Mimi (Paulomi) Niles, PhD, MPH, CNM, is Assistant Professor/Faculty Fellow at NYU Rory Meyers College of Nursing. She is a theorist, educator, researcher and certified nurse-midwife. Her work explores the potential of integrated models of midwifery care in creating health equity in historically disenfranchised communities. She is trained in utilizing critical feminist theory, as theorized by Black and brown feminist scholars, and qualitative research methods as a means to implement policy and programming rooted in intersectionality and anti-racist frameworks. As a researcher, she hopes to generate midwifery knowledge as a tool to build equity and liberation for marginalized and minoritized people and grow the profession of midwifery in the US. She grew up in Queens, NY – the proud daughter of immigrants, has lovely two children, and honors her mother’s legacy as a nurse-midwife in India.
Notes:
Mimi kindly donated her speaker fee to Ngamumu (For Mothers) a creative and cultural project that supports mothers and their babies during the first 1000 days.
Follow Dr Mimi Niles on Twitter at @mi_niles
Read more about Mimi’s work here
Transcript
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RUTH DE SOUZA (host) — Doctor Mimi Niles, who I’m so excited about talking to, has described health care as a very large, vast, deeply problematic institution. It’s a sentiment and an observation I share—I care about this; I care about it deeply.
MIMI NILES (guest) — I said ‘What are you and who are you?’ and she said, I’m a midwife. And then it was almost like, you know in the Matrix when everything kind of lines up and you walk through the portal? It was almost like everything went ch-ch-ch-ch-ch. And then it just became clear, like this is what I need to do with my life. And so I just did everything I could to figure out how to become a midwife.
So excited to welcome Doctor Mimi Niles to the podcast. Like me, Doctor Niles is the daughter of migrant parents. She grew up in Queens, New York, and this experience has led to the belief that every sort of disparity and inequity plays itself out in the bodies of Black people in the United States. This is Birthing and Justice with Doctor Ruth De Souza: a conversation series about birth, racism and cultural safety. Mimi, thanks so much for being with us. It’s so good to have you.
Thank you so much Ruth.
[music fades]
Mimi, please tell me: why do you care about maternity?
I care about birth and birthing people, and people with the capacity to birth, because it is one of the most human experiences that anyone can go through. It is a portal, it’s sort of like an expressway portal to meeting your truest self, meeting your own humanity, and for me—because of who I am and what I believe in—it is a privilege to be a guide for people.
I’m really interested in how you came to have such a powerful understanding about bodies and histories in the US, particularly around African-American women?
Mmm, well, I mean, I came into the understanding through my own body, I would suppose—living in a Brown body in America is a serious crime apparently. [Laughs] It’s, you know, it’s a criminalised body, it’s a pathologised body, and I came with my immigrant parents to America, and so I have a lived understanding of exclusion. I grew up in a predominantly Black neighbourhood. My father, when he immigrated, was a physician trained in India, but he had to repeat his training here in the States because of all the gatekeeping. My mother was a midwife in India and she wasn’t actually able to practise in the US because of… you know there’s no pathways for midwives trained in other countries to practise midwifery here without repeating their schooling, and that just wasn’t a possibility for my mother. So we lived in a predominantly, I would say, Caribbean West Indian Black neighbourhood in New York city—that was the hospital system that my father got hired into—and that was very normal for me to be in Black communities as a child. And I mean, I was the one who was not Black, so I was the one who usually stuck out.
And I think the thing that really interests me about what you’re saying is how you access this understanding through your own body of… how bodies are pathologised, how bodies are surveilled, how bodies are managed, particularly in public spaces. And I’m kind of interested in how you have the capacity to think beyond your own abilities and understandings, to have a broader understanding of what it’s like to be even more marginalised and even more surveilled. And this politic is really interesting to me because I think so often, so many people are consumed by their own identities, and then find it difficult to extrapolate understandings of social justice beyond that. So Mimi, how did you develop an understanding of the social determinants of health?
You know for me it’s not a linear understanding. So it’s not like I started with my own internal understanding and then that sort of blossomed in some ecological movement outward. I think it’s always sort of… I think of it as like a spiralling movement of the constant sort of internal reflection and the external reflection, and seeing both the sociological world mirrored in my own experience. And then being so confused [laughs] by a lot of the experiences of people, as you said, who are more marginalised and more minoritised than I am because of, I would say mostly class privilege, and skin privilege, that I think I’ve always been searching for other ways of understanding and grappling something that was so inherently unjust to me. Not just from the way I was treated, but even the way my mother was treated or, you know… and then once I became… prior to becoming a midwife I was actually an educator, I was a high school teacher. And so I think there was always an internal drive to be with people and serve people who were experiencing almost greater injustices than me. I think the training and the education I got and chose for myself were really aligned with this curiosity and this also kind of inner rage [laughs] at, you know, these really profound global injustices that I thought, ‘Well if there’s anything that can teach me about why things are the way they are, and if there’s any kind of work that I can do to sort of somehow correct some of the off-coursing that is happening…’ and for me midwifery was the place where that kind of lined up.
And did your mother’s kind of background as a nurse midwife in India influence that coming to midwifery? Did you feel you could make more of a difference than through teaching?
Yes and no, you know, I’m… you know, I don’t know. For Indians in America becoming a physician is very, sort of the epitome of status and prestige and financial wealth, and so that was always a part of my familial, you know, indoctrination of like ‘You need to become a physician no matter what; you have to become a physician.’ And as I was in college and taking sort of pre-medical courses, it was just so clear to me that I was so deeply unhappy, and it just was not in alignment of what I wanted for myself. And so I majored in Comparative Literature, and if you know anything about Comparative Literature, it is… it starts from the ethos of, you know, sort of the remnants of colonisation and what impact that had on sort of a broader literary field and the political field and sort of the… you know, the consequences of all those. And so it was like the perfect place for me. And my mother… although, you know, I grew up, my brother and I—who… my brother is a physician, so he has lived out my parents’ dream… [both laugh]
Good!
…which kind of took the pressure off me too, in a way. But my mother, you know, at the dining room table, she would tell us stories about, you know, all the births that she attended in India, and she worked in rural India. She worked for UNICEF [United Nations Children’s Fund] and she worked, I think at the tail end of like, Indira Gandhi’s reign. So, you know, there were just these really wild, but very vibrant and painful stories of women having their thirteenth child and like bleeding and bleeding and bleeding. And, you know, as a kid my brother and I were like ‘Oh mom, that’s so disgusting.’ [Laughs] But they must have wired something into my DNA, because it wasn’t until I became a high school teacher and I thought ‘Oh my God, this really is not it for me either,’ because it was just so much sort of classroom management and all that kind of stuff. And I really just wanted to go and teach, you know, teach E.E. Cummings, and Toni Morrison, and Gabriel García Márquez, everyone that I loved, I wanted to bring to the classroom. And I worked with children who, you know, were coming from abject poverty. They were not… this was not on their radar, you know, they just wanted to be in a safe room for two hours with me and be themselves, and so, you know, that part of it I think has remained, my commitment to create safe spaces for people. But what I really thrived on was the intimate, personal connections with people, really hearing people’s stories, really hearing people’s life stories, their narratives. And when I was twenty-three I became pregnant and I had an abortion and it was with the midwife—the person who did my intake was a midwife—and it was the most connected, grounded, thoughtful, meaningful healthcare exchange I had ever had. And I remember looking at her and I was definitely in a vulnerable place—I was living alone and I was having an abortion; I was with a person who was not kind to me—and I said ‘What are you and who are you?’ and she said, I’m a midwife. And then it was almost like, I just did everything I could to figure out how to become a midwife.
Oh wow, wow! What a story, Mimi. And also just showing how, you know, one conversation can be utterly life changing. And I could so relate to what you were saying about the doctor, because I remember when I said to my parents ‘I’m going to become a nurse’—I’m from Goa in India, you know—[laughs] and they’re like ‘Why don’t you become a doctor?’ you know? And so now I laugh because I say, ‘Well, I’m a doctor nurse,’ you know, and like you’re a doctor midwife, so that’s kind of… it’s kind of hilarious. And my sister became an anaesthetist, so that kind of took the pressure off, so I can relate to a lot of your story. And I’m really interested in what it’s like to be a midwife in the US like you are, where midwives are really primary providers. And I think it’s something like, out of a hundred births, only ten or twelve… ten to twelve will be attended by a midwife, and nine out of ten of these midwives are white. I’m really interested in what it’s been like for you being a minoritised, racialised midwife?
You know I think again, you know, I mean I think we have to really, very… Given the moment in time we are in in the US—we just had a massacre of Asian women in Atlanta, Georgia—and I would say that we’re almost an invisible minority group here in the US for many different reasons. And in some ways I think we invisibilise ourselves as well to kind of fly under the radar of what we see as the violence against Brown and Black and other minoritised people. And so I think it’s a protective mechanism that we partake in as Asians. And then we really kind of pursue, I think, things that will bring wealth and will bring prestige, and the doorways are more open to us. Because in America, there is a lot of pitting of different racial groups against each other, with always sort of… you know the comparison against Black people who have a very deep and long history here, a violent history here, of enslavement that no other immigrant body can compare themselves to. And I think often immigrants are settlers. I know, as they say in Canada, we’re modern settlers, we can never understand what the history of that experience is. And I don’t think our education system is very thoughtful in teaching us what that reality is, right? And so I think Asians are really pitted against, in some ways Black people, and told ‘Well look what you, look what your group has achieved, and look what your group is able to do,’ without this sort of historical, or very apolitical understanding of what it means to be like, melanated in this country, and how it’s not all…
Absolutely!
it’s not all the same for everyone, it’s very stratified, it’s very malevolent the system, you know, and there’s like these written rules and these unwritten rules, right? and you’re constantly trying to figure them out. I think midwifery is no different, because midwifery is a institution in the US that was brought here with enslaved… with the knowledge that enslaved communities brought with them, right? And so there was a… there’s a long history of grand and Black midwives in the US that was really decimated by the professionalisation of nursing, I would say.
Yeah.
And physicians and the public health institutions that really wiped out Indigenous ways of knowing, Indigenous ways of healing, and any kind of Indigenous knowledge was just… was decimated. Midwifery is that to me, it’s a very ancient profession, we’re older than nurses. I know I’m in a nursing department…
Yes!
and , like, agitated. But we’re like as old as human civilisation—there’ve always been midwives in communities that did not just attend to birth, but they were really sort of the community wise women who also attended to death and illness and abortion and contraception. And so now I feel like midwives in the US are clawing our way back to that, with the wrong tools, because we are trying to be apolitical and atheoretical and ahistorical, and it is not serving us in any way. And it’s a very fractured profession in the US.
Mimi, I’m really excited about the way you talk about this history, because I think one of the things that makes midwives politicised is they’ve created a separation between medicine, biomedicine and midwifery in a way that nurses haven’t. So you’ve already automatically got this critique that’s embedded in your practice. You’re really clear about the ways in which white supremacy has set up these competing others, and you also try and disrupt that. I’m wondering how racism and bias look in maternity care in the US in this very, kind of, corporate, industrialised system, and whether you could explain that?
Oh my god, I feel like it will take a lifetime for me to understand it myself [Ruth laughs], because I think when you have a sort of… an inner sort of justice compass, nothing makes sense actually—none of it makes sense, you know? And so sometimes I feel very naive, because using the feminist, particularly a Black feminist logic, that it’s really the system that needs to be critiqued and dismantled, right? That a lot of times what happens, I think, in the US conversation around racism and gendered depression and classism, is it sort of stays very… it stays at the surface level. And so really—and I don’t know if this is like… this is how it is as well where you are—but it stays at the interpersonal level. And so it’s, you know, a lot of like, ‘I’m not racist,’ or ‘I did an anti-biased training,’ or ‘I did an implicit bias training,’ and a lot of the rhetoric around implicit bias comes from academics, you know, who are looking for this very kind of white glove approach to something that is very inherently messy, bloody, violent, just covered in faeces. [Laughs]
Yeah!
Like it’s a very dirty, dirty, shameful thing that has happened in the US. And so in the maternal health system, you have very little access to choice, you have no universal health coverage, you have very limited health coverage. So for example, even if you have public insurance for your pregnancy, you only get covered then thirty days after you’ve had a child, right? Some of those laws are changing, but you know, they’re not universal, you don’t have universal coverage—I don’t care what anybody says, it doesn’t exist. And we know that most maternal deaths happen, sixty percent of maternal deaths in the US happen in the postpartum period. And if you’re not covered in that time, you’re more likely to experience morbidity and mortality events. We know that the workforce is not diverse—as you mentioned it’s a very white workforce—and there’s not universal midwifery, so midwifery is not the standard of care for most people. And so the model is not the standard model for most people, the relationship-based model, the autonomy-based model, the shared decision-making model—it’s not the centre of what drives maternity care.
I think for me, part of the problem has been around how embedded Liberalism is in midwifery and maternity. So what happens is there’s this idea that if we’re being nice, everything will be fine. You know, ‘We’re nice people, we treat people well,’ and there’s a lack of recognition that injustice is built into the very foundation of systems, into the ways in which we work and so on. And in the US there’s a deeply racialised maternal health crisis, and Black women particularly are three to four times more likely to die of a childbearing complication. And I’m kind of wondering, you know, amidst all this adversity that you’ve kind of described, and all the obstacles, how do you start to shift the harm that has been caused to Black, Brown and mixed-ethnicity birthing people?
I think the solutions and the exemplars and the champions are the people who’ve reclaimed community logics and community models, and who have decentralised health. I would say that that to me is where you’re going to see shift. We know that Black people and Indigenous people and other minoritised people are excluded from institutional access in general, that could be—fill in the blank, what institution do you want that to be: healthcare, education, justice system, housing, you know, I mean, any kind of… it’s a do-gooder profession, particularly nursing I think is really… that’s the ethos. You know, I mean, I don’t know if you educate, you know, young midwives, new midwives—sorry, nurses—they are the most tender, gentle, kind hearted, you know, [laughs] nineteen year olds that you will ever meet, with a real kind of pure intention of wanting to help and to serve, and the system will very quickly chew you up and spit you out, and almost rewire your brain [laughs] and your heart, to give into the needs of the system, to feed the system, to make the system run efficiently, to cost save for the system. And you don’t even realise that you’re doing it. This is like you said, the systems were not designed to include any of us that don’t fit this sort of model of, you know… And even if you look at research—clinical research—the default in maternal health is white women—all of us are compared to white women. And so there’s no textured, thorough, thoughtful understanding of what it is, what we’re facing, especially for Black and Indigenous women in this country. This is generations of weathering, and generations of deprivation, and generations of also resilience and grit.
Absolutely Mimi. As I’ve been listening to you, I’ve also been thinking about how, you know, we develop in these beautiful young nurses, we beat out the tender heartedness, and what happens is we have systems that are full of callous disregard for humans. And that’s why your work is such a beacon for me, because [of] how you keep your heart very present, not just your brain. And I’m wondering how you’ve had this warm heart, while working in a public hospital during COVID?
Oh I don’t know if it’s warm anymore. [Ruth laughs] You know I have a very strong spiritual centre, and spiritual core and a spiritual practice. And it’s interesting, I always hesitate to talk about it, even as you asked me, you know, that other voice in your head that’s like ‘Should you talk about this?’ But I think I promised myself I would talk about this more, because it is a very grounded… I am a Buddhist practitioner and an engaged practitioner, so it’s not sort of sitting on a cushion without any purpose; it’s sitting on a cushion with the purpose of bringing more connection and more justice and more equity and equanimity into my life, and, you know, everyone around me that I’m connected to, in ways that are big and small. So sometimes it’s someone I’m sitting on the train next to, as I go to work to the hospital, filled with dread, because you know, you never know what you’re going to encounter on the floor, especially during these COVID times. It was really so unpredictable and unknowable what each day would be like. Also, this sounds so silly, but when you wear all the mask and the suit and, you know, the face shield, it sort of… you get a little less… you get more distal, I feel like, from the people that you’re taking care of. So I had to warm up my heart even more, [laughs] I feel like.
Yeah!
Because the connection to me during the labour and the birth process is medicine.
That’s so beautiful Mimi. I’ve got one last question before we wrap up. And you describe yourself as having radical political integrity. What would you like to accomplish in your own career or lifetime, and what might help you do that?
Oh, this is a question I’ve been asking myself so much lately. I’m kind of in a transitional space as a human and as a woman. To me radical, I take the original route, you know radic-, and which is to get to the root of the thing, you know. I can’t help but think of potatoes when I think about roots. [Laughs] So, for me, I think as I get older it becomes more and more about being in relationship to community, and being in authentic relationship to whatever community I’m with. So even, for example, in midwifery, I think I’m gaining a reputation [laughs] of being a disruptor, a little bit, of the status quo, and I’m finally getting comfortable with that because I think American midwifery has a lot to do and a lot to learn and a lot of truth telling to tell—a lot of truth to be telling—and a lot of reckoning that needs to happen. And because of this culture of nice, it is… I need to see it happen in my lifetime, you know. And I’m not going to let this sort of politic of nice dictate and determine where I’m going to take this work. Because this work is not about me, you know. It’s nice when someone from across the world, you know, reaches out over Twitter and you know, there’s a connection there, but this is about the people that I take care of, you know, that I want them to have the same freedoms and joys and vision for themselves as I get to have, you know, or you get to have, or… and it’s just not that right now.
[music plays]
Mimi, it’s been such an amazing morning talking with you here. I’m so humbled by your community accountability, your integrity with yourself, your commitment to the people that you work with, and the next generation. Thank you so much for sharing your insights with us. And people who are listening, you can find out more about the work the amazing Doctor Mimi Niles is doing by following her handle on Twitter, and it’s @mi_niles. Thank you so much Mimi.
Thank you so much, Ruth. I look forward to building a relationship with you.
OUTRO — This has been Birthing and Justice with Doctor Ruth De Souza. We’ll be back with another series of conversations soon, but in the meantime please share these episodes and send me your feedback and suggestions for future topics or guests. You can reach me at my website, http://ruthdesouza.dreamhosters.com. Special, special thanks to the amazing Simon and his puppies for sound design and mix. Thank you Regan McKinnon, amazing artwork Atong Atem, design Ethan Tsang, title track by Raquel Solier and fabulous producer and patience-of-a-Saint person, Nicola Harvey at Pipi Films.
LINKS & RESOURCES:
–Find Mimi on Twitter @mi_niles
–Read more about Mimi’s work here
END NOTES — Audio transcript edited and designed by Abbra Kotlarczyk, 2022. Note: the purpose of this audio transcript is to provide a record and pathway towards accessing all Birthing and Justice conversations. Editorial decisions around the omission of certain words and non-verbal utterances have been made purely for stylistic purposes towards greater legibility, and do not infer a desired ethics of speech.