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Bringing Midwifery Back to Black Mothers

[calm piano music]

Amber was so excited about starting this new chapter

and becoming a mother.

She would come to me every week.

The baby’s the size of an orange.

The baby’s the size of a troll doll.

Things like, every week.

[calm music]

To be quite honest,

I was frustrated from the very first appointment.

The OBGYN is asking about our marital status.

Amber told her we’re not married, but we have plans.

The OBGYN kind of like gave us a look.

She’s having this shortness of breath,

and she’s starting to feel a weakness in her fatigue.

COVID is starting to peak,

and she’s trying to leave work a month early.

And she voiced those concerns to her OBGYN.

Her OBGYN looks at her and tells her,

You’re not the only one that’s pregnant

going through this.

Why do you need to leave?

Leaving her second trimester coming into her third,

it was just a nightmare.

She always had to stop and catch her breath and sit down.

She was feeling dizzy and we were terrified.

We’re not being listened to.

We’re not being taken serious.

We’re not being heard.

Her platelets are dropping,

and we’re not made aware of this.

They’re strictly doing tele-health.

We were supposed to have a high-risk appointment.

That got canceled.

No matter how much I’m advocating for her,

she’s advocating for herself, it doesn’t change anything.

We felt it was racial.

We felt Amber wasn’t being cared for

because she was a black, unmarried, pregnant woman.

So we found the perfect midwife for us.

And she’s understanding why Amber is feeling so weak

and her fatigue and because her health is deteriorating.

She’s telling us

that we need to go get medical assistance immediately.

[somber music]

They called Amber’s time of death at 12:36 past midnight.

She really died as soon as she gave birth.

The first thing that they tell us is,

We’re sorry for your loss.

I lost it.

I’m getting flashbacks of all the negligence

that stemmed into this.

This is their doing.

They dropped the ball on this one.

Black women are three times more likely

to die in childbirth than white women.

The system was never built for us to thrive in it.

This is something that is institutional, it’s cultural,

it’s just a part of the fabric of America.

[Doctor] Yeah, making good progress.

[Nikia] And so how do we push back against that?

How do we create healthy families?

How do we turn back some of these poor outcomes,

these stressors that people are experiencing?

And I think it does have a lot to do with the care

that we provide and growing more midwives in our community

is going to really change the maternal and infant outcomes

that we have been seeing.

[gentle music]

Birth culturally always has been managed

by women caring for women.

What’s interesting to me about my great-grandmother

is that she was the first person in her family line

that was born outside of slavery.

She learned midwifery from her mother

who had been midwife as a slave.

I would often sit with my grandmother

and my great-grandmother and I got to hear people

and watch people pull up to the house

and come get my granny because so-and-so is sick

or so-and-so is in labor.

And so that was my reality of what midwives were.

They were experts, they were knowledgeable,

they were highly respected.

It wasn’t until medicine decided

to start professionalizing itself

at the beginning of the 20th century,

that suddenly midwives were a little bit of a threat.

It is not the forceps,

but it is the man behind the forceps that counts.

When they were trying to develop obstetrics

as a specialty, the way for obstetricians

to get better at birth and at surgery

and at all the obstetric procedures would be to have access

to large populations of women

to care for over and over again.

This instrument is one of the most beneficent gifts

that the art of medicine has given to humanity.

That sense of profession starts to become dominant.

That we are obstetricians.

We are the specialists in childbirth.

Hospitals themselves go from being places where

only the very poor went to places of science.

The one place midwifery persists is in the deep south.

Because white physicians might not be willing

to attend births to black women,

and hospitals themselves were segregated.

And so women couldn’t go to those.

Basically every state developed a regulation process

and began licensing.

But one the downsides to that

was this demonization of the midwife.

and especially what they called the granny midwife.

Two days ago, a baby delivered by a midwife died

when it ought to have lived.

My examination showed that his cord got infected

and you all know what that means.

Something wasn’t clean.

Maybe the midwife didn’t boil her scissors long enough.

Especially in an era when white supremacy

was very prevalent, when Jim Crow laws in the south

are controlling how black people can be educated

and when and where.

If you say that every midwife is required

to complete these documents

on every mother that’s registered,

but her literacy is limited, and then that’s a barrier.

You may have had someone

who had delivered every baby in a county,

but all of a sudden if she couldn’t adhere to those rules

or wouldn’t adhere to those rules,

she was now essentially criminalized or at least a renegade.

Part of what led to the elimination of midwives

was just by stereotyping people as ignorant,

dirty, illiterate.

The fact that this workforce was mostly black women,

and that those that weren’t black women were immigrants,

this really was about race and class.

[somber music]

Over time, nurse-midwifery became recognized

as a profession.

Nurse midwives are now being formally educated

in a university setting where for most black women

it was out of their reach.

I entered midwifery school in 1980.

It was overwhelming, overwhelming white.

I always knew that I wanted to go to Harlem Hospital.

I was going to be the best midwife that I possibly could.

And that’s exactly where I wanted to be.

The struggle was just to prove

that we were a legitimate profession.

And we had a right to exist and be.

Over time, however, that changed.

We became more integrated into the institution,

into the department.

Midwives show decreased Cesarean section rates,

lower preterm birth rates, higher breastfeeding,

higher bonding, just higher any parameter

that one would ascribe to having better outcomes,

integration of midwives contributes to that.

There are studies that compare what happens

when you have low risk cases dealt with

by obstetricians and low-risk cases dealt with by midwives.

And generally midwives do better.

It’s part of a system where there’ll be referral

of higher risk cases to obstetricians, but great.

That’s exactly how it should be.

For high-risk cases, you absolutely want to have

the highest trained obstetrician possible.

But the fact of the matter is for most women,

they don’t need that.

The challenge in the United States,

as we built up the system around obstetrics,

and systems don’t change very easily

and without much pain.

You’ve got to develop a relationship.

It’s the relationship that’s the most important thing.

And that’s what the women got.

They got a relationship that was not affected.

It was genuine.

And they knew it.

If we’re going to try to address the problem

of racial disparities in outcomes,

midwifery is in one sense, really prepared to do that

because of the nature of the care they provide.

On the other hand,

midwifery is an overwhelmingly white profession

at the moment.

And so there’s a dire need

to diversify the profession itself.

If it’s going to reach those folks who most need it.

Before we were black midwives,

we were black women and we have the same shared

living daily experiences that these women have.

That’s what black midwifery brings.

And that’s what’s different from midwifery in general.

I decided to create a midwifery practice in Memphis

because I thought that it could really shift

the outcomes that we were seeing

in terms of maternal health and child health.

Memphis is a predominantly black city,

and it’s also a poor southern city.

There were not as many providers that look like us.

There’s a lot of mistrust in healthcare,

especially in the black community.

Women come to us with stories of being mistreated

and not heard, not listened to.

Her feeding’s going okay? Yes.

Okay, good.

She’s getting so big.

What we’re seeing is that women and families

are demanding midwifery care and out-of-hospital birth,

but accessing out-of-hospital birth options for families

can be hard.

When we decided to start midwifery services here,

one of the things that we knew we would do

was to center black and brown families,

but also to center families that were on Medicaid.

Come on this side.

Start on the top.

Tell me what you feel.

I want it to also be a training space

for a black midwifery students.

And to develop this center of excellence.

To me, it was important to grow a workforce

and to restore black midwifery to the south.

Hello, how are you doing?

Fine.

Good to see you.

Our work is not just in caring for this pregnant person

and caring for this baby.

How do you feel emotionally?

I feel good.

But really to help them through all stages

of whatever it is they experience

because they bring their whole self to care.

[gentle music]

I remember when I first met Rhonda,

she started telling me about her birth story

and how her water had broken,

and she had told her provider that her water was broken,

and they did not believe her.

They kept telling me things like,

Oh, you’re peeing on yourself.

Or, That’s normal.

And I’m like, I don’t think that’s normal.

My water has broken.

And I knew that that meant

that I was basically on a timeline

that I needed to have him delivered

to make sure that he was safe, I was safe.

We ended up in an unplanned C-section.

So it was almost like an emergency was induced

on the situation.

I really thought that me being a nurse,

people would listen even more

when I was saying things were going on with my body

or with the baby.

Just the whole process made me have a lot of anxiety.

And so it just really messed with me for awhile.

And so I knew that if we got pregnant again,

that we would want a completely different experience.

Contractions are working.

They are doing something.

And the fact that they’ve been spaced out,

that gives you a little bit time to rest.

And that’s what we should look at.

From the time I went into the appointment with Nikia,

I really felt like they wanted to make sure

that me as a person was okay,

and not just that the pregnancy was was okay.

Give us some deep breaths, Rhonda.

[breathing deeply]

Whenever somebody is really listened to,

it makes you feel validated.

It makes you feel worthy.

Like you’re worth listening to.

This time around,

I know that I’m able to advocate for myself.

And so even though things were progressing slowly,

there was never any anxiety.

There was never any fear

because it was so many people reassuring me

that this is normal.

Everything is going right.

[Midwife] Calm your body.

[moaning]

It really has become a village of families

who come together and support each other.

And I think that that’s how it was before.

Before midwifery, it was communal.

And so that’s what we’re seeing now.

We’re seeing a return to that.

[moaning and cheering]

[Midwife] He’s here. Your baby’s here.

[baby crying]

Baby girl.

Yeah.

As soon as the baby was born,

I was almost on this euphoric high almost. [laughing]

When I saw her face, I cried.

I felt like that was really my redemption moment.

My time, yeah.

[gentle music]

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