Series 2 Episode 4: Annabel Farry on finding the sweet spot

Transcript

INTRO — You’re listening to Birthing and Justice: a series of conversations about birth, racism and cultural safety. I’m Ruth De Souza. I’m speaking to you from the unceded sovereign lands of the Boonwurrung people of the Kulin Nations. I pay my respects to all the Elders and Warriors who’ve resisted colonisation, invasion and genocide, and to any Indigenous people listening. This land always was, and always will be, Aboriginal land. Today I’m joined by Annabel Farry who’s a third-generation Lebanese immigrant to Aotearoa. Annabel is a lecturer, a researcher and a midwife. She leads the Bachelor of Health Science (Midwifery) at AUT University in Auckland, and is a doctoral candidate. In her research she’s looking at going beyond cultural safety and using critical Te Tiriti Analysis to decolonise midwifery learniang and teaching. She’s married to Moss Te Ururangi Patterson and they have two daughters who they gave birth to at home. A reminder also that parts of this conversation may be distressing for some listeners. So without further ado, let’s start.

 

RUTH DE SOUZA (host) — Tell me, Annabel: why do you care about birth?

 

ANNABEL FARRY (guest) — We need good medicine in birth, and in life, obviously. But we also need a critical mind to understand what that good means, that it’s not… that, you know, we have this system of care where very wealthy women can purchase obstetric services that they don’t really need, and also be given a reasonable amount of that service in the public purse. Whereas we have a number of women in Aotearoa who cannot afford private obstetric care, who are in the public system, and not receiving the level of care that they do need, because it’s been taken up by bodies that really are quite healthy and strong from a lifetime of privilege. So there’s deep, deep inequities in our system. And as a midwife I’m aware that we’re often painted in opposition to medicine, but nothing could be further from the truth. We are arm-and-arm, you know, we… our scope of practices cross over with our medical colleagues. We refer, we rely on their advice and on their expertise. But the system… the way the system works is that often the people that really need the care the most are getting the least care, and the people that need it the least are getting the most. And no one’s winning. Because the… it’s just as harmful to get… over-intervention is just as harmful as under-intervention. So it’s the sweet spot that interests me; it’s the place where we are all working together as a community to actually provide the very best services to everybody. ‘Cause there is enough, it’s just that some people out of fear, use too much—out of fear of pain—and some people, out of, you know, being disenfranchised and not able to access care, they can’t actually get the services they need. Getting too much care I think can be problematic. Sometimes people who are giving birth need a level of control because of fear. And that’s ok, you know, if that’s how… if that’s what’s needed. Sometimes that’s just the way it is. But often times with a little bit more information, and a little bit more encouragement, these people can face in to this terrifying place and actually find in themselves the courage to continue to face… what they saw as terrifying, it becomes much less scary than what they thought it was going to be, but they just need someone to help them along. And that’s why birth matters to me: because it’s an opportunity to keep facing this imaginary fear that’s been built up by, you know, years of media bombarding us with this terrifying thing called birth, when actually it’s our bodies just opening up to a natural journey and it’s quite a opportunity for self discovery. And when we can’t manage, and things are looking not as they should be, then we have our medical colleagues to hand over to and to work with, in order to take it to that next place. Or, if anything has happened in the pregnancy to indicate that that’s required, obviously. But in the first instance, it’s really a beautiful journey to be on, you know, with yourself and with your baby and actually getting to be really honouring in that place.

 

How did you decide that you wanted to go even deeper into trying to transform the system of birthing, by doing a PhD? Can you tell us a little bit about that?

 

We were lucky enough to be able to give birth to our daughters at home. And that was a really… you know a big journey with Māori midwives who helped me understand about letting go, really, and about understanding how to… I was so in my mind I didn’t even know—with my first birth—how to let go, really, and how to be in that embodied place. I was so intellectualising everything all the time, even after eight years of being a midwife before I had my first baby. Well probably because of that, I thought I understood so much. And of course I did; I understood… you know I’d done a degree in physiology and then a degree in midwifery and then practiced for eight years, so it’d been quite a journey. And I thought that I knew what my body needed to do, but I didn’t know that the biggest part of what my body needed to do was actually to surrender. And it was the surrendering that was the biggest learning curve for me, that allowed my first-born baby to come into the world. The falling-in to labour, the letting… allowing the natural forces to overwhelm me, and to actually just let things be what they are in the moment. Until I did that I was just judging and judging, and my midwives were so patient with me, and they knew that I just needed to do it. And they waited and they waited and they waited. [Laughs] And they touched me, and you know they did all the right things. And eventually we, we go there. And then my second baby was just a completely different experience of complete wild abandon, and she just came flying through me into this world. And it was one of the most triumphant experiences of my life. And then, you know, the early years were… I’m talking about their births because, it was a process for my whānau to actually… you know, my Lebanese whānau, my… not so much my Scottish whānau ‘cause they were—on my mother’s side—they were all kind of quite homebirth, you know, kind of au fait with all homebirth and everything that came with that. But for my Lebanese family there was some resistance. ‘Cause my uncles, you know… I have two uncles who are dentists, two uncles who are doctors, and they all kind of… you know, with my first birth especially there was this concern. And that concern kind of continued when we decided to school our daughters in kura kaupapa, or kohanga reo, the language nest, which is set up as a, really… I mean that whole journey of understanding the history of kohanga reo was my next education about things Māori and about Te Tiriti o Waitangi. And understanding, or beginning to grasp the amazing depth in Te Aho Matua o Ngā Kura Kaupapa Māori o Aotearoa, which is an incredible document that outlines the education of a child, and brings in mātauranga and te ao Māori into legislation. And understanding that through… again through my husband, and I have to speak to this here because he took a lot of flack from me, and from, you know, people who didn’t understand in my family that this would be, this would actually protect our children. It was like we were denying them what they would need to be a success in the world. Because my immigrant whānau—and I feel emotional talking about this—but they had to do what they needed to do, you know they had to do it to be the successes that they became. A lot of that had to do with letting go of a lot of what they held precious, you know. And our grandfather knew that he was losing his language in us, you know, and that was a painful thing. Losing your name is a painful thing. But they did what they had to do. But then coming alongside the… I guess, they did what they had to do to succeed, but what Māori had to do was survive. And so for me it actually became clear that this was my children’s birthright to know te ao Māori, or te reo, but that took a lot of bravery from me, it doesn’t… it seems like [laughs] you know my husband suffered through quite a lot of naive tears and probably privileged tears in order to help me come to understand the importance for our children. And I’m glad he did that, because—for their sake—because now what I see as they emerge into young adulthood, that they have a string to their bow. Well it’s more than a string to their bow, they have a foundation to their identity that is unshakeable. Which I never had, actually. You know, I had… I did, I had a very strong awareness of self through my whānau but not through my own family, but not really of my identity, like I’ve struggled with that a bit: who am I, in this place. But who I am in this place, that’s why I say I identify as tangata tiriti, because my children are tangata whenua, and in order for them to have been educated in that way, it’s my honouring of Te Tiriti o Waitangi was, or my understanding of the importance of te reo Māori is… you know it took more than it should have for us to educate our children in that way, it took more than it should have. It took us driving for miles and finding, you know, and overcoming some quite huge barriers that shouldn’t have existed, because te reo Māori should never have been disrespected by our institutions—our learning institutions—in the way that it has been. So it’s a very long story to get to what you were asking me, but it’s all really relevant because my witnessing of kura kaupapa, my ongoing witnessing of kura Kaupapa Māori schooling, is informing my journey into learning and teaching of midwifery at a tertiary level. So it’s a coming together really of what I want for my daughters—not just as young women and going into maybe their own experience of gestation and you know, birthing bodies and everything that that will require in order for them to maintain their integrity—but also their… you know, bigger than that, their… who they are as tangata whenua of Aotearoa, on that level, what will that… you know, what will they need in that respect? I want us as a team of teachers in the school of midwifery here at AUT, to be able to prepare our graduates to work with wāhine Māori, as well as wāhine of all other cultures—and not just wāhine, you know, birthing people—from all marginal and mainstream and everything else, to be able to work with them in a way that helps them maintain their integrity and find that physiological place. And it doesn’t mean that everyone has to have this exultant physiological birth, but it is important that everyone has a right to informed consent. And has a right to know what the decision making that they need to make for their wellbeing, and that the people that are there supporting them have their best interests at heart, and will always listen to what they need; to their smallest voice, their most scared place. ‘Cause we all go there don’t we, when we’re in that place we actually… you know we need someone that’s gonna hear what we’re really saying. And if we don’t have someone alongside us that can do that, then it means that we risk missing the opportunity to really stand alongside someone as they… like my midwives did for me. That they actually let me figure it out. And that figuring out can take a lot longer than what we give time for in our institutions. And the timeframe has got to be questioned, because it’s just… even the generous timeframes are not long enough sometimes. And provided mothers and… like we’ve got this fear of prolonged birth—that’s been a big part of shaping my mindset, is time and embodied time and natural time as opposed to clock time, and everything that that imposes on us.

 

Annabel I’m so impressed with your commitment to tino rangatiratanga, to sovereignty, and to Te Tiriti and cultural safety. And I’m wondering, as someone who’s got a Lebanese background, in a relationship with someone Māori, who’s diasporic, you know, how you kind of position yourself in this kind of landscape of Māori knowledges?

 

I certainly understand the tensions of even being involved in any way in researching Māori when you’re non-Māori. It’s a very… it’s an intrepid space, or… you know , it’s… So my own positioning is super important, and I’ve spent a long, long time—and I’m quite old [laughs]—trying to understand myself before, and who I am. But I’m realising I needed that amount of life experience really to be ready in some ways to actually start this journey. I really understand my own identity now more than ever, as a non-Māori, Brown woman, tangata tiriti, of Lebanese and Scottish ancestry. And my identity as a… you know my husband’s Māori, my children, my daughters are Māori—and identify strongly as Māori—because we’re in Aotearoa, you know, it was not easy but they were able to access their journey, their language and become fluent in te reo Māori which, I’m on a very… also a passionate but infant journey [laughs] of that myself. And so for me I have absolutely no intention of in any way critiquing mātauranga, or even like… it’s not even on my cards! But what I do want to do is just simply make space, and it’s that that I can do because I’ve been in this space of academia now for many years, teaching and learning in the midwifery space, and I do understand how those systems and processes work. So for me, really, all I’m attempting to get to in this research is to actually make way for all those incredible scholars that have already done the hard yards and to just figure out a way that we can actually make the stage way big enough for everybody, but how to bring it in so that we can then let the students have a high, top quality experience of the very best knowledge there is in this space, in a Te Tiriti honouring framework. And I think we can do that it’s just, you know, with the team—it’s not me—and I work alongside many others who come together in this space to talk about cultural safety, and what it means to us as lecturers as well, and as educators, not just our students, but we have to also be ready for these changes. So it’s a wider conversation and that’s what I think I can bring. Because I’m a middle child and because I’m… you know, Myers-Briggs [laughs] said that I’m a turbulent mediator—which I think was quite spot on! [Laughs] And you know I’ve got this kind of place of always being in that… I quite enjoy the turbulence in the mediation kind of area. [Laughs] Because I like the non-closure, I like the unfinished business, and I like to have really in-depth conversations about how we know what we know, who we are. And I don’t expect to be any expert on any level at all, but that’s how I’m trying to position this space. And it’s always, always in collaboration, always, always in research, and always going back to mana whenua to understand and to consult and to say… [laughs] which, I’ve had some fascinating conversations and some amazing, specially wāhine Māori who’ve really set me straight about… you know, and what I always find fascinating in that space is that wāhine Māori are never victims, I’ve never met one. [Laughs] You know it’s always like, it’s a celebration to be in… you know, to be able to give birth, to be able to be pregnant, to be able to be… but even wider than that, to be a wāhine Māori is a celebration. And I think sometimes, yeah, that’s a whole interesting conversation about mana wāhine and I know you’ve had that, I think, in this podcast, in the first series. I really enjoyed the conversation that you had with Naomi Simmonds, and her mahi in this space, which has always inspired me. So yeah, but as an Arab woman—a woman of Arab heritage—I feel that, you know, there’s many, many students that look to me to actually bring my heritage, more and more, you know as our classroom gets more and more diverse, they look to me. They look to me for leadership, because there’s still… in Aotearoa, we still haven’t really come into that space where we’re comfortable with the intersectionality and the racial diversity and how it relates to biculturalism—you know our multicultural kind of classroom. So I bring that. You know that’s a huge part of my identity as well as being in front of the classroom in a way that really honours who I am. And that’s an ongoing journey for me, that I hope to find out more about who I am through my journey with Te Tiriti o Waitangi.

 

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Te Tiriti o Waitangi is important because it’s actually alive and it informs the conversations that we have here in Aotearoa. And it speaks of the space in-between, which I guess many Māori are quite tired of talking to, but I believe it’s a way forward. And because it’s unresolved it keeps giving us ways to talk to each other and bring hope into those spaces, for something better. Dr Heather Came published a critical Te Tiriti analysis tool and she, along with co-researchers have applied that tool to policy and curriculum in Aotearoa. So in this research, myself and a group of midwives are applying it to a third-year midwifery course at AUT. And that group of people includes tangata te tiriti and tangata whenua—so people who are here in Aotearoa by virtue of Te Tiriti o Waitangi, and people who are native to this land, tangata whenua. And we come together in a co-governance framework to try and embed the values inherent in Te Tiriti o Waitangi in our learning and teaching methods.

 

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And those values are whanaungatanga, which relates to relationships, and kāwanatanga which is all about governance and how we come together. And ōrite, around equity, rangatiratanga, self-determination, and wairuatanga, spirituality. Those values are drawn directly from Te Tiriti o Waitangi articles, and they offer a way to kind of more fully honour the physical, the psychosocial, the environmental and the spiritual dimensions of childbearing. So that’s why it’s so important that we get that right and we bring it in in a way that actually allows for the conversations to happen in a tika way, or you know, in the right way, in right relationship to each other. So that we can come up with a… with learning and teaching that actually honours the spaciousness in the conversation—what is yet to be known and understood.

 

You know, cultural safety and Te Tiriti, they’re these things that can be quite abstract. And you’re trying to very hard to operationalise them at the moment, in terms of teaching, and in terms of how your midwifery students practice. Can you tell me a little bit about how this relates to cultural safety, or you know, what the relationship is between these two things, as you understand it, and how it applies to your research?

 

I think cultural safety is essentially about relationship and understanding your relationship to the whenua. And I think that’s for everybody: if you have the ability to express yourself from that place— when you’re of right relationship—you will be culturally safe to those that you come. And that takes a lot of self-knowledge and a lot of self-awareness. So students need to be given the time and the space to explore who they are in the classroom, so that when they go into the world, they actually have done the mahi—‘cause it’s work, it’s not something that just comes easily. Because you have to really question: ko wai au, who am I? That is fundamental to health. Until you understand your own self, you can’t possibly be of help, be of service to anybody else. So we know from like extensive research already, that Māori students do better when they are actually… when they see themselves reflected in the curriculum. And when the people that are teaching them look like them, and that’s another big part of cultural safety. So, teachers need to have compassion for students’ history of colonisation, and discrimination and subjugation, and all those things that put barriers in the way of Māori students, or else it’s not a culturally safe environment. But we also know that non-Māori students, you know from having the… from being challenged to understand Te Tiriti o Waitangi and the history of colonisation in Aotearoa, they actually develop their critical consciousness, and that’s foundational to cultural safety too, and reflexivity. If they’re able to constantly grow and shift and become lifelong learners, they have to understand the depth of the resistance that’s occurred in Aotearoa, really. The depth of what it means to share this nation with tangata whenua, or to have a conversation about how… about multiple ways of knowing, being and doing. That there’s not just one truth. So we know that in practice graduates who actually learn to honour Te Tiriti o Waitangi in its nuance, in its uncertainty, in its living, breathing, non-final beauty, that they have better tools to be transformational with whanau. And that brings them into a solution focus, rather than, like, just seeing deficit and propping up those existing inequities with their kind of ignorant… or bias. So the classroom in Aotearoa I think is starting to grapple with the history of Aotearoa, the mainstream classroom is looking at all of the history of the land battles that have been silenced for nearly two-hundred years. And I think the next step really is that we in the tertiary setting need to really consider the battles that happened over the way that disciplines of knowledge were understood and ordered. If we’re going to have this conversation properly we have to remember that all the official attempts to restrict Māori education that happened in the nineteenth and the early twentieth century with pupils that were, you know, forced to not speak te reo Māori, and there’s evidence to suggest that there were deliberate attempts to limit preparation of Māori students. Ranginui Walker writes about the inspector of native schools who said Māori should be prepared to live among Māori and not to mingle with Europeans, and compete with Europeans in trade and commerce. So there was also the Tohunga Suppression Act of 1907 which actually was trying to outlaw traditional Māori psychology and medicine, and pre-Christian Māori religion which was aligned to the natural world and used to heal and to learn and to grow. And the curriculum was actually… in the native schools was set by missionaries, and it kind of then set in place the formalised colonial structures that exist still, in some respects. [Restrained laughter] But Moana Jackson, who’s a lawyer and a highly respected scholar here, describes the early education of Māori as the midwifing of colonisation.

 

Mmm.

 

Which I kind of… and modernity, which I kind of think is an interesting way of describing this imposition of the hierarchy of knowledge that happened all over the colonised world. So honouring Te Tiriti, I guess it’s not something that you can ever actually achieve. It’s just a long-term process that is kind of a multi-faceted, multi-layered, and it calls us in. And it calls us in to try to look at our bureaucracy, our cultural approaches, our linguistic approaches, and our psychological kind of ways of being with students. And learn to give them up if they’re not serving, and it’s difficult, it’s not ever finished. [Laughs] But it’s time to take the challenge seriously, you know I think it’s really time, yeah.

 

Yeah! And I guess when you were talking I was also thinking about how you make space for this in the curriculum. And how exactly are you doing this? Because I’m aware in nursing curricula, there’s so much pressure on filling it with content, you know, and the more content we have the less time we have for process, which is what I think you’re talking about.

 

Mmm. We have this computer in our pocket, and the knowledge that is easily accessible, we have to know how to apply it. Obviously it’s not as simple as Doctor Google or whatever, but the hierarchy of knowledge is fundamental to our learning, so the conversation is already there. You know, we talk about the hierarchy of knowledge all the time, but it’s just extending that to understand that the hierarchy of knowledge needs to also be a considered space, it’s not as simple as some would have us believe. And that conversation is ongoing, to try to push back, to say how the hierarchy needs to be ordered in order to honour Te Tiriti o Waitangi. And we now have ready access to incredible Māori scholars—really, honestly—who are just like revitalising mātauranga, or Māori knowledge; using the rigorous in-depth like, peer-reviewed enquiry in relation to so many areas that relate to childbearing. Like parenting or menstruation, you know there’s just everything in-between, there’s just so much rich availability, that we’ve got no excuse anymore. There should have never been an excuse, but you know it’s even harder to not go there now. And why would we not go there? Because mātauranga is a powerful, local epistemology, and it’s embedded in the whenua, and developed over thousands and thousands of years in a line to the natural world, which is what we are all trying to achieve. So what an amazing opportunity to do it in a midwifery curriculum, and looking at how we centre… how we utilise, and not just utilise but really respect and nurture and nourish all these things we know as wāhine who have given birth, or want to give birth, about being with out unborn child, about growing our… about listening, deeply listening to our unborn child’s movements. It’s all helped by a more nuanced conversation about tino rangatiratanga, bodily autonomy, about really breathing into what we… the power of pregnancy, various parenting.

 

I’m thinking about how your mahi and those of your colleagues at AUT is really focused on trying to make sure that midwifery education is culturally safe for Māori students. I’m kind of interested in how you might prepare them for the world of practice, and, you know, the kind of experiences they might have that might not be mana enhancing?

 

Yeah, great question Ruth. Currently we start off our degree with a great gusto in this space. And they learn about Te Tiriti o Waitangi, they learn about cultural safety in conversation, on marae, with all sorts of exciting activities [laughs] you know, and speakers. And then we sort of get into the next kind of courses, after that initial start, and they tend to then become—as you were saying—really content driven and really sort of Eurocentric in their ways of knowing, being and doing. And kind of like… biomedically, you know fundamentally about biomedicine. Although we do have a really exciting narrative curriculum that runs through our midwifery degree, which does make space for our marginal voices, but I feel like it’s more like a resistant pedagogy at the moment, whereas we need more like a resistant epistemology that underpins that. And I think that’s where Te Tiriti o Waitangi and cultural safety come in, is to develop that space, that we’re really starting to question how we… but your question is how do we prepare our students. And obviously it’s about having the graduate attributes sorted, so we’re trying to think about: what are those values that we want our students to graduate as to become citizens of the world that have this amazing capability about being with pregnant people who are becoming whānau or becoming families. And so our mana values that we’ve developed are really precious and important to us. But bringing them in requires changing the entire curriculum. And that’s where, you know, we’re on this train hurtling into the future. And things are changing so fast everyday. So we’re trying to start in this one space to look at this in a new way, essentially we… you know it’s a huge change of being—ways of being. And I think we’re making it as a team of lecturers, but I think that our students, once they get into practice, they hit the hidden curriculum. And that’s basically colonisation, racism, privilege and, you know all of the things that students of colour—and particularly Māori students—face. Where they still get asked to change their name to make it easier for their mentor, or they get asked to do the karakia, or they get mistaken for cleaning staff, and you know by other health professionals, and all of these barriers come up with so many stories, honestly, of being… ‘cause we debrief with our students one-to-one, regularly, and they often have tales of feeling like they haven’t got the tools to have these racial conversations. And that’s something that I think we haven’t done well yet; we haven’t really provided those tools in a really practical way. So if we want this kind of racism to stop happening in practice, I really believe that we need to make room for mātauranga, Māori knowledge and theory.

 

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Annabel, thank you so much for this incredible conversation covering your own personal history and how it connects to settler colonial histories in Aotearoa. The issue of decolonising midwifery is crucial for addressing health and equities from the very beginning of peoples’ lives. Thank you for this amazing work.

 

OUTRO — You can find more episodes, transcripts and links at ruthdesouza.com/podcast. I’ll add some more links to Annabels’ work there too, and if you’ve enjoyed this episode, please give us a rating wherever you listen to your podcasts. Next time on Birthing and Justice:

 

NISHA KHOT (guest) — That is the one thing that keeps me going, the fact that no matter where you are, you are making a difference to the one person that you are with at that time. They are giving birth and that experience is something that will stay with them forever.

 

I’ll be talking with Doctor Nisha Khot, a Melbourne-based obstetrician who trained in India and the UK before moving to Australia. Birthing and Justice with Doctor Ruth De Souza is written and hosted by me, and recorded at my home on the traditional lands of the Boonwurrung people of the Eastern Kulin Nations. Sound design and mix by Jon Tjhia, artwork by Atong Atem, design by Ethan Tsang, theme music by Raquel Solier and produced and edited by Jon Tjhia. This podcast is supported by funding from the RMIT University Vice-Chancellor’s Fellowship Program. Thanks so much for listening. I look forward to spending time with you again really soon.

 

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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.