Generation Midwife

Susan Schnur: You’re 29, you went to Oberlin and Stanford for undergrad, you worked at a non-profit in China for three years, largely on H.I.V. and malaria prevention. Now you’re at Columbia University’s School of Nursing, studying to be a nurse-midwife. Help us connect the dots.

Jessica Angelson: I thought I’d have a career in public health, but it wasn’t satisfying day-to-day, so I started thinking about clinical work. I’d always had an interest in reproductive justice. In China, I trained as a birth doula — I speak Mandarin — then discovered that midwifery was a modern profession. A brilliant 70-year-old midwife mentored me. 

S: You grew up in an elite world, attending a well-heeled private school. Doesn’t that class perspective valorize becoming an M.D., not a nurse?

J: Growing up, I didn’t know any nurses. There was an ingrained judgment about what constitutes an appropriate professional choice. If you’re a doctor, people are impressed. “Oh, you have a doctor in the family….” 

I researched obstetrics, shadowed physicians, and despairingly witnessed a culture that objectified women’s bodies and pathologized reproduction. The obstetric approach to a pregnant woman’s care is, “We need to perform X or Y procedure. With these data points, we cut your abdomen open….” 

Instead of normal labor, I saw a barrage of strangers come into a woman’s room, inserting their fingers into her without introducing themselves, without consent, without explaining why they would do such a thing. She’s placed in such a position of non-agency that they make it possible to cut into her vagina without her permission or even her knowledge, to speak to her like a child. 

I knew immediately that this wasn’t how I wanted to be with women. Reproductive processes are not necessarily pathologies, but they may require assistance. I looked at the culture of medicine and felt it was frankly toxic to women’s health.

S: You call reproductive choice the linchpin of women’s lives.

J: When I was 14, I declared I was a feminist. I also had a visceral fascination with the idea that women were growing other human beings inside their bodies. When I went to college, I realized I’d not had a teen pregnancy. Then I made it to the huppah without children. I had access to birth control cheaply and freely; I am continually thankful for this privilege.

This isn’t fashionable to say, but women’s liberty is dependent on their ability to control their fertility. Having a child you don’t want changes everything: educational opportunities, economic reality, relationships you’re forced into, where you live, status in the workplace. It’s the linchpin of all aspects of your life. 

I just sat through a lecture on the hundreds of ways you can control fertility: three types of I.U.D.s; birth control inserted into your fallopian tubes; scores of different birth control pills; birth control for men; hormonal implants. It’s mind-boggling. The ability to not become pregnant is central in the lives of many women and it’s underappreciated. 

S: What’s your ideal midwifery practice?

J: The dream is an independent, freestanding health center with a few other midwives. We’ll be embedded in a community where people know and trust us over the course of their lives. We’ll care for everyone from teenagers to menopausal women. We’ll attend births at the center or in a woman’s home, and follow women for hospital care if there’s an acute situation. We’ll have great consultative relationships with physicians. We’ll play a role in women’s lives: providing education, helping them decide if, how, and when they want to form families. Because of our commitment to providing women with whatever healthcare they need, we’ll do abortions.

S: Any Jewish inflection? 

J: Midwifery has been part of the reproductive justice movement, in which Jewish women have been consistently active. Fully one-third of the students in my midwifery class are Jewish. We think in these terms: What’s critical for women? How do we improve women’s status, women’s lives? Jewish physicians and midwives are disproportionately abortion providers, which may reflect the traditional Jewish view that, particularly early on, a fetus is not a full-fledged, autonomous human being. 

Traditional Judaism is very focused on the body: family purity laws, the very raw nature of circumcision…. Not all peoples are as intensely interested in the body’s goings-on. Claiming our role in this conversation and in modern healthcare is consistent with Jewish women’s worldview. 

I feel very at home as a Jewish woman becoming a midwife. In a different time or place, I might have become a physician, but in present-day America it would be philosophically inconsistent for me. I won’t be Dr. Angelson, OB/GYN; I’ll only make half the money; my choice marginalizes me. The transcendent experience of being with a woman as a midwife makes it worthwhile.