Competency: Understanding and Interacting in Varied Cultural Settings

This week's episode is a special one recorded AT the Evidence Based Birth Conference in Lexington, KY, where Dr. Sayida Peprah delivered two powerful keynote addresses. In this interview, Dr. Sayida discusses the importance of being authentic, humble, and curious when interacting with others from different cultures or circumstances.   TRANCRIPT: Sara: Welcome, Dr. Sayida, to the Birth Words podcast. It's a pleasure to have you here.   Dr. Sayida: Thank you.   Sara: I wanted to talk with you a little bit about some of the really important work you're doing around cultural humility and helping birth workers being aware of how they can support those who have been really victims of transgenerational trauma. And so my question for you is, what guidelines would you give to birth workers who are striving to show through their language that they are culturally competent, sensitive and humble? How do they show that in their spoken interactions with their clients?   Dr. Sayida: I think one of the most important things to me like as a psychologist who really, one of the most important parts of my work, especially working with people, typically in very intense situations when I'm coming in, or I'm being invited in or I'm being asked to be there, or they're being brought to me because there's like been a crisis … We don't know each other and there's a lot of intensity. I need to make like a very strong, immediate rapport so that we can like help solve the situation. So whether that's been like with the incarcerated population, and there's like aggression or frustrations going on, and the domestic violence shelter, I used to work in a center where women were coming directly from their abusive situation right to the emergency shelter where I was a therapist, and a psychiatric hospital working with people who had just attempted to take their life or just been brought in by family members out of concerns. And so, in all the various situations, there isn't time to like, get to know each other, and I have to be effective at showing people that I actually care and that I'm listening to them and that I don't have any overt biases against them. Most pertinently, like why they're coming in like oh, that you were in an abusive relationship to start with, or that you found yourself in prison to start with, or that you tried to take your life, or cut yourself or whatever. So that comes into play a lot. And what I think is most important is that I actually do care. So it's nothing that I do that's like a guideline, it's not a script. It's not like let me check and make sure that I do anything in particular, that I like, center myself, and I go into a space of like common humanity, where a person has found themselves in a very difficult situation. And I am like, blessed to be able to be with them at like their lowest moment and be with them, like as a human. And then I have some skills and some tools to help them through whatever it is. And to me that's not very different. And how I approach being a doula, which is outside of that practice in that work, but with the same energy of your person who is going through—and a lot of times its first time moms that are coming to want to have a doula, or women who've had experiences in birth and people who've had experiences that didn't actually reflect for them what they wanted in their first birth. So they're really coming like, I need support, right? When you come to a doula like, I want help right in some ways, and so, how do I show you that you don't have to be guarded with me? That you don't have to worry about trust issues because I have some other agenda, is that I don't have another agenda, right? Like I have to…really human beings really detect BS. Like we are like, masters at that, and especially people that have historical disparities, historical trauma, especially if it's race related, if they're marginalized populations, like they know, by protection and resilience of the community, like you teach every generation like you've noticed, ways that people protect themselves and dominant, like aggressive, potentially harmful spaces. And so that's a way of being that a lot of people have wherever they are marginalized, whether that's because of their gender identity, sexuality, whether it's race and culture, whether it's religion… of this, like, are you a safe person for me to be with people come with a guard, because they've had experience that they're not safe. And so how you show that they don't have to be is that you actually just have like, ease with them like, but you have to develop that as a person, right, in your own time. Like, you've got to know various types of people and I always tell people you need to think about the people that you're most uncomfortable working with. And get to know people who are in that lifestyle, whatever that looks like. And maybe especially with technology, it might look like just being familiar with images, documentaries, stories, like real ones, not like stereotyped characters of groups, but like watch things and read things that are from the community you're interested in and hear perspectives. So then you can learn like the world view, the experience, like listen to presenters, you know, that talk about you know, historical trauma or talk about how it is to be a queer person in the birth world and not be accepted, or even like talked about in general space but yet you're there and yet you're pregnant and yet you need support and that maybe there are birth workers that you know, have that you know, that you can be safe with, like how could you ever know that? But you could know that by the way people use language in open space, like if they're in a crowd of people like who they say hi to, like people notice that like if you're a bunch of people and there are people you feel uncomfortable with you typically avoid people you feel uncomfortable with. And I talked about that a bit and the implicit bias part that we talked about the other day, that people's eye contact is different, that their proximity is different to people that they don't feel comfortable with. And people notice that people, certain people avoid them often. And then it's like, oh, well, didn't seem too friendly. So probably not going to be the birth worker that I'm going to go to for this. Yeah. But the ones that are openly open and friendly and look you in your eye and greet you like basic human stuff, it is not deep. It's just real. And so the question is like, if you want to be if you have the question of how do I be more culturally congruent to work with a population that I don't know? That question means that you are not comfortable either because you haven't had opportunities to gain comfort, which is not necessarily a fault of your own. It could be demographics, situations, and we talked about the here at this conference was really interesting because certain people live in worlds that they, you know, maybe the first black person that they ever met was when they were in college, right. And so they had to leave where they were from and never had an experience where people are different outside of the TV, you know, and so like, you're going to have stereotypes. But being able to have experiences where you could sort of work out your discomfort on your own time and not work on your clients time, right? Which is not amazing to be like, “Oh, my gosh, I’ve never worked with a black family! Like, I hope I can do the best I can!” I mean, I feel your love and you're wanting to be helpful, but I also feel like I don't know what it means that you never work in a black family and that, like you're hoping you're going to be like that everything's gonna go okay, right. What does that mean? Like, are we different kind of human? And what does that mean for you? Yes, there are cultural things, but like, if that's like how you come to it, I feel like you should… And I don't want to say I don't think that certain people shouldn't work with certain people in that way. But you need to, if you are not comfortable working with certain people you create harm in the interactions through micro aggressions through, like inter personal in congruence, like you did something and said something, you perceive something, you judge something that was incorrect, and I'm going to keep having to either be silent about it to not offend you or to not have another drama that I have to deal with. Or I'm just not going to talk about it and I'm silent, or I'm gonna say something, we're gonna have a conflict, or I don't know, if I'm gonna have a conflict. Now I'm anxious, right? Like all of that most people have to deal with when they're like going to providers, or birth workers and they're not sure that they are cool, right? So be a person that can be cool in space. And if you're not, get it together and go into that space, and also have a good referral system. Like if you there are certain communities that you know, you're not. You have this conference in like for me, I haven't worked with all populations on the planet, but I've tried my best to expand my perspectives and like global perspectives and different types of family systems and different types of ways of seeing the world and spirituality but I have not sat in front of them worked and studied every single population, but I feel really confident and comfortable that if you put anybody in front of me, I could figure it out. Because I've learned to listen, I've learned to watch, I understand that I can make mistakes, and I'm okay with that. And I'm okay with being corrected. And I've had enough diverse perspectives that I don't believe in my own way, and enough to be like, malleable. And yet I'm challenged every day when I like come across a new thing and a new perspective that that, especially as I'm trying to continue to expand, so, but I'm not uncomfortable in a space where I don't know. But if you're that person, you are uncomfortable. You need to check that discomfort. Yeah, yeah, that's what I bet it's not about you haven't had interaction. It's about How comfortable are you? How much do you really feel like you can like just show up and some people don't like, I just love, you know, birth work. I just love the baby's coming. And I just love to support people who you know, really could have any support in the family system. And it doesn't matter to me what they look like and I'm just going to figure it out. And if you feel confident in that and you lead with the heart, a lot of times like those nuances people can figure out. Especially if they're hiring you, like they are willing to work with someone cross-culturally because they're hiring you, unless they've been assigned to you. And then that's something to consider how that feels for people as a birth worker, but they don't necessarily have a choice. And maybe they would have chosen someone more culturally connected to their family experience, and how you can show them that they can still trust you.   Sara: Sara: Yeah, thank you.   Dr. Sayida: That was a long answer.   Sara: No, I feel like I can't add anything.   Dr.Sayida: I didn’t even know if I was going to have a full answer to that question!   Sara: You have, you've got the answers. Thank you. I think that's really important. You talked about like putting yourself in the spaces that you're not comfortable in until you're comfortable, so that when you're speaking and interacting, you can be yourself authentic. And because sometimes you grow up in a demographic situation where you haven't been in those spaces, but that doesn't mean you're shot. You can interact with those people, right? Just get yourself in those spaces, find comfort, and then yeah, you're able to..   Dr. Sayida: And getting into spaces, to be clear, doesn't mean getting in and like doing a lot of talking right making it about yours. Right? It's like getting into a space and being an observer. Right, and like being asked to be in that space, so you will have to find someone that will take you on that journey. And a lot of times it makes them be like, boy, you're in somebody else's culture is like weird in most cases, maybe not. And some, but most of the time, you need to, like be invited into that space. But also, you must know that when you're there, it changes. Even though you're in the space, and you may have been in the space for 20 years or 50 years, you may have had family members that are from a cross cultural community. And again, there's still something that happens when there's another person in somebody else's cultural space, like it just changes. Sometimes the way that people interact, the language that they'll use, the relaxation, that they'll talk in their conversations. I'd really like thoughtfulness for like what the other person might experience of their… eventually, maybe you might be blessed to be so congruent to a cultural community that when you're there, they forget. That's a beautiful, powerful sacred space that you will never know. You got to… only they know that and you might think that like, Oh, it's not a big deal. I'm here. It's really like something that in the community, like people get to a space and they're like, man, I totally forgot so and so was white. Like, we just, you know, I never and then I'll be like, ah man…I'm sorry I said that I totally forgot you were here. And then it's like, that's actually like a positive thing, like if you're trying to learn to be able to immerse yourself in cultural space where people don't feel like it's about you, that they can have their space and you can just be in it. And I think everybody needs that sacred secrecy of their own space. But also, it's a blessing to be able to do the cross cultural thing because we must do it like in this world in America in all these spots. Yeah.   Sara: Thanks for the clarification, and that's important. My other question for you is: as a birth giver of color, when did you feel the most seen and heard?   Dr. Sayida: Okay. So when I was giving birth, I felt most seen and heard, actually was a unique situation. So my… I hemorrhage pretty terribly, but I didn't realize that because it was my first birth and I thought that, you know, bleeding was normal or something right and so I'm bleeding out there's towels with blood all over the place and they're like going in and I'm, like, comfortable but like all the while I'm like, “I got a baby. This is great.” I've been trying to be happy and so in such pain because of what they're doing to stop the bleeding and I'm like, I guess this is a normal part of like childbirth. So really going through that and losing one lose one and eventually they're like, No, she needs Pitocin. And I'm like, that was like I had like all these rules like my birth plan was tight. No. pitocin no epidural, no, you know, episiotomy, nothing. Like I want nothing but myself and my doula and just like the nature. So what I was done having a baby already and like, I didn't understand the use of Pitocin after that, so my doula got in my face. Like in front of the midwife who was like you really need this. And I'm like, I don't care anything about any of this. Like, I'm not getting Pitocin, like I don't do medication like. And she was like, you need, I understand, like, I know, I know, you’re natural, and I know like, I know everything I understand. You need this. You're bleeding too much. Like this is serious. Like, I need you to trust me, and I need you to let them give you medication.   And I was like, okay, that's fine.   And I was fighting. Like, I was not going down. That he was gonna believe that. I was like, No, I will not as when my ears are ringing and like, I'm like hearing like, just like I can't really see I just remember that whole state after birth, which I still… my memory, my memory of that is like, totally blissed out and in complete joy. But I was hemorrhaging. And that was what was physically happening to me. That made me that I interpreted as this beautiful blissed out like angelic space. I felt heard. And I feel so yeah, my doula heard me. But yet she could respond to like the need that I had and that, but she was like I felt her know that this is like against my will. And that she was also waiting for me to get permission. Like it wasn't like nobody can do anything to you like you, you have to make this choice and I if you trust me, you can make this one. I felt like that I felt hurt and I felt seen.   Sara: And it sounds like you had a pretty strong relationship of trust with your doula that she was able to come right into your personal space and communicate with you, like I know where you're coming from. And I want you to know that I want what's best for you. This is really what's best for you.   Dr. Sayida: And this isn’t a sham. This is like a medical thing that we say we don't do all this stuff like this is like the time we do it. And I think that is very important like for birth workers, to you have to establish that level of trust ahead. It's the only thing that you have for when the when it goes to hell is that even if it's like mom is like totally, you know, or birthing person is totally beside herself like there's no way that transition period like I just can't do this give me the epidural, I just there's no way, I can't, like I just can't you're just looking at it like you definitely can. But I know it feels like you can't but literally that is just a feeling that if you keep breathing and we keep doing this, you're the baby's gonna come out like now and that feeling of like I can't do this is like, is intense. I know that we all if we've done that with nothing with no medical, you know, medicine assistant, there is a point where you're like, I mean seriously, this is intense, like what the… like, Come on, baby like, I just like gotta be done this labor, right? But you can move through that. Like, if somebody can look you in your eye and be like, I know, it's terrible. And we're going to breathe. And we're gonna go through the next moment because you can do this, like the convincingness that I'm able to lend them that they gave me and me being a relationship with them seeing how powerful they are, like knowing that they can do it. We just like, it's a dance. And I think, you know, I never would say like, the power that a woman has in birth is going to come from the doula or the midwife or whoever is like the birth attendant, the family, but that trust that, like, I do respect you, when I see you, and I hear you, and I'm with you. And I believe in you, like, just, you know, we all need people to believe in us more like feeling weak, you know, and, and I mean, I just think that's like, it's golden. And it's just the relationship. It's literally like the relationship, it's the same thing a mother can do. You I've seen, you know, family members do it like, yeah. My so… my best friend in high school, she was having a baby. And I was there, and her mom was there. And you know, she just gets a point where she's getting like, all like dramatic and, you know, nobody was paying any attention to her because everybody had babies, not me. But everybody else had had babies who was in the room, her sister, mom. And they were just like, yeah, like, this is not that bad, like, whatever it is, whatever it is, it doesn't matter because the baby's gonna come out. It's like not necessary. So there's a lot of like, not really gouging, which I don't know, she seemed to be okay with it, but there was a moment where I was like, “Girl, you got this!” You know, I mean, it was like well, I mean yeah, it's good you know? And I remember just being like wow, that was so effective. Like, just like the confidence of someone who can tell you I see you in that… like, right you have it it's like okay, “It’s almost over!” I mean, I mean, it was like such a short labor like I don't even remember us being there for any amount of time. We walked in and the couple hours later start to finish yet baby. But that's like the 17-year-old body. It's just, yes pretty that's… it's always like everyone’s always worried about teen moms. Like all the teen moms I know had like really like shorter labor's and like moms like they have babies like in their 20s like me. And the accounts of them…not all but a number of them… It's like, in retrospect, like they have really like their bodies were like really ready and easy to have, baby. Yeah, that's a whole nother conversation.   Sara: Cool. Well, thank you for sharing your thoughts and helping us consider just like… I like, how you're talking about seeing people. Like with your friend, when you felt seen. And in the … for the first question we talked about, how do you show this cultural competence and humility? It's just seeing people, right?   Dr. Sayida: Yeah.   Sara: And just Yeah, like, like actually seeing, recognizing we have common humanity and yeah, recognizing that, and then that the interaction just…   Dr. Sayida: Everything else follows… And the grace follows, like, if you make a mistake, if you say something, they feel the heart, and they're just like, “Oh, I actually this is how we do it.” And “this is actually how I, you know, call myself” and “this is actually like, you know, my partner, not my husband” and you know, right… The details are like, people are so forgiving when they feel like you care about them.   Sara: Yeah, yeah. Cool. Thank you for sharing your thoughts.   Transcribed by https://otter.ai