Diversity in Birth

Male midwife John Fassett is an extreme rarity in the profession. Here, he shares his experience navigating the gender gap in midwifery.

Photography by Smeeta Mahanti

John Fassett has long blazed a trail as the lone male in a female-dominated profession. He was the first man to specialize in obstetrics as a nursing student at the University of San Francisco, and he was the first man to matriculate at the University of California San Francisco nurse-midwife program in 1992—a time when the school motto read “Women Caring for Women.”

Today, he is one of only about 100 male midwives practicing in the United States. Men in the profession are shockingly rare, comprising just 0.6 percent of 13,000 nurse midwives certified by the American College of Nurse-Midwives, according to a 2008 review by Vanderbilt University.

It’s a surprise to most that male midwives even exist. The word itself is a bit of a misnomer—conjuring a portrait of a gendered profession where experienced maternal types guide their fellow sisters through a natural birth. The term midwife, however, is derived from the Middle English term “med wyf,” which translates simply to “with woman,” and makes no specification for gender. Yet it’s been a historically female trade.

So when people find out that Fassett, 55, is a midwife, they’re understandably surprised. Take the time he settled into his airplane seat for a flight from Texas to California, and ended up helping the nervous new mother next to him to breastfeed successfully. “20 minutes into the flight, and she was still trying to get the baby to latch on, and I finally I couldn’t take it anymore,” Fassett says. The baby stopped crying, he apologized for being a little forward, and then they talked childcare for the rest of the flight. “I’m so comfortable with what I do that I don’t even think it’s unusual,” he says.

Fassett might be a rarity in his field, but after two decades as a practicing midwife, the past 16 as part of an 11-physician clinical group at Sutter Pacific Medical Foundation at California Pacific Medical Center, where he oversees 120 deliveries per year, he’s also busier than ever. Midwife-assisted births are on the rise—they’ve increased each year since the Centers for Disease Control started tracking them, reaching 8.2 percent of all births in the US in 2013, according to the American College of Nurse Midwives. As public interest in midwife-assisted hospital births grows in tandem with studies confirming their good outcomes and low rate of birth interventions like C-sections, the traditional portrait of a midwife as a young, white female might evolve as well. The ACNM ethics committee recently created a task force to boost the diversity and inclusion within the field.

In other countries, midwifery is a more gender-neutral profession, says Julio Diaz-Abarca, 46, a San Francisco-based certified nurse midwife who completed his training in Chile before emigrating to the US more than 20 years ago. “Of the 40 students in my class, 15 were men. But here, it is a really, really low number,” Diaz-Abarca says. “There are far more men working as midwives in Chile than there are here.”

By contrast, Fassett’s domestic midwifery training was challenging. Because of his gender, he faced discrimination, uncooperative classmates, and questions about whether he even deserved a spot in the UCSF program. “I don’t think a man wakes up one day and says, ‘I want to be a male nurse midwife.’ Dealing with the issues of getting into a program, proving myself—women don’t have to do that. They don’t have to defend why they’re there. I got a good dose of what women go through trying to be in a profession where it’s mostly male dominated.” But he’s doing exactly what he wants to be doing.

“Midwifery is this amazing process where you get to watch the baby grow, and you get to participate in the entire whole growth process, and then you get to be in the room and watch this magnificent miracle occur. That’s what it is for me. It’s a calling.”

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Want to know what it’s like to be a man in a woman’s world? Here, John Fassett shares his experiences becoming a male midwife. Responses have been edited for clarity.

How did you get into midwifery?

I had no intention whatsoever of getting into women’s health. But when I was in high school in 1976, I went to my sister’s graduation from nursing school, and I was impressed by the camaraderie. So I went to nursing school with the idea I’d be a pediatric practitioner. Then in my senior year, I entered a lottery to specialize in a field, and of course I didn’t get pediatrics, which was very popular. My other options were general medicine, which I didn’t want to do, or obstetrics, where not a single man had trained. I thought I could fight for obstetrics and they would just switch me into pediatrics if I were lucky. So I went to the dean, and because I was male, she said, “You’re not doing obstetrics, you’re doing general medicine. That’s just how we do it here.” On my own I went to the faculty representative, who happened to be the lead for the obstetric rotation, and she told me I would be the first man she would train. And actually, I loved it.

Shortly after nursing school I joined the Navy. When I showed up for my first duty station, they put me in maternity. I kind of found my niche there, and after six months, they put me in labor and delivery. It was much more specialized—just one registered nurse, two technicians, and two female physicians. It was busy. We did about 150 deliveries a month. Then I got out of the military in 1986 and was trying to find work in labor and delivery, but I couldn’t find a job in San Francisco because no one would hire me as a male. My mom one day just said, “Why don’t you just go to county?” So I called and asked to speak to the manager in charge of L&D. Whoever the woman who answered the phone was asked, “Are you an RN?” and I said, “I am.” She said, “Hold on,” and all of a sudden I got transferred to the manager and she says, “Trained in labor and delivery by the military?” “Yes ma’am.” “Four years L&D?” “Yes ma’am.” And she said, “Can you work tonight?”

Nurse midwifery only became legal in California in 1978, and you were the first male in the graduate program for midwifery at the University of California San Francisco in 1992. What was that like?

It was hard. My very first day, it was 11 women and one man—me. I’m hearing about everybody’s issues about men, and it was overwhelming for me. They made me feel like I shouldn’t have the position that I had. Midwifery has traditionally been women caring for women. That was the program’s motto. But there is no gender association with the term midwife—that’s something that history has done. And by that point I had been in labor and delivery care for 10 years, so I had to voice that I’d done my time at the bedside.

I already knew a couple of the L&D nurses, who were supportive, but then I had faculty members who were not supportive. By the beginning of my third quarter, I was just done with the whole thing. What actually did it for me was being accused of plagiarism. As part of a research course, I was in a group project, and the two women in my group didn’t want to meet, so finally I just wrote up our project myself and turned it in. But they had made a copy of it and just changed the first title page and put their names on it. Remember this is before computers, so it was clear that my particular word processor was the original. I said, “You know what? I’m done.” And I actually quit. Then all of these students rallied around me and said, “Look, we know we’ve been shitty. We’re going to support you.” And I got through the rest of the second year, because of them. We took care of our own. It was great.

What is your role as a midwife?

I deliver babies, I help moms get babies on breast, I sometimes assist during C-sections, but the majority of what I do is teaching. I teach all day long. I’m there to check in, I’m there for safety, I’m there to help manage labor, and if we come to a fork in the road, my experience will help guide us through the next decision. It’s a lot of the education aspect of the nursing. Some of my visits are a little bit longer—I try and make sure that I meet all the expectations the patient had when they came in that day. I’m not going to be in the room throughout labor, but I do tend be in the room for the majority of the pushing.

What effect does that attention and education have on your patients?

Last Saturday I got a call from a nurse about a patient who had been there for an hour and a half, and the on-call doctor had recommended giving her some morphine and sending her home, but she was my patient and wanted to see me. I walked into the room and the patient was like, “Thank God. Nobody is listening to me. I don’t feel comfortable going home, because I really think today is the day that I have my baby.” I said okay, and asked if I could examine her. The nurse let me know she had been examined 45 minutes ago, so I asked the patient if I could examine her again. Her cervix was completely effaced—100% effaced—but not dilated. I said, “Let me just see if I can get my finger in the cervix,” and all of the sudden the cervix opened up to three or four centimeters. And she delivered seven hours later.

In her mind I did something special, but I didn’t. I was just listening to her. I think that when patients feel they’re empowered, that’s what labor is all about. I’m telling you, if the mothers don’t think they’re safe, they just don’t go into labor. They just don’t.

I’ve had patients who have been there all night long and stalled out, and we sit down to chat, and all of the sudden they start laboring again. It’s not any special power, it’s just building trust over nine months.

Have you seen a recent uptick in interest in midwife-assisted births?

There’s definitely a trend in the US of patients taking more responsibility for their birth, and I think there’s this idea that they’re more likely to get the type of birth they want from a nurse midwife versus a physician. There’s also a trend away from hospitals and towards doing home births (I don’t do home births). In many of those cases, what they really want is to not have a traditional hospital birth. In our particular practice, we are low-intervention, and we have a low C-section rate.

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Have patients ever rejected you in favor of a female midwife?

On occasion, and not always because they want a woman. A couple of years ago I had a woman who didn’t want me—I was on call, but she wanted to have a physician. And patients know about me, it’s not like they’re surprised. I went in the room, and I said, “I understand that my back-up physician is in the operating room, but let me just be with you, and at least you’ll have some support in here and I will do my best to get a physician in the room.” It didn’t happen. She went very quickly and I ended up doing the delivery. I know that she thought it was a compliment when she said, “If I couldn’t have a physician, at least I had you.”

But I have been told over and over that I give the male partner a sense of being at ease during the process. And as of now, nobody really questions it, at least not in my little world. On occasion I have patients, who say, “How the hell did you get into it?” And I tell my little story. Patients are generally fascinated. The interesting thing is that I have women for whom I delivered their children—one of their sons is a 19-year old who has always known me as John the midwife. To him it was a normal thing. He never questioned it. I delivered one of my friends’ 16-year-old son, and he has also always called me John the midwife. They don’t know anything different. To them, men are midwives.

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