Right as 2011 was wrapping up two articles were posted about home birth and midwifery revivals in communities of color. Having written about the question of race in the home birth movement back in 2009 for RH Reality Check in these two articles, I’m excited when new outlets pick up the story. There is much movement in this arena, and also much more than can be done to make sure US midwifery is accessible to people of color.
In New America Media, Valeria Fernandez writes about efforts to revive Mexican midwifery in Arizona:
Marinah Valenzuela Farrell is one of only a few licensed midwives in Arizona. Though it isn’t a profitable venture, helping mothers bring their newborn children into this world is for Farrell a calling deeply rooted in her native Mexican tradition.
“It is really hard to be a midwife,” said the 41-year-old. “You don’t sleep, and you don’t make money. People think you’re crazy because you’re doing homebirths.”
A majority of Farrell’s clients are middle class and white, though as a Latina she aims to make midwifery accessible to low-income women in dire need of prenatal services but too afraid to seek them out in a state virulently hostile to undocumented immigrants.
“I think they don’t know that we exist,” she said. “I think the more the community knows that there’s a midwife who will come and visit them at home and do a homebirth… [attitudes] will change and shift.”
I spoke to the author while she was working on the piece, and a quote of mine is included toward the end.
In The Grio, Chika Oduah writes about black women and home birth. The article includes a video, which is a good primer of the issues at hand with home birth. It also references my Colorlines article about the possible connection between maternal health in communities of color and access to midwifery care.
What is clear from the research about this issue is that women of color are less likely to receive midwifery care, and that disparity is larger than the population numbers would suggest. I think this dynamic is complicated by global sociopolitical historical factors. For example I experienced resistance from Latina immigrant women to midwifery care because of the stigma toward parteras (midwives) in their home countries. In many places in Latin America, midwives and home birth are seen as the option used by women who can’t afford to go to hospital for birth–basically an option only for those who have no other option.
That creates class and race stigma on home birth and midwifery care.
This stigma is no accident. Global socioeconomic policy in Latin America (and I assume elsewhere as well) has long promoted hospital-based childbirth as a marker of development, and encouraged this move with foreign aid dollars and other development initiatives. The medical students I observed in Ecuador were clear that their obstetrical training and guidance came from US practice. So does the push toward hospital-based birth and away from traditional midwifery care.
We cannot ignore the fact that lack of access to emergency obstetrical care and trained birth attendants does lead to increased maternal and infant mortality. But we must also acknowledge what is lost and what new risks emerge when the model is pushed wholly toward medicalized hospital based care. Example: the United States. 98% of births happen in hospitals in the US, but our maternal and infant mortality rates are a serious concern, and lag behind 48 other countries. Clearly simply moving birth from home to hospital does not solve infant or maternal mortality.
I digress a bit, but the ultimate point is this stigma comes with immigrant women, and influences the choices they might make when it comes to maternity care in the US.
With African American folks who might not be recent immigrants, there is another factor at play. Claudia Booker was the first to make this connection for me. When hospital birth first began in the US, and for quite some time after, black women were excluded because of racism and classism. Those barriers to receiving care in the hospital created a similar race and class stigma to that I described from Latin America–meaning that women of color might also see midwifery or home birth as the thing you do when you have no other option. Hospitals are the place that people with wealth and privilege go to give birth. Why would one then choose to opt out?
When we talk about midwifery care (and doula care for that matter) needing to be accessible to communities of color–we’re not just talking about Medicaid reimbursement or even language access. It’s a much more complicated sociopolitical history that must be understood. We have to remember and learn how racism has impacted the way we give birth, the options we have, and understand the ways in which that history affects our choices today.
I often feel like discussions of the need to “educate” certain populations are condescending. It implies that we hold knowledge that the other group does not–that we know better than they do what is best for them. Really I think this kind of accessibility will be gained by listening, rather than teaching or educating. By asking the people we seek to reach what keeps them from working with us, what shapes their decisions, and then adjusting our practice accordingly.
In reality, and this is what these articles get at, what will really change the number of people of color using midwifery–it will be midwives of color. Often those from the community themselves are the best advocates and have the cultural competency necessary to serve the community effectively.
Update: Native communities and their history was very absent from this post. In that vein I’m adding a link to this guest post, Why doulas are important in Native American Communities, from Raeanne Madison, which provides some context.