Living Their Genius: Libertad Kotlyarov Montoya
By Michelle Molitor, with Nicole Young
The Living Their Genius series is dedicated to profiling the organizations and people who compose the wider community of The Equity Lab. Even when you may feel alone in this work, we hope these highlights will remind you that we are always doing this together. As bell hooks encourages us, “When we talk about that which will sustain and nurture our spiritual growth as a people, we must once again talk about the importance of community. For one of the most vital ways that we sustain ourselves is by building communities of resistance, places where we know we are not alone.”
Libertad Montoya is an absolutely fascinating person.
In one conversation, not only is it clear that she’s lived a thousand lives, but it’s more than evident that she’s nowhere near done: in her work, in her personal growth, or in her fight for equitable care in her chosen field. Talk with Libertad for 30 minutes—maybe even less—and you will be ready to quit your job and jump into a career in health care.
So what is Libertad Montoya’s work exactly? Well, she seems to have her hand in every single part of obstetric health care (both the patient-facing and clinician-facing sides of the house). Not only is Libertad a bedside clinician in Labor & Delivery at MedStar Washington Hospital Center, she teaches onboarding obstetrics classes there as well. She and her colleague, Dr. Sara Parker, have developed a training program for new obstetrics residents that focuses on anti-racism, particularly as it relates to OB healthcare deserts and the maternal mortality crisis plaguing Black women and birthing people in Washington, DC and across the country. She is lecturing faculty at the Community College of Baltimore County School of Nursing and clinical faculty at George Washington School of Nursing. When Libertad is not teaching or attending to patients bedside, she’s designing training and simulations to improve patient outcomes.
The unifying thread in all of this work is Libertad’s personal mission: “to deliver consent-premised, trauma-informed, evidence-based care (birth justice, really)...through infusing antiracist work into education.” It’s a bold goal in the American health care system—a sector infamous for often prioritizing profit over patients’ needs and sometimes, their well-being. Even positioned within a system with such well-documented racial and economic disparities in care, when Libertad Montoya talks about her mission, there is no doubt that she will succeed.
Libertad’s personal mission “to deliver consent-premised, trauma-informed, evidence-based care (birth justice, really)...through infusing antiracist work into education” is a bold goal in the American health care system—a sector infamous for often prioritizing profit over patients’ needs and sometimes, their well-being.
About ten years ago, Libertad entered the health care profession because as her friends were having children, they were also relating harrowing birthing stories. They said they weren’t being listened to by doctors, that they didn’t get a say, and that their wishes were ignored. And so, Libertad went to nursing school and afterwards pursued a master’s degree in education. Along with her background in feminist epistimologies, she focused everything she learned on usurping the troubling trends in obstetric health.
Of the ethos and energy she brings into every aspect of her work, Libertad is clear: she’s punk rock to the core. She says as a young person, “I became interested in the idea of punk (DC punks, since that's where I was) as a way to intentionally stand out and—specifically in the context of the activist punk community of DC—speak up and do things from the ground up. This aligned with my interest in grassroots activism and justice movements, and gave me an opportunity to work with a community of committed activist people as a young person. It gave me a language for rejecting the respectability politics many of my relatives cling to. This ethos of grassroots organizing informs my approach to training clinicians (and future clinicians) to give them the tools to analyze and challenge the systems in which we work and live.”
In many ways, the realities of the COVID-19 pandemic provided an opportunity to widen the reach of her punk rock approach to obstetric health care. When the pandemic began, Libertad’s simulation and training work pivoted to telehealth and virtual platforms. The nuance of her work could have easily gotten lost in this transition, but she saw it as an opportunity to deepen the most critical part of her mission—unearthing the unconscious bias that results in the dehumanizing and honestly, terrifying care that Black, Latinx, and other marginalized people often receive in obstetrics.
Libertad remembers that a patient of hers once had an eclamptic seizure in the middle of the night. The patient’s partner was asleep beside her, “And then all of a sudden, he woke up to see two anesthesia providers, who just happen to be tall, big guys, putting a mask over her face, to help her breathe—but he woke up to this. And a roomful of probably 20 strangers all talking once and all juggling stuff and hooking stuff up where previously all they had done is go down for a nap right before they had their baby.” In the moment, she knew that as a Black man, his fear would be read as aggression, and she asked the midwife to intervene to “protect him from us.” It was scenarios like this that Libertad knew she had to bring into the telehealth space if these COVID trainings were going to be effective.
“When COVID started, we saw all of the already existing disparities amplified,” Libertad remembers. Birthing people were being separated from their children, if they were COVID positive. Suddenly, all good science about breast-feeding and skin-to-skin contact were thrown out of the window. The classist and racist undertones to these choices made around parental and child health were also folded into her simulation work. Obstetric simulations are a critical (and expensive) element of nurse and doctor training. In Libertad’s work they use a mannequin that can actually give birth and a mannequin baby that can be resuscitated, if the scenario calls on it. Before COVID, simulations included an actor who would play the voice of the patient/mannequin. During COVID, Libertad augmented the simulation protocol to include additional actors to play the patient’s partner or family member and a debrief process after each scenario.
Most importantly, Libertad and her colleagues’ approach is to help health care professionals engage their patients as partners in their treatment and experts in their own lived experience.
Libertad describes these simulations as an opportunity for health care professionals to practice their “dance moves” both with the patient, their fellow practitioners, and the patient’s support people. “The main dance move is communication,” she says. In these simulation debriefs, actors are able to bring the voice of loved ones—like the partner who woke up to his partner having an eclamptic seizure—into the room. Doctors hear an actor voice over that person’s fear, as well as their anxiety and frustration. Additionally, an actor can help doctors and nurses in training understand how a COVID-positive birthing person might feel when their child is ripped away from them immediately after birth. Most importantly, Libertad and her colleagues’ approach is to help health care professionals engage their patients as partners in their treatment and experts in their own lived experience.
In every aspect of Libertad’s work, it is clear that she believes in the amplified power of working in community. She talks with joy about struggling together towards, struggling to, and sometimes struggling against. Maybe it’s her punk rock ethos, but perhaps it’s her own family background. Libertad’s mother was a theater person, an actor and director, she says. Libertad remembers late nights in Peru, before they immigrated to the U.S., when “people just come over at the end of the night…after whatever the show was. They would just take turns in our house doing whatever their art was…So, I sort of grew up watching the process of them putting it together and how it fit in, and stopping and editing and considering what they were doing, and then kind of reframing it.”
This was the model from which she began to learn about struggling together to create something more than the sum of its parts. When asked about what it means to walk in her personal and professional power, Libertad rejects the premise of the question entirely. “Power isn’t my paradigm,” she explains. But struggle, this type of artistic and productive struggle she witnessed as a child, is the practice and the framework with which Libertad views her own work. And she is constantly struggling towards better outcomes, not only for her patients, but with them.
About Libertad Kotlyarov Montoya
Nearly a decade ago, I decided to pursue a career in obstetrics because I was witnessing many friends feel disempowered in their experiences with health care and specifically, with their birth experiences. I wanted to be a frontline clinician to help disrupt racial, class, and gender inequities in women's health. At the time, I viewed being a bedside nurse as a stepping stone to midwifery or medical school. When I began working, however, it became apparent to me that bedside nurses spend the most direct time with the patients and can have a powerful impact on health practices and outcomes. Now, with an MS in Nursing Education, I am able to not only provide day-to-day bedside care to my patients, but I also lead various education efforts within my hospital and at other hospitals and universities throughout DC and Maryland. I came to the DC area from Peru as a child with my mother, but that was actually my second move — I was born in and defected from the Soviet Union as an infant. I have spent most of my life being personally, academically, and/or professionally aware of these inequities and how they intersect, and am committed to working towards creating a language and action of empowerment that is accessible and relevant.