, not for the blog. I remember a Facebook group for PPD linked somewhere — could someone repost that for me?

    My baby was born easily (nine minutes of pushing) on Sunday morning with apgar scores of 8 and 9. She was kind of lethargic though and by afternoon was diagnosed with hypoglycemia and started getting donor milk to supplement her nursing sessions.

    The next morning while she was having a blood draw to retest, she stopped breathing. It was like she drew in a big breath to scream and then just never let the scream out. Two nurses and a pediatrician were on her in an instant but it felt like forever before she cried. They called it a choke. Later throughout the day while I was nursing with a syringe of donor milk in the side of her mouth, she would kind of mini choke on occasion no matter how slowly I tried to go with it. Finally I gave in and poured the milk in a bottle I had brought and she was so much better when she got to pick when to suck and swallow instead of me doing it for her with the syringe. By the end of the day we added jaundice to her list and she went under the lights.

    This morning we met with the pediatrician to go over everything and as she put together her plan, she added that she would set me up with the LC and a pump. She got to the end and asked “is all that ok?” And I said no. I had wanted to breastfeed but with the choking and the jaundice it was more important for me to keep my baby fed than to keep at it. I just wanted the donor milk in bottles. I said i would let her keep going to the breast for comfort and if my milk came in I would try later. She agreed, told the LC not to come.

    I just got word that the bilirubin levels are going up instead of down. I told my night nurse to transition the baby to formula and that I’m giving up. She okayed it without a protest. Baby went to the nursery and I cried alone in the room for about an hour.

    Wait, did I mention my mystery temperature of 103 after delivery?

    I’ve always been SO HEALTHY. I ran circles around people half my age. My pregnancy was perfect until blood pressure readings started climbing just a few weeks ago. I was literally hallucinating cat sized Miyazaki style animals in here a little bit ago and I can’t get my feet into the shoes I walked in wearing. This is not at all how I expected things to go.

    Sorry this got longer than I meant it to.

  • Roadstergal
  • Sheven

    Perhaps someone could explain this to me. Do black women have a higher maternal mortality rate simply through lack of medical care, or do black women have a higher maternal mortality rate even if they receive the same medical care as other women? In other words, do we know that the problem is lack of medical care, or are we missing something crucial about black women’s general health/birth process?

    • Empress of the Iguana People

      It might be a bit of both. Sickle cell is just about unheard of in the non-black population, but i’ve heard that a lot of other diseases aren’t as well attended to in the African-American population. Sometimes because they don’t trust the medical establishment (for historically good reasons) and sometimes because the medical establishment doesn’t trust them to be relaying their symptoms accurately. Or so the NewsHour was telling me.

      • Gatita

        It’s definitely both. For example, there’s evidence that black women have a higher rate of short cervices, which can put them at higher risk of premature birth. Vaginal progesterone can lower that risk but if black women don’t have access to healthcare or aren’t flagged as being at risk for premature labor, they don’t get the treatment they need.

        • Empress of the Iguana People

          upvoting for the info, not the depressing facts

        • Also, android pelves, which are less favorable for birth, are more common in black women, and there are higher levels of pre-eclampsia and pregnancy-induced hypertension, as well as the problem of sickle-cell trait or anemia. These situations have nothing to do with social class, education, or nutrition.

      • Dr Kitty

        Ahhh Sickle Cell.
        Had an email exchange with a sports coach at a US college explaining that while his policy may require Sickle Cell screening for all athletes, I couldn’t really justify the use of NHS resources on the test for a patient with at least 7 generations of Irish ancestors just because they had a scholarship to attend that institution.

        The coach didn’t really seem to understand that the genetic background of his typical American athlete put them at a very different risk to my patient.

        I advised that his institution was free to arrange whatever tests they wanted at their own expense once my patient was in their custody.

        Haemochromatosis and Cystic Fibrosis are the genetic diseases my patients get, BTW.

        • Empress of the Iguana People

          *snort* Yeah, I don’t worry about my Irish father-in-law being a carrier, either.

        • mabelcruet

          And coeliac disease. Lots and lots of very abnormal duodenal biopsies in our neck of the woods.

          • Empress of the Iguana People

            That’s part of the intestine, right? (Trying to see if my memory of my anatomy class 20 years ago still works occasionally)

          • mabelcruet

            Yes, first part of the small bowel just after the stomach. In Ireland we have a huge incidence of coeliac disease. It is also seen in association with diabetes (type 1), so all of our diabetic kids get screened for it.

            We also have a high incidence of multiple sclerosis.

          • Empress of the Iguana People

            Ah. thank you

    • Merrie

      Black women who are college-educated, insured, and receive prenatal care have worse birth outcomes than white women with only a high school degree who don’t get prenatal care.

    • RMY

      Find a black woman who has equivalent care to a white woman who wasn’t experienced racism and systematic prejudice, and we’ll find out.

  • oscar

    This is such a great piece of analysis. Appropriately savage. Thank you for all your untiring principled effort, Dr. Amy. The world is becoming a safer place for women because of it.