What We Didn't Learn From Yale

Over time, more and more Latinas who were pregnant sought care at the health care center. We became increasingly aware that many of them felt isolated.

They came from a culture in which one experiences pregnancy and birth surrounded by mothers and aunts and sisters and grandmothers. These young women now found themselves in a foreign country at the mercy of a strange medical system, often with only a partner for support.

We began to see how social isolation was contributing to anxieties during pregnancy and to postpartum depression. Poverty and other social stresses exacerbated the challenges these young families were facing.

In response, we began to explore initiating an approach to prenatal care that provides a group context.

The model, known as Centering Pregnancy, had been pioneered at Yale University’s midwifery school. It integrates medical care, education, and support, as women whose babies are due at about the same time meet eight to ten times, throughout the course of their pregnancy. Each woman brings the gift of her pregnancy and life experience to the group, and the result is that they learn at least as much from one another as from staff and providers who are present.

As we began to explore moving to this model for offering prenatal care, we realized that it entailed a paradigm shift.

We providers would need to move away from seeing our role as that of professional health care providers offering our technical expertise and information. We would need to move toward being facilitators of a group process, charged with eliciting the gifts of women who were unsure that they had something to offer.

To make this transition in our self-understanding, we realized we would benefit from recruiting a midwife with experience with Centering Pregnancy.

In the course of acquiring information and training in Centering Pregnancy, we discovered that Beth, a long-time friend of the health care center, was a trainer for the method. Fifteen years earlier, she had offered prenatal education classes at the health care center. Then she went to Yale to study midwifery.

We recruited her to join our staff as a midwife with extensive Centering Pregnancy experience.

Beth had offered groups for English-speaking women and groups for Spanish-speaking women. But we were operating on a small scale and we didn’t have enough women expecting babies at any one time to offer two groups, one in Spanish and another in English.

We considered starting a bilingual group, but Beth and others who had experience with the model were skeptical; they objected that the cross-cultural dynamics and language barriers would interfere with group dynamics. We felt stymied.

According to Matthew’s Gospel, a Canaanite mother once approached Jesus about a need. “But he did not answer her at all. And his disciples came and urged him, saying, ‘Send her away, for she keeps shouting after us.’ He answered, ‘I was sent only to the lost sheep of the house of Israel.’ But she came and knelt before him, saying, ‘Lord, help me.’ He answered, ‘It is not fair to take the children’s food and throw it to the dogs.’ She said, ‘Yes, Lord, yet even the dogs eat the crumbs that fall from their masters’ table.’ Then Jesus answered her, ‘Woman, great is your faith! Let it be done for you as you wish.’ And her daughter was healed instantly” (Matt. 15:22-28).

Despite misgivings, we decided to try assembling a bilingual, cross-cultural group.

At our first session, we began by acknowledging that the subcultures these Anglo and Latina women belonged to probably did not have much contact with each other. But this group of women was forming in order to prepare to receive babies — children who would play together and go to school together and perhaps eventually make new families together. Part of our task would be to begin to form a common community to welcome them.

Our interpreter translated everyone’s words. All the Spanish was carefully translated into English, and all the English was translated into Spanish.

In the living room of the bungalow where we met, the sense of a dominant culture diminished, and we did not have a sense that some people are inside it and some are outside it. We all needed the interpreter’s services. And we discovered that the translation in both directions slowed down our speaking and enhanced our listening and made our responses to each other’s words more thoughtful. These cross-cultural interactions were rich and illuminating.

For years I had tried to promote exclusive breast-feeding as the best way of providing newborn nutrition and good mother-baby bonding. Repeatedly I observed that Latina mothers wanted to initiate some bottle feeding alongside breastfeeding, even during their postpartum hospital stay. Unlike their Anglo counterparts, they did often succeed in maintaining breastfeeding. I didn’t understand why that was so, and I continued to discourage introducing the bottle at least until breastfeeding was well established.

One afternoon in the group’s conversation about breastfeeding, Beth asked the expectant mothers why one might consider introducing bottle feeding.

A Mexican woman responded, “So you have something to give the baby when your milk is bad.”

Puzzled, Beth asked, “Why would your milk be bad?”

The response was, “If a mother is angry or upset, her milk is bad, and she should discard it, until she’s calm again.”

All the Latinas around the circle nodded along with the explanation. All the Anglos looked puzzled. We could understand the link between an upset mother and an upset baby, but we were inclined to dismiss as mere folklore this explanation of milk as a substance (a kind of humor) that could transmit dis-ease to the baby.

As the conversation continued, we began to realize that we medical care providers tended to see breast milk as a nutritional commodity that offers calories, nutrients, and immunity to disease. The Latinas saw breastfeeding as an expression of the relationship between mother and baby, as participating in the dynamics of the relationship. When a mother is upset, continuing to nurse means risking conveying that turmoil to her infant. To nurture her child well requires waiting until her tranquility is restored.

I still don’t recommend that women who are upset stop breastfeeding their babies, but I came away from that conversation with a new respect for the relationship breastfeeding fosters and expresses, a new sense of the way mother’s milk, such an ordinary substance, can be infused with extraordinary qualities in the context of a calm and nurturing interaction.

The Canaanite woman met Jesus in a high-stakes encounter. The wellbeing of her child was at stake. For Jesus, too, it was a moment of risk. Reluctantly he let her persistence, vulnerability, and faith draw him from refusal to eagerness in offering his people’s food to one outside his circle of kinship and ethnicity. Through his conversation with her, through entering into her experience, his own sense of his ministry was transformed.

In centering groups, from our first cross-cultural circle conversation on, hearing one another’s perspectives and stories has again and again enriched and moved us.

Cultural diversity had seemed like a barrier to prenatal care, a strain on our logistical resources. Instead that very diversity has become a vehicle for learning at a deeper level and building a more integrated community.

Instead of creating a context for learning about pregnancy and childbirth, we now make space in which staff and women, Anglo and Latina, can encounter each other in perspective-altering, even life-changing—ways.

Our reluctant embrace of a change in model has, through the faith of those who have participated so generously in the conversation, made all of us more whole.