midwives

Remembering the work of Black Midwives of the South

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A screen shot of the film: All My Babies, with Mary Coley pictured

 

A screen shot from the film All My Babies

Over at Colorlines I wrote about the Black midwives of the South who birthed generations of babies until the medical establishment pushed them out of business by the 1970s:

By the 1970s, births in hospitals attended by doctors and nurses (and later, nurse midwives) became the norm and these community midwives were phased out. This was done both by passing new laws and policies regulating the practice of medicine and who could provide services like attending childbirth, and through messaging campaigns that implied midwives were uneducated, dirty or even practicing witchcraft. By 1975, only 0.3 percent of all births were attended by a midwife outside a hospital.

In Alicia Bonaparte’s dissertation, “The Persecution and Prosecution of Granny Midwives in South Carolina, 1900-1940” she describes how these campaigns also used sexist and racist undertones to discredit the practicing midwives. “Some physicians even labeled grannies as ‘a cross between a superstitious hag and a meddlesome old biddy,’” she writes. “[This] evaluation served as an attack against the very bodies and ages of black women who were well respected in their communities.”

“All My Babies” is a respectful approach to Coley’s work as a midwife, and she’s portrayed as an accomplished woman in her community. But it also reveals her deference to the white doctor and nurse at the county clinic, and it even shows her questioning her own hygiene practices after a lecture by the doctor.

You can watch a full-length film about Coley online, which is a fascinating peak into the era and the practices of midwives like her.

After I posted the article online, Claudia Booker, a Washington, DC based midwife and doula, responded with this:

“Interesting footnote. The Elder African American Midwives, who had been referred to as “Granny Midwives” had a meeting about 20 years ago which was attended by many of our own current Elder midwives and proclaimed that they no longer wanted to be called “Granny”. They requested that they be referred to as “Grand Midwives’. This discussion was also transmitted to the white midwifery organization at a MANA Conference attended by Makeda Kamara and other Elder Grand Midwives. However the white midwifery organizations still struggle with the title the Grand Midwives have proclaimed for themselves. Let’s honor their request and referred to our Elder Midwives as “Grand Midwives”. They are grand!!”

Important to understand the history, but also respect how these midwives prefer to be referred to.

History of Black Midwives slideshow by ICTC

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The International Center for Traditional Childbearing published this slideshow about the history of Black midwives in the US. It’s important for all us to understand the role Black midwives have played in the midwifery movement. While this is unlikely to be comprehensive, it’s an important resource in elevating this history.

ICTC also has a doula training program that centers communities of color. Read this guest post for one perspective on their training. They have a training coming up in March in Portland, OR. More info here.

American College of Nurse Midwives urges quality care for trans and gender variant people

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Anyone else feel like it really is a tide that is turning these days? The American College of Nurse Midwives issued a statement in support of working towards quality, competent care for trans and gender non-conforming people. Woo-hoo! While it may seem like this is a no-brainer, it’s actually a big step in the right direction for ensuring that trans people can find medical care that doesn’t try to pathologize trans identity, and hopefully someday with providers who understand the needs of trans folks.

From the statement, issued in December of 2012:

It is the position of ACNM that midwives:

  • Exhibit respect for patients with nonconforming gender identities and do not pathologize differences in gender identity or expression;
  • Provide care in a manner that affirms patients’ gender identities and reduces the distress of gender dysphoria or refer to knowledgeable colleagues;
  • Become knowledgeable about the health care needs of transsexual, transgender, and gender nonconforming people, including the benefits and risks of gender affirming treatment options;
  • Match treatment approaches to the specific needs of patients, particularly their goals for gender expression and need for relief from gender dysphoria;
  • Have resources available to support and advocate for patients within their families and communities (schools, workplaces, and other settings).

That all sounds great to me. It’s actually a really fabulous statement, much more comprehensive and far-reaching than the one issued by the American College of Obstetricians and Gynecologists last year. It addresses the need for education about transgender issues in midwifery education, and even the fact that it enumerates the different identities: transgender, transsexual, gender variant, gender non-conforming, is a big step that I haven’t seen many other medical bodies take.

This is my favorite part:

As many as half of gender variant individuals report having to educate their health care providers about their health care needs, but gender variant people do not by default have unique or complicated health issues. Most members of this community require the same primary, mental, and sexual health care that all individuals need. The most important thing all midwives can do to improve the health care outcomes of gender variant individuals is to use their skills to provide care that is welcoming and accessible.

Amen to that. I would say the same thing for doulas.

It’s really incredible to witness the strides being made, while still acknowledging the serious barriers and often really challenging conditions that trans people face in the United States. A longform journalistic article I wrote for Political Research Associates was recently published, and in it I explored a new ad campaign run by the DC government that tries to address discrimination against transgender people by promoting trans respect and awareness. It was a pleasure to interview the many folks involved in working to improve conditions for trans people–it’s clear just how much incredible activism has been happening, primarily led by trans folks themselves. But it was also a reminder of how far we have to go, and how trans and gender variant people face serious discrimination in pretty much every area of life. You can read the article here.

Lastly, another new resource from a group I used to work for, The National Latina Institute for Reproductive Health, about creating health care that is inclusive of trans and gender variant Latin@s.

h/t Claudia Booker for the ACNM link

Documentary: Catching Babies

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This weekend I had the pleasure of seeing the new documentary Catching Babies. Claudia Booker of Birthing Hands DC organized the viewing.

The film is about a midwifery school in El Paso Texas called Maternidad La Luz. It’s a unique place–an intensive midwifery program that trains non-nurse midwives in a 13 month program that is extremely hands on. Two of the student midwives in the film describe catching their first babies just months after arriving at the school.  Students who complete the program can work as out-of-hospital midwives across the country, depending on the laws in their state governing non-nurse midwives.

I actually visited the school in 2007, did an overnight where I shadowed students and midwives as they did their visits and attended births. I went because at the time I was still planning on becoming a midwife, and I was excited by the possibility of attending a school that almost entirely catered to the Latina community.

Because the school is based in El Paso, steps from the border with Juarez, Mexico (the two cities are actually contiguous, the only thing separating them a bridge that represents the border) the vast majority of the women who birth at Maternidad La Luz (it is a free-standing birth center, as well as a school) are Mexican and Spanish-speaking. Many are not US citizens, but living on the border are allowed to travel back and forth with a certain area on what are called “radial visas.”

The film is really well done. The filmmakers are both women of color, which comes across clearly in their perspective and in who they choose to focus on as subjects of the film. We see one African-American student midwife, another who identifies as indigenous Mexica and grew up in El Paso, along with two other student midwives as they take their journey to midwifery. Throughout their stories is the birth stories of the women they support during pregnancy and birth, all of whom are Spanish-speaking women of color.

This focus of the film stood in stark contrast to my own experience when I visited the clinic in 2007.

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Responding to the home birth debates

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My latest column for RH Reality Check is up. With some serious hesitation I decided to respond to the conversation about the safety of home birth started by Michelle Goldberg recently at the Daily Beast. It’s been really challenging to see how polarized these conversations are, how vast the divide is between what feels like two camps: the home birthers (who are assumed to hate hospitals, obstetricians and people who use either) and the hospital birthers (who are assumed to hate midwives, home birth and people who use either). It feels like the potential for debate and rational dialogue is minimized because of this polarization. Maybe I shouldn’t be surprised by any of this. Anyway, my response is excerpted below.

A recent heated dialogue between journalists Michelle Goldberg and Jennifer Block about the safety of home birth has been the latest in a recent media flurry about the rise in home births reported by the CDC in January. A New York Times Magazine profile of Ina May Gaskin, arguably our nation’s most famous home birth midwife, was just one of the most mainstream of the recent articles, and seems to have stirred up much scrutiny of the practice.

I feel compelled to dip my toe into the conversation, if only to try and steer it in a different direction. The source of the back and forth between Goldberg and Block centers on this question: “Is home birth safe?” It’s not a new question; in fact it has been debated since the beginning of obstetrics and hospital birth at the turn of the 20th century.

Unfortunately, though, it’s exactly the wrong question to which to be devoting so much air time. A scant share of all women giving birth in the United States do so at home. Despite the reported 29 percent increase in home births nationally between 2004 and 2009, fewer than one percent of births happen out of hospital. While home birth gets much scrutiny, particularly when wealthy white women are seen as forging a new trend by choosing it, the place where the majority of women give birth in the United States — the hospital — goes largely un-scrutinized.

Hospital births do get a lot of attention in birth activist circles (where I spend significant time, as part of my work at Radical Doula). Midwives and doulas will quickly recite the problems with hospital birth, e.g., why high intervention rates (c-sections, inductions) are bad for mother and baby. But outside of that arena, where it’s arguably most needed, the conversation is stalled.

Here is the reason this matters: we are in the midst of a maternity care crisis. I’ve said it before, but I’ll say it again: our maternity care system is broken. Why? Because our maternal and fetal mortality rates are worse than 40 other countries worldwide, despite the fact that we spend more money than anyone else on maternity care. And where is  almost all that care being delivered? In hospitals.

Read the rest here.

New column: More on maternity care and race

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My second column is up at RHRC, an expansion on my thoughts about the new census numbers and maternal health.

The Center for Medicaid and Medicare Innovation just announced 43 million in funding for new approaches to prenatal care that address the problem of premature births — something that leads to much higher mortality rates, and a host of other complications for newborns. But once again it looks like midwifery will be kept out of this discovery process — the only eligible providers are those who see at least 500 births per year — something that few midwifery practices or birth centers do. These requirements are based on the desire for statistically significant findings, but they might just exclude those who can actually produce the results they are seeking.

It’s hard to imagine that a medical provider who is forced to carry a high volume of clients will be able to provide the care necessary to eliminate race-based health disparities. If Medicaid doesn’t make room for alternative, potentially life-saving maternal health models, we risk endangering the health of generations to come. The challenges are clear, what we require are the innovative solutions. Our nation’s health depends upon it.

I also owe a big thank you to Claudia Booker, who got in touch after I wrote this post, to talk with me about the challenges of making a living as a midwife who serves mostly low-income women of color. Much of our conversation didn’t make it into my column, but it’s an absolutely crucial conversation for us to have: how can midwives make a living and still serve low-income women? Medicaid, only an option in a portion of states, makes it extremely difficult to make a living and stay true to the midwifery model.

Without it, midwives have little chance of reaching women of color, and midwives who want to work exclusively with low-income populations will have to make a living through alternate means. Our providers have to make a living, and if they can’t make a living serving low-income women, we’re screwed.

Thank you Claudia, for pointing out that making midwifery accessible to communities of color also means making the midwifery profession accessible to those who want to serve communities of color. That’s going to require an innovative business model for midwifery.

One thing we talked about was having a diverse clientele–for each midwife to serve clients who can pay the full fees (either through private insurance or out of pocket) and low-income clients via Medicaid or a sliding scale.

The challenge, she said, is racism. Namely that it can be difficult for midwives of color to attract clients who can pay (who are more likely to be white), and these biases make it difficult for all midwives to have a diverse client base. She pointed out that we all want providers who look like us.

I have a lot more to say on the subject. For now, you can read my column, and stay tuned for more.

More on the resignation of midwives of color from MANA

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I mentioned a bit about the news that a key group of midwives of color, who were previously involved with the Inner Council at the Midwives Alliance of North America, resigned early this week.

More has been released regarding their resignation, so I wanted to post additional information here.

I realized shortly after posting that I in fact do know quite a few of the midwives who resigned–I just hadn’t been in contact with them lately, and did not know they were so active in MANA. Jessica Roach sent me their letter of resignation, which is also posted on this blog.

The first part is a letter from MANA, seemingly in response to the resignation of the midwives of color. What follows is the resignation letter.

Again, because I am not involved in MANA, I don’t want to comment on the situation specifically, except perhaps to say that I feel much solidarity with the women who have resigned. Claudia Booker, Jennie Joseph and Michelle Peixinho I know to be really incredible midwives and passionate leaders–I trust their opinions and experiences.

Again, for me, the bottom line is this: we can no longer ignore the disproportionately high negative maternal and infant health outcomes faced by communities of color.

And it’s going to be damn hard to address those disparities if we can’t even address racism in our own organizations–especially if that racism means that providers of color choose to leave or are pushed out.

The needs of communities of color in maternity care can no longer be the topic of an interest group, or a caucus, or a breakout session. It has to be THE FOCUS. And my guess is that if we address the needs of communities of color, we’ll probably change maternity care in ways that benefit everyone.

Jessica Roach also wrote a follow-up letter about the resignation that Claudia posted on her facebook page–I’ll share it at the Radical Doula facebook page.

Birth politics in a “majority minority” country

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There has been a lot of news lately that keeps tying back to the thread I started a while back, about how midwifery can truly be accessible to communities of color.

First, last week we had a big media splash with new census data that shows the majority of babies being born in the US today are not white. This has been true for quite some time in certain parts of the country, like California, but now it’s a national fact. Demographers have been predicting for a long time that we’re heading in this direction, so it’s not a surprise. But it does make for good headlines, and stirs the pot of zenophobia and racist panic.

It also makes extremely clear how important it is that we focus on the needs of communities of color when it comes to maternal health. It’s no longer about an interest group! It’s no longer about the minority! Dealing with race-based health disparities in maternal health is actually about the majority of births. Wow.

Feels like a game-changer to me.

Unfortunately for midwives and birth activists, women of color are still a very small minority of those accessing out of hospital birth. A bigger slice is likely accessing in hospital midwifery care (anyone know those stats?) but we’ve got a long way to go.

Then, yesterday, the news that the Midwives of Color contingent of MANA, Midwives Alliance of North America, resigned in protest. Still waiting to see a statement from MOC about what prompted this move, but MANA already acknowledged it on their facebook page:

It is with heavy hearts that the Midwives Alliance today received the resignation of several key members of the MANA Midwives of Color (MOC) Section, including the Chair. MANA is fully aware of its history of privilege and the issues related to cultural and systemic hierarchies in decision-making. We are committed to working towards a structural change in the way our organization operates in light of the repeated failures to address the needs of our midwives of color. We recognize the disproportionate impact of perinatal disparities and poor outcomes for women, infants and communities of color. MANA has an ongoing responsibility to address these issues in order to fulfill our mission of providing a professional organization for all midwives.

I’m not involved in MANA, I’m not a midwife, I haven’t talked to anyone from the MOC. (I did attend a MANA conference back in 2005/2006 in Mexico City). I don’t know the specifics of what went down, what prompted this major move.

What I do know is this: We have to center the needs of communities of color in maternal health. The disparities alone should have been enough of a reason. Black women are FOUR times more likely to die during childbirth than white women. FOUR TIMES. But of course, that’s how racism works.It perpetuates systems of oppression by marginalizing the needs of those most in need.

But now we’re no longer the minority. Now, the health of the nation very literally depends on our ability to tackle race-based health disparities, particularly in maternal health.

I personally believe that the midwifery model of care is a big piece of the puzzle when it comes to answering the problem of race-based maternal health disparities. And a big piece of the puzzle of making midwifery care accessible in communities of color? Midwives of color.

So I sincerely hope that MANA, or whatever other governing bodies exist in the midwifery world, can get their priorities straight, and do what work needs to be done.

The numbers don’t lie–and they point in a clear direction. We need to be putting all of our attention on race-based maternal health disparities. All of it. It’s a concern of the majority now.

Increase in home birth leaves women of color behind

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Last week, the CDC released data proving what those of us in the birth activist community have noticed for years: home birth is on the rise. They evaluated home birth numbers from 1990-2009.

After a decline from 1990 to 2004, the percentage of U.S. births that occurred at home increased by 29%, from 0.56% of births in 2004 to 0.72% in 2009.

There are many reasons for this increase, from Ricki Lake and the Business of Being Born, to studies that show serious problems with our maternal and fetal mortality rate. Also midwifery is on the rise, and CPMs have been successfully pushing for recognition at the state level.

To those of us who support the midwifery model of care and believe that leaving the hospital setting is a good idea for many low-risk births, this is great news. It’s also still disappointing that the overall percentage is so low–less than 1% of all births! Although when you look at it on a state level, there are places (like Montana and Oregon) where the rates are double the national average.

CDC graph of home births broken down by race/ethnicity

But, as we’ve come to expect, when you examine these numbers based on race and ethnicity, the picture is very different:

For non-Hispanic white women, home births increased by 36%, from 0.80% in 2004 to 1.09% in 2009. About 1 in every 90 births for non-Hispanic white women is now a home birth. Home births are less common among women of other racial or ethnic groups.

About 90% of the total increase in home births from 2004 to 2009 was due to the increase among non-Hispanic white women.

The chart above shows just how dramatic the disparity is. I addressed some of my thoughts about what’s behind this gap in this post, which generated some good discussion in the comment thread.

I think we’ll see that racial gap diminish when midwifery advocates include people of color in their work. When more midwives and doulas of color are leading these initiatives, and also when public funding for out-of-hospital birth care is addressed.

The other disparity that the CDC study points out is a geographic one, which may also mirror the racial disparities:

Map of US with percentage home births by state

The percentage of home births was generally higher in the northwestern and lower in the southeastern United States.

This Northern/Southern disparity is true for many health outcomes, and can probably be attributed to demographic differences, as well as a political climate that more favors midwifery and out of hospital birth in the Northwest. It’s clear we need more strong midwifery advocates in the South–and that would also be a place where it would make sense for people of color to take the helm.

We know that a shift as radical as bringing maternity back out of the hospital is going to take decades. It was a decades-long,  well-funded campaign that brought birth into the purview of doctors and hospitals to begin with. The good news is we are moving in the right direction, but if we leave women of color behind, we’re not going to achieve the wide-spread culture shift we’re working towards.

How can midwifery truly be made accessible to communities of color?

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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.

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