Bringing Midwifery Back to Black MothersWatch the video
BRUCE MCINTYRE: 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.
BEARING THE BURDEN: BLACK MOTHERS IN AMERICA
BRUCE MCINTYRE: To be quite honest, I was frustrated from the very first appointment. The ob-gyn is asking us about our marital status. Amber told her we’re not married, but we have plans. The ob-gyn kind of like gave us a look.
She’s having the 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 ob-gyn. Her ob-gyn 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 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 seriously. We’re not being heard. Her platelets are dropping, and we’re not made aware of this. They’re strictly doing telehealth. 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. She’s understanding why Amber’s feeling so weak and, you know, her fatigue, and, because her health is deteriorating. So she’s telling us that we need to go get medical assistance immediately.
TEXT ON SCREEN: Amber had a serious pregnancy complication that had gone untreated.
She eventually underwent an emergency C-section.
BRUCE MCINTYRE: 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.
NIKIA GRAYSON (CERTIFIED NURSE-MIDWIFE): 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, it’s just a part of the fabric of America.
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.
MICHELLE DREW (CERTIFIED NURSE-MIDWIFE): Birth, culturally, always has been managed by, you know, women caring for women.
What’s interesting to me about my great grandmother is that, you know, she was the first person in her family line that was born outside of slavery. She learned midwifery from her mother, who had been a midwife as a slave. I would often sit with my grandmother or my great-grandmother. And I got to hear people and watch people pull up to the house. And, you know, come get my granny because, you know, 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.
ARCHIVAL (YOUTUBE, 1934):
DR. DELEE: It is not the forceps, but it is the man behind the forceps that counts.
MICHELLE DREW: 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.
ARCHIVAL (YOUTUBE, 1934):
DR. DELEE: This instrument is one of the most beneficent gifts that the art of medicine has given to humanity.
EUGENE R. DECLERCQ (PROFESSOR, BOSTON UNIVERSITY): 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.
MICHELLE DREW: Basically every state developed a regulation process and began licensing. But one of the downsides to that was this demonization of the midwife and especially what they called the granny midwife.
ARCHIVAL (LIBRARY OF CONGRESS, 1953):
DOCTOR: Two days ago, a baby delivered by a midwife died when it ought to have lived. My examination showed that its cord got infected and you all know what that means. Something wasn’t clean. Maybe the midwife didn’t boil her scissors long enough.
MICHELLE DREW: Especially in an era when white supremacy was very prevalent, when, you know, 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, you know, essentially criminalized, or at least a, you know 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.
TEXT ON SCREEN: Over the next few decades, traditional Black midwifery faded away.
PATRICIA LOFTMAN (CERTIFIED NURSE-MIDWIFE): 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, higher, any, any parameter that one would ascribe to having better outcomes, integration of midwives, contributes to that.
EUGENE R. DECLERCQ: 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 is we built up this system around obstetrics and systems don’t change very easily and without much pain.
PATRICIA LOFTMAN: 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.
EUGENE R. DECLERCQ: 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 that 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, most need it.
PATRICIA LOFTMAN: 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.
NIKIA GRAYSON: 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 looked 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.
NIKIA GRAYSON (TO A MOTHER): Breastfeeding is going OK?
NIKIA GRAYSON: Ok, good! She’s getting so big!
NIKIA GRAYSON: What we’re seeing is that women and families are demanding midwifery care and out of hospital birth. But access to 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.
NIKIA GRAYSON (TO A TRAINEE): Come on this side, start at the top. Tell me what you feel.
NIKIA GRAYSON: I wanted to also be a training space for Black midwifery students and to develop this center of excellence. To me, it was important to grow a work force and to restore Black midwifery to the South.
NIKIA GRAYSON (ENTERING A CLIENT’S HOME): Hello, how you doing, good to see you.
NIKIA GRAYSON: Our work is not just in caring for, you know, this pregnant person and caring for this baby.
NIKIA GRAYSON (TO KATRICE): So how do you feel emotionally?
KATRICE: I feel good.
NIKIA GRAYSON: But really to help them through all stages of whatever it is that they’re experiencing because they bring their whole self to, you know, to care.
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 had broken and they did not believe her.
RHONDA OKOTH: They kept telling me things like, “Oh, you’re peeing on yourself,” or, you know, “That’s normal.” And I’m like, “I don’t, I don’t think that’s normal.” Like my water has broken, and I knew that that meant that I had, 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, you know, people would listen even more, you know, when I was saying, you know, 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, it just really messed with me for a while. And so I knew that if we got pregnant again that we would want a completely different experience.
NIKIA GRAYSON (TO RHONDA OKOTH): The contractions are working. They are doing something, right. And the fact that they then space out, that gives you a little bit to rest. And that’s what we should look at it as.
RHONDA OKOTH: From the time I went into the appointment with Nikia, you know, 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.
BIRTH TEAM (TO RHONDA OKOTH): Give us some deep breaths Rhonda. Deep breaths.
RHONDA OKOTH: Whenever somebody is really listened to, it makes you feel validated. It makes you feel worthy, like, you know, 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 there was so many people reassuring me that this is normal. Everything is going right.
BIRTH TEAM (TO RHONDA OKOTH): Calm your body.
NIKIA GRAYSON: 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 with midwifery, it was communal and so, that’s what we’re seeing now, we’re seeing a return to that.
BIRTH TEAM: She’s here, baby’s here. Yeah.
RHONDA OKOTH (TO HER BABY): Hi, baby girl.
RHONDA OKOTH: As soon as the baby was born, I was almost on this like euphoric high almost.
BIRTH TEAM: Wooh, moma!
RHONDA OKOTH: When I saw her face, I cried. I felt like that was really my redemption moment. My, my time, yeah.
TEXT ON SCREEN: Amber and Bruce’s son, Elias, is now a year old.
Bruce is working to expand access to midwifery services for families of color in the Bronx.
Amber’s ob-gyn did not respond to requests for comment.
Montefiore Medical Center, which treated Amber, says that ninety-four per cent of those who give birth at the hospital are people of color, and that their maternal-mortality rate is lower than the national average.
The U.S. has the highest maternal-mortality rate among wealthy countries.