Published: May 19, 2021
We recently sat down with Jemma Nonog, CNM to learn more about her path into midwifery, what drives her every day, and how we can all help ensure better health outcomes for our patients and communities.
The month of May also happens to be Asian American and Pacific Islander Cultural Heritage month. Heritage month celebrations are important in providing the space to teach and learn about cultural history, and to examine the way in which these cultures are viewed within American discourse.
My path in midwifery was long and windy. My parents wanted me to be an engineer, as I was good at math and I come from a family of engineers. However, I always felt a calling to help people. After witnessing poverty and health disparities in the Philippines--including family members pushed into poverty because they couldn't pay for medicine--I knew my heart belonged in health care.
One year out from graduating and studying for my MCATS, I got pregnant and had a preterm baby at 33.5 weeks. Sadly, I fell into the same statistics we hear about pregnant individuals of color where the rate of preterm birth in the U.S. is highest for Black infants (14% ), followed by American Indian/Alaska Natives (11.7%), Hispanics (9.8%), whites (9.2%). While the Asian/Pacific Islander preterm birth rate is 8.8%1, disaggregating the data shows the rate for Filipinos is 11.7%.
Although it was a rough start with my daughter in the NICU for two weeks, that's where I learned how the nursing philosophy differed from other practices, centering on a deep relationship with patients, empowering families, and providing holistic care.
I graduated a year later but started work right away, landing in medical administration. After three years of saving money for school, I pursued nursing to become a neonatal nurse practitioner. My heartstrings were pulled seeing babies smaller than mine and their complications. Serendipitously, I worked as a nurse for NeighborCare’s midwifery practice. After three years at NeighborCare, working with immigrants or low-income families who struggled from the similar systemic racism in the United States my family faced, I saw midwifery as my calling.
My experience at NeighborCare showed me that by partnering with patients, we could create spaces where families could begin or continue to heal from trauma they endured. In some of life's biggest transitions, nurses, midwives, and clinicians can sit with their patients and say with confidence, "I know this is hard, but you can do this. I believe in you.” One of my goals is to wrap our patients in all the resources they need to succeed.
Ultimately, midwifery is a marriage between art and science, where we get to treat the human aspect of perinatal and/or gynecological care. We want to reduce trauma in that intimate and vulnerable space. Whether it's giving birth or receiving a pap smear, we acknowledge that we work with parts of the body that were historically traumatized for many people of color. I hope to give patients back the respect of their bodily autonomy. And through that, build trust between our Asian and Pacific Islander (AAPI) communities and the health care system.
I love that I get to build a relationship with people.
Years later, I still receive photos from families we've helped and hear how we made a difference in their lives. I love having an opportunity to help people re-establish faith in their bodies and can rally support around them in this magical way.
We've all heard about disparities in health care, how black women die in pregnancy and childbirth at higher rates than their white counterparts, or how Pacific Islanders don't have access to breast and cervical cancer screenings. There's been significant harm done through health care in these communities, specifically through the colonialization of Pacific Islanders in the U.S. for economic growth (trade routes) and militarization, resulting in the loss of home and health in indigenous populations. Although the United Stated promised health care and education, it was either revoked or unfulfilled.
This position gives me a chance to work with my Asian American and Pacific Islander community—figure out what they feel is important, identify what resources they need for a healthier life, and help them on a path to healing. We've gone astray by telling our patients, "this is what you need to do," and ending the conversation there.
What can we do?
When approaching individuals from the AAPI community, it's likely they already know what needs to be done. We need to build trust and develop trustworthiness. Our traditional approach to treating the patient is rooted in a patriarchal, white supremacy culture approach. To change it, we must start identifying how this is expressed in our interactions. We can be ethical and justice-oriented by partnering with our patients and understanding their communities. And that's what's so beautiful about midwifery; we have a long history rooted in partnering with our communities.
The first step, especially in maternal health, is to learn about informed consent through an anti-racist lens. Our BIPOC communities have lacked access to a truly ethical approach to medicine, where they're given all the information they need to choose and are reassured that even if they decline—they'll still receive excellent care. That we recognize we may not know everything. A power dynamic occurs in medicine (when we make plans or recommendations) that we must acknowledge and remedy. By approaching medicine as a partnership, it returns power to the patient, which is precisely how we regain trust. Research shows that PTSD can emerge from health care trauma, and the pivot point shows that it transpires when invalidation occurs; as midwives, we're taught to be empathetic listeners.
Secondly, we must look at our processes and break them down – perhaps parts of our system aren't easy to navigate for a non-native English speaker. With this in mind, the next time we're tempted to consider a patient non-compliant, pause and consider their fears or the process as they experience it. In this way, we make sure we're not shunting the responsibility on the patient unfairly or perpetuating an injustice.
I strive to validate what people are going through. For example, Asian and Pacific Islanders have minimal access to cancer screenings (breast and cervical). But we can change that when we approach our patients in a culturally sensitive and thoughtful way to identify barriers and validate their concerns. We have a chance here to decrease health care disparities just by altering our approach and being aware of how we practice medicine.
Lastly, we must take a hard look at the diversity within our clinical teams. Cultural congruence has shown to improve outcomes, and we need to invest in programs that support young aspiring clinicians of color to overcome the barriers systemic racism puts in place. At Kaiser Permanente Washington, we have our very own health care pathway initiative to nurture Indigenous, Black, Latinx and Pacific Islander students into entering post-baccalaureate health care degree programs.
What does that look like in midwifery?
Kaiser Permanente Washington offers the Centering Pregnancy program in Capitol Hill. Taking place in a prenatal group, everyone is engaged in health screenings, supported through midwife-facilitated discussions with the same cohort of future parents throughout their pregnancy, with in-depth perinatal education each step of the way. Data shows this leads to increased healthy birth weights, increased rates of chestfeeding, reduced risk of preterm pregnancies, and a reduced risk of gestational diabetes.
Our practice also goes beyond pregnancy and childbirth – offering a vast array of preventative care. This includes adolescent sexual health, preconception care, prenatal screenings, menopausal care, and physical exams. As midwives, we also play a pivotal role in preventative health visits to partner with and empower AAPI communities with the knowledge they need to reduce known health disparities such as cervical cancer, breast cancer, and STD screenings.