An Obligation to Effect Change
Miriam Gurniak ’79 says her work as a midwife in northern Florida is challenging. But she can’t imagine doing anything else.
BY JODY RECORD
Miriam Gurniak ’79 is a midwife. She’s also a woman of faith — faith that she shares with her congregation and faith in herself that she is doing the work she was meant to do. That doesn’t mean she doesn’t feel tested because she does, sometimes for days on end. When she delivers children to mothers who aren’t yet women, for example, like the 13-year-old who is repeating seventh grade after the birth of her premature twins.
And then there is the poverty and racism that shadows the area of northern Florida that she serves. The lack of good nutrition. Of education. Access to birth control. Proper care.
“People here don’t see any possibility of being able to escape,” Gurniak says. “They’re working at the chicken processing plant, the marijuana plant, the Dollar Store. This is a world that many people don’t have any clue about.”
Gurniak, the daughter of an Episcopal priest, counts herself among those who didn’t have a clue when she first arrived in Tallahassee, some 27 years ago. “I was really naïve and arrogant when I moved down here. I didn’t know it was so rural, so poor.” What’s more, there are multiple factors that interfere with Gurniak’s patients’ ability to get the care they need. “The need is complicated. We assume they have choice over their bodies. We are often dealing with very high medical and social risks.”
An example of that is the woman who is waiting to learn if her baby suffers from a debilitating birth defect. Insurance won’t pay for testing in the first trimester and by the second trimester, if the news is bad, she won’t be able to do anything about it. Gurniak contacted her state representative about the issue.
“As a woman of privilege, I have an obligation to effect change, to communicate to the rest of the world — to policy makers, the people who can make a difference — what goes on here,” Gurniak says. “I can sit with the women; I can rub their bellies and help the babies come and hold their hands when they lose one, but my legacy from St. Paul’s is the policy part. How does one person make a difference?”
When Gurniak was at St. Paul’s, she didn’t know that her interest in feminist women’s health care would lead to a career in midwifery. She recalls talking with friends in their dorm, reading “Our Bodies, Ourselves,” and encouraging each other to learn everything they could about the kind of care they wanted to receive, the kind of people they wanted to become.
“One of the things St. Paul’s does well is that, during those formative teenage years, you are exposed to people who are making a difference, and it makes you ask how you are going to serve.”
— Miriam Gurniak ’79
Before she knew the answer to that question, Gurniak earned her undergraduate degree in art history from Oberlin College. That was, she says, just a placeholder and not a career path. She spent the next several years in New York working as a fundraiser for private schools. She was in her early 30s when she turned her ruminations about her future — and her present — into action.
“I was driving across Pennsylvania by myself and had hours to think about what I wanted to do. After a while, I ended up flipping my thinking,” Gurniak says. “Instead of thinking about what I might do, I thought, ‘What would I regret later if I didn’t do it?’ Midwifery kept coming back to me.”
She didn’t have the science requirements and was afraid of blood. She spent a couple of years taking basic science classes, then went to Yale because it was one of the only schools at the time where you could get a graduate-level advanced practice degree in nursing/midwifery without being a nurse. To help pay for her schooling, she turned to the National Health Service Corps, which she describes as similar to the Peace Corps but for primary care workers. The organization connects providers to people in the United States who have limited access to health care.
“They front your schooling and you owe them two years of working for them,” she says. At the time, the program’s only option for midwifery was in northern Florida. Gurniak now works for the Tallahassee Memorial Hospital Family Medicine Residency Program, where she also trains doctors who are doing their residency in family medicine.
“It’s an ironic and wonderful thing that I’m serving the same population I did when I came here,” Gurniak says. “I love my patients, they love me, and I know I’m making a difference. My obligation to the St. Paul School legacy is one of service and attempting to make a broader impact. It’s a justice issue. It’s a ‘feed the hungry, go to the prison’ faith piece to me.”
While she is doing the same work she did when she began her career, Gurniak also is involved now with the politics of that service. She deals with health care programs, prenatal care and education.
“The need is more complicated now,” she says. “We’re dealing with medical and social issues, things like access to contraception. Some of it has to do with state policy, some has to do with administration challenges. There are systemic issues.”
Gurniak says she used to think that if she got patients to tell their stories, it would make a difference. But she knows that’s not enough.
“What makes me think someone else is going to fix it?” she says of the issues that interfere with people getting adequate health care. “But I know I have to try. So I talk to my pastor who sits on the board of the local hospital. I tell my patients’ stories to state legislators. I do what I can. At the same time, I have been blessed with a very broad and very deep sense of reality and don’t live in a bubble.”
Which means it’s hard, day to day, knowing that once you have seen you cannot unsee. And yet, she considers herself lucky.
“Is it hard here? Sure,” she says. “But I have a great church, fabulous community support and things that nurture me so that I can go back out and serve people. I’ve been gifted with having my assumptions and realities completely pulled apart and then ultimately put back together and rearranged in ways that I never, ever could have imagined and yet are completely fulfilling, affirming, and a source of joy that gives me the energy to keep fighting the good fight. It’s a great gift from God. How lucky am I?”