Birth & Motherhood - “Birth and the Virtues” with Julie Gunby
Shownotes:
Most of our culture’s conversations about birth revolve around safety and legality. The cultural expectations surrounding birth negate a wide range of experiences that lead up to the birthing process and the virtues that birth requires of women. Though the nuances of pregnancy and birth are more commonly discussed in the medical field than in Church circles, all of a woman’s experiences over the course of her life contribute to the way she delivers her baby. With this in mind, how can we have better conversations that connect birth and the virtues?
In this episode, Chris and Eddie talk to Julie Dotterweich Gunby, a certified nurse midwife who has delivered over 1,000 babies. Julie describes the vocation of midwifery as a way of positioning oneself to help women articulate what it means for them to birth well. She speaks to the constraints that women face when sharing their needs and desires in the midst of preparing for mothering, and she shares the importance of creating space for women to reflect upon generations of mothers who came before them. Julie encourages mothers and future mothers that they can birth with greatness of soul no matter the circumstances.
Series Info:
Birth and motherhood are intrinsic to the human experience, yet there are aspects of these topics that often go undiscussed in church circles. Infertility, discerning birthing options, and the experience of caring for the woman who once mothered you are conversation topics that are as necessary as they are complicated. These topics are easy to overlook until they are experienced firsthand, and it’s important for the Church to understand all of the experiences that birth and motherhood bring.
In this series, we will listen to the wisdom and experiences of women who know these issues personally. Through these conversations, we hope to provide a space to recognize how spouses, friends, family, and others can come alongside mothers on their journey in a manner that is empathetic and understanding. Join in on this discussion as we consider the weight of these topics and cultivate a willingness within the Church to engage hard conversations.
Resources:
To see how birth ethics are often framed in terms of autonomy and individualism rather than virtue, click here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2667293/
Facing the uncertainty of birth requires both personal and societal virtue. For a summary of some of the complex race, class, and socioeconomic issues plaguing America’s birth outcomes, click here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2667293/
Check out Birthing From Within, a classic book that does better than most to help women and families prepare for the demands of giving birth well
Follow Julie Gunby on social media:
Full Transcript:
Chris McAlilly 0:00
I'm Chris McAlilly.
Eddie Rester 0:01
And I'm Eddie Rester. Welcome to The Weight.
Chris McAlilly 0:04
Today we're talking to Julie Dotterweich Gumby who is a certified nurse midwife and a friend of mine. I say right out of the gates I messed up her title. So I'm sorry, Julie for that. But.
Eddie Rester 0:15
But you got it right that time.
Chris McAlilly 0:16
I got it right that time, so that that's helpful. Today, the conversation is around birth and the virtues. Julie is a mother herself. And she's attended over 1100 births over the course of her career as a practitioner.
Eddie Rester 0:33
And she really talks about what does it mean to birth well. What does it mean to live virtues in the birthing process and beyond and talks about different situations and how she sees the virtues lived out for people.
Chris McAlilly 0:50
The conversation is about kind of cultural constructions around these conversations. Like on the one end, you have kind of hospital birth that's a safe environment and maybe medical eyes. On the other end, you can imagine, like, the hippie waterbirth that really emphasizes the autonomy and empowerment of the mother in the process. Wherever you fall within that spectrum, I think you're going to find this to be a nuanced conversation, maybe a different way in than you've heard before. It certainly was for me.
Chris McAlilly 1:21
And I'll just say, as a man, as a father, you know, I think it's worth listening to this conversation, because it's about some broader cultural trends and streams in the way we think about life and death, and the way that we kind of navigate difficult things in our lives and in our marriages. And so, you know, I found that really, really helpful.
Eddie Rester 1:50
And even conversations around how can we, as larger communities, be a part of the birthing conversation, you know. The conversation on birth is kind of pushed off to doctors and in medicine, and she really at one point talks about getting rid of baby showers, which you need to listen to what she would replace baby showers with.
Chris McAlilly 2:14
And I think really, it's bringing our whole life back into the community and the ways in which we can accompany one another through difficult things and call forth virtues and strength, that we need as individuals within the context of the community.
Eddie Rester 2:32
And this is a part of our larger series talking about birth and parenting and family life. And so if you didn't listen to the episode last week, make sure you go back and catch up on that as well.
Chris McAlilly 2:44
And then we'll have another episode next week that you're not gonna want to miss.
Chris McAlilly 2:48
[INTRO] We started this podcast out of frustration with the tone of American Christianity.
Eddie Rester 2:55
There's some topics too heavy for sermons and sound bites.
Chris McAlilly 2:58
We wanted to create a space with a bit more recognition of the difficulty, nuance, and complexity of cultural issues.
Eddie Rester 3:05
If you've given up on the church, we want to give you a place to encounter a fresh perspective on the wisdom of the Christian tradition in our conversations about politics, race, sexuality, art, and mental health.
Chris McAlilly 3:18
If you're a Christian seeking a better way to talk about the important issues of the day, with more humility, charity, and intellectual honesty, that grapples with scripture and the church's tradition in a way that doesn't dismiss people out of hand, you're in the right place.
Eddie Rester 3:33
Welcome to The Weight. [END INTRO]
Chris McAlilly 3:36
We're here today with Julie Dotterweich Gunby, who is a good friend of mine. She's also a certified midwife and nurse practitioner, and we're so excited to have you on the podcast today.
Julie Dotterweich Gunby 3:47
Thanks, Chris. We're really glad to be here.
Chris McAlilly 3:50
I wonder if you would give a little bit of your journey to the vocation of midwifery. I know that you began as a philosophy major.
Eddie Rester 3:59
That's right. That seems like a long journey.
Julie Dotterweich Gunby 4:01
It is. It's been a long kind of pendulum swing back and forth. I think it's finally settling out in a way that makes sense, Lord willing, but if you were to trace it from the time that I was really little, I, you know, said I wanted to be a doctor and work where there were dirt floors. And where I work as a hospitalist midwife taking care of uninsured women now is actually pretty similar to that, but there were a lot of movements in between.
Julie Dotterweich Gunby 4:29
So when I was in college, I did what everybody who wants to be pre-med does and studied microbiology initially and discovered that I was uninterested in x equals eight as the answer to any question and decided to move to philosophy, where I could do epistemology and virtue ethics and ancient philosophy and found this all really fascinating and thought then that everything I knew was completely worthless.
Julie Dotterweich Gunby 4:59
There was a series of circumstances where I was doing a seminar in theology at Notre Dame and ended up in a swimming pool with some folks with developmental disabilities and through a series of very fortuitous circumstances ended up spending about two years in a L'Arche Community on the West Coast.
Eddie Rester 5:18
Share a little bit about L'arche Communities, because probably a lot of folks listening aren't going to be overly familiar with that. Flesh that out for us.
Julie Dotterweich Gunby 5:26
Sure. So this is a worldwide network of Catholic intentional communities, in a kind of social-justice Jesuit vein, where people with and without severe to profound developmental disabilities live together as a household. And the folks with disabilities are the core members, the central people, and those of us without are the assistant to kind of support life together. So we managed to all make dinner and clean up and get ourselves off to our various jobs on the farm or the workshop. And that kind of daily life, tending to people's bodies, it was both a missional place and also had a real practical role as a state licensed adult family home.
Julie Dotterweich Gunby 6:11
So I learned that the problems that I might solve through logic were actually helpful also in designing bedsheets and recognizing symptoms and reporting this to healthcare practitioners. So I was a nursing assistant, which is about as low as you can get on the rungs and realized that I did want to become a practitioner. And of course, though, for me, there was a pendulum, and instead of just going straight off to nursing school and specializing, I thought, well, I should finish out that line of thought where I'd thought I would be a philosopher or theologian when I grew up. And so I did a Master's of Theological Studies at Duke. And while I was there, did my prereqs for nursing school and did a lot of reflecting on virtues and medical practice and how to kind of tie those things together.
Chris McAlilly 6:57
We want to talk to you a little bit about that connection between birth and the virtues. But before that, it might be helpful to just kind of also mention that you are a mother, and just talk a little bit about your journey. You know, there's one dimension, it's part of your vocation and your career, but it's also part of your life experience.
Julie Dotterweich Gunby 7:18
That's right. That's right. It's interesting, as someone who's delivered right at about 1100 babies right now, I would think of my three births as among some of the easiest, most straightforward, boring, uncomplicated ones that I've been at. And that requires a fair bit of luck, like certain things to go your way in addition. So the actual acts of kind of my birth, I feel didn't demand a tremendous amount of the virtues that I would think about if I think about how women birth well. I think of them as kind of uneventful.
Julie Dotterweich Gunby 7:54
But the journey to motherhood for me was also something I think I just sort of fell into. I didn't, I wasn't pursuing it in any way. I thought, I'll just have this career and my vocation is kind of my work. And then I fell head over heels in love and married this guy, five months after I met him. And then a few months after that, I was really convinced I wanted to have his babies. So I ended up, you know, with the household of three small children and as a full-time working midwife, and now I'm homeschooling them during the pandemic while I'm delivering babies. So.
Chris McAlilly 8:29
When you mentioned the phrase "birthing well," that's a phrase that has, you know, it has a lot of meaning for you. I wonder if you could kind of flesh that out, because you've seen in various interpretations as to what it would look like at this point, I would assume both kind of in your own experience, and then also in multiple settings, you know, from a hospital to home birthing experiences. Just talk a little bit about what makes for a good birth and what birthing well looks like for you.
Julie Dotterweich Gunby 8:58
That's right. It's interesting. Yeah, no one becomes a certified nurse midwife without having some pretty strong beliefs about how birth ought to be done. Right? That is, this is how you get into this racket. But the way that I would describe it now after 10 years of practice is radically different than the things that motivated me and kind of drove me to become a midwife and that I think a lot of people if they hear that word, kind of glow, and come off the page like it did for me, I think they think about it perhaps in a different way than I would now.
Julie Dotterweich Gunby 9:27
So if I were to summarize that, I think, when you're first exposed to the idea of, like, how obstetrics is practiced in America, and what really is kind of pretty readily described as, like, a medicalization or an industrialization of birth. And then you come to understand that actually, you're gonna have better outcomes, that birth is a physiologic process, so that pregnancy is not an illness and birth is not an emergency until proven otherwise. And that not having that disposition, modern American obstetrics can create more problems than it solves both for actual perinatal outcomes for mothers' experience, for their bonding, for their transition to motherhood.
Julie Dotterweich Gunby 10:11
So I came into midwifery with that pretty strong constellation of beliefs, which, for people listening, that'll either be a very easy shorthand for something they know all about, or that might seem like a really big mouthful. But you think, well, I want to be a midwife because I want to support people, women to have their babies in a way that is responsive to the normal kind of flow of this unique life experience, but a deeply human life experience. Whereas I think our hospitals are motivated like solely by the notion that a birth is... A good birth is a safe birth. The idea of midwifery is like, well, a good birth would be one in which a mother is kind of enabled to own her birth, or to make this transition into motherhood as a springboard that she can navigate well, and that maybe empowers her or something like that.
Julie Dotterweich Gunby 11:05
And sometimes then it has real, particular modifiers that involve it being natural or unmedicated or vaginal, or these kinds of things. I did waterbirth. I have probably delivered about two hundred babies in the tub. I've done, you know, lots of these vaginal deliveries, after c-sections, and even breeches, things where you're pushing the envelope to really make things stay as normal as possible. And I would just say that what I would describe now as birthing well is much more complicated, and I think, much more abstract than any of those particulars. And it involves much more kind of virtues that can be instantiated in any kind of particular birth. So it would probably be hard for me to describe that better without telling you some stories.
Eddie Rester 11:56
Yeah, tell us some stories, then I want to talk a little bit more about those virtues. But yeah, share some stories with us.
Julie Dotterweich Gunby 12:02
So you know, and just as a note of kind of professionalism, any story that I would tell, I've kind of made care to obviously not mentioned patient information, or women's information, but also to obscure enough of the details that respect people's privacy. But I think about... So in some ways, like the quintessential kind of "good birth" in this midwifery culture, or natural birth culture is like this waterbirth, the woman's in a tub, and she brings her baby up, and maybe her partner has been there with her. And it's this like, beautiful ecstatic moment where the baby is just... Like, it's just, it's almost like this iconic thing that people are trying to achieve.
Julie Dotterweich Gunby 12:46
And I think of was one woman who did in fact, have a water birth. And I would describe her birth as just really a terrible one. Where I had admitted her the day before, after weeks of conversation about why she needed to be induced for preeclampsia, which can be a life threatening condition that's immediately curable, in most cases by delivery. So I needed to medically induce her labor, and I had the process going and she was all but kind of underway, it was time to break her water. And she just decided that... She refused all of these interventions. She was not going to let me break her water. She's not going to let me start pitocin. She had had enough and she wanted to go home. She thought that the right thing would be to come back and to have the baby naturally. And so she signed out and left.
Julie Dotterweich Gunby 13:30
It turned out I had to kind of counsel her, "This is really taking your life into your own hands in a way that what you pay me for is to give you kind of wise counsel," and she didn't care and left and came back just over a week later. I was on call again at the hospital; as a hospitalist, I take whoever comes in. And she labored spontaneously and had the baby and it was uneventful. So I'm not saying that the only bad birth is a bad outcome. But I think that what was going on in this particular case was a real failure of if you think some of the virtues necessary are courage and wisdom and transcendence or what Aristotle would call the greatness of soul, I think some of what was really lacking there in this particular woman's case were some of those essential elements, right.
Julie Dotterweich Gunby 14:22
So being able to be responsive to one situation, to be grateful for things as they're given, to continue to have hope or an ability to expect the best even when the circumstances are not kind of what you desire. And that lack of like responsiveness I really perceived as an absence of virtue, absence to really bring her baby into the world well, in a way that would support her in her mothering well. Like, you can't insist on outcomes as a mother any more than you really ought to try and insist on outcomes as that birthing woman.
Julie Dotterweich Gunby 14:57
I think likewise, a convert story where you think of someone who's having a birth that is deeply medicalized and would by the modern standards be bad. Think of a woman who was just straight up induction at 39 weeks, had the epidural for it. She's actually having a preterm baby about, you know, in the early 34 weeks, epidural couldn't feel a thing. Pushed and birthed her baby with the most grace and kind of profound beauty. She had told me the story of this pregnancy in the course of our prenatal visits. Baby had been conceived in a pretty devastating rape, and she had been in an abortion clinic ready to abort, walked out, chose to have this baby and found just a tremendous struggle through the whole pregnancy. And the way that she kind of trembled as she had this baby. As she was birthing, I was like, "This is some emotion, this kind of response, I've never really..." It was a rare one, the way that she was kind of trembling. And I remembered then her entire story.
Julie Dotterweich Gunby 16:02
And so what she was doing in bringing her entire self to bear on this outcome, the kind of practicalities of what she did not want in any way, because this capacity to say yes to that made this this, you know, I think beautiful, tremendously virtuous birth. Which, you know, again, I'm not gonna demand of everyone who was raped. But I think I would like to bear witness to kind of what she was able to do in that moment, which is far more beautiful than having the photo of bringing your baby up out of the water.
Eddie Rester 16:33
So as you talk about the virtues in birth, what I hear you talking about is you're talking about the kind of these virtues developed as the pregnancy moves along or the virtues, do you think, that just the process of conversation and change, they begin to emerge? Are where where do these virtues come from? Or do they emerge even at times after the birth?
Julie Dotterweich Gunby 16:57
Mm hmm. No, I think that's right. I mean, I think one of the privileges I have as a midwife and attending birth is one of these experiences. There's birth and death on a scale of intensity and kind of liminal experiences where we're crossing this boundary between life and death and doing this kind of superhuman thing, that I have the kind of privilege of witnessing this over and over again. And so some of what I feel like I see is I have this window into women's souls, into the character that they have that they bring to the experience. So virtue is a matter of kind of habituation and practice.
Julie Dotterweich Gunby 17:37
There's a certain way in which you feel like you're having the curtain kind of pulled back, and you're seeing the character that a person brings to this experience, just from the course of her entire life. And that's a place where all of who someone is, might build her up into a person that would birth in a particular way. And whether that's, you know, her formation in a community of faith, a church or formation by life that's been unusually easy, which might make her ill-disposed to birth well, or life has been enormously difficult. Some of my patients now have terrifically difficult lives. And sometimes I feel like you can see a molding of their character that's exposed there.
Julie Dotterweich Gunby 18:20
So some of it is who they are, in general. Also, I think the process itself kind of demands and calls forth some of those resources from women that they might not realize that they had, which is a grace, right, like, it's a kind of a crucible that draws this things forward. They experience themselves as courageous or as having a certain kind of vitality or ability to have hope in the face of difficulty, but then they might not have appreciated that capacity until then they give birth in this particular way, and then they carry that with them into their mothering.
Eddie Rester 18:55
So I think, you know, I'm thinking about the birth of my two daughters. We went to the hospital, it's kind of that standard traditional thing. But your role as a midwife. really, there's a relationship I think there that I'm hearing that really is reflective, maybe even restorative at times. Am I right and understanding that that role?
Julie Dotterweich Gunby 19:19
That's right. I mean, I think nurse midwives practice in different ways. And so I do have patients that I see prenatally. I'm in kind of a large practice, because we're also the hospitalists, so I take care of anyone who comes in, so I end up with people with no prenatal care, people who haven't even heard of prenatal care, who are kind of at the very bottom end of the socioeconomic spectrum. So I do a lot of deliveries for women completely sight unseen, given the kind of practice that I'm in. But I do think there's a way that certainly can build this kind of beautiful relationship over time. And at the same time, kind of in that moment of encounter where I often meet someone and then delivering their baby within minutes or certainly hours of having met them. And to this kind of building rapport and enabling them to kind of bring their whole self to that encounter is certainly a huge aspect of what I do.
Chris McAlilly 20:16
I think one of the things that I hear in your story, and that I think is is worth just underlying or noting is that the way birth happens in a particular place or time is very, it's just very culturally constructed. And in a similar way, that if you go to a different part of the country, or maybe, you know, you go to a funeral, of a person of a different race or ethnicity, you know, you're kind of struck by or surprised by the cultural dimensions of death practices, and then also funeral practices and rituals. And it sounds like what you you're describing is kind of these two poles, or like, along a spectrum. There's a hospital birth, that's, you know, conventional, and in certain places, then you have folks who have very strong convictions about the way in which that has kind of unfolded in American culture through time, and are kind of rejecting a kind of standard and conventional way of birthing in America for this more kind of autonomous and kind of empowered birth, that's not medicalize.
Chris McAlilly 21:30
But it sounds like what as, you know, 10 years into practice, and having practice in a range of different settings that you've come to, you know, just talk a little bit more, you talked about it before, but I think it's worth kind of talking about how those different cultural constructions offer different settings for the practice of the virtues. But it sounds like for you, it's, you know, whereas, you know, there's this one way in which the conversation has unfolded in midwifery circles, you want to kind of push the conversation a different way. Am I hearing you correctly in that?
Julie Dotterweich Gunby 22:06
I think that's right. That I think in a more medicalised language, the conversation is driven almost solely by safety, and kind of legality or litigiousness, and those are the kind of the only goods really at the end of the day that matters, like healthy mama healthy baby. And, you know, for the practitioner, like no lawsuits, right? Those are the things, the goods that kind of you're obsessed with or concerned with on that side.
Julie Dotterweich Gunby 22:35
And then in a more kind of midwifery vein, it can be, you know, certainly much more like patient-centered care, maternal empowerment, and perhaps even like the lowest intervention possible, even, you know, certainly so that would be you know, less induction, less cesarean, and less epidural, less episiotomy, all of those things. And I guess, I would say both of those ways of framing the question or erring on the side of like, maybe the idea between hope and expectation. They're framing, like, really clear expectations about what a good outcome would be, rather than having a disposition of hope. So how do we encounter this contingent, under-determined process with a kind of appropriate stance, I would say of creatureliness, of receiving life as a gift, while at the same time doing everything that we can to kind of make it come out well. If you add all those parameters, it coming out well is no more coterminous with healthy baby, healthy mama than it is with I got the designer birth that I wanted. It coming out well as this dynamic process of engaging with the receiving life. I mean, you are in fact receiving life. And what it means for you to do that well is going to be written in that moment, based on all of the contingent factors that are coming together.
Chris McAlilly 24:06
I want to just highlight another dimension that I hear in what you're saying, which is that the cultural constructions around birth are very socioeconomically driven. I mean, just the phrase "the designer birth that you wanted" versus, you know, the factors of contingency that are going to be way beyond the control of a particular kind of mother who doesn't have insurance or who has certain kind of circumstances around life, work, and money. Just talk about what you've seen there and, I guess, the way in which that has, I guess, reshaped the way that you consider what it means to birth well.
Julie Dotterweich Gunby 24:48
No, that's right. I spent the first few years of my practice in a very... It was really a lovely, you know, midwifery, midwife-run practice, which is pretty rare in the state of Georgia, with women who pretty much exclusively sought us out for the kinds of low intervention births that we could offer, and for them, in my kind of most critical stance, I would say, it began to feel like a consumer choice that people were making. Like, would you prefer organic milk or, you know, kind of the standard conventional cow's milk? Well, of course, organic, right. And I think that didn't have an appropriate respect for kind of what we were doing.
Julie Dotterweich Gunby 25:32
But these are women who, you know, have the traditional, they're deeply thoughtful about how they want to have their baby. So in that sense, I think that that's important, like you are having a baby. This is something you're only going to do a couple of times in your life. It does make sense to be thoughtful about it. But these would, you know, we'd be having questions about how the birth would go at the, you know, initial seven week sonogram, right. And every visit after every visit after, you know, pages and pages and lots of questions and birth plans. And that certainly was a particular socioeconomic population. Like, we didn't accept Medicaid in that kind of practice.
Julie Dotterweich Gunby 26:09
And then, so everyone had lots of thoughts about how they wanted their birth to go, and now delivering women who are all kind of uninsured or Medicaid patients by and large. I still almost I do this almost out of, like, to crack myself up or just almost out of like, deep curiosity. So one of my questions about history and physical when I'm admitting a woman to the hospital is, I say, "What do you want me to know? Like, what hopes and dreams do you have for this? For this delivery, for this work? Like, what would be important for me to know about you having this baby?" And like, the question remains, like, unintelligible. Like, I get a blank stare every time and I still ask it, like, every time just kind of, for the sake of it. And maybe somebody will say, "Mmm, healthy baby." Like, "I don't want to have a c-section," as if that is kind of the end of that thought.
Eddie Rester 26:55
A word that you've mentioned a couple times, it's in that question, and you mentioned it earlier, is the word "hope." And I was just sitting here thinking, you know, of course, that's what new birth is about. It's about hope. It's about life springing forth when you read tales of birth, stories of birth in the 1800s, 1700s. That is what it's about. It's about extending life. And why do you think it's hard for folks to articulate kind of their hopes about that birth in that moment? Is it just they've never thought about it? Nobody's ever said, "Hey, birth is about more than just, you know, a child showing up?" What's the constraint there?
Julie Dotterweich Gunby 27:42
I think there's a lot of reasons. I mean, I think for a lot of women, their lives are... More than half of all pregnancies in America are unplanned, and there's varying degrees of unplanned, you know, that these are women who've kind of made a choice to carry to term a baby that they didn't intend to have. And so I think there's a lot of mixed emotions that come with that having a baby, that may be not something yet that you desire, still. Like, you desire enough to have carried through with it. But there's not this kind of full yes, it's been said in that way.
Julie Dotterweich Gunby 28:21
There's a way that, you know, I think I could talk about these kind of terrifically difficult births, but also just in a very mundane way, the act of having a baby can obscure hope, right? Like, you're either in terrific kind of repetitive pain, or you're pushing for some very, very long period of time. And you actually get lost in the experience. And it's the job of the people accompanying you to kind of remind you that like, there is a baby. There was a point to this suffering. And so some of it is it's just such an all-encompassing experience, it can be really hard to keep your ,to kind of... You almost can't do that work yourself entirely, to remember what it's about or for. And that's where the role of people accompanying you kind of help bring that out.
Chris McAlilly 29:08
Yeah, I think that I hear that, you know, as a thread, that there are parts of the experience of giving birth that are singular, that are the responsibility of the individual to meet the moment or not, you know, that to say yes to the experience. But you've also said, like, there's a role for those who are accompanying those who are going through that experience. It seems like the community for you is an important dimension, both in terms of the development of virtue on the front end, you know, within a life that's difficult or within the context of a Christian community. And then also kind of like, accompanying somebody who's going through suffering that has to remind them that there is a point. For you, I mean, that kind of comes back to why midwifery as a vocation, you know. I guess, what do you see in that vocation that says something to that dynamic between kind of individual and singular experience and communal, I guess accompaniment?
Julie Dotterweich Gunby 30:17
That's right. No, I think that's very much how I think of my role and kind of my gifting is in this ability to come alongside and be present to someone who is suffering, and to narrate that back to them both with my body and my stance and the way that the room is managed, and speech or absence of speech and to enable them to kind of do what they wouldn't otherwise be able to do, and to feel and know that they're safe, even without kind of needing to say that and help them access kind of those parts of kind of their self and their courage. I mean, I think that's very much the role of a midwife, right, "with woman" is what it is. And if you think of someone midwifing you, that's what you picture them doing for you, whether it's abstractly, helping you solve a problem, or helping you have a baby.
Julie Dotterweich Gunby 31:05
I think, if I could change, like, one thing, in the way that our culture helps women get to the point of having babies, well, we have to get rid of the baby shower, guys. Like ,this is an atrocity. It's doing absolutely nothing to help women prepare for the transition to motherhood. And if they're... Like the idea that just like oohing an awwing over some onesies is going to help you do kind of the most difficult thing you ever do in your life from which you emerge a different person, regardless of how you have that baby. It's just, it's just really laughable. And so, there's ways of doing so in kind of more pagan rituals. There's an idea of a birthing way ritual, which, in certain kind of Christian circles that I've been in, we've really had a chance to baptize and change it to a Christian Liturgy of enabling women to reflect on their mothers and grandmothers and fore mothers and to tell their stories of things that they have overcome with difficulty and help this woman to name parts of her fears and pray, lay hands on and bless parts of her body as she kind of begins to go into motherhood. So if I could kind of begin some sort of crusade on that front, I suppose that would not be time wasted.
Eddie Rester 32:25
You would probably not get real far. But I think what...
Julie Dotterweich Gunby 32:28
[LAUGHTER]
Eddie Rester 32:29
But you're okay with gender reveals but not good with baby showers.
Julie Dotterweich Gunby 32:33
Oh, yeah, sorry. Yeah. I don't really support either one.
Eddie Rester 32:38
But I think what you're saying is part of maybe our societal amnesia across the board is that we don't do a good enough... Maybe it's because our generations have been split apart. We don't live even in the same town, much less the same street or the same property with multiple generations of our family. So we don't do a good job of talking about what was, what is, what could be. We don't reflect much except in hurried snatches in, about family history even.
Chris McAlilly 33:13
Yeah, I mean, that's part of what I hear is that, you know, there's a fracturing of communities of memory, or you know, that the way in which your wisdom gets carried through time within the context of a community or family, and that's something that could be re-stitched, or kind of there could be re-ritualized.
Eddie Rester 33:31
You think about courage being brought forward, that courage is something you get, I would think, from, in my own experience, from hearing the stories of courage of others. When you think about the virtue of hope that comes because you've seen people who have, whose hope has carried them through. And I love that idea of having that communal storytelling to help women prepare.
Chris McAlilly 33:56
You.
Julie Dotterweich Gunby 33:57
That's right.
Chris McAlilly 33:58
You kind of, oh, sorry to interrupt you, Julie.
Julie Dotterweich Gunby 34:00
No, I was just going to say that there's a parallel to death, right, that death has been obscured from view in the same way that birth is where, you know, I think we have this, it's very hard to hope that you would die especially well, if the first death you're ever at is your own. I think, likewise, with a birth, those birthing women, the very first time that they've been at a birth, they were the ones giving birth. And so that it's something that you've not seen or been around, and perhaps we're not going to change that. We're not going off to the birthing tent at some young age. But to how do you create communal ways of telling stories and of enabling those gifts, both for birth and for death?
Chris McAlilly 34:42
I think so. You've you've said it several different times in slightly different ways that for you, what is really important in this experience is not just giving birth well, but preparing for the experience of being a mother. And that those two things can go hand in hand. Talk a little bit about that, saying yes to birth as a way of saying yes to being, or becoming a mother.
Julie Dotterweich Gunby 35:11
That's right. Like, I think about, the thing that motherhood demands of you in terms of persistence: so, being able to finish a course of action, in spite of whatever obstacles are in front of you, or bravery to not kind of shrink from challenges or difficulties. This wisdom, this ability to remain curious and to have perspective, even when there's kind of this relentless, unsolvable problem in front of you, which just in my experience, like, children fall into that category. And so it is kind of this little microcosm of that, I think, and even if you can't get it all at once, but it's almost like you get this dose or this reminder of what it might feel like to have those virtues. Or this reminder that you have the capacity for it, because you've seen yourself do it once in this difficult way, that in some ways, you can draw forward into the kind of dailiness of life that demands those things.
Chris McAlilly 36:15
So I want to ask you, I mean, because I do think, you know, there is someone out there who's listening who is thinking about this, either as a prospective mother or someone who is currently pregnant or thinking about, you know, in a very personal way, what this experience is going to look like for them. I want to get to that. I want to put a pin in that. But I want to first ask you, kind of, you know that we've been talking a little bit about the virtues that are a part of giving birth, but I guess, as a practitioner, for you, what have you learned about what it means to be a virtuous midwife or practitioner? And what are the things that you're continuing to learn that you would want to highlight?
Julie Dotterweich Gunby 37:00
Yeah, thank you. Yeah. It's funny. This is one of those times where having the pendulum that swung my life, I think, puts me in a position to have a take on this that not everyone shares. And I think some of my practitioners, kind of fellow practitioners would agree with and some might not. But I think there's got to be a line--and I need to further develop this thought--a line between some of what's so, so wrong in American birth, where if we look at our perinatal mortality and morbidity rates, we rank kind of last for maternal mortality among industrialized nations. Our perinatal morbidity, so severe, kind of catastrophic outcomes, have increased by 200%, in the past 20 years, including severe hemorrhages, women needing to lose their uterus, be intubated. I mean, really, that kind of outcomes for mothers and for babies, including low birth weight, we're just not doing a great job on all these markers. And it could be hard to say why.
Julie Dotterweich Gunby 38:00
Again, the kind of standard midwifery answer tends to be like, well, we have excessive intervention. And if we would kind of just intervene less, we would improve those numbers. I think there's some truth in that. But my angle, my way of thinking about that, having worked with so many different nurses and physicians and midwives, is part of the thread that I would want to point to is it's not a matter of like clinical skill. Like, here's an algorithm for when to do a C-section. Here's an algorithm for when you need to have a c-section. This is a time when you have to use an episiotomy. And if you just got the algorithm right, people would interview right and not wrong, and you have better outcomes. It's just not that. Because as practitioners, just like mothers, we're not machines. And this is not an experience that we can kind of automate.
Julie Dotterweich Gunby 38:48
And that what's required to make decisions well, and to kind of handle oneself well in attending birth is this fornices, this practical wisdom and this bodily kind of virtue that, like, it requires character of me to judge rightly, to see what's happening rightly and to kind of, then make the judgment call about how we proceed with a birth. Like I think a lot about if we talked kind of about the greatness of soul or transcendence for the birthing mother. I think a lot about courage and justice for the practitioner so that there's a way that I have to have neither cowardice nor should I be cavalier. And you know, there are practitioners who the nurses will not call them into the room for a decel, for the baby's heart rate having gone down, because the minute the person walks in the room, they're going to say, "Open the back!" and they'll rush back and have a C-section, where if they just leave it for six minutes, let the nurses do what they're gonna do, it's fine. It's a blip on the radar, and it's resolved. But you have this twitchy practitioner who just by their disposition is going to be inclined to over intervene.
Julie Dotterweich Gunby 40:06
Or on the same kind of token, there are people who are so committed to patient-centered care that their language, they no longer kind of will counsel a woman and say to her, "Yes, it will probably be fine, but you're not paying me for probably will be fine. Here, in this case, we need to make a wise judgment. And I know that you do not want a c-section. But we've we've pushed for this many hours. And at this point, I have to say the wisest kind of safest thing for your baby is this." And I just say to someone, the thing that they don't want to hear and to disappoint them, to kind of bear that burden just requires a certain depth of discipline and character in both your temperament and kind of the way that you learn to do that in the job.
Chris McAlilly 40:47
I feel like one of the things that I wonder about is I see healthcare, especially during a pandemic, and especially the range of practitioners who are going into hospitals day-in and day-out and bearing the burden on behalf of all of us, a part of the community of this burden of suffering and sickness and death. I wonder what you would say to church leaders or to Christian communities that are out there, folks who... What do you think the church could do differently to support healthcare workers in the development or the sustaining of discipline and character?
Julie Dotterweich Gunby 41:29
Hmm. That's a very good question. I mean, I think it's a hard conversation to open up. Like we tend to be really proud of our capacity as nurses, or nurse midwives, or physicians, like our capacity to, like, live through some kind of catastrophic outcome or in this case, the grave difficulties of a pandemic, and to just to take it in stride. And so even when you have someone come in and say, you know, we want to ritualize or enable you to mourn or grieve what has happened... I have a friend at a hospital out of state where one of their labor and delivery nurses was giving birth at their hospital on their unit, and died in labor. It was a maternal mortality. And they had in that month, a number, like multiples, single digits of maternal mortality, which is the number on this in the US should be like... should be just infinitesimally small. There's just this catastrophic outcome. And they had arranged for a ritual for grief and for this perinatal counselor to come in and work with the chaplain and talk to the staff. And they had free food, and it was a shift change, and nobody showed up. And so some of that is how do we even have the wherewithal to say, to kind of to name our fragility? Like I think so much of what we need from ourselves and from each other is this ability to rise to any occasion and then go on into the next room and do it again. It's hard to know how you step into that and convince us to come and to do that.
Eddie Rester 43:17
Yeah, I mean, there's a certain sense of, you know, as we talk in the church, about confession, there has to be a willingness to admit there's a need, at some level.
Chris McAlilly 43:28
I think that, yeah, we could have another conversation about that. I wonder if you would just for the young woman out there who's considering the range of things that come with pregnancy and birth and motherhood, any advice or anything that you would say to them in closing?
Julie Dotterweich Gunby 43:50
I love Pam England's book, "Birthing from Within," which is a little bit on the hippie end of the spectrum. But one of the insights in there is, there are three things that you need to know about birth and anybody lies to you if they only say one or two of them. That birth is hard work. It hurts. And you can do it. And no matter how you have your baby, like, all of those things are true. And I have seen women bring their babies into the world in some of the most graceful, unplanned cesareans where what they did was give birth. And there's this way of saying yes to that terror of being wide awake for major abdominal surgery and being helpless as your child is kind of brought from you. And I've seen women do that, with, like, power and grace, that will bring tears to your eyes even when you've done this 1000 times. So I would say to this woman, like, what you are going to do, you can do with greatness of soul no matter what the circumstances are, and you don't have to do it alone. That you need and Lord willing will have someone with you who you can tell you what to do and that points in the road where you don't know. And that you will, at the end of the day, say with the Lord's help, "I have made a baby," which is a pretty spectacular thing to be able to say.
Chris McAlilly 45:12
Julie, thank you so, so much.
Eddie Rester 45:15
Great conversation today. We appreciate your work.
Julie Dotterweich Gunby 45:18
Absolutely. Thanks for having me.
Eddie Rester 45:22
[OUTRO] Thank you for listening to this episode of The Weight.
Chris McAlilly 45:25
If you like what you heard today, feel free to share the podcast with other people that are in your network. Leave us a review. That's always really helpful. Subscribe, and you can follow us on our social media channels.
Eddie Rester 45:37
If you have any suggestions or guests you'd like us to interview or anything you'd like to share with us, you can send us an email at info@theweightpodcast.com. [END OUTRO]