We need leaders who are more like midwives

A conversation on birthing new worlds with midwife Gina Grove

"In spite of the tensions and uncertainties of this period, something profoundly meaningful is taking place. Old systems of exploitation and oppression are passing away, and out of the womb of a frail world new systems of justice and equality are being born."
-Rev. Dr. Martin Luther King, Jr., Nobel Lecture

In July before I left for Nepal, I sat down with midwife and University for Peace student Gina Grove on Zoom to talk about the wisdom midwives and doulas have to offer us in birthing new worlds. Our conversation helped inform the workshop I gave on hospicing modernity at the International Institute on Peace Education, and I have been thinking about our conversation ever since (though my bout with dengue kept me from writing about it sooner).

Earlier this year, I wrote about why we need birth stories:

We need more stories of birth and death, because I believe what we are being called to do right now is be death doulas and birth doulas at the same time. We are being called to, in the words of Vanessa Machado de Oliveira¹, hospice modernity, while simultaneously give birth to what is next, which we cannot fully imagine yet, especially from within the imaginary of modernity.

Along with birth stories, we need the wisdom of midwives and doulas - birth and death - to help us develop our skills and capacities for the process of birthing new worlds. The main question of my conversation with Gina was:

How can the wisdom of midwives and doulas inform the work of birthing new worlds and hospicing current worlds?

This hospicing and birthing process feels urgent, pressing, dire. We are in transition. The old world, while it feels like it is dying, also very much feels like it is in violent death throes, taking everyone and everything down that it can along its way, not going gently. The new world whispers from beyond, and maybe can’t quite be seen yet, just in glimmers. My curiosity lies in what the wisdom of people who work at this portal of birth and death can teach us for this pressing work. I invite you to join me in taking in the wisdom Gina had to offer, which was incredibly rich, abundant, inspiring, and motivating.

Through the portals of death and birth

Gina on deployment in Afghanistan

Gina’s path to midwifery, which has profoundly shaped the way she views the world, began through the death part of the life cycle, working as an Air Force nurse in a trauma ICU and then in Afghanistan. While on deployment, she began studying midwifery through a distance learning course, so she was learning about birth work while engaged in caring for very traumatic injuries and witnessing a lot of death. “I was done being on the death end of things,” she told me, “and when I was looking at what I wanted to be as a healthcare worker, and how I could make a difference in the world, I started to think I could have more impact on the front end of things.” In her very first midwifery class, she fell in love with it, and has been on that path ever since.

Describing this process of falling in love with midwifery, Gina said, “I just started to see birth as this magical place where everything starts. It's where family starts, where families are born. The birthing person is reborn themselves in a birth. And I started to think, if we really want community change and systemic change, the moment that has to change is the moment at birth.”

I was struck by how Gina’s path to being a birth worker was through the door of working with a lot of death - I knew she had been a trauma nurse, but I hadn’t made the connection to this part of her story until our conversation. As we talked about the similarities between birth and death, she said, “There are more similarities than there are differences. I don't even know that there's that many differences in the end. You're in a place where the veil is really thin. It's like you're at a portal, a place of transformation that's happening, and it doesn't really matter which direction it is. In this place of transformation, it can feel really unknown.”

Learning to die (and live)

“You live differently right when you remind yourself our time is short. We do die, and if you do have that awareness, I think you use your time differently.”

In our conversation, we talked a lot about modern culture’s dysfunctional relationship with death, and the need to learn how to die well - which also affects the way you live. Gina said: “Our culture doesn't know how to die at all. We're not really taught that, and in fact, we're taught to be terrified of it. So we don't have any wisdom surrounding it in our culture today, at least in the United States or in the Western culture. Whereas life teaches us that death is a part of life, and it is part of the same circle. This is a big part of the dysfunction of our culture, and the question is, how do we change that?"

This fear of death shows up in not letting things die, including systems and the myth of perpetual growth. Gina continued, “I can see in our society and in capitalism, how much we just keep things going, and we're like, ‘It's going to get better.’ And we just keep resuscitating it, but in reality, we just have to let it die so that new things can emerge. There has to be a way of making space for new things, and not trying to keep shifting it and tweaking it to be better because things have to die. We have to be okay with it and celebrate it, and look at it as a beautiful thing.”

To hospice current worlds, we need to relearn that death is a part of life, and to overcome the fear of it, and learn to celebrate it. It would seem that part of the work of hospicing is reorienting our relationship to death, and as Gina said, learn to see it as a beautiful thing rather than something to be feared and avoided.

Birth support (photo provided by Gina, shared with permission)

Skills, dispositions, and capacities

The heart of our conversation was about the skills, capacities, and dispositions that birth and death workers need to develop to assist people in this portal of transformation. Whether one is working on the death or birth side of things, the skills are very overlapping, and the skills themselves are very entangled with each other (bearing witness demands an ability to listen deeply, for example).

Bearing witness

The ability to bear witness was one of the skills that is essential to both birth and death workers. As Gina described, “In both cases, to be able to have someone that's able to stand with you, or be with you in that space like a guardian is so helpful…So much surrounding birth and death is a process of surrender. If you’re a birth worker or working with people that are dying, a lot of it is just being able to sit and bear witness and acknowledge the transformation that's happening, almost narrating it back to the person or reassuring that it's okay to trust the process.”

It is worth noting that having a witness at birth significantly improves outcomes. Gina added, “Overwhelming studies show that a doula, or just having a person that's with somebody during birth throughout the whole time, has a significant impact on outcomes. So we know just the physicality of a person being with you to witness with you, no matter what their level of medical expertise is, improves outcomes.”

Recognizing and acknowledging what is happening

A part of bearing witness is acknowledging and recognizing what is happening and helping others to be able to acknowledge and recognize it, too. With the death process in particular, there can be some level of denial on the part of the dying person and/or family members. A birth or death doula can help people overcome the denial.

Only once we have acknowledged what is happening can we consider what we want to happen. As Gina said, “We can take a step back and say: How do we want this to happen? This can happen multiple ways.”

Supporting the relational web

Birth and death are both deeply relational. While this is perhaps obvious, in modern Western culture these processes can become individualized and isolated to the birthing or dying person. In the case of supporting births and deaths, Gina described the careworker’s crucial role of supporting the relational web, and offering support not just to the birthing or dying person, but to their extended family as well, and how at times this is the most crucial part of the role, especially if the person is dying and not conscious or able to make decisions.

Gina also talked about how birth is transformative, not just for the birthing person, but for everyone witnessing it. She said, “It's totally pure magic. I don't know how you can witness a birth and not be somewhat changed by it in a way…Being a part of that [birth or death] is so life-changing because it shapes everything that you think about what's going to happen to your own self or to the other people that you love, and it can be so transformative for the onlookers or the participants that aren't the actual person themselves.”

Guiding

Part of this support is acting as a guide for the birthing or dying people and their families, and in the case of dying people, it is often working with the family when the dying person is beyond making their own decisions. The doula or midwife is not making decisions for people - they are helping guide them to make the best decisions for themselves.

Being neutral

Related to guiding and bearing witness, neutrality means letting go of your own goals or visions of how things should be. Gina talked about how there is often a tension between birthwork and activism, and how a lot of people get involved in birthwork as a form of activism, something she resonates with. However, the role here is not to influence people, but rather to provide them with evidence-based knowledge that can help them make the best decision for themselves. A birth or death worker shouldn’t be pushing their own agenda or opinions in this role, she said, but rather holding space and helping guide others to make the best decisions for themselves.

Empowering and enhancing

Related to guiding is empowering and enhancing what the birthing person is doing. Making decisions demands empowerment, and can also result in feeling more empowered. Enhancing what the birthing person is doing supports what they are doing and augments it. For example, as Gina said, it might mean telling the person, “This is what is happening and it's beautiful, and you're beautiful in it, and your body knows exactly what it's doing.”

Following intuition

The birth worker must use their own intuition as a guide, and encourage and empower the birthing person to follow their own. The birth or death worker has to be in touch with their own intuition and learn to trust it to enable and enhance this process for the birthing or dying person.

Holding space

On holding space, Gina said, “This ability to hold space for people is so important, and that comes in a very humble and unselfish way, where you're putting yourself aside, like this isn't really about me, but I can create and hold the space, but it's not up to me to fill it with anything. I'm just creating space for this person and being a gatekeeper in a way. Some people do it innately, but I do think it takes some work, intuition, and being able to separate your own desires or thoughts to the side.”

Additional skills, capacities, and dispositions

Some additional skills and dispositions that relate to many of the ones above include:

• Listening

• Providing comfort

• Asking helpful questions: “Having the wisdom of being able to ask the right kinds of questions of people to help them, to be able to process what's happening themselves as opposed to like an instruction.”

• Less is more: “We have to learn to do less: to sit, listen, ask questions, and support might seem like small things, but they make the most difference.”

• Having a basic understanding of birth process & being able to identify warning signs of an emergency

• Knowing different techniques that might help in different situations (massage, birthing positions, etc.)

There is a lot of overlap among these skills and dispositions, especially holding space, bearing witness, and neutrality. I see holding space more as being the guardian of the container for this portal, which also might mean protecting it from outside forces (in birth and death, particularly in hospital settings, there might be a push for outside intervention, and the guardian’s role would be to help the birthing or dying person to be empowered to decide about any interventions). Neutrality is part of what is protecting the space from outside intervention, protecting the needs and desires of the birthing or dying person.

Gina, far right, assisting a birth (photo shared with permission)

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At the end of the conversation, I returned to the main question, “What do you think about how the wisdom of midwives can inform our work and birthing new worlds and hospicing current worlds?” Gina’s replied:

“One thing would be the ability to see how everything connects, kind of like where you hover above, and you can see that everything is connected in its way. And that takes the fear out and brings trust in. And I think if we're thinking of birthing new worlds or ideas, we have to find a way to move through the fear, because I think a lot of it is hinged on fear of the unknown, or letting go of what we have known. So if we're able to see a bigger picture of how things all connect, and that new things are not something to be feared, and, in fact, can be like something we can take part in and be a part of, is a start.

When I think of why we get stuck in old ideas, it’s fear, and if we could move through it, if we could imagine ways to move through that fear or redefine the feeling that we're feeling - because fear and excitement have very similar feelings. The way you sense the sensation can be reshaped in our minds as to something that can also be exciting. When we think of childbirth or death, a lot of where we get stuck to is the idea of fear of the unknown, or “what am I going to be on the other side” - it’s the same thing you have to work through if you're thinking of new systems or new ideas.

So a way of reframing that: how, as a society, can we stop being so afraid of change, and maybe how we can help society take ownership of newness, which I have no idea how you do that. But in the same sense of where we're talking about, how do we empower a birthing person in the moment, where they might feel a little unsure, but you can trust because you are the one that's going to do it. How do we create a sense of ownership, of the newness of society to where we can - instead of being fearful, think, ‘No, we know how to evolve. We've been evolving for centuries - more than centuries - into new things.’

So we're in a moment of transition and of birth, and in that of being fearful. We have to surrender to the change in a way that is not fearful, where we can create more space.

But I don't really know what that means in an actual sense of, ‘How do we create a society that feels empowered for change?’ And not be fearful to let the current way or the way we know right now to fall to the side.

Because probably most of us, if we can at least be in tune a little bit - the denial piece is really true, but if we can put that aside, we probably all have these urges for something new, something different to come out of it. So how can we trust that and surrender, to allow, to create, to hold space for society to change? But I don't really know what that means in a practical sense.”

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When I asked if she had any questions for me, a thought occurred to her:

“We need leaders who are more like midwives!”

She continued:
”We need leaders who are more like midwives, to be wise, to create space for change, to be able to hold space. In a political way, or in a big leadership way, what would that look like? Leaders who have midwife skills, leaders who value life. That feels like a big part of it. Midwives know how to bring life into the world, and inherently value life in wanting to do that work. Leaders that valued life would be like a really really big step.
A good step.”

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Taking all of this in, and applying it to hospicing and birthing worlds…

How do we create a society that feels empowered for change?
What abilities do leaders who are more like midwives need?

For hospicing old worlds…
Overcome the fear of death and ending. Learn to see death as a part of the regenerative life cycle.
Celebrate it and learn to see it as something beautiful.
Turn fear into excitement.
Bear witness.
Listen.
Recognize and acknowledge what is happening.
Overcome denial.
Ask helpful questions.
Learn to die well.
Surrender, allow.

For midwives birthing new worlds…
Bear witness. Hold space. Listen.
Ask helpful questions.
Act as a guide, a guardian.

Practice neutrality - put our own desires or thoughts of how things should be to the side so we can be with what is and what wants to emerge.

Provide comfort and relief where it is needed, especially where suffering is happening.

Learn different techniques that can help the situation (survival skills, first aid and seed storage, growing food, getting water, conflict transformation, restorative practices, communication, community building - what would you add here?).

Try to enhance what is emerging.
Imbue the new world with confidence and empowerment.

Learn to see how everything connects
Take the fear out and bring the trust in.
Move through the fear
Redefine the feeling
And resense the sensation as excitement.

Create a society that feels empowered for change
Take ownership of newness
See that we can all take part.
Lead like a midwife.

Here is to hospicing the old world and birthing new ones that are more life-affirming, loving, caring, just, and peaceful. May we learn to be doulas and midwives in this process, moving through the fear towards excitement and empowerment.

Thank you, Gina, for sharing your wisdom and experience with us!

With love and care,

Stephanie